Public, private, non-profit and for-profit nursing education enterprises in the U.S. are competing with one another in a newly complex and volatile educational landscape, placing academic leaders into situations fraught with moral, ethical and legal compromise with few precedents for guidance. This case study provides a richly contextualized narrative exploration of ethical and legal challenges to one leader’s moral courage, a fictionalized exploration drawn from multiple sources over time, to form a composite that is nonetheless firmly rooted in the (...) complexity and competitiveness characteristic of nursing education today. Our purpose is three-fold: 1) to direct the reader to moral and ethical questions that require thoughtful discourse and analysis among current and future academic nursing leaders; 2) to raise the issue of the need for regulations and oversight that reflect the changing realities of today’s increasingly complex and competitive educational arena; and 3) to encourage nursing education leaders to share additional cases that resonate for them, and in so doing, to expand the wellspring of ideas from which we can all draw in becoming more effective and morally courageous leaders. (shrink)

Some nurses are responding rebelliously to the changing healthcare landscape by challenging the status quo and deviating from suboptimal practices, professional norms, and organizational rules. While some view rebel nurse leadership as challenging traditional structures to improve patient care, others see it as disruptive and harmful. These diverging opinions create dilemmas for nurses and nurse managers in daily practice. To understand the context, dilemmas, and interactions in rebel nurse leadership, we conducted a multiple case study in two Dutch (...) hospitals. We delved into the mundane practices to expand the concept of leadership‐as‐practice. By shadowing rebel nurse practices, we identified three typical leadership practices which present the most common “lived” experiences and dilemmas of nurses and nurse managers. Overall, we noticed that deviating acts were more often quick fixes rather than sustainable changes. Our research points to what is needed to change the status quo in a sustainable manner. To change unworkable practices, nurses need to share their experienced dilemmas with their managers. In addition, nurse managers must build relationships with other nurses, value different perspectives, and support experimenting to promote collective learning. (shrink)

Background: In accordance with ethical guidelines for nurses, leaders for nurse services in general are responsible for facilitating professional development and ethical reflection and to use ethical guidelines as a management tool. Research describes a gap between employees’ and nurse leaders’ perceptions of priorities. Objective: The purpose of this article is to gain deeper insight into how nurses as leaders in somatic hospitals describe ethical challenges. Design and method: We conducted individual, quality interview with 10 nurse leaders, nine females and (...) one male nurse aged 34–64 years. We used a hermeneutical approach to analyse the data. Ethical considerations: The participants received oral and written information about the study. Participation in the study was voluntary, and the participants were given the opportunity to withdraw. All of them gave written consent. The Norwegian Centre for Research Data approved the research project. In addition, the head of the hospitals gave permission to conduct our study. Findings: Four main areas were identified: deficient ethical language, conflicting demands on nurse leaders regarding staff management, concerns regarding young nurses’ ethical consciousness and restricting factors on the creation of a climate of ethics. The nurse leaders experienced considerable pressure. An unexpected finding was the lack of – and even disregard for – an ethical language. Discussion and conclusion: It is crucial to recognise ethics in all types of nursing approaches and to make it explicit. Ethical language must be implemented in nursing education. It must be recognised and used in clinical practice. Recommendations: We recommend further research be conducted into how nurses understand the concept of ethics and how to incorporate ethical principles into clinical nursing and nurse leadership. (shrink)

Most nurse leadership studies have concentrated on a classical, heroic, and hierarchical view of leadership. However, critical leadership studies have argued the need for more insight into leadership in daily nursing practices. Nurses must align their professional standards and opinions on quality of care with those of other professionals, management, and patients. They want to achieve better outcomes for their patients but also feel disciplined and controlled. To deal with this, nurses challenge the status quo (...) by showing rebel nurse leadership. In this paper, we describe 47 nurses’ experiences with rebel nurse leadership from a leadership‐as‐practice perspective. In eight focus groups, nurses from two hospitals and one long‐term care organization shared their experiences of rebel nurse leadership practices. They illustrated the differences between “bad” and “good” rebels. Knowledge, work experience, and patient‐driven motivation were considered necessary for “good” rebel leadership. The participants also explained that continuous social influencing is important while exploring and challenging the boundaries set by colleagues and management. Credibility, trust, autonomy, freedom, and preserving relationships determined whether rebel nurses acted visibly or invisibly. Ultimately, this study refines the concept of rebel nurse leadership, gives a better understanding of how this occurs in nursing practice, and give insights into the challenges faced when studying nursing leadership practices. (shrink)

