Nursing leadership in palliative care: The point of view of committed and experienced nurse leaders

This study aimed to understand the phenomenon of leadership in palliative care (PC) nursing from the nurse leaders' experience by describing its nature and elements that facilitate and hinder its expression within the healthcare system of Quebec.;The results show that the phenomenon of PC nursing leadership is composed of five dimensions, i.e., Philosophical/ Ethical, Systemic/ Institutional/ Service, Professional, Relational, and Personal (Objective I), and an overarching pattern of facilitating and hindering conditions to the expression of PC nursing leadership, i.e., Experiencing Congruence or Incongruence Across Dimensions (Objective II). This pattern holds four major themes: Heeding or not Heeding the Call of Conscience and Responsibility, Fostering or Thwarting Freedom of Practice, Strengthening or Weakening Professional Identity, Creating Community or Existing in Isolation.;Combined, these two structures form a dynamic gestalt represented by concentric circles, starting with the Philosophical/ Ethical dimension on the outside and the Personal Dimension at the center. As such, emphasis is placed on mutual influence between contiguous and outer dimensions, including the greater world, and on the interrelatedness and interdependence of the dimensions. In addition, this framework emphasizes the importance of the mutual influence of the context/ environment upon the leader and the leader upon the context/ environment. Lastly, the expression of PC nursing leadership is facilitated by the alignment of environment/ context with the PC nurse leader. In turn, this alignment breeds a sense of congruence, meaningfulness, autonomy, empowerment, and belonging. Conversely, misalignment tends to lead to incongruence, ethical dilemmas, loss of meaning, erosion of professional identity, and isolation.;A qualitative research design grounded in descriptive phenomenology (Giorgi, 1985, 2009) was used. A purposive sample of 14 participants was selected based on their recognition as PC nurse leaders by peers. The types of settings where they practiced were university hospitals, PC and/or oncology units, community-based settings, a long-term care setting, and a home that specialized in PC. Participants were all French-speaking females from the Province of Quebec, practicing in urban and semi-rural regions, ranging between 34 and 64 years of age, with nursing experience that varied between 11 and 45 years, and with 5 to 36 years of palliative care experience. Face-to-face semi-structured interviews were undertaken that lasted between 1.5 and 2.5 hours each.