HUNDIMIENTO Y AGRIETAMIENTO DE SUELO

Abstract

Nurses are being called upon to play a transformational leadership role in creating a better healthcare system. Developing the leadership capacity in nurses at every level of practice is pivotal to the ability of the profession to effect the innovative change envisioned for the future of health care. A metasynthesis was conducted to explore experiential learning of nurses and its contribution to their leadership development. Noblit and Hare’s approach was used for the

metasynthesis process. Three overarching themes emerged. They include: not quite ready to lead: connecting the dots through experiences, key relationships that guide the journey, and a toolkit for the process. Providing relevant leadership learning experiences with the support of a guiding relationship, facilitated by helpful tools and techniques, enhances the leadership

competency development of nurses at all levels. Inclusion of purposeful, guided experiential learning into the leadership development of nurses has potential to better prepare nurses for their leadership roles in healthcare.

The opportunity for nurses to exercise leadership has never been greater. Nurses are being called upon to play a transformational leadership role in creating a healthcare system that is of high quality, safe, affordable and accessible (IOM, 2011). The nursing profession, with its scientific foundation, understanding of care processes, and close connection to patients and families throughout the continuum of care, is expected to lead as well as collaborate in improvement and innovation. Developing the leadership capacity in nurses at every level of practice is pivotal to the ability of the profession to effect the innovative change envisioned for the future of health care.

Strategies to effectively prepare nurses for their leadership roles are being explored worldwide. The literature describes curricular enhancement, leadership continuing education programs, programs to enhance role transitions, and the creation of opportunities and experiences for nurses to engage in leadership behaviors and activities. Both formal and informal learning experiences have been shown to enhance nursing leadership competence and confidence. Qualitative studies have provided an understanding of strategies nurses perceive to facilitate or limit their leadership development.

The purpose of this study is to construct a synthesized understanding of nurses’ leadership learning experiences beyond the classroom. The intent is to capture nurses’ voices related to the effect of experiential learning on their leadership development. Knowledge of the contribution of these learning opportunities, as described in qualitative studies, will inform efforts to improve the application of formal leadership learning in the practice setting and policy arena, and better prepare nurses for their transformational leadership role.

Method

A metasynthesis related to the role of experiential learning on the leadership development of nurses was conducted. Metasynthesis is an interpretation of the findings of relevant qualitative studies. Through the interpretive process, the study findings are integrated into a synthesized whole that provides greater insight into the experience than any one study could provide (Sandelowski & Barroso, 2007). Noblit and Hare (1988) describe the method as a “holistic interpretation” (p. 10) that preserves the integrity of each of the individual studies while translating them into one another to better explain a phenomenon.

Sample

The sample for this metasynthesis included 24 studies, either qualitative or mixed method, that reported findings related to the contribution of experiential learning to leadership development in nurses. The studies were published between 1999 and 2012. The qualitative research was conducted in various countries throughout the world. Three studies were conducted in Australia, one in Finland, six in the United Kingdom and fourteen in the United States.

A total of 973 nurses at various stages of leadership development were included in the studies. Nurse participant roles included nursing students, newly licensed nurses, experienced staff nurses, charge nurses, nurse managers, nurse executives and nurse faculty leaders. Two articles, one published by Young, Pearsall, Stiles and Horton-Deutsch (2011) and one published by Horton-Deutsch, Young and Nelson (2010), were based on the same sample of 21 nurses, but focused on different aspects of the findings. For the purpose of calculating a total sample of participants for the metasynthesis, the 21 nurses from these two articles were counted only once.

Various qualitative research designs were used in the studies. The most frequently used design was focus groups (n = 7) either alone or in combination with other data collection

methods. Descriptive designs, using interviews to obtain data, were also frequently used (n = 6). There were three interpretive phenomenological studies, two case studies, two narrative analyses, and one grounded theory study. Two studies used surveys with qualitative components,

including one conducted by email. Appendix A includes the demographic and methodological characteristics of the sample.

Data Collection and Analysis

This metasynthesis of the role of experiential learning in nursing leadership development was conducted using the Noblit and Hare (1988) approach for synthesizing qualitative studies. The analytic process consists of a series of phases that allow for the systematic translation of studies into one another; ultimately leading to a synthesized interpretation of the phenomenon of interest. The seven phases may overlap and be repeated until the process is complete.

The study began with an interest in the perspective of nurses on leadership development and the experiences that have contributed to it. Online databases including the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed were searched from the years 1997 to 2012. Key terms such as leadership development, nursing, qualitative research, clinical leadership, experiential, mentor, preceptor, and coach were used alone and in combination to identify relevant published qualitative or mixed methods studies. As studies were reviewed, reference lists were explored for other potentially pertinent qualitative studies.

It was important to decide what studies would be relevant to this research question (Phase 2). The criteria for inclusion in the metasynthesis were that the study focused on the

development of leadership competencies in nurses, included an experiential learning component, and the research design was qualitative or that there was a qualitative component to the study. Key roles or processes that fostered experiential leadership learning were important to include.

There were no limitations on the type of qualitative design. This phase culminated in the selection of 24 qualitative studies that included findings pertinent to the research aim. Phase 3 required repeated reading of the studies and reflection on their findings and metaphors or themes. Repeated reading and reflection set the stage for Phase 4, the process of deciding how the studies relate to one another and to the research question. It involved identifying the key metaphors and juxtaposing them; conceptualizing how they related or fit together. Key metaphors were inserted into a mind map using Mindjet MindManager software allowing for movement and placement of related concepts into a visual thematic framework. Appendix B reflects the results of the juxtaposition process.

The fifth phase was translating the studies into one another. This was an interpretive process that preserved the integrity of the initial account of the phenomenon and the metaphors used to describe it, but translated those metaphors into those identified in the other studies. In the case of this metasynthesis, the translation was reciprocal (Noblit & Hare, 1988). That is, the studies had similar metaphors or themes for translating into one another. Phase 6 involved synthesizing the translations into a whole which was more than the sum of the individual parts described in individual studies. The last phase in this iterative process was expressing the synthesis in such a way as to fully describe the role of guided experiential learning in nursing leadership development.

The synthesis of the themes or metaphors in the studies suggests that there are three important elements that comprise guided experiential learning as a key ingredient for successful nursing leadership development. They include: not quite ready to lead-connecting the dots through experiences, key relationships to guide the journey, and a toolkit for the process.