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Wang et al. BMC Nursing (2024) 23:930
https://doi.org/10.1186/s12912-024-02582-9 BMC Nursing
*Correspondence:
Ming Liu
karryliu@mpu.edu.mo
1Faculty of Health Sciences and Sports, Macao Polytechnic University,
Macao, China
2Peking University Health Science Center - Macao Polytechnic University
Nursing Academy, Polytechnic University, Macao, China
Abstract
Aim To provide a comprehensive overview of situational leadership theory as applied to nursing management,
outlining its relevant measurement tools, intervention modalities, and reporting gaps.
Design A scoping review of the literature was conducted according to the JBI guidelines.
Data sources Eight databases were used including PubMed, Embase, CINHAL, Web of Science, CNKI, WanFang,
Cqvip, SinoMed. References of included studies were also searched. All literature published up to 9 September 2024
was included.
Review methods According to the PCC framework, the search formula was developed and a three-stage integrated
search strategy was employed to search the literature. The titles, abstracts, and full texts were assessed by the
reviewers followed by the data extraction and synthetization of results.
Results Nineteen articles were included in this study, including ve cross-sectional studies, thirteen quasi-
experimental studies, and one mixed study. The research identied that situational leadership theory has multiple
applications in nursing management and plays an important role in the development of nurses’ leadership and
maturity. However, the studies were reported with low transparency and did not adhere to the relevant reporting
guidelines. In addition, further validation of the relevant measuring instruments is needed.
Conclusion Situational leadership is a follower-centred leadership skill that enables leaders to adapt their leadership
style to achieve optimal management results, facilitate the achievement of organizational goals, and increase follower
satisfaction and growth. Further research is needed to develop standardized intervention protocols to apply this
theory eectively and enhance the reporting quality of relevant studies.
Impact The situational leadership theory emphasizes the necessity for nursing managers to use dierent leadership
styles depending on their nurses’ maturity. However, the study suggests that it is necessary to further dierentiate
between dierent situational leadership models and to explore relevant research tools and interventions further. This
could lead to a more standardized and eective clinical application of the theory.
Keywords Nursing, Management, Scoping review, Situational leadership theory
Situational leadership theory in nursing
management: a scoping review
XinWang1, YachenLiu1, ZhongyanPeng1, BowenLi1, QingqingLiang1, ShutingLiao1 and MingLiu2*
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Page 2 of 16
Wang et al. BMC Nursing (2024) 23:930
Introduction
e proliferation of international public health prob-
lems in recent years means a growing need for carers
and a growing carer community [1]. Nursing teams can
only be built with the nurse manager and nurses work-
ing together. e role of the nurse manager is to trans-
form the organization’s culture and strategy into practical
action at an operational level and to manage resources,
coordinate care, plan and facilitate nursing care, and
provide assessment services and support [2]. Leadership
is the inner force that determines a leader’s leadership
behavior and is the driving force that achieves group or
organizational goals and ensures that the leading pro-
cess runs smoothly [3]. Nursing leadership is the drive
of nursing leaders to eectively bring followers together
to establish and achieve their goals [4]. However, using a
single leadership model may limit outcomes when faced
with dierent aptitudes of nurses. To sustainably enable
nurses to make progress and to improve the quality of
nursing care and the eciency of nursing management,
more and more nurse managers use situational leader-
ship theory as a guide. Using situational leadership the-
ory helps nursing managers do this; management skills
must also be involved. Situational leadership theory is
valued in nursing management as a global applied lead-
ership theory. It can provide a specic theoretical refer-
ence for nursing managers to explore practical ways to
solve problems and construct evaluation standards for
nurses. Situational leadership theory advocates that dif-
ferent leadership styles should be used when dealing with
nurses with varying maturity levels to make management
more eective [5]. However, with the gradual growth of
the nursing team and the evolution of the theory, situ-
ational leadership theory has a variety of applications,
approaches, and content in nursing management. Taking
into account the problems and improvements in existing
implementations can provide useful information for the
future construction of intervention programs and facili-
tate further optimization. It is important to identify cur-
rently available nursing interventions and research gaps
that need to be addressed.
Background
Situational leadership theory was proposed and devel-
oped by Paul Hersey, a renowned psychologist and
organizational behaviorist, and Kenneth Blanchard, a
managerial scientist [5]. It is also known as the leader-
ship life cycle theory, a theory of change that values sub-
ordinates. e theory suggests that leaders should adopt
a leadership style appropriate to their team members’
abilities and willingness [6]. e situational leadership
model reduces the factors that inuence the eective-
ness of leadership behavior to three: employee maturity,
the leader’s task behavior, and the leader’s relationship
behavior. e theory suggests that there is no single opti-
mal leadership style, but rather that leaders should be
exible in adapting their leadership styles to the matu-
rity (M) level (both in terms of ability and willingness)
of their subordinates and the characteristics of the task.
Ability is the knowledge, experience, skills, and abili-
ties demonstrated by an individual or organization in a
particular job or activity. Willingness is the condence,
commitment, and motivation of an individual or organi-
zation to perform a particular job or activity. is process
of employee growth from immaturity to maturity was
divided into four stages, named readiness (R) or devel-
opment (D). e leader’s task behaviors and relation-
ship behaviors comprise the leadership style (S) (shown
in Fig.1). Employees with a high level of maturity may
require less guidance and more supportive behaviors,
whereas employees with a low level may require more
guidance and directive behaviors [5]. Situational Leader-
ship eory suggests that leaders must be able to dier-
entiate and recognize the current state of the employees
if they are to manage eectively.
For leaders, this theory requires leaders to have three
skills: diagnosis, exibility, and agreed-upon leader-
ship styles [7]. Diagnosis refers to assessing the current
readiness level of team members; it is the most critical
part of situational leadership theory. Flexibility refers to
the leader’s ability to apply dierent leadership styles to
dierent readiness levels of subordinates or to treat the
same person with dierent leadership styles when the
situation changes. Agreed-upon leadership style refers
to partnering with the person to agree on his or her
desired leadership style [8]. In addition, for employees,
two dimensions can be used to dene the dierent stages
of an employee’s development: work maturity (ability)
and psychological maturity (willingness). Work maturity,
which includes a person’s knowledge and skills. Subor-
dinates with high work maturity are well educated and
trained, have sucient knowledge and abilities, and are
experienced enough to perform their work tasks inde-
pendently without guidance from others. Psychological
maturity refers to a person’s willingness and motivation
to do something. Subordinates with high psychological
maturity have high self-condence and are motivated
to work. ey do not need external incentives but rely
mainly on internal motivation [9]. at is, a subordinate’s
stage of development is viewed from two perspectives:
Ability to work, the relevant knowledge and skills dem-
onstrated by the subordinate when engaged in a particu-
lar goal or task; willingness to work, the motivation and
condence of the subordinate when working on a specic
goal or task. Accordingly, Hesse and Blanchard catego-
rized the employee growth process into four types (or
stages) from low to high [10].
