Methodological approaches that facilitate the constant learning in nursing leadership

Enfoques metodológicos que facilitan el aprendizaje constante en liderazgo en enfermería

ABSTRACT

Objective:

To know the methodological approaches that facilitate the constant learning of leadership by undergraduate nursing students.

Method:

Qualitative research, of case study type, carried out with 26 nursing students from a federal public university in the Northeast Region. For the collection, the workshop technique was applied in July and December 2017, with two different groups. Analyzed with the support of content analysis and Nvivo®11 software. Interpreted with the theoretical contribution of Peter Senge.

Results:

They listed two codes, understood as, essential to the formation of leaders, emerging the categories: Adoption of a leadership style; Qualities and attributes of the leader; Methodological approaches that facilitate the constant learning of leadership.

Final considerations:

It was identified that the application of teaching techniques and strategies, brings students closer to the performance scenarios. It is necessary to offer more stimuli during training since there are shortages in teaching for the development of leadership.

Keywords:
Learning. Leadership. Nursing. Health services administration. Education; nursing

RESUMEN

Objetivo:

Conocer los enfoques metodológicos que faciliten el aprendizaje constante de liderazgo por parte de los estudiantes de licenciatura en enfermería.

Método:

Investigación cualitativa, del tipo estudio de caso, realizado con 26 estudiantes de enfermería de una universidad pública federal de la Región Nordeste. Para la colección se aplicó la técnica del taller en julio y diciembre de 2017, con dos grupos diferentes. Analizado con la ayuda de análisis de contenido y software Nvivo®11. Interpretado con el aporte teórico de Peter Senge.

Resultados:

Enumeraron dos códigos, entendidos como esenciales para la formación de líderes, surgiendo las categorías: Adopción de un estilo de liderazgo; Cualidades y atributos del líder; Enfoques metodológicos que faciliten el aprendizaje constante del liderazgo.

Consideraciones finales:

Se identificó que la aplicación de técnicas y estrategias de enseñanza, acerca a los estudiantes a los escenarios de desempeño. Es necesario ofrecer más estímulos durante la formación, ya que hay escasez en la enseñanza para el desarrollo del liderazgo.

Palabras clave:
Aprendizaje; Liderazgo; Enfermería; Administración de los servicios de salud; Educación en enfermería

RESUMO

Objetivo:

Conhecer as abordagens metodológicas que facilitam a aprendizagem constante da liderança por discentes da graduação em enfermagem.

Método:

Pesquisa qualitativa, do tipo estudo de caso, realizado com 26 discentes de enfermagem de uma universidade pública federal da Região Nordeste. Para a coleta aplicou-se a técnica da oficina em julho e dezembro de 2017, com dois grupos distintos. Analisados com o auxílio da análise de conteúdo e software Nvivo®¹¹. Interpretados com o aporte teórico de Peter Senge.

Resultados:

Elencaram dois códigos, entendidos como, imprescindíveis à formação de líderes emergindo as categorias: Adoção de um estilo de liderança; Qualidades e atributos do líder; Abordagens metodológicas facilitadoras da aprendizagem constante da liderança.

Considerações finais:

Identificou-se que a aplicação de técnicas e estratégias de ensino, aproxima os discentes com os cenários de atuação. Sendo necessário ofertar mais estímulos durante a formação, uma vez que há carências no ensino para o desenvolvimento da liderança.

Palavras-chave:
Aprendizagem; Liderança; Enfermagem; Administração de serviços de saúde; Educação em enfermagem

INTRODUCTION

In the current perspective, new paths are opened for the construction of knowledge and development of skills and abilities considered essential for the entry and performance of future nurses in the labor market. This is due to the growing market transformations, a consequence of technological advances, globalization and competitiveness, which have been demanding a better performance of professional nurses in the meantime of labor activities1^-5. In this way, it is encouraged the application of methodological approaches that facilitate the approximation and stimulate the protagonism of nursing students in the development of leadership in the course of graduation.

Taking leadership as an essential managerial competence for the exercise of the profession, as it involves a set of knowledge, skills and attitudes that enable nurses to act in line with the needs of patients and the services offered4^-5. It is worth noting that leadership is one of the managerial competences of nurses, which have been included in their general training process since 2001, in the National Curriculum Guidelines (Diretrizes Curriculares Nacionais - DCN) of the Undergraduate Nursing Course6.

