Sustainability in Clinical Practice: A Cross-National Comparative Study of Nursing Students in England and Sweden.

BACKGROUND: Delivering health care negatively influences the environment and contributes to climate change. This study examined how nursing students in England and Sweden can make changes in clinical practice to enhance environmental sustainability. METHOD: Third-year undergraduate nursing students at English and Swedish universities responded to open-ended questions on the Sustainability Attitudes in Nursing Survey. Data were analyzed using inductive content analysis. RESULTS: Students in both countries identified lack of confidence as the main barrier to challenging unsustainable practice, followed by a resistance to change in practice. English students predominantly changed their own behavior or influenced the practice of others. Swedish students either changed their own behavior or their own attitudes to sustainability. CONCLUSION: There is a need to ensure students have confidence to act as change agents to enhance sustainable practice in the clinical environment. [J Nurs Educ. 2022;61(7):390-393.].

Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study.

BACKGROUND: Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness. OBJECTIVES: This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014. DESIGN: A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. SETTINGS: Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia). PARTICIPANTS: A convenience sample of first-year undergraduate nursing students. METHODS: The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020. RESULTS: Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1-6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the 'inclusion of climate change and sustainability in the nursing curricula'. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland). CONCLUSIONS: Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.

Sustainability in critical care practice: A grounded theory study.

BACKGROUND: Sustaining high-quality, critical care practice is challenging because of current limits to financial, environmental, and social resources. The National Health Service in England intends to be more sustainable, although there is minimal research into what sustainability means to people working in critical care, and a theoretical framework is lacking that explains the social processes influencing sustainability in critical care. AIMS AND OBJECTIVES: This study aimed to explain the concept of sustainability from the perspective of practitioners caring for critically ill patients. DESIGN: The qualitative research followed a Charmazian constructivist grounded theory approach, including concurrent data collection and interpretation through constant comparison analysis. METHODS: In-depth interviews were conducted online or by telephone with 11 health care professionals working in critical care in the South of England (8 nurses, 2 physiotherapists, and 1 technician). Schatzman's dimensional analysis and Straussian grounded theory techniques supplemented the data analysis. RESULTS: Sustainability was defined as maintaining financial, environmental, and social resources throughout the micro, meso, and macro systems of critical care practice. The most pertinent social process enabling sustainability of critical care was satisficing (satisfaction of achieving a goal of quality care while sufficing within the limits of available resources). Increased satisficing enabled practitioners to fulfil their sense of normative, responsible, sustainable, and flourishing practice. Satisficing was bounded by the cognitive and environmental influences on decisions and an ethical imperative to ensure resources were used wisely through stewarding. CONCLUSIONS: An explanation of the concept of sustainability and significant social processes, in relation to critical care, are presented in a theoretical framework, with implications for how financial, environmental, and social resources for critical care practice can be maintained. RELEVANCE TO CLINICAL PRACTICE: This theory offers clinicians, managers, educators, and researchers a definition of sustainability in critical care practice and provides a structured approach to addressing critical care sustainability issues.

Student nurses exposed to sustainability education can challenge practice: A cohort study.

Climate change will adversely affect the health of populations and the ability of healthcare systems to deliver appropriate and timely care. Furthermore, resource scarcity requires nurses to practice in more sustainable ways. This study investigated the extent to which student nurses reported that they were able to apply their knowledge of sustainability in clinical practice following educational sessions on relevant topics. Students were exposed to scenario-based sustainability education in years 1, 2, and 3 of their 3-year program. Data were collected using a questionnaire that asked participants if they were able to implement sustainable practice. In year 2,121 students, and in year 3, 68 stated they made a change or challenged practice as a consequence of learning about sustainability. Barriers preventing them from challenging unsustainable practice were lack of confidence and resistance to change. Year-3 students were more able to influence unsustainable practice than were those in year 2. This study indicates that sustainability sessions, focused on aspects of clinical relevance, can support nurses to implement change; barriers remain that require confidence building for the students.

