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Accepted: 27 June 2017
DOI: 10.1111/jocn.13949
ORIGINAL ARTICLE
The development of the Person-Centred Situational
Leadership Framework: Revealing the being of
person-centredness in nursing homes
Brighide M Lynch BSc, PhD, RGN, Research Associate1
| Tanya McCance BSc, DPhil,
RGN, Director of the Institute of Nursing and Health Research2 | Brendan McCormack BSc,
DPhil, RGN, Head of Division of Nursing3 | Donna Brown BSc, DPhil, RGN, Lecturer in
Nursing1
1
Faculty of Life and Health Sciences,
Institute of Nursing and Health Research,
Ulster University, Jordanstown, UK
2
Faculty of Life and Health Sciences, Ulster
University, Jordanstown, UK
3
Queen Margaret University, Edinburgh, UK
Aims and objectives: To implement and evaluate the effect of using the Person-Centred
Situational Leadership Framework to develop person-centred care within nursing homes.
Background: Many models of nursing leadership have been developed internationally in
recent years but do not fit with the emergent complex philosophy of nursing home care. This
study develops the Person-Centred Situational Leadership Framework that supports this phi-
Correspondence
Brighide M Lynch, Faculty of Life and Health
Sciences, Institute of Nursing and Health
Research, Ulster University, Jordanstown,
UK.
Email: b.lynch@ulster.ac.uk
losophy. It forms the theoretical basis of the action research study described in this article.
Methods: This was a complex action research study using the following multiple
methods: nonparticipatory observation using the Workplace Culture Critical Analysis
Tool (n = 30); critical and reflective dialogues with participants (n = 39) at time 1
(beginning of study), time 2 (end of study) and time 3 (6 months after study had
ended); narratives from residents at time 1 and time 2 (n = 8); focus groups with
staff at time 2 (n = 12) and reflective field notes. Different approaches to analyse
the data were adopted for the different data sources, and the overall results of the
thematic analysis were brought together using cognitive mapping.
Results: The Person-Centred Situational Leadership Framework captures seven core
attributes of the leader that facilitate person-centredness in others: relating to the
essence of being; harmonising actions with the vision; balancing concern for compliance with concern for person-centredness; connecting with the other person in the
instant; intentionally enthusing the other person to act; listening to the other person
with the heart; and unifying through collaboration, appreciation and trust.
Conclusions: This study led to a theoretical contribution in relation to the PersonCentred Practice Framework. It makes an important key contribution internationally
to the gap in knowledge about leadership in residential care facilities for older people.
Relevance to clinical practice: The findings can be seen to have significant applicability internationally, across other care settings and contexts.
KEYWORDS
culture change, nursing homes, older people, person-centred practice, person-centredness,
personhood, residential care, situational leadership
J Clin Nurs. 2018;27:427–440.
wileyonlinelibrary.com/journal/jocn
© 2017 John Wiley & Sons Ltd
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1 | INTRODUCTION
The endorsement of a leadership approach that will change the culture of care for older people living in nursing homes is an important
agenda internationally. There are, however, few robust studies in the
What does this paper contribute to the wider
global clinical community?

gap in knowledge about leadership in residential care
literature that explore the correlation between transformational leadership and effective nursing care in long-term care facilities for older
people (Lynch, 2015). Although several models of leadership have
facilities for older people.

enabling and person-centred and is the first of its kind in
icy situations, many of them are not appropriate for nursing home
Contemporary nursing home care espouses the concept of “person”
A model of leadership is presented (the Person-Centred
Situational Leadership Framework) that is facilitative,
been developed for acute care settings and for management and polcontexts (McCormack, Roberts, Meyer, Morgan, & Boscart, 2012).
This study makes an important key contribution to the
residential care.

This study illustrates that engagement in a facilitated
and “personhood” and is increasingly influenced by the philosophy of
critical reflective process is fundamental to the develop-
“household,” where the physical environment of the nursing home
ment of person-centred leadership and more person-
and all its features are designed to mirror a true home for the resi-
centredness among care staff.
dents (Chapin, 2006; Shields & Norton, 2006; Thomas, 2004). The
development of a theoretical framework of situational leadership in
residential care for older people (Lynch, McCormack, & McCance,
empirical evidence in the literature to demonstrate the impact this
2011) can be considered as an approach that supports this philoso-
culture change movement has had on the quality of life of the resi-
phy—the Person-Centred Situational Leadership Framework (PCSLF).
dents living in nursing homes (Petriwskyj, Parker, Brown Wilson, &
The framework integrates person-centred theory as depicted in the
Gibson, 2015).
