Meta-Reflections

PlexusCalls on The Future of Nursing

2012-01-29T18:52:00.006-05:00

I had the good fortune of serving for the past seven years on the Plexus Institute board of trustees. In 2010-11, I served as chairman of the board. Plexus does great work! In service of my intention in writing this blog, "Meta-Reflections" (creating community and inviting action through reflection and sharing of personal, professional and public resources), I invite you to explore resources available to you at Plexus Institute. There are a great number of PlexusCall podcasts available free of charge at iTunes or by accessing archived PlexusCalls at Plexus Institute.

I want to particularly draw your attention to a series of calls, titled "The Future of Nursing," that were produced in the fall of 2011. (Thanks to Prucia Buscell of Plexus Institute for providing some of this information.) The Future of Nursing podcasts, Parts I, II and III, included nurses from across the country who explored the RWJF and Institute of Medicine Future of Nursing report and discussed how complexity principles could influence and inspire effective change and provide solutions to issues challenging nurses in education and practice settings. Below is a brief description of each part, linked to the appropriate podcasts. I hope these calls will provide you with new information and opportunities for reflection and action.

The Future of Nursing, Part I

On the first call, Liana Orsolini-Hain, PhD, RN, CCRN, a Robert Wood Johnson Foundation (RWJF) Fellow from California, says nurses, as the largest portion of the health care work force, are in the best position to promote improved patient protections and increased access to care. Itemizing key messages in The Future of Nursing report, she emphasizes that all nurses should:

Practice to the fullest extent of their education and training.
Achieve higher levels of education and training through an improved education system revised to promote seamless progression.
Be full partners with physicians and other professionals in designing health care.
Work toward improved data collection and infrastructure that makes policy making more effective.

Orsolini-Hain says leadership is needed to shift focus from individual practices to the needs of national populations and the role of health care teams. The educational goals, she says, include increasing the number of nurses with bachelor’s degrees to 80 percent by 2020, and doubling the number of nurses with doctorates.

The Future of Nursing, Part II

This series of calls features a description of how the complexity-informed processes of Appreciation, Influence and Control (AIC) were used to create, with the future transformation of nursing education in mind, an appreciation of the nursing culture. AIC, developed by William E. Smith, PhD, author and principal of Organizing for Development, was introduced to nurses at the 2009 Plexus “Nursing On the Edge” Conference. Building on work introduced in 2009, Smith partnered with Cynthia Hornberger, PhD, MBA, RN, ARNP, professor and special assistant to the president at Washburn University School of Nursing, and me, chair of Plexus Institute board of trustees (2010-11) and professor of nursing at Indiana School of Nursing, to use the AIC process with attendees at conference, held at Gonzaga University in Spokane, Washington, USA.

Using the AIC process, we asked participants what it would take to transform the future of nursing education. Analyzing the data we gathered, we developed power maps. A summary and implications of the AIC Appreciation of Nursing Culture are shared on the call.

Results suggest that we nurses, for the most part, go about our work in a very open, appreciative way. We listen, learn and discover. We rely more than most on our innate intuition and sensing capacities. Our first preference is for the use of appreciative power (47 percent). Secondarily, we rely on our ability to relate to other people (influence power), but this extends to our ability to relate to new ideas and technologies. Our preference level for the use of influence power is 38 percent. When we have to, we can also be directive, relying on our knowledge and experience. Our preference level for the use of control power is 15 percent. Ideally, preference levels for appreciation, influence and control should each be at 33 percent. The implications of this assessment? Nurses probably need to be more open to influence of others and, in turn, influence others more and act accordingly in supporting nursing values, ideals and purposes.

The Future of Nursing, Part III

This series of calls features Phyllis Beck Kritek, PhD, RN, FAAN, an internationally known nurse scholar and writer who is frequently engaged as a facilitator by organizations and health care agencies seeking to create effective strategic changes. She is noted for her ability to create conceptual maps that assist individuals and groups grappling with challenges and dilemmas. She is the author of two books on conflict resolution and healing: Negotiating at an Uneven Table: Developing Moral Courage in Resolving Our Conflicts and Reflections on Healing: A Central Nursing Construct. She discusses the need for nursing leadership and how to build productive relationships that increase standards of care and improve organizational outcomes in complex environments. Individuals, she points out, need to move from toleration (where people do their work in silos) to cooperation (where they work together for mutual benefit) to collaboration (where they retain their autonomy but become skilled at facilitation, analysis, reframing issues, and working with others to overcome obstacles and achieve shared values).

Kritek discusses the importance of deep personal reflection and attention to the shadow work that is necessary to collaborate more effectively. Leadership and collaboration, she notes, requires people to assume they are operating in a complex adaptive system where they must adapt to uncertainty and emergence. It takes courage to act in the face of danger and rejection. “If that were easy, we’d all rush around being leaders,” she says.

Plans are being developed to launch a 2012 Nursing Learning Network Call Series. Plexus Institute invites your support and participation. Stay tuned! Stay engaged! What the future holds for you depends on what you hold for the future.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

The ingredients of well-being: PERMA 2051

2011-09-19T12:50:00.008-04:00

I have followed the work of Martin E.P. Seligman, PhD, for about 36 years! I first became aware of his work when I was getting my master’s degree in psychiatric mental health nursing at the University of Texas Health Science Center in San Antonio. Seligman is often referred to as the father of positive psychology. Early in my career, I was interested in his theory of “learned helplessness” as a model for explaining depression. Over time, Seligman shifted his focus and began to study and create theories of optimism and authentic happiness.

Recently, he has refined and amalgamated his thinking and created a theory of well-being, which he explains in a new book titled Flourish. In this work, he proposes that well-being involves five measurable elements: Positive Emotions (P), Engagement (E), Relationships (R), Meaning (M) and Achievement (A), or PERMA.