However, because it is about the ability to influence and/or guide people to achieve common goals, the insecurity in exercising leadership due to lack of experience represents one of the challenges experienced during professional insertion in work settings7^-8. In view of this, a study about the teaching of leadership in nursing indicated that, in the training process in nursing, the adoption of theoretical-methodological approaches favors the improvement and perfectioning of technical skills by students, resulting from a teaching model that is still very much linked to technicist learning. And, it pointed out to the need to strengthen and improve the managerial outlook and leadership potential even in undergraduation8.

In view of the above, it is clear that, in order to achieve effective leadership by nurses, they lack the application of different strategies that favor the adoption of a posture for participatory management in favor of nursing care9^-10. An international study11⁾ about trends in development of leadership demonstrates the urgency of such competence for the performance of nurses and also among students. Furthermore, it needs to be recognized as an essential component for the training and practice of the profession, especially in a context of few investments in favor of teaching leadership during undergraduation11.

In the fields of teaching and research12, the ability to exercise leadership is one of the factors that lead nursing professors to assume university management positions, although the lack of specific training to exercise it compromises the construction of this professional profile. These results show the lack of investment and sensitization on the part of educational institutions and health services for the development of this competence early, from the beginning to the end of undergraduation, and later when entering the field of work.

In view of these aspects, teaching leadership during the training process presents important benefits to nursing students in improving their capacity for decision-making, awakening them to the dialogicity, criticality and horizontality of relationships, in the creation of possible strategies to transform the reality in which they are and in the preparation for entry into the labor market13.

A research14 carried out in the United States revealed that nursing professionals seek to offer quality services to the community and, for this purpose, new teaching models that enable the training of nurse leaders are reaffirmed as important, since these professionals involve the team looking for better results.

In this sense, it is aimed, through constant learning of leadership, to value the interrelationship between academy and health services, as a way to stimulate encouragement, autonomy, discussion, reflection and socialization of practices experienced in the context in which the students are inserted, in a movement to share new and different knowledges15^-16. As well as encouraging the development of new strategies as contributions to the advancement of the teaching-learning process, regarding the application of innovative and problematizing methodologies, which favor criticality and reflexivity by linking the student in the various work settings.

Thus, it is intended that the use of constant learning of leadership occurs transversally during nursing undergraduation, in order to provide the student with knowledge and better preparation for coping with situations that may occur while the nurse is conducting the work, given the specificity and complexity of the profession17.

For this study, a preliminary research was carried out, revealing a gap in the literature regarding the use of constant learning of leadership during undergraduate in nursing. Therefore, in order to address weaknesses related to the training of leaders and with the aim of transforming the operating scenario and strengthening individual and collective commitment, through the continuous improvement of personal and organizational capabilities. It was adopted the theoretical framework of Peter Senge18, about the five subjects that contribute to constant learning in organizations, namely, the personal mastery; the mental models; the shared vision; team learning and systems thinking, which “represent approaches (theories and methods) to develop the three core capabilities of learning: stimulate aspirations, develop reflective conversations and understand complexity”. This theoretical framework was adopted for weaving explanations about the development of leadership in the organizational environment, which made it possible to bring its constructs closer to the object of study, by seeing the characteristics that make up the organizational structure of higher education institutions, in this case, specifically of the Nursing Course at a Public University.

Regarding the role of leadership in the learning organization, Senge18⁾ highlights it as challenging for instigating behavior changes and reinforces that, in the past, leadership was associated with wisdom, however, nowadays the concept of leader represents personality traits of those in prominent position. As a result of confusion and lack of understanding of the meaning of leadership, a limited idea that only people in management positions are responsible for change.

Thus, in view of the importance of teaching leadership during undergraduate nursing and the impacts it generates on the performance of these future professionals, the question is: how methodological approaches facilitate the constant learning of leadership by undergraduate nursing students. To answer this question, the objective was defined to know the methodological approaches that facilitate the constant learning of leadership by undergraduate nursing students.

METHODOLOGY

Qualitative and exploratory study, of case study type, linked to a matrix project, financed by the Support Program for Young Doctors (PROPESQ), developed at the School of Nursing of a public university located in the Northeast Region, Brazil.