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Wang et al. BMC Nursing (2024) 23:930
As situational leadership theory continues to evolve and
spread, the two founders of the theory have each rened
and dierentiated the application model of situational
leadership theory based on their own perspectives. Paul
Hersey [11] registered for Situational Leadership Model,
and Ken Blanchard registered for Situational Leadership
Model II. With regard to these two situational leader-
ship models, their core advocates a exible leadership
style, whereby leaders should utilize dierent leadership
styles in accordance with the dierences in their subor-
dinates’ ability and willingness to perform, as well as the
dierences in the work tasks and work environments.
Whether it is Situational Leadership Model or Situational
Leadership Model II, the steps are the same for leaders
when utilizing the situational leadership approach. e
rst step is to dene specic work tasks and goals. e
second step is to diagnose the ability and willingness of
the subordinates in the context of the specic job tasks
and goals. e third step is to apply a matching leader-
ship style [10]. Nevertheless, they are dierent. In Situ-
ational Leadership Model, Paul Hersey categorizes it into
four dierent performance readiness according to their
Fig. 1 Situational Leadership Theory Model
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Wang et al. BMC Nursing (2024) 23:930
ability and willingness, R1-R4 (R1: unable and insecure or
unwilling; R2: unable but condent or willing; R3 able but
insecure or unwilling; R4: able and condent and willing),
S1-S4 (telling, selling, participating, delegating). In Situ-
ational Leadership Model II, the Ken Blanchard divides
it into four dierent developmental stages according to
their ability and willingness, D1-D4 (D1: low compe-
tence, high commitment; D2: low to some competence,
low commitment; D3: moderate to high competence,
variable commitment; D4: high competence, high com-
mitment), S1-S4 (directing, coaching, supporting, dele-
gating). It is worth noting that the dierence between the
two models is mainly in the classication of employees,
and there is no dierence in the connotation of leader-
ship style.
Situational leadership theory has been extensively stud-
ied and applied in the context of nursing management
for many years. With the continuous development of the
medical market and the continuous improvement of the
public’s medical needs, the comprehensive quality of the
nursing team, especially the head nurse, has been sub-
jected to higher requirements. It is especially important
to improve the leadership of nurse leaders and construct
eective nursing teams through the use of situational
leadership theory [12]. e nurse manager’s leadership
behavior directly aects the nurses’ enthusiasm and the
improvement of nursing quality [13]. e challenge of
building a nursing team with ecient execution to pro-
vide patients with high-quality care to meet the demands
of modern clinical nursing is a signicant problem that
every nurse manager must address. Applying situational
leadership theory can assist nursing managers in moti-
vating nurses to enhance management eciency. Studies
have shown that nurse managers use dierent leadership
styles to manage nurses based on maturity levels, eec-
tively avoiding resistance from nurses to their managers,
inspiring nurses’ work enthusiasm, and improving nurses’
performance appraisals [14]. Zhang et al. [15] report that
applying situational leadership theory improved over-
all clinical quality, including medical document writing
quality, accidental injury prevention, medication safety,
patient satisfaction, and the quality of clinical teaching.
Additionally, the nurse manager is relieved of the bur-
den of overseeing the entire unit and can delegate tasks
to highly prepared nurses who are able and willing to
assume responsibility [15]. e nurse manager can dedi-
cate more time to managing the work, which improves
eciency and contributes to the quality of nursing care.
To practically implement situational leadership theory
into the specic work of nurse managers and nurses,
managers should assess nurses’ readiness dynamically
and use various management techniques to help nurses
progress along the R1-R4 or D1-D4 as quickly as possible.
at is to facilitate the development of the nursing team
[7].
Although situational leadership theory has been widely
used in nursing management, the research has many dif-
ferent types of research designs and tools and variations
in the methodology used to apply the theory. erefore,
to identify how situational leadership theory has been
applied in the eld of nursing management, we synthe-
sized the existing literature using a scoping review [16].
To the best of our knowledge, no systematic review of
situational leadership theory has been published. In
addition, we found that the transparency of the relevant
studies was an apparent absence deciency through our
previous review of the studies on situational leadership
theory in nursing management. Given that, our objec-
tive was to know how situational leadership theory works
in nursing management and how the interventions were
carried out. erefore, the transparency of the study
plays an important role in the overview of this study
and provides some guidance for the referencing as well
as reporting of future related studies. In summary, we
reviewed studies using reporting guidelines relevant to
the study design of the included studies.
Research questions
(1) How to use situational leadership theory in nursing
management?
(2) What interventions does situational leadership
theory provide for nursing management? /How do
the intervention programs work?
(3) What are the measurement tools and measures
related to situational leadership theory?
(4) How transparent is the reporting of existing studies?
The review
Aim
is scoping review aimed to provide a comprehensive
overview of situational leadership theory as applied to
nursing management and reporting, and to explore the
research gap regarding situational leadership theory in
nursing.
Design
e study used a scoping review, which is a method-
ological amalgamation of summaries, explanations, and
interpretations of existing qualitative and quantitative
studies [17]. e review was conducted following the
Joanna Briggs Institute (JBI) Scoping Review Guidelines
[18], which were based on a framework derived from the
concepts of Arksey and O’Malley [19] and subsequent
enhancements proposed by Levac et al. [20] e research
protocol was not registered and was reported according
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Wang et al. BMC Nursing (2024) 23:930
to the Preferred Reporting Items of Systematic Reviews
and Meta-Analyses Extension for Scoping Reviews
(PRISMA-ScR) [21], as shown in Appendix S1.
Literature selection
is review question was assigned to this study based
on the PCC (Population, Concept, Context) framework.
