Question:
You can think of the best patient service you’ve ever received.
Why was it so successful?
What were the factors that made it great?
How did you know it was so good?
What were the factors that made it possible?
What factors could you identify as part of the management strategies?
In patient safety strategies
Now think about the worst care you’ve ever received from a patient.
What caused it to be so terrible?
Why was it so bad?
How did you know it was bad for you?
What factors contributed to the cheese being bad?
What could you find in the ‘nursing environment’?
What could be identified in the management or leadership strategies in use at the time?
What are the patient safety policies?
You can think about the best nurse that you have ever met.
(Imagine a mentor, a friend, or a trusted mentor.
What was it that made them so great?
What factors made them great?
How did you know they were so good?
What was it about their nursing work environment that allowed them to be successful?
What management strategies supported them?
What could you identify in their patient safety strategies?
At the ward or at the organisational level?
Or was it organisational?
Now think about the worst nurse ever.
(An antimentor is someone you don’t want to be a nurse.
Use the same questions you asked above.
Think back to the Coroner’s Cases which were discussed in Tutorial Week 4
How to use single case studies as a way to look at complex and deeply troubling issues
Be able to apply your contextual knowledge to dig deeper than may appear apparent.
Answer to Question: CNA417 Exploring Nursing Leadership
There are many systems in hospitals that determine the quality of care patients receive.
Policies, governance, rules, and regulations of the state can all have an impact on the quality of patient care (Lamont, Stewart, & Chiarella, 2017.
Nurses should adopt a reflective approach to their patient care (Winslow et. al., 2011, 2011).
This paper describes, using a case of a clinical placement, or a more general experience with patient care, how nurses can demonstrate their practices and the impact of hospital governance on the quality of the patient’s services.
The case will help answer five key questions about patient care.
Secondly, the example will illustrate how nurses respond in hospitals to regulations related to the provision services.
Additionally, the essay will examine the context of that regulation in relation patient-centered care and human right of patients.
The essay shows the best and worst practices one can encounter, and what lessons can be drawn from these experiences.
Clinical Placement Example
In one of the clinical placements I have in a hospital, I come across three patients who complain that the tuberculosis patient next to them is a problem.
Because they believe that he may transmit the disease to them, they worry about being near him in the same hospital ward.
They told the nurse they had discussed the matter with her and were told that the doctor in charge can only relocate a patient based upon his condition. Patients suggestions are not accepted.
I was aware of the danger and decided to try to reach our team leader. She advised me to wait to see the doctor as relocating patients or isolating them requires approval from the doctor.
After explaining the situation to me at midnight, the doctor-in-charge arrives. He tells me that although the hospital doesn’t have such arrangements, he will relocate the patient right next to the window.
It was in this form that I was allowed to record the incident, explaining some of our dissatisfactions.
The doctor also provided the latest advice on handling hand tools.
He recommended that we keep the same course of action when delivering our services.
Analyse
The clinical experience has shown that there are always concerns that patients must address.
First, tuberculosis (a common airborne disease) can lead to infection via airborne transmission.
Patients can be exposed to risks if the nurse does not adhere to hospital policies.
Although it’s true that one patient could transmit an infection to another, the nurse is reluctantly to transfer them. It is the doctor who is responsible for making this decision.
This worries me. I contact my team leader to discuss the matter. He or she will need to approve.
Patients are at risk of contracting tuberculosis if they don’t do enough.
Hospital policies must not only address the problems of patients, but also be consistent with the hierarchy.
A 2014 study regarding hospital epidemiology and infection control found that hospitals should use an evidence-based approach to develop policies regarding each medic’s responsibility.
This will allow patients to be helped more quickly in the event of an emergency (Aiken.
Staff members must also embrace autonomy and be able to access resources in order to improve their productivity in healthcare settings.
Research from 2014 that looked at leadership style for nurses shows that autonomy gives members the ability to take control of their own activities, rather than being dependent upon it (Gardner Gardner and O’connell, 2014).
