Introducing a "Made-for-Healthcare" Leadership Approach: Strengths-Based Nursing and Healthcare Leadership.

We are excited to share the promise and innovation of Strengths-Based Nursing and Healthcare (SBNH) Leadership (SBNH-L). As a mindset, SBNH-L is more than a management philosophy. It is an intentional and purposeful value-driven approach that puts humans at the forefront and helps leaders honour, mobilize and cultivate the strengths that reside in individuals and teams. SBNH leaders focus on people, systems and solutions, cultivating relationships and being transformative in the service of others and the system at large. An SBNH leader is one who leans into change with an open mindset, who thinks about the ecosystems we are in and who acts to make a positive difference and address challenges across the healthcare sector as we emerge from the pandemic period. What we need right now is authentic leadership to foster positive change, influence work environments and support much-needed recovery and healing. In short, this issue of the Canadian Journal of Nursing Leadership has arrived at the right time. You will find articles that offer valuable exemplars of how SBNH-L has guided advancements in nursing administration and leadership, practice, teaching and research.

Cultivating Strengths-Based Leadership Capabilities: The Strengths-Based Nursing and Healthcare Leadership Capabilities Framework.

As we recover from the global pandemic, leadership is essential to help stabilize workforces, inspire nurses and re-construct health systems to enable nurses to provide humanistic care. This paper outlines a philosophy and value-driven leadership approach with its associated leadership capabilities framework. The Strengths-Based Nursing and Healthcare (SBNH) Leadership (SBNH-L) Capabilities Framework is designed to help leaders translate SBNH-L values into action. We outline steps to enable a leader to embody an SBNH leadership style and discuss how the SBNH-L Capabilities Framework can facilitate this process.

Talking About Strengths-Based Nursing and Healthcare Leadership: What Canadian Nurse Leaders Have to Say.

Nursing leadership is essential to improving nurse retention, their well-being, the quality of nursing care and patient safety. As healthcare leaders become increasingly aware of Strengths-Based Nursing and Healthcare Leadership (SBNH-L), we dialogued with Canadian nurse leaders to understand their views on this leadership approach. Five senior nursing leaders representing practice, academic and health policy contexts were interviewed. Five themes emerged: connections, opportunities for growth, humanism, optimism and hope for the future. Leaders shared that SBNH-L is a valuable, timely leadership approach that will promote system-wide health and healing post-pandemic. A call to action is offered to advance adoption of this essential leadership approach.

Mapping the current state of pediatric surgical pain care across Canada and assessing readiness for change.

Background: Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, health care professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain management is essential to prevent the transition from acute to chronic pain after surgery. Aims: The aim of this study was to identify current pediatric surgical pain management practices and assess health system readiness for change at health care institutions conducting pediatric surgery in Canada. Methods: An online survey was completed by 85 multidisciplinary health care professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC). Results: Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and postsurgical pain care varied (38.1%-79.8% reported "yes, for every child"), with tertiary/quaternary children's hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between health care institutions serving pediatric populations only versus those also serving adults. Health care professional experience/practice was the most reported strength in pediatric surgical pain care, with inconsistent standard of care the most common gap. Participants "somewhat agreed" that their institutions were committed and capable of change in pediatric surgical pain care. Conclusions: There is a continued need to improve pediatric pain care during the perioperative period at Canadian health care institutions to effectively prevent the development of pediatric postsurgical pain.

Contexte: La prévention de la douleur post-chirurgicale chronique pédiatrique est une priorité des patients, des parents/prestataires de soins, des professionnels de la santé et des décideurs. La douleur pré-chirurgicale et post-chirurgicale aiguë mal prises en charge constituent des facteurs de risque connus de la douleur post-chirurgicale chronique pédiatrique. La prise en charge efficace de la douleur périopératoire est essentielle pour prévenir la transition de la douleur aiguë à la douleur chronique aprés une chirurgie.Buts: Le but de cette étude était de recenser les pratiques actuelles en matiére de prise en charge de la douleur chirurgicale pédiatrique et d'évaluer l'état de préparation au changement du systéme de santé dans les établissements de soins de santé menant des chirurgies pédiatriques au Canada.Méthodes: 85 professionnels de la santé multidisciplinaires (infirmiéres, chirurgiens, anesthésistes, auxiliaires médicaux) ont répondu à un sondage en ligne de 20 établissements de santé au Canada concernant les soins pédiatriques pré et post-chirurgicaux en établissement, les services spécialisés de traitement de la douleur, les services de la douleur spécialisés et la préparation organisationnelle à la mise en œuvre du changement.Résultats: De tous les services de la douleur spécialisés, les services de la douleur aiguë et chronique/complexe étaient les plus fréquents, principalement avec la participation d'un médecin et d'une infirmiére. L'adéquation avec les pratiques recommandées pour les soins pédiatriques pré et post-chirurgicaux était variable (38,1 %-79,8 % ont déclaré « oui, pour chaque enfant ¼), alors que les hôpitaux pour enfants tertiaires/quaternaires ont déclaré moins d'adéquation que les autres institutions (hôpitaux communautaires/régionaux ou de réadaptation, centres de traitement communautaires). Aucune différence significative n'a été rapportée entre les établissements de soins de santé desservant uniquement les populations pédiatriques et ceux desservant aussi les adultes. L'expérience professionnelle/la pratique en matière de soins de santé a été la force la plus rapportée dans les soins de la douleur chirurgicale pédiatrique, tandis que les normes de soins incoh'rentes constituaient la lacune la plus courante. Les participants ont « quelque peu convenu ¼ que leurs institutions étaient engagées et capables de changer les soins chirurgicaux pédiatriques.Conclusions: ll y a un besoin continu déaméliorer les soins de la douleur pédiatrique pendant la période périopératoire dans les établissements de soins de santé canadiens afin de prévenir efficacement le développement de la douleur postopératoire.

