A reflective essay based on an episode of patient care.

| December 3, 2012

Introduction

This is a reflective essay based on an episode of care that I was directly involved in managing during a community placement. This episode of care will be analysed using up to date references, health care policies and relevant models. Issues and theories relating to leadership qualities and management styles will also be explored, taking into consideration any legal, ethical and political factors that may have impacted on patient care. Care delivery, delegation and prioritisation will be examined along with team working, risk assessment and patient safety. I will also take into consideration my role as a supervised student nurse and analyse the roles and responsibilities of those supervising me and what influence this has on my practice. These issues will be debated and questioned within the framework of leadership and management theory

In order that I could use this situation for my reflection the patient will be referred to as “Mrs A”. In this assignment confidentiality will be maintained by the use of pseudonyms, this is to maintain privacy and confidentiality in line with the NMC Code of Professional Conduct (NMC, 2008), “as a registered nurse, midwife or health visitor, you must protect confidential information”, and to “Treat information about patients and clients as confidential and use it only for the purpose for which it was given.”

Starting an extended practice placement as a third year nursing student enables the student to develop their knowledge and skills in management and leadership ready for their role as a qualified adult nurse. During my extended practice placement there were many opportunities to develop these skills and manage my own caseload of patients and arrange many complex aspects of their care.

During this placement an 88 year old patient, to be known as Mrs A, was due to be discharged from a rehab centre following recurrent falls, issues with safety at home, and self neglect, the referral had been made by a concerned General Practitioner. Mrs A had spent the last 6 weeks receiving holistic multidisciplinary care, including; intensive physiotherapy, occupational therapy and nursing care. Mrs A had made much improvement and was able to safely administer her own medication.

One of the Physiotherapists called Ken, had commented during handover, that Mrs A had seemed confused during their session together, and asked if the nurses would go in and review her.  Upon visiting Mrs A it was clearly evident that she was not herself, and seemed confused. Following discussion with my mentor I felt that Mrs A was not safe to administer her own medication. I recommended to the patient to let the rehabilitation staff administer her medication. Mrs A consented to this, thus reducing a great risk of Mrs A causing her-self harm. I delegated to the support workers to obtain a urine sample which was tested and confirmed that Mrs A had a urinary tract infection, antibiotics were prescribed by her GP. The team leader at the rehabilitation centre was informed of Mrs A’s infection and plan to handover the administration of her medication to them, she was happy with this decision and pleased that I had informed her.

This episode of care was managed effectively as the underlying cause of the patients confusion was discovered and treated, a risk assessment was completed and a referral was promptly made to medicine management and a dossett box was supplied to Mrs A, to help her manage her own medications safely. All members of the multi-disciplinary team were fully committed to the team approach to care delivery and this facilitated efficient and organised care delivery. The care delivered was patient-centred and teamwork was integral to providing this care.

First will be a discussion on the importance of self awareness and how this awareness enabled a more assertive and confidant approach to be made to managing patient care.

Self awareness must be considered as the foundation for management and is a vital skill and quality needed in leadership. If you wish to provide care that is of a high standard and improve your own performance as a skilled health care professional you need to manage the cognitive, affective and behavioural self in order to engage effectively in therapeutic relationships. Self awareness is the process of understanding one’s own beliefs, thoughts, motivations, biases and limitations and recognising how they affect the care and services provided (Whetten and Cameron, 2010).

Without being self aware, recognising personal and cultural beliefs, and understanding interpersonal strengths and limitations, it is impossible to establish and maintain good relationship with co-workers and patients. Maslow’s Hierarchy of Needs Theory (1954) depicts self-actualisation at the highest level of the hierarchy of needs. This relates to the need to maximise potential and achieve a sense of personal fulfilment, competence, and accomplishment (Maslow, 1954).  It is important as a student nurse to be completely aware of strengths and weaknesses, and to be conscious of any limitations, self-awareness helps to exploit strengths and cope with weaknesses (Walshe and Smith, 2006).

When organising and planning patient care it is vital to have effective management and leadership skills, this is part of every nurse’s role, and involves planning, delivering and evaluating patient care. These management responsibilities are part of every nurse’s role (Sullivan and Garland, 2010) and to exhibit these professional behaviours demonstrates their value to the organisation (Huber, 1996). To understand nursing management it is crucial to understand what nursing management is and the theory behind it.

Managers are defined as “a member of a specific professional group who manages resources and activities and usually has clearly defined subordinates” (Gopee & Galloway, 2009).  Another definition of management is a process by which organisational goals are met through the application of skills and the use of resources (Huber, 1996).

Borkowski (2010) argues that Douglas McGregor made a significant impact on organisational behaviour and was an American social psychologist that proposed the ‘X-Y’ theory of management and motivation. McGregor (1966) describes the ‘X-Y’ concept as the theory that underpins the practices and attitudes of managers with regard to their employees. Huber (2006) states that theory ‘X’ managers assume that employees are lazy, that they dislike responsibility, would rather be directed, oppose change and desire safety. Theory ‘X’ implies that employees are rational and easily motivated (either by money or threat of punishment); therefore managers need to impose structure and control and be active managers (Huber, 2000).

Huber (2000) asserts that the opposing theory, (‘Y’) assumes that people are not lazy and unreliable by nature rather that they are self-directed and creative if well motivated in order to release their true potential. Businenessballs.com (2002) asserts that most managers are inclined towards the ‘X’ theory and usually obtain poor results whereas managers who implement the ‘Y’ theory produce better performance and results thus allowing people to grow and develop (Businessballs.com, 2002).

References

Borkowski, N. (2009) Organizational behaviour, theory, and design in health care , USA: Jones & Bartlett Publishers

Cameron, K. and Whetten, D. (2010) Developing Management Skills, USA: Prentice Hall

Gopee, N.  and Galloway, J. (2009) Leadership in Management in Heathcare, London: Sage Publishers

Huber, D. (2006) Leadership and Nursing care Management. 3rd Edn. USA: W.B Saunders Company

Maslow, A. (1954) Motivation and Personality, New York: Harper & Row

McGregor, D. (1966). The human side of enterprise. Leadership and motivation. Cambridge:

MA: The MIT Press.

Sullivan, E. And Garland, G. (2010) Practical Leadership and Management in Nursing, Essex: Pearson Education Limited

Walshe, K. And Smith, J. (2006) Healthcare Management, New York: Open University Press

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