First Line Managers' Experiences of Shaping Organisational and Relational Preconditions for Patient Safety in Swedish Intensive Care Units During the COVID‐19 Pandemic: A Qualitative Study.
Objectives: The COVID‐19 pandemic placed extraordinary demands on intensive care units (ICUs), posing significant challenges to patient safety and underscoring the critical role of healthcare managers. Although leadership has been widely studied during the pandemic, little is known about how first‐l...
| Publicado en: | Journal of Nursing Management Vol. 2026; pp. 1 - 10 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
8/29/2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196562662&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196562662 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09660429 81U jtl: Journal of Nursing Management issn: 09660429 maglogo: Y pubinfo: dt: 8/29/2026 vid: 2026 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 196562662 196562662 196562662 10.1155/jonm/2665196 196562662 ppf: 1 ppct: 9 formats: tig: atl: First Line Managers' Experiences of Shaping Organisational and Relational Preconditions for Patient Safety in Swedish Intensive Care Units During the COVID‐19 Pandemic: A Qualitative Study. aug: au: Berggren, Karin Ekstedt, Mirjam Lynga, Patrik Sackey, Peter Swedberg, Lena Joelsson-Alm, Eva Schandl, Anna affil: Department of Perioperative and Intensive Care,, Sodersjukhuset,, Stockholm, Sweden sug: subj: Nurse Managers Psychosocial Factors Nurse Attitudes Evaluation Patient Safety Intensive Care Units Critical Care Nursing COVID-19 Pandemic Psychosocial Factors Work Environment Interprofessional Relations Frontline Nurses Psychosocial Factors Support, Psychosocial Human Male Female Adult Middle Age Funding Source Sweden Qualitative Studies Nursing Role Semi-Structured Interview Thematic Analysis Health Resource Allocation Workload Psychological Well-Being Adaptation, Occupational Trust Collaboration Learning Multidisciplinary Care Team Ethics, Nursing Descriptive Research Interview Guides Personnel Staffing and Scheduling Decision Making Leadership Descriptive Statistics Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Objectives: The COVID‐19 pandemic placed extraordinary demands on intensive care units (ICUs), posing significant challenges to patient safety and underscoring the critical role of healthcare managers. Although leadership has been widely studied during the pandemic, little is known about how first‐line ICU managers experienced their work supporting staff and shaping organisational and relational preconditions for patient safety. This qualitative study aimed to address this gap by exploring first‐line ICU managers' descriptions of their work during the pandemic. Methods: Individual interviews were conducted with 15 first‐line managers (nurses and physicians) who had operational responsibility for ICU staff, including nurses, physicians and assistant nurses, during the first wave of the COVID‐19 pandemic (1 March–30 September 2020). Participants were recruited from five ICUs across three Swedish hospitals. Data were analysed using thematic analysis. Results: The first‐line managers' experiences were described in three themes: Balancing resources, workload and the well‐being of ICU staff; fostering a responsive and adaptive work environment; and building trust and collaboration. According to the first‐line managers, they experienced conflicts between maintaining efficiency and ensuring preconditions for patient safety, often struggling to balance care with limited resources. They explained how flexibility, continuous learning and mutual trust contributed to an adaptable healthcare environment that enabled the identification of safety risks. Conclusions: This study highlights the unique role of first‐line managers in shaping organisational preconditions for patient safety in ICUs during the COVID‐19 pandemic. Their leadership was enacted in real time, embedded in clinical care, shaped by ethical complexity, resource constraints and the need to support staff well‐being. The findings reveal how adaptive leadership, characterised by flexibility, continuous learning and trust, enabled managers to respond effectively to rapidly changing conditions and maintain patient safety under pressure. Implications for Nursing Management: The results underscore the importance of equipping first‐line managers with leadership competencies that promote adaptability, trust‐building, and continuous learning, especially in high‐pressure environments such as ICUs. By demonstrating how managers balanced staff well‐being, resource constraints, and preconditions for patient safety, this study offers practical strategies to strengthen resilience in healthcare teams. These insights can inform leadership development programmes, organisational policies and system‐level reforms aimed at enhancing patient safety and preparedness for future healthcare crises. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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