WAC Paper Plan

WAC Paper Plan

Introduction

Introduce nursing leadership. Discuss problems associated with ethical leadership in patient care. Discuss how nursing education courses prepare nurses for leadership roles which allows for optimal patient outcomes.

Leadership in Nursing

• Definition of leadership in nursing
• Role of a nurse leader
• What is involved in being a nurse leader
• Use of ethics in nurse leadership
  • “One of the most powerful methods to promote ethics in health care and the nursing practice is to role model ethical performance on the managerial level” (Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, 2017).

Ethics in Nursing Leadership

Definitions and Explanation of Ethics in Nursing

• Discuss the different types of nursing ethics: justice, beneficence, autonomy, fidelity, and nonmaleficence.
• Discuss how ethical issues impact patient rights
  • The range of ethical problems that nurses encounter along with their level of stress should be considered on how it impacts their ability to provide ethical care for their patients (Ulrich, Taylor, Soeken, O’Donnell, Farrar, Danis, & Grady, 2016).
  • “Ethical leaders must strive to model and support ethical performance and at the same time be sensitive to moral issues and enhance nurse’s performance by fostering respect for human dignity; thus, they can play an important role in promoting patient safety, increase the capacity to discuss and act upon ethics in daily activities, and support the ethical competence of nurses” (Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, 2017).

Impact of unethical leadership in nursing

• Discuss the implications unethical leadership can have on patient care.
  • “Disappointment and lack of confidence, commitment and motivation are among the side effects of leaders’ unethical behavior that influence both patients and organizational efficacy negatively” (Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, 2017).

Appropriate Leadership Behaviors and Skills

• Discuss expectations and qualities of nurse leaders
• “There is the expectation that nurses should treat patients in an ethical manner and put ethics first in their professional performance. Across the world, nurses are guided to use professional codes that emphasize their obligation to respect, protect and defend the fundamental rights of the people involved in nursing and health care” (Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, 2017).

Description of Scenario

• In the scenario, an 86-year-old male patient has been repeatedly admitted to the hospital the past 6 months. The patient is struggling with depression and loneliness and does not have a support system. He admits to not eating healthy or monitoring his blood glucose levels. He has type II diabetes that is uncontrolled. He requires further teaching, referrals to grief support groups/counseling, scheduled follow-up care, and he should be seen by the physician for a possible prescription for an anti-depressant. The charge nurse wants to discharge him to free up his bed because he will most likely be readmitted shortly anyways.

Evaluation of scenario

• Why this action by the charge nurse is wrong
• Legal aspects
• Possible negative affect on the patient

Plan and Implementation to improve scenario outcome

• Advocate for the patient to the charge nurse.
  • Give him further teaching, referrals to grief support groups/counseling, scheduled follow-up care for him, and make the physician aware of his depression.
  • “Communication with elderly patients can be problematic as they can feel uncomfortable about asking questions, and it can be difficult to find the appropriate teaching levels” (Bergh, Friberg, Persson, & Dahlborg-Lyckhage, 2015).
  • “Another initiative for improving people’s health, mentioned by the managers, was the “Senior-Health” project: an initiative to reach out to seniors by offering conversations on health and lifestyle and a contact phone number. According to managers, having a nursing-responsible-nurse/medical responsible-physician has improved continuity and security, and facilitated patients’ knowledge and understanding about self-care management” (Bergh, Friberg, Persson, & Dahlborg-Lyckhage, 2015).
  • “DSME/S has been shown to be cost-effective by reducing hospital admissions and readmissions (10–12), as well as estimated lifetime health care costs related to a lower risk for complications” (Powers, Bardsley, Cypress, Duker, Funnell, Fischl, … Vivian, 2016).
• Educate the charge nurse on why her action of wanting to prematurely discharge the patient is wrong and is not setting a good example of effective leadership

