Gibraltar in the Context of Elderly Care Homes Dissertation

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Management Performance Within Elderly Care Homes in Gibraltar

The elderly nursing community in Gibraltar is dispersed and characterized by different institution specific challenges and particularities. The current project assesses the general level of leadership competencies within three pre-selected institutions, the management performance assessments of employees, the basic leadership skills required and formulates a series of recommendations as to how these competencies could be obtained. The approach is predominantly a quantitative one, combining various research methods, such as the questionnaire, the case study and structured interviews.

With the aging of the population, more pressure is placed on the health care system throughout the world, and Gibraltar is no exception. As 15.41 per cent of its population is aged over 65 years (Website of the Central Intelligence Agency, 2015), a question arises regarding the country's ability to provide adequate care for its aging population. In this sense then, the current project sets out to assess the elderly care system currently in place in Gibraltar through a managerial standpoint, to assess its current competencies and to provide recommendations for future

Much emphasis has been placed on the health care system throughout the past recent years, due to the numerous changes and pressures faced by the sector, such as inequities in the globalised world, ecological, demographical and socioeconomic changes, global partnerships for social development, disease control and renewed action for primary health care. In such a complex context, the responsibilities of the nursing workforce are a core component to the adequacy of the care management practices, especially due to their ability to reduce inequalities, increase the access to medical care and promote quality and safe care.

The training of nurses then plays a quintessential role in the provision of quality health care, as well as in the composition and dynamics of the nursing workforce, the quality and appropriateness of care and the development of institutional capacity in health (Arras, 1995). The nurse / or professional demonstrates competence when applied effectively a combination of knowledge, skills and clinical judgment in daily practice or job performance. Management of nursing care should be conducted by a professional nurse and technical and managerial skills in the field of care to have the powers to organize, monitor, evaluate and promote the improvement of the quality of nursing care. So the concept of Care Management as the stable union of two words - management and care - meaning itself and greater than the sum of its parts arises (Wilson, 2015).

Thus, for the proper management of nursing care, implementation of management actions and nursing administration is required. In nursing home for elderly people, performance management is important to organize care through the allocation of sufficient resources. But this is not enough, since elderly care should integrate a true and deep caring for patients, not only the management of care - nursing homes should manage to care, not only exist to manage. This approach is important since it indicates how best to organize resources in order to provide humane care.

1.2. Problem statement

Leadership is defined as the process or art that involves the influence to make people voluntarily strive towards achieving the objectives of the group. It includes knowledge, skills and abilities that allow the leader to direct the forces of those who are around in a collective effort through effective and strategic collaboration, negotiation skills, oral and written communication high-level development and team motivation and decision-making (Reid & Weller, 2010). As part of the leadership skills and teamwork, it is expected that the nurse can communicate in a style of appropriate values which support the health system and the nursing workforce, and which are consistent with a healthy work environment (Reid & Weller, 2010).

Management skills and leadership are recognized as an essential part of the practice, not only nurses but also for all health professionals whose development will enable an outstanding healthcare for the future (Reid & Weller, 2010;Cummings et al., 2010; Calhoun et al., 2008). The goal of any health care organization should be to influence the quality of patient care and nursing leadership plays a key role in encouraging staff to gain a better understanding of the patient. Germain & Cummings (2010) show in their research that the nursing leadership style has an impact on nursing performance. From this review, the factors that nurses perceived as motivators for good performance include autonomous practice, labour relations, access to resources, the individual characteristics of nursing and leadership practices.

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Understanding these factors is a necessary condition for quality nursing care and positive patient and organizational outcomes (Germain & Cummings, 2010; Wong & Cummings, 2007).

Therefore, it is the responsibility of academic nursing and health organizations to continue studying and teaching this subject. Managing the performance of elderly home in Gibraltar is a daunting task which needs leadership skills, training skills and management skills. Thus, nursing home management performance requires that nursing homes for elderly in Gibraltar be managed with multiple competencies and skills.

1.3. Purpose of the study

In the context so far present, the purpose of the current study is that of exploring and understanding the management performance of nursing homes for the elderly in Gibraltar. The scope then is that of revealing how these nursing homes are managed through the use and employment of the most appropriate leadership competencies. Subsequently, the scope of the study is that of answering four specific research questions and therefore supporting the further development and improvement of elderly care in Gibraltar.

A secondary purpose of the study is that of adding to the current body of literature on the traits of elderly care in general and in Gibraltar, in particular. This specific topic of health care in the region is only limitedly addressed within the literature, meaning that the current project will then add more useful data on the subject. This virtually means that the current projects aims not only towards a better understanding of the sector of elderly care in Gibraltar, but also to a better understanding of its theoretical stance and the promotion of further research in the field.

1.4. Research objectives

The current study on the assessment of the managerial competencies in the elderly care facilities in Gibraltar seeks to attain the following four research objectives:

To assess the general situation of nursing homes for elderly in Gibraltar from leadership competencies perspective;

To explore the assessment of the management performance of employees in nursing homes for elderly in Gibraltar;

To evaluate the basic leadership competencies required to manage nursing homes for elderly in Gibraltar;

To recommend such competencies and skills of leadership which will help to better manage nursing homes for elderly in Gibraltar

Aside from these four specific research objectives, another scope is that of raising awareness of the problems encountered by the elderly care sector in Gibraltar, within both the academic and the care communities. The issue of elderly care is becoming more and more important within the modern day society due to the multitude of social, economic and technological changes and the current project seeks to raise awareness of its problems in order to stimulate improvements within the actual sector, as well as more study and attention from the research community.

2. Literature review

2.1. Introduction to the literature review

The literature review section is the starting point of any research processes since it completes a thorough analysis of the available literature in terms of nurse care, elderly care, nursing appraisal systems and other topics related to the studied issue, as these are available within the literature. The shortage of the literature section is that is presents general data from the available sources, without direct reference to the aspects of evaluating the management performances within the elderly care facilities in Gibraltar. Nevertheless, the specific issues are further on addressed through the actual study of the topic via primary and secondary research, and the literature review represents the general theoretical context against which the future research is set.

2.2. Review of nursing qualifications

The increased severity of patients, decreased hospitalization time and the proliferation of care technologies have increased the need for nurses with specific skills that enable them to adapt to these changes and meet the challenges that entails. In general, studies that analyze the focus nursing competencies as essential to ensure health care for their readiness are safe, quality and essential aspects of practice that affect users, families and other nurses (Cathcart et al., 2010; Tabari et al., 2007).

Benner (1982) defines five levels of competence development in nursing:

A novice nurse, or a beginner

Advanced nurse

Proficient nurse

Capable nurse and An expert beginner nurse

The author recognises the novice nurse competence to implement tasks through knowledge of attributes that do not require previous experience owning, i.e. tasks requiring only theoretical knowledge for execution (knowledge in action). Furthermore, the nurse advanced beginner is one that demonstrates acceptable performance level, can perform more complex.....

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