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Leadership and Clinical Governance in Nursing

Question:

Discuss about the Leadership and Clinical Governance.

The assignment is the part of learning leadership and clinical governance. A critical role is played by the nurses in identifying and responding to changes in the health status of the patient.  It is the role of the registered nurse to prevent adverse events and support the patients throughout the care. A variety of leadership skills are required to be cultivated to ensure patient safety. One of these skills is to identify and mange the patient risk to safety. The aim of the assignment is to examine and critically disuses the evidence related to the impact of effective communication on maintaining patient safety.  Further, the assignment presents the reflection on an incident where the patient safety was identified at risk as a result of ineffective communication. The discussion in the reflection is based on the role of the registered nurse as the leader in risk management.  

Patient safety is considered a public health issue. Communication is considered a crucial factor in the patient care process. According to Brock et al. (2013), communication between the physicians, patients, nurses, and other care providers is vital for care process. Adverse events were recorded in the last decade as a result of the miscommunication between the heath care professionals. Medical errors have been reported in several countries such as Australia, US and others that were severe and fatal. It was estimated by the World Health Organisation or WHO that 10% of all the hospital admitted people suffer damage due to care process (Wittich et al., 2014). Amongst all the adverse events one third of them are found to result from the human errors. As per the literature review these errors are preventable and can be prevented by effective communication. It can be interpreted that effective communication enhances the patient care and it plays a vital role.


In the book, “critical conversation for patient safety: an essential guide for health professionals” edited by Tracy Levett-Jones, a greater emphasis has been laid on therapeutic communication. There is a need of therapeutic communication between patients and the health professionals. However, the focus is now extended to include communication between the health care providers. The author of the book also emphasise on addressing the critical relationship between the patent safety and communication. Patient safety is enhanced by the critical conversation as it bridges the gap between the care providers and the care users (Levett-Jones, 2017). It means that effective communication is critical not only between the health care professionals and the patients but also among the health care professionals. It ensures better sharing of the health status of the patient with other specialists and physicians in the interdisciplinary team. According to Levett-Jones & Bourgeois (2015), therapeutic and the interpersonal communication was found to satisfy the innate needs of the patients. It includes the feelings of safety and confidence during the treatment as outlined in the Maslow’s hierarchy of needs. There are many evidences that effective communication ensures the patient safety. 

The Role of Registered Nurses in Patient Safety

The SBAR system was developed for eliminating the simple communication error in the health care. This system stands for situation, background, assessment and recommendations. It is the information transfer system between the nurse and doctor in concise manner. This tool is used during the medical handover in the intensive care unit. This system was found to improve the communication between the health care providers and enhanced the patient safety.  However, the tool is criticised in terms of lack of awareness among the patient and difficulty for nurses in communicating the sensitive issues to the patient (Randmaa et al., 2014). It can be interpreted from the literature review that there are more advantages than disadvantages of SBAR in ensuring the patient safety. It can be concluded from such system that effective communication is challenged by the coexistence of inter-personal, intra-personal and organisational dynamics.


Other structured communication tool used for improving the hand offs and the communication across the organisation is group rounds and the briefings. Group rounds involve visiting of the whole care team to the patient to dscuss and communicate the heakth status.  Briefings set the tone for the open communication. It improves the collaboration as the team members discuss to identify the patient risks. Briefing and debriefing are useful before and after the process is over (Johnson et al., 2015). This effective communication tools have helped in reducing the medication error and enhanced the patient safety. Effective communication enhances the safe care and team work among the health care professionals. In unsafe situation the use of common critical language among the care providers helped to create an environment where the patient could share their concerns. Application of the briefings in the surgical setting ensured high reliability perinatal care as per Lyndon et al., (2011). Effective communication can help make positive changes in the environment, meet the language needs of the patients, which aids in providing support and understanding in the workplace. This is also evident from the modern tools like telehealth and telemedicine that have improved the health care access and quick sharing of the patent information and management of risks immediately (Lyngstad et al., 2013).

 Overall the impact of effective communication in the health care setting is positive and was found to have postie outcomes in the patients. It helps the patients in the vulnerable situation to feel safe, respected and secure. Therapeutic communication ensures individualised care, and better sharing of the concerns by the patients, increase the patient satisfaction and safety.  

Communication and Patient Safety - Literature Review

Refection is the process of learning from mistakes and makes better decisions. In health care system reflection helps in healing and therapeutic process (Tashiroe et al., 2013). I was placed in the mental health setting where I have diagnosed him with Schizophrenia. While I was conducting the mini mental settle exam I realised that he was answering irrelevantly. The other nurse in the room rebuked him for his behaviour which made the patient more aggressive. I realised that the patient was at risk of physical harm due to lack of empathy and emotional abuse by other nose in the wards. The patient needed effective verbal and nonverbal communication as the ineffective communication has shattered the nurse patient relationship. I could observe a gap formed and the patient concerns were not addressed.


