Nurse middle managers contributions to person-centred care in nursing homes: A qualitative managerial work analysis

Abstract

Background: Many residents in nursing homes receive poor care. Person-centred care (PCC) is an innovative approach aimed to improve the quality and is therefore the first pillar of the new quality framework for Dutch nursing homes. This framework encourages nurse middle managers (NMMs) to give substance to the themes of PCC. Considering this, it is crucial to comprehend how NMMs contribute to PCC. Aim: The aim is to explore what NMMs in nursing homes do in their daily work and how they contribute to PCC. Methods: This managerial work study combined time-use patterns with ethnographic work. The study focused on NMMs working in Dutch nursing homes. Six NMMs were shadowed for in total 95 hours. Results: With regard to NMMs contribution to PCC three characteristic findings stand out. First, NMMs who seldom visit the ward and not see residents do not contribute to PCC. Secondly, NMMs who were ‘hands-on’ involved in direct residential care did contribute to PCC. At last, NMMs who shown a ‘heads-on’ focus did contribute to PCC. Those NMMs kept a focus on resident-related issues when doing ‘organizing work’. Conclusion: NMMs in nursing homes contribute to PCC when they show a ‘heads-on’ or/and ‘hands-on’ focus within their daily work. Recommendations: Development of NMMs clinical leadership towards PCC is crucial for nursing home practices. Perceptions of excessive bureaucracy that interferes with care provision and losing focus on core value of care are important pitfalls. Therefore, support from the higher management is needed. Further studies should consider action research and practice-based approach to identify organisations where they are in relation to PCC and supporting those organisations in becoming more person centred.