Peter Senge’s theoretical contribution 18, emerged as a reference for the interpretation of the findings, as a model for new perspectives for the constant learning of leadership during undergraduate nursing. Author of the learning organization concept, graduated in Engineering and Philosophy, with a master’s degree in Social Systems Models and a PhD in Management. Senge is known around the world as one of the most influential thinkers in management and leadership, founder, and director of the Society for Organizational Learning (SOL).

Thus, in order to understand and apprehend the concepts of constant learning in organizations, it was proposed to approach and adjust for nursing, the author’s ideas about the five disciplines (systemic thinking, personal mastery, mental models, shared vision and team learning). By providing reflexivity, dialogicity, criticality and autonomy in students during undergraduation, in order to train nurse leaders18.

The author⁽¹⁸⁾ describes the application of theoretical-methodological approaches to the progress of central abilities of group learning. In addition, it presents three examples of leadership that make up the organization, defined as “ecology of leadership” (Figure 1), namely: 1) Local line leadership that integrates innovative practices, tests the effectiveness of systemic tools and works with mental models; 2) Network leadership where local leaders on the front line works closely, in building skills and integrating with practices; 3) Executive leadership who are the developers of the work models (mission, values ​​and vision), but they are not necessarily the authors for creating the models, however, they are responsible for them in order to ensure trust, in addition they are considered essential because they represent the purposes of the organization. Furthermore, Senge (2018) also points out that each of these leadership styles interrelate and are important within the organization.

Figure 1 -
Ecology of leadership

Senge18⁾ , also presents “the new vision of leadership in the learning organization” and identifies leaders as follows: leader as a designer who is related to the organizational infrastructure, thought as the human body, a “living system”, organized and performing its functions; the leader as a teacher who stands out for acting as a facilitator of the teaching process and for stimulating people to grow and/or for creating spaces for the development of learning.

As for the participants, 26 students regularly enrolled at the HEI were invited, selected based on the following inclusion criteria: students regularly enrolled in the Undergraduate Nursing Course and who were attending the curricular component Management of Health Systems and Services. Students transferred from other schools were excluded.

For data collection, two workshops were held, named W1 and W2. The workshop4, is considered to be a methodological tool that serves as a space for negotiation of meanings and/or points of view, as well as for exposing individual conceptions, with the aim of motivating participants to reflect on their experiences.

The workshops took place in 2017 and were scheduled in advance, with groups who attended the discipline in two consecutive academic semesters. The first workshop took place in July and was attended by 15 students, the second in December of the same year, with 11 students, totaling 26 participants. The approximate length was 30 to 45 minutes. Four researchers were present (undergraduate and graduate students and professors) previously trained for the actions.

The activities were recorded with the help of a smartphone that has the audio-visual recording feature. Initially, a sociodemographic questionnaire was applied and then the workshop began guided by a pre-established script, with the explanation of the dynamics of the workshop, divided into two moments: Moment I (thematic investigation with the presentation of the trigger video about the leadership in the design of the group and, subsequently, the opening for discussion); Moment II (coding, decoding and critical unveiling, from the selection of reflective phrases on the theme of leadership and teaching in nursing with the exposure of the students’ ideas).

The elements extracted from the workshops were identified by the respective acronyms, W1 and W2, followed by the letter S (referring to student) and a number corresponding to the order of participation (e.g., W1S1, W2S1).

For data analysis and treatment, content analysis was used, according to the operative proposal of Minayo19, being conducted through the following phases: 1) ordering, with the organization of collected materials, reading/rereading and arrangement of transcripts; 2) categorization by searching for units of meaning, pre-analysis based on empirical and theoretical material, separated by subjects in the Word software, for classification and gathering of information; 3) attentive, in-depth and pervasive reading of the categories and units of meaning; 4) conclusion, with the presentation of information11. Data were processed using the NVIVO®11 software, in which the materials were typified by similarities and correspondence to the objectives of the work.

The workshops allowed the identification of two codes intertwined with each other: knowledge and understanding of students about the concept of leadership, types, styles, characteristics and attributes of the leader and methodological approaches applied to teaching leadership, elements pointed out by them as essential for the development of this competence constantly at undergraduation. Thus emerging, three thematic categories: Adoption of a leadership style; Qualities and attributes of the leader; and Facilitating approaches to the constant learning of leadership. With the theoretical contribution of Peter Senge.

