You are required to complete both parts One and Two of this assignment. Identify an experience from placement when you observed nurse leadership in action. The experience you choose must be relevant to current issues in nursing, health and social care.
Part 1 – 1000 words (learning outcome 4) Critically reflect on this experience.
Part 1 is a piece of written reflection, you must use the ‘What, So What and Now What’ model, making each stage clear using these headings to structure your work.
In this reflective account you must include,
The ‘What, So What, Now What’ model has been described by Rolfe at al. (2001) and you follow that framework. In demonstrating critical reflection, you should expect the descriptive ‘What’ stage to be the shortest of the three elements.
Where you have identified serious issues for patient safety you must provide an explanation of how these were addressed.
Describing incidents without recording any intervention aimed to escalate and/or resolve the issue may constitute a breach of the NMC code.
In the first section, I’ll reflect on an incident that occurred on one of my second-year placements using the Rolfe reflective model (What, So What, and Now What) (Rofle et al., 2001). Due to a language barrier, poor interpersonal communication, and staffing shortage, an incident happened, putting a patient’s life at risk. As the incident evolved, my mentor demonstrated powerful transformational leadership, emphasising the importance of nursing leadership in preventing damage and providing safe nursing care to a multicultural community. Reflecting on the situation, I’ll explore the various nurse leadership styles and how to use the NMC Code of Conduct 2018 to provide safe and efficient nursing care to patients through successful transformational leadership.
During a night shift on a busy ward with only one registered nurse and a nursing associate, I was given a patient who was hyperglycaemic and in severe condition by the nurse associate while my mentor was busy with an ill patient in another bay. It was difficult to understand the patient’s glycaemic index because the handover was hasty, and instructions were given fast. I was instructed to inform my mentor that hyperglycaemic medication, as prescribed by the doctor, which needed to be administered immediately. However, the patient notes were missing, and when I inquired about them, I was assured that I would receive them soon, and that the patient would then be left in my care. (No Reference needed for this WHAT section)
Patient was detreating more, therefore I checked patient vital signs to ensure patient observations are stable. I suspected that the patient was perhaps hypoglycaemic, because she was shaking, sweating, turning pale, heart rate was faster than normal range and feeling dizziness, according to NHS England, (2020) those are the signs and symptoms of hypoglycaemic. I also tried to check patient’s blood sugar levels but as a student nurse I can only carry out blood glucose monitor under my mentor’s supervision; therefore, I went look for a healthcare assistant who could check it for me, but the HCA was not competent to monitor the blood glucose. However, I also needed further assistance in the form of an interpreter as it was clear that the patient couldn’t speak English. As it was late-night, I realised I wouldn’t be able to get hold of an interpreter so I looked to find some nurses that could probably speak the same language, but it turned out to be futile.
Leadership in nursing definition
Student nurses cant gain the leadership naturally therefore they have to undertake practical placements
Implications for safety and quality of care in the practice setting.
to adhering to the NMC code of conduct 2018 which states for nurses
Patients with a language barrier, such as my patient, have additional problems due to a lack of personnel and poor interpersonal communication, which leads to inadequate nursing leadership.
Individual nursing staff members must still take leadership of their roles and do their utmost to meet their patients’ nursing requirements via compassionate nursing care (NMC Code of Conduct, 2018). This offers opportunities for student nurses like me to gain leadership experience and reflect on my participation in the incident. I realise that as I was receiving the patient’s handover, I should have taken command of my role as a student nurse by using SBAR to offer the quality nursing care possible.
In addition, I should have communicated my concern about the patient’s misdiagnosis to a qualified member of staff, for example going back to the nurse associate and asking her to check the patient with me and bleep the doctor to come and review the patient; similarly, I went to my mentor and expressed concern that I suspected the patient was misdiagnosed, such as hypoglycemic rather than hyperglycemic.
My mentor, a senior staff nurse, checked our patient’s blood glucose twice and both times it came back at 1.4 on the glycemic index, which can cause other complications such as seizures, coma, and cardiac arrest (NICE.co.uk, 2020; Diabetes.co.uk, 2020).
Poor interpersonal communication put the patient’s life at risk, and miscommunication has been linked to major drug errors, delays in treatments and interventions that result in unfavourable patient outcomes, and delays in care transfer (Reference needed).
Fortunately, patient’s condition did not worsen, and she was given an emergency glucose 10% intravenous infusion per NICE recommendations 2020 and monitored until he was hemodynamically stable.
Talk about how poor interpersonal communication, language barrier and shortage of staff nurses can be reduced through effective nursing leadership
Talk about how transformational leadership improve patient care
What is the NMC Code of Conduct 2018 says about mentorship on placement student nurses and ways to develop and enhance (transformational) leadership skills and emotional intelligence (the ability to adapt to stress).
