Health Advancement And Health Promotion

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Health Advancement And Health Promotion

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Health Advancement And Health Promotion

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There is a growing concern in the area of the aged care in Australia. Recent literature in this area demonstrated that geriatric population is experiencing significant health issues (Henderson et al., 2016). Leadership is the important component of health care services. However, this aspect is being neglected in the residential aged care sector (RAC) (Hungerford et al., 2016). It was evident from the research study of Jeon et al., (2013) that Australian nurse leader and managers are not delivering high quality care to the geriatric population. Unlike acute hospital care, in residential care patient prefer more “consumer directed services” (Hunter et al., 2007). There is a knowledge gap amongst the nurses regarding the concept of “leadership and management” (Holm & Severinsson, 2014). Lea et al., (2016) demonstrated a negative attitude among RAC nurses due to organizational barriers. There is an increase in the use of aged care services since a decade in Australia.  Therefore, there is a need for the development of the useful framework for leadership and management for delivering high quality care in nursing elderly population.
The research objective is to identify the barriers to delivery of effective aged care by nurse’s leaders and managers and to understand the benefits of the existing models of care in this area. Therefore, the author of this study finds significant to review aged care literature (2006-2016) related to nursing leadership and management framework in Australia and evaluate trends in the literature during this period.
The articles related to this problem area were searched in Cochrane Library, Pubmed, and CDU Library. The search terms used for literature search includes aged care, residential and community care for elderly populations, policies for geriatric nurses, leadership of aged care nurses, leadership, and management framework in Australia for aged care. The inclusion criteria for these articles include those published in the period of ten years. Articles published in the language other than English and those related to leadership management of chronic diseases has been excluded. The review has mainly focused on the epidemiologic literature, and studies were mostly conducted on the human population. These are mostly observational and experimental studies. No studies are based on the laboratory or animal based research. The articles that were mainly conference proceedings, dissertations, abstracts, and practice guidelines were excluded from the systematic review. This systematic review is relevant as it helps to explore previous studies eliminating the need of the conducting primary research. For data extraction, the chosen articles are critically reviewed.
PRISMA Statement

(Source: Moher et al., 2015)  

