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Self-leadership in diabetes: spreading the message

Heather Daly
, Mags Bannister
, Maggie Watkinson
, Debbie Hicks

The first article in this two part series on self-leadership briefly outlined several exercises undertaken by a group of DSNs to explore leadership within diabetes nursing. An important conclusion of the exploration undertaken by the group is that we all have the potential to lead and self-leadership is the first stage in the development of leaders. Sharing this insight with other DSNs became a priority for the original group. Six one-day workshops across the UK enabled 200 DSNs to participate in selected exercises. Due to over-subscription of the workshops a shortened satellite session was run at the Diabetes UK conference 2003 in Glasgow. The current article describes the exercises used in the workshops in more detail and analyses the feedback from participants.

To maximise the impact of the 1-day workshops, the core group of diabetes nurses selected elements from the original pilot study (Avery et al, 2003) which had greatest impact on their own development:

  • Dilts’ logical levels 
  • The feedback model 
  • Value elicitation 
  • Imagineering the future

Feedback model
The feedback model was explored at the start of the study day to enable participants to practice using the tool during the day.

Feedback appears to be something we all crave and require, but delivering feedback in a constructive manner is a major challenge. Feedback should only be given about observed behaviours, not about the individual as a person. Key components of feedback should always be considered:

  • Always seek permission before giving feedback. 
  • Base the feedback on reality. 
  • If you cannot think of a recommendation, do not give the feedback! 
  • Do not give feedback if emotional.

The feedback model included in the study day gives a clear framework to provide constructive feedback and ensures that feedback is directed at the correct (behavioural) level.

Values exercise
The values exercise is a means of establishing what is most important to people, as it enables their values to be prioritised from lower to higher levels.

In groups of three, each person is identified initially as A, B or C; they then take it in turns to experience the roles of explorer, guide and coach/observer:

  • A is the explorer, who answers B’s questions in an open and honest way.
  • B is the guide, whose job is to find out A’s values, and their relative importance in a particular situation.
  • C is the coach/observer, who keeps a note of A’s values, and their relative importance.

The situation used in the self-leadership workshops was what was important to A about their job. A fictional situation can be chosen, but it needs to be of importance to A, in order that A’s higher level values are identified. B starts by posing the question:

‘What would have to be true for you to leave your job?’

A’s answer will reveal one or more values. B asks a follow-up question in order to find a higher value:

‘Even if this were true, what would make you stay in your job?’

B then repeats the above questions until the highest value is revealed. For a more detailed role explanation, see Figure 1.

Outcomes from the values exercise
The participants found the values exercise relatively easy to do and many were amazed at the discoveries they made about their values. Knowing their values enabled some participants to understand why they felt unease or anger in certain situations. Ohers found that it gave a way to manage a situation, which had appeared impossible before. The majority of participants felt they would use this exercise at work and in their personal life.

Here are some examples of feedback statements about the exercise:

‘I intend to practise the values exercise with my team.’

‘Very thought provoking. Will use the exercises as a tool in practice.’

‘I have learnt new things which I can use at work and home.’

‘I gained a lot of information and most of all learning about myself!’

We found that when the values exercise was used with other nursing and multidisciplinary groups the outcomes were identical. Many colleagues realised (often for the first time) what is important to each other and how they could help each other to achieve their values. The values exercise is a simple, yet powerful tool.

Imagineering exercise
The afternoon session of the leadership workshops involved an exercise named ‘Imagineering the future – or knowing better where you are going’.

Overview of the imagineering exercise
The objective of the imagineering exercise is to enable participants to experience the creative cycle from the dreamer, realist and critic perspectives and use the insights gained to improve their ability to turn dreams into reality. The exercise uses physiology (postures) to help enter into the state of mind for each step. Key questions are used to help draw out the different states. There are three roles to play:

  • The explorer undertakes the exercise. 
  • The guide asks the questions. 
  • The observer helps the explorer maintain the correct posture in each state.

The questions stimulate the thinking patterns associated with the dreamer, realist and critic states. (Please refer to Part 1 of the series for further information about these states [Avery et al, 2003].) It is important to remember that a dreamer question, answered from a critic’s physiology is not likely to produce a congruent dreamer answer. Similarly, a critic or realist question answered from a dreamer physiology will not yield a ‘good’ answer. The aim of the observer is to ensure the explorer does not ‘contaminate’ his or her answer by shifting to an inappropriate physiology while answering the questions from the guide.

At the end of the exercise the explorer is asked to come out of the critic physiology and back into the dreamer physiology and state what advice they would take from the realist and the critic. The explorer is then asked to come out of the dreamer physiology and back to being themselves. The explorer is asked what advice they would give themselves following the experience to help them achieve their dreams. The three states should be positioned in the correct layout to enable the participant to get the most benefit from the exercise.

The following extract is feedback from a participant who completed this exercise:

‘When I went through this exercise as the explorer I chose my dream as being a nurse consultant. At the beginning of the exercise I would have done anything to achieve that dream. However, as the exercise progressed into the realist stage I quickly realised that there were other important factors in my life that may affect or be affected by my dream. When I moved into the critic stage I became aware that the other factors, namely my family, were far more important than my dream to become a nurse consultant. The only way to resolve my needs and those of my family was to seek a nurse consultant post that was close to home. This exercise made me acutely aware of thinking a situation through, looking at all perspectives before making a decision which could affect not only myself but others either at work or home. It was a very powerful experience for me.’

This very personal account is reflected in many of the comments from course participants, as shown below:

‘Very thought provoking discovery of self.’

‘Nice to have the opportunity to focus on myself for once.’

‘On the whole a good day. It will be of ben- efit to me personally.’

Evaluation of the workshops
A total of 198 delegates attended the six nurse self-leadership workshops across the UK. The evaluation of the study days focused on five areas:

  • Meeting personal learning objectives 
  • Organisation of the day 
  • Content 
  • Personal and professional development 
  • Future needs

Meeting personal learning objectives
Figure 2 illustrates that 73% of participants reported that all or most of their learning needs had been achieved.

Organisation of the day
The organisation of the day was well evaluated. The timing for the day was considered appropriate (if at times over too quickly!). The opportunity to work in groups with nurses from different workplaces appeared to contribute to an atmosphere that was considered safe and relaxed. The comment below reflects many of the comments on the evaluation form.

‘I really enjoyed this study day. It was well facilitated and presented. Very friendly and welcoming.’

The exercises chosen as the main focus of the days were positively evaluated. Many participants stated that the new skills had been acquired as a result of the excellent group work and were transferable to their lives at work and home. The high quality of the information packs that supported the sessions were appreciated.

Personal and professional development
The comments relating to personal and professional development suggested that participants had started a journey of self- discovery. Many left motivated to practice and develop the new skills that they had acquired.

Future needs
Strong support for additional events was identified. Some individuals wanted more time to explore the topic of leadership in greater depth, while others wanted the opportunity to explore how people use the skills in practice.

The self-leadership workshops were a huge learning experience for all those involved; the facilitators learned as much as the participants, both in the preliminary stages of planning and in the workshops themselves. It is hoped that they were of use to the DSNs who attended and will equip them with new ways to achieve their dreams for people with diabetes, diabetes nursing and themselves. It would be fascinating to ask those who attended in 5 years time if their dreams have come true!


Avery L, Brown F, Da Costa S, Watkinson M (2003) The leader within: self-leadership in diabetes nursing. Journal of Diabetes Nursing 7(10): 390–93

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