The Impact of Superfast Broadband, Tailored Booklets for Households, and Discussions With General Practitioners on Personal Electronic Health Readiness: Cluster Factorial Quasi-Randomized Control Trial.

BACKGROUND: Electronic health (eHealth) may improve health outcomes, but many people remain digitally excluded. Personal readiness to use the internet for health may be limited by lack of internet infrastructure, personal skills, social support, service provision, and cost. The impact of interventions to reduce these barriers is unknown. From 2011, the British Government supported the implementation of "superfast" broadband (Superfast) across the rural county of Cornwall. This provided the opportunity to assess the impact of interventions at regional, practice, and household levels. OBJECTIVE: This study aimed to assess the impact of 3 interventions on personal eHealth readiness: (1) regional-level implementation of Superfast, (2) practice-level discussions with general practitioners to encourage greater internet use in health service provision, and (3) household-level tailored booklets providing information to help improve personal skills in eHealth. METHODS: This was a cluster quasi-randomized factorial controlled trial. Implementation of Superfast was monitored, and postcodes were classified as having early or late availability. An algorithm selected 78 from 16,385 eligible postcodes to minimize the possibility of overlap between general practices and ensure a balance of urban and rural areas; 1388 households were randomly selected from the 78 postcodes and allocated to the 8 (2 × 2 × 2) study arms. A modified version of the Personal eHealth Readiness Questionnaire was used to compare scores (0 to 10) and 4 components (personal, provision, support, and economic) from baseline (August 2013) to the 18-month follow-up between the 8 arms, to assess the impact of interventions. We compared SDs of scores to assess changes in eHealth inequalities. RESULTS: eHealth readiness improved over 18 months from 4.36 out of 10 to 4.59 out of 10 (t235=4.18; P<.001; CI=0.13 to 0.35), resulting from increases in personal and provision components of the score (t255=3.191; P=.002 and t258=3.410; P=.001). However, there were no significant differences between the 3 interventions, either singly or in combination using intention-to-treat analysis. The proportion of internet users did not significantly increase (79.2%, 205/259 to 81.5%, 211/259) and mobile use was significantly greater (50.5%, 101/199 to 64.8%, 129/199). There was no change in eHealth inequality. CONCLUSIONS: People in Cornwall became more ready to adopt eHealth services, increasing both their personal ability to use eHealth and their methods of access. The implementation of Superfast may have contributed to this; we are certain that our other 2 interventions did not. This increased eHealth readiness did not cause a larger digital divide. The study illustrates the complexity of conducting a randomized controlled trial to assess the impact of interventions at regional, practice, and household levels. Our method may be of use to others. TRIAL REGISTRATION: ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT02355808 (Archived by WebCite at http://www.webcitation.org/75oEz0E1x).

The impact of hot food takeaways near schools in the UK on childhood obesity: a systematic review of the evidence.

BACKGROUND: Obesity is the greatest health issue for this generation; schools have improved food offered within their grounds. The built environment surrounding schools and pupils' journeys home have not received the same level of attention. This review identified papers on impacts of hot food takeaways surrounding schools in the UK. METHODS: Methods were informed by the PRISMA (QUORUM) guidelines for systematic reviews. Searches were completed in 12 databases. RESULTS: A total of 14 papers were included and quality assured before data extraction. Three descriptive themes were found; descriptions of hot food takeaway's geography and impacts concerning schools, strategic food policy and pupils reported food behaviour. CONCLUSIONS: Most included studies compared anthropometric measures with geographical location of hot food takeaways to find correlations between environment and childhood obesity. There was good evidence of more hot food takeaways in deprived areas and children who spend time in deprived neighbourhoods tend to eat more fast food and have higher BMIs. Few studies were able to quantify the correlation between school's environment and obesity amongst pupils. This lack of evidence is likely a factor of the studies' ability to identify the correlation rather than lack of a correlation between the two variables.

Developing digital educational materials for nursing and sustainability: The results of an observational study.

