Get Answer: Building Relationships Trust Question Guide
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Start by identifying the main issue, then apply relevant academic frameworks.
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This topic involves building relationships trust. A strong answer should include explanation, application, and examples.
Original Question
Building relationships and trust. Empowering others. Contributing to an environment that supports knowledge integration. ( i wanted to use this as my strength ) Leading, supporting and sustaining change. Balancing complexities of the system and managing competing priorities (e.g. work-life balance). ( i wanted to use this as my weakness) Assessment: Briefly reflect on / describe how you feel about your current leadership behaviours in comparison to what the RNAO document describes. Strength: Consider behaviors outlined in each of the five practices and identify one (1) out of 5 practice areas you excel in. (0.5 mark) Reflect on / discuss how exceling in this area can be an asset to your nursing practice. (1 mark) Apply course content to support your answer (must use in-text citation(s) and reference(s). (1 mark) Area for improvement: Consider behaviors outlined in each of the five practices and identify one (1) out of 5 practice areas that you would like to develop further. Reflect on and discuss in depth one (1) example of how this can be a barrier to your nursing practice. Use 1 scholarly nursing article to explain how this area is important for nursing leadership. How are you going to use the information from this article to make a difference in your practice? (2 marks) Planning / SMART Goal: Develop one (1) SMART goal that would most facilitate your future practice as a leader in nursing (You may choose to further build on your strength OR to focus on leadership behaviors you identified as needing improvement) USING THIS ARTICLE BELOW ( please dont use other references except this article below. Nursing Research Influencing Work Culture: A Strengths-Based Nursing Leadership and Management Education Program Pam Hubley, Laurie N. Gottlieb and Michele Durrant Article PDF Full Issue PDF Citation Manager Abstract Little is understood about developing the capacity of healthcare leaders to influence work cultures that promote health and healing. A program designed for clinical leaders to teach them how to create Strengths-Based care environments was piloted and evaluated using mixed methods. Data were collected from a convenience sample of 15 participants from two clinical sites. Evaluation of the data revealed that the program was impactful and that participants had the impetus to influence work environments by shifting their discourse from traditional deficit models of care toward an approach that illuminates a focus on strengths and relational ways of being a leader. Introduction Leadership is required to promote a positive work culture and a quality workplace environment that humanizes patient care and prioritizes well-being for all. During the COVID-19 pandemic, we witnessed extreme psychological stress experienced by healthcare providers and challenges were uncovered in work environments not attuned to humane caring. Healthcare providers, particularly nurses, have reported high levels of psychological distress experienced during this sustained crisis, impacting the workplace culture within clinical work settings (Khamisa et al. 2013; RNAO 2021; Sriharan et al. 2021). The prevalence of reported mental health problems includes depression, anxiety and insomnia (Pappa et al. 2020). Where there was a leadership gap before the pandemic, there is now a significant crevasse that requires leaders to create empowering workplace conditions (Gottlieb et al. 2021). Lynn Nagle (2020), the immediate past editor of the Canadian Journal of Nursing Leadership, aptly framed the leadership required to navigate through and past this pandemic describing how leaders need to create meaning by acknowledging emotions and channeling actions into something purposeful during a crisis. Nagle suggested that leaders need a playbook from which to operate (2020). We suggest that this playbook should focus on humanizing care and the care environment through a Strengths-Based lens. The program we describe sets the stage for the development of nurse leaders who are compassionate innovators and situationally responsive in their ability to create such a playbook for themselves, their staff and their organizations. This program builds resiliency and attends to interventions that are attuned to the needs of staff and, ultimately, patients. This article describes the development of an innovative program based on the value-driven philosophy of Strengths-Based nursing and healthcare (Gottlieb 2013; Gottlieb et al. 2012) that fosters leadership development with the aim to create healthy and healing workplaces for staff and patients alike and reports on the associated program evaluation’s findings. Several leadership programs have been launched at local, national and international levels over the past 20 years (Embree et al. 2018; Ferguson et al. 2016; Fitzpatrick et al. 2016; Flowers et al. 2004; Franklin et al. 2020; Koeckeritz et al. 1995; Lacey et al. 2017; Mackoff et al. 2017; MacPhee and Bouthillette 2008; Rumsey et al. 2017; Sabo et al. 2008; Scott et al. 2018; Tesh and Kautz 2017). Most of these programs