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Reflection on Adult Nursing

PART 1: Reflection on Learning

Part 1 of the portfolio includes discussions on self-awareness and self-efficacy to foster understanding of my beliefs, values, attitudes, knowledge, skills, and attributes for leadership development. According to Choperena et al. (2019), to become an effective leader, it is essential to understand your personality, motivation, and the values that drive me to maintain my curiosity about others and myself. In addition, reflection helps in emotional intelligence development; therefore, this part of the portfolio critically explores the contemporary management and leadership styles that I follow, impacting the inter-agency team relationships, organisational culture, and nursing practices, using Rolfe’s model of reflection (Salem, 2021). 

What?

I work as a student nurse, and to develop myself as a registered nurse, I work in an acute care area for cardiac care in a hospital setting. While practising as a nurse, I have observed specific weaknesses that could pose several threats in my nursing practice. However, I also possess specific strengths that, based on the findings of Shaughnessy et al. (2018), I can utilise for developing more learning opportunities to become an influential leader in nursing practices. My strengths as a nurse include dealing with uncertain situations because I am adaptive to uncertainties. In addition, while dealing with uncertain situations, I have developed a capacity to think effectively.

Further, I am a good learner and tend to seek assistance and guidance where required.  The mentioned qualities make me adaptive to gather information and involve myself in multidisciplinary teams, according to Krepia et al. (2018). I have also observed that I am calm and can track constant evolving situations. On the other hand, my weaknesses include a lack of confidence and skills that I have learned, making it challenging for me to deal with uncertainties in practice. 

So What?

Based on my experience working in a cardiac care unit in a hospital setting, I have realised that I must follow a transformational leadership approach as it aligns with my strengths of being calm and communicating with a multidisciplinary team. Poghosyan and Bernhardt (2018) state that the transformational leadership style can develop followers into leaders because this leadership style allows enough space to raise concerns and beliefs. The idea of Poghosyan and Bernhardt (2018) is supported by Liukka et al. (2018) claiming, transformational leadership style helps bring a positive change within an individual or a setting. In addition, I have realised the importance of peer review for my development as a nurse, with the help of team feedback and updating my knowledge from research published in the area. In addition, in my practice as a nurse in the cardiac care unit, I have realised the importance of CQC as a quality improvement guide based on their inspection reports. 

Now What?

To develop myself as a nurse, I follow the transformational leadership style to enhance my ability to communicate with the team members. Based on the findings of Boamah et al. (2018), following the transformational leadership style, I will be able to use my quality to communicate to increase my confidence level by collecting constant feedback and learning outcomes from my colleagues. In addition, I will update my knowledge regarding healthcare and effective practices with the help of effective feedback, which will also be helpful for the juniors as they will be sharing their concerns, leading to better care outcomes in my nursing practice. Finally, based on the CQC inspection reports, I will respond to the care concerns of the patients and develop an action plan to improve my techniques for a better setting. All in all, my core focus is on to learn stress management skills, as stress is the one that can burnout and puts the negative impact on the overall delivery of care. Therefore, once I will be able to develop resilience, I will be better able to manage stress at work that will allow me to make less mistakes and learn from the past experiences by ensuring better quality of care is delivered to the patients. 

References

Boamah, S.A., Laschinger, H.K.S., Wong, C. and Clarke, S., 2018. Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing outlook, 66(2), pp.180-189.

Choperena, A., Oroviogoicoechea, C., Zaragoza Salcedo, A., Olza Moreno, I. and Jones, D., 2019. Nursing narratives and reflective practice: a theoretical review. Journal of advanced nursing, 75(8), pp.1637-1647.

Krepia, V., Katsaragakis, S., Kaitelidou, D. and Prezerakos, P., 2018. Transformational leadership and its evolution in nursing. Progress in Health Sciences, 8, pp.185-190.

Liukka, M., Hupli, M. and Turunen, H., 2018. How transformational leadership appears in action with adverse events? A study for Finnish nurse manager. Journal of Nursing Management, 26(6), pp.639-646.

Poghosyan, L. and Bernhardt, J., 2018. Transformational leadership to promote nurse practitioner practice in primary care. Journal of nursing management, 26(8), pp.1066-1073.