Mentoring relationships occur across a range of nursing contexts and are shown to have multiple, favourable personal and professional outcomes. Specifically, mentoring has been associated with the development of nurse leaders. This study describes features that are integral to initiating mentoring relationships that focus on nursing leader development. These significant features are addressed in relation to the nursing literature. Thirteen nurse leaders from eastern states of Australia were interviewed during 2005 and 2006 about their understanding and experiences (...) of mentoring for leadership. Their narratives were analysed using a hermeneutic phenomenological methodology. Mentoring relationships for nurse leadership were revealed as developing from esteemed connections between two people. Mentors were shown to unconditionally champion their mentee’s careers, and mentees were shown to possess a leadership vision for nursing. The findings of this study have implications for establishing mentoring relationships for nurse leader development. Consideration should be given to the specific focus and context of these relationships to ensure that the full potential of the mentoring process is realised. It is also important to better understand the key aspects that contribute to the phases of mentoring relationships for nurse leader development because they are shown to influence the dynamic and function of these relationships over time. (shrink)

Nurse clinician‐scientists are increasingly expected to show leadership aimed at transforming healthcare. However, research on nurse clinician‐scientists' leadership (integrating researcher and practitioner roles) is scarce and hardly embedded in sociohistorical contexts. This study introduces leadership moments, that is, concrete events in practices that are perceived as acts of empowerment, in order to understand leadership in the daily work of newly appointed nurse clinician‐scientists. Following the learning history method we gathered data using multiple (qualitative) methods to get (...) close to their daily practices. A document analysis provided us with insight into the history of nursing science to illustrate how leadership moments in the everyday work of nurse clinician‐scientists in the “here and now” can be related to the particular histories from which they emerged. A qualitative analysis led to three acts of empowerment: (1) becoming visible, (2) building networks, and (3) getting wired in. These acts are illustrated with three series of events in which nurse clinician‐scientists' leadership becomes visible. This study contributes to a more socially embedded understanding of nursing leadership, enables us to get a grip on crucial leadership moments, and provides academic and practical starting points for strengthening nurse clinician‐scientists' leadership practices. Transformations in healthcare call for transformed notions of leadership. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. (...) We learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Background:Attention to ethical leadership in nursing has diminished over the past several decades.Objectives:The aim of our study was to investigate how frontline nurses and formal nurse leaders envision ethical nursing leadership.Research design:Meta-ethnography was used to guide our analysis and synthesis of four studies that explored the notion of ethical nursing leadership.Participants and research context:These four original studies were conducted from 1999-2008 in Canada with 601 participants.Ethical considerations:Ethical approval from the original studies covered future analysis.Findings:Using (...) the analytic strategy of lines-of-argument, we found that 1) ethical nursing leadership must be responsive to practitioners and to the contextual system in which they and formal nurse leaders work, and 2) ethical nursing leadership requires receiving and providing support to increase the capacity to practice and discuss ethics in the day-to-day.Discussion and conclusion:Formal nurse leaders play a critical, yet often neglected role, in providing ethical leadership and supporting ethical nursing practice at the point of patient care. (shrink)

Ethical theories -- Healthcare ethics -- Modern healthcare ethics : landmark events that shaped hospital ethics protocols -- A nurse-led ethics committee -- Common ethical challenges -- Ethics case studies.