(1) Population: nurses; (2) Concept: use of Situational
Leadership eory; (3) Context: clinical nursing man-
agement. e primary question of this review is how to
use situational leadership theory in nursing management.
e inclusion criteria for this study were limited to peer-
reviewed original journal articles, theses, and disserta-
tions published in Chinese or English that describe the
use of situational leadership theory in nursing manage-
ment. No time limit for inclusion in the included litera-
ture. Exclusion criteria: We excluded letters to the editor,
reviews, guidelines, and conference abstracts as they did
not provide the necessary information on using the the-
ory in nursing management. In addition, literature with-
out full text and duplicate publications were excluded.
Search strategy
A three-stage integrated search strategy was applied to
search articles both published and unpublished literature
in English and Chinese, as well as gray literature. Ini-
tially, two reviewers (PZY & LBW) searched PubMed and
CNKI to identify synonyms and index terms, determin-
ing the number of potentially relevant studies to develop
a nal search strategy for all databases. e search
strategy was nalized with the assistance of a librarian,
approved by all authors, and employed MeSH terms, key-
words, and Boolean operators across all databases. In the
second stage, the librarian performed a comprehensive
search using databases such as PubMed, Embase, CIN-
HAL, Web of Science, CNKI, WanFang, Cqvip, SinoMed,
with the last search date of September 9, 2024. Finally,
two authors (PZY & LBW) conducted additional searches
by manually examining the reference lists of all eligible
papers. e English search terms for this study included
‘nurs*,’ ‘situational leadership,’ ‘leadership life cycle the-
ory,’ and ‘manage*.’ e search strategy and results for all
databases are shown in Appendix S2.
All retrieved articles were imported into Endnote X9.
After excluding duplicates, two reviewers (PZY & LBW)
independently assessed the titles, abstracts, and full texts
based on the inclusion and exclusion criteria. Any dis-
crepancies were resolved through discussion between
the two reviewers. Reasons for exclusion during the full-
text screening stage were documented. In our review, we
didn’t assess the quality of the literature [22].
Data synthesis and analysis
Two reviewers (WX & LST) performed iterative read-
ings and multiple reviews of the retrieved literature
[20]. e data extraction form was determined through
iterative inductive review and consultation among the
research team in order to provide a logical and descrip-
tive summary of results consistent with the objectives
and questions of the scoping review. Microsoft Excel
was ultimately used to extract the following information:
authors, year, country, study population, sample size,
study aims, study design, methodology, and study conclu-
sions. All analyses were resolved by consensus.
e TREND (Transparent Reporting of Evaluations of
quasi-experimental studies) Statement was used to check
the reporting of the included quasi-experimental study
articles, and the STROBE (Strengthening the Reporting
of Observational Studies in Epidemiology) checklist was
used to examine the reporting of the included cross-sec-
tional study articles [23, 24].
Results
Database search
A search of eight databases and a manual search yielded
657 articles. After excluding 196 duplicates, the titles and
abstracts of 461 studies were screened against the eligi-
bility criteria, resulting in the exclusion of 366 studies.
Subsequently, 95 studies were screened for eligibility in
the full text and 19 were included in the review (Fig.2).
Characteristics of included articles
e characteristics of 19 included articles are shown in
Table 1, and Table 2 presents the categorical statistics
that 13 (68.4%) in Chinese, and 6 (68.4%) in English; thir-
teen (68.4%) articles were quasi-experimental studies,
and 5 (26.3%) were cross-sectional studies; the majority
of articles (12, 63.2%) were published between 2011 and
2020. More than half of the included studies (13, 68.4%)
were conducted in Asian countries.
Situational leadership model assessment tools
e included studies identied methodologies and tools
for the assessment of nursing leadership styles and nurse
maturity.
Nursing leadership
e review found that overall there are 5 validated tools
for measuring and assessing leadership in the context
of situational leadership management models. Leader-
ship Eectiveness and Adaptability Description (LEAD)
focuses on assessing the leadership style of nursing
leaders in terms of style preference, style range, and
style adaptability [5]. Leadership Behaviour Analysis II
Scale (LBAII) consists of two sections: LBAII-Self and
LBAII-Other. e LBAII-Self was used for the leader’s
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Wang et al. BMC Nursing (2024) 23:930
self-assessment and the LBAII-Other was used for the
subordinate’s evaluation of the leader. is scale assesses
the exibility and eectiveness of a leader’s leadership
style [43]. In order to explore nurse leadership styles, Car-
doso et al. [27] developed a self-administered question-
naire to assess the nurse Coaching leaders’ knowledge,
skills, and attitudes. Leadership Style Assessment Tool
(LSAT) is designed to examine the characteristics of
leadership styles in diverse contexts. e objective of the
scale is to assess the consistency between the self-rated
and subordinate-rated leadership styles of nursing man-
agers [44]. Leadership Style Self-Questionnaire (LSSQ)
Fig. 2 The PRISMA ow diagram
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Wang et al. BMC Nursing (2024) 23:930
Author/year Country Participants/sample Aim of study Study
design
Methods Conclusions
Cai D.
(2002) [25]
China 7 new head nurses To explore the eective management method
of competitive recruitment of head nurses, the
leadership life cycle theory is applied to the
management of competitive recruitment of
head nurses.
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory can improve the maturity
needs of new head nurses, and can implement targeted manage-
ment of head nurses at dierent levels.
Cao Y.
(2019) [26]
China 60 gastroenterology
patients and 16 nurses
To explore the eect of situational leadership
theory in nursing management of internal
medicine digestive ward
Quasi-ex-
perimental
study
Quan-
titative
research
The use of the situational leadership theory to guide nurse leaders
to adopt dierent leadership styles in managing nursing sta is
conducive to developing the subjective initiative of nursing sta,
improving work quality and patient satisfaction.
Cardoso, M. L.
(2011) [27]
Brazil 111 Private general
hospital nurses
To assess nurses’ leadership and identify, mea-
sure and analyze the acquisition of competen-
cies from the perspective of nurse coaches,
based on situational leadership theory as a
framework.
Cross-
sectional
study
Quan-
titative
research
By investigating nurse leadership, identify, measure, and analyze
the acquisition of nurse leadership competencies, results show
links to communication, giving and receiving feedback, and as-
signing and receiving power.
Castillo, A. L. R.
(2021) [28]
Mexico 31 managing nurses and
125 of their subordinate
To evaluate the concordance between the
leadership styles self-evaluated by the nursing
managers and evaluated by their subordinates
in a private hospital.
