Systems and Complexity Thinking to Master Leadership Challenges in Interprofessional Health Professionals Education.

The purpose of this article is to propose that knowledge, understanding, and application of systems and complexity thinking can improve assessment, implementation, and evaluation of interprofessional education (IPE). Using a case story, the authors describe and explain a meta-model of systems and complexity thinking to support leaders in implementing and evaluating IPE initiatives. The meta-model incorporates the use of several important, interrelated frameworks that tackle issues of sense making, systems, and complexity thinking as well as polarity management at different levels of scale in an organization. Combined, these theories and frameworks support recognition and management of cross-scale interactions and help leaders make sense of distinctions among simple, complicated, complex, and chaotic situations among IPE issues associated with healthcare disciplines within institutions. The application and use of Liberating Structures and polarity management practices enable leaders to engage people and gain insight into the complexities involved in successful implementation of IPE programs.

Pilot Test of a Theory-Based Instrument to Measure Nursing Informatics Leadership Skills.

Understanding organizational cultures helps leaders focus on the content, context and levels of perspective needed to be successful leaders in the area of nursing informatics. The Minnesota Nursing Informatics Leadership Inventory (MNILI) was developed to expand assessment options and tools in the area of nursing informatics leadership. This article describes the result of the pilot test of the instrument. Using an ordinal Likert scale (0 = not like me to 4 = very much like me), respondents rated 12 leadership skills associated with four types of cultures across four scenarios. Respondents preferred collaborative culture leadership skills across all scenarios and differentially preferred culture-specific skills by scenario. Overall, older and more experienced respondents were more satisfied as leaders (p = 0.003) and more often used a democratic leadership approach (empower and care about all voices; p = 0.012). In three of the four cultures, nursing informatics leaders reported preferred and collaborative leadership skills that matched the scenario. This study provides preliminary evidence for using the MNILI to assess the requisite variety of nursing informatics leadership skills. Further research is needed to understand the dynamic interactions between organizational culture and nursing informatics leadership that are informed by conscious leadership and attention to the requisite variety of leadership skills.

Anticipating Disruptive Innovations With Foresight Leadership.

The purpose of this article is to discuss the importance of foresight leadership to anticipate disruptive innovations in health care. Nursing foresight leadership is defined. Types of foresight leadership styles are described. Selected disruptive trends in health care are identified. Strategies to develop foresight leadership are discussed. Foresight requires transformational leadership skills. Resources to support the development of foresight leadership are referenced. Readers are invited to engage in actions and learning activities to develop foresight leadership capacity to anticipate disruptive innovations in health care and build transformational leadership capacity of people in the profession of nursing.

A summative evaluation of productivity and accomplishments of Robert Wood Johnson Foundation Nurse Faculty Scholars Program participants.

From 2008 to 2017, the Robert Wood Johnson Foundation Nurse Faculty Scholars Program inspired, developed, and supported cohorts of next generation national leaders in academic nursing through career development awards. With support from mentors, scholars in the program created individual development plans focused on scholarship, teaching, service, and leadership. The curriculum of the scholar development program combined goals and objectives related to leadership development, enhancement of nursing education skills, and focused programs of research and scholarship. In addition, program outcomes emphasized engagement in institutional, university, and professional governance systems. This article describes and recounts findings from the program participants regarding accomplishments, productivity, and facilitators contributing to their achievement of program outcomes.

Nursing leadership in academic nursing: The wisdom of development and the development of wisdom.

The purpose of this article is to discuss insights derived from adult cognitive developmental theories and relate the insights to vertical leadership development in academic nursing contexts. Equipped with developmental understanding, academic leaders are in a better position to support the vertical leadership development of one's self, faculty, peers, and colleagues. From a cognitive developmental perspective, the authors' reason as leaders develop, grow, and evolve, sense making becomes more sophisticated and nuanced resulting in the development of wisdom. Leadership wisdom is a function of horizontal (acquisition of information, skills, and competencies) and vertical development (the development of more complex and sophisticated ways of thinking). Ways to enhance vertical development, and sense making to cultivate wisdom are discussed. Principles and practices that promote vertical development in self and others deepens performance expectations of those in the academy and supports personal professional development and organizational success.