BACKGROUND: There is limited European literature on nursing and sustainability; nursing students are poorly prepared on the connections between resources, climate change, sustainability, and health, so they must acquire knowledge and develop skills and competencies in this field. The use of digital technologies and teaching via E-learning has grown, and has been widely adopted as a learning method for nursing. OBJECTIVES: The aim of the current study was to test and evaluate digital educational materials on environmental sustainability and health, in the context of university nursing education in different European countries. DESIGN: An observational cross-sectional design. SETTINGS: University of Plymouth, University of Jaén, and University of Esslingen for Nursing Degree Studies. PARTICIPANTS: 299 nursing students: 161 students from University of Jaén; 106 from Plymouth; and 32 from Esslingen. 22 professional evaluators with different profiles were recruited: Teachers, Clinical professionals, Delphi Experts, and Technical Experts. METHODS: We conducted a piloting and validation process. The materials were designed and adapted to the NurSusTOOLKIT Sustainability Literacy and Competency framework. Evaluation was developed by professionals and students. We used the Spanish Standard for the assessment of Digital Educational Material Quality at University level questionnaire. All students provided informed consent prior to taking part in the learning and evaluation. RESULTS: The overall evaluations of materials by students and professionals were 7.98±1.28 and 8.50±1.17, respectively. The Ability to generate learning was scored higher among students (mean difference: 0.84; 0.22-1.47; p=0.008). In the overall assessment by students, statistically significant differences were found between the three universities (Welch: 11.69, p<0.001). CONCLUSIONS: Students, professionals, and technical experts considered the materials to be very good quality, especially regarding the quality of contents, format, and design. For students, these materials can generate reflection and learning regarding environmental and health issues during nursing training.

Developing awareness of sustainability in nursing and midwifery using a scenario-based approach: Evidence from a pre and post educational intervention study.

BACKGROUND: The delivery of healthcare has an impact on the environment and contributes to climate change. As a consequence, the way in which nurses and midwives use and dispose of natural resources in clinical practice, and the subsequent impact on the environment, should be integral component of nursing and midwifery education. Opportunities need to be found to embed such issues into nursing curricula; thus bringing sustainability issues 'closer to home' and making them more relevant for clinical practice. OBJECTIVES: The study was designed to measure the impact of a sustainability-focussed, scenario-based learning educational intervention on the attitudes and knowledge of student nurses and midwives. DESIGN: Pre test/Post test intervention study using scenario-based learning as the educational intervention. The Sustainability Attitudes in Nursing Survey (SANS_2) was used as the outcome measure. SETTINGS: Clinical skills session in a UK University School of Nursing and Midwifery. PARTICIPANTS: 676 second year undergraduate nursing and midwifery students. METHODS: The 7-point scale SANS survey was completed before and after the teaching session; standard non-parametric analysis compared pre and post intervention scores. RESULTS: Changes were observed in attitude towards climate change and sustainability and to the inclusion of these topics within the nursing curricula (p=0.000). Participants demonstrated greater knowledge of natural resource use and the cost of waste disposal following the session (p=0.000). Participants also reported that sessions were realistic, and levels of agreement with statements supporting the value of the session and the interactive nature of delivery were higher following the session. CONCLUSIONS: Using a scenario-based learning approach with nursing and midwifery students can change attitudes and knowledge towards sustainability and climate change. Embedding this approach in the context of clinical skills provides a novel and engaging approach that is both educationally sound and clinically relevant.

Tweet if you want to be sustainable: a thematic analysis of a Twitter chat to discuss sustainability in nurse education.