Working with colleagues and students at the University of Pennsylvania, Seligman has developed a number of measures and interventions to support positive accomplishment, resilience and well-being. Listen to his remarks as he shares how he is using knowledge created to influence and stimulate change in education and therapy, including military settings. I particularly like his notion of the complementary pair of post-traumatic stress ~ post-traumatic growth syndrome. I also admire and appreciate his visionary goal that, by the year 2051, 51 percent of the people of the world will be flourishing.

Personally, after reading the book, I have decided to take up the practice of two evidence-based exercises that seem to influence and support one’s well-being: the Gratitude Visit and the Three Blessings Exercise.

The Gratitude Visit involves conjuring up an image of someone still alive who did or said something that changed your life for the better, and you never properly thanked him or her. The task is to write a 300-word letter of gratitude to that person with specific details about what they did and how it affected your life. Once you have written the letter, surprise him or her with a visit and personally deliver the letter. Read it out loud to and then discuss the content and your feelings for each other.

The Three Blessings Exercise is also a useful practice to develop. This involves reflection and appreciation. Every night, set aside 10 minutes before you go to sleep to write down three things that went well today and why they went well. Writing about what went right rather than what went wrong is likely to support your PERMA and increase your feelings of well-being.

I believe nurses around the world already understand the importance of PERMA for health and well-being. Seligman has provided specific measurements, tools and resources that may help and support the work nurses do to develop resilience and promote well-being in themselves and for those for whom they care. With the support of nurses who flourish, I believe his 2051 PERMA Vision will be realized.

Reference:

Seligman, M. (2011). Flourish: A Visionary New Understanding of Happiness and Well-Being. (New York: Free Press).

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Self as coach: Professional renewal through strength and character

2011-08-01T17:07:00.054-04:00

One of the most significant challenges leaders face is how best to maintain optimism, hope and a sense of renewal when confronted with competing commitments, conflicts and struggles that are a part of leadership responsibilities. Nurse leaders need to engage inner work in order to more effectively provide outer service (Pesut, 2001). Renewal is accomplished by clarifying one’s strengths, values, gifts and talents—and using them with intention. A strengths and character-based approach to personal and professional renewal helps people appreciate and value their signature themes and natural talents. Knowing what one’s signature strengths and values are promotes personal mastery and self-management in the creation of a purpose-driven life.

Some leaders choose to work with professional coaches to discern their strengths and learning edges. Others believe there is value in developing self as coach, through deliberate inquiry and practices connected to personal and professional renewal efforts. I encourage leaders I know to use two assessments to obtain information about signature and character strengths. The first is the VIA Survey from the VIA Institute on Character. This instrument assesses strength in character. Based on responses to a series of questions, the instrument rank orders 24 character strengths and then groups them by the virtue categories of wisdom, courage, humility, justice, temperance or transcendence. Knowledge of character strengths and learning edges promotes insight, action and development.

Another resource I think is most valuable for nursing leaders is the book, Strengths Based Leadership, by Tom Rath and Barrie Conchie (Rath & Conchie, 2009). This book provides access to the Gallup Corporation StrengthsFinder assessment tool. Knowing what your top five signature strengths are gives voice to your talents and skill mix. Even more valuable, this reference and resource provides specific strength by strength-based strategies to help a leader master most of the characteristics that followers want in leaders: trust, compassion, stability and hope. The best thing nursing leaders can do to strengthen the profession is to know what values support and sustain individual character and how to support followers through intentional activation of personal strengths and virtues.

References and Resources:

Pesut, D.J. (2001). Healing into the future: Recreating the profession of nursing through inner work. In N. Chaska (Ed.), The nursing profession: Tomorrow and beyond (pp. 853-867). Thousand Oaks, CA: Sage.

Rath, T., & Conchie, B. (2009). Strengths based leadership. New York, NY: Gallup Press.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Join the 100 Top Squiggles of Nursing project

2011-03-10T13:50:00.011-05:00

In my July 12, 2010 Meta-Reflections post, I commented on the squiggle sense and the complementary nature of nursing phenomena. I was delighted and surprised when David A. Engstrom, PhD, creator~designer of The Squiggle Sense blog and co-author, along with J.A. Scott Kelso, PhD, of The Complementary Nature, contacted me and invited me to be interviewed! We exchanged many an e-mail and now that interview is posted on the Squiggle Sense blog!

Dr. Engstrom also posted a comment to my July blog post, in which he extended an invitation to the nursing community to participate in the 100 Top Squiggles of Nursing project, part of his effort to gather the 100 top squiggles in a variety of disciplines. I think this would be a very interesting exercise that would add to our understanding and appreciation of the complementary nature and dynamics nurses negotiate on a daily basis.

So, here is the plan. I invite all my nursing colleagues to use the comment feature provided at the bottom of this blog post (click on the word “comment”) or send directly to me (dpesut@iupui.edu ) a list of squiggles you notice in your practice, education or research contexts. I, in turn, will pass them along to Dr. Engstrom, and we will slowly but surely build a list of the top 100 squiggles in nursing! For example, a few of my candidate squiggles of nursing are: nursing~negligence; suffering~succorance; health~illness; mindfulness~mindlessness.

What complementary pairs or “squiggles” has your squiggle sense perceived and acted upon? Participating in this project is easy. All I need are your squiggles, but if you care to spend a few minutes to let us know why you chose your particular candidate(s), please do so.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Becoming wholehearted

2011-02-10T13:37:00.003-05:00

Recently, I became aware of the work of Brené Brown, PhD, LMSW, who studies wholeheartedness. The evolution and development of her interests and research career is enlightening and inspiring. For a quick introduction to her work, check out this TED video, where she talks about the power of vulnerability and the importance of human connection. What is most fascinating to me is that she began studying wholeheartedness as a result of her research interest in the concept of shame. I struggle with issues of shame. Everyone does. Brown’s definition? Shame is the intensely painful feeling or experience of believing that we are flawed and, therefore, unworthy of love and belonging.