This study also shows that when top leadership is provided by junior staff, it is easier for them to motivate their employees to perform better.
A second example is that clinical experience indicates that both patient choice as well as risk should be considered.
The nurse who is in charge of the patient does not provide assistance and may even be a danger to other patients.
Due to the leadership problems at the hospital, the decision to transfer the patient to another area is not affected.
I do my best and raise the concern to my boss, but he just tells me that it’s out of his responsibility.
When he arrives, I contact the doctor to discuss the situation. He then deals with it according to hospital regulations.
Tuberculosis infection can still be transmitted to patients in rooms with poor ventilation. As an example, the doctor may decide to move the patient to a window.
Safety in a hospital may not always be assured (Stalpers et. al., 2015.
Routine audits are recommended by the same study to ensure that the hospital environment where patients or health care workers operate is safe.
But, the study shows that there are many factors that make it difficult for that degree to be achieved, including sufficient health care providers to serve patients.
My leader seems to ignore the concerns of the patient and nurse, only answering to show her where she’s allowed to work.
It is common for nurses to refuse to fulfill their duties using hospital or other healthcare center rules. However, this can be dangerous or even harmful to patients.
While it is not her responsibility to move patients, she should have attempted to provide more information on the options for the nurse involved to solve the problem.
She is failing to act as a leader. She should be giving direction, mentoring, and advice to her subordinates.
A medic’s leadership ability and skill is critical in healthcare.
Leadership can be improved by involving themselves in solving problems faced by junior staff members (Reem Kitsantas, Maddox, & Maddox, 2014).
An analysis of senior and junior staff in health care revealed that there is poor communication between them. This can lead to poor quality healthcare for patients and a decrease in the provision of these services.
According to the same study, an integrated approach should be used. It should be done at regular intervals in order to determine satisfaction between senior and junior staff.
This could close any loopholes or help the hospital reach its goals.
A medic’s job is dependent on the care of patients.
Hospital dynamics are a threat for what is known as patient-focused medicine (Scholl, et al. 2014).
Hospitals are so crowded that patients are at increased risk of getting sick due to their hospital settings.
It is no longer possible for a physician to come to a patient’s house to give treatment. Instead, they will have to go to a facility that offers the same care.
A hospital can pose a danger to the patient because of the many roles they play.
This is because a patient could be in urgent need but not be able to access help due to the division of labor.
In the clinical placement case, the team leader seems to be against patient-focused care.
She should have responded to her question with more than a statement about what she is permitted to do.
Nurses are at high risk for infection if this happens.
Nurses and other healthcare professionals who are patient-focused put patients’ needs first.
According to Travaglia et. al. (2011), service delivery has become inefficient because of the complexity and organization in modern-day hospitals.
The lack of proper organization or resources can hamper the effectiveness of patient services.
Kaye et.al. (2015) state that there should always be another way to solve the problem than waiting (Kaye, et al. 2015).
This study shows that it is vital to continue restructuring, and one that focuses on patient-focused care.
It is also a step in the right direction for good clinical governance practices.
The daily audit is where patients can register their grievances about the day’s activities.
It shows that the hospital is serious about putting in place good clinical governance.
In 2011, a study on the clinical governance of rural hospitals found that many of these injuries and malpractices are due to poor clinical governance. Therefore, nurses and other staff can freely handle patients and perform procedures without following correct procedures (Travaglia und al., 2011).
Finally, health centers understand that patients have to have their rights protected and respected.
Patients have the right, except in extraordinary cases, to receive the best medical care possible, to access care, and to be treated with respect.
Patients’ health care is put at risk by the presence of patients close to them, as an example.
Their worry and anxiety about infection is not taken into account.
Furthermore, it is a human rights for everyone to feel safe. In the above case however, this appears to not be the case (Gagnier and al., 2014).
Nursing should avoid certain roles set by hospital leadership.
The team leader also ignores patients’ needs, increasing their vulnerability and risk of infection.
Patients’ human rights are being violated as the patient doesn’t receive the best medical care.