Cross-
sectional
study
Quan-
titative
research
The nursing managers and their subordinates perceive vari-
ous leadership styles, but there is low concordance. To achieve
superior leadership, subordinates must develop autonomy and
empowerment while also strengthening interpersonal relation-
ships with the subordinates.
Chen H.
(2010) [29]
China 141 nursing graduate
interns
To explore the eect of situational leadership
theory in intern nursing management, explore
eective methods of nursing clinical teaching
management, and improve teaching quality
Quasi-ex-
perimental
study
Quan-
titative
research
Situational leadership theory can be used to guide trainers in the
management of training, improving trainees’ clinical practice skills
and basic assessment scores, and increasing trainees’ satisfaction
with their trainers.
Chen Y.
(2016) [30]
China 209 clinical nurses To explore the eect of situational leadership on
nurses’ job satisfaction
Quasi-ex-
perimental
study
Quan-
titative
research
The implementation of situational leadership management can
improve nurses’ motivation, increase their job satisfaction and
promote the development of nursing specialisation.
de Oliveira, D.
(2021) [31]
Brazil 71 nurses To analyze the leadership prole of nurses from
the perspective of the Situational Leadership
Model.
Cross-
sectional
study
Quan-
titative
research
The situation leadership model was used to analyse the general
situation of hospital nurses and their leadership, The leaders were
highly eective in adapting to dierent leadership styles, with
most falling within the eective range.
Foster, D.
(1995) [32]
United
Kingdom
61 charge nurses To explore whether nursing professionalism is
supported by the management structure pre-
ferred by nurse managers and charge nurses.
Self-ques-
tionnaire
and semi-
structured
interview
Mixed
research
The practice of situational leadership theory helps to increase col-
legial autonomy and professional satisfaction, to identify nurses’
and nurse managers’ preferences, to adapt nursing management
strategies and to improve the eciency of decision making.
Furtado, L. C.
(2011) [33]
Portugal 22 nurse managers and
244 sta nurses
To explore the leadership behaviours of nurse
managers, compare them with sta nurses’
perceptions of their leadership, and determine
whether leadership aects sta nurses’ job
satisfaction.
Cross-
sectional
study
Quan-
titative
research
The application of situational management theory to guide nurse
managers in adopting various leadership styles for managing
nursing sta can enhance the quality of nursing services.
Table 1 Description of characteristics of included articles
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Wang et al. BMC Nursing (2024) 23:930
Author/year Country Participants/sample Aim of study Study
design
Methods Conclusions
Huang W.
(2016) [34]
China 16 nursing sta To explore the eectiveness of situational lead-
ership theory in improving nurse performance.
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory to train nurse leaders and
instruct them to use dierent leadership styles when managing
nurses is conducive to improving the quality of nurses’ work,
patient satisfaction and nurse performance.
Li Y.
(2011) [35]
China 10 full-time chief nurses
of clinical nursing units
To explore how situational leadership theory
can be applied to improve the management of
nurse leaders.
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory to guide the director of
nursing and the chief nursing ocer to use dierent leadership
styles to manage the nurse leaders is conducive to improving the
nurse leaders’ job evaluation rate and enhancing the nurse lead-
ers’ management ability.
Liu C.
(2020) [36]
China 72 operating room
nurses
To explore the impact of training based on
situational leadership theory on the core com-
petencies of operating room nurses
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory can eectively improve
the core competencies of operating room nurses, training eects
and the quality of operating room nursing services.
Liu Z.
(2017) [37]
China 154 head and assistant
head nurses
To observe the inuence of the training of situ-
ational leadership theory on the leadership style
of nursing heads, and summarize the applica-
tion of situational leadership theory in nursing
management.
Quasi-ex-
perimental
study
Quan-
titative
research
The training in situational leadership theory and knowledge can
help to improve the exibility and eectiveness of the nurse
manager’s leadership style.
McElhaney, R. F.
(2003) [38]
America 11 full time nurse man-
agers and 79 registed
nurses
To survey nurse managers and registered nurse
teams on their perceptions of nurse managers’
leadership styles, and by studying registered
nurses’ perceptions of job satisfaction.
Cross-
sectional
study
Quan-
titative
research
The leadership style of the nurse manager can signicantly impact
the team, sta, and patient care and dierent leadership styles
may have varying eects in dierent situations, it is important to
develop appropriate leadership strategies for specic situations.
Peng S.
(2012) [39]
China 18 emergency training
nurses
To explore the application eect of situational
leadership theory in the teaching of emergency
nurses
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory in teaching advanced
nurses can enhance their maturity and improve teaching quality.
Wang W.
(2016) [40]
China 139 clinical nursing
instructors
To explore the eectiveness of situational
leadership in the management and training of
nursing instructors.
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory to guide the training of
trainers is likely to increase interns’ satisfaction and improve train-
ers’ level and ability to deliver training.
Xue M.
(2019) [41]
China 53 head nurses To explore the eectiveness of situational
leadership theory training for head nurses in im-
proving their nursing management capabilities
Quasi-ex-
perimental
study
Quan-
titative
research
The use of situational leadership theory for head nurses can
improve their management capabilities and the job satisfaction of
nursing sta in their departments.
Yan X.
(2010) [42]
China 25 outpatient nurses To explore the eect of situational leadership
theory in the nursing management of outpa-
tient nurses
Quasi-ex-
perimental
study
Quan-
titative
research
The application of situational leadership theory to direct nurse
leaders in utilising diverse leadership styles for managing nursing
sta is benecial for enhancing the quality of nurses’ work and
patient satisfaction.
Zhang X.
(2019) [15]
China 67 neonatology nurses To provide a theoretical reference for the
practice of hierarchical nursing management,
through the analysis of the eect of leader-
ship life cycle theory on hierarchical training of
nurses.
Quasi-ex-
perimental
study
Quan-
titative
research
The use of leadership life cycle theory to carry out hierarchical
nursing training management in the neonatal department of our
hospital, the overall clinical quality of the department has been
greatly improved compared to before.
Table 1 (continued)
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Wang et al. BMC Nursing (2024) 23:930
also measures the eectiveness of nursing leadership
styles and the exibility of leadership styles through dif-
ferent contexts, but only for nursing leaders [45].
Nursing maturity
ere was no mention of specic measurement tools
for nurse maturity in the included studies. ree studies
focused on assessing the maturity level of nurses in terms
of their productivity, management and innovation [25,
35, 40]. Five studies assessed the level of maturity of nurs-
ing sta based on education, professional title, and years
of work experience [15, 26, 34, 39, 42].