The study complied with the recommendations of Resolutions 466/12, 510/16 and 580/18 of the National Health Council. The project was submitted and approved under opinion nº. 1,479,217 by the Research Ethics Committee; and, after approaching the students, they were invited to participate in the research. All participants read and signed the Informed Consent Term in duplicate (participant and researcher), as well as being informed about the right to accept or not participate in the research or to withdraw at any time, without any prejudice.

RESULTS

Adoption of a leadership style

In the students’ perception, the choice of a leadership style by the nurse, in a given situation, can influence relationships with the team. The statements of the students are close to Senge’s theoretical precepts18 about network leadership and they understand the participative action of the nurse leader as a motivator and/or multiplier capable of propagating actions and connecting with different groups and work settings. Thus, for students, the exercise of participatory, shared and dialogic leadership is essential for labor activities:

[...] participatory leadership, which he will share, he will build together with his followers [...], there are several types of leadership. Good leadership will depend a lot on the type of leadership the nurse leader will adopt (W1S5)

[...] (in the dialogic perspective) the leader will not only manage to solve those problems, those conflicts, but always count on the collaboration of these workers to improve the organization. I believe it is more in this sense [...]. (W1S8)

[...] I believe that from the moment a leader does not have an authoritarian stance, but rather dialogic with his workers, he is able to better lead the work process within nursing, in the sense that workers will recognize themselves [...]. (W2S8)

The statements also indicate characteristics and skills of the leader that can provide nurses with greater autonomy and better performance to work together with the team, as well as facilitating decision-making and resolving actions and conflicts.

Qualities and attributes of the leader

Students reported that the development of behaviors that promote harmonious interpersonal relationships represents a fundamental tool for the construction of a leadership profile by the nurse, as it favors approximation, bonding, and teamwork. For Senge18, people with different behaviors who share the same space tend to obtain similar results, that is, people with different views can share the same ideas and build the results they want to achieve:

[...] during all semesters to have a contribution to be able to empower ourselves to lead [...]. (W1S11)

[...] understanding that working as a team is listening to the other, having this qualified listening, this sensitive listening [...] helps in this decision-making, in this leadership process [...]. (W2S1)

[...] productive experiences can really make a big difference in decision-making moments [...]. (W2S10)

The students’ reports are similar to the concepts of Senge18, about the leader as a teacher, who is characterized by his participation in theoretical-practical activities as a model of leadership based on their experiences and knowledges, acting as a transforming agent that it promotes empowerment, stimulates trust, listens to its employees, encourages teamwork and promotes a participative leadership posture mediated by dialogue.

[...] be dialoguing in this process so that people can also state what they think [...]. (W2S1)

[...] dialogue... It is fundamental, a basis mainly in conflict management [...] to horizontalize the relationship, it is not something authoritarian, vertical (W2S5)

As reported above, students point out to dialogue as an element that provides horizontality in relationships and refers to the primary skill to be acquired during nursing education, as it favors the conduct of the work process and strengthens interpersonal relationships. For Senge18, the practice of dialogue is made possible by team learning and comprises empathy, being attentive to the other’s speech, knowing how to listen and sharing ideas that provide better decision-making. Furthermore, keeping the open dialogue avoids conflicts and misunderstandings among the team.

Facilitating approaches to the constant learning of leadership

The use of tools that favor the apprehension of knowledge and training of students is highlighted as resources that promote the approach to the theme and encourage the freedom of actions in an integrated manner with theoretical and practical knowledge:

[...] it is a training that allows a lot of this autonomy, some components are still stuck in that process of throwing information, but I see, mainly from the middle of the course to the end, this dialogical way of working in the classroom, allowing a conversation wheel and other ways of evaluating, as we have tutorials, summaries, which allow the autonomy of the education process [...]. (W1S4)

[...] nursing training, the conduct based on productive experiences [...], the opportunity for an internship, an extension group, a research project [...]. Bring someone new, recently graduated, with experience [...]. (W1S5)

Likewise, they indicate the use of teaching strategies as facilitating methodological approaches for the training of nurse leaders:

[...] a pilot project and they could articulate with the disciplines [...] in which there is hospital practice, hold workshops, forums, promote events that talk more about leadership [...]. (W1S7)

[...] strategy so that we don't stay the eight semesters just glued to the professor and when we reach the curricular internship, we have to do it alone, like the unit's nurse [...]. (W1S11)

It is observed that the encouragement of constant learning of leadership even in the undergraduate course in a transversal way and with the support of the management component since the first semester provides the development of this competence by students and can promote better performance associated with theoretical-practical knowledge in different performance settings (academy, health services and community). In addition, it facilitates the understanding and comprehension of the complexities that eventually present themselves and favors the autonomy and critical-scientific capacity to seek new paths for the care offered.