BSN Nursing Classes related to leadership, ethics in nursing, and the scenario

• BSN nursing classes educate new nurses on how to practice ethically and prepare new nurses for leadership roles.
  • (find an article regarding the necessity of a BSN for a nursing leadership role)
• Standards of Nursing Practice
  • Ethical principles of beneficence, justice, and nonmaleficence.
    • Beneficence is doing good for the patient, which would include giving him resources for his depression and grieving and properly educating him about caring for his diabetes.
    • Nonmaleficence is doing no harm, which could be prevented by not prematurely sending the patient home.
    • Justice is fairness, which would include fairly and justly distributing care instead of discharging a patient because his bed is needed for a new admission. These principles will help my argument that the charge nurse’s decision is not ethical and is cause for change.
  • Applied Ethics
    • Applying and analyzing ethical theories. Analyzing the actions of the charge nurse and to determine a more ethical response and course of action to best care for the elderly population of patients.
  • Transcultural Nursing
    • Identifying biases in the nursing field. In this specific instance, the charge nurse may have biases or set beliefs about the elderly population. It is imperative nurses are sensitive to individual patients and their needs and preferences so that every patient receives respect and quality care.
  • Psychological Inquiry and Applications
    • Identifying biases in the nursing field. In this specific instance, the charge nurse may have biases or set beliefs about the elderly population. It is imperative nurses are sensitive to individual patients and their needs and preferences so that every patient receives respect and quality care.

Evaluation of Leadership

• “Today’s healthcare environment is driven by discordant demands to provide high quality care and to manage costs with diminishing resources” (Ulrich, Taylor, Soeken, O’Donnell, Farrar, Danis, & Grady, 2016).
• “A change in nurses’ patient education can be achieved when managers truly use nurses’ ideas and support the process of change, thus achieving creative discursive practice that changes the social practice” (Bergh, Friberg, Persson, & Dahlborg-Lyckhage, 2015).

Leadership Styles

• Current style of leadership in the scenario: authoritarian.
  • Authoritarian leadership style in nursing is when the nurse manager makes decisions and gives orders to team members. Team members are expected to follow what they are asked and their input is not considered. This style of leadership fails to promote trust, communication, and teamwork.
• Desired style of leadership for this scenario: affiliative.
  • Affiliative leadership style in nursing is when the leader is great at making relationships and motivating team members. Affiliative leadership is effective when there is a need to bring a team together, rebuild broken trust, and for team harmony. Valuing emotions more than goals will benefit the patient in this scenario because he needs additional compassion, care, and teaching.
  • “Thus, health care professionals and their leaders need to find adaptive ways to contain anxiety and to develop and sustain self- and other-awareness and emotional resilience in order to sustain compassionate practice” (De Zulueta, 2015).

Conclusion

Leadership is a part of nursing at all levels from new graduates to experienced nurse managers. Facilitating changes and improvements in nursing care is essential to effective leadership. Making ethical decisions as a leader is imperative to providing quality patient care.

References

Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2017). Obstacles and

problems of ethical leadership from the perspective of nursing leaders: a qualitative content analysis. Journal of medical ethics and history of medicine, 10, 1.

Bergh, A. L., Friberg, F., Persson, E., & Dahlborg-Lyckhage, E. (2015). Registered Nurses’

Patient Education in Everyday Primary Care Practice: Managers’ Discourses. Global qualitative nursing research, 2, 2333393615599168. doi:10.1177/2333393615599168

De Zulueta P. C. (2015). Developing compassionate leadership in health care: an integrative

review. Journal of healthcare leadership, 8, 1–10. doi:10.2147/JHL.S93724

Haddad, L. & Geiger, R. (2019). Nursing Ethical Considerations. StatPearls.

https://www.ncbi.nlm.nih.gov/books/NBK526054/

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … Vivian, E.

(2016). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical diabetes : a publication of the American Diabetes Association, 34(2), 70–80. doi:10.2337/diaclin.34.2.70

Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2016).

Everyday ethics: ethical issues and stress in nursing practice. Journal of advanced nursing, 66(11), 2510–2519. doi:10.1111/j.1365-2648.2010.05425.x