Salem, M., 2021. Violence against Nurses: A Reflection Paper. Journal of Advanced Practices in Nursing, 6(3).

Shaughnessy, M.K., Griffin, M.T.Q., Bhattacharya, A. and Fitzpatrick, J.J., 2018. Transformational leadership practices and work engagement among nurse leaders. JONA: The Journal of Nursing Administration, 48(11), pp.574-579.

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PART 2: Quality in the NHS Review

Part 2 of the essay deals with the critical evaluation of how the role of quality assurance, clinical governance, local, national, and international initiatives steer healthcare quality. This part emphasises the interaction and relationship between the diversity within an organisation, developing positive teamwork, enabling a multi-professional environment. For this purpose, this part of the portfolio will critically evaluate the role of healthcare providers, NHS commissioner, the care quality commission (CQC), and monitoring the quality care in the NHS. 

The role of healthcare provider in quality care

According to Asthana et al. (2019), to enable quality care in healthcare, the role of a healthcare provider is to be responsible for developing innovative methods to improve their practices for better healthcare. The NHS long term plan emphasises transformation and the role of a leader nurse to promote innovation and transformation within a healthcare setting. Further, the healthcare providers are responsible for enabling clear access to healthcare facilities. On the other hand, the findings of Asthana et al. (2019) are supported by Wake and Green (2019), claiming that the employees in healthcare are responsible for active engagement within the healthcare setting to understand patients’ needs and concerns. Additionally, Leistikow and Bal (2020) suggest the healthcare professionals’ role in providing quality healthcare, stating that the healthcare professionals’ role is to develop resilience within their personality to promote patient safety, which is their utmost duty. Further, the healthcare providers’ role is to follow the principles of safety management, which state that t to provide flexible solutions to potential problems in healthcare, supporting the findings of Wake and Green (2019) and Asthana et al. (2019). Asthana et al. (2019) further added that the role of the healthcare providers is to ensure that junior nurses are trained accordingly. When junior nurses are trained according and asked to work on their weaknesses such as communication, decision making, and leadership skills, then nurses are able to perform their duties accordingly and are in a better position from where they can develop stress management and resilience skills. The adoption of resilience also allows the junior nurses to develop their skills via evidence based learning, in which they study the academically published papers and then are asked to apply the theories in their practical life so that the quality of care can be delivered to the patients and the nurses can manage their burnout or stress timely. 

The role of NHS commissioner in quality care

NHS England (2021) states that the healthcare commissioners in NHS services are responsible for identifying the care and concerns regarding a specific need in a community. The role of a healthcare commissioner in NHS involves ensuring the care needs in a particular community are met. The care needs can be related to a particular community or the general public. The services that healthcare commissioners are involved in include rehabilitative care, planned hospital care, mental health and learning disability services, urgent and emergency care, and community health services. 

The role of the Care Quality Commission (CQC) in quality care

According to Care Quality Commission (2021), the role of CQC is to register and monitor services and plan the inspection for healthcare settings. After the inspection, CQC is responsible for developing roles, doing the ratings, and taking action afterward. The Care Quality Commission (2021) statement is supported in the report by Glasper (2019), claiming that CQC has been playing an essential role in developing strong leadership and opening new cultural arenas in NHS with the help of unannounced and specific inspections. The role of CQC is to bring nurses in a position from where they can ensure that nurses are psychologically not drained and are able to deliver quality of care. CQC is not only about ensuring the team collaboration, but at the same time, it ensures that the nurses have written down all the significant aspects, so that errors can be reduced by ensuring the handover communication between the nurses.  

References

Asthana, S., Jones, R. and Sheaff, R., 2019. Why does the NHS struggle to adopt eHealth innovations? A review of macro, meso and micro factors. BMC health services research, 19(1), pp.1-7.

Care Quality Commission (2021). Inspection reports. Available at: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/inspection-reports (Accessed: 5 November 2021).

Glasper, A., 2019. Have CQC hospital inspections resulted in better quality care?. British Journal of Nursing, 28(10), pp.654-655.

Leistikow, I. and Bal, R.A., 2020. Resilience and regulation, an odd couple? Consequences of Safety-II on governmental regulation of healthcare quality. BMJ quality & safety, 29(10), pp.1-2.