Brown makes the following points about shame. We all have shame, and it is one of the most primitive human emotions we experience. The only people who do not have shame lack the capacity for empathy and human connection. We are all afraid to talk about shame. The less we talk about shame, the more control it has over our lives. Shame is the opposite of owning our story and feeling worthy. Shame is different than guilt, which is about doing something bad. Shame is a belief that I am bad and not enough.

It was through her study of shame that Brown discovered wholehearted people, individuals who had developed shame resilience. Men and women with high shame resilience have four things in common. They understand shame and recognize what messages and expectations trigger shame for them. They practice critical awareness by reality-checking the messages and expectations that tell us being imperfect means being inadequate. They reach out and share their stories with people they trust. They speak shame. They use the word “shame.” They talk about what they are feeling and ask for what they need.

As I reflect on my nursing career, I realize that many of the dysfunctional dynamics I have observed in individuals, groups and organizations oftentimes involve issues of and responses to shame. I wonder what would happen if we started talking about shame and the effects of shame in our personal and professional lives?

Antidotes to shame involve the following: cultivation of authenticity, self-compassion, a resilient spirit, gratitude and joy, intuition and trusting faith, and creativity. Developing shame resilience also includes letting go of exhaustion as a status symbol and productivity as self-worth. It involves cultivating calm and stillness, and letting go of self-doubt and “supposed-to.” It involves cultivating laughter, song and dance, and letting go of being cool and “always in control.”

If you want to learn more about wholeheartedness and developing shame resilience, check out Brown’s work. She is delivering important messages to the world about the power and value of vulnerability, compassion, courage and connection. Nurses everywhere will benefit personally and professionally from her wisdom, advice and careful attention to the research available on the subject of wholeheartedness and authenticity. Developing shame resilience is a practice worth pursuing.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Gremlins and grace: Challenges for a new year

2011-01-03T17:09:00.006-05:00

As the holiday season and another year came to a close, I reflected how, in the recent past, my gremlin kept surfacing to influence, hamper and interfere with my thinking, doing and relating. One of my colleagues suggested I read Rick Carson’s book, Taming Your Gremlin. I did, and it has given me new ways to monitor, notice and respond to my personal gremlins.

As we begin a new year, I think it is a good time to take stock, reflect and consider how best to tame one’s gremlins. According to Carson, taming one’s gremlin involves the process of noticing and choosing—
moment-to-moment—light over darkness, good over evil and the love that sustains over the fear likely to destroy. If you have one or more gremlins that need taming, explore Rick Carson’s website and learn more about gremlin taming.

Of special note are his tips for taming gremlins. Pictures people have created that visually represent personal gremlins of many types and varieties is available in his Gallery of Gremlins. Feeling creative about describing your personal gremlin? Perhaps you will want to respond to Carson’s invitation to draw and submit a picture of your own gremlin to his Gremlin gallery?

Gremlins often take charge of the chatterbox inside our heads. Gremlin taming is one way to manage the chatterbox. Another way is to create a state-of-grace document for yourself and with others.

The five components of a state-of-grace document are: 1) the story of me/us, 2) interaction styles and warning signs, 3) expectations and core values, 4) questions to return to peace, and 5) short- and long-term agreements. A state-of-grace document can become a blueprint for positive healthy relating. Creating a state-of-grace document for yourself and with those you care about provides a stimulus for conversation, dialogue and understanding.

Learn more about these documents and consider how gremlin taming and grace can be incorporated into your personal and professional development plans for the new year, 2011.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Paradoxes of group life: Is the profession of nursing caught in a self-referential bind?

2010-09-07T12:00:00.004-04:00

Group life is permeated with contradictory thoughts, actions and emotions. Groups bound together by a purpose often spend time trying to negotiate and unravel the contradictory forces associated with relating to each other in a meaningful way. Such negotiations often result in a paralyzing circular process of conflict, enmeshment and paralysis rather than reflection and transformational dialogue. Smith and Berg (1987) in their classic work, Paradoxes of Group Life, note that making the invisible, paradoxical nature of group life visible helps unravel some of the paradoxical dynamics of conflict.

Clustered under the three essential group concepts of belonging, Smith and Berg identify tensions associated with identity, involvement, individuality and boundaries. Under the concept of engagement, they discuss tensions and issues associated with the dynamics of disclosure, trust, intimacy and regression. The issue of speaking in group life is explained in the dynamics of individual versus collective voice, authority, dependency, creativity and courage.

Group life revolves around several paradoxical tensions. Consider the complementary dynamics associated with tensions between the individual~group, self~other, conscious~unconscious processes, dependence~independence, stuckness~movement, framing~reframing, participation~control, disclosure~non-disclosure, fear~courage, isolation~intimacy, belonging~not belonging, splitting~connecting, and issues of introjection~projection.

Smith and Berg suggest the dynamic responsible for the paralysis and difficulty in group life is a “self-referential bind.” They write: “When a social entity uses itself as a mirror through which it judges what it is like, it often only sees those parts of itself that confirms what it wants to know, that is, that it will enable it to remain as it wants to be. Systems that are self-referential create binds for themselves that are difficult to get out of” (1987, p 48).

The bind that groups create is the paradox that emerges as a result of projections and introjections as groups engage in splitting and fractionation around issues of identity (we-they) and issues related to errors of logical type. Projections are defined as taking something from the inside and mapping it to the outside. Introjections are the mapping of outside onto the inside. Projections and introjections are forms of displacement, where some dynamic that belongs in one place is moved to another.

When the projection~introjection dynamic is co-mingled with subgroup formation in group role taking, collective splitting results in social interactive processes that are paradoxical and paralyzing. Multiple frames create conflicts that appear to be irresolvable and foster double-bind situations that elicit multiple contradictions and meanings. Framing and reframing these contradictions in different ways leads groups to developmental insights that evolve the group beyond intractable, paralytic dynamics. Reframing changes the meaning, content or context of a situation so people develop new insights about intentions and actions.

