Atsalos C, Greenwood J
University of Western Sydney, New South Wales, Australia.
J Adv Nurs. 2001 May;34(3):408-16. doi: 10.1046/j.1365-2648.2001.01758.x.
A network of nine Clinical Development Units (Nursing) (CDU(N)) were recently created in the Western Sydney Area Health Service. These units are designed to develop patient-focused nursing practice through group process and action research, based on principles of transformational leadership.
Although there is documented evidence from Australia and the United Kingdom (UK) that CDUs and Nursing Development Units (NDUs) are very successful in improving both patient and staff satisfaction, there is also growing evidence that the stressors experienced by nurse leaders are threatening the survival of some of these units. This study set out to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership when these stressors were likely to impinge.
Hermeneutic phenomenology was employed in order to identify how these experiences changed over time. Two rounds of interviews were conducted: approximately 4--6 months after the launch and, again, 12 months later.
The Clinical Development Unit (Nursing) philosophy provided a framework on which these very motivated leaders began to enhance nursing accountability in their units through reflective practice and participatory governance. While reinforcing many previously published positive and negative aspects of Clinical Development Units and Nursing Development Units, this paper also highlights how the expectations and experiences of these leaders changed over time with unanticipated pressures of work, a high turnover of clinical leaders, a perceived diminution of management support and unrealistic self-expectations. A significant theme that emerged as these stressors began to impinge was the leaders' own need for leadership in order to sustain their confidence and motivation.
Insights harvested from this study have since been incorporated into a revised leadership preparation programme and support mechanisms for the leaders of eight new Clinical Development Units (Nursing) in the Western Sydney Area Health Service.
西悉尼地区卫生服务中心最近设立了一个由九个临床发展单元（护理）（CDU(N)）组成的网络。这些单元旨在基于变革型领导原则，通过群体过程和行动研究来发展以患者为中心的护理实践。
尽管澳大利亚和英国有文献证据表明临床发展单元和护理发展单元在提高患者和员工满意度方面非常成功，但也有越来越多的证据表明，护士领导者所经历的压力源正威胁着其中一些单元的存续。本研究旨在了解当这些压力源可能产生影响时，临床发展单元（护理）领导现象的情况。
采用诠释现象学以确定这些经历如何随时间变化。进行了两轮访谈：在启动后约4 - 6个月，以及12个月后再次进行。
临床发展单元（护理）理念提供了一个框架，这些积极性很高的领导者开始通过反思性实践和参与式治理在其单元中加强护理问责制。在强化许多先前发表的关于临床发展单元和护理发展单元的积极和消极方面的同时，本文还强调了这些领导者的期望和经历如何随着工作中意外的压力、临床领导者的高流动率、管理支持的感知减少以及不切实际的自我期望而随时间变化。随着这些压力源开始产生影响而出现的一个重要主题是领导者自身对领导力的需求，以维持他们的信心和动力。
从本研究中获得的见解已被纳入西悉尼地区卫生服务中心八个新的临床发展单元（护理）领导者的修订领导力培训计划和支持机制中。
