| BackgroundWith rapid economic and social development,there is a growing public demand for nursing care,as well as higher nursing care quality.Nurses’ work behaviors directly affect nursing care quality,but their positive work behaviors were significantly impaired by negative work experience.Caring leadership refers to a leader’s concern for the individual’s values,dignity and interests,developing personal relationships with employees,and providing assistance and support to employees.Caring leadership is essential in improving nurses’ work experience,strengthening their work behaviors,and improving the quality of nursing care.However,research on caring leadership is still in the exploratory stage,the concept and structure are still undefined,and there is a lack of professional measurement tools,which seriously limit its application in nursing management.Moreover,the influence pathways of caring leadership on nurses’ work behaviors should be further discussed.Objectives1.To develop a caring leadership model in Chinese cultural background.2.To develop a caring leadership scale and test the validity,reliability and acceptability.3.To explore the nurses’ perception of caring leadership and influencing factors and analyze its influence pathways on nurses’ work behaviors.Methods1.Research on the development of a caring leadership model via grounded theoryWith the guidance of Strauss and Corbin’s grounded theory method,ten nursing leaders and 11 first-line nurses were recruited for in-depth semi-structured interviews through purposive sampling and theoretical sampling,and 168 nursing leaders and 286 first-line nurses were recruited for an open-ended questionnaire survey.The data from the interviews were transcribed and clustered into the coding process,and the data from the open-ended questionnaire survey were homogenized after preliminary screening,and then compared with the data from the semi-structured interview and included in the coding process.After* This work was supported by 2020 scientific research project of Chinese Nursing Association(No.ZHKY202006)。the coding process,the connections between the codes were established,resulting in a conceptual model of caring leadership.2.Research on the development and psychometrical test of the Caring Leadership ScaleBased on the conceptual model of caring leadership,the item pool of the scale was developed through relevant scales and group discussion following the principles and procedures of scale development.Then,two rounds of expert consultation were conducted to revise the items and construct the primitive scale.The preliminary investigation was conducted to modify the items.Subsequently,a formal survey including 2125 first-line nurses was conducted in 6 general hospitals in the eastern,central and western regions of China,and the final version of the scale was formed through item analysis.Finally,the validity,reliability and acceptability of the scale were evaluated statistically.3.Research on nurses’ perception of caring leadership and its influence pathways on nurses’ work behaviorsA multi-center,large-sample cross-sectional survey including 2502 first-line nurses was conducted in 6 general tertiary hospitals in the eastern,central and western regions of China through stratified convenience sampling.The Caring Leadership Scale,the Chinese Calling Scale,the Affective Organizational Commitment Scale,the Utrecht Work Engagement Scale,the Voice Behavior Scale and the Patient-Centered Organizational Citizenship Behavior Scale were applied for data collecting.The data were organized and then analyzed using descriptive analysis,independent sample t-test,one-way ANOVA,linear regression analysis and hierarchical regression analysis to explore nurses’ perception of caring leadership and influencing factors,as well as the test for influencing pathways.Results1.Research on the development of a caring leadership model via grounded theoryThe model of caring leadership includes three aspects: the core attributions,the working way and the potential influence.The core attributes of caring leadership consist of benevolent to others,appreciate the uniqueness,facilitate self-actualization,maintain mutual benefit and motivate with charisma.The working way of caring leadership contains caring and leading.The potential influence of caring leadership includes nurse well-being,patient healing,and organization excellence.2.Research on the development and psychometrical test of the Caring Leadership Scale(1)Based on the conceptual model of caring leadership,the item pool of the scale was developed through relevant scales and group discussion,including five dimensions with 40 items.After two rounds of expert consultation and group discussion,the draft of the scale contains 39 items after the modification,including benevolent to others(9 items),appreciate the uniqueness(8 items),facilitate self-actualization(6 items),maintain mutual benefit(7items)and motivate with charisma(9 items).(2)A total of 2125 nurses were recruited for the analysis,of which 1062 were used for item screening and 1063 for psychometrical tests.After item analysis,a total of 12 items were deleted for not meeting the preset standards,and the final scale was developed with five dimensions including a total of 27 items.The psychometrical test showed that the ICVI ranged from 0.90 to 1.00,the S-CVI/UA was 0.89 and the S-CVI/Ave was 0.99.The results of confirmatory factors analysis showed that the initial model fitting indicators were as the following: RMSEA=0.096,CFI=0.919,NFI=0.912,TLI=0.920,IFI=0.910.Modified model fitting indicators were as the following: RMSEA=0.079,CFI=0.946,NFI=0.939,TLI=0.939,IFI=0.946.Confirmatory factors analysis also showed that the standardized factor loadings of the items corresponding to each dimension of the scale ranged from 0.707 to 0.940,the average variance extraction ranged from 0.682 to 0.834,and the combined reliability ranged from 0.930 to 0.968.The correlation coefficients between the scale and job satisfaction ranged from 0.463 to 0.484(P<0.001),the Cronbach’s alpha coefficients for the whole scale and the dimensions ranged from 0.962 to 0.993,and the Spearman-Brown split-half reliability ranged from 0.955 to 0.982.3.Research on nurses’ perception of caring leadership and its influence pathways on nurses’ work behaviorsThe mean scores of nurses’ perceived caring leadership were 119.21±21.20,with the scores of each dimension ranging from 12.92 to 44.13,and the mean scores of each item ranging from 4.23 to 4.47,showing a high level of nurses’ perception of caring leadership.The results of linear regression analysis showed that average monthly income,employment method,working years,working in outpatient and emergency/ICU/operating department,and marital status as divorced or widowed were the influencing factors of nurses’ perception of caring leadership(P<0.05).The results of the stratified regression analysis showed that caring leadership,calling,and affective organizational commitment all positively predicted nurses’ work behaviors(P<0.001).The test of path analysis showed caring leadership can influence nurses’ work behaviors indirectly through calling or affective organizational commitment,and there is a significant chain-mediated effect of calling and affective organizational commitment between caring leadership and nurses’ work behaviors.Conclusions and Suggestions1.This study developed a concept model of caring leadership based on grounded theory approach,revealing the core attributions,working way and potential influence of caring leadership.This model possessed Chinese cultural characteristics and was in accordance with nursing management practice,it could provide theoretical guidance for the development of caring leadership scale,as well as the nursing management practice.2.The Caring Leadership Scale was developed with good validity,reliability and acceptability,providing a scientific,reliable and credible assessment tool for evaluating the caring leadership of nursing managers.3.Nurses’ perception of caring leadership was at a high level,and nurses’ personal characteristics can affect their perception of caring leadership,indicating nursing managers should demonstrate personalized caring behaviors for nurses to improve leadership effectiveness.4.Nurses’ perception of caring leadership indirectly influenced their work behavior mainly through calling and affective organizational commitment,deepening the understanding of nurses’ work behaviors,and nurse managers can improve nurses’ work behavior by strengthening their sense of calling and affective organizational commitment to facilitate the achievement of organizational goals. |
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