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1. Reflect upon the Registered Nurse’s role as a leader in the health care team;

2. Critically examine the role of the nurse leader in quality improvement and change management practices

3. Critique the principles and processes of clinical risk management and their application in health care domains; and

4. Reflect on the importance of continuous professional development in preparation for transition to the role of registered nurse.
 

Importance of patient participation in healthcare

Patient’s engagement in the overall care plan is considered as one of the significant aspect of the nursing profession and at helps to increase the overall quality of care (Domecq et al. 2014). According to the Nursing and the Midwifery Board of Australia (NMBA) (2018), it is the duty of the nursing professionals to engage in the therapeutic relationship with the patients and thereby helping them to engage in the process of therapy plan. The following essay aims to analyse how patients’ participation helps to increase the quality and safety of patient’s care. The essay will discuss different aspects of the patient’s engagement in healthcare and the manner in which it promotes positive health outcomes. The essay will initiate with a personal reflection followed by a detailed illustration of the strategies which the registered nurse to ensure patient participation and thereby reducing the chances of clinical risk.

During the time of my placement I was assigned to care for an older adult (Mr X) in the domain of preventing the chances of the accidental fall. Mr X was a 70 year old man suffering from dementia along with shiftiness in joint with poor eye sight. During by busy shift timing, I fail to make time to indulge effective communication with Mr. X. Moreover, I was less interested in interacting with older adults, in other words I was biased. Even when I got scope to indulge him in the process of care, as he used to try to inform me many things, I used to dodge his conversation saying that we are provide him the best therapy. Later my ignorance made Mr. X completed opposed to care and he complained my mentor (registered nurse) that he no longer wants to avail the therapy as he is highly satisfied. My mentor understood the overall scenario and I was asked indulge in therapeutic relationship with the patients in order to deliver patient centred care. Eventually, Mr. X become cooperative and his level of satisfaction in receiving the therapy increased.

Initially the incident made me quite upset. I felt sorry for by biased attitude and my inability to indulge in therapeutic relationship with client and procurement of patient centred care. I went to my mentor (nurse leader or the registered nurse) in order to discuss about my gap in practice. I was shattered and was suffering from lack of confidence and was unable to concentrate on the task. My mentor explained me that my gap in communication with the patient created barrier in the patient engagement and thereby decreasing the level of patient satisfaction in the care process. I understood my fault and gradually tried to overcome my bias and also felt the need to work on my interpersonal communication skills.

Negative impact of lack of patient engagement

The negative part of the incident was patient’s sudden withdrawal from the therapy. On evaluating my performance, the nurse leader guided me and helped to work on my inter-personal communication skills. She also made me realize that every patient is same for the nurses and we cannot have a biased or ignorant attitude just because the patient is an older adult. She also highlighted that not engaging him in the therapy plan or not listening to his concerns made him feel humiliated and thus decreased his satisfaction. I felt sorry about the overall behaviour.

Under this context it can be said that the nursing professional holds a significant part in the process of the patient engagement and highlighting the exact needs of the patient. Effective communication with the patient, and actively listening to their concerns, help to improve their level of satisfaction and trust. It is the duty of the bedside nurse to foster interaction with the patient while respecting their needs (Radtke, 2013). I realised that patient engagement is of prime importance in order to increase the provision and quality of care. During my clinical placement, I deliberately ignored his concerns and this might have resulted in clinical risk. However, I was lucky enough not to encounter the same as it that care the conditions might have been fatal. However, my ignorance decreased patient satisfaction and he attempted to withdraw from the therapy or care. Thus I think in order to procure quality care during my professional practice; I will refine my effective communication skills and will reduce my level of bias.

Conclusion

Thus from the above discussion, it can be concluded that patient engagement and development of therapeutic relationship are two prime pillars for care delivery and improving patient outcome.

Going forward in order to promote my professional development, I will refine my effective communication skills under the supervision of my nurse mentor. I will also take help about the reflective practice in order to highlight my gaps and improve my critical thinking skills.

Clinical risk management is another important aspect of the nursing professionals. Clinical risk management deals with improving the quality of care of the patient while ensuring safety in the health care practise. According to the National Safety and Quality Health Standards by the Australian Commission on Safety and Quality in Healthcare (2012), Standard 2 (partnering with consumers standards) and Standard 6 (communicating safety standard) are two important aspect of the effective management of the clinical risk. Partnering with the consumers standards is defined by the concept of the clinical governance which help to increase the level of the patient’s participation in the care plan. The communicating safety standard helps to avoid the nursing error during the change of shift nurses. The communication safety standard, emphasize on the importance of the effective communication skills to highlight patient’s exact needs and drafting of the patient’s centred care (Briner, Manser & Kessler, 2013).

Nursing professionals' responsibility in reducing clinical risk

The study conducted by Hannaford et al. (2013) highlighted that use of the effective communication with the patients also help to avoid the clinical risk. Hannaford et al. (2013) highlighted effective communication during the transfer of the clinical handover during the time of the change of shift nurses help to avoid the chances of the medication error and thereby helping to overcome the chances of the clinical risk. The systematic review conducted by Hamine et al. (2015) revealed that effective communication of the nursing professionals with the patients help to uncover any past aspect of health or drug allergies or hereditary predisposition and thereby helping to avoid risk and improving the quality of care.