Application of situational leadership theory
Intervention studies
Given the heterogeneity of interventions and the lack of
transparency, it is dicult to categorize them by inter-
vention program. In addition, the included studies did
not describe the types of situational leadership theory
models used. Situational leadership theory guides an
intervention program that focuses on identifying subor-
dinates’ maturity, and the leader selects a matching lead-
ership style based on the subordinates’ maturity. Besides
being applied to clinical nursing management, situ-
ational leadership theory has also been applied to clini-
cal nurse training [36] and nursing internship supervisor
[29]. Due to dierences in the purpose of the included
studies, there were dierences in the identication of
nurse maturity and the leadership style/teaching style/
training content used by the leaders (preceptors). At
the same time, individual studies [37, 41] reported on
how to train leaders in the use of situational leadership
theory. Although there are many dierences, we identi-
ed and summarized the following areas based on the
main concerns: model choice, nurse management inter-
vention, nurse training intervention, and theory training
programs.
Model choice Included studies did not describe the type
of situational leadership theory model that was used. By
dening the concepts in the articles, the researcher deter-
mined that 7 of the articles used the SL model [15, 25, 26,
29, 34, 39, 42] and 4 used the SLII model [30, 35, 37, 40].
Furthermore, there was a conceptual confusion in one
article, which used the word “development” from the SLII
model, but dened it as “readiness” from the SL model [41].
Nurse management intervention Eight studies [25, 26,
30, 34, 35, 40, 41, 42] reported interventions in situational
leadership theory for clinical nurse management, with
components including identify and match. Identify the
subordinates’ maturity (work ability and work willingness)
and classify them into four types: R1-R4 (some studies
used M instead of R) or D1-D4. Leaders master dierent
leadership styles (S1-S4) based on task and relationship
behaviors, matching the appropriate leadership style to
the maturity level of the subordinate, where R1 or D1 is for
S1, R2 or D2 is for S2, R3 or D3 is for S3, and R4 or D4 is
Table 2 Details of selected literature
Study/article characteristics n(%) Study/article characteristics n(%)
Year Methodology used
1991–2010 5 (26.3) Quantitative research 18 (94.7)
2011–2020 12 (63.2) Mixed research 1 (5.3)
2021- 2 (10.5) Study design
Region in which the study was conducted Cross-sectional 5 (26.3)
Asian 13 (68.4) Nonequivalent control group 4 (21.1)
North America 2 (10.5) One-group pretest-post test 9 (47.4)
South America 2 (10.5) Interview 1 (5.3)
European 2 (10.5) Method of data collection
Language Questionnaires 18 (94.7)
English 6 (34.6) Interview and questionnaires 1 (5.3)
Chinese 13 (68.4) Sample size
Type of evidence source < 10 1 (5.3)
Journal 18 (94.8) 10 ~ 40 4 (21.1)
Dissertation 1 (5.3) 41 ~ 70 3 (15.8)
Presentation of result 71 ~ 100 4 (21.1)
Yes 18 (94.7) 101 ~ 130 1 (5.3)
No 1 (5.3) > 130 6 (31.6)
Participants Describe the research tools
Nurses 9 (47.4) Yes 17 (89.5)
Managing nurses 8 (42.1) No 2 (10.5)
Coaching nurses 2 (10.5)
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Wang et al. BMC Nursing (2024) 23:930
for S4. Among these studies, Chen et al.’s [30] study added
an intervention to improve nurses’ maturity was added
to the intervention, which included assigning individual
training programs to nurses at dierent maturity levels,
providing psycho-material incentives, and so on. Li & Li’s
[35] study divided the intervention into three steps: iden-
tify, adapt, and match. Adapting emphasizes the need for
leaders to continue learning to master dierent leadership
styles within this theoretical leadership model. Xue’s [41]
study adds to what leaders need to be trained in within
this theoretical model.
Nurse training intervention Five studies [15, 29, 30, 36,
39] reported intervention programs in which situational
leadership theory guided the training of nurses. Based on
this theory, nurses and practical nurses were grouped into
four categories according to their maturity level, and dif-
ferent teaching methods and leadership styles were used to
train nurses. Liu & Zhang [36] classied nurses into three
mastery levels (M1 low, M2 medium, M3 high) based on
their mastery of manipulative skills. M1 nurses used com-
mand health promotion to start demonstration teaching
to nurses, M2 nurses used persuasive participatory teach-
ing methods to instruct nurses in small groups and con-
duct manipulative training, and M3 nurses used empow-
erment teaching to allow nurses to practice manipulative
skills and instruction. Zhang et al.’s [15] study details the
training content for nurses at dierent maturity levels,
including four parts: leadership model, training objec-
tives, training priorities, and training methods.
eory training programs In addition, two studies [37,
41] reported on how leaders were trained in situational
leadership theory. Liu et al. [37] trained nurse leaders in
a theory course that included four sections: goals, foun-
dations, and skills of situational leadership theory; nurse
development needs; characteristics of dierent leader-
ship styles; and rules of situational leadership. Meanwhile,
Xue’s [41] study reported that the training included an
overview of situational leadership theory, the basics of
situational leadership theory, the leadership styles that
leaders need to have, how to assess the nursing readiness
of the led, and so on.
Observational studies
ere are two dierent research designs for situational
leadership theory in observational research. One was
to analyze the leadership prole of hospital nurses with
the tools of situational leadership theory [27, 31]. e
other was to investigate the leadership behavior of nurse
managers (self-evaluated) and the comparison of nurses’
perceptions of their leaders’ leadership [33], leadership
style [28, 38] (subordinated evaluated) to explore the
dierences between nurse managers and nurses’ percep-
tions of leadership.
Intervention outcome indicators
e applications of situational leadership theory used
a considerable number of outcome indicators. Over-
all these studies reported positive outcomes for nurses,
nursing managers, nursing students, and patients.
Eects on nurses
Situational leadership management model has multiple
eects on nurses. Improved quality of clinical care for
nurses, according to the ndings of ve research [15, 26,
29, 36, 42]. ree studies reported an increase in nurses’
job satisfaction, as measured by their contentment with
their employment, their relationships with coworkers,
their possibilities for professional growth, and their perks
[15, 30, 38]. At the same time, teaching nurses situational
leadership theory enhanced their abilities and core com-
petencies. Zhang’s study [15] found that nurses’ scores on
the operational skills test improved, Peng [39] reported
that nurses’ scores on the theoretical test improved, and
Liu [36] showed an increase in condence and nursing
skills. In addition, according to Huang’s [34] research, the
performance (salary) of nurses has also been signicantly
improved under the contextual leadership management
model.
