07 September 2010

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

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.

12 July 2010

The squiggle sense and the complementary nature of nursing

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.

04 May 2010

Strengths and values

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.

07 April 2010

What is MOJO? And have I lost it?

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

08 March 2010

Transforming and creating the future of learning in nursing

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.

08 February 2010

Knowledge complexity and the complexity of knowledge

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.

27 January 2010

Courage, conflict engagement and communities of practice

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.

05 January 2010

2010 International Year of the Nurse

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.