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.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
287
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.
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.
Residential Long-Term Care Facilities
Taichung, Taiwan
Leader Empowerment Behavior
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.
Time frame: Baseline and immediately post-intervention (approximately 12 weeks)
Staff-Perceived Leader Empowering Behavior
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Occupational Burnout
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Psychological Empowerment
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Job Satisfaction
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Job Stress
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).
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Health Status (SF-36)
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Quality of Life (WHOQOL-BREF)
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Care Quality / Customer Satisfaction
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.
Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Nursing Staff Retention Rate
Time frame: 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
Time frame: 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
Time frame: 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)
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