adopted leadership models from the business literature and were offered as continuing education opportunities for point-of-care nurses and nurse managers. Primarily, these programs used ideas from transformational leadership theory (Bass 1985; Burns 1978; Fisher 2016), the five practices of exemplary leadership by Kouzes and Posner (2017) and Kotter’s eight-step change model (Kotter 2012). One program was grounded in complexity science in an attempt to capture complex systems in healthcare (Malloch and Porter-O’Grady 2009). These programs aimed to nurture the leadership capacity of nurses working in the health system (Embree et al. 2018; Fitzpatrick et al. 2016; Franklin et al. 2020; Lacey et al. 2017; Scott et al. 2018). Scott et al. (2018) built upon Kouzes and Posner’s (2017) five practices of exemplary leadership framework to include concepts such as emotional intelligence, self-care, collaborative relationships and person-centred care as core content in their program. Lacey et al. (2017) built upon Kotter’s change framework and incorporated quality-improvement process tools needed to advance change projects (plan-do-study-act, project planning, logic models, data collection and analysis skill sets). Five other programs were designed that used evidence-informed strategies: leader competencies derived from a 360° performance review of nurse leaders (Flowers et al. 2004), a hospital-wide gap assessment (Koeckeritz et al. 1995), national role competencies (Mackoff et al. 2017), leadership competencies based on a Canadian province-wide needs assessment (MacPhee and Bouthillette 2008) and a Coach MasteryTM framework (Sabo et al. 2008). Despite the existence of programming that primarily used concepts and tools from business and quality-improvement literature, a gap remained with regard to deepening participants’ connection to and understanding of a leader’s role as it relates to the model of care delivery. Our program differs from others, in that it is built upon the seminal work of Gottlieb (2013) and Gottlieb and Ponzoni (2015) and grounded in the foundational concepts of person-centredness, relationships, empowerment, innate abilities and partnership – and operationalized through eight core values. Our program was designed to develop leaders who cultivate healthy and healing work environments that balance competing values within the complex health system using a Strengths-Based Nursing and Healthcare Leadership and Management (SBNH-LM) approach while integrating business acumen and common healthcare management approaches. We piloted and evaluated our leadership program, which is deeply aligned with a clinical frame that fosters health and healing of patients, and evaluated this approach. As such, the introduction of the SBNH-LM program offered a value-based approach intended to develop capabilities in clinical leaders, which strengthen and humanize care and caring environments that are often trumped by dominant deficit models of medical care and uninspired leadership. This paper outlines the components of the program and findings of its evaluation. Program Innovation Based on the results of a needs assessment, the SBNH-LM program was developed to include 10 modules that enabled flexibility in delivery. With input from participating hospitals and in discussion with those who had experience in delivering intensive programs to healthcare leaders, it was decided that the program would be delivered in three segments over four months. The grant funded by the Canadian Institutes of Health Research and Social Sciences and Humanities Research Council of Canada situated the 10 modules into segments (see Appendix 1: Table A1) (Appendix 1: Tables A1-A4 are available online here) that integrated mentorship and story sharing into the training program. This program was delivered jointly to staff from two pediatric hospitals – The Hospital for Sick Children and Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON. Unique to this program was the integration of arts-based active learning exercises. Active learning exercises were designed to facilitate reflection about the clinical context from which these leaders worked. These strategies promoted participant story sharing, self-reflection and small-group and peer learning. Emphasizing reflective practice within the program was intentional. This allowed for participants’ experiences to be heard, discussed, analyzed and reconceptualized or labelled from the perspective of the course’s core content and the values embedded within SBNH-LM. Cinema verité film vignettes were created by a Canadian photojournalist and in partnership with the nursing leadership at Holland Bloorview Kids Rehabilitation Hospital and the Centre for Oral History and Digital Storytelling at Concordia University, Montreal, QC. These vignettes beautifully captured leaders’ insights about themselves, their staff, their patients and the practice setting, and set the stage for sharing stories within the classroom setting. These intimate digital vignettes were curated and used in the classroom to reflect upon leadership values and actions relevant to advancing SBNH-LM (Cahana 2018). A three-month structured mentorship program was implemented as an integral component of the program. Each participant was assigned a mentor to support them as they set goals and a leadership action plan. Mentors were given an orientation to their role and access