Person-Centred Nursing Framework (McCormack & McCance, 2006,
Consistent with international reviews (Bamford-Wade & Moss,
2010, 2017) with situational leadership theory (Hersey & Blanchard,
2010; Bowles & Bowles, 2000; Govier & Nash, 2009; Thyer, 2003),
1982, 1997). The PCSLF emphasises the key behaviours and contex-
recommendations from a number of reviews in the Republic of Ire-
tual variables involved in the process of developing others to accom-
land (HIQA, 2009; Murphy, O’Shea, Cooney, Shiel, & Hodgins, 2006)
plish the optimum outcome of effective person-centred practice. The
all call for a change in the culture of care and a move to a more per-
framework was used in an action research study in residential care
son-centred approach led by a transformational nurse leader. More
as the foundation for developing and facilitating a leadership inter-
recently, the Francis report (2013) highlights the need for the nurs-
vention programme for six leaders. The purpose of this study was to
ing profession to develop skilled nurse leaders who will enable the
report on one aspect that emerged from this complex action
delivery of effective person-centred care.
research study, focusing on seven core themes/attributes that contribute to our understanding of person-centred situational leadership
2.1 | Culture change and person-centredness
in residential care settings.
There are opposing views in the literature as to how the culture of
an organisation can be changed. Some writers suggest that the cul-
2 | BACKGROUND
ture can be manipulated by the leader (Bate, 1994; Schneider, 1994),
while others describe a shaping and moulding of the culture by the
The nursing home, as a community for older people living together
actions and reactions of the leader, and the leader in turn being
and a place where staff come to work, embodies a complex array of
shaped and moulded by that culture (Bass & Avolio, 1994). Within
relationships, interactions and connections. This complexity often
these opposing views, a consensus still exists suggesting that leader-
leads to a control model of management and leadership that can be
ship and culture are strongly interwoven (Schein, 1992). With refer-
observed in the way staff schedules and routines control the space,
ence to nursing homes, culture change involves the complete
the time and the people in the building (Brown Wilson, 2009; Grant
transformation of the institutional practices, routines and schedules
& Norton, 2005). Over the past 10 years, there has been a signifi-
that govern the delivery of care to residents—in other words, a
cant change in the philosophy of nursing home care for older people
person-centred culture. McCormack and McCance (2010) define per-
internationally (Ragsdale & McDougall, 2008). In the USA and
son-centredness as:
Canada, this change stemmed from the recognition that older people
living in nursing homes were lonely, bored and helpless (Thomas,
an approach to practice established through the forma-
2004). Several culture change models advocating the radical trans-
tion and fostering of therapeutic relationships between all
formation of nursing home care were developed around the same
care providers, older people and others significant to
time and included Wellspring (Stone, Reinhard, Bowers, Zimmerman,
them in their lives. It is underpinned by values of respect
& Phillips, 2002), Eden Alternative (Thomas, 2004) and the House-
for persons, individual right to self determination, mutual
hold Model (Shields & Norton, 2006). To date, there is a lack of
respect and understanding. It is enabled by cultures of
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429
empowerment that foster continuous approaches to prac-
interpersonal skills, clarity of values and beliefs and knowledge of
tice development. (McCormack & McCance, 2010; p. 31)
self, outlined in the Person-Centred Practice Framework (McCormack & McCance, 2017). For example, in relation to performing a
For over a decade, the literature on nursing leadership has demon-
specific task to deliver care, the leader and the follower agree on
strated the endorsement of transformational leadership as the pre-
the diagnosis of the follower’s developmental level, ranging from D1
ferred style in leading nursing through a constantly changing
(enthusiastic beginner) through to D4 (self-reliant achiever). Using a
healthcare environment (Bamford-Wade & Moss, 2010; Bowles &
person-centred approach, the situational leader adopts a leadership
Bowles, 2000; Govier & Nash, 2009). To date, very little work has
style, ranging from S1 (directing) through to S4 (delegating) and
been performed to make a correlation between transformational lead-
aligns it to the follower’s developmental level. By combing high and
ership and effective nursing care in nursing homes. McCormack et al.
low supporting behaviours with high and low directing behaviours,
(2012) carried out a review of several new models that claim to have
the situational leader takes the follower through the developmental
a person-centred focus and aim to de-institutionalise care settings for
levels in order to manage the care environment and deliver effective
older people. In their review, the authors explore the implications of
person-centred care (Lynch et al., 2011).
these models for the role of the registered nurse in residential care
and caution against their implementation in the absence of a clear
understanding of the concept “person” and “personhood.” McCormack
et al. (2012) argue that for an effective person-centred culture in
nursing homes to develop, the personhood of all persons (residents,
3 | THE STUDY
3.1 | Aim
staff members and family members) needs to be honoured and
The main aim of the study was to implement and evaluate the effect
respected so that meaningful relationships are created within a sup-
of using the PCSLF to develop person-centred care within nursing
portive context that enables person-centred care to take place. Nolan,
homes.
