E L P LAN DE D ESARROLLO Y LA S EGURIDAD : G OBIERNO DE S ERGIO F AJARDO

The formal leadership course or program content was of critical importance to the leadership learning achieved by participants in 18 of the 27 studies. Successful programs included content that had a strong theoretical foundation and were evidence-based. Educational content addressed specific identified learning or developmental needs. Leadership content that was culturally compatible, developmentally appropriate, and practically relevant was most effective.

A foundation in theory and evidence.

The importance of a foundation in theory and current evidence for academic curricula was described by study participants. Nurses valued the theoretical foundation for leadership provided in their formal nursing education. They described the need for both theory and skills training to prepare them for their leadership roles in clinical settings (Rani, Brennan, &

Timmons, 2010; Woolnough & Faugier, 2002). As the health care system becomes more complex and global, the evidence base evolves and the curricula must be adjusted. Participants in a study of global nurse leaders stressed the importance of inclusion of international nursing leadership content in educational curricula as the need for global nursing leadership increases (Kim, Woith, Otten, & McElmurry, 2006).

Recommendations for relevant nursing leadership curricula based on current evidence was particularly important for graduate programs (Eddy et al. 2009). As graduate students in nursing are taught essential evidence-based leadership and communication competencies, they should recognize leadership as a “vital nursing function” (p 7). An academic-practice

partnership to develop and implement an evidence-based, nontraditional graduate leadership curriculum to develop the nurse leader of the future has shown positive early outcomes (Dyess, Sherman, & Prestia, 2013).

An evidence and theory base was also considered essential for continuing education programs for nursing leadership development. Nurse leaders participating in a nursing leadership institute with an empowerment framework appreciated that the program was

“evidence-based and rigorous” (MacPhee, Skelton-Green, Bouthilette, & Suryaprakash, 2011, p. 6). This appreciation for a strong foundation was also true for programs focused on specific leadership competencies such as conflict communication (Brinkert, 2010). Evidence-based programs resulted in enhanced leadership competency and confidence and helped participants make the connections between theories and practice (Dyess & Sherman, 2011; Werrett, Griffiths, & Clifford, 2002).

Relevance for identified needs.

Leadership development programs were often offered based on perceived developmental needs and the desire to respond more effectively to environmental pressures. Programs in the United Kingdom, Canada and Belgium were implemented in response to perceived needs for improvement in healthcare leadership performance in complex systems (Dierckx deCasterle, Willemse, Verschuren, & Milisen, 2008; Janes, 2008; Spiers et al., 2010; Woolnough &

Faugier, 2002). The Leading an Empowered Organization program, launched as a governmental strategy to improve patient care by enhancing clinical leadership, helped participants lead more effectively and positively affected patient care. “I am clearer with staff about what is acceptable and what is not. This has been reflected in my staff’s performance—their approach towards patients has changed” (Woolnough & Faugier, 2002, p. 420). Similarly, in Canada, a province- wide Leadership Development Initiative was launched not only to improve leadership practices but also to enhance the leadership culture (Spiers et al., 2010). The program was seen as a means to reconnect leaders with one another, the organizational mission and vision and

ultimately improve care. All of these leadership programs were implemented with the belief that the content they offered would meet identified leadership development needs enabling the

system to produce better results.

In other studies, the identified leadership development content was specific to role, setting or skill. Multiple studies described participant experiences with continuing education content specific to their learning or developmental needs. The relevant content varied as nurses moved through different stages in their nursing careers. A developmentally appropriate design led to greater leadership learning success. For example, the content and structure of a novice nurse leadership institute (NNLI) enhanced the ability of new nurses to acquire clinical

leadership competencies. According to one nurse leader participant, “The program (the NNLI) gives the novice nurses an opportunity to reflect on their work and integrate the knowledge with their experiences and their practice setting” (p. 320). Several studies identified specific

developmental needs of charge nurses. Program content including unit finances and business management, staff performance and development, effective communication, and the

address specific knowledge and skill deficits (McCallin & Frankson, 2010; Patrician, Oliver, Miltner, Dawson, & Ladner, 2012). Nurse manager participants also described the value of program content specific to their leadership development needs and level of experience (Sullivan, Bretschneider, & McCausland, 2003). From newly qualified nurses to nurses in formal leadership roles, participants described a “practical skills deficit” (Rani et al., 2010, p. 98) and expressed an interest in content that was current and relevant to practice. As described by one participant, “Whatever you do, if you could really make it practical and tangible so they could take (the theoretic information) and apply it, that’s the very best” (Eddy et al., 2009, p. 13).

Culturally compatible.

Leadership content must not only be evidence-based, meet identified needs, and be relevant to nursing leadership practice, it must also be culturally appropriate. Participants in one study described dissatisfaction with some of the culturally-incompatible content and language used in the leadership development program and its effect on their learning (Werrett et al., 2002). They shared that the content contained jargon and was “Americanised” resulting in difficulty understanding the concepts (p. 468). Global nurse leaders also discussed the importance of culturally relevant content and mentorship in preparing for international leadership or interacting effectively with international colleagues (Kim et al., 2006). Other considerations for leadership course content include generational differences (Rani et al., 2010), learning styles (Foster, 2000), and the benefits of a specific nursing focus (MacPhee et al., 2011).