Bailey Donald E, Docherty Sharron L, Adams Judith A, Carthron Dana L, Corazzini Kirsten, Day Jennifer R, Neglia Elizabeth, Thygeson Marcus, Anderson Ruth A
School of Nursing, Duke University, Durham, NC ; Center for the Study of Aging and Human Development, Duke University, Durham, NC.
School of Nursing, Duke University, Durham, NC.
J Healthc Leadersh. 2012 Aug;2012(4). doi: 10.2147/JHL.S32686.
In this paper we discuss the concept of leadership as a personal capability, not contingent on one's position in a hierarchy. This type of leadership allows us to reframe both the care-giving and organizational roles of nurses and other front-line clinical staff. Little research has been done to explore what leadership means at the point of care, particularly in reference to the relationship between health care practitioners and patients and their family caregivers. The Adaptive Leadership framework, based on complexity science theory, provides a useful lens to explore practitioners' leadership behaviors at the point of care. This framework proposes that there are two broad categories of challenges that patients face: technical and adaptive. Whereas technical challenges are addressed with technical solutions that are delivered by practitioners, adaptive challenges require the patient (or family member) to adjust to a new situation and to do the work of adapting, learning, and behavior change. Adaptive leadership is the work that practitioners do to mobilize and support patients to do the adaptive work. The purpose of this paper is to describe this framework and demonstrate its application to nursing research. We demonstrate the framework's utility with five exemplars of nursing research problems that range from the individual to the system levels. The framework has the potential to guide researchers to ask new questions and to gain new insights into how practitioners interact with patients at the point of care to increase the patient's ability to tackle challenging problems and improve their own health care outcomes. It is a potentially powerful framework for developing and testing a new generation of interventions to address complex issues by harnessing and learning about the adaptive capabilities of patients within their life contexts.
在本文中，我们将领导力视为一种个人能力进行探讨，它不取决于一个人在层级体系中的职位。这种领导力使我们能够重新审视护士及其他一线临床工作人员在护理和组织方面的角色。目前很少有研究探索在护理现场领导力意味着什么，特别是关于医疗从业者与患者及其家庭护理者之间的关系。基于复杂性科学理论的适应性领导力框架，为探索从业者在护理现场的领导行为提供了一个有用的视角。该框架提出，患者面临两大类挑战：技术性挑战和适应性挑战。技术性挑战通过从业者提供的技术解决方案来解决，而适应性挑战则要求患者（或家庭成员）适应新情况，并进行适应、学习和行为改变等工作。适应性领导力是从业者为动员和支持患者进行适应性工作所做的努力。本文的目的是描述这个框架，并展示其在护理研究中的应用。我们用五个从个体到系统层面的护理研究问题范例来展示该框架的实用性。该框架有可能引导研究人员提出新问题，并对从业者在护理现场如何与患者互动以提高患者应对挑战性问题的能力和改善其自身医疗保健结果获得新的见解。它是一个潜在的强大框架，可用于开发和测试新一代干预措施，通过利用和了解患者在其生活背景中的适应能力来解决复杂问题。
