• Subject Code : NUR5065
  • Subject Name : Nursing

Nursing Professional Values and Evidence-Based Practice

Introduction to Leadership Roles and Management Functions in Nursing

Mental health nursing is challenging in many ways, such as in the case of Jeremy. From the case study, it is evident that his mental health is continuously deteriorating, decreased in the status of MMSE (Mini-mental status examination) has significantly decreased post his second stroke, causing memory loss, dysphagia, poor diet and dysfunctional behaviour with the family members, which was the reason he was admitted into the hospital for treatment. It was also noted that Jeremy was becoming aggressive towards the nursing staff and also misbehaved with other patients. In this essay, the key themes of nursing practice, developing a therapeutic relationship through effective leadership qualities and multidisciplinary approach can provide comfort to the patient and help in restoring his dignity (Sandström et al. 2011).

Section 1: Nursing Care, Empowerment, and Collaboration.

One major nursing problem in the case of Jeremy includes violent and aggressive behaviour, which can cause him to harm himself as well as others. Nursing intervention includes having a good leadership skill (CH 2019). The two important qualities of a leader are having effective communication with the patients and the ability of clinical decision-making. Communication has a profound impact on the patient-nurse relationship. An effective communication includes factors such as, active listening attitude, empathy, ability to provide counselling, developing a trustworthy bond with patients and having team-building skills. Leadership stems from forming strong bonds based on the intent of genuine care for one another (Schroeder 2013). Thus, effective communication helps team building within nurses and also offers comfort to patients by counselling and empathizing with them. It offers motivation to the patients to be compliant with the treatment goals and medication management, especially for patients need prolonged treatment. With the application of these learnings, it was noticed that Jeremy started to improve his concentration while talking to then nursing staff and showed active participation in the conversations (Wong 2013). It helped me realize the importance of how the therapeutic relationships are developed or formed between the health caregiver and the patients. It offers motivation to the patients to be compliant with the treatment goals and medication management, especially for patients need prolonged treatment, such as in the case of Jeremy. The role of effective communication in building therapeutic relationships leads to better healthcare outcomes. It also helps the care provider to provide culturally safe environment to the patients and work out the treatment plan in a holistic manner (Arnott Paliadelis and Cruickshank 2018). Another important coping strategy involves the collaboration of patients in the treatment (Mattos dos Santos et al., 2016). This can be done by increasing the visiting hours of the parents and asking them to help Chaz to understand the process of hospitalization. The parents can be asked to bring his favourite toy so that he can remain calm and engaged with his toy and does not miss his home and family during the duration of hospitalization.

Analysis: The concept of comfort is directly linked to the patient satisfaction, safety and experience delivered through the nursing care. Jeremy’s health has been deteriorating and it can be found that he is nearing the end of life and requires palliative care at this stage. He had developed urinary tract infection and he is unable to eat properly, and is being fed by nasogastric tube and his MMSE score has further declined to 8. His respiration has become shallow and his chest x-ray is indicative of right lower lobe pneumonia, due to aspiration of food leading to further ethical as well as ethical difficulties in maintaining his nutritional needs (Sandström et al. 2011). Therefore, it is very critical that nursing care and comfort are provided to Jeremy through the intervention of therapeutic communication to improve compliance, close follow-ups, to address his emotional and physical needs (Ardian Hariyati and Afifah 2019). (Theme 5)

Prevention of breach of comfort: Nursing intervention is also necessary in the prevention of breach in the patient's comfort (Pasarón 2013). This involves understanding the complex needs of Jeremy. The breach of comfort included the use of nasogastric tube for feeding, despite of guidelines in the advanced care direction of Jeremy which stated that he did not wish to have any unnecessary interventions in his end term stage. (Themes 2 and 4)

Relation with collaborative initiative: As Jeremy was found to be repeating names of Shirley and Claire, the visiting hours of the family must be increased. It shows that Jeremy is missing his family and feels lonely. With the emotional support of his family, Jeremy can be helped to stabilize himself and feel loved and cared (Giles at al. 2019). He was sent to a home eventually where he was taken care by Shirley and Claire, it was noted that his symptoms about confusion was improved. A few adaptations were done in the house to prevent harm to Jeremy such as removal of rugs in the home to prevent falls. There were signboards on the rooms and toilet doors and nightlights were used to facilitate orientation. (Theme 3)