NHS England (2021). Clinical Commissioning Groups (CCGs), England.nhs.uk. Available at: https://www.england.nhs.uk/ccgs/ (Accessed: 5 November 2021).

Wake, M. and Green, W., 2019. Relationship between employee engagement scores and service quality ratings: analysis of the National Health Service staff survey across 97 acute NHS Trusts in England and concurrent Care Quality Commission outcomes (2012–2016). BMJ open, 9(7), p.e026472.

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PART 3: A Critical Evaluation of Leadership 

Critical evaluation and reflection of the leadership style 

According to Rizki et al. (2019), transformational leadership style allows the maximum engagement of the employees in a healthcare setting. Further, the idea is also supported in the study of Khan and Ismail (2017), which claims that the transformational leadership style enables sharing of concerns and feedback from the healthcare employees leading to collaboration and teamwork. According to a study by Putra et al. (2019), transformational leadership styles significantly impact organisational culture because it promotes involvement of employees, leading to efficacy and satisfaction, supporting the findings of Khan and Ismail (2017) and Rizki et al. (2019). Putra et al. (2019) is further supported by Suprapti et al. (2020), claiming that transformational leaders are capable of encouraging high performance among the healthcare professionals in healthcare by setting challenging goals to develop enough excitement. In addition, Tian et al. (2020) state that inter-agency team relationships are developed in the organisation or healthcare setting if the leadership styles like situational or transformational are followed because these types of leadership styles are capable of generating social identity among the healthcare professionals by increasing their confidence by maximising their performance. The idea of Suprapti et al. (2020) and Tian et al. (2020) is further elaborated in the study of Naguib and Naem (2018), claiming that situational leadership style can enhance shared vision and interests among health professionals, which makes this style important for the development and ensure the quality of care for the patients. Both transformative and situational leadership styles are effective in challenging the status quo leading to a motivation of the junior employees, offering more growth opportunities. The care management and services in a healthcare setting are positively affected by effective leadership, as it helps to achieve the organisational objectives concerning the needs and concerns by delivering adequate quality of care by developing resilience and emotional intelligence. Ellis (2021), claiming that the leadership styles in cardiac care can shape the outcomes of the treatment and the services because they have the potential for team development and improve emotional intelligence among nurses. 

Considering the mentioned aspects and the available literature on transformational leadership style, I have realised that I have been following this approach and will continue to do so. In addition, following the transformational leadership style will help me raise more awareness regarding my field of practice since it promotes raising discussions and questions when needed, aligning with my personality. However, as Gifford et al. (2018) have stated, the transformative leadership style will require me to bring changes and alterations in my practices because the style of leadership requires task-oriented behavior that would support clinical care. 

Critical evaluation and reflection of the management theories 

According to Winkens et al. (2019), management theories refer to the ideas and rules followed by an organisation to lead their behavior and manage their organisation. The management theories help the supervisors and leaders to develop, manage, and achieve the goals built for the organisation. It may also involve strategies and frameworks to develop or improve an organisational setting. Kelly et al. (2017) state that behavioural management theory aims to work on human relations and the effect of different human dimension affecting work. In addition, productivity is said to be improved by applying the behavioral management theory since this management theory focuses on motivating the individuals working in a specific organisation. The focus on motivation and its development among the employees in healthcare affect their work performance as the expectation of the employees is increased regarding their performance and the appreciation based on it. In addition, the theory focuses on group dynamics and their effects on the performance of the organisation, leading to service outcomes. The idea of Kelly et al. (2017) is further supported in the study of Heckemann et al. (2017), revealing that behavioural management theories are also known as human relations theory because the main focus in the interaction among the employees at work, emphasising their way of work in a healthcare setting. In addition, the theory puts emphasis on human understanding and their conflicts because they affect human interactions and hence the way they deal with their responsibilities in a healthcare setting. The behavioural management applied by Gifford et al. (2018) in their critical study proves that the model can encourage leadership qualities in an organisation to improve performance levels. The employees in a healthcare setting can be developed as task-oriented employees in an organisation since moral support is available for the employees. The findings of Gifford et al. (2018) and Winkens et al. (2019) are further supported by the study of Chiang et al. (2018), claiming that the behavioural management model enables patient-centered care in a hospital setting; however, the study also claims that additional trials and cardiac issue prevention is further required in the domain, following behavioural management theory.