Influencing Work Culture: A Strengths-Based Nursing Leadership and Management Education Program.

Little is understood about developing the capacity of healthcare leaders to influence work cultures that promote health and healing. A program designed for clinical leaders to teach them how to create Strengths-Based care environments was piloted and evaluated using mixed methods. Data were collected from a convenience sample of 15 participants from two clinical sites. Evaluation of the data revealed that the program was impactful and that participants had the impetus to influence work environments by shifting their discourse from traditional deficit models of care toward an approach that illuminates a focus on strengths and relational ways of being a leader.

The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital.

This qualitative study explored the experiences of social workers, nurses, and physicians providing end-of-life care to children in a pediatric acute-care hospital setting. Findings demonstrated that participants experienced both professional and personal impacts of their work and employed various coping strategies under each of these domains. The acute-care setting was found to create unique challenges in providing end-of-life care. Implications for policy and practice include promotion of both individual and institutional-level coping strategies and supports that meet the various needs of staff. Implications for future research include a nuanced examination of differences in experiences among nurses, social workers, and physicians.

Attributes and Actions Required to Advance Quality and Safety in Hospitals: Insights from Nurse Executives.

To lead effectively within their organizations, nurse executives must possess quality and safety literacy and be able to engage and motivate clinicians to participate in safety and quality initiatives. Given the paucity of research in Canada, a study was undertaken to explore nurse executives' understanding of the key concepts and strategies associated with patient safety and quality improvement, and their engagement with patient safety and quality improvement in their hospitals and healthcare systems. This study used an exploratory qualitative design with a content analysis approach on 20 nurse executives working in hospitals in Ontario. Three key themes emerged from the narrative data set including: (1) being a strategic and system thinker while possessing the emotional intelligence to influence staff; (2) building credibility and relationships with point-of-care staff, board of directors, and leadership team and (3) creating a culture of safety and high reliability. Study findings can be useful in informing future learning opportunities for nurse executives and nurses leaders at all levels to enhance their quality and safety literacy.

A conceptual framework for advanced practice nursing in a pediatric tertiary care setting: the SickKids' experience.

Advanced practice nurses (APNs) at The Hospital for Sick Children (SickKids) are pediatric healthcare providers who integrate principles and theories of advanced nursing with specialty knowledge to provide autonomous, independent, accountable, ethical and developmentally appropriate care in complex, often ambiguous and rapidly changing healthcare environments. Caring for children and adolescents requires culturally sensitive and family-centred approaches to care that incorporate a unique body of knowledge. Family-centred care is an approach to planning, delivery and evaluation of healthcare that is governed by the establishment of mutually beneficial partnerships among APNs, health professionals and children/families. The cornerstone of APN practice at SickKids is the recognition of "family" as the recipients of care. By valuing and developing relationships with families, APNs promote excellence in healthcare across the care continuum to optimize the child's and family's physical, emotional, social, psychological and spiritual well-being. This paper outlines the evolution of advanced practice nursing at SickKids, beginning with the introduction of APN roles in the 1970s and culminating in the current critical mass of APNs who have been integrated throughout the hospital's infrastructure. We describe the process used to create a common vision and a framework to guide pediatric advanced nursing practice.

Interruptions and pediatric patient safety.

This study explored interruptions in pediatric nurses' work and the systems issues related to interruptions in nursing work environments. A total of 5,325 interruptions were observed in this study, providing information on sources, types, and causes of interruptions. The nursing work being performed when interrupted and the outcomes of these interruptions are described.

Close to the tipping point.

Nursing leaders play a critical role in creating and enacting a vision for collaborative practice with advanced practice nurses (APNs). In this special issue, Nancy Carter and colleagues have identified many important influences and outcomes of successful nursing leadership in the context of promoting advanced practice nursing roles. The authors make a strong case for the importance of nursing leadership to facilitate large-scale systems change, noting the multiple levels on which nursing leaders work to ensure advanced practice nursing roles are well introduced to improve patient care. Nursing leadership can move an innovation like advanced practice nursing practice forward toward the "tipping point," when the new idea takes hold and becomes socially acceptable and desired, when the early adopters have influenced the early majority and about 15 to 20% of the population have adopted the idea (Berwick 2003). In many ways our nursing leaders have achieved this with advanced practice nursing roles, and we should celebrate. APNs are now more common, and certainly members of the public are proud to speak of the roles APNs play in their health services. An idea that once captured the minds of a select few has spread, thanks in large part to the nursing leaders who had a vision, believed in an idea, fought for it and worked to embed the change in the system.