Eects on nurses managers
Eight studies reported that by training nurse managers
in situational leadership theory, the managerial compe-
tencies of nurse managers improved compared to the
pre-training period [25, 27, 28, 32, 35, 37, 33, 41]. Two
reports indicated that applying situational leadership
theory aected the leadership styles of nursing man-
agers, including increased exibility, adaptability, and
eectiveness of leadership styles [31, 37]. Furthermore,
the followers are more satised with their management
after nurse managers apply situational leadership theory
to manage their followers [38, 41]. Cai [25] reported
that nurse managers had increased maturity, the degree
of people’s willingness and ability to accomplish specic
tasks, including increased levels of business qualities,
management skills, creativity, and job titles.
Eects on others
From the ndings of one study, student nurses’ satisfac-
tion with their internships was enhanced when the nurse
teacher applied situational leadership theory to manag-
ing the student nurses. is satisfaction included the
student nurses’ satisfaction with the training method,
their satisfaction with the learning environment, their
satisfaction with the organizational management, their
satisfaction with their gains, and their overall satisfaction
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Wang et al. BMC Nursing (2024) 23:930
[40]. According to a dierent study, intern nursing stu-
dents’ performance on the skills and basic theory of
nursing tests increased, and they performed better on
assessments of the nurse leader’s nursing care, teaching
design, and relationship with the teacher [29]. In addi-
tion, two studies found that patient satisfaction with care
improved after nursing managers applied a contextual
leadership management model [29, 42].
Reporting status of included literature
is review included 13 quasi-experimental and 5 cross-
sectional studies (one mixed study not reviewed for
reporting guidelines). Table3 summarizes adherence to
reporting guidelines, using the TREND (for quasi-experi-
mental studies) and STROBE (for cross-sectional studies)
guidelines. Introduced in 2004, TREND provides check-
lists for quasi-experimental studies [23]. is guideline
emphasizes reporting on theoretical frameworks, inter-
vention and comparison details, study design, and bias-
adjustment methods [46]. STROBE, an international
collaboration, aims to enhance the transparency, accu-
racy, and completeness of cross-sectional studies [24].
ere were signicant gaps in adherence to these two
guidelines in all included studies. Adherence to both
guidelines will be judged using a cut-o value of 50% in
all included studies, regardless of whether they are classi-
ed as experimental or cross-sectional.
TREND for evaluation of quasi-experimental studies
Based on the TREND reporting guidelines, a rela-
tively low percentage of entries reported studies in the
“Method” and “Result” Sect. (39.3% and 75.0%, respec-
tively), shown in Table 3. Methodology included “sam-
ple size” (item 7, 3/13), “assignment method” (item 8,
0/13 − 7/13), and “blinding” (item 9, 0/13). In the results
section, “participant ow” (item 12, 0/13 ~ 9/13), there
were signicant gaps in the specic ratings of partici-
pants. Additionally, “baseline data” (item 14, 0/13 ~ 11/13)
had poor coverage of the baseline and target populations
and was not reported in any of the included articles.
Similarly, the reporting rates for “numbers analyzed”
(item 16, 0/13), “ancillary analyses” (item 18, 0/13), and
“adverse events” (item 19, 0/13) were absent. However,
there were articles that met the criteria for this item,
although the results were not favorable.
STROBE for evaluation of cross-sectional studies
According to the STROBE reporting guidelines, only two
of the ve studies addressed potential sources of “bias”
(item 9, 2/5). One-fth of the studies mentioned “study
size” (item 10, 1/5), “analytical methods considering sam-
pling strategy” (item 12d, 1/5), and “sensitivity analysis”
(item 12e, 1/5). Notably, none of the studies explained
how missing data were handled (item 12c, 0/5). ere
were gaps in the results section, as many cross-sectional
studies had to explicitly report the number of partici-
pants with missing data (item 13b, 1/5). In addition, none
of the included articles used ow charts (item 13c, 0/5)
and reported “funding sources or grants” (item 22, 0/5).
Details are shown in Table3.
Discussion
is scoping review identies how situational leader-
ship theory can be utilized in nursing management with
respect to theory-related tools, application contexts,
roles, and the quality of reporting. e ndings high-
light the impact of situational leadership theory on nurs-
ing management, which theory fully uses the nursing
manager’s leadership skills, including the ability to iden-
tify and eectively utilize the talents of team members.
Situational leadership management is benecial because
of its capacity to optimize leadership eectiveness by
adaptively adjusting leadership behaviors based on the
growth needs of team members and the complexity of
the task [10]. In fact, nursing managers need to exercise
eective leadership, which can guide team members to
enhance organizational cohesion and core competencies
[4]. Consequently, we recommend that situational leader-
ship management be employed to enhance the leadership
of managers and the maturity of nurses, thereby further
improving the quality and eciency of care. However, as
the included articles report, although empirical research
supports the validity of situational leadership theory,
the specic application of practice in the nursing eld
remains inadequate. We found that the SL model and
SLII model were not dened in all included studies, that
there is a dierence between the two theories in distin-
guishing the levels of employees, and that this dierence
aects the application of the theories and the implemen-
tation of the intervention. We suggest that the SL model
or SLII model should be clearly dened in future studies
to avoid conceptual confusion and misapplication.
Regarding leadership assessment tools in the situa-
tional leadership management model, there are some dif-
ferences and limitations between the tools. First of all, in
terms of assessment criteria, the questionnaire developed
by Cardoso [27] used a 6-point Likert scale to assess the
knowledge, skills, and attitudes of nurses, while the other
tools used situational tests to assess leadership styles.
