Human-centred leadership in health care: A contemporary nursing leadership theory generated via constructivist grounded theory.

AIM: To generate a unique and contemporary leadership theory reflecting the essence of nursing within a complex health care environment. BACKGROUND: As health care faces unprecedented change and increasing complexity, a nursing leadership theory embedded within complexity science is vital for teams to be innovative, nimble and focused on human-centred care. METHODS: Constructivist grounded theory framed exploration of human issues embedded in nursing leadership. The constructivist approach sought thematic and theoretical sensitivity through the rich co-creative experience of participants, researchers, literature and data. Focus groups were convened over 18 months with 39 nurse leaders from bedside to boardroom. RESULTS: Constant comparative methods resulted in 15 attributes. Advanced coding positioned the 15 attributes into constructs: Awakener, Connector and Upholder. Definitions emerged through the constructivist process organically connecting attributes and constructs to the potential outcomes identified in the theory as cultures of excellence, trust and caring. CONCLUSIONS: The final constructivist process revealed a nursing-specific theory: human-centred leadership in health care uniquely suited to assist leaders in addressing structure, process and outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Efforts by nurse leaders to test the theory with metrics related to nursing excellence will result in validation of the theory and validation of the proposed sustained culture change.

Human-Centered Leadership in Health Care: An Idea That's Time Has Come.

The Human-Centered Leadership model, which is relevant for leaders at all levels in a complex health care system, embraces change from the inside out. The Human-Centered Leader (HCL) is embedded in the organization, rather than positioned above it, and recognizes the expertise and value of those who serve at the point of care. The HCL starts with a focus on self-awareness, self-compassion, self-care, and mindfulness while focusing on others through demonstration of the characteristics of an Awakener, a Connector, and an Upholder. As an Awakener, the HCL grows and cultivates the team through the development of individual growth plans and staff empowerment in decision making. The result is a professionally prepared workforce that delivers market-leading patient outcomes. The HCL, as a Connector, builds the community in the microsystem by creating a healthy work environment. Finally, as an Upholder, the HCL recognizes the humanity in others and brings out the best in them. Demonstration of sincere care for those who care for patients results in improved staff satisfaction and, in turn, exceptional patient experience. The sustainable changes resulting from Human-Centered Leadership are realized through development of Cultures of Excellence, Trust, and Caring.

N-15 NMR study of the immobilization of 2,4- and 2,6-dinitrotoluene in aerobic compost.

Large-scale aerobic windrow composting has been used to bioremediate washout lagoon soils contaminated with the explosives TNT (2,4,6-trinitrotoluene) and RDX (hexahydro-1,3,5-trinitro-1,3,5-triazine) at several sites within the United States. We previously used 15N NMR to investigate the reduction and binding of T15NT in aerobic bench-scale reactors simulating the conditions of windrow composting. These studies have been extended to 2,4-dinitrotoluene (2,4DNT) and 2,6-dinitrotoluene (2,6DNT), which, as impurities in TNT, are usually presentwherever soils have been contaminated with TNT. Liquid-state 15N NMR analyses of laboratory reactions between 4-methyl-3-nitroaniline-15N, the major monoamine reduction product of 2,4DNT, and the Elliot soil humic acid, both in the presence and absence of horseradish peroxidase, indicated that the amine underwent covalent binding with quinone and other carbonyl groups in the soil humic acid to form both heterocyclic and non-heterocyclic condensation products. Liquid-state 15N NMR analyses of the methanol extracts of 20 day aerobic bench-scale composts of 2,4-di-15N-nitrotoluene and 2,6-di-15N-nitrotoluene revealed the presence of nitrite and monoamine, but not diamine, reduction products, indicating the occurrence of both dioxygenase enzyme and reductive degradation pathways. Solid-state CP/MAS 15N NMR analyses of the whole composts, however, suggested that reduction to monoamines followed by covalent binding of the amines to organic matter was the predominant pathway.