Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

DeLuca, Sandra

Abstract

In this critical hermeneutic study, I critically explore nursing leaders’ storied experiences of phronesis within the COVID-19 pandemic. Phronesis is the ability to perceive a situation and deliberate well in order to determine the best course of action for human beings. Theoretically informed by critical social theories, I considered how the enactment of phronesis was often performed according to normative discourses and the socio-political historical situatedness of nursing leaders. I utilized Frank’s (2012a) narrative dialogic analysis to interpret and bring into conversation participant stories, and multiple discursive voices. Based on Pinkola Estés (1995), I use the metaphor of the wild wolf to frame the narratives of nursing leaders’ who, I argue have at times, relegated their ‘wildish nature’ to the poorest lands of their authentic self. Amidst the chaos and unknowns of the early months of the COVID-19 pandemic nursing leaders collaborated with leadership “command teams” to make decisions based on institutional and government directives. The findings in this research demonstrate how phronesis is often performative based on socially constructed leadership models that have created images of how to be a competent and effective leader. Managerialist discourses and hegemonic cultures are argued to lurk in the shadows and to sustain the health care hierarchy shaping nursing leaders’ prioritization of dominant views over nursing perspectives. While nursing leaders in this research often framed their thinking and actions based on altruistic values and beliefs, the discrepancy between values, beliefs and actions was also evident in the data. It is argued that a consideration of what is “best” in nursing leadership practice requires reflexivity and a critical understanding of how discourses influence one’s identity and world view. Phronesis was revealed through nursing leaders embodied sense of the right thing to do and the articulation of clear principles that underpin decision-making and actions. Recognizing how hegemonic cultures shape one’s ‘self’ has the potential to transform and (re)connect nursing leaders with their authentic selves. Additionally, interpretations offer considerations for nursing leadership education and professional development by taking into account how managerialist and institutional discourses shape nursing leader’s ontological perspectives. Greater attention to critical perspectives, reflexivity, knowing and naming institutional discourses and cultures has the potential to inform a reimagining of phronesis as a ‘way of being’ for nursing leaders.

Summary for Lay Audience

This research critically examines nursing leaders’ storied experiences of practical wisdom during the COVID-19 pandemic. Practical wisdom involves making decisions considering what is best for human beings. I consider what insights might be gained by critically examining how practical is enacted by nursing leaders and the broader context surrounding decision-making, judgement, and actions. Critical perspectives were used to challenge some of the taken-for-granted norms within nursing leadership. Emerging from this research are different ways of thinking about how institutional contexts shape nursing leaders thinking, behaviors, and actions. Within the chaos and uncertainty of the pandemic, many nursing leaders defaulted to traditional hierarchies out of concern for the safety of patients, staff, and families. Nursing leaders performed the role of being confident, in control and visible which aligns with organizational management. Nursing leaders articulated a strong regard for nursing however, actions did not always align with the values, beliefs, and mandate of nursing. Within this research, nursing leaders drew on experiential, personal, and intuitive knowledge to consider the best course of action. The findings reveal that nursing leaders often prioritized government or institutional mandates with little consideration of the ripple effect on patients, families, and communities. Front-line nurses were often not included in decision making regarding their work or on formal leadership decision making team(s). The findings in this research suggest that wisdom involves more than intelligence and experience. Practical wisdom requires nursing leaders to consider how their values, beliefs and dominant institutional norms shape decision-making and the power institutions wield over who they are, how they behave and what they believe. Critical reflexivity holds potential for nursing leaders to extend their focus inward in order to discover hidden assumptions, biases, and dominant ways of seeing, thinking, and acting. This research offers a new way of thinking about how to be a nursing leader by inviting nursing leaders to question what informs one’s position and actions. Wise nursing leadership includes attention to critical reflexivity and a prioritization of nursing values and nursing knowledge. The findings from this research have implications for nursing leadership professional development, nursing education and health professional education.

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