In light of the situation and the transformational leadership summary, I believe my mentor demonstrated transformational leadership. My mentor empowered me to grasp the value of nursing leadership by being assertive, taking charge, and making prompt decisions for our patient to obtain effective priority nursing care.
Part 2 Brief
Part 2 – 1500 words (learning outcome 1, 2 and 3) Based on the same experience from practice, identify one issue from your reflection linked to wider issues in nursing practice within contemporary health and social care.
Critically examine how the current government or delegated authorities are responding to this issue, and analyse how these responses influence nursing practice. To meet the requirements for
Part 2 you must:
These criteria for successful completion are mapped against module learning outcomes; you need to pass all four outcomes in order to pass. Use a range of resources including:
Check that you are using the most recent version of reports, policies, standards and guidelines. Critical analysis involves the following steps so that you develop and explore discussion points:
In the second section of the essay, I’ll talk about the difficulties and consequences of inadequate ‘interpersonal communication’ on service users’ safety, experience, and outcome. The link between poor interpersonal communication and broader challenges in the NHS and health and social care will next be examined. Eventually, I’ll look at how the government and delegated authorities respond to inadequate interpersonal communication in NHS health and social care by adopting guidelines and policies, as well as how this affects nursing practise.
What is ‘interpersonal communication’?
How poor miscommunication cause issues in nursing care in a hospital and community care setting, for example put patient life at risk, drugs errors can cause serious health incidents, causes delays in patient care, delays in treatment and interventions, and sometimes even death
can cause incidents like the Mid Staffordshire NHS Foundation trust incident (Francis Report, 2013).
While it’s necessary to evaluate and analyse the scope and extent of poor communication in the NHS healthcare system, it’s even more important to address the root of the problem.
Importance of written communication
Due to a nursing shortage, nurses are more likely to utilise jargon and abbreviations in their written communication on IT systems, which can easily lead to misunderstandings, errors, and delays in patient care (Improvements. nsh.uk,2018).
communication tools (written communication) such as SBAR promotes service user safety
different communication training background, information technology and written communication reduce effective interpersonal communication.
Poor leadership abilities and a lack of empathy, such as failing to listen to patient and being overly solution-oriented, such as failing to perceive the person behind the problem cause poor interpersonal communication skills in the NHS.
The Francis Report of 2013, which emphasised inadequate communication skills and leadership, backs up this allegation. According to the Shropshire Maternity Crisis and the subsequent report Ockeden Report, (2020) patients felt they were not listened to or heard when they had issues about care obtained more recently
Evidence suggests that ineffective infection control strategies are harmed by poor nurse communication, such as when patients are sent to nursing homes without being informed that their resident is covid-19 positive or has Cdiff.
The setting of an ageing population, a shortage of funds, growing disease, and issues the NHS health and social care service encounters, such as the issue of weak interpersonal communication skills, prompted the government to reform the way health care was delivered.
Health and social care act 2014, the government delegated the department of health to introduce a new policy to the UK. This new policy produced new bodies such as (Public Health England) and (Community Commissioning Groups) (Gov.co.uk, 2013).
advanced digital technologies to establish good quality collaboration and communication between healthcare organisations for example NHS England, Public Health England, Health Education England and NICE
This project’s five-year plan was unveiled (england.nhs.uk,2014) For this purpose, a number of consistent guidelines and IT systems have been developed, including the Prescribing Information and Communication System (PICS) and the SBAR
SBAR is a vital communication tool used across all NHS health and social care services (Quality Improvements.nhs.uk,2020) and has helped to improve patient care while reducing communication issues.
Nevertheless, while SBAR is simple to use and provides structured, correct communication assistance for both the provider and recipient, it does not address the issue of interpersonal communication
hospitals and community care organisations have adopted IT programmes like PICS, which are accessible to all trained healthcare workers, and this has improved patient safety, experience, and outcomes.
The NMC Code of Conduct 2018 places a greater emphasis on nursing leadership than ever before.
the Francis Report 2013 states that failed nursing leadership, communication and transparency was the primary reason for the Mid Staffordshire Foundation Trust incident. As a result of this nurses are now given increased responsibility and autonomy (nmc.org.uk, 2020) through training and theory on the practise of good nursing leadership when providing care to patients.
As a result, policymakers, such as the care and quality commission (CQC) and the community commission groups (CCG), must effectively lead to ensure that nurses/hospitals and community healthcare services provide high-quality care, and that funding is readily available and distributed appropriately (nhs.co.uk, 2015).
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