DISCUSSION

Students identify and understand that the adoption of a leadership style by nurses, developed since undergraduation, promotes more proactive, collaborative, and confident behavior, encouraging harmony in relationships and bonding with the team. Thus, the different leadership models and their respective components represent aspects considered relevant when it comes to the quality of care, as they help professionals in their work routine and involve all those who, directly or indirectly, are inserted in this context7.

Based on the results obtained, it is noted that leadership models are relevant for the development of the organization and professional performance, as they act in an integrated way to deliver services in accordance with Senge’s conception18, about interrelationship existing in the ecology of leadership and places local line leadership by encouraging insertion and reflection in the construction of shared visions, related to the experienced scenario, in the preparation of learning spaces added to the service and addresses the network leadership as collaborators of this process, for promoting the link between these environments, reverberating in the propagation of learning and knowledge.

A correlation research20 between leadership styles indicates that the presence of the leader is essential in the services, as it anticipates the solution to problems. However, they point out that for the effectiveness and resoluteness of a leadership style, behaviors and conducts that favor sensitive listening and the participation of the team in decision-making are necessary, as well as attitudes consistent with the needs of the health institution, of patients and the professionals who work there.

In this case, Senge18, describes the personal vision as one of the elements that contributes to leadership in the development of team learning to achieve the results they want, by sharing the same ideas, attitudes and purposes and, it encourages participation and approximation of all involved. Thus, it is observed, in the reports of this study, mention of some behaviors that characterize a more participative and dialogic leadership style, such as the ability to put oneself in the other’s place, the creation of bonds of trust and the promotion of the horizontality of the relationships through dialogue and sensitive listening13.

In addition, the students report that the construction of the leader takes place continuously and together, as well as involving knowing how to work in a team and the willingness to assume a relational behavior favorable to the adoption of a leadership posture by the nurse during management of care11^,13. Researchers21, express the importance of strengthening leadership with continuous team learning and at all levels of an organization and highlight that the attributes of the leader influence people to follow the same purposes. Corroborated by another study9 that deals with satisfaction and improvement in the work environment, based on the practice of relational network leadership. In nursing education, moving towards constant learning of leadership may be a new alternative, due to the strengthened theoretical basis proposed by Senge, capable of supporting curriculum components that strive to develop this professional competence.

Students also considered certain knowledge, skills and attitudes as essential attributes for the better conduct of interpersonal relationships, which permeates the obligation of the mere execution of tasks and moves towards the involvement and appreciation of team members8. That said, it is clear that the improvement of leadership during undergraduation favors the understanding of students about the importance of developing some characteristics, such as: self-awareness, engagement, cooperation, sense of equality, common purpose and citizenship22. Thus, it is worth noting that aspects related to the labor routine such as technicality, professional devaluation and work overload can represent obstacles to the construction of a leadership style focused on dialogue and sensitive listening.

It was also reported by the respondents that the domain of theoretical-practical knowledge constitutes a guiding contribution of a leadership profile and is an aspect valued and recognized by the nursing team. However, they express little interest and little effort by some professionals to develop and improve this competence during their work performance and for insertion in the field of work. A research carried out in Indonesia23 showed that for nurses to develop knowledge and skills related to leadership, support and perseverance in education is important, seeking recognition and encouragement from organizations, with the purpose of minimizing the challenges for nurses to exercise this competence.

Senge18 considers learning the true source of leadership and argues that the true teacher is, above all, an apprentice. From this perspective, the “leader as a teacher” stands out through the constant search for learning, which uses instruments to assist in the recognition and identification of the weaknesses and/or potentialities of the students. In addition, it appoints the professor as a facilitator of the learning process, which contributes to the development of leadership during undergraduation by creating spaces and/or methodological tools that facilitate and favor knowledge by students and cultivate the characteristics and skills that can be improved or enhanced.

