Empowering Leadership, Long-Term Care, Nurse Leaders
Conditions
Brief summary
This pilot cluster quasi-experimental study tested a 12-week empowering-leadership training program delivered through flipped learning to nurse leaders in residential long-term care facilities, compared with a conventional brochure-based approach. Six facilities in central Taiwan participated: two (one public, one private) received the flipped-learning program for their leaders, and four (one public, three private) served as controls. The study examined effects at three levels: nurse leaders' own empowering leadership behaviors and facility-level nursing staff retention/turnover and resident hospitalization rates; nursing staff's perceptions of their leader's empowering behaviors, burnout, psychological empowerment, and job satisfaction; and residents' health status, quality of life, and satisfaction with care.
Interventions
BEHAVIORALFlipped-Learning Empowering Leadership Program
A 12-week, 24-hour empowering leadership program (one 2-hour module per week). Each week, a 60-minute instructional video was posted for asynchronous pre-class learning, followed by a 1-hour face-to-face session (small-group discussion, case studies, brief presentations, practical exercises), with instructor summary. Post-class activities included reflection and assignments.
BEHAVIORALEducational Brochure (Conventional Learning)
Nurse leaders in the control group received a printed brochure covering the same empowerment/empowering-behavior content as the intervention group, without structured flipped-learning sessions. The research team maintained regular contact to answer questions but provided no additional training.
Sponsors
I-Hui-Chen
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Nurse Leaders: * Age ≥ 20 years * Employed as nursing director, supervisor, or head * Employed at the facility for more than 6 months * Willing to participate and able to give informed consent Nursing Staff: * Registered nurse, licensed practical nurse, or nursing assistant * Employed at the facility for ≥ 3 months * Age ≥ 20 years * Informed consent given Residents: * Resided at the facility for ≥ 3 months * Mini-Mental State Examination (MMSE) score ≥ 24 * No severe hearing impairment * Not terminally ill * Written informed consent given (or via authorized representative as applicable)
Exclusion criteria
Nurse Leaders: \- Indicated intent to leave the position within the next 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Leader Empowerment Behavior | Baseline and immediately post-intervention (approximately 12 weeks) | Leader Empowerment Behavior Scale (Chinese version), a 27-item self-report measure across 5 subscales (extending meaning of work, engaging staff in decision-making, expressing confidence, encouraging goal achievement, providing autonomy). Each item rated on a 7-point Likert scale (1=strongly disagree, 7=strongly agree); total score range 27-189, with higher scores indicating more empowering leadership behavior (better outcome). Cronbach's α=0.71; test-retest r=0.83. |
| Staff-Perceived Leader Empowering Behavior | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | Modified version of the Leader Empowerment Behavior Scale, a 27-item measure completed by nursing staff about their leader, across 5 subscales. Each item rated on a 7-point Likert scale; total score range 27-189, with higher scores indicating more empowering behavior as perceived by staff (better outcome). Cronbach's α=0.85; test-retest r=0.71. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Occupational Burnout | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | Occupational Burnout Inventory Scale, a 21-item self-report measure across 4 subscales (personal burnout, work-related burnout, client-related burnout, over-commitment to work). Each item rated on a 5-point Likert scale; total score range 21-105, with higher scores indicating greater burnout (worse outcome). Cronbach's α=0.80; test-retest reliability=0.78. |
| Psychological Empowerment | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | Spreitzer's Psychological Empowerment Scale, a 12-item self-report measure across 4 subscales (meaning, competence, self-determination, impact). Each item rated on a 5-point Likert scale; total score range 12-60, with higher scores indicating greater psychological empowerment (better outcome). Cronbach's α=0.87; test-retest reliability=0.82. |
| Job Satisfaction | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | Minnesota Satisfaction Questionnaire Short Form, a 20-item self-report measure. Each item rated on a 5-point Likert scale; total score range 20-100, with higher scores indicating greater job satisfaction (better outcome). Cronbach's α=0.88; test-retest reliability=0.84. |
| Job Stress | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | Single-item self-report measure ("Do you often feel very stressed at work?"), rated on a 5-point Likert scale; score range 1-5, with higher scores indicating greater job stress (worse outcome). |
| Health Status (SF-36) | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | 36-Item Short Form Health Survey (SF-36), across 8 domains (physical functioning, role limitations due to physical health, role limitations due to emotional problems, pain, emotional well-being, social functioning, energy, general health). Each domain scored 0-100, with higher scores indicating better health status (better outcome). Cronbach's α=0.78-0.90; test-retest reliability=0.86-0.91. |
| Quality of Life (WHOQOL-BREF) | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | World Health Organization Quality of Life Questionnaire, Abbreviated Version (WHOQOL-BREF), across 4 domains (physical health, psychological health, social relationships, environmental health). Domain scores range from 4 to 20, with higher scores indicating better quality of life (better outcome). Cronbach's α=0.80-0.88; test-retest reliability=0.90-0.95. |
| Care Quality / Customer Satisfaction | Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019) | Customer Satisfaction Scale, a 25-item self-report measure across 4 subscales (comfort/cleanliness, nursing care, food services, facility care/services). Each item rated on a 5-point Likert scale; total score range 25-125, with higher scores indicating greater satisfaction with care quality (better outcome). Cronbach's α=0.94; test-retest reliability=0.75. |
| Nursing Staff Retention Rate | 12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up) | — |
| Nursing Staff Turnover Rate | 12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up) | — |
| Resident Hospitalization Rate | 12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up) | — |
Countries
Taiwan
Outcome results
None listed