Background: Leadership style adopted by nursing managers is a key element in progress and development of nursing and quality of healthcare services received by the patients. In this regard, the role of ethical leadership is of utmost importance. Objectives: The objective of the study was to elaborate on the ethical leadership and its role in professional progress and growth of nurses in the light of work condition in health providing institutes. Methods: The study was carried (...) out as a qualitative study following conventional content analysis method. In total, 14 nursing faculty members and nursing managers at different levels were selected through purposive sampling method. Semi-structured interviews were used for data gathering. The data were analyzed using latent content analysis and constant comparison analysis. Ethical considerations: This study was conducted in accordance with ethical issues in research with human participants and national rules and regulations related to informed consent and confidentiality. The study was approved by the Committee of Ethics in Research at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, under the code: sbmu.rec.1393.695 on 15 February 2015. Findings: Five subcategories were obtained based on the analysis, which constituted two main categories including “all-inclusive satisfaction” and “productivity.” Nursing leaders highlighted the point that their ethical behavior creates “inner satisfaction of the leader,” “employees’ job satisfaction,” and “patients’ satisfaction.” Improvement of productivity was another outcome of ethical behavior of the leaders. This kind of behavior resulted in “providing better services” and “inspiring ethical behavior in the employees.” It has great influence on progress and growth of the nursing profession. Conclusion: By creating an ethical climate, ethical leadership leads to positive and effective outcomes—for the patients as well as for the nurses and the leaders—and professional progress and development of the nursing profession. Therefore, an ethical work environment that supports nurses’ progress and development can be developed by paying more attention to moralities in recruitment, teaching ethical values to the leaders, and using a systematic and objective approach to assess morality in the environment. (shrink)

Background Care is the basis of the nursing profession and nurse’s caring behavior is one of the important factors in patient satisfaction. On the other hand, psychological empowerment can improve the provision of care services, and leaders have a significant impact on the behavior of followers. This study determined the correlation between ethical leadership, psychological empowerment, and caring behavior from nurses’ perspective. Methods This cross-sectional descriptive study was conducted in 2019. A total of 200 nurses were selected by (...) stratified random sampling. Data were collected with ethical leadership, caring behavior and psychological empowerment questionnaires and analyzed with descriptive statistics and inferential statistics using SPSS20. Results The findings showed a significant correlation between ethical leadership, psychological empowerment and caring behavior of nurses. Also, there was a significant correlation between psychological empowerment and nurses’ caring behavior. The regression analysis showed that ethical leadership and psychological empowerment are a predictor of caring behavior of nurses. Conclusion Applying an ethical leadership style by nursing managers can lead to nurses’ improved psychological empowerment and caring behaviors and ultimately, patient care quality. Thus, considering guidelines at the team and organizational levels and programs such as providing workshops and periodic counseling to cultivate ethical nurse leadership can lead to better caring behavior. (shrink)

Background: Nurses’ service behaviors have critical implications for hospitals. However, few studies had adequate ethical considerations of service behaviors and accounted for how organizational or individual antecedents can induce nurses to engage in service behaviors. In addition, they mainly focused on the one side of role-prescribed or extra-role service behavior. Objective: This study aims to explore the chained mediation effect of ethical climate and moral sensitivity on the relationship between organizational ethical leadership and nurses’ service behaviors and to examine (...) the relationship, from a comparative view, of the role-prescribed service behavior and extra-role service behavior. Methods: In all, 476 nurses from three tertiary hospitals were investigated with the Ethical Leadership Scale, Ethical Climate Scale, Moral Sensitivity Questionnaire and Service Behavior Questionnaire. Structural equation modeling was adopted to analyze the data. SPSS and Mplus statistical software was used in the data analysis. Ethical considerations: Approval was obtained from the Ethics Committee at School of Nursing, Hebei Medical University. Data privacy and confidentiality were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Results: The effects of ethical leadership on nurses’ service behaviors are mediated by two variables in turn: ethical climate and nurses’ moral sensitivity. Ethical climate and moral sensitivity partially mediated the relationship between ethical leadership and nurses’ role-prescribed service behavior and fully mediated the relationship between ethical leadership and nurses’ extra-role service behavior. Conclusion: Organizational ethical leadership positively affected ethical climate, which positively affected nurses’ moral sensitivity and affected both their role-prescribed service behavior and extra-role service behavior. (shrink)

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent‐based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. (...) The purpose of this paper is to describe the work conducted in preparation for the development of an agent‐based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation. (shrink)

Background: Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care. Aim: This study aims to determine the missed nursing care and its relationship with perceived ethical leadership. Research design: A cross-sectional study. Participants and research context: The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data (...) were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale. Ethical considerations: The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants’ written and verbal consents were obtained. Findings: The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care, and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care. Discussion: Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce. Conclusion: The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context. (shrink)

