Complexity and nursing

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

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

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

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

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

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

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

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 ...

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.