First-Line Nursing Home Managers in Sweden and their Views on Leadership and Palliative Care

Cecilia Håkanson*, 1, 2, Berit Seiger Cronfalk 1, 3, 4, Eva Henriksen 2, 5, Astrid Norberg 1, 6, Britt-Marie Ternestedt 1, 2, 7, Jonas Sandberg 1, 8
1 Palliative Research Centre, Ersta University College and Ersta Hospital, Stockholm, Sweden
2 Department of Neurobiology, Care science and Society, Karolinska Institutet, Stockholm, Sweden
3 Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden
4 Stord Haugesund University College, Norway
5 FOU-nu, Stockholm County Council, Stockholm, Sweden
6 Department of Nursing, Umeå University, Umeå, Sweden
7 Stockholms Sjukhem foundation, Research, Development and Education Unit, Stockholm, Sweden
8 Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden

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© Håkanson et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Palliative Research Centre, Ersta University College and Ersta Hospital, P.O. Box 111 89, SE-100 61 Stockholm, Sweden; Tel: +46 76-636 5078; E-mail:


The aim of this study was to investigate first-line nursing home managers’ views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care.

Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes.

The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.

Keywords: End-of-life, first line managers, leadership, older people, palliative care, qualitative analysis..