Cheryle Moss

Transformational leadership and shared governance: an action study.

bamford-wade a. & moss c. (2010) Journal of Nursing Management 18, 815–821 Transformational leadership and shared governance: an action study Aims  The present study demonstrates the practical relevance of the concepts of transformational leadership as a Director of Nursing working with structure (shared governance) and active processes, informed by action research, to achieve the incremental breakthroughs associated with culture change in nursing. Background  Responding to the context of a decade of health reforms in a New Zealand tertiary hospital, the leadership challenge, as a Director of Nursing, was to find ways of transforming the nursing workforce. How could nursing evolve from a relatively disempowered position within the organization (impact of the reforms) and reshape to achieve effectiveness within the new organizational culture? Methods  Interwoven with transformational leadership are action processes progressively moving forward through cycles of reconnaissance, planning, implementation and evaluation. The principles of shared governance ‘partnership’, ‘equity’, ‘accountability’ and ‘ownership’ underpin and work synchronically with the active processes in advancing the effectiveness of nursing. It is leadership for and in action. This study is descriptive and exploratory overall, and more specifically it uses reflective practice and self-reporting as methods. Results  The outcomes of transformational leadership are evident in a confident, competent and committed nursing workforce which embraces continuous learning and expresses a professional respect for each other. Conclusions  The practical inter-weaving of the concepts of transformational leadership, shared governance and action processes provide a framework for sustainable change processes both at a unit and organizational level. Implications for nursing management  It is the interplay between the three concepts that generates a process of creative innovation, questioning and challenging existing structures to try and reach a new level of excellence through the participation and valuing of nurses and nursing practice.

Exploring the value of dignity in the work-life of nurses.

In this paper the authors draw attention to the value of nurse dignity in the work-life of nurses. How does the profession currently understand this as a concept and construct? How might the valuing of worker dignity in the workplace affect the wellbeing of the workforce? A review of nursing literature and a theoretical lens on worker dignity derived from recent work by Hodson (2001) was used to explore these questions. In the context of current and international workforce issues associated with recruitment and retention, analysis of the construct of worker dignity within the profession takes on a strong imperative. The large existing body of research into nursing workplace environments highlights concern that nurses have in understanding and improving work-life quality. Findings of this inquiry reveal that while there is a degree of coherence between the nursing research and elements of Hodson’s (2001) research on worker dignity, the dignity of nurses, as a specific construct and as an intrinsic human and worker right has received little explicit attention. Reasons for this may lie partly in approaches that privilege patient dignity over nurse dignity and which rely on the altruism and self-sacrifice of nurses to sustain patient care in environments dominated by cost-control agendas. The value of dignity in the work-life of nurses has been under-explored and there is a critical need for further theoretical work and research. This agenda goes beyond acceptance of dignity in the workplace as a human right towards the recognition that worker dignity may be a critical factor in sustaining development of healthy workplaces and healthy workforces. Directing explicit attention to nurse dignity may benefit the attainment of both nurse and organisational goals. Hodson’s (2001) framework offers a new perspective on dignity in the workplace and leads to new insights and a slightly different view of a ‘road well travelled’ in nursing literature.

A model of treatment decision making when patients have advanced cancer: how do cancer treatment doctors and nurses contribute to the process?

This qualitative study describes how doctors and nurses report their contribution to treatment decision-making processes when patients have advanced cancer. Thirteen nurses and eight doctors involved in cancer treatment and palliation in one geographical location in New Zealand participated in the study. Data were collected using qualitative in-depth, face-to-face interviews. Content analysis revealed a complex context of decision making influenced by doctors and nurses as well as the patient and other factors. A model of clinician and patient decision making emerged with a distinct and cyclical process as advanced cancer remits and progresses. When patients have advanced cancer, nurses and doctors describe a predictable model of decision making in which they both contribute and that cycles through short- and long-term remissions; often nowadays to the point of the patient dying. In conclusion, the findings suggest doctors and nurses have different but complementary roles in what, when and how treatment choices are negotiated with patients, nevertheless within a distinct model of decision making.

Understanding moral habitability: a framework to enhance the quality of the clinical environment as a workplace.

Abstract There is compelling evidence in the nursing literature that the workplace is experienced as morally uninhabitable for many nurses and yet the concept of moral habitability remains underdeveloped. An integrative review on moral habitability in nursing was undertaken. The findings reveal that the primary concepts by which nurses write and research aspects of moral habitability are moral climate, moral agency, moral sensitivity and moral distress. It is revealed that nurses in their clinical work experience adversity and moral distress through relational challenges and contextual difficulties that can challenge habitability and inhibit nurses’ capacity to provide morally sensitive patient care. The primary concepts identified provide a framework for further development of the concept of moral habitability within nursing practice. The related data within the integrative review also highlights the need for further research into enhancing and sustaining morally habitable workplaces for nurses.

Re-visiting scholarly community engagement in the contemporary research assessment environments of Australasian universities.

Abstract Restructuring of university environments to meet funding requirements based on research performance presents challenges internationally to nursing and other allied health groups. These funding models generate more emphasis on the scholarship of discovery than on the scholarship of integration, the scholarship of application, and the scholarship of sharing knowledge. Yet achievement of health advances by these disciplines is unlikely to emerge through laboratorybased research. They are more likely to emerge through scholarly research activities which involve partnerships between universities and communities. Current emphases on research assessment and quantum measurements are particularly associated with the scholarship of discovery, and thus raise concerns that such pressures may lead universities and other organisations away from community engagement. In response to these issues, the importance of linking scholarship and communities, furthering mechanisms to legitimise scholarly community engagement, and reducing barriers to this in the context of the contemporary university research environments are argued. Boyer’s model of scholarship (that the work of universities centres around four areas of scholarship: discovery, integration, application and sharing knowledge) highlights these tensions. It is suggested that by revisiting Boyer’s model and considering the ways in which it may generate possibilities for scholarly community engagement, university schools of nursing in the contemporary research assessment environment could find ways to balance the forms of scholarship by which social good can be advanced.