Furthermore, in terms of the content of the assessment,
Hersey and Blanchard’s leadership style assessment tool
and LEAD were used to determine the type of leadership
style, while LBAII and LSSQ were used to examine the
exibility of the leadership style and the eectiveness of
the style; in terms of the study population, only Hersey
and Blanchard’s leadership style assessment tool and
LBAII were used for leaders’ self-evaluation and subordi-
nates’ evaluation of leaders. Although there are multiple
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Wang et al. BMC Nursing (2024) 23:930
TREND Item No Reported STROBE Item No Reported
Title and abstract Title and abstract
Title and abstract 1(a) 7/13, 53.8% Title and abstract 1(a)5/5, 100.0%
1(b) 10/13, 76.9% 1(b)5/5, 100.0%
1(c) 11/13, 84.6% Introduction
Introduction Background/rationale 2 5/5, 100.0%
Background 2(a) 12/13, 92.3% Objectives 3 4/5, 80.0%
2(b) 13/13, 100.0% Methods
Methods Study design 4 4/5, 80.0%
Participants 3(a) 11/13, 84.6% Setting 5 5/5, 100.0%
3(b) 9/13, 69.2% Participants 6 5/5, 100.0%
3(c) 9/13, 69.2% Variables 7 3/5, 60.0%
3(d) 11/13, 84.6% Data sources/ measurement 8 4/5, 80.0%
Interventions 4(a-1) 11/13, 84.6% Bias 9 2/5, 40.0%
4(a-2) 11/13, 84.6% Study size 10 1/5, 20.0%
4(a-3) 2/13, 15.4% Quantitative variables 11 3/5, 60.0%
4(a-4) 9/13, 69.2% Statistical methods 12(a) 4/5, 80.0%
4(a-5) 9/13, 69.2% 12(b) 3/5, 60.0%
4(a-6) 4/13, 30.8% 12(c) 0/5, 0.0%
4(a-7) 9/13, 69.2% 12(d) 1/5, 20.0%
4(a-8) 0/13, 0.0% 12(e) 1/5, 20.0%
Objectives 5 11/13, 84.6% Results
Outcomes 6(a) 8/13, 61.5% Participants 13(a) 3/5, 60.0%
6(b) 4/13, 30.8% 13(b) 1/5, 20.0%
6(c) 7/13, 53.8% 13(c) 0/5, 0.0%
Sample Size 7 3/13, 23.1% Descriptive data 14(a) 3/5, 60.0%
Assignment Method 8(a) 7/13, 53.8% 14(b) 1/5, 20.0%
8(b) 0/13, 0.0% Outcome data 15 3/5, 60.0%
8(c) 0/13, 0.0% Main results 16(a) 3/5, 60.0%
Blinding (masking) 9 0/13, 0.0% 16(b) 2/5, 40.0%
Unit of Analysis 10(a) 6/13, 46.2% 16(c) 0/5, 0.0%
10(b) 0/13, 0.0% Other analyses 17 2/5, 40.0%
Statistical Methods 11(a) 8/13, 61.5% Discussion
11(b) 0/13, 0.0% Key results 18 5/5, 100.0%
11(c) 1/13, 7.7% Limitations 19 3/5, 60.0%
11(d) 8/13, 61.5% Interpretation 20 4/5, 80.0%
Results Generalisability 21 4/5, 80.0%
Participant ow 12(a-1) 6/13, 46.2% Other information
12(a-2) 9/13, 69.2% Funding 22 0/5, 0.0%
12(a-3) 5/13, 38.5%
12(a-4) 1/13, 7.7%
12(a-5) 0/13, 0.0%
12(b) 0/13, 0.0%
Recruitment 13 10/13, 76.9%
Baseline Data 14(a) 11/13, 84.6%
14(b) 3/13, 23.1%
14(c) 0/13, 0.0%
14(d) 1/13, 7.7%
Baseline equivalence 15 0/13, 0.0%
Numbers analyzed 16(a) 0/13, 0.0%
16(b) 0/13, 0.0%
Outcomes and estimation 17(a) 6/13, 46.2%
17(b) 4/13, 30.8%
17(c) 3/13, 23.1%
Table 3 Adherence with TREND and STROBE reporting guidelines
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Wang et al. BMC Nursing (2024) 23:930
well-established situational leadership theory measure-
ment tools, not all studies have validated and reported
the reliability and validity of their research tools. Most of
the studies from China reported on nurse maturity, but
none of them measured nurse maturity using specic
measurement tools [15, 25, 26, 34, 35, 39, 40, 42]. is
would lead to biases in the assessment results, errone-
ous ndings, and insucient credibility of the research
conclusions. erefore, scholars need to strengthen the
reporting of measurement tools in future research on sit-
uational leadership management. In addition, situational
leadership theory may have dierent leadership dynam-
ics in dierent cultural healthcare settings, and scholars
should enhance the development of assessment instru-
ments appropriate for dierent cultural contexts and uti-
lize modern technological tools to support the practice
of situational leadership theory, such as the development
of employee maturity assessment systems and leader-
ship development platforms to improve the accuracy of
the measurement of leadership styles and maturity in this
leadership model [47].
Situational leadership theory is a theoretical per-
spective suitable for studying team functioning in large
inter professional events. In the context of the current
complexity of diseases and the growing health needs of
patients and families, there is a need to provide compre-
hensive medical care based on interdisciplinary teams
and the full integration of various resources [4]. Lead-
ership is contextual and inuenced by situational fac-
tors. It suggests that leaders should adjust the degree to
which they direct or support their subordinates based
on the context [48]. Leaders should adapt their leader-
ship style based on the maturities of their team mem-
bers and respond to situational demands [49]. Situational
leadership requires individuals to be exible, adapt to the
situation, and adopt a leadership style that best suits the
needs of their team members to achieve organizational
goals, motivate employees, and increase productivity
[50]. Leaders can increase employee job satisfaction by
using dierent leadership styles with employees at dier-
ent maturity levels [51]. It is useful for managers to use
situational leadership theory to manage followers. e
right management style will enable employees to build
on their strengths and complement their weaknesses to
improve their work eciency [10]. Nevertheless, while
situational leadership theory emphasizes adjusting lead-
ership styles in response to changes in follower maturity,
there may be a degree of continuity and stability in the
leadership behavior itself. Leaders need to consider this
when adjusting their leadership style and avoid chang-
ing it too frequently, which may aect team stability and
follower trust [51]. ere is also the fact that the imple-
mentation of situational leadership theory relies on the
leader’s judgment of the employee’s maturity and analysis
of the situation. However, these judgments and analyses
may be inuenced by the leader’s subjective factors, lead-
ing to a biased choice of leadership style [28]. erefore,
management should organize leadership theory training
and require leaders to participate actively in the train-
ing. Participation in training develops exibility and
recognition of leaders’ leadership styles [52]. Encour-
aging followers to provide feedback to leaders actively
will encourage leaders to manage the organization with
a more appropriate leadership style, promoting orga-
nizational goals [53]. It is worth noting that the review
identied major shortcomings in the current report-
ing of interventions. Specically, most of the interven-
tion descriptions in the trials are limited in their lack of
detail and transparency regarding allocation settings,
the timing of the intervention, duration, incentives, and
measures taken to reduce potential bias from non-ran-
domization and non-blinding. Moreover, these studies
did not provide recommendations for further developing
their interventions. is lack of transparency and under-
reporting of interventions may be barriers to developing
standardized intervention programs [54, 55]. We suggest
that future research needs to further improve the report-
ing of intervention protocols and develop standardized
intervention protocols. is will support of the applica-
tion of situational leadership theory in care management
and increase the replicability and quality of research in
this area.
