Middle managers' ethos as an inner motive in developing a caring culture

Middle managers play a key role in promoting a caring culture in nursing homes. However, there is limited knowledge about middle managers' inner motives and their experiences of their responsibility in developing a caring culture.

The aim of the study is to get a deeper understanding of middle managers' motives and their experiences of their responsibility to develop a caring culture in nursing homes.

A qualitative design with a hermeneutic approach inspired by Gadamer was chosen which guided the interpretation of data. Qualitative semi-structured interviews were conducted.

Data were collected from thirteen middle managers in nursing homes, in six municipalities in northern Norway in September and October 2021.

The study was approved by the Norwegian Centre for Research Data. Oral and written informed consent was obtained from participants.

The findings show that the middle managers had non- egoistic motives to promote a caring culture as expressed in their attitudes and actions. They felt responsible to promote a caring culture where both patients and staff experienced care and were respected and recognized as unique individuals. Middle managers as good role models are responsible for being present and raising awareness of the importance of care in the nursing home culture by systematically reflecting on care values. However, a strong focus on the financial and administrative demands limits the middle managers' possibilities to promote a caring culture and prevented them from always acting as they wanted to act, which often causes moral distress.

Being in contact with inner motives, enables the leader to promote a homelike and caring culture where both patients and staff feels respected and recognized as unique individuals. This study highlights the importance of systematic reflection on caring values in nursing homes which leads to value awareness among all actors.