AIM: To explore the concept of sustainability in nursing using social media as a vehicle for discussion on the topic. BACKGROUND: There is a need for an increased awareness among nurses of the issues that are crucial for the healthcare sector to prepare for climate change and contribute to sustainable development. However, topics about sustainability and climate change are not a requirement of nursing curricula in Europe; social media provides an opportunity to raise issues and promote discussion. DESIGN: A thematic analysis of a Twitter discussion. METHODS: A Twitter discussion session hosted by @WeNurses took place on 24 March 2015 over 1 hour. Data were gathered via this online discussion hosted on Twitter, a social media platform. Following the discussion a thematic analysis of the posted Tweets was conducted. FINDINGS: One hundred and nineteen people posted nine hundred and ninety six Tweets, a reach of 3,306,368. Tweets broadly followed the questions posted by the team. Several threads related to the sustainable use of healthcare resources and the need to reduce waste was evident. A Word Cloud of the Tweets highlighted prominent words in the discussion: sustainability, nursing/nurses, curriculum, important, waste, practice, resources, student, plastic, health, gloves. CONCLUSION: Social media is an effective way of engaging nurses and students in a discussion on challenging issues. Sustainability appears to be important for nurses, with a particular emphasis on resource use and the importance of sustainability topics in nurse education.

Including sustainability issues in nurse education: A comparative study of first year student nurses' attitudes in four European countries.

INTRODUCTION: Education in sustainable development is a goal recognised by a large number of countries and a vital concept in healthcare. It is therefore important that nurse education incorporates elements of sustainable development into nursing education curricula. However, there is limited research on student nurses' attitudes towards sustainability and no comparison of attitudes towards sustainability and its inclusion in the nursing curriculum across Europe. AIM: This project aims to assess student nurses' attitudes towards sustainability, its relevance to nursing and its inclusion in the nursing curricula. 1. To assess base-line attitudes at the start of nursing and midwifery training; 2. To compare sustainability awareness between students participating in training in a number of European universities. DESIGN: A comparative survey design using the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. SETTINGS: Nursing classes of Universities and Nursing Schools in four European countries were investigated using a questionnaire consisting of five sustainability-related items. PARTICIPANTS: 916 nursing students (UK: 450, Germany: 196, Spain: 124, Switzerland: 146). DATA ANALYSIS: Standard descriptive and inferential statistical methods were used to establish psychometric quality (Principal Components Analysis, Cronbach's alpha, Pearson correlations) and compare student nurses from the four countries. RESULTS: The reliability of SANS_2 was good (Cronbach's alpha=.82) and the five items loaded on a single factor which explained 58% of variance. ANOVA of the SANS_2 total score showed significant differences between countries with German nursing students showing more sustainability awareness than students from the UK and Spain. CONCLUSIONS: SANS_2 is a reliable instrument to assess nursing students' sustainability awareness; there are significant differences in sustainability awareness of students of different European countries. Limitations of the study include non-random sampling, possible method effects and social desirability effects. RELEVANCE TO CLINICAL PRACTICE: Sustainability will become increasingly important in clinical practice; greater knowledge about the attitudes of nurses towards sustainability can support the development and testing of sustainability-focused teaching and learning materials.

Nursing students' attitudes towards sustainability and health care.

Aim To evaluate attitudes towards embedding sustainability and climate change in nursing curricula among nursing students, some of whom had participated in a sustainability and health skills session, and determine whether the session could improve knowledge of sustainability. Methods Three months after the sustainability session, students who had participated along with a sample of students who had not, completed a Sustainability Attitudes in Nursing Survey questionnaire. This investigated attitudes towards climate change and sustainability in nursing curricula and the costs of clinical and domestic waste disposal. Results Nursing students were positive about sustainability and climate change and its inclusion in the curriculum, irrespective of their participation in the sustainability scenario session. Participants in the sustainability session were more likely to identify correctly the cost of clinical waste disposal in the NHS. Conclusion The sustainability and health skills session has the potential to improve nursing students' knowledge of the cost of clinical waste disposal.

"I assumed that one was a placebo": exploring the consent process in a sham controlled acupressure trial.

