Illuminating the inner leadership journey by engaging intention and mindfulness as guided by caring theory

What Native Americans want nurses to know: Attitudes and behaviors desired in client/nurse relationships

OBJECTIVE

This study examined Native American perceptions of attitudes and behaviors desired in their client/nurse relationships for the purpose of informing cultural-competency education and practice.

DESIGN

A descriptive-qualitative methodology was used and face-to-face interviews were conducted.

SAMPLE

A targeted sampling approach was applied; the sample included Native Americans employed at a western reservation casino.

ANALYTIC STRATEGY

Thematic analysis involved constant-comparison through the examination of similarities and differences, and relationships between concepts.

RESULTS

Theme I, Native American Experiences with Nurses and Theme II, Native American Experiences with Other Native Americans. Subthemes offer participant perspectives of the dynamics within their client/nurse interactions. Participants offer advice to both nurses and other Native Americans that promotes mutual understanding and respect.

CONCLUSIONS

Becoming a culturally competent nurse is a complex developmental journey. Four implications are offered. First, nurses can feel confident doing what they do best; valued nurse attributes and behaviors are being taught and practiced that are foundational for cultural competence. Second, within the context of a population-health focus, consider individual preferences and beliefs. Third, empower Native American self-advocacy. Lastly, disrupt racism at the relationship level by seeking cultural humility and practicing critical self-reflection and dialogue.

Intentionality in reducing health disparities: Caring as connection

OBJECTIVE

Inadequate health care quality may contribute to Native American health disparities through racial/ethnic discrimination by health care professionals. Nursing approaches to relationships and caring offer a means to understand health disparities through an unconventional lens. The study objective was to examine health disparities within the context of patient/nurse relationships.

DESIGN

A descriptive-qualitative method guided data collection and analysis. Eleven nurses who serve Native Americans were interviewed. They described attitudes, meaningful relationships, and nurse leadership.

RESULTS

Nurses discussed their perceptions of and experiences with Native American patients. Four themes emerged: shared patient/nurse values, patient-centered care, external forces, and stereotype-driven care.

CONCLUSIONS

Are we ready for the challenge to advocate for, build, and sustain organizational structures that support caring relationships? Implications for public health nursing include being intentional about recognizing implicit biases and ethnocentrism; examining nurses' complicit roles in perpetuating racism; and developing mechanisms to collectively advocate for improved Native American health.

The mindful nurse leader: Improving processes and outcomes; restoring joy to nursing

In this first installment of a three-part series on mindfulness, we describe a dynamic project aimed at elevating the importance of mindfulness, compassion, and presence as key competencies for professional nurses across the career span in all healthcare settings.

Voiced inner dialogue as relational reflection-on-action: The case of middle managers in health care

We look to the experiences of middle managers in a health-care setting to empirically develop and explore the concept of voiced inner dialogue. Voiced inner dialogue is conceptualised as a form of reflection-on-action whereby fragments of narrative self-reflection reveal an organisation’s unspoken backdrop conversation or interpersonal mush. The normalised intensity that characterises many health-care settings, an artefact of increased governmentality and responsibilisation, leaves middle managers experiencing increased work and personal pressures. The interpersonal mush in this context is centred upon individuals’ felt disconnect between espoused and enacted organisational values. Voiced inner dialogue was triggered in dialogic conversation with the researchers, a type of participant-focused reflexivity. From our qualitative analysis, we present three themes to illuminate how organisational context can inform the creation and maintenance of interpersonal mush, impeding managers’ reflection. Voiced inner dialogue offers an opportunity for managers stuck in the silence of interpersonal mush to engage in reflection-on-action. We conclude with the implications for reflection, reflexivity and management learning.

Building personal and professional resources of resilience and agility in the healthcare workplace

This article describes the rationale, implementation and results of a pilot study evaluating the personal and organizational impact of an educational intervention on the stress of health team members. The compelling imperative for the project was to find a positive and effective way to address the documented stress levels of healthcare workers. Pilot study of oncology staff (n=29) and healthcare leaders (n=15) exploring the impact of a positive coping approach on Personal and Organizational Quality Assessment-Revised (POQA-R) scores at baseline and 7 months using paired t-tests. Personal and organizational indicators of stress decreased in the expected directions in both groups over the time intervals. The majority of POQA-R categories were statistically significantly improved in the oncology staff, and many of the categories were statistically significantly improved in the leadership group. The findings from this project demonstrate that stress and its symptoms are problematic issues for hospital and ambulatory clinic staff as evidenced by baseline measures of distress. Further, a workplace intervention was feasible and effective in promoting positive strategies for coping and enhancing well-being, personally and organizationally.

Fostering the coexistence of caring philosophy and economics in today's health care system

For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.

Occupational Health Nursing Practice through the Human Caring Lens

Many health care and academic centers have adopted Watson's Theory of Human Caring as their guiding principle; the theory is also used in other disciplines, such as library science. Human caring theory offers occupational health nurses a structure that not only defines a focus for practice, but also provides a basis for moral and philosophical practice analyses. In particular, nurses may find this theory useful in confirming the definition of “caring” and reconsidering what nursing is all about. More importantly, consideration and application of this theory may lead to research on its applicability to the field of occupational health nursing. This article presents the science and philosophy of human caring, specifically Watson's Theory of Human Caring. Two case studies are presented that demonstrate how the theory could be used to evaluate occupational health nursing practice. To demonstrate its possible relevance as an occupational health nursing framework, an analysis of and comparison to existing occupational health nursing guidelines are detailed and discussed.

Occupational health nursing practice through the Human Caring lens

Many health care and academic centers have adopted Watson's Theory of Human Caring as their guiding principle; the theory is also used in other disciplines, such as library science. Human caring theory offers occupational health nurses as structure that not only defines a focus for practice, but also provides a basis for moral and philosophical practice analyses. In particular, nurses may find this theory useful in confirming the definition of "caring" and reconsidering what nursing is all about. More importantly, consideration and application of this theory may lead to research on its applicability to the field of occupational health nursing. This article presents the science and philosophy of human caring, specifically Watson's Theory of Human Caring. Two case studies are presented that demonstrate how the theory could be used to evaluate occupational health nursing practice. To demonstrate its possible relevance as an occupational health nursing framework, an analysis of and comparison to existing occupational health nursing guidelines are detailed and discussed.

Evidence and leadership

The call for evidence has swept the healthcare landscape in medicine and nursing and more recently in nursing management. Nurse managers and administrators have been identified as important to support research use and evidence-based practice. The primary focus of this article is (1) to describe the concept of evidence, (2) to challenge the wisdom of basing the practice of leadership on a narrow (reductionistic) understanding of the concept of evidence, and (3) to argue for a rethinking on what should count as evidence in nursing administration. Semantic analysis and examination of dictionaries reveal that evidence as a concept has both an internal and an external dimension. To understand the concept of evidence in a profound sense as well as its significance for leadership this article describes 3 different meanings of the concept: ontological, contextual, and King's evidence.

Learning With Leaders

This column focuses on ideas concerning leaders and leadership. The author proposes that leadership is about showing up and participating with others in doing something. “Mandela: His 8 Lessons of Leadership” by Richard Stengel is explored in light of selected philosophical writings, literature on nursing leadership, and nurse theorist Rosemarie Rizzo Parse's humanbecoming leading-following model. Teaching-learning questions are then posed to stimulate further reflection on the lessons of leadership.