End‐of‐life care in acute hospitals: an integrative literature review

bloomer mj, moss c & cross wm (2011)Journal of Nursing and Healthcare of Chronic Illness 3, 165–173 End-of-life care in acute hospitals: an integrative literature review Aim.  To explore and define the current status of published literature related to end-of-life care in the acute hospital setting. Background.  Chronic illness is now the leading cause of death in developed countries because the population is and the advances in health care delivery. In Australia, two-third of people with chronic illness who die is inpatient in an acute hospital. Whilst most of the attention regarding end-of-life care and dying has focused on palliative care settings, there is a need to consider those dying outside of specialist palliative care settings. Design.  Integrative literature review. Methods.  Using an integrative approach, electronic searches of selected databases were undertaken, using comprehensive search terms. Secondary sources were also identified through the reference lists of retrieved literature. Results.  The literature review identified a lack of high-quality scientific evidence to direct end-of-life care as delivered in the acute (non-palliative care) sector. From the literature available, five core themes/issues were generated to reflect the literature. Conclusions.  There is a need for research to investigate end-of-life care in the acute hospital setting. Care pathways are in use to varying degrees without validation, but implementation alone does not ensure quality end-of-life care. Cultural factors can impede/impact practice and the ability of clinicians to recognise ‘active dying’ has been shown to be problematic, delaying the transition to end-of-life care. Relevance to clinical practice.  Given that the majority of deaths in Australia occur in acute hospital settings, clinicians should be delivering expert life-sustaining acute care and also quality end-of-life care.

Blending practice development methods with social science research: An example of pushing new practice research boundaries

Innovating research methods to better suit clinical contexts and practice puzzles is key to the advancement of practice. To illustrate a mechanism by which this development can be achieved the authors offer a research narrative which is revealing of their thinking, methodological positioning and research activities as they sought to innovate a research design to suit the clinical issues, puzzle and research context. The trigger for this innovative research design was the opportunity provided by a short timeframe and small amount of research funding to work with a health board clinical puzzle to explore presentations of older people to emergency departments in relation to those could be avoided, and by implication consider how better ways of caring for older people could be devised. In the example provided, the authors reveal how they blended practice development methods with collaborative action research to develop a reconnaissance study. The findings and outcomes of the study are affirming of the approach, methodological strategy and use of practice development methods to support engagement and puzzling as methods which support reconnaissance in relation to a complex clinical scenario such as ‘avoidable’/‘inappropriate’ presentation of older persons in the emergency department.

Plotting care: A modelling technique for visioning nursing practice in current and future contexts

Abstract Health professionals in health-care organisations are frequently challenged to strategise their services, reshape patterns of care delivery and to adapt to changing environments. Relocation of services into new hospital buildings is one example of a situation that generates these challenges. In this paper the authors discuss an innovative modelling strategy that was employed to assist nurses to explore their current daily care practices, to visualise them in the context of proposed new buildings, and to work towards planning care in readiness for the new context. The modelling technique of ‘plotting’ is presented as a way of capturing the natural spatial-service wisdom that exists within teams, and assisting them to translate their knowledge of this to each other and to co-operatively work towards a new clinical future. Plotting will be of use to health professionals, clinical leaders and educators who are interested in spatial analysis of care and other health service practices.

What does practice development (PD) offer mental health‐care contexts? A comparative case study of PD methods and outcomes

Accessible summary Comparing three bespoke practice development (PD) projects reveals similarities in the principles of person-centred practice and cathartic personal growth, as relevant concepts to mental health. PD offers a collaborative approach to practice-driven quality improvement initiatives suitable to the psychologically informed mental health context. Creating a workplace culture that allows all involved to contribute to service improvement can be achieved through embracing a PD-driven change management strategy that aims to stimulate culturally sensitive care delivery. Abstract Practice development (PD) in mental health nursing has been progressing over the last decade; however, the level and impact of PD activity in the field of mental health remains poorly understood outside localized project impact. More specific reporting and comparative analysis of PD outcomes will improve this situation. In response, this paper presents three case scenarios from work taking place in Australia and New Zealand, as working examples of how PD methodologies have been applied within mental health practice settings. Using a comparative framework that captures the contributing assumptions, practices, processes and conditions imperative to effective PD work within a mental health-care context, three case vignettes are reviewed. The critical question driving this paper is ‘what mental health-care services does PD offer in terms of transformational change approaches and the promotion of effective workplace cultures?’ Conditions considered necessary for successful PD initiatives within mental health contexts are explored such as how PD converges and diverges with mental health-related theories, plus where and how PD activity best integrates with the specific elements associated with mental health-care provision. The findings are further reviewed in line with reports of PD outcomes from other fields of health care.

Single‐room usage patterns and allocation decision‐making in an Australian public hospital: a sequential exploratory study

AIMS AND OBJECTIVES The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service. BACKGROUND There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice. DESIGN This study used a sequential exploratory design with data collected in 2014. METHODS A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation. RESULTS Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need. CONCLUSION Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making. RELEVANCE TO CLINICAL PRACTICE There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.