Results and Discussion
Out of the total 100 articles selected four has been chosen for the systematic review. The literature research led to an identification of 3 qualitative studies, Delphi study, and one quantitative study. The studies have been relevant in meeting the research objectives. However, the studies were mainly from Australia, one study of Norway and one of Canada.
In Australia, Advance Practice Model of Care is an integrative model that has been recognized to be effective in generating positive outcomes in RAC services and is recommended to be implemented in Australia (Venturato & Drew, 2010). According to Meissner & Radford, (2015) there is the discrepancy between the perception of the importance of the managerial skills among the mid-level managers of RACs and their performance. Based on the cross-sectional study design with 199 middle managers it was evident that there was the lack of communication skills and self-awareness. The results implied that the managers perceived the need of developing soft skills-focused training to enhance leadership and management in RAC services. The research findings from the qualitative study of Dwyer, (2011) revealed that the RAC nurses with the high level of motivation had obtained best outcomes while nursing elderly. Also, lack of professional support in the organization, clinical leadership education in medical colleges was primary barriers to the development of the effective framework for leadership and management. It has been found that the Aged care Clinical Leadership Qualities Framework or ACLQF established in Australia has been validated (Stanley, Latimer & Atkinson, 2014). This program has been recognized to be useful in addressing leadership requirements by Jeon et al., (2015). These findings have been the significant contribution to the literature as well as for policy makers and stakeholders in developing the similar relevant framework in Australia. There is a need for policies and regulations as well as education and training programs (Holm & Severinsson, 2014). It was found that a “positive staff experiences of the leadership” leads to enhanced job satisfaction and workforce retention (Griffiths et al., 2014). There is a lack of effective partnership approach including the collaboration with policymakers, care providers, different educational organizations and the accreditation body (Hungerford et al., 2016).  A descriptive study by MacPhee et al., (2012) demonstrated that “theoretical empowerment framework” has led to enhancement of leadership style among the nurses and managers. It increased their self-efficacy and confidence. Håkanson et al., (2014) has opined that the basic model underpinning the practice of aged care is the “person-centered care.”
The significant factor impeding the development of effective leadership framework is the lack of clinical leadership education as well as congruent guidelines in the organization. The other critical factor is that the leadership is not reflected by managers in their role. The “Advanced Practice Model of Care” and the “theoretical empowerment framework” is appearing to be relevant for nurses as they are central to “communication, delegation, and decision-making.” These models can be used as the template for developing effective strategies or framework for improved leadership and management. A training framework that is RAC specific, cost effective, compatible to organizational uniqueness, accessible, and based on the leadership time constraints is essential (Broad et al., 2011). The frameworks reviewed in the literature as well as the models of the care act as a strong evidence base for the in-depth understanding of the nursing leaders and managers, and other stakeholders. It allows operationalising the concept of clinical leadership in aged care. It has provided an illustration of new research into the role of registered nurses.
There is an expansion of the literature in this field. The number of publications reporting the leadership and management issues in Australian aged care has expanded. Based on the literature review it can be concluded that a paucity of work has been done in Australia to address this problem area. Further investigation is required in this field with more longitudinal and intervention studies to provide a stronger base for the practice and policy. Further research is needed in the area of implementation of rigorous training programs and integration of multidisciplinary knowledge as well as studies from the overseas to address the burden of ineffective leadership and management of residential aged care services. Further studies of evaluations of the best outcomes using effective leadership framework that may occur in residential and community settings are essential. 
Broad, J. B., Boyd, M., Kerse, N., Whitehead, N., Chelimo, C., Lay-Yee, R., … & Connolly, M. J. (2011). Residential aged care in Auckland, New Zealand 1988–2008: does real trends over time match predictions?. Age and aging,40(4), 487-494.
Dwyer, D. (2011). Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review. International Journal of Evidence‐Based Healthcare, 9(4), 388-402.
Griffiths, D., Morphet, J., Innes, K., Crawford, K., & Williams, A. (2014). Communication between residential aged care facilities and the emergency department: a review of the literature. International journal of nursing studies,51(11), 1517-1523.
Håkanson, C., Cronfalk, B. S., Henriksen, E., Norberg, A., Ternestedt, B. M., & Sandberg, J. (2014). First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care. The open nursing journal,8, 71.
Henderson, J., Willis, E., Xiao, L., Toffoli, L., & Verrall, C. (2016). Nurses’ perceptions of the impact of the aged care reform on services for residents in multi‐purpose services and residential aged care facilities in rural Australia. Australasian Journal on Ageing.
Holm, A. L., & Severinsson, E. (2014). The effective nursing leadership of older persons in the community–a systematic review. Journal of nursing management, 22(2), 211-224.
Jeon, Y. H., Simpson, J. M., Chenoweth, L., Cunich, M., & Kendig, H. (2013). The effectiveness of an aged care specific leadership and management program on the workforce, work environment, and care quality outcomes: design of a cluster randomized controlled trial. Implementation Science, 8(1), 1.
Jeon, Y. H., Simpson, J. M., Li, Z., Cunich, M. M., Thomas, T. H., Chenoweth, L., & Kendig, H. L. (2015). Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality. Journal of the American Medical Directors Association, 16(7), 629-e19.
Lea, E., Andrews, S., Haines, T., Nitz, J., Haralambous, B., Moore, K., … & Robinson, A. (2016). Developing networks between residential aged care facilities as a result of engagement in a falls prevention project: an action research study. Contemporary nurse, 1-13.
MacPhee, M., Skelton‐Green, J., Bouthillette, F., & Suryaprakash, N. (2012). An empowerment framework for nursing leadership development: supporting evidence. Journal of Advanced Nursing, 68(1), 159-169.
Meissner, E., & Radford, K. (2015). Importance and performance of managerial skills in the Australian aged care sector–a middle managers’ perspective. Journal of nursing management, 23(6), 784-793.
Meissner, E., & Radford, K. (2015). Importance and performance of managerial skills in the Australian aged care sector–a middle managers’ perspective. Journal of nursing management, 23(6), 784-793.
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., … & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews,4(1), 1.
Pickard, A. (2012). Research methods in information. Facet publishing.
Stanley, D., Latimer, K., & Atkinson, J. (2014). Perceptions of clinical leadership in an aged care residential facility in Perth, Western Australia.Health Care: Current Reviews, 2014.
Venturato, L., & Drew, L. (2010). Beyond ‘doing’: Supporting clinical leadership and nursing practice in aged care through innovative models of care. Contemporary Nurse, 35(2), 157-170. doi:10.5172/conu.2010.35.2.157

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