to web-based resources to support the mentor-mentee relationship. Resources were also made available to participants through an online SharePoint site. These included slides, examples, video links, handouts and articles related to core concepts taught. This forum allowed for real-time communication as the program delivery unfolded for participants. Program Evaluation Methodology The course evaluation was approved by both academic health science centres’ quality improvement programs and research ethics boards. Emerging healthcare leaders who could commit to attending the full program were recruited. The commitment was then endorsed by senior leaders to whom they reported in their organization. Data were collected from a convenience sample of 15 participants of the 16 who self-enrolled on a voluntary basis from the two sites (Appendix 1: Table A3). Self-report surveys were administered to participants following each module, and a final evaluation survey was conducted after the last module. The surveys assessed course content, teaching methods used to facilitate learning and learning outcomes focused on participants’ abilities to facilitate change and transfer learning to the clinical area through 5-point Likert scales and open-ended questions (Appendix 1: Table A4). Mentorship logs from both mentees and mentors were collected that elicited participants’ perceptions of the mentorship experience, as well as the leadership goals set and action plans established by the mentees. Mentor logs were completed three months after the classroom modules were delivered and the mentorship period came to a close. Data were collected using a mixed-methods approach and were analyzed using descriptive methods described by Miles et al. (2019). Three questions guided the analysis of data (Appendix 1: Table A2). Quantitative data were represented as mean scores (Appendix 1: Table A4). Qualitative data were reviewed, and both descriptive and in vivo codes were determined based on participants’ responses. Codes were then clustered into categories to look for patterns and recurrences of accounts, and then final categories were established as themes. Matrix displays were used to allow for noting of patterns and looking for data that verified conclusions drawn. Findings Participant Characteristics A total of 16 leaders in nursing and other health disciplines enrolled in the Strengths-Based leadership/management course. Fifteen participants participated in the evaluation. See Appendix 1 (Table A3) for participant characteristics. Program Effectiveness Participants rated on a 5-point scale their overall satisfaction with the programming as high, with an overall mean score of 4.8 and a median score of 4.8. Rankings of session content and the impact of the overall program can be found in Appendix 1 (Table A4). Learning Participants ranked their learning from each session as high (4.0-5.0), with a mean score of 4 (rankings are found in Appendix 1: Table A4). Participants also provided descriptive comments about their learning, which are described in the following sections. Becoming a reflective leader Two processes were cited that influenced the participants’ learning: engaging in reflective practice and goal setting. Engaging in reflective practice was cited most often, which was anticipated, given that there were several reflective practice strategies intentionally embedded throughout the course. This was done to allow participants to make connections, see themselves and others in the core content taught and facilitate application to the practice setting. Reflective practices included art-based activities, case studies, cinema verité vignettes and the mentorship experience. A number of participants identified the benefit of these reflective activities, stating that they helped them “understand the concepts,” “integrate concepts” and commit “them to memory.” The activities were described as useful in providing participants with the insight and the ability to “recognize their own leadership skills.” Two participants specifically commented on their ability to become more self-reflective. A participant stated that [they learned to be] “more self-reflective and the importance of creating the space for this.” Another participant said the following: [A]t the start of the course, I didn’t think I had many leadership skills. What I have learned is to [now] be more patient with myself and activate more self-reflection. Almost all the participants described for themselves the goals that they envisioned would impact patient care, their team and the work environment. These included creating “safer, more efficient patient care” that will result in staff “learning more about our patients and families” and fostering “happier staff” and a “stronger team.” Another participant identified the impact that their SBNH-LM leadership goals would have on patient safety and noted that the SBNH-LM approach would also “help me care for my patient as a whole person rather than focusing on a diagnosis.” Others described a change in team climate. One participant noted how “interactions [with] clients and families” will be “improved” through the use of this relational approach. Stress, another participant said, would decrease with improved capacity to communicate as a result of the program. They explained that they would experience “decrease[d] stress [from] challenging conversations while anticipating [issues] [and then], recognizing staff” within the context of challenging situations. Another added that staff would be “more supported,” which would lead to “better patient outcomes” as leaders applied the SBNH-LM approach, resulting in more “joy in work-employee engagement” and thereby improving the “client and family experience.” Participants clearly stated that they anticipated that the SBNH-LM approach could change the work climate through improved relationships and team dynamics, leading to better patient care. Insights about SBNH-LM skill development Most participants described their learning in the context of their leadership, development of their management skills and their intent to practise as a Strengths-Based leader. In doing so, they shared their new understandings about the leader’s role in navigating day-to-day conversations. They recognized that these could influence the work environment and work culture, and as such, they recognized the importance of being intentional in using a Strengths-Based approach and the need to shift not only their mindset but also their actions. A number of participants explained how these changes required that they adopt a new script. One participant stated: We use these care values every day, but it is important to begin to change my language and use these in my day-to-day conversations with staff, patients and families. Participants identified their responsibility as leaders to engage team members and influence work culture. One participant explained that they have learned about the “ability to rally [their] team.” In doing this, they noted that they “need[ed] to ask more questions/use the spiraling process [a communications strategy taught], slow down and remember to role model.” This and other such reflective comments demonstrated new insights and the ability to unpack the steps required to fully engage and involve team members. Other participants noted how they could influence team members and the workplace culture by “empower[ing] others [and] creat[ing] a more positive culture [by] fostering greater teamwork.” Another participant described using the strategy of reframing their previous actions to influence their future actions, which is an example of using generative reflective practices as a leader. They stated that “being more self-reflective allowed the space for feedback and reframing [their actions] in a positive/Strengths-Based manner.” Participants described embedding these new practices during meetings and education sessions that they delivered. They modelled best practices as they set new leadership goals for themselves. One participant stated that they wanted to “increase [their] confidence in embedding Strengths-Based care during debriefs and demonstrating active listening and trust.” In order to meet their goals, they would “build [this] into meetings, [providing] more supportive Strengths-Based [approaches in order to influence the] environment.” By doing this, they would, in turn, role model by “foster[ing] and reinforc[ing] examples of [Strengths-Based] leadership in staff.” Mentorship Accounts In all, 53% of the participants (n = 8) returned mentorship logs, revealing that 31 contacts were made between mentors and mentees. The most contact was made by telephone (n = 17); however, face-to-face interactions were made both virtually (n = 2) and in person (n = 7). Two encounters involved small group meetings as opposed to one-on-one meetings. Participants’ descriptions revealed an intention to reflect and learn through their leadership actions, which in turn impacted the goals that they set to influence the work environment, hone their communication and integrate SBNH-LM values within their leadership, management or clinical practice. Participants’ reflections revealed three themes: uncovering strengths, influencing the workplace culture and leading others. Uncovering strengths Most participants said that they wanted to hone their communication skills (n = 7), which were required of them in a variety of situations. These included conversations both within their clinical teams and in addressing family needs that involved managing “difficult conversations,” “unexpected conversations,” “conflicts” and what they referred to as situational “complexities.” Goals related to enhancing their communication required them to engage others and guide their own leadership approach to uncover and discover strengths that facilitated health and healing. This area of focus relates to the person-centred, empowerment-based and relational foundations of the SBNH-LM approach. Several participants’ (n = 5) mentorship logs revealed that there was a clear intent to create a positive experience for family members when describing their communication goals. They described their intent to “address learning needs,” “collaborate,” “attain shared goals,” “identify strengths,” “manage or resolve tension” and “enable family resilience and growth.” All these goals identified by participants described clinicians’ actions to facilitate a process for health and healing aligned with Strengths-Based care (Gottlieb 2013). Influencing the work culture Participants’ logs about their environment most often involved reflection of themselves in relation to the larger clinical team, but for two participants, it involved them in the context of delivering patient care. Participants’ goals included the development of greater