Furthermore, the cardiac care unit requires the nurses to practice patience and develop emotional intelligence since the range of emotions due to fatigue can lead to negative responses, leading to professional misconduct. Therefore, I will apply the behavioural management model for maintaining the motivation level among the healthcare professionals in the healthcare setting to promote patient wellbeing and quality care services. The positive impact of behavioural management theory has been evident in a quasi-experimental study by Zahmatkeshan et al. (2021), revealing that the behavioural management model can be helpful to produce better outcomes in nursing practices for cardiovascular diseases in a hospital setting. 

References

Chiang, C.Y., Choi, K.C., Ho, K.M. and Yu, S.F., 2018. Effectiveness of nurse-led patient-centered care behavioral risk modification on secondary prevention of coronary heart disease: A systematic review. International journal of nursing studies, 84, pp.28-39.

Ellis, P., 2021. Leadership approaches for modern nursing practice. British Journal of Cardiac Nursing, 16(2), pp.1-5.

Gifford, W.A., Squires, J.E., Angus, D.E., Ashley, L.A., Brosseau, L., Craik, J.M., Domecq, M.C., Egan, M., Holyoke, P., Juergensen, L. and Wallin, L., 2018. Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implementation Science, 13(1), pp.1-23.

Gifford, W.A., Squires, J.E., Angus, D.E., Ashley, L.A., Brosseau, L., Craik, J.M., Domecq, M.C., Egan, M., Holyoke, P., Juergensen, L. and Wallin, L., 2018. Managerial leadership for research use in nursing and allied health care professions: a systematic review. Implementation Science, 13(1), pp.1-23.

Heckemann, B., Peter, K.A., Halfens, R.J., Schols, J.M., Kok, G. and Hahn, S., 2017. Nurse managers: Determinants and behaviours in relation to patient and visitor aggression in general hospitals. A qualitative study. Journal of advanced nursing, 73(12), pp.3050-3060.

Kelly, M., Wills, J. and Sykes, S., 2017. Do nurses’ personal health behaviours impact on their health promotion practice? A systematic review. International Journal of Nursing Studies, 76, pp.62-77.

Khan, S.A. and Ismail, W.K.W., 2017. To evaluate the impact of transformational leadership on organizational learning. CLEAR International Journal of Research in Commerce & Management, 8(9).

Labrague, L.J., Nwafor, C.E. and Tsaras, K., 2020. Influence of toxic and transformational leadership practices on nurses' job satisfaction, job stress, absenteeism and turnover intention: A cross‐sectional study. Journal of Nursing Management, 28(5), pp.1104-1113.

Naguib, H.M. and Naem, A.E.H.M.A., 2018. The impact of transformational leadership on the organizational innovation. The International Journal of Social Sciences and Humanities Invention, 5(1), pp.4337-4343.

Putra, G.N.S. and Dewi, I.G.A.M., 2019. Effect of transformational leadership and organizational culture on employee performance mediated by job motivation. International research journal of management, IT and social sciences, 6(6), pp.118-127.

Rizki, M., Parashakti, R.D. and Saragih, L., 2019. The effect of transformational leadership and organizational culture towards employees’ innovative behaviour and performance.

Suprapti, S., Asbari, M., Cahyono, Y. and Mufid, A., 2020. Leadership Style, Organizational Culture and Innovative Behavior on Public Health Center Performance during Pandemic Covid-19. Journal of Industrial Engineering & Management Research, 1(2), pp.76-88.

Tian, H., Iqbal, S., Akhtar, S., Qalati, S.A., Anwar, F. and Khan, M.A.S., 2020. The impact of transformational leadership on employee retention: mediation and moderation through organizational citizenship behavior and communication. Frontiers in Psychology, 11, p.314.

Winkens, I., van Heugten, C., Pouwels, C., Schrijnemaekers, A.C., Botteram, R. and Ponds, R., 2019. Effects of a behaviour management technique for nursing staff on behavioural problems after acquired brain injury. Neuropsychological rehabilitation, 29(4), pp.605-624.