Elkin et al. (2014) are of the opinion that increasing the participation of the patient in the decision-making process is one of the important aspect of the procuring patient-centred care and as per the nursing professional code of conduct. The systematic review conducted by Domecq et al. (2014) have highlighted that effective involvement of the patient in the decision making process helps to avoid the chances of the clinical risk and at the same time increase the therapy adherence. The study conducted by Powers et al. (2017) among diabetic patient highlighted that engaging patients in the decision-making process helps to increase the patient’s knowledge in the disease progression and thereby helping to improve on the diabetes self-management skills and at the same time reduces the chance of clinical risk like injecting higher dosage of insulin or non-adherence of anti-diabetic diet.

Nursing leaders also holds the prime responsibility in reducing the clinical risk. The nurse leaders by guiding the newly recruited nurses in effective communication skills, helps them to develop therapeutic relationship with patient and promoting shared decision making process (Wallis and Kennedy, 2013). The research conducted by Kelly, Wicker and Gerkin (2014) on the nursing leaderships highlighted that training and effective leadership provided by the nurse leaders to the newly recruited nurses help to reduce the chances of the clinical error due to lack of experience. 

Quality improvement also helps in reducing the risk of the clinical errors. Important aspect of the quality improvement is engaging patients in the process of giving informed consent. Nishimura et al. (2013) stated that informed consent enables their nursing professionals to give the patients a detailed aspect of care along with the project outcomes, highlighting all the pros and cons of the treatment. This helps to increase the patient’s trust and the level of patient’s satisfaction and creating provision for patient engagement in care (clinical governance). Cole, Wellard and Mummery (2014) are of the opinion the concept of the informed consent helps to define the ethical principle of autonomy, advocacy, dignity and respect. By giving the patient the sole right to give consent for his or treatment helps to abide by the ethical principle of autonomy and at the same time, make student feel empowered. The while designing of the informed consent, patient cultural, spiritual and religious preferences are given preferences and thereby helping to uplift the concept of dignity and respect (Judkins-Cohn et al., 2013)

Importance of informed consent and its impact on patient's trust and satisfaction

Stewart, C. (2014) stated that transforming the scope of the continuous professionals’ development to professional learning helps to increase the depth of the knowledge of the nursing professionals and thereby helping to reduce the chances of the clinical risk in practice. The review of the literature conducted by Jayatilleke and Mackie (2013) highlighted that reflective practice is a part of the continuous professional development for the nursing professionals. Reflective practice helps to increase the critical thinking skills of the nurses and thus helping to procure quality care.

Thus it can be said that it order to decrease the chances of the clinical risk and increase the level of the patient’s participation in the care plan two of the effective approaches are establishment of the therapeutic relationship with the patient by the execution of the effective communication skills and informed consent.

References

Australian Commission on Safety and Quality in Healthcare. (2012). National Safety and Quality Health Service Standards. Access date: 25th March 2019. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf

Briner, M., Manser, T., & Kessler, O. (2013). Clinical risk management in hospitals: strategy, central coordination and dialogue as key enablers. Journal of evaluation in clinical practice, 19(2), 363-369.

Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing ethics, 21(5), 576-582.

Domecq, J. P., Prutsky, G., Elraiyah, T., Wang, Z., Nabhan, M., Shippee, N., ... & Erwin, P. (2014). Patient engagement in research: a systematic review. BMC health services research, 14(1), 89.

Elkin, I., Falconnier, L., Smith, Y., Canada, K. E., Henderson, E., Brown, E. R., & Mckay, B. M. (2014). Therapist responsiveness and patient engagement in therapy. Psychotherapy Research, 24(1), 52-66.

Hamine, S., Gerth-Guyette, E., Faulx, D., Green, B. B., & Ginsburg, A. S. (2015). Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. Journal of medical Internet research, 17(2).

Hannaford, N., Mandel, C., Crock, C., Buckley, K., Magrabi, F., Ong, M., ... & Schultz, T. (2013). Learning from incident reports in the Australian medical imaging setting: handover and communication errors. The British journal of radiology, 86(1022), 20120336.

Jayatilleke, N., & Mackie, A. (2013). Reflection as part of continuous professional development for public health professionals: a literature review. Journal of Public Health, 35(2), 308-312.

Judkins-Cohn, T. M., Kielwasser-Withrow, K., Owen, M., & Ward, J. (2013). Ethical principles of informed consent: Exploring nurses’ dual role of care provider and researcher. The Journal of Continuing Education in Nursing, 45(1), 35-42.

Kelly, L. A., Wicker, T. L., & Gerkin, R. D. (2014). The relationship of training and education to leadership practices in frontline nurse leaders. Journal of Nursing Administration, 44(3), 158-163.

Nishimura, A., Carey, J., Erwin, P. J., Tilburt, J. C., Murad, M. H., & McCormick, J. B. (2013). Improving understanding in the research informed consent process: a systematic review of 54 interventions tested in randomized control trials. BMC medical ethics, 14(1), 28.

Nursing Midwifery Board of Australia (NMBA). (2019). Registered Nurses Standards for Practice.Access date: 25th March 2019. Retrieved from: https://www.nursingmidwiferyboard.gov.au/

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., ... & Vivian, E. (2017). 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. The Diabetes Educator, 43(1), 40-53.

Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse Specialist, 27(1), 19-25.

Stewart, C. (2014). Transforming professional development to professional learning. Journal of Adult Education, 43(1), 28-33.

Wallis, A., & Kennedy, K. I. (2013). Leadership training to improve nurse retention. Journal of Nursing Management, 21(4), 624-632.

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