So, as I witness the dialogue and debate surrounding the Advanced Practice Registered Nurse (APRN) consensus model, and ponder consequences of the Essentials of Doctoral Education for Advanced Practice Nursing on the future of master’s degree education, and consider services the profession will provide to the public, and explore the fifth iteration of the Draft Masters in Nursing Education Essentials document, I ask myself: As a profession, are we caught in a self-referential bind? How might we reframe all of the contradictions in such a way that we gain insights that move us beyond intractable, paralytic dynamics?

What do you think?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

The squiggle sense and the complementary nature of nursing

2010-07-12T16:36:00.004-04:00

I once heard a quote and am not sure to whom it is attributed: “Life is bipolar and everything contains its opposite.” I have had my share of challenges trying to negotiate and reconcile what seem to me oppositional issues in my own life. I now have a new understanding of the complementary nature of polarities and paradoxes.

The squiggle sense has been proposed by scientists J.A. Scott Kelso and David A. Engstrom to represent the complementary nature and coordinated dynamics of opposites that, in fact, are components of a greater dynamic process. Such coordinated processes are linked to the way the brain processes information and engages in sense making. Kelso suggests the tilde or squiggle (~) as the symbol of the complementary nature that relates contrarities, opposites and their kin. Think about the squiggle sense and the complementary nature of nursing.

For some time, I have suggested there is a complementary nature to nursing and that the opposite of nursing is negligence. Thus, the squiggle sense of this would be nursing~negligence. I believe most nurses have a well-developed sixth sense about the complementary nature of nursing care. Now we have a way to represent—and perhaps make explicit—our squiggle sense of complementarity in terms of patient-care needs. Other complementary pairs relevant to nurses and the care they provide also come to mind.

Consider the complementary pair of any nursing problem with its opposite or desired nursing-sensitive outcome. For example, pain~comfort, anxiety~ anxiety control, impaired mobility~mobility, body~mind and self-care deficit~self care. In fact, one of the essential aspects of nursing is management of the complementary nature of human responses to health~illness situations. I wonder what would happen if nurses moved away from the development of problem lists and began to identify and note the complementary nature of each identified problem in terms of its coordinated opposite. We would then be identifying problems~outcomes and, perhaps, have a new appreciation of nursing care responsibilities in light of the squiggle sense of issues presented by individuals, groups, families and communities.

Why not explore the complementary nature website and see how the theory of coordinated dynamics resonates with your own thinking, personal experience and the practice of nursing. The squiggle sense mission is to provide an “evolving online resource for the study and appreciation of a sixth sense of the complementary nature, and its philosophical~scientific grounding in coordination dynamics, the science of coordination.” Nursing is grounded in the science of coordination. I hope you accept the invitation to explore the complementary nature site and reflect on how coordinated dynamics might influence your thinking, doing and nursing practice.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Strengths and values

2010-05-04T14:17:00.005-04:00

People who know me are familiar with my enthusiasm for a strengths-based approach to personal and professional development. Personally, I belive every nurse in the world ought to know their signature strengths. Such strengths-based knowledge supports learning in service of caring.

Do you know the constellation of character strengths you possess? There are a couple of ways to learn about and maximize your strengths skill set. I invite you to take some time to explore the VIA Institute on Character. It evolved as part of an evoluationary vision connected with developments in the field of positive psychology. Since its inception, the institute has focused on classification, testing and research related to character strengths. These classifications include cognitive, emotional, interpersonal, civic, self-control and strengths attuned to connections with the larger universe in which we live and make meaning.

Do you have a cluster of strengths related to the acquisition of knowledge? Strengths that fall under this category include creativity, curiosity, judgment and open –mindedness, love of learning and mastery of providing perspective. Courage is the category of strength that includes bravery, perseverance, honesty and zest. Humanitarian interpersonal strengths include the capacity to love and be loved, coupled with kindness and social intelligence. Commitments to building community involve the civic strengths of justice, teamwork, fairness and leadership.

Temperance, as a strength, modulates and works against excess and includes the value set of self-control, prudence, modesty and humility, as well as forgiveness and mercy. Finally, strengths that help us transcend and find meaning in the larger universe include appreciation of beauty and excellence, gratitude, hope, humor and spiritual consciousness, supported by faith or purpose. Wouldn’t it be great to know what your character strengths and values are? Such self-knowledge enables one to be clear about personal and professional contributions to the nursing care enterprise.

Once upon a time, you could take the brief version of the Character Strengths profile for free. A recent visit to the VIA Institute on Character revealed they no longer offer that service as an option. However, they do have a number of free resources. Check out the research studies. Perhaps the most useful resource is "340 Ways to Use VIA Character Strengths." As you consider some of the suggestions about using and developing your strengths, share your plans with a friend or colleague, and invite them to develop their strengths. Contemplate how development of your individual strengths contributes to your leadership in the greater community where you live and work!

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

What is MOJO? And have I lost it?

2010-04-07T19:19:00.006-04:00

Not very long ago, I thought I had lost my MOJO. So I was really excited to read Marshall Goldsmith’s latest book, MOJO: How to Get it, How to Keep It, and How to Get It Back When You Need It. I really enjoyed reading this book, and I gained new insights into myself and people with whom I work. I now believe I understand and know how to better self-manage the four keys to MOJO—identity, achievement, reputation and acceptance. Goldsmith defines MOJO as “the positive spirit toward what we are doing now that starts from the inside and radiates to the outside.” He and his team have actually developed a MOJO Survey to help people discern their level of MOJO, which is defined in terms of short-term satisfaction (happiness) and long-term benefit (meaning). The results of the survey make explicit the dynamics of a person’s relationship to any activity. The categories are: surviving, sacrificing, succeeding, stimulating and sustaining. How do you recognize people with MOJO? People with MOJO take responsibility, move forward, run the extra mile, love doing it, appreciate opportunities, make the best of it, are inspirational, grateful, curious, caring, have zest for life and are awake! In contrast to MOJO, there is NOJO, which is defined as “that negative spirit toward what people are doing now that starts from the inside and radiates outside.” People with NOJO play the victim, march in place, are satisfied with the bare minimum, feel obligated to do it, tolerate requirements, endure it, are painful to be around, are resentful, uninterested, indifferent, Zombie-like and asleep. Goldsmith makes a distinction between professional MOJO, which is powered by the ingredients of motivation, knowledge, ability, confidence and authenticity, and personal MOJO, which is powered by happiness, reward, meaning, learning and gratitude. He has even developed a MOJO scorecard for people to track and rate their MOJO, based on the activities in which they engage every day. This is a very revealing exercise, if you decide to do it! Finally, he provides people with a MOJO tool kit comprised of strategies and techniques as well as principles and practices. These strategies help in the management and development of one’s identity. There are also clues and tips about how best to support achievement and reputation. Finally, the advice and wisdom about accepting change and influencing what you can while letting go of what you can’t change was significant and resonated with me. So, now I am on a MOJO recovery program and that positive inner spirit is beginning to radiate outward once again! Thanks, Dr. Goldsmith!