Diversity dynamics: The experience of male Robert Wood Johnson Foundation nurse faculty scholars.

BACKGROUND: Managing diversity dynamics in academic or clinical settings for men in nursing has unique challenges resulting from their minority status within the profession. PURPOSE: The purpose of this study was to share challenges and lessons learned identified by male scholars in the Robert Wood Johnson Foundation Nurse Faculty Scholars program and suggest strategies for creating positive organizations promoting inclusive excellence. METHODS: Multiple strategies including informal mentored discussions and peer-to-peer dialogue throughout the program, formal online surveys of scholars and National Advisory Committee members, and review of scholar progress reports were analyzed as part of the comprehensive evaluation plan of the program. DISCUSSION: Diversity dynamic issues include concerns with negative stereotyping, microaggression, gender intelligence, and differences in communication and leadership styles. CONCLUSION: Male nurse faculty scholars report experiencing both opportunities and challenges residing in a predominately female profession. This article attempts to raise awareness and suggest strategies to manage diversity dynamics in service of promoting the development of a culture of health that values diversity and inclusive excellence for both men and women in academic, research, and practice contexts.

Perceived patient safety culture in a critical care transport program.

BACKGROUND: The purpose of this study was to examine the association among selected safety culture dimensions and safety outcomes in the context of a critical care transport (CCT) program. METHODS: A descriptive cross-sectional correlational design used the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture to validate perceived safety culture among personnel (n = 76) in a large Midwestern CCT program. RESULTS: Findings revealed significant associations between 1) teamwork and frequency of error reporting (r = .428, P < .001), overall perception of safety (r = .745, P < .001), and perceived patient safety grade (r = -.681, P < .001); 2) between perception of manager actions promoting safety and frequency of error reporting (r = .521, P < .001), overall perception of safety (r = .779, P < .001), and perceived patient safety grade (r = -.756, P < .001); and 3) between communication openness and frequency of error reporting (r = .575, P < .001), overall perception of safety (r = .588, P < .001), and perceived patient safety grade (r = -.627, P < .001). CONCLUSION: The study supports other literature showing significant associations among safety culture dimensions and safety outcomes and provides a framework for future research on safety culture in CCT programs.

Creativity and innovation: thought and action.

The purpose of this article is to discuss the significance of creativity and innovation in contemporary health care contexts, and to provide nurses and other health care professionals with models, resources, and ways of thinking about creativity that informs the development of an innovation-action and creative thinking mind-set. As the complexity of health care and nursing escalates, health care providers are challenged to think more creatively and develop innovations that advance the knowledge, learning, and service contributions of their discipline to the health care enterprise. Nursing requires creative thought and innovative action in service of the greater good.

Evaluating the outcomes of a distance-accessible PhD program.

The Doctor of Nursing Science (DNS) Program at Indiana University School of Nursing matriculated the first students in 1978. In 1996, the DNS program was phased out and the PhD in Nursing Science program was approved. Given advances in technology, market demand, and faculty expertise, a decision was made in 2002 to revise the PhD program to make it "distance-accessible" with courses and other learning experiences designed to be delivered using both synchronous and asynchronous Web-based technologies. As part of the newly designed program, distance-accessible courses were paired with an annual 2-week summer residential intensive learning experience on the Indiana University-Purdue University at Indianapolis (IUPUI) campus. This article discusses the process and outcome evaluation for this innovative program, with a particular focus on pedagogies faculty have found effective for scholarly mentoring and on best practices for distance-accessible doctoral education. Evaluation of program outcomes indicates graduates are well positioned to provide leadership in the areas of knowledge development for nursing science, practice, and education.

A database for nurse practitioner clinical education.

