HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Open University of the Netherlands and Sioo, Interuniversity Centre for Organization Studies and Change Management, Utrecht, The Netherlands.
Int J Nurs Stud. 2016 Nov;63:179-188. doi: 10.1016/j.ijnurstu.2016.09.006. Epub 2016 Sep 11.
Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role.
We explore how the caring disposition of nurse middle managers' habitus influences their clinical leadership behaviour in patient safety practices.
Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study.
Two Dutch and two American acute care, mid-sized, non-profit hospitals.
A total of 16 nurse middle managers of adult care units.
Observations were made over 560h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants.
We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and 'compensatory modes'); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition.
The dispositions of the nurse middle managers' habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant 'always' answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers' clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition.
护士长在医院实施患者安全实践中发挥着重要作用。然而，他们的专业背景对其临床领导行为的影响尚不清楚。研究表明，布迪厄（惯习的习性、资本和场域）概念有助于描述这种影响。它揭示了惯习习性的各种配置，其中关怀习性起着至关重要的作用。
我们探讨护士长惯习的关怀习性如何影响他们在患者安全实践中的临床领导行为。
我们的论文报告了一项布迪厄式的、多地点、民族志案例研究的结果。
两家荷兰和两家美国急性护理、中型、非营利性医院。
16 名成人护理病房的护士长。
对护士长进行了 560 小时的跟班观察、半结构化访谈和与参与者的成员核对会议。
我们观察到三种不同的惯习习性配置，这些配置影响了护士长在患者安全实践中的临床领导行为；它们都包含关怀习性：（1）一种以关怀习性为主导的配置，这种配置有助于（通过解决紧急问题）和阻碍（通过临时和被动反应，导致快速修复和“补偿模式”）；（2）一种关怀和同事关系的交互配置，导致临床参与的缺失，并阻碍患者安全实践；（3）一种以主导科学习性为特征的配置，表现出调查、非评判、分析的立场，关注循证实践，抑制关怀习性的临时剧目。
护士长惯习的习性影响了他们在患者安全实践中的临床领导行为。关怀习性的主导地位，意味着“总是”回应求助电话和反应性和临时反应，并不支持护士长的临床领导角色。通过将护士团队视为准患者，患者安全实践受到威胁，因为临床习性受到侵蚀。护士长的临床领导能力通过基于临床和科学习性的领导行为得到增强，这种行为表现为调查、非评判、分析的立场，关注循证实践和抑制关怀习性。