Zahmatkeshan, N., Rakhshan, M., Zarshenas, L., Kojuri, J. and Khademian, Z., 2021. The Effect of Applying the Information-Motivation-Behavioral Skills Model on Treatment Adherence in Patients with Cardiovascular Disease: A Quasi-Experimental Study. International Journal of Community Based Nursing and Midwifery, 9(3), p.225.

Appendices

Appendix 1. Self assessment

The NHS Healthcare Leadership Model (HLM) 9 Dimensions are referred as a framework, based on which a personal assessment was conducted. The nine dimensions include leading with care, sharing the vision, influencing  for results, engaging the team, evaluating information, inspiring shared purpose, connecting our service, developing capability, and holding to account. 

Appendix 2. Leadership Observation

Using the HLM 9 dimensions Model the leadership observation was conducted, as mentioned below. 


Appendix 3. Peer Review (Table 1)

S.No

 

CASP Checklist

Asthana et al.

(2019)

 

Glasper (2019)

 

Leistikow and Bal, (2020)

 

Wake and Green (2019)

 

Chiang et al. (2018)

 

Ellis, (2021)

 

Gifford et al. (2018)

 

Heckemann et al.

(2017)

 

Kelly et al. (2017)

 

Khan and Ismail

(2017)

 

1

Did the study address a clearly focused issue?

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

2

Was the cohort recruited in
an acceptable way?

YES

YES

YES

NO

NO

YES

NO

YES

YES

YES

3

Was the exposure accurately
measured to minimise bias?

NO

NO

YES

NO

YES

YES

YES

YES

YES

NO

4

Was the outcome accurately
measured to minimise bias?

YES

YES

YES

YES

YES

YES

YES

YES

NO

YES

5

(a) Have the authors identified
all-important confounding
factors?

YES

YES/NO

NO

YES/NO

YES

YES

NO

YES/NO

YES

YES

(b) Have they taken account of
the confounding factors in the
design and/or analysis?

YES

YES/NO

NO

YES/NO

YES

YES/NO

NO

YES/NO

YES

NO

6

(a) Was the follow up of
Are subjects complete enough?

NO

YES

YES

YES

YES

YES

NO

YES

YES

YES

(b) Was the follow up of
subjects long enough?

 NO

NO

NO

NO

YES

NO

 NO

NO

YES

YES

7

Do you believe the results?

YES

YES

YES

YES

YES

YES

YES

YES

NO

NO

8

Can the results be applied to
the local population?

YES/NO

NO

YES

NO

YES

YES

YES

NO

YES

NO

9

Do the results of this study fit
with other available
evidence?

YES

YES

NO

YES

YES

YES

NO

YES

NO

YES

Appendix 3. Peer Review (Table 2)

S.No

CASP Checklist

Naguib and Naem, 2018

 

Putra and Dewi, 2019

 

Rizki et al. 2019

 

Suprapti et al. 2020

 

Tian et al. 2020

 

Winkens et al. 2019

 

1

Did the study address a clearly focused issue?

YES

YES

YES

YES

YES

YES

2

Was the cohort recruited in
an acceptable way?

YES

YES

YES

NO

NO

YES

3

Was the exposure accurately
measured to minimise bias?

NO

NO

YES

NO

YES

YES

4

Was the outcome accurately
measured to minimise bias?

YES

YES

YES

YES

YES

YES

5

(a) Have the authors identified
all-important confounding
factors?

YES

YES/NO

NO

YES/NO

YES

YES

(b) Have they taken account of
the confounding factors in the
design and/or analysis?

YES

YES/NO

NO

YES/NO

YES

YES/NO

6

(a) Was the follow up of
Are subjects complete enough?

NO

YES

YES

YES

YES

YES

(b) Was the follow up of
subjects long enough?

 NO

NO

NO

NO

YES

NO

7

Do you believe the results?

YES

YES

YES

YES

YES

YES

8

Can the results be applied to
the local population?

YES/NO

NO

YES

NO

YES

YES

9

Do the results of this study fit
with other available
evidence?

YES

YES

NO

YES

YES

YES

Appendix 4. Quality Improvement

The quality improvement of the practices will be ensured by applying the criteria of Care Quality Commission (CQC) which is a health and social care regulator. 

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