Davies, Brown, Keady, and Nolan (2004) conclude that “relationshipcentred care” is a more suitable term (Nolan et al., 2004, p. 47). However, as an understanding of the concept of personhood and meaningful relationships is essential to the implementation of person-centred
care, it is apparent that a like-minded view between person-centred
3.2 | Objective

To use the PCSLF as the foundation for developing and facilitating a leadership intervention programme for six leaders.
care and relationship-centred care exists. The Person-Centred Situational Leadership Framework (PCSLF) in nursing homes (Lynch et al.,
2011) can be considered an approach that supports these principles.
3.3 | The context
The research study was undertaken in the Republic of Ireland in
2.2 | An overview of the Person-Centred
Situational Leadership Framework (PCSLF)
established privately operated nursing home. The nursing home had
84 residents who lived in three households, within the facility. Each
household mirrored a normal home environment, with its own
Working from the premise that transformational leadership is situa-
kitchen, sitting room, dining room, bathrooms and bedrooms. The
tional leadership enacted within the Person-Centred Nursing (PCN)
services provided in the nursing home included residential care,
Framework, a theoretical framework of situational leadership in nurs-
nursing care for the frail older person and care for the person living
ing homes was developed that brings together previous empirical
with dementia. The leaders in the nursing home were the director
research by McCormack and McCance (2006, 2010, 2017) and Her-
of nursing (DON) and her assistant, the care manager (CM). Each
sey and Blanchard (1982, 1997)—the PCSLF. This action research
household had a clinical lead (a registered nurse) and a house lead
study was used to demonstrate the use of the framework.
(a senior member of care staff), and they reported directly to the
The PCSLF focuses on the leader’s ability to diagnose the perfor-
DON and CM. At the time of recruiting the leader participants,
mance, competence and commitment of the follower. By adopting a
there were six leaders in the nursing home: one household did not
flexible approach, the leader modifies their style of leadership to
have a clinical lead appointed and another household did not have a
align it with the developmental level of the follower. Blanchard
house lead appointed. All the leaders in the nursing home (n = 6)
(2007) defines the “follower” as:
participated in the study: Rose (DON), Bell (CM), Dot and Jen (clinical leads) and Polly and Iris (house leads). These are pseudonyms for
the person being led by the situational leader (p. 88).
the leaders.
Through the process of “partnering for performance” (Lynch,
2015), the situational leader diagnoses the follower’s effectiveness in
4 | METHODS
delivering person-centred care. This is established by determining
where the follower sits on the developmental continuum in relation
The study adopted an action research approach similar to the pro-
to the five prerequisites of professional competence, commitment,
cess described by Lewin (1946/1948; p. 206):
430
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LYNCH
It proceeds in a spiral of steps, each of which is com-
ET AL.
4.2 | Sample/study participants
posed of a circle of planning, action and fact finding
The study participants were recruited from the staff and residents in
about the results of the action.
the nursing home. Different approaches to sampling were adopted
A qualitative approach to the evaluation of the implementation
dependent on the method of data collection. For the observations of
of the PCSLF was adopted. This approach focused on gaining a deep
practice, a convenience sampling strategy was used to include all
understanding of the relationship between situational leadership pro-
team members as key participants during the negotiated time period
cesses and how these processes are operationalised in the context
of each observation. Convenience sampling was used for the resident
of person-centred culture change.
narratives at time 1 and time 2 of the study. A purposive sampling
strategy was used to recruit six participants for the staff focus group.