This article presents the utility and lessons learned regarding subscription to a database service for tracking nurse practitioner clinical education at the Indiana University School of Nursing. Initiatives and activities, such as the one described in this article, support the implementation of the Technology Informatics Guiding Educational Reform strategic agenda related to the transformation of nursing education through evidence and informatics. Descriptive reports of clinical database management are useful to conceptualize the evaluation of teaching and learning experiences as well as document the significance to students, faculty, future employers, and administration. The use of a database system for documentation of clinical experiences allows the student to practice and master informatics capabilities. Through data analysis, faculty can coordinate and assess students in the clinical environment and tailor learning experiences based on aggregated sets of patient encounters. Examination of the nature of patient encounters and clinical activities experienced permits an evidenced informed approach to student progress, curriculum development, and formative and summative evaluations.

Appreciative inquiry for leading in complex systems: supporting the transformation of academic nursing culture.

Increasingly complex environments in which nurse educators must function create distinct challenges for leaders in nursing education. Complexity is found in the presence of knowledge-driven economies, advancements in technology, and the blurring of campus boundaries created by online learning versus traditional classroom education. A dual bureaucracy of faculty and administration coexists in nursing education. The transformation of bureaucratic culture is a strategic challenge for academic leaders who strive to move dichotomous groups toward a collective vision of a preferred future. This article advocates for the affirmative administrative process of appreciative inquiry for academic nursing leadership, in nudging the dual bureaucracy toward transformational change. The intent and characteristics of appreciative inquiry are discussed, appreciative leadership strategies and actions are explained, methods for leading cultural paradigm shift are outlined, and an exemplar of the actualization of appreciative inquiry is presented.

Evaluating the impact of problem-based learning on learning styles of master's students in nursing administration.

Problem-based learning (PBL) was adopted in 1999 as the major teaching strategy in the four core courses of the master of science in nursing (MSN) program in Nursing Administration. Three standardized tests were used to assess the impact of PBL on student learning and performance. This article reports a study designed to assess the impact of a PBL curriculum on master's students' Learning Style Inventory (LSI-IIa). Experiential learning theory is used in this descriptive comparative design to compare LSI scores of 29 MSN students before and after two consecutive semesters of using PBL in Nursing Administration core courses. The post-PBL findings suggest that, in the learning cycle, students' preference increased for the conceptualizing-experiencing pole. Prior to PBL, 38% of the students selected the accommodator learning style and 34% selected the converger learning style. In post-PBL, 11 students changed their learning style, fewer students were in the accommodator group, and the converger group was unchanged. Differences in LSI scores are compared with those of post-RN students and medical students experiencing PBL curriculum changes. Assessing student outcomes in Nursing Administration MSN curriculum is possible with standardized tests designed by management and psychology educators. Experiential learning theory is a useful perspective from which to study PBL.

Learning Skills Profiles of master's students in nursing administration: assessing the impact of problem-based learning.

Attempts to compare graduate student performances before and after introducing new curricula are rare; yet faculties need outcome measures to justify program costs and demonstrate effectiveness. Boyatzis and Kolb's Learning Skills Profile is used to assess the outcomes of a problem-based learning MSN program. Increases were demonstrated among all 12 learning skills; statistically significant increases were found in eight of the personal learning skills and six of the job skill demands. Comparisons are made between scores of students in the MSN program and scores of master's students in business administration.

Using NANDA, NIC, and NOC (NNN) language for clinical reasoning with the Outcome-Present State-Test (OPT) model.

PURPOSE: To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS. A scoring instrument was developed and 100 worksheets were retrospectively analyzed. FINDINGS: NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. CONCLUSIONS: NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. IMPLICATIONS FOR PRACTICE: If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use.

The motivation to care: application and extension of motivation theory to professional nursing work.