awareness of their environment and social relationships that influence the work culture, as well as using their management/leadership approaches to shift the work culture in a positive, strengths-focused manner. Deepening an understanding of one’s environment, the healthcare team and their relationship to health and healing represents a key concept of the SBNH-LM approach. Caring for families Two participants were able to reflect on patient experiences within the clinical environment and recounted their thinking and actions within the context of providing clinical care. One participant identified the need to reframe their line of questioning in a way to allow them to see the strengths of families within the context of the complexity of the illness experience. The goal of “seeing strengths in very complex families” was achieved by their ability to “reframe the question,” they explained. “What has been going well?” was cited as an example of this line of questioning. Prior to this program, this simple approach to understanding a patient and their family was not something that they had engaged in. Teamwork Other participants (n = 4) reflected on teamwork, their leadership opportunities and the relationship of the team to the clinical milieu or work culture. Caring for oneself and others within a clinical unit or team was an opportunity to facilitate culture change for one participant: [What is the] one thing/activity that we can implement to nurture ourselves? Starting with me, move to we [the staff] and finally [to] us [culture change] in the facility. They went on, in other log entries, to reflect on the importance of self-care, nurturing environments and the goodness-of-fit concept in their workplace. One participant indicated that they would begin to ask new questions to better understand and lead their team – for example: “What environment brings [out] the best of someone? Why does a team work well? What values are important to the team?” This notion of reflecting on oneself to influence the team or unit culture was described by other participants through actions such as “modelling” and/or “talking about it openly” and “asking open ended questions.” These descriptions illustrate how participants recognized the impact that social relationships had on influencing the culture of the work environment. They set personal goals in an effort to enhance their own management/leadership approaches to shift the team in a positive and strengths-focused manner. Leading others Most (n = 7) participants articulated an intent to lead others. All descriptions represented how SBNH-LM values drove their actions to explore meaning and uncover strengths in both themselves and others, which included bringing out the best in others; leading with an intention to build confidence, growth and resiliency; and facilitating change. Three participant logs specifically detailed upcoming meetings with members of the management team or the executive that required reflection, and anticipatory preparation focused on SBNH-LM values. Participants used the SBNH-Care (SBNH-C) value wheel to explore their own growth, development and future leadership opportunities. Referring to one of the SBNH-C values, one participant wrote that “person and environment are integral” for “my personal growth at work.” “Being seen as a leader outside my unit. Being invited to meetings and asked my opinion more” were hopes/goals identified by this participant that could be actionable and could strengthen their leadership presence within the organization. Summary Participants’ log entries of goals and the actions taken to achieve them illustrated their intent to apply the course content as a developing leader. The mentorship component of the program offered a supportive approach that enabled practical application of new knowledge and skills learned throughout the program. The mentorship component was highly valued by all participants and facilitated uptake of new knowledge. Discussion Prior to the inception of our SBNH-LM program, several leadership programs had been launched (Embree et al. 2018; Ferguson et al. 2016; Fitzpatrick et al. 2016; Flowers et al. 2004; Franklin et al. 2020; Koeckeritz et al. 1995; Lacey et al. 2017; Mackoff et al. 2017; MacPhee and Bouthillette 2008; Rumsey et al. 2017; Sabo et al. 2008; Scott et al. 2018; Tesh and Kautz 2017). Our program differs in that it focuses on foundational concepts of person-centredness, relationships, empowerment, innate abilities and collaborative partnerships operationalized through eight core foundational values required to deliver care and that, in turn, cultivates health and healing environments through SBNH-LM leader practices (Gottlieb 2013; Gottlieb and Ponzoni 2015). As such, the introduction of the SBNH-LM program offers a value-based approach intended to develop capabilities in clinical leaders that strengthen and humanize care and caring environments that are often trumped by dominant deficit models of medical care and uninspired leadership. Arts-based active learning activities and cinema verité film vignettes were a unique aspect of the program that were found to be useful in providing examples for context-specific real-world application, which supported learning about leadership within clinical settings. Participants of our program revealed how important reflective practice was to them as they engaged in a process that required changing