The participants were recruited from across the three households
4.1 | Data collection
and included a registered nurse and a carer from each household. All
In order to gain a deep understanding of leadership practices and
six leaders in the nursing home were included as a convenience sam-
principles and how these were understood by team members, resi-
ple for the focus group with leaders. Clarification of the overall sam-
dents, managers and the leaders themselves, the data came from
pling process used in the study is presented in Table 1.
several sources:



The Workplace Culture Critical Analysis Tool (WCCAT; McCormack, Henderson, Wilson, & Wright, 2009) is a nonparticipatory
In order to analyse the data, different approaches were adopted for
observation tool that uses combined practice observations and
the different data sources. Table 2 provides a summary of how each
critical dialogue approaches to data collection. It was used in
data source was analysed separately and then the overall results of
the study to analyse the culture of the practice settings where
the thematic analysis brought together in the final stage.
the leaders work. The tool itself adopts a holistic and person-
The planning and co-ordination of data analysis took place during
centred perspective and the observation criteria are specifically
the supervision sessions of the study and involved a team approach.
designed to explore the processes of practice and the extent
Getting immersed in the raw data helped to uncover the feeling and
to which they reflect person-centred principles, team relation-
flavour of the common threads, the differences, the unique occur-
ships and the way these do or do not support person-centred
rences and the tentative themes that were arising from the data set
practice.
as a whole (across the three time periods). The results of the the-
Critical and reflective dialogues between the lead researcher (BL)
matic analysis were brought together using the process of cognitive
and each of the six leaders helped to generate a deep under-
mapping (Eden, 2004). Cognitive mapping techniques help to struc-
standing of the culture and the experiences of the leader partici-
ture a large amount of data material from different sources while
pants.
initial
encouraging creative ways of working and displaying the data clearly
workshops, debriefing following observations of practice and
in a map (McCormack and Garbett, 2003; Semple and McCance,
monthly meetings with leaders.
2010). The overall cognitive map was large; however, a section from
Narratives from residents at time 1 and time 2 of the study. The
the map is presented in Figure 1.
These
conversations
were
initiated
during
main aim of the narration was to gain an understanding of how
residents perceived leadership in the nursing home. At the commencement of the narrative interview, the resident was given an

4.3 | Data analysis
4.4 | Ethics
explanation of the purpose of the study and the main focus of
Ethical approval for this research study was received from Ulster
the narration was identified. Bauer (1996) suggests that the nar-
University Research Ethics Committee, ethical approval number:
rative interview uses an ordinary day-to-day method of communi-
REC/10/0193. Participation in the study was voluntary and informed
cation that combines the telling of a story with listening and in
consent procedures were designed to provide the leaders/team
so doing, gathers data in a natural way.
members/residents with sufficient information so that they could
Focus groups held with staff at time 2. Participants were asked
make an informed decision about the potential inconveniences and
to focus on what they saw as the particular skills required by the
benefits of participating in the study. Participants were assured of
leader to lead person-centred care effectively and how they felt
anonymity, confidentiality and their right to withdraw.
the PCSLF had or had not contributed to the developmental level

of the team in the household.
Reflective field notes helped tie the whole process together. The
5 | RESULTS
reflective field notes by the lead researcher (BL) were structured
to capture a description of the experience, the issues that arose
Through the process of cognitive mapping (Figure 1), seven core
during it, the feelings about the experience, what could have
themes were identified, and as part of the analysis, a descriptor was
been changed and the learning from the experience.
developed for each of the seven themes. The themes have been
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431
T A B L E 1 Clarification of the overall sampling process
Method of data collection
Sample
11 observations of practice
A convenience sampling strategy was used to include all team members as key
participants during the negotiated time period of each observation
Residents’ narratives at time 1 and time 2
Observation
Participants
Activity in household
(n = 4) 1 leader and 3 staff members
Meal and mealtimes
(n = 6) 2 leaders and 4 staff members
Meal and mealtimes
(n = 2) 1 leader and 1 staff member
Meaningful interactions
(n = 5) 1 leader and 4 staff members
Leadership behaviour
(n = 2) 2 leaders
Leadership behaviour
(n = 3) 3 leaders
Leadership behaviour
(n = 2) 2 leaders
Connecting with the residents
(n = 5) 1 leader and 4 staff members
Team meeting
(n = 11) 3 leaders and 8 staff members
Team meeting
(n = 11) 3 leaders and 8 staff members
Leadership meeting
(n = 6) 6 leaders
A convenience sampling strategy was used to recruit participant residents at time 1 and
time 2.
Four resident participants at time 1 and four different resident participants at time 2
were selected on the basis that they volunteered to share their narratives (n = 8).