TREND Item No Reported STROBE Item No Reported
Ancillary analyses 18 0/13, 0.0%
Adverse events 19 0/13, 0.0%
Discussion
Interpretation 20(a) 6/13, 46.2%
20(b) 12/13, 92.3%
20(c) 5/13, 38.5%
20(d) 10/13, 76.9%
Generalizability 21 7/13, 53.8%
Overall Evidence 22 13/13, 100.0%
Detaile d items are referenced in Ap pendix S3
Table 3 (continued)
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Wang et al. BMC Nursing (2024) 23:930
Five of the nineteen articles included in this review
used observational studies. After a one-by-one check,
none of the articles fully met the STROBE review crite-
ria, and a notable deciency was noted in the methodol-
ogy. e remaining 13 articles used a non-randomized
controlled trial approach, and none of the study designs
fully followed the TREND guidelines. ese 13 non-
randomized controlled trials have deciencies in the
completeness of reporting of methods and results. e
TREND reporting guidelines were developed to improve
the transparency and accuracy of reporting behavioral
and public health evaluations of non-randomized designs
[56]. e frequent use of STROBE for reporting obser-
vational studies also aims for the same purpose [57]. e
early emergence of this type of research and discussion
on applying situational leadership theory in nursing man-
agement resulted in a low level of transparency and accu-
racy in the literature in this area.
Situational leadership theory was used in observational
studies to assess the leadership of nurse managers. e
results of the STROBE statement show that these obser-
vational studies have shown a lack of reporting of rigor-
ous study design and funding, with the least reported
part of the study design section being the reporting of the
study sample size. is means that the representation of
these sample sizes to the population was called into ques-
tion, which could lead to measurement errors in these
studies. Consequently, the ndings of these observational
studies should be referred with caution [27]. At the same
time, situational leadership theory explores the relation-
ship between nurse managers’ leadership and the judg-
ments of nurses’ maturity and the match between them.
Several quasi-experimental studies have indicated its use-
fulness in nursing leadership contexts. However, accord-
ing to a TREND assessment, these studies were found to
have poor reporting of study methodology and results.
e lack of methodological reporting will similarly aect
other scholars’ diculties to refer to such literature to
apply situational leadership to nursing management. Fur-
thermore, it is noteworthy that less than half of the stud-
ies reported on the validity of the tools, which puts the
reliability of the ndings in doubt. In conclusion, the lack
of transparency in reporting has resulted in the absence
of a referenceable, standardized intervention program
and situational leadership theory intervention process in
nursing management. Future research may benet from
using STROBE and TREND as a guiding tool to conduct
research related to applying situational leadership theory
in nursing management. is may increase the transpar-
ency and quality of research in this area.
Limitations
We acknowledge that this review may be subject to cer-
tain limitations. Most of the studies included in this
review were conducted in Asian countries, which may
limit the application of the ndings in other regions,
especially in Western healthcare settings. Addition-
ally, we excluded literature in languages other than Chi-
nese and English, meaning relevant studies from other
regions may not have been included, potentially leading
to incomplete global coverage. Several of the included
studies were reported with less transparency and did not
report validated assessment instruments, which limits
the information available in this review. is also high-
lights the need for future research to increase the trans-
parency of relevant research reports and to develop and
validate relevant measurement tools.
Conclusion
Nurse leadership is essential in the current healthcare
environment, and it is key to facilitating nurse pro-
fessional development and achieving organizational
objectives. Situational leadership theory promotes the
development of nurse leadership and maturity by iden-
tifying and matching nursing managers’ leadership styles
and nurses’ maturity to promote improved organizational
outcomes. is review provides a comprehensive over-
view of how situational leadership theory can be used
in nursing management, outlining measurement tools,
research designs, intervention methods and indicators,
and reporting gaps. e extant literature emphasizes the
role of situational leadership theory in nursing manage-
ment. However, some of the applied tools need to be
validated, model types and concepts need to be further
dened, and the articles report poor transparency, which
reduces the credibility of the research and hinders fur-
ther improvement of the applied methodology. ere-
fore, in future research, further development of research
tools, standardizing application protocols, and adherence
of reporting guidelines are strongly recommended.
Abbreviations
D Development
LBAII Leadership behaviour analysis II scale
LEAD Leadership eectiveness and adaptability description
LSAT Leadership style assessment tool
LSSQ Leadership style self-questionnaire
R Readiness
S Leadership style
STROBE Strengthening the reporting of observational studies in
epidemiology
TREND Transparent reporting of evaluations of quasi-experimental studies
Supplementary Information
The online version contains supplementary material available at h t t p s : / / d o i . o r
g / 1 0 . 1 1 8 6 / s 1 2 9 1 2 - 0 2 4 - 0 2 5 8 2 - 9 .
Supplementary Material 1
Supplementary Material 2
Supplementary Material 3
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Wang et al. BMC Nursing (2024) 23:930
Acknowledgements
Not applicable.
Author contributions
X, W; M, L; YC, L; ZY, P; BW, L; QQ, L and ST, L were involved in the
conceptualization, methodology, validation, and manuscript draft preparation.
ZY, P and BW, L were involved in the literature selection and search strategy.
X, W and ST, L were involved in data synthesis and analysis. M, L and X, W
performed critical revisions for important intellectual content. All authors were
involved in the conduct of the study, and all approved the nal version of the
manuscript.
Funding
This research received no specic grant from any funding agency in the
public.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Ethics approval and consent to participate
The study is a scoping review of published material; therefore, ethics approval
was not required.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Received: 10 September 2024 / Accepted: 6 December 2024
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