Background Ethical nurse leaders play a pivotal role in helping their nurse employees deliver high-quality healthcare services. However, we still lack a comprehensive understanding of the mediating and moderating mechanisms by which ethical leadership improves job performance. Purpose This study aims to investigate: (1) whether ethical leadership would enhance nurses’ job performance; (2) whether learning goal orientation acts as a mediator; and (3) whether co-worker support operates as a moderator. Participants and research context We collected two-wave data from (...) 218 nurses working in hospitals located in Jiangsu, China. Research design A time-lagged study based on an online survey design was utilized for data collection between September 2022 and January 2023. PROCESS Model 5 was employed to test the research hypotheses. Ethical considerations We obtained ethics approval from the University Ethics Committee. The nursing participants were assured that their survey responses were completely anonymous. Results and discussion Ethical leadership is not significantly correlated with job performance. However, ethical leadership has an indirect impact on nurses’ job performance through the mediator (learning goal orientation). Moreover, co-worker support moderates the relationship between ethical leadership and job performance. Conclusion The conceptual model provides us with a fine-grained understanding of the relationship between ethical leadership and nurses’ job performance. We highlight the mediating role of learning goal orientation and the moderating role of co-worker support. We suggest that healthcare organizations should devote more efforts to promoting ethical leadership, co-worker support, and learning goal orientation. (shrink)

Although ethical leadership by formal nurse leaders is critical to enhancing ethical health-care practice, research has shown that many nurses feel unsupported by their leaders. In this article, we consider the limited attention directed toward ethical leadership of formal nurse leaders and how our own research on ethical nurse leadership compares to other research in this field. In searching Nursing Ethics since its inception 20 years ago, we found only a dozen articles that directly addressed this (...) topic. We then reviewed nurses’ professional codes of ethics in Canada and found significant retractions of ethical guidelines for formal nurse leaders’ ethical responsibilities over the past decade. We began to seek explanations of why this is so and offer some recommendations for the study and enhancement of ethics for formal nurse leadership. (shrink)

Evidence points to nurses as possessing particular skills which are important for public health leadership; in particular, investigators have found that a nurse public health director is strongly associated with positive health department performance. To better understand this association and to guide the effective deployment of nurse leaders, researchers sought to explore the specific leadership strategies used by nurse public health directors, using a critical thematic analysis approach to examine these leadership strategies in the context of certain (...) ideologies, power differentials, and social hierarchies. Data were collected via semistructured interviews conducted from July to September 2020 with 13 nurse public health directors from across the United States. Major themes illustrate a distinct picture of the nursing approach to public health leadership: (a) approaching their work with an other-focused lens, (b) applying theoretical knowledge, (c) navigating the political side of their role, and (d) leveraging their nursing identity. Findings articulate the nurse public health director's distinctive combination of skills which reflect the interprofessional nature of public health nursing practice. Such skills demonstrate a specialized approach that may set nurse leaders apart from other types of leaders in carrying out significant public health work. (shrink)

BackgroundNurses working in the intensive care unit clung tenaciously to their job during the COVID-19 pandemic in spite of enduring stressed psychological and physical effects as a result of providing nursing care for the infected patients, which indicates that they possessed a high degree of professionalism and career calling. The aim of this study was to explain the associations between resilience, thriving at work, and ethical leadership influencing the calling of ICU nurses.MethodsFrom December 2020 to January 2021 during (...) the COVID-19 pandemic, a cross-sectional survey of 15 provinces in China was conducted using an online questionnaire. A total of 340 ICU nurses completed sufficient responses to be used in the study. Sociodemographic factors, job demographic factors, resilience, calling, thriving at work, and ethical leadership were assessed using the questionnaire. General linear modeling, hierarchical linear regression analysis, and generalized additive model were performed to examine all the considered research hypotheses.ResultsResilience was positively and significantly associated with calling. Moreover, thriving at work partially mediated the relationship between resilience and calling. The indirect effect of resilience on calling was 0.204, and the direct effect of resilience on calling through thriving at work was 0.215. The total effect of resilience on calling was 0.419. In addition, ethical leadership played a moderating role in the relationship between resilience and calling.ConclusionGreater resilience can positively predict increased calling among Chinese ICU nurses during the COVID-19 pandemic. Moreover, thriving at work is a mechanism that partly transmits the positive effects of resilience on calling. Overall, nurses possessing greater resilience tend to maintain thriving at work in the face of such adversity, further resulting in subsequently increased calling. Besides, findings suggest that there is stronger influence of resilience on calling among nurses working in an organization managed by an ethical leader. The current findings may offer two insights for nursing practitioners and policymakers in the postpandemic world. First, resilience training and intervention are necessary to foster nurses' sense of thriving at work in the nursing industry, further promoting career calling. Second, better training and effort on the development of ethical leadership for leaders in nursing practice are essential to encourage followers to engage in social learning of ethical behaviors and abiding by normatively appropriate conduct, further enacting prosocial values and expressing moral emotions. (shrink)