Focus groups/leaders time 2
All six leaders in the nursing home were included as a convenience sample in the study
Focus groups/staff time 2
A purposive sampling strategy was used to recruit six participants. The team member
participants were recruited from across the three households and included a registered
nurse and a carer from each household. The criterion was that all 6 team members
were working in the respective households during the period of time that their leader
was participating in the study.
synthesised with the evidence in the data and emerge as specific
workshop revealed that, up to this point, none of the leaders had
core attributes of transformational leadership that need to be pre-
ever considered how they were “being” as leaders when managing
sent in the situational leader in order to bring about person-centred-
the care environment, nor had they thought about the style of lead-
ness. The seven core themes are as follows:
ership that they most frequently used with the members of their







team (e.g., directive, coaching, supportive or delegating).
relating to the essence of being;
harmonising actions with the vision;
balancing concern for compliance with concern for person-centredness;
connecting with the other person in the instant;
intentionally enthusing the other person to act;
listening to the other person with the heart; and
unifying through collaboration, appreciation and trust.
I have a fear of delegating various aspects of the dementia care programme to members of my team in case they
don’t get it done adequately. . .I tend to make the
changes in the House myself . . .I always relate with the
them as the leader because I am the one who has to
take responsibility. I know now . . . from the PCSLF. . .
my style of leadership is quite a directive one.
(critical dialogue with Iris, following initial workshop;
time 1)
5.1 | Relating to the essence of being
Descriptor The situational leader experiences an arising awareness
and a witnessing of their emotions as they relate to the
other person in the moment.
The PCSLF isn’t just about me developing them as leaders, it’s also about developing me. . .I’m not only a facilitator for this group of leaders but also a situational
leader as well.
(BL reflective field notes; time 1)
The first example of a clear synthesis between the evidence in
A second workshop with leaders at time 1 focused on the princi-
the data and the theme “relating to the essence of being” comes at
ples of the WCCAT. Following this, several initial WCCAT observa-
time 1, during the workshop with the six participant leaders to intro-
tions of practice took place that looked at the leaders’ changing
duce the PCSLF. The critical dialogue that took place following the
practice. The first observation looked at meal and mealtimes for the
432
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ET AL.
T A B L E 2 Approaches used to analyse the data
Data source
How were the data analysed?
By whom?
When?
The Workplace Culture
Critical Analysis Tool
(WCCAT)
Analysis followed six-step process of thematic
analysis (McCormack et al., 2009). Information
was read /re-read by each individual member of
the group who captured meaning and shared
with the others. Each participant themed/refined
the data and shared themes and explanations
with rest of the group. The final shared tentative
themes were agreed upon and the data sources
identified.
Lead researcher worked with
leaders and staff in household
where observation took place to
support them in theming the data.
Immediately following each
observation of practice
Residents’ narratives
Duration of recorded narratives ranged between
half an hour to 1 hour—each one transcribed
verbatim. Thematic approach for each analysis
(Riessman, 2008). Set of themes inductively
created by identifying key words/ideas/
impressions from the data and linking themes
together using short extracts and examples from
the narratives.
Took place during the supervision
sessions of the study and involved
a team approach.
Time 1 and time 2 of the study
Critical and reflective
dialogues
Thematic approach—similar to the approach
adopted for the residents’ narratives (total of
114 conversations over 227 hrs)
As above
At the 3 time periods of
the study
Focus groups with staff
Inductive approach to analyse the data (Ely, Anzul,
Friedman, Gardner, & McCormack Steinman,
1991; McCormack, 2002). Transcription of tape
recordings verbatim, making notes and creating
initial tentative themes across the data set and
matching data extracts to the themes.
As above
At time 2 of the study
Entire data set
Immersion in the entire data set. Reading and rereading all the extracts (including BL’s reflective
field notes). Process helped determine whether
the themes were representative of overall data
set and helped identify additional themes.
Results of the thematic analysis brought together
using the process of cognitive mapping
(Eden, 2004)
As above
Final stage of analysis
residents and Iris, house lead, was an observer during this observa-
and take over during the observation of practice but held back and
tion. Iris noted that staff member Rhonda, who was assisting a resi-
continued observing—she remained present in the moment. Her
dent with eating and drinking, was not communicating with the
reflective dialogue captures how she sensed her essence of being:
resident or relating to her in any meaningful or person-centred way.