A study24 carried out in Turkey with undergraduate nursing students concluded that leadership is intentional and requires a personal willingness to work collaboratively. It considers leadership socially responsible, vital for social change, as it portrays an expanded understanding of this competence, beyond the innate characteristics of the individual. In this perspective, the nurse leader enhances changes in the relationship between people and, consequently, provides a more harmonious work environment, in addition to better quality of care.

Another aspect identified in the statements refers to the presence of approaches that facilitate the constant learning of leadership as an element that allows the approach of students to different scenarios of action and promotes the practical experience of situations presented in the context in which they are inserted. A study7 addresses the relevance of using active methodologies as tools that provide the training of professionals committed to the services and favor the process of leadership with autonomy, decision-making and resolution of actions and conflicts, also with reflections on the improvement of assistance and interpersonal relationships.

For Senge18, better and lasting results can be achieved by applying systemic thinking to leverage important gains to services, in order to favor the recognition of the complexities that present to know the whole to understand its parts and be able to act in the processes of effective and efficient way, including the planning and resolution of problems that may occur.

The American Association of Colleges of Nursing 24 (AACN) points out some difficulties for the development of leadership in both the bachelor’s and graduate programs. Contexts of shortage of labor and, at the same time, a focus on quality care, intensify this perspective and make it essential to develop this capacity from the beginning of undergraduate nursing.

In the present study, a weakness pointed out by the respondents is related to the use of the Health Services Management component, as it is only approached in the eighth semester. According to them, it is necessary to approach the discipline in a transversal way with the others during the undergraduation course. It calls for reflection on the need for greater investments by higher education institutions and health services in the training of nurse leaders.

In this way, it is clear that the application of facilitating methodological approaches, integrated into the fields of practice, represents a tool and opens up essential spaces for the development of skills and abilities by undergraduate nursing students. It is noteworthy that this contact provides students with reflection on the practice of leadership and stimulates their learning, due to the early recognition of the role played by the nurse leader in the labor market. Furthermore, it is a way of valuing the profession and the bond with the team, motivating them to share decision-making processes and improve the care offered.

FINAL CONSIDERATIONS

The present study sought to know methodological approaches that facilitate constant learning of leadership. These approaches, understood by the respondents as the use of teaching techniques and strategies in an articulated way between theory and practice, such as: workshops, tutorials, discussion forums, extension actions, internships, participation in research groups. And they express that such methodological resources applied in the classroom or in practical activities in laboratories and/or services, favor this learning and help to broaden the discussion, stimulating behavior change in promoting new attitudes by the group, facing the complexities that arises.

Thus, the adoption of Peter Senge’s theoretical framework supports the importance of continuous and improved leadership development, of breaking paradigms, in the transformation of thought, through metanoia, and provides means for reformulating the curriculum of the higher education institution studied, and perhaps other institutions, in the construction of a future that one wants to achieve.

Furthermore, deficiencies in the teaching of leadership were evidenced in the lack of investments and preparation during undergraduation so that students can progress in this competence. However, despite this gap in teaching, students recognize essential aspects for leadership development, such as: interpersonal relationship, sensitive listening and dialogue, which will allow the construction of critical, reflective and empowered professionals.

The study has as limitation the fact that it was carried out in a single educational institution, which prevents comparisons with other contexts in the training of nursing students. Due to the relevance of the theme for Nursing, it is considered essential to promote reflections on this matter in different regions of the country and to persevere so that its peculiarities are included in the curriculum guidelines.

In this sense, the present study contributes to achieving these purposes, as it indicates important ways to strengthen the development and improvement of this competence early on, even during the undergraduation of future professionals.

Acknowledgments:

Support Program for Young Doctors at the Universidade Federal da Bahia (PROPESQ) - funding the project and Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES) - financial support related to the Master’s scholarship.

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Edited by

Associate editor:

Dagmar Elaine Kaiser

Editor-in-chief:

Maria da Graça Oliveira Crossetti

Publication Dates

• Publication in this collection
  03 Dec 2021
• Date of issue
  2021

History

• Received
  20 May 2020
• Accepted
  17 Mar 2021