Background:
Person-centeredness within care relationships has received considerable attention in nursing literature, research and healthcare policy since the turn of the century. Concept analyses and conceptual frameworks have been developed and it is considered by some a core value that when enacted forms an essential attribute of effective workplace cultures. However, there has been no exploration of person-centeredness within clinical nurse leadership relationships. In an era of competing needs and dwindling resources traditional hierarchical and autocratic styles of leadership have been shown to be inadequate, but continue to persist, especially in healthcare settings. Whilst a relational approach to leadership is being propagated and showing positive outcomes, the majority of models referred to were developed outside a healthcare context. This study set out to explore and develop the concept of person-centred leadership within a nursing context.
Aims and research questions:
Having negotiated conducting a three year study with stakeholders, we set out to find answers to the questions: “What is person-centred leadership? How can it be developed?” The primary aim was to explore person-centred leadership as it was developed in collaboration with a nurse leadership team of a ward in a Dutch urban general hospital.
Approach and methods:
A critical participatory action research methodology was chosen to enable research done with rather than on leader participants and other stakeholders. The initial orientation phase explored care and leadership relationships using
patient and staff narratives alongside participant observation. Narratives were critically and creatively analysed with participants and after combining with other data sets, the whole team reviewed results and identified issues for action. Four action spirals structured the rest of the fieldwork. A critical and creative reflective inquiry method was designed to facilitate leader exploration of the lived leadership experience. A new nursing system based on primary nursing was implemented. Participant leader facilitated storytelling sessions with staff were set up and self-reflective inquiries were conducted. Collected data was thematically analysed post fieldwork and member-checked.
Findings:
The findings revealed relational processes and contextual influences on the development and living of person-centred leadership in a nursing context. A conceptual framework was created through blending findings with existent propositional knowledge. The relational domain describes the leader attributes enabling being in relation in
a person-centred way, processes for achieving relational connectedness, and positions leaders can take as they aim to enable associate wellbeing and empowerment. Contextual elements which influence and are influenced by leader-associate relating form the contextual domain. An additional framework describes facilitated workplace experiential/
transformative learning in safe, critical and creative learning spaces for leaders/learners to connect thinking with doing in order to influence future being.
Conclusions and implications:
The person-centred leadership framework contributes to relational leadership theory and offers clinical nurse leaders, educators and researchers a style of leadership congruent with the person-centred movement and developed within a nursing context. As the concept is new to nursing and healthcare, further research and
development is recommended.