she experienced a total awareness and a witnessing of her emo-
Rhonda made no eye contact or attempt to communicate with the
tions. From the reflective dialogue, it was evident that there were
resident and walked away leaving food residue dripping from the resi-
a development and an enlightenment taking place with Iris, facili-
dent’s mouth. During the dialogue with Iris afterwards, she reflected:
tated by the learning from both workshops. Iris coached Rhonda
over several weeks in assisting the residents with their nutrition
I actually felt uncomfortable, to the degree that I
and reflected:
wanted to step in and take over. . . I didn’t, I just
stayed observing, which was very difficult. . . she
Learning how to coach Rhonda has really helped me
[Rhonda] didn’t relate to Mary [resident] at all! I knew
to see the benefit of working in a partnership way
from the workshop on the observations of practice that
with her. She feels much more capable in assisting the
if I stepped in it would have an effect on the out-
residents with their meals . . . she’s at the “capable
come. . . I just took deep breaths and kept observing. . .
but cautious contributor” stage. . . she can now really
(reflective dialogue with Iris; time 1)
relate with the resident in a meaningful way for
them. . . with who they are in essence. . .
Iris, who had revealed after the initial workshop that her dominant style of leadership was directive, had the impulse to walk in
(reflective dialogue with Iris following partnering for
performance with Rhonda; time 2)
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FIGURE 1
A section from the cognitive map
5.2 | Harmonising actions with the vision
Descriptor
433
The uncovering of an authentic vision of personcentredness is dependent on the situational leader giving
the team and the residents the space and presence to
reflect on, and refine their individual values and beliefs, so
that their overall intention is revealed naturally.
and in harmony, with the detail of what “having a great life” looked
and felt like for the residents living there.
In partnering Rose for performance, BL focused on diagnosing
Rose’s ability to support the individual team members in articulating
their values and beliefs and thereby enlist the overall team in a common vision for the household. Rose felt she was at the enthusiastic
beginner stage with respect to facilitating a values clarification exercise as a way of developing a common vision with the team. There-
An observation of practice that looked at activity in Household B
fore, BL used a directing style of leadership with Rose initially,
at time 2 revealed that some care practices in the care environment
taking her through the principles of Manley’s (2000) values clarifica-
were not aligned or in harmony, with the person-centred vision that
tion tool:
Household B espoused. In the critical dialogue with Rose following
the observation of practice, Rose expressed concern about what she
. . .In your own home a visitor wouldn’t come in and
had just observed:
change the TV channel. . .why should they do it here?
When Rose asked me about my values that’s what I
It really goes against the vision.
said. . . I value people treating here as if it was my home
they were coming into. . .
Rose described the vision for the household as being:
(narrative from Sarah, resident, Household B; time 2)
The residents who live in Household B have a great life
A narrative from one of the residents at time 1 illustrates the resi-
here and our mission is to work as a team to make this
dent’s confidence and trust in Rose’s leadership skills and indeed in
vision a reality.
her ability to inspire a shared vision for the residents and the team:
These words were visible in a framed vision statement on the
Rose is just super, no use in saying otherwise. . . she’s as
wall of Household B and Rose confirmed that all the staff were
straight as a rush. . . there’s no back doors with Rose.
aware that this was the goal of their household. However, during
She’s like an umbrella and she shelters us all under-
the dialogue, she agreed that the statement gave the impression of a
neath. . .guides us along the path to where we’re going-
guideline that was set in time but not “a living ethos.” BL and Rose
. . .she can see what’s up ahead and we all trust her to
discussed examples of the practices that Rose might witness in the
take us there. . .
care environment if the actions of the team members were aligned,
(narrative from Lil, resident, Household B; time 1)
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5.3 | Balancing concern for compliance with
concern for person-centredness
Descriptor
The situational leader supports the follower in moving
from a complete focus on the “doing” perspective of a care
process for the resident, to a greater focus on “being”
totally present in the moment with the resident while
carrying out the care process.
During a second observation of practice that looked at lunch-
ET AL.
style to support Polly in facilitating the group. The residents made
the decision that the best way to let them know what was on the
menu was to see a sample of each choice plated and they could
then choose the food they preferred. The main outcome from this
action was that the care practice of demonstrating the offer of
choice to residents at mealtimes became one that was visual, tangible and meaningful for the residents, including those residents who
had a cognitive impairment. It also fulfilled the regulatory requirements and aligned a person-centred approach to care with concerns
for compliance:
time for the residents (time 2), Polly, house lead, observed various
members of the staff going over to each table where residents
The discussion circles are great for getting everyone’s
were seated, and prior to the meal being served, they repeatedly
opinion. I’ve told them that I think there’s a lot of was-
called out what was on the menu. In the consciousness raising and
te. . .food waste and there shouldn’t be food wasted with
problematisation phase of the WCCAT,

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