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International

Transforming and creating the future of learning in nursing

2010-03-08T12:52:00.008-05:00

A number of significant studies are emerging about the need to transform nursing education. One recently published study is the Carnegie report titled Educating Nurses: A Call for Radical Transformation. Another activity that is taking place is the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. I plan to keep up with the developments of these initiatives and am anxious to see what evolves. Consider bookmarking the link for the RWJF initiative to your favorites list or visit the initiative’s blog periodically. Better yet, engage in the dialogue and conversation.

Any transformation or “future-casting” of nursing needs to be framed within the greater context of the anticipated forces that will affect education. If you have not yet explored the Map of Future Forces Affecting Education, visit this Web site and think about how these predictions might influence and impact the reforms called for in the RWJF and Carnegie initiatives.

The map was developed by the KnowledgeWorks Foundation in collaboration with the Institute for the Future to stimulate conversations and prompt foresight, insight and action among stakeholders concerned about the future of education. The map has been described as a “conversation catalyst” or “thinking tool” to stimulate scenario development and storytelling about possible futures in the world of education.

The future-forces map outlines possible developments in five areas: 1) Family and community; 2) markets; 3) institutions; 4) education and learning; and 5) tools and practices. Each of these areas is cross-referenced or cross-impact-analyzed against six drivers of change that are predicted to impact developments in education.

The change drivers are: 1) evolution and expansion of a grassroots economy; 2) emergence and ongoing development of smart networking, social networking and connecting technologies; 3) positive and negative opinions, played out in a global media configuration, that simplifies complex issues; 4) tension and polarity between a health or illness orientation; 5) impact and influence of urban versus rural living environments; and 6) merging and integration of physical and digital information through connective media and social networks.

Consider the elements of KnowledgeWorks Foundation’s “2020 Forecast: Creating the Future of Learning.” Attention to the Map of Future Forces Affecting Education requires effort, curiosity and a commitment to understand future forces that will shape and influence policy, practice and education reform among those invested in transforming and creating the future of learning in the nursing profession. With so much attention and creative thought being generated about transformation in nursing, it is clear that changes are inevitable and creative mindsets will be needed to see us through.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Knowledge complexity and the complexity of knowledge

2010-02-08T15:40:00.004-05:00

The Honor Society of Nursing, Sigma Theta Tau International was founded on the conviction that knowledge, learning and service are essential ingredients to professional growth, development, satisfaction and well-being. Knowledge supercedes data, evidence and information. Data leads to information, information is transformed into knowledge, and making meaning of that knowledge leads to development of philosophy and wisdom. Hopefully, wisdom supports sustainability and the greater good. My ideas about knowledge complexity and the complexity of knowledge have been greatly influenced by the work of Verna Allee.

Verna Allee has skillfully integrated all of these dimensions about knowledge into what she calls the Knowledge Complexity Archetype/Framework. I enjoy exploring Allee’s Knowledge Management Library. Her masterful synthesis of a variety of models and theories enables one to appreicate how knowledge and learning modes are connected to action and performance. I think the knowledge complexity archetype expands and deepens our notions about knowledge, learning and, ultimately, service. I am not sure the founders of the honor society fully realized the depth and breadth of their vision when they dedicated themselves to knowledge, learning and service as fundamental values for the community they intended to create.

Each of the dimensions or levels in Allee’s Knowledge Complexity Archetype requires a different mode of learning and has a different action and performance focus, as well as a variable time perspective. For example, data gathering requires instinctual sensing and learning with moment-to-moment attention and awareness. Information requires attention to single-loop learning and involves procedural adherence. Double-loop learning is required for doing things the best way because self-conscious reflection is required. Beyond knowledge, meaning-making becomes important in the context of relationships and trends, so communal learning is fostered. Communal learning fosters self-organization and development of philosophies that support pattern recognition, creativity and generative learning in service of a greater sense of community.

Perhaps, you are curious enough to study the Knowledge Complexity Framework Easy Reference Chart. As you do, ask yourself the following questions:

Where on the knowledge complexity archetype do I spend most of my time and attention?
What learning mode is most comfortable for me?
Do I spend time gathering information and conforming to standards trying to do something in the most efficient way or am I wanting to do it the best way?
How do I understand what promotes or impedes effectiveness?
Do I generally see where an activity fits into the whole picture?
How does my learning influence my sense of integrity and purpose management?
When do I take time to reflect and consider all the complexities of knowledge in the greater contexts of universal understandings?

I think the knowledge complexity archetype is a useful tool for reflecting on how best we engage in practice, education and research, and how each of these contexts can benefit from a deeper understanding of the complexity of knowledge. I am very grateful to Verna Allee for expanding my understanding and challenging me to think about all of these complexities.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Courage, conflict engagement and communities of practice

2010-01-27T16:13:00.006-05:00

I love think-tank invitations. Recently, I was invited to participate in an emerging community of practice around conflict engagement in health care. The sponsoring organization is Emerging Health Care Communities (EHCCO). Besides the fact that there were many diverse and interesting people engaged in this three-day event, I was impressed that the conveners invited Etienne Wegner to introduce the group to the idea of a community of practice.