Background The case of Margaret Haywood, the ‘undercover nurse’, is a significant one for the UK's National Health Service (NHS). She investigated complaints made about the Royal Sussex County Hospital and covertly filmed inpatients experiencing care detrimental to their health. The material was subsequently broadcast on the BBC's Panorama programme. It caused a scandal and brought about changes at the hospital, as well a demand for greater clinical leadership. Margaret Haywood was, however, struck off the nursing register for (...) breaching confidentiality and because of the methods she used to blow the whistle. Methods The authors apply the ethical lenses of purpose, principle, people and power to explore this case. Results This is a morally ambiguous situation in which both the protagonist and the organisation compromised their core values. The undercover nurse used individuals as a means to a ‘higher’ end, and the Brighton and Sussex University Hospitals NHS Trust are seen to have deviated from the ethical to the business map, in a contradiction of what the health service represents. Conclusions These deficits can be repaired by reinforcement of the ethics of duty and ideals on a practical level and the involvement of clinicians to lead at a management level, to act as a moral compass. (shrink)

This pilot study explores four nursing leaders' experiences with the ethical dimensions of leadership in education. Gathering and interpreting such data of experience fosters greater understanding of the nature of moral leadership as it is lived in nursing education. A phenomenological approach was used to collect and analyze the data. The results revealed four major themes: integrity, justice, wrestling with decisions in the light of consequences, and the power of information. These themes clarify the values that (...) direct these leaders' actions as they mediate community needs common to educational and health care institutions. (shrink)

Background:Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers’ ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care.Objective:The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care.Design and participants:Qualitative individual interviews were performed with (...) 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data.Ethical considerations:The Norwegian Centre for Research Data granted permission for this study.Findings:The analysis resulted in seven subcategories that were grouped into three main categories: managers’ perception of the importance of the role, managers’ experiences of exercising the role and managers’ opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees.Discussion:The leaders tended to perceive ethics as a ‘personal matter’ and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals’ vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care.Conclusions:Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs’ ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means. (shrink)

This chapter contains sections titled: Introduction Tracing a History of Nursing Ethics The Sociopolitical Context of Nursing and Nursing Ethics The Renewal of Ethics in Nursing: The Insufficiency of Bioethics Desired Futures Nursing Leadership in Practice and Policy through Attention Ethics Summary References.

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and (...) APA PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data were collected through in‐depth interviews with (...) nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational ‘rule‐centred’ culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child‐centred approach. (shrink)

Forms of collective leadership, such as Distributed Leadership, have become increasingly important. The need for measurement of the variables involved in the delegation processes, represents a new challenge for organizations that want to ensure high-level working. The present research aimed to validate the Italian version of the Distributed Leadership Agency (DLA) and verify its applicability in different contexts. The study involved all the employees of an Italian public Hospital, which were selected to complete a survey on organizational (...) perceptions. The sample comprised 704 employees (doctors, nurses, clerks, staff workers, healthcare assistants, consultants, management). Multiple Confirmatory Factor Analyses (Maximum Likelihood) have been computed to explore the factorial structure of the DLA, along with associations with other work outcomes. Results clarified that the Italian DLA respects the tri-factorial structure of the construct, suggested by Yukl (2002), with good fit indexes and reliability; moreover, in line with the literature, DLA was strongly related to satisfaction, commitment, and trust. Results contribute to underline the robustness of the construct of distributed leadership agency in different cultural sectors, and provide a useful tool to be adopted in the Italian context. (shrink)