OBJECTIVES: In clinical trials where participants are likely to be able to distinguish between true and sham interventions, informing participants that they may receive a sham intervention increases the likelihood of participants 'breaking the blind' and invalidating trial findings. The present study explored participants' perceptions of the consent process in a sham controlled acupressure trial which did not explicitly indicate participants may receive a sham intervention. DESIGN: Nested qualitative study within a randomised sham controlled trial of acupressure wristbands for chemotherapy-related nausea. Convenience sample of 26 patients participated in semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Transcripts analysed thematically using framework analysis. SETTING: Study conducted within three geographical sites in the UK: Manchester, Liverpool, and Plymouth. RESULTS: All participants indicated that they believed they were fully informed when providing written consent to participate in the trial. Participants' perceived it was acceptable to employ a sham intervention within the trial of acupressure wristbands without informing potential participants that they may receive a sham treatment. Despite the fact that participants were not informed that one of the treatment arms was a sham intervention the majority indicated they assumed one of the treatment arms would be placebo. CONCLUSIONS: Many trials of acupuncture and acupressure do not inform participants they may receive a sham intervention. The current study indicates patients' perceive this approach to the consent process as acceptable. However, the fact participants assume one treatment may be placebo threatens the methodological basis for utilising this approach to the consent process.

Effect of climate change and resource scarcity on health care.

Climate change and resource scarcity pose significant threats to healthcare delivery. Nurses should develop the skills to cope with these challenges in the future. Skills sessions using sustainability scenarios can help nursing students to understand the effect climate change and resource scarcity will have on health care. Involving design students in clinical skills sessions can encourage multidisciplinary working and help to find solutions to promote healthcare sustainability.

A non-participant observational study of health and social care waste disposal behaviour in the South West of England.

INTRODUCTION: The National Health Service in England has a large carbon footprint. Waste production and disposal contributes to this carbon footprint and costs the National Health Service England over £82 million per annum. This study builds on existing work regarding health care waste management in the United Kingdom where the potential for recycling has begun to be studied. The study focuses on a private hospital and social care organizations, and provides a more detailed study of the behaviour of individuals across a variety of waste management systems. METHODS: The study was an overt observational study at four health and social care sites in the South West of England. Systematic observations were made of the waste disposed of by employees in which the observer recorded: a description of the waste item; the bin into which the waste was placed; the type of employee who disposed of the waste; the material the waste comprised and the appropriateness of the disposal behaviour. RESULTS: The domestic waste bin was found to be most commonly used by employees to dispose of waste (51%), and the materials observed being disposed of most often were paper (26%), organic wastes (19%) and plastic (19%). There were significant differences between the four sites indicating that the activities performed at each site may have been influencing the waste being disposed of. CONCLUSION: It was concluded that the transfer of waste from the domestic waste stream to the recycling waste stream should be a central focus for the design of new health and social care waste management systems. Employees will require guidance and training in identifying and classifying waste materials for recycling.

The effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: a randomized controlled trial.

CONTEXT: Both positive and negative results have been reported in the literature from the use of acupressure at the P6 point, providing evidence of highly suggestive but not conclusive results. OBJECTIVES: To clarify whether acupressure is effective in the management of chemotherapy-related nausea and vomiting. METHODS: A randomized, three-group, sham-controlled trial was designed. Patients with cancer receiving chemotherapy were randomized to receive standardized antiemetics and acupressure wristbands, sham acupressure wristbands, or antiemetics alone. Primary outcome assessment (nausea) was carried out daily for seven days per chemotherapy cycle over four cycles. Secondary outcomes included vomiting, psychological distress, and quality of life. RESULTS: Five hundred patients were randomized. Primary outcome analysis (nausea in Cycle 1) revealed no statistically significant differences between the three groups, although nausea levels in the proportion of patients using wristbands (both real and sham) were somewhat lower than those in the proportion of patients using antiemetics-only group. Adjusting for gender, age, and emetic risk of chemotherapy, the odds ratio of lower nausea experience was 1.18 and 1.42 for the acupressure and sham acupressure groups, respectively. A gender interaction effect was evident (P = 0.002). No significant differences were detected in relation to vomiting, anxiety, and quality-of-life measures. CONCLUSION: No clear recommendations can be made about the use of acupressure wristbands in the management of chemotherapy-related nausea and vomiting as results did not reach statistical significance. However, the study provided evidence of encouraging signals in relation to improved nausea experience and warrants further consideration in both practice and further clinical trials. TRIAL REGISTRATION: This trial is registered with the ISRCT register, number ISRCTN87604299.