Nurses have been tacitly using and developing communities of practice around specific issues for some time. Making the principles and practices of cultivating a community of practice more explicit enables the evolution of new ideas and promotes mastery of understanding social learning, identity, belonging, relationships and the value of community in advancing learning, growth, change and new knowledge.

Perhaps, you are interested in developing a community of practice around an issue you are passionate about. Cultivating communities of practice requires attention to open dialogue, different levels of participation and diversity of thought, opinions and ideas, as well as commitment to the community that is evolving.

A highlight of the event for me was an award ceremony where my good friend and colleague Phyllis Kritek was recognized for her work in conflict engagement. It takes courage to engage and stay with the conflict resolution process. It also takes attention to communication and conflict resolution skills that can be used in any context. Phyllis blogs for a group known as Disruptive Women in Health Care. Perhaps, some of the posts and issues raised in the Disruptive Women in Health Care forum will give you the courage to engage in conflict resolution around issues that matter to you and the nursing profession at large.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

2010 International Year of the Nurse

2010-01-05T11:47:00.005-05:00

Are you keen on making New Year’s resolutions? I suspect most of us think of personal resolutions, and then some of us think of professional resolutions. One of my professional resolutions is to promote 2010 as the International Year of the Nurse. This is the centennial year of Florence Nightingale’s death (1820-1910).

To commemorate and honor Ms. Nightingale and her contributions to modern nursing, the Honor Society of Nursing, Sigma Theta Tau International, the Nightingale Initiative for Global Health and the Florence Nightingale Museum in London have collaborated in creating a campaign to increase public awareness of the impact, influence and leadership nurses bring to health initiatives around the world. The campaign builds on the United Nations Millenium Development Goals.

Become involved in this effort by signing the Nightingale Declaration. Consider contributing and sharing stories related to the work that you do! Encourage your friends and colleagues to visit www.2010IYNurse.net and participate in the yearlong celebration. Create celebrations and other activities in your hometown and add them to the calendar of events! I hope to attend the Commemorative Global Service at the National Cathedral in Washington, D.C. on 25 April 2010. This is one of my professional New Year’s resolutions that will last all year long!

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Complexity and nursing

2009-12-14T12:22:00.005-05:00

A few years ago, I became intrigued with the application of complexity science principles to issues of health care and nursing. My curiosity was fueled after reading some of the Institute of Medicine’s Quality Series reports. Crossing the Quality Chasm: A New Health System for the 21st Century was of most interest. More importantly, one of the appendices of that book, authored by Paul Plsek, argued that the only hope of redesigning a 21st-century health care system rested in our understanding and application of complex adaptive systems science and principles to help augment our understanding of systems thinking and relationships of control, chaos and zones of complexity.

Since that time, I have joined a community of professionals who are dedicated to the application of complexity-inspired solutions to wicked, complex problems. The mission of the Plexus Institute is to “foster the health of individuals, families, communities and our natural environment by helping people use concepts emerging from the new science of complexity.” Over time, I have been committed to and involved in the Plexus Nursing Learning Network. You may want to explore the Plexus Web site and learn the Plexus story.

If you are new to complexity, explore and evaluate the resources available to you. Consider inviting some colleagues to discuss and evaluate ways to master complexity in action. More specifically, consider how you and a group of interested folks could begin to replicate some of the work being done by nursing colleagues around the globe. Also, consider how liberating structures and positive deviance are useful strategies and tools that will help you design a complexity science-inspired 21st-century health care system that makes a difference in nursing care.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Dialogical leadership for global challenges

2009-11-23T10:49:00.009-05:00

As you engage in dialogue with others, do you find yourself defending or suspending? William Isaacs explains that human conversation evolves in two potential directions: defending or suspending. “Defending” conversations use facts and data to answer problems and employ explicit reasoning. They often lead to controlled discussions in which advocacy and abstract verbal brawling devolve into competition, debate and down beating. By contrast, “suspending” is a more conscious and choiceful state of listening without resistance. Suspending conversations may lead to reflective dialogue, and reflective dialogue frequently leads to generative dialogue that is creative and inventive, and which produces new insights, unprecedented possibilities and group flow.

There is a need for greater reflective dialogue among all of us as we navigate the complexity of our personal and professional lives and the global challenges that confront us. Dialogue has a rich history, and there are many ways to conduct a dialogue session.

Isaacs identifies four dialogue types: movers, followers, opposers and bystanders. Movers provide direction. Followers support completion and follow through, based on the suggestions and leadership of movers. Opposers oftentimes confront or block movers’ suggestions and support correction of courses of action. Bystanders provide perspective as they look at situations from the “outside-in.” All of these types, in a proper dialogue, move through states of voicing, listening, respecting and suspending.

Voicing is the process that asks, “What needs to be said?” Voicing entails speaking the truth of one’s own authority and thinking. Listening is the process that asks, without resistance or imposition, “How does this feel?” Respecting is the process of asking, “How does this fit?” It requires awareness of the integrity of another’s position and the impossibility of fully understanding his or her perspective. Suspending is the process of asking, “How does this work?” and is the suspension of judgment, certainty and assumptions. Progression through each of these states is a valuable learning experience for members of an interdisciplinary team.

What is your dialogical leadership style? Are you often in defending or suspending mode? What is your preferred role? Are you a mover, follower, opposer or bystander? Dialogical leadership skills are essential to success, given the debate that is being waged in terms of health care reform in this country and around the world. Consider exploring some resources that will support dialogical approaches to global challenges.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International

Next tech-generation leaders

2009-11-16T10:50:00.007-05:00

I learned an interesting statistic while at the 40th Biennial Convention of the Honor Society of Nursing, Sigma Theta Tau International (STTI). Forty-five percent of the members of the honor society are now under the age of 50! What this means to me is that there will be next-generation leaders to guide and navigate STTI into the future. What also fascinated and intrigued me was that some of the younger members of the honor society will clearly be next-generation leaders who are also technology-generation leaders.