Now in its sixth edition, this highly popular text covers the range of ethical issues affecting nurses and other healthcare professionals. Authors Simon Robinson and Owen Doody take a holistic and practical approach, focused in the dialogue of ethical decision making and how this connects professional, leadership and governance ethics in the modern healthcare environment. This focuses on the responsibility of professionals and leaders, and the importance of shared responsibility in the practice of healthcare. With a foreword by the (...) eminent medical ethicist Alastair Campbell, the revised edition includes contemporary topics, such as the duty of candour, recent cases, such as the Mid Staffs scandal, and ethical perspectives on vulnerable groups, such as; persons with intellectual/learning disability, dementia and those with an enduring mental illness. It builds on professional identity and personal development as part of ongoing learning, individual and organizational, and provides interactive ways that helps the reader to develop reflective ethical practice. This text aims to enable ethical engagement with the ever changing healthcare environment, and is a must-have for anyone serious about ethics in healthcare. Holistic and practice relevant approach New perspectives on vulnerable groups, such as persons with intellectual/learning disability, dementia and those with an enduring mental illness Descriptive as well as normative ethical theory Promoting dialogue and engagement with practice, practitioners, patients and families Development of professional ethical skills Connecting professional ethics to leadership, governance and social ethics Highly accessible format Case studies/Scenarios presented within chapters and pause for thought exercises to promote dialogue and engagement? Suitable for pre/post registration nurses, students, health care professionals. (shrink)

MIRÓ M, GASTALDO D, NELSON S and GALLEGO G. Nursing Inquiry 2012; 19: 270–280 Spanish nursing under Franco: reinvention, modernization and repression (1956–1976)This article examines Spanish nursing during a critical 20‐year period (1956–76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state‐run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional (...) denomination of ATS–Ayudante Técnico Sanitario (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women’s Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid‐twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first‐year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender‐related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women’s branch of the ruling Falangist Party in mid‐twentieth century Spain. (shrink)

Background: The 21-item Nurses’ Moral Courage Scale was developed and validated in 2018 in Finland with the purpose of measuring moral courage among nurses. Objectives: The objective of this study was to make a Dutch translation of the Nurses’ Moral Courage Scale to describe the level of nurses’ self-assessed moral courage and associated socio-demographic factors in Flanders, Belgium. Research design: A forward–backward translation method was applied to translate the English Nurses’ Moral Courage Scale to Dutch, and a pilot study was (...) conducted to improve readability and understandability. A non-experimental, descriptive cross-sectional exploratory design was used to conduct a survey. Descriptive analysis was used. Participants: The data were collected from a convenience sample of 559 nurses from two hospitals in Flanders. Ethical considerations: Ethical approval was obtained from the university ethics committee, permission to conduct the study was obtained from the participating hospitals. Participants received a guide letter and gave their informed consent. Findings: The readability and understandability of the Dutch Nurses’ Moral Courage Scale were positively evaluated, and the scale revealed a good level of internal consistency for the total scale and all subscales. Nurses’ mean score of the 21-item Nurses’ Moral Courage Scale was 3.77. The total Nurses’ Moral Courage Scale score was associated with age, experience, professional function, level of education and personal interest. Discussion and Conclusion: The Nurses’ Moral Courage Scale was successfully translated to Dutch. The Flemish nurses perceived themselves as morally courageous, especially when they were in a direct interpersonal relationship with their patients. Acting courageously in ethical dilemmas that involved other actors or organizations appeared to be more challenging. The results strongly suggest the important role of education and ethical leadership in developing and supporting this essential virtue in nursing practice. (shrink)

Reflections on incivility and why civility matters -- The costs and consequences of incivility : rationale for change -- The inextricable link between stress and incivility -- The "dance of incivility and civility" in nursing education -- Raising awareness, naming the problem, and creating a vision for civility -- Principled leadership and the power of positive role-modeling and mentoring -- Pathway for fostering organizational civility : institutionalizing change -- Fostering effective and meaningful communication -- The first day of (...) class : co-creating a positive learning environment -- Scholarly teaching, engaged learning, and finding our joy -- The healing power of stress management and self-care -- Seeking and keeping civility in nursing education. (shrink)