The use of evidence-informed sustainability scenarios in the nursing curriculum: development and evaluation of teaching methods.

BACKGROUND: Climate change and resource scarcity pose challenges for healthcare in the future, yet there is little to raise awareness about these issues in the nursing curriculum and nurses are poorly equipped to practice in a changing climate. The aims of this paper are to describe how an evidence-informed 'sustainability and health' scenario based on two sustainability issues (resource depletion and waste management) was introduced into a nursing clinical skills session, and to report the evaluation of the session. METHODS: Based on evidence from our own research on waste management, sustainable procurement and resource scarcity, a practical hands-on skill session was delivered to 30 second year student nurses as part of a scheduled clinical skills day. The session was observed by one of the facilitators and interactions recorded and this was followed by a brief questionnaire completed by participants. FINDINGS: Observations of the group sessions and discussion found that students demonstrated limited knowledge about natural resources (such as oil) used in the production of items used in healthcare; they engaged in discussions following the use of Internet resources, and were able to segregate waste appropriately. Thirty (100%) students completed the evaluation questionnaire, found the resources used in the skill session helpful, and thought that the scenarios were realistic. Nineteen reported being more aware of peak oil; 30 were more aware of risks to patient experience and service delivery if resources become unavailable; 30 reported greater awareness of the management of waste in healthcare. Comments on the questionnaire indicated a high level of engagement and interest in the subject. CONCLUSION: The problem of climate change and resource scarcity can too easily be seen as a distant or intractable problem. However one way to make this topic real for students is through the use of clinically relevant scenarios in skill sessions.

Strategies to identify future shortages due to interruptions in the health care procurement supply chain and their impact on health services: a method from the English National Health Service.

OBJECTIVES: The uninterrupted supply of essential items for patient care is crucial for organizations that deliver health care. Many products central to health care are derived from natural resources such as oil and cotton, supplies of which are vulnerable to climate change and increasing global demand. The purpose of this study was to identify which items would have the greatest effect on service delivery and patient outcomes should they no longer be available. METHODS: Using a consensus development approach, all items bought by one hospital, over one year, were subjected to a filtering process. Criteria were developed to identify at-risk products and assess them against specific risks and opportunities. Seventy-two items were identified for assessment against a range of potential impacts on service delivery and patient outcomes, from no impact to significant impact. Clinical and non-clinical participants rated the items. RESULTS: In the category of significant impact, consensus was achieved for 20 items out of 72. There were differences of opinion between clinical and non-clinical participants in terms of significant impact in relation to 18 items, suggesting that priority over purchasing decisions may create areas of conflict. Reducing reliance on critically scarce resources and reducing demand were seen as the most important criteria in developing sustainable procurement. CONCLUSION: The method was successful in identifying items vulnerable to supply chain interruption and should be repeated in other areas to test its ability to adapt to local priorities, and to assess how it functions in a variety of public and private settings.

To explore and understand the leadership experiences of modern matrons, within an acute NHS Trust.

Aim The aim of this study was to explore and understand the leadership experiences of modern matrons. Background Modern matrons were re-introduced to the National Health Service in 2002, and effective leadership has been identified as being essential for the role to be successful. However, there is minimal evidence of how modern matrons experience effective leadership. Methods The study used a descriptive generic qualitative methodology; one-to-one semi-structured interviews were conducted with nine matrons. This was subjected to an inductive thematic analysis. Results Three themes were found to influence modern matron's leadership experiences: leadership behaviours, negative influences and leadership investment. They did not follow one leadership style but adapted this to their situation. Various factors appeared to restrict their leadership effectiveness. Conclusions The findings suggest that exposure to a range of leadership styles should be included in preparation and CPD for the modern matron role and a more consistent job description and job purpose should be developed. Implications for nursing management Leadership styles such as transformational leadership alone do not meet the complex demands of nursing leaders, and therefore there is a requirement for greater flexibility in leadership development for all health care professionals.