Barriers for implementation of the nursing interventions can be Jeremy’s own emotional and mental status (Kelly et al. 2018). Theme 2 describes how Jeremy often was forgetful of his family members and exhibited signs and symptoms of being disoriented. Therefore, making it challenging for the nurse, carers and his family members to talk to him and provide him comfort (Jacobs 2019). The barrier can also be from the end of the caregiver, in establishing effective communication and care, these include overthinking, which leads to an inability to focus on the patient, and to make well-informed decisions for them. Shortage of time, due to an increase in the healthcare burden on the nursing staff, it is difficult to find enough time for the nurses to listen and efficiently talk to the patients. The nurses must be supervised while they try to establish communication with the patients in a clinical setting.

Section 2: Law and Ethics (Theme 4)

The nursing practice establishes a strong core value system for delivering work in a clinical set up (Cynthia, H. S. A., & Stoots, 2013). The ethical and legal circumstance in case of Jeremy is lack of consent as he was sent to the hospital for palliative care without his consent, as his family was unable to support him and offer adequate comfort at home. In this scenario, the advanced care directives provide the guidelines for the healthcare professional to make decisions about the health of the patient. It is noted that the advanced directive of about ten years ago that Jeremy did not want any unnecessary interventions or procedures, regardless of which he was fed with a nasogastric tube, and it led to aspiration right lower lobe pneumonia, adding to the severity of illness in Jeremy. Jeremy has taken out the tube on several occasions, as he wished to drink water orally. A health professional may be liable under civil law and criminal law for failing to follow a valid and applicable common law Advance Care Directive. The critical care nurse must now be aware, as the patient advocate, of the choice of each patient regarding his or her medical management or withholding of treatment (Department of Health n.d.). A critical care nurse must also know the state statutes, relevant to the state that she or he practices, regarding the Advance Directive (QUT n.d.; Tanaka Taketomi Yonemits and Kawamoto 2016).

Lack of autonomy: Autonomy is described as the ability of the patient to make well-informed decisions about his health. In the case study it is evident that due to poor mental control and decrease in MMSE to score of 8 post the second stroke the cognitive ability of the Jeremy was compromised, thus he was not in a capacity to make his own decisions, therefore the decision-making was done by his family members in collaboration with the healthcare provider and the consensus was reached to continue the end of life care in the hospital setting instead of following the advanced care directives (Giles et al. 2019).

According to the National Mental Health Policy, 2008, "People with mental health problems and mental illness have rights and responsibilities to be informed about and involved in decisions about their treatment.” (Mental Health Foundation n.d.)

Section 3: Reflection

As a nurse, I found it very difficult to handle Jeremy’s behaviour, due to his aggressive, unpredictable and violent behaviour. These emotions exhibited mainly in the form of abuse, self-harm, aggression and even apprehension to harm the carers as well. It became a cause of emotional frustration and stress in my professional as well as personal life (Ardian Hariyati and Afifah 2019). I started to doubt my competency skill as a nurse. However, with experience, I understood that as a nurse I must practice calm and display a therapeutic behaviour with my patients, keeping aside my emotional turmoil. Nonetheless, this scenario has grave consequences on the nurses and negatively influences productivity, leading to poor outcomes (Walker et al., 2017).

Two positive behaviour attitudes which I will maintain during practice are providing patient centred care by developing a therapeutic relationship with the patient, showing empathy and trying to understand the needs of the patient (Ferri et al., 2017). The principles of patient-centred care have also been embedded in the standards of Nursing and Midwifery Board of Australia and is practised within clinical nursing practice. It is important for me as a nurse to reflect a positive and a caring attitude while providing care to the patient, so that the patients feel uplifted. This is what I would have expected if one of my family members were in the hospital, that they have cared without any negativity around (NMBA, 2016).

As a nurse, I will comply with all the standards of delivering care and show competency in clinical practice. Secondly, I will work on enhancing my knowledge and skills, such as developing emotional intelligence, and living my values throughout the daily routine care activities (Hunter & Cook, 2018).