The nursing metaparadigm, as described by Fawcett in 1984, includes human, health, nursing, and the environment, all of which support theory development by giving direction to our focus as a scientific body. Nursing scientists make their mark in biotechnological applications, mobile health, informatics, and human factors research. We give voice to the patient through design feedback and incorporating technological advancements in our evolving nursing knowledge; however, we have not formally acknowledged technology in our metaparadigm. To continue (...) patient‐centered care in this age where machines are enmeshed in daily human life, we propose technology must be a domain of the metaparadigm to continue advancing nursing science and knowledge. In this paper, we propose a separate domain of technology within the metaparadigm to challenge nurses to consider approaches within their research and practice of how technology will impact patient care and their personal development within the profession. A technology‐specific domain within the metaparadigm also is a signal to other bodies of science of our willingness and ability to run at pace with novel, exciting new discoveries while adding our perspective. Nurses may become active agents in novel developments rather than passive adopters, continuing our legacy of patient advocacy through new knowledge generation. Emerging and continuing nurse leadership has set the stage for the next era of nurse‐led innovation and technology development, which provides an opportunity to embed technology as a core aspect of the nursing metaparadigm. (shrink)

In the profession of nursing, whiteness continues to be deeply rooted because of the uncritical recognition of the white racial domination evident within the ranks of nursing leadership. White privilege is exerted in its ascendency and policy-making within the nursing discipline and in the Eurocentric agenda that commands nursing pedagogy. While attention to antiracism has recently increased, antiracism pedagogy in nursing education is nascent. Pedagogical approaches in the nursing profession are essential. Because it (...) encompasses the strategies used to transmit the science in how nurses practice and teach, which has predominantly been informed using a Eurocentric lens. This paper presents a literature review on antiracist pedagogy in nursing education, discussing how nurse educators can integrate antiracism pedagogy in nursing education, highlighting examples presented by the authors. Key terms related to antiracism are reviewed. The resultant themes from the literature review include resistance to antiracist pedagogy, managing emotional responses, and supporting transformative learning using an antiracist approach. The primary implementation of Eurocentric pedagogical approaches whiteness pervasive in nursing education must be uprooted. Antiracist and other antioppressive learning approaches must be embraced to understand the insidiousness of racial inequities and its power in sustaining structural oppression in nursing academia. (shrink)

Mentorship, often viewed as a central capacity of leadership, is acknowledged as influential in growing nurse leaders. Mentoring relationships are perceived as empowering connections offering a dynamic guided experience to promote growth and development in personal and professional life. A hermeneutic phenomenological approach informed by Heidegger and Gadamer was used to explore understandings and experiences of mentorship for nurse leadership by 13 Australian nurse leaders. We found that learning and transformation associated with becoming a nurse leader mentor was (...) experienced as an enduring evolutionary process. Participants' life journeys provided experiences that developed their understandings and established their personal identity as a leader and mentor. We considered the journey motif in terms of its inextricable connection with lived time and used Heidegger's ecstasies of temporality as a lens to understand how the temporal dimensions of past, present and future influenced and shaped the development of nurse leader mentors. We found that our temporal existence influences interpretation of ourselves and the world. Individuals can benefit from multiple separate mentoring interludes, with different mentors, over a lifetime. For some nurses, becoming a leader and mentor is a lifelong transformative process that grows from diverse experience and influential role modelling rather than formal instruction. (shrink)

The idea of solidarity is in vogue, especially since the eruption of the COVID-19 pandemic. However, the term “solidarity,” as used in nursing, is imprecise and vague, lacking clear definition and connoting a variety of general meanings. Based on the original meaning of “solidarity” in ancient Roman law, this article captures the archetypical idea of solidarity from a historical and interdisciplinary perspective. This archetypical or primary meaning comes before the development of any other meanings of the word, and it (...) is therefore authentic and genuine because it does not derive from something else. After establishing the archetypical meaning of solidarity, the article translates this meaning into the area of nursing and demonstrates a deep connectivity between healthcare and solidarity. The second part of the article offers and develops a new definition of nursing solidarity as the responsibility for the healthcare of a person shared as a whole by that person and a nurse or a nursing team. This new definition has some implications for nursing practice and education, since the definition emphasizes the idea that solidarity helps to foster respect and avoid discrimination, promote cohesion in health communities, increase individual responsibility and a spirit of service, stimulate motivation, improve communication, create an engaging workplace, and develop leadership. (shrink)