PURPOSE: The purpose of this research is to describe a model of nurses' work motivation relevant to the human caring stance of professional nursing work. DESIGN/METHODOLOGY/APPROACH: The model was derived from selected theories of behavioral motivation and work motivation. Evidence-based theory addressing nurses' work motivation and nurses' motivational states and traits in relation to characteristics of organizational culture and patient health outcomes is suggested in an effort to make a distinct contribution to health services research. An integrated review of selected theories of motivation is presented, including conceptual analyses, theory-building techniques, and the evidence supporting the theoretical propositions and linkages among variables intrinsic to nurses' work motivation. FINDINGS: The model of the Motivation to Care for Professional Nursing Work is a framework intended for empirical testing and theory building. The model proposes specific leadership and management strategies to support a culture of motivational caring and competence in health care organizations. ORIGINALITY/VALUE: Attention to motivation theory and research provides insights and suggests relationships among nurses' motivation to care, motivational states and traits, individual differences that influence nurses' work motivation, and the special effects of nurses' work motivation on patient care outcomes. Suggestions for nursing administrative direction and research are proposed.

Promoting clinical reasoning in undergraduate nursing students: application and evaluation of the Outcome Present State Test (OPT) model of clinical reasoning.

Promoting clinical reasoning in undergraduate nursing students through application of the Outcome Present State Test (OPT) Model of Clinical Reasoning, is a challenge that can be successfully managed through effective teaching-learning strategies. Empirical evidence to support teaching strategies that foster both cognitive and metacognitive skill acquisition is limited. The purpose of this research was to evaluate the development of clinical reasoning skills among nursing students through the application and evaluation of teaching-learning strategies associated with self-regulated learning and the OPT model (Pesut & Herman, 1998; 1999; Pesut, 2004). The model and self-regulated learning prompts were used to structure learning with junior level baccalaureate nursing students during a ten-week, medical-surgical clinical experience in acute care telemetry units. Data analysis revealed students effectively made gains in learning associated with the OPT model. Qualitative analysis of self-regulated learning prompt journal data revealed students made significant gains in self-observation, self-judgment, knowledge work and use of health care personnel resources during clinical experiences. Results indicated the intentional use of guided reflection coupled with structure and learning tools of the OPT model significantly enhanced clinical reasoning skill acquisition, and provided evidence for the effectiveness of structured teaching learning strategies.

Promoting cognitive and metacognitive reflective reasoning skills in nursing practice: self-regulated learning theory.

BACKGROUND: Effective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skills. While a number of strategies have been implemented and tested to promote these skills, educators have not been able consistently to predict their development. Self-regulated learning theory suggests that this development requires concurrent attention to both the cognitive and metacognitive dimensions of reasoning in nursing care contexts. AIMS: This paper reports on a study to explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills. METHODS: Integrative review of published literature in social science, educational psychology, nursing education, and professional education using the Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resource Information Center (ERIC), and American Psychological Association (PsychInfo) Databases. The search included all English language articles with the key words clinical reasoning, cognition, critical thinking, metacognition, reflection, reflective practice, self-regulation and thinking. FINDINGS: Reflective clinical reasoning in nursing practice depends on the development of both cognitive and metacognitive skill acquisition. This skill acquisition is best accomplished through teaching-learning attention to self-regulation learning theory. A critical analysis of the literature in the areas of critical thinking and reflective practice are described as a background for contemporary work with self-regulated learning theory. It is apparent that single-minded attention to critical thinking, without attention to the influence of metacognition or reflection, is but one perspective on clinical reasoning development. Likewise, single-minded attention to metacognition or reflection, without attention to the influence of critical thinking, is another perspective on clinical reasoning development. While strategies to facilitate critical thinking and reflective practice have been used in isolation from each other, there is evidence to suggest that they are inextricably linked and come together with the use of self-regulated learning prompts. CONCLUSIONS: Students and practising nurses are able to improve their cognitive and metacognitive skills in clinical contexts by using self-regulated learning strategies. The self-regulated learning model in nursing is offered to support teaching and learning of reflective clinical reasoning in nursing practice contexts.