Take, for example, Robert Fraser. He is a registered nurse±a graduate student—from Canada who has an amazing Web site called Nursing Ideas. I had the opportunity to chat with Robert at the convention. He is passionate about nursing and technology. He was actively roaming and scanning the convention—back pack over one shoulder and tripod grasped in his right hand. He tried to capture as many nurse leaders as he could and get their ideas on nursing leadership. It was amazing to me how passionate he is about using technology to inspire, connect and help create nursing-knowledge networks.

For example, he recorded his own presentation at the convention, in which he challenged all of us to use the technology that is available to advance knowledge sharing and community building in nursing. Next tech-generation leaders, like Fraser, are using the vehicles of social media to link and expand connections while simultaneously supporting aggregation of knowledge, development of skills and the spirit of connection among nurses around the world.

I suspect there may be a young person with whom you work who is up on the technology and social-media trends emerging in your organization? If so, I believe we all can learn a great deal from these emerging leaders. Through the magic of dialogue, each of us can engage in transformational learning. Find the next tech-generation leaders in your organization and ask them what they are up to. What you learn may surprise, delight and fascinate you.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Paths to global health

2009-11-06T11:20:00.013-05:00

The 40th Biennial Convention of the Honor Society of Nursing, Sigma Theta Tau International (STTI) was exciting, full of challenges and celebrations! Several things captured my attention, and I want to invite action by sharing some reflections and resources with you.

First, I admire and appreciate the fact that the House of Delegates voted in favor of a resolution to support the United Nations Millenium Goals. I first learned of the Millenium Project when I became interested in future studies. Nurses are ideal leaders and can exert influence in millenium goal achievement. In fact, with regard to research methods and health, several resources are available to support teaching and learning about the millenium goals.

What is most exciting is President Karen Morin’s call to action: Connecting through knowledge for global health. When you combine and cross-reference the 2009-11 presidential call to action with the Millenium Project, you realize that nurses can and do make a difference on a global scale.

Another exciting development is the honor society’s intention to seek associative status with the United Nations, another resolution that was approved by the House of Delegates. Past President Carol Huston notes that we should hear about the status of our application in December. Stay tuned!

Once STTI becomes recognized and actively engaged in more UN activities, the influence of nursing leadership will contribute even more to global health. How will you learn more about the millenium goals and decide what role you will play in supporting achieving achievement of those goals?

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Honor society energy boosters

2009-10-28T20:05:00.006-04:00

I am so excited that the 40th Biennial Convention of the Honor Society of Nursing, Sigma Theta Tau International (STTI) is taking place here in Indianapolis next week, 31 October through 4 November. Convention is such an exciting time! What I value most is connecting with people and sharing stories of success and inspiration. There is a special energy that is created at the convention and, luckily, that energy sustains me for two years until the next convention.

There is also a special developmental life to biennial cycles. While one set of activities is coming to a close, another set is about to begin. One leadership team passes the torch and charge to the next leadership team, which is full of hopes, aspirations and ideas and will face new challenges. This developmental rhythm keeps the honor society vital and alive.

Of course, you do not have to wait for convention to become engaged with the activities of STTI. You can experience the same vitality by connecting with people in the organization and sharing your talents and skills throughout the year. Whenever you need an energy boost, there is a global community of nurses ready to connect with you. So make sure you have your talents registered in the Volunteer Interest Profile (VIP).

If you have already made your talents and interests known, then be sure to connect to the online member forum, or find yourself engaged in the Community Public Health Nursing Forum, the Palliative Care/Hospice Nursing Community, Crossing the Bamboo Bridge: An Educational Project Exploring the Complementarity of Nursing and Healing Traditions, or the Good Work in Nursing Community which is affiliated with the GoodWork Project at Harvard University.

Whenever you feel like you need an energy boost, look to the Honor Society of Nursing and the community of nurses around the world to fuel your imagination and stimulate your knowledge, learning and service needs. See you in Indianapolis!

Daniel J Pesut, PhD, RN, PMHCNS-BC, FAAN

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

The compassion of communication

2009-10-23T12:44:00.006-04:00

I am always amazed at how difficult it is to achieve true and responsible communication. What is your experience with communication?

One of the people I admire is Marshall Rosenberg. He has devoted his life’s work to creating a language of compassion. Such a language is essential. Every nurse knows that compassion is the essence of presencing. Effective nursing response to the needs and requests of patients can only be achieved through observation and awareness. Such a simple concept can become so complicated in the frenetic world of a hospital, outpatient clinic or surgery center.

There is a life energy that creates needs, values, desires and expectations. Nurses, as a rule, are sensitive to that energy. I often wonder how nurses communicate their needs in places they work. When needs aren’t met, there is discontent and disconnection. If needs, as Rosenberg defines them, are met, I suspect people are largely satisfied with the work they do, and that they find purpose, meaning and connection with others in their daily activities. Nonviolent communication creates human connections that empower compassionate giving and receiving.

Are your needs being met? Are the needs of your patients, peers, colleagues and family members being met? Check out the needs inventory proffered by Rosenberg. Connection, meaning, physical well-being, autonomy, peace, honesty, play and peace are indicators of needs we have that energize us. In contrast, review the feelings inventory that Rosenberg and his colleagues have developed which indicate when needs are not being met. If you are a generative leader and are sensitive to your needs and the needs of others, you are more likely to have an open heart, will and mind and will know how best to develop compassion through communication.

You may also be interested in learning more about the American Academy for Communication in Health Care. The goal of this organization is to transform health care by helping people relate more effectively.

How compassionate is your communication? What needs and feelings do you experience daily? How will you use resources around you to communicate more effectively and, by using your compassionate communication skills, make a difference in the nursing care you provide?