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? Which strategies do nurses use to provide compassionate care? What is the specific model of compassionate care for the nursing context? A grounded (...) theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: contextual factors affecting compassionate care, the compassionate care actions, and the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses’ ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses’ ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model provides a model to guide nursing care and research. (shrink)

ObjectiveTo examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units.BackgroundProximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support (...) on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports—i.e., family and organizational support—moderated the relationship between nurse adaptability and COVID-related PTSD symptoms.MethodsA sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N= 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms.ResultsAdaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r= 0.51 and 0.56, respectively,p< 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r= −0.43,p< 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r= −0.30,p< 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for.ConclusionFindings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis. (shrink)

ANGUS J, HODNETT E and O’BRIEN-PALLAS L. Nursing Inquiry 2003; 10: 218–228Implementing evidence-based nursing practice: a tale of two intrapartum nursing unitsDespite concerns that the rise of evidence-based practice threatens to transform nursing practice into a performative exercise disciplined by scientific knowledge, others have found that scientific knowledge is by no means the preeminent source of knowledge within the dynamic settings of health-care. We argue that the contexts within which evidence-based innovations are implemented are as influential (...) in the outcomes as the individual practitioners who attempt these changes. A focused ethnography was done in follow-up to an earlier trial that evaluated the effectiveness of a marketing strategy to encourage the adoption of evidence-based intrapartum nursing practice. Bourdieu's (1990, 1991) concepts of habitus, capital and social field were used in our refinement of the analysis of the ethnographic findings. Nursing leadership, interprofessional struggle with physicians, the characteristics of the community and the physical environment were prominent issues at all of the sites. Detailed descriptions of the sociohistorical context and of the experiences at two sites are presented to illustrate the complexities encountered when implementing innovations. (shrink)

The concept of phronesis is venerable and is experiencing a resurgence in contemporary discourses on professional life. Aristotle’s notion of phronesis involves reasoning and action based on ethical ideals oriented towards the human good. For Aristotle, humans possess the desire to do what is best for human flourishing, and to do so according to the application of virtues. Within health care, the pervasiveness of economic agendas, technological approaches and managerialism create conditions in which human relationships and moral reasoning are becoming (...) increasingly de‐valued. This creates a tension for nurses, and nursing leaders, as the desire to do what is morally right is often in conflict with contextual demands. In this paper, Aristotle’s writing on phronesis is examined with a focus on his classic conceptions of eudaimonia, the virtues, deliberation, judgement, and praxis. Building on Aristotle’s work, a number of contemporary views are explored with a focus on what various conceptualizations offer for the discipline of nursing. These expanded conceptions of phronesis include attention to: embodiment in practice; open‐mindedness including the capacity to stay curious and open to recognizing what we do not know; perceptiveness as a disposition towards insight and aesthetic understanding; and reflexivity as an ongoing process of interrogation and inquiry into ourselves and our actions. Drawing on these concepts, we discuss the affordances of phronesis as a morally informed guiding force to attend to modern‐day challenges in nursing practice and nursing leadership. (shrink)

The emerging new multidisciplinary and crosscultural field of bioethics will require sen sitive, open-minded professionals to take the lead in hospital ethics, in genetic coun selling, and in the teaching of bioethics to students in nursing, medicine and the basic sciences. Nurses with ward experience who return to university to gain an MA or PhD in bioethics are eminently suited for this leadership role, for they may be more likely than physicians to study for a liberal education to (...) supplement their professional know ledge ; their first-hand experience in nursing is an antidote to the pointless subtleties into which philosophical ethics so often degenerates. When teaching ethics to nurses one must remember that, while some will simply use this knowledge in their own clinical work, others will go on to be teachers and researchers in bioethics. Their training must therefore be broad and interdisciplinary, including real substantive philosophy (as opposed to philosophical ethics), as well as mystical bioethics, religious law, ethics of genetic counselling, clinical approaches to ethical pseudo prob lems, research skills, etc. (shrink)