Clinical leadership and effective nursing teams

Abstract—Health-related policy and its implementation into everyday practice is complex. The key challenge facing contemporary healthcare is to nurture cultures through effective leadership that continually improve high quality, safe and compassionate care. In the role as guardians of patient safety and quality, clinical nurse leaders are ideally situated to influence the performance of nursing teams through positive leadership qualities, strategies and behaviors. Leaders are effective when they are confident and competent, aware of their own behaviours, strengths, areas for development. Effective leaders can establish positive relationships between individuals helping them to make sense of change, implications for poor performance, successes and the future.This present study focuses on clinical leadership and nursing teams and involves a synthesis of findings from qualitative studies to gain further insight into key characteristics of leadership and the reasons why nursing teams are functional or dysfunctional. Using a systematic framework for qualitative data analysis, three distinct themes were revealed. These relate to factors involving individual aspects of leaders, team members and the working environment for clinical teams. The dominant theme was the characteristics of the clinical leader and the impact these have in relation to effectiveness of clinical nursing teams and the culture of the working environment. Clinical leaders demonstrating positive characteristics were described as being ‘authentic,’ ‘inspirational’ and ‘transforming’ leaders for the team. These characteristics were regarded as being the essence of effective leadership. In contrast, others were described as being ‘toxic’ or ‘poor’ leaders. ‘Toxic’ leaders displayed negative personal characteristics, behaviours and conduct which were destructive to the culture and damaging for teams. ‘Poor’ leaders did not display the required knowledge, ability or characteristics. Findings contributed to current evidence that key characteristics of teams include commitment, coordination, communication, cohesion, decision making, conflict management, social relationships and performance feedback. The effectiveness or ineffectiveness of nusing leadership was strongly associated with the impact it had on individuals and teams, their performance and on the culture of the working environment which could have long-lasting effects

The Role of Gatekeepers in Research: Learning from Reflexivity and Reflection

Research is now an integral part of everyday health, education and social science practice. These professions need to be responsive to meet the changing needs in light of evidence based research findings. Within this process, gatekeepers have a key role to ensure researchers gain access to potential participants and sites for research. Positive influences of the gatekeepers can be invaluable to the research process by facilitating the smooth running of research activity to completion. At times, gatekeeping can be problematic with researchers having limited or no access to sites. In this present study to recruit vulnerable adolescents, a number of gatekeepers denied, limited or delayed access to potential participants and sites despite ethical, professional and organizational approval. In response, the researchers incorporated learning tools to address challenges brought about by gatekeepers in this study and for improvements in future studies. Reflexivity was used during the study to critically review all aspects of the research process and retrospective reflection identified areas that worked well and those areas for improvement in future studies. In broad terms, a number of factors were found to influence the action of gatekeepers. This related to level of understanding about the research, communication issues, motivation issues and fear or anxiety about the outcome. One recurring issue seemed to relate to the sensitive nature of the study and the deeply held attitudes and values of the individual gatekeepers. Researchers need to engage and involve the gatekeeper/s early in the research process. Other positive influences include sharing of clear information with the purpose of the research, the gatekeeper being motivated with a positive attitude to research which is also supported within the gatekeeper’s environment. When these positive influences are not present then this can have a negative influence on research activity

Lesson plans to stimulate beginning creative writing in grades three, four, and five

Thesis (Ed.M.)--Boston Universit

Psychological consequences of childhood obesity: psychiatric comorbidity and prevention

Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs

Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: natural experimental evaluation using interrupted time series methods.

