Nursing leadership in Ireland: experiences and obstacles

Vries, Jan de; Curtis, Elizabeth

doi:10.1108/lhs-11-2017-0068

Cited by 6 publications

(7 citation statements)

References 62 publications

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“…ED members of the KPC described a culture of command and control, with an emphasis on task orientated care provision as a way of managing and organising complexity in an environment where a critically ill child could arrive unannounced at any moment. This cultural imperative drove the unquestioning acceptance of rules-based pain management by nurses, exemplified by NIA [ 30 , 31 ]. The transactional nature of organising practice relied heavily on policies and rules to create order and clarify expectations, rewarding compliance and productivity at the department level.…”

Section: Findings and Discussionmentioning

confidence: 99%

Building effective engagement for implementation with i-PARIHS: a collaborative enquiry into paediatric pain care in the emergency department

Williams

Keogh

Herd

et al. 2022

BMC Health Serv Res

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Background Pain is a central and distressing experience for children in the emergency department (ED). Despite the harmful effects of pain, ED care often falls short of providing timely and effective pain relief. Knowledge translation research targeting systems of care holds potential to transform paediatric pain care. This article reports on the first stages of an implementation project aimed at embedding effective and sustainable practice change in an Australian children’s hospital ED. Methods The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework underpinned a cooperative process of engagement to establish a practitioner-led, interprofessional research collaborative. The Kids Pain Collaborative (KPC) aimed to co-design innovation in paediatric ED pain care, facilitating an extensive reconnaissance of research evidence, clinician and family experiences, and local evaluation data. This critical appraisal of the context and culture of pain management generated foci for innovation and facilitation of implementation action cycles. Results Engaging in a complex process of facilitated critical reflection, the KPC unpacked deeply embedded assumptions and organisational practices for pain care that worked against what they wanted to achieve as a team. A culture of rules-based pain management and command and control leadership produced self-defeating practices and ultimately breakdowns in pain care. By raising a critical awareness of context, and building consensus on the evidence for change, the KPC has established a whole of ED shared vision for prioritising pain care. Conclusions In-depth key stakeholder collaboration and appraisal of context is the first step in innovation of practice change. The KPC provided a space for collaborative enquiry where ED clinicians and researchers could develop context-specific innovation and implementation strategy. We provide an example of the prospective application of i-PARIHS in transforming ED pain care, using a collaborative and participatory approach that has successfully enabled high levels of departmental engagement, motivation and ownership of KPC implementation as the facilitation journey unfolds.

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Section: Findings and Discussionmentioning

confidence: 99%

Building effective engagement for implementation with i-PARIHS: a collaborative enquiry into paediatric pain care in the emergency department

Williams

Keogh

Herd

et al. 2022

BMC Health Serv Res

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“…This will require debate and effort to unify the language around the required developments in leadership. Without this, health care workers will continue to perceive leadership as essentially the same as management ( Curtis et al , 2011 ) and fail to see beyond the hierarchical model ( De Vries and Curtis, 2019 ). Principles derived from transformative, authentic ( Katrinli et al , 2008 ) and distributed leadership ( Comiskey et al , 2021 in press) will need to be translated into clear actionable approaches that health care workers will understand how to implement.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, decentralisation of health care, as seen in the move towards more emphasis on care in the community, requires that leadership should be expressed at all levels of the organisation and dissociated from formal management structures. The bottom-up leadership needed in community health care emphasises equality between staff, collaboration, initiative and devolved decision-making ( De Vries and Curtis, 2019 ).…”

Section: Background and Context To The Studymentioning

confidence: 99%

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Leadership and community healthcare reform: a study using the Competing Values Framework (CVF)

O'Neill

Vries

Comiskey

2021

LHS

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Purpose The Health Service Executive in Ireland seeks to further develop healthcare in the community. It has identified that this reform requires developing leadership amongst the staff. This study aims to identify what kind of leadership staff in community healthcare observe in practice and their leadership preferences. The core objective has been to identify the readiness of the organisation to implement the adopted national policy of integrated community care reform in terms of leadership development. Design/methodology/approach An online cross-sectional survey was conducted using the Organisational Cultural Assessment Instrument, based on the Competing Values Framework. This tool identifies four overarching leadership types: Clan (Collaborative), Adhocracy (Creative), Market (Competitive) and Hierarchy (Controlling). Participants (n = 445) were a representative sample of regional community health care employees. They were asked to identify presently observed leadership and preferred leadership in practice. The statistical analysis emphasised a comparison of observed and preferred leadership types. Findings Participants reported the current prevailing leadership type as Market (M = 34.38, SD = 6.22) and Hierarchical (M = 34.38, SD = 22.62), whilst the preferred or future style was overwhelmingly Clan (M = 40.38, SD = 18.08). Differences were significant (all p’s < 0.001). The overall outcome indicates a predominance of controlling and competitive leadership and a lack of collaborative leadership to implement the planned reform. Originality/value During reform in healthcare, leadership in practice must be aligned to the reform strategy, demonstrating collaboration, flexibility and support for innovation. This unique study demonstrates the importance of examining leadership type and competencies to indicate readiness to deliver national community health care reform.

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“…The need for leadership within all staff in the health and social care system has been expressed [ 18 ] and within intellectual disability, staff are from either a nursing or social care context who respond to situations that require intervention. Such responses require initiative, resourcefulness, motivation, an ability to solve problems, active awareness, persistence to achieve goals, and communication with team members i.e., leadership [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Leadership in intellectual disability practice: design, development, and evaluation of a programme to support practice

Doody,

O’Halloran,

Carey

et al. 2024

BMC Health Serv Res

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Background Intellectual disability services have and continue to experience changes in service provision. This has an implication for leadership in practice as the quality of leadership has a direct influence on staff practice and care provided. Aim To design, deliver, and evaluate a leadership programme for nurse and social care managers in Ireland. Design An accredited programme was designed based on evidence from literature, practice, and national expertise. A cross-sectional survey was used to collect information on the attitudes and behaviour of participants before commencing and after completing the programme. Data from the questionnaires were analysed using SPSS and open-ended questions were analysed using content analysis. Setting Intellectual disability services. Participants 102 participants completed the programme and survey. Methods Pre-post survey and reported using the CROSS guidelines. Results Participants’ expectations were rated highly, and all items scored higher in the post-survey. Qualitative data was overall positive regarding opportunities for more time to work through each aspect of the programme. The key learning was through the forum day where participants shared their group projects. Conclusions Overall, the programme was positively evaluated and through engaging with the programme participants’ perceptions moved from seeing leadership as mostly task-oriented to realising that qualities such as good communication, person-centredness, advocacy, supporting, role modelling, and empowering are key to leadership.

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Nursing leadership in Ireland: experiences and obstacles

Cited by 6 publications

References 62 publications

Building effective engagement for implementation with i-PARIHS: a collaborative enquiry into paediatric pain care in the emergency department

Building effective engagement for implementation with i-PARIHS: a collaborative enquiry into paediatric pain care in the emergency department

Leadership and community healthcare reform: a study using the Competing Values Framework (CVF)

Leadership in intellectual disability practice: design, development, and evaluation of a programme to support practice

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