This violates fundamental principles of patient rights.
Patients have the right and obligation to care.
Sydney Law School research into regulatory reforms and health complaints found that patients in admission programs are often in a venerable and more frequently than not.
Their rights to access, consent, information, and care are frequently violated (Faden and Beauchamp, 2014).
It is therefore the responsibility for the leaders of health care to take measures to protect patients’ rights.Conclusion:
In order to ensure the provision of quality services, healthcare centers need leadership.
The delivery of healthcare services can be accelerated if there is good leadership.
The best practices for healthcare leaders must encourage autonomy among junior staff members, promote access to resources, stimulate motivation.
On the other side, although there needs to be a division in labor and responsibilities based on abilities, it should not be at patients’ expense but be for their benefit.
Policies must be made to ensure safety, protect patients’ rights and promote the best interests of all patients.
The clinical example illustrates that nurses can offer both the best services and the worst.
Although nurses may not be willing to bend to the organization’s dictates, it is possible for them to ignore patients.References:Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., … & McHugh, M. D. (2014).
An observational retrospective study to examine nurse staffing, education, hospital mortality and other factors in nine European countries.
The Lancet. 383(9931), 1824-1830.Botterill, L. C., & Hindmoor, A. (2012).
Turtles all down: bound rationality and evidence-based age. Policy Studies, 33(5), 367-379.Cummings, G. G., MacGregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., … & Stafford, E. (2010).
Systematic review: Leadership styles and outcomes for the nursing workforce.
International journal nursing studies, 47(3).Epstein, R. M., & Street, R. L. (2011).
Values and benefits of patient-centered care.Faden, R. R., Beauchamp, T. L., & Kass, N. E. (2014).
Informed consent, comparative effectiveness, & learning health care.
N Engl JMed, 370(8). 766-768.
Gagnier J. J. (2014).
The CARE guidelines are consensus-based clinical guideline development for case reports.
Journal of clinical epidemiology, 67(1). 46-51.Gardner, G., Gardner, A., & O’connell, J. (2014).
To assess the safety and quality nursing service innovation, the Donabedian framework was used.
Journal of clinical nurses, 23(1-2), 140-155.Hoch, J. E., & Kozlowski, S. W. (2014).
Leading virtual groups: Hierarchical leadership, support structures, and shared team leadership.
Journal of applied psychology 99(3), 390.Ignatavicius, D. D., & Workman, M. L. (2015).
Medical-Surgical Nursing – E-Book: Patient Centered Collaborative Care. Elsevier Health Sciences.Kaye, J., Whitley, E. A., Lund, D., Morrison, M., Teare, H., & Melham, K. (2015).
Dynamic consent is a patient interface that allows for the twenty-first century’s research networks.
European Journal of Human Genetics. 23(2), 141.Lamont, S., Stewart, C., & Chiarella, M. (2017).
Capacity to consent: Knowledge and application of legal and health standards.
Nursing ethics. 0969733016687162.Reem, A. D., Kitsantas, P., & Maddox, P. J. (2014).
A systematic review of the effects of residency programs on nursing graduates’ clinical decision making and leadership skills.
Nurse Education Today, 34(6) 1024-1028.Scholl, I., Zill, J. M., Harter, M., & Dirmaier, J. (2014). An integrative model of patient-centeredness-a systematic review and concept analysis.
PloS one (9(9),e107828.Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015).
An analysis of the literature revealed that there are associations between five characteristics of the nurse work environment, and five nurse-sensitive outcomes in hospitals.
International journal nursing studies, 52(4). 818-835.Travaglia, J. F., Debono, D., Spigelman, A. D., & Braithwaite, J. (2011).
Clinical governance: A review of key concepts from the literature.
Clinical Governance: An International Journal. 16(1).Winslow, S. A., Fickley, S., Knight, D., Richards, K., Rosson, J., & Rumbley, N. (2011).
Through shared governance, staff nurses renew a clinical ladder system.
Journal for Nurses in Professional Development (27(1)), 13-17.