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Chapter 2: Literature Review
early 1990s (Brody, 1996; Hofland, 1994; Erlander, Drechler and Wallin Pearson,
1993; Quill and; Smith, 1992). Many researchers found that leadership permeates all
aspects of care (Forbes-Thompson and Gessert, 2005; Swagerty, Lee and Smith,
2005) and that lack of leadership results in fragmented, task-based approaches to
care (Swagerty, Lee and Smith, 2005). Ford and McCormack (2000) stated that
registered nurses possessing expertise in their individual practice are not enough to
sustain effectiveness in gerontological care, and that nurses require expertise in
leadership to create an organisation that values an approach to care that sustains
expert practice.
One study explored nurses’ experiences one year after an organisation’s commitment
to providing a client-centred and client-empowering approach to care (Brown,
McWilliam and Ward-Griffin, 2006). Using an interpretive phenomenological
design, the researchers purposively selected eight Canadian nurses and conducted in-
depth interviews (averaging 55 minutes in length). Their aim was to understand the
lived experience of registered nurses practicing in home care who had implemented a
philosophy of flexible client-driven care. Hermeneutic analysis was used to elicit
themes and patterns from the data. The researchers found that barriers to introducing
the new approach to care were encountered at system, organisation and personal
levels. They suggested that nursing leaders need to promote professional knowledge
and practice regarding relationship building, client-centredness and autonomy if
nurses and clients are to be empowered. The study identified potential pitfalls in
implementing a change in approach to care-giving, and further identified the
potential ways for nurses in other care settings to address the leadership challenges
in dealing with these pitfalls. The decision to adopt a phenomenological approach
was appropriate to meet the aim of this research, which was to understand the lived
experience of the nurses. The main concern with this piece of research is that the
case manager selected the participant population from which the researchers were to
recruit their sample. The data analysis was described in detail, but the design of the
open-ended interview guide was not detailed.
In another study, Forbes-Thompson and Gessert (2005) found that leadership
permeates all aspects of care in residential homes for older people. They discussed
the impact of structures, processes and outcomes in an organisation’s approach to