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Generative leadershiphttp://www.blogger.com/img/blank.gif

2009-10-12T16:24:00.011-04:00

Are you a generative leader? A generative leader is someone who creates and fosters creativity wherever they go. Generative leaders are purpose-driven people who have spent time clarifying their highest goal and aligning their personal and professional visions with the mission of the organizations they serve. They are clear about who they are and what they believe, and they have the capabilities and skill sets to accomplish what they desire in the environments in which they find themselves.

Generative leaders are solution-focused and outcome-oriented, and they excel in framing and reframing challenges, situations and the meaning of facts. Generative leaders encourage appreciative and cooperative strategies among agents in a system. Generative leaders challenge people in systems where they work to think in new ways and generate creative solutions to seemingly intractable problems. Generative leaders ask the question, “What do I want to create for myself and the people I care about?” They also consistently reflect on the question, “How am I responsible for what is happening to me?”

Is there a secret to such generative leadership? Michael Ray believes clarification of one’s highest goal is that secret. The author of a book by that name, Highest Goal: The Secret That Sustains You in Every Moment, Ray’s essential message is that connection with one’s highest goal serves to develop capacity for generative leadership. He explains: “To be of service and make the contribution only you can make to the universe, you must become a generative leader—no matter what your role in life. When you are generative, you contribute to a cycle of renewal. Your synergy, something more than the sum of its parts, starts a spiral of intelligent growth; this is what life is all about: it is living with the highest goal. You can be a generative leader to yourself, to one other person or to the world. And if you start right now with an intention of being generative and to create creativity around you, as you give and receive, you’ll see remarkable things happen (Ray, 2004, page 140).

Jim Collins, author of Good to Great: Why Some Companies Make the Leap ... and Others Don’t, was a student of Ray’s and certainly benefited from his teaching. Read what Collins has to say about discovery of his highest goal.

I believe every member of the Honor Society of Nursing, Sigma Theta Tau International is a generative leader. In times of stress and turbulence, each of us is likely to benefit from clarifying our highest goal. After all, if our highest goal is the secret that sustains us in every moment, then it is worthwhile to know and consistently remind ourselves what that highest goal is. So—no pressure here—are you willing to engage in an exercise suggested by Michael Ray?

It goes something like this: Ask yourself, what was the most meaningful thing you did last week? As you contemplate that question and “download” your answer, consider the next question: Why was that experience so meaningful and important? When you have your answer, take the next step and ask yourself the next why question: Why is that important to you? The idea is to keep interrogating yourself with why questions, drilling down and downloading your answers, until you are able to identify in one, two or three words the real reason why that experience you had last week was so meaningful to you. (This is similar to the “Five Whys” exercise associated with quality improvement efforts.) The final answer you come up with in this exercise may or may not be your highest goal, but perhaps it is the secret that sustains you in every moment, the motivation and drive that keeps you going.

It is useful to periodically make tacit motivations more explicit so they can serve us more effectively as North Star or navigation points. Who are the generative leaders you admire in your organization or social network? Can you discern the secret that sustains them in every moment? How will you use this information to structure your own reflections on your generative leadership skill set?

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

Open mind, heart and will

2009-10-02T12:00:00.004-04:00

I had the good fortune to have a sabbatical from September through December 2008. During that time, I had a chance to study integral theory, mediation and conflict resolution, and leadership development. One of the more influential books I read during my sabbatical was by Otto Scharmer. Titled Theory U: Leading from the Future as It Emerges, the book addresses the social technology of presencing.

Every nurse knows presencing. Scharmer defines it, "to sense, tune in and act from one's highest future potential—the future that depends on us to bring it into being." Presencing blends the words "presence" and "sensing" and works through "seeing from our deepest source."

Presencing is about the economy of creating, and it involves shifting attention and moving through stages and states of downloading—from talking nice; to debating, or talking tough; to dialoguing, which involves reflective inquiry; to presencing, which supports collective creativity. This is in contrast to the economy of destruction, which silences the views of others, supports blaming and absencing, which are grounded in hubris and often lead to intrigue and disinformation, harassing, bullying, annihilation and collective collapse.

Presencing requires effort and individual action. If you want to read stories about presencing or learn more about tools and practices that support Theory U processes, consider spending some time investigating the Presencing Institute.

Given today's fast-paced health care contexts, presencing is more challenging than ever. It is also more essential and necessary than ever before. Nurses are the people who can assume a leadership role in creating a more highly evolved health care system through strategic and sustained application of Theory U principles, practices and presencing.

I hope you investigate this theory and learn how it was used to create new models of health care delivery. How might you begin to use Theory U and intentional presencing in your work?

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.

In the beginning ...

2009-09-25T14:30:00.004-04:00

One of the things I enjoyed most about serving as president of the Honor Society of Nursing, Sigma Theta Tau International (2003-05), was linking members with members and connecting people who had similar ideas, or who were working on similar projects. I called this activity my "bumble bee" function. I would learn of a new and innovative project in one part of the country and, when I found myself in another part of the country, I would say, "Do you know what they are doing in Colorado about this issue?" Just like a bumble bee cross-pollinating from flower to flower, spreading innovation, creativity and connection.

Because I discovered people who were doing great things and wanted their creativity and efforts to get recognized and diffused throughout the honor society, I would connect members with Jim Mattson, editor of Reflections on Nursing Leadership. I've missed that "bumble bee" activity. So when I was invited to consider doing a blog, I thought to myself, this would be a chance to build on my strengths of connecting, learning, strategizing and achieving to share "reflections about my reflections," or meta-reflections.

Perhaps these meta-reflections will stimulate and inspire people to respond and link to ideas, thoughts, opinions, references, resources and each other in support of creative works. So I will give this a try and hope you find my meta-reflections of interest and value. Such interest requires an open mind, open heart and will—the subject of my next post.

For Reflections on Nursing Leadership, published by the Honor Society of Nursing, Sigma Theta Tau International.