Conclusion on Leadership Roles and Management Functions in Nursing

The role of mental health nurse is a challenging one as the mental health patients exhibit complex emotional as well as physical needs. As a nurse, it is essential to display competency in leadership skills to ensure the development of therapeutic relationships with the patients and effective communication are vital components in improving healthcare outcomes. Furthermore, the case study revealed the importance of compliance to the advanced care directives of the patient from ethical as well as a legal angle. In this, It also helps the care provider to provide culturally safe environment to the patients and work out the treatment plan in a holistic manner.

References for Leadership Roles and Management Functions in Nursing

Ardian, P. Hariyati R. T. S. and Afifah, E. 2019. Correlation between implementation case reflection discussion based on the Graham Gibbs Cycle and nurses’ critical thinking skills. Enfermeria Clinica, 29, 588-593.

Arnott, N. Paliadelis, P. and Cruickshank, M. Eds. 2018. The Road to Nursing. Cambridge University Press.

CH, M. B. L. 2019. Leadership roles and management functions in nursing: Theory and application.

Department of Health n.d. The rights and responsibilities of people with mental health problems and mental illness. Retrieved from https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-pol08-toc~mental-pubs-n-pol08-2~mental-pubs-n-pol08-2-1#:~:text=All%20Australians%2C%20including%20those%20with,without%20discrimination%2C%20stigma%20or%20exclusion.

Ferri, P. Rovesti S. Panzera, N. Marcheselli, L. Bari A. and Di Lorenzo R. 2017. Empathic attitudes among nursing students: a preliminary study. Acta Bio Medica: Atenei Parmensis, 88Suppl 3, 22.

Giles, T.M. Hammad, K. Breaden, K. Drummond, C. Bradley, S.L. Gerace, A. and Muir-Cochrane, E. 2019. Nurses’ perceptions and experiences of caring for patients who die in the emergency department setting. International Emergency Nursing, 47, p.100789.

Hunter, K. and Cook C. 2018. Role‐modelling and the hidden curriculum: New graduate nurses’ professional socialisation. Journal of clinical nursing, 27(15-16), pp: 3157-3170.

Jacobs, M.S., 2019. Psychological contract breach as predictor of job embeddedness of professional nurses (Doctoral dissertation, University of Johannesburg).

Kelly, K. Cumming, S. Kenny, B. Smith-Merry, J. and Bogaardt, H. 2018. Getting comfortable with “comfort feeding”: An exploration of legal and ethical aspects of the Australian speech-language pathologist’s role in palliative dysphagia care. International Journal of Speech-Language Pathology, 20(3), pp.371-379.

Mattos dos Santos, P. da Silva, L. F. Bastos Depianti J. R. Gallindo Cursino, E. and Ribeiro, C. A. 2016. Nursing care through the perception of hospitalized children. Revista brasileira de enfermagem, 69(4).

Mental Health Foundation n.d. Human Rights and Mental Health. Retrieved from https://www.mentalhealth.org.uk/a-to-z/h/human-rights-and-mental-health

NMBA 2016. Registered Nurses Standard Codes for Practice. Retrieved from file:///C:/Users/User/Downloads/Nursing-and-Midwifery-Board---Standard---Registered-nurse-standards-for-practice---1-June-2016%20(3).PDF

Pasarón, R. 2013. Nurse practitioner job satisfaction: Looking for successful outcomes. Journal of Clinical Nursing, 22:17-18, pp 2593-2604.

 Sandström, B. Borglin, G. Nilsson, R. and Willman, A. 2011. Promoting the implementation of evidence‐based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence‐Based Nursing, 8(4), 212-223.

Schroeder, R. 2013. "The seriously mentally ill older adult: Perceptions of the patient–provider relationship." Perspectives in Psychiatric Care 49, pp. 1: 30-40.

Tanaka, M. Taketomi, K. Yonemitsu, Y. and Kawamoto, R. 2016. Professional behaviours and factors contributing to nursing professionalism among nurse managers. Journal of nursing management, 24(1), 12-20.

Wong, C. A. Cummings G. G. and Ducharme, L. 2013. The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.

QUT n.d. End of life in Australia. Retrieved from https://end-of-life.qut.edu.au/advance-care-directives/common-law-advance-care-directives

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