I was determined to adhere to the Nursing and Midwifery Board of Australia’s nursing standards of registered nurse. I approached to the patient once again and continued with my examination. I engaged with him in therapeutic relationship. I was critically analysing his symptoms with the evidence based information (Nursingmidwiferyboard.gov.au., 2017). The patient shared that he does not feel like living. I was aware of the accountability of my practice. I also responded to the other nurse’s capability for practice to prevent harm to any other patient by emotional abuse. I ensured conducting the assessment of the patient with holistic and culturally appropriate approach.  I planned for actions that were ethical and goal directed and evaluated the outcomes on a timely basis (Nursingmidwiferyboard.gov.au, 2017). 

As a part of my leadership imitative I conveyed the other nurse about her poor nursing management, communication error and insufficient training evident from such behaviour. My aim was to increase the supervision to prevent such ineffective communication by carers. According to Laschinger (2014) lack of supervision and workplace mistreatment is the barrier to effective communication. Mental health is likely to be devastated by the communication flaws (Varcarolis, 2016). I realised that therapeutic communication allowed the patent to share his feelings and concerns.  My leadership role helped me mange the risk of physical harm in the patient. I tried to improve my colleagues and my weak points by collecting feedbacks in the workplace.  As a registered nurse I have emphasised on empathy, awareness and active listening skills to manage the risk as per Lyndon et al. (2011). 


My role aligned with the transformational leadership. As per Hutchinson & Jackson (2013), transformational nurse leaders should be full partners with the health professionals in redesigning the health care and be accountable for their contributions towards high quality care. It also emphasises that nurse leaders must transform the new research findings to the practice environment. Engaging in therapeutic communication was evidenced based option that led to positive options. I had collaborated with other team members for improving the quality of care of the patient which was the key strategy of leadership in collaborative environment (Ryan et al., 2015). My leadership skills were strong as per Reem et al. (2014) as my strategies wee based on evidence and experience and also mutually respected others opinions.  Though the patient was taking long time to recover, he was out of risk of physical harm. 

Therapeutic Communication and Critical Conversation

Conclusion

Health care is the complex system and effective communication can prevent the medical errors, disruptions and save patient lives. Registered nurses are frontline carers of the patient; they have the opportunity to make improvement in the communication system as it is the fundamental component of the patient safety. It can be concluded from the above discussion that effective communication leads to positive outcomes of the patients.  Therefore, it is worth the time and investment of the health care providers and the organisation. Nurse may commit error in communication skills.  To sustain the therapeutic nurse-patient relationship effective communication and leadership skills are required by registered nurse. Transformational leadership is the effective leadership style in addressing the communication barrier in health care and enhancing the patient safety.

References

Brock, D., Abu-Rish, E., Chiu, C. R., Hammer, D., Wilson, S., Vorvick, L., ... & Zierler, B. (2013). Interprofessional education in team communication: working together to improve patient safety. BMJ Qual Saf, 22(5), 414-423.

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), 11-22.

Johnson, C., Carta, T. R. I. C. I. A., & Throndson, K. (2015). Communicate with me: information exchanges between nurses. Can Nurse, 3, 24-7.

Laschinger, H. K. S. (2014). Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. Journal of Nursing Administration, 44(5), 284-290.

Levett-Jones, T. (2017). Critical conversations for patient safety: an essential guide for health professionals - Version details. Trove. Retrieved 30 November 2017, from https://trove.nla.gov.au/work/182790573?q&sort=holdings+desc&_=1512013127960&versionId=212201920

Levett-Jones, T., & Bourgeois, S. (2015). The Clinical Placement-E-Book: An Essential Guide for Nursing Students. Elsevier Health Sciences.

Lyngstad, M., Melby, L., Grimsmo, A., & Hellesø, R. (2013). Toward increased patient safety? Electronic communication of medication information between nurses in home health care and general practitioners. Home Health Care Management & Practice, 25(5), 203-211.

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Fact Sheets. Nursingmidwiferyboard.gov.au. Retrieved 30 November 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ.aspx

Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 30 November 2017, from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Randmaa, M., Mårtensson, G., Swenne, C. L., & Engström, M. (2014). SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study. BMJ open, 4(1), e004268.

Reem, A. D., Kitsantas, P., & Maddox, P. J. (2014). The impact of residency programs on new nurse graduates' clinical decision-making and leadership skills: A systematic review. Nurse Education Today, 34(6), 1024-1028.

Ryan, R. W., Harris, K. K., Mattox, L., Singh, O., Camp, M., & Shirey, M. R. (2015). Nursing leader collaboration to drive quality improvement and implementation science. Nursing administration quarterly, 39(3), 229-238.

Tashiro, J., Shimpuku, Y., Naruse, K., & Matsutani, M. (2013). Concept analysis of reflection in nursing professional development. Japan Journal of Nursing Science, 10(2), 170-179.

Varcarolis, E. M. (2016). Essentials of Psychiatric Mental Health Nursing-E-Book: A Communication Approach to Evidence-Based Care. Elsevier Health Sciences.

Wittich, C. M., Burkle, C. M., & Lanier, W. L. (2014, August). Medication errors: an overview for clinicians. In Mayo Clinic Proceedings (Vol. 89, No. 8, pp. 1116-1125). Elsevier

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