their mindset and actions. The importance of engaging in reflective practice for our participants was not a surprising finding as there were several reflective practice strategies embedded throughout the program. This was done to allow participants to make connections, see themselves and others in the core content taught and facilitate application in the practice setting. There were no programs that illustrated how to use reflection to encourage the embodiment of leadership identity and actions; however, Mackoff et al. (2017) found that program participants had developed a self-awareness of their emotional reactions to situations and its impact. Mentorship was found to be an important and integral method of supporting program participants in developing their leadership capabilities further as they engaged in translating knowledge gained through the program into their leadership practice within the context of their work environment. In this evaluation, participants described how they were able to uncover their own strengths and had begun to develop strategies that could influence workplace culture and empower others within the work environment. Our review of leadership programs found that mentorship was an important component of these programs and was used to facilitate work-based leadership projects (Embree et al. 2018; Ferguson et al. 2016; Lacey et al. 2017; MacPhee and Bouthillette 2008; Rosser et al. 2020; Rumsey et al. 2017) and actionable goals set by participants (Franklin et al. 2020; Koeckeritz et al. 1995), and build the sustainability of programs and participants’ leadership capacity (Sabo et al. 2008). However, few have described their strategy in much detail. Embree et al. (2018) described the need to have an open, regularly scheduled collaborative relationship that advanced the mentee’s goal development. The process described was aligned with our strategy. Rosser et al. (2020) described as an adjunct to the mentorship a community of interest that allowed for mentors to meet over 18 months to facilitate communication across a community of mentors and mentees. Franklin et al. (2020) provided mentorship throughout a 12-month leadership program that used a coaching model grounded in adult learning and positive psychology and that was to yield learning, goal-setting and personal growth. Although we did not use a coaching model, many of these elements align with our programming. The nursing leadership programs reviewed address a gap. However, this pilot is the first leadership program that develops a leadership style aligning with a model of care in which both are underpinned by the same value-driven philosophy – namely, SBNH. Conclusion The pilot program described in this paper provides a solid foundation from which to introduce the next iteration of our SBNH-LM program. Evaluation data suggest that the program was impactful to clinical leaders and demonstrated evidence of capacity building within participants, enabling them to learn and begin to embody this value-based approach to leadership. Evaluation data also demonstrated that participants had the impetus to begin to influence work environments by shifting their discourse from traditional and dominant deficit models of care toward a more balanced and integrated approach that illuminates a Strengths-Based focus and the impact of relational ways of being a leader. The results of this pilot project are being used to refine and scale up the next iteration of the program that recruits participants from two Canadian cities – Toronto, ON, and Montreal, QC – engaging 125 participants from five major healthcare institutions. The research will be undertaken that will result in an evidence-based leadership program grounded in Strengths-Based leadership foundations and values that will focus on transformation of the clinical environment and adoption of an embodied Strengths-Based leadership identity (Hubley et al. 2020). It will also examine gender, diversity, equity and inclusion in order to advance our understanding of how these factors impact the healthcare work environments and how these can be examined, better understood and addressed through an SBNH lens. In reflecting on these findings, we have made a number of recommendations to enhance future programming. As mentorship was found to be such a key component of the leadership program, it would be valuable for it to be further defined and evaluated in the next program iteration. It would also be valuable to elaborate on leadership capabilities within an SBNH-LM approach. Moreover, to further develop the arts-based element of the program, it would be useful to develop materials that guide faculty in deepening their reflection triggered by arts-based active learning activities and cinema verité film vignettes to encourage story sharing, deep listening and linking and labelling what was observed in the various art forms to SBNH-LM values. We also recommend that longitudinal research be carried out to determine the long-term and sustaining effectiveness of this program on leadership style and its impact on the healthcare system. Further suggestions on how to implement a philosophy into practice can be found in the article by Gottlieb et al. (2012). These are the initial recommendations to develop SBNH-LM as an embodied form of leadership practice. About the Author(s) Pam Hubley, RN
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