OBJECTIVES: To determine whether introduction or withdrawal of a maternal financial incentive was associated with changes in timing of first attendance for antenatal care ('booking'), or incidence of small for gestational age. DESIGN: A natural experimental evaluation using interrupted time series analysis. SETTING: A hospital-based maternity unit in the north of England. PARTICIPANTS: 34 589 women (and their live-born babies) who delivered at the study hospital and completed the 25th week of pregnancy in the 75 months before (January 2003 to March 2009), 21 months during (April 2009 to December 2010) and 36 months after (January 2011 to December 2013) the incentive was available. INTERVENTION: The Health in Pregnancy Grant was a financial incentive of £190 ($235; €211) payable to pregnant women in the UK from the 25th week of pregnancy, contingent on them receiving routine antenatal care. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was mean gestational age at booking. Secondary outcomes were proportion of women booking by 10, 18 and 25 weeks' gestation; and proportion of babies that were small for gestational age. RESULTS: By 21 months after introduction of the grant (ie, immediately prior to withdrawal), compared with what was predicted given prior trends, there was an reduction in mean gestational age at booking of 4.8 days (95% CI 2.3 to 8.2). The comparable figure for 24 months after withdrawal was an increase of 14.0 days (95% CI 2.8 to 16.8). No changes in incidence of small for gestational age babies were seen. CONCLUSIONS: The introduction of a universal financial incentive for timely attendance at antenatal care was associated with a reduction in mean gestational age at first attendance, but not the proportion of babies that were small for gestational age. Future research should explore the effects of incentives offered at different times in pregnancy and of differing values; and how stakeholders view such incentives

Supporting Nursing Leadership by the Implementation of an increased Supervisory Role

Clinical nurse leadership is essential for the provision of high quality patient care. Recent research has highlighted the need for all Senior Charge Nurses (SCNs) to be equipped to deliver effective ward management, staff development and ultimately a positive patient experience. The provision of ‘supervisory hours’ is a vital component of an SCN role, enabling the effective leadership of their teams. This paper describes the increased supervisory role implemented by the Leading Better Care program within one Health Board area of Scotland. Mixed methods research (online survey n=52 and in-depth qualitative interviews n=12) explored the experiences of SCNs using their increased supervisory time and its perceived impact on clinical practice. Findings demonstrate that increased supervisory time positively impacted several key areas of clinical practice. Although the increased supervisory role empowered SCNs and promoted their professional development, they require greater role clarity, managerial support and leadership development to reduce role stress and promote future career aspirations

Making meaning from student evaluations of teaching: Seeing beyond our own horizons

Within postsecondary education, the assessment of effective teaching has largely relied upon student evaluations of teaching. However, the process through which teachers make sense of their student evaluations is unclear. A research team of six undergraduate nursing students and four nursing educators explored the research question: How do nursing educators make meaning from their student evaluations of teaching? Gadamerian hermeneutics guided unstructured interviews with nursing educators working at a Middle East campus of a Canadian university. The interview transcripts were interpreted through a process of naïve readings, rereadings, interpretive dialogues, and interpretive writing that generated the following hermeneutic interpretations: Teachers make meaning of their student evaluation through generalized subjective characterizations of students and through their expressed intentions for their teacher-student relationships. Some of these characterizations and expressed intentions obscured what truths could be learned from the student evaluations of teaching. The experience of receiving critical student feedback invoked a personal response, at the same time, paradoxically, teachers worked hard to “not take it personally.” We suggest the practice of deep listening as a way to understand students’ feedback. The main takeaway message from this research is that teachers need a supportive and sustaining community of peers who are also open to listening deeply to the truths embedded in student evaluations of teaching

“You feel like you kind of walk between the two worlds”:A participatory study exploring how technology can support emotion regulation for Autistic people

An increasing amount of technological solutions aiming to support emotion regulation are being developed for Autistic people. However, there remains a lack of understanding of user needs, and design factors which has led to poor usability and varied success. Furthermore, studies assessing the feasibility of emotion regulation technology via physiological signals for autistic people are increasingly showing promise, yet to date there has been no exploration of views from the autistic community on the benefits/challenges such technology may present in practice. Focus groups with autistic people and their allies were conducted to gain insight into experiences and expectations of technological supports aimed at supporting emotion regulation. Reflexive thematic analysis generated three themes: (1) communication challenges (2) views on emotion regulation technology (3) ‘how’ technology is implemented. Results provide meaningful insight into the socio-emotional communication challenges faced by autistic people, and explore the expectations of technology aimed at supporting emotion regulation