Leadership for Health - Essay Example

?Leadership for Health Strategies That Nurses Can Adopt To Challenge Practice In Relation To the Care of Older People Nurses are expected to provide optimal health services, personal well-being and enhanced quality of life to the patients, colleagues and the wider population that they interact with when conducting their duties. This requires proper leadership and management of the care-giving strategies. Leaders that promote fidelity in nursing create working environments characterised by ethical principles, supportive to the staff, and upholds the ethics of care. Practising ethical practices, values and principles lead to moral decision making and action that are the prominent constituents of moral leadership. Nursing ethics are not a set rules or principles, but they are a practice that incorporates specific moral qualities focusing on the behaviours that characterises the right action. Some of the constituents of the ethics of care include responsibility, responsiveness and attentiveness. The last two decades have been characterised by pronounced changes in health care environment. Establishment of environment that fosters safe and high-quality patient care has been complicated by the increase in the acuity and complexity of health care environment. There has been a growing need for the possession of high level skills required for operating the increasingly health care technology. Other factors contributing to the complication of the health care environment include shortage of the work force, fiscal pressures, and changes in diversity patterns related to generational, gender and ethnic as well reliance on supplement staff. Challenges such as nursing shortages impact negatively on the health sector’s ability to create a favourable working environment where nurses can achieve the vision for nursing, effective communication and enhance the moral activity of nursing. The challenges have affected performance involved in caring for the old. The essay below explores the strategies that nurses can adopt to challenge practice in relation to the care of older people. Part Two Most of the competent organisations rely on effective leadership to ensure that they remain competitive. Health care organisations as well as the industry are not an exception. Health care industry should be among the most excellently managed industries globally. Leaders in the health care industry should familiarise with the most effective leadership styles and strategies from successful institutions and organisations in applying them for promoting their own. Some of the variably admired traits that nursing leaders should possess include the ability to inspire, exhibit honesty, intelligence, competence and visionary. The four leadership styles that demonstrate the ideals of moral leadership include transformational, evidence-based, authentic and servant leadership. Transformational leaders are charismatic and act as role models to their followers. This is because they yearn to inspire autonomy as well as promote servant leadership (Nielsen, Yarker, Brenner, Randall and Borg, 2008). They motivate nurses to engage in problem solving strategies, team work in decision making procedures and personal professional development through strategies such as coaching and mentoring. According to Leach (2005), application of transformational leadership style enhances the act of communicating organisational or professional mission, vision and goals. Shirley (2006) posits that authentic leadership is practised by individuals committed to personal core values, compassionate leadership as well as understanding their own sense of purpose. Authentic leaders possess profound integrity and have abundant sense of personal conviction in matters related to personal beliefs and values. Authentic leaders are appropriate for managing and overseeing the nursing units and departments dealing with the care of old people because their high level of awareness enables them to advise and lead their followers accordingly. Servant leadership is a product of the possession of personal attributes such as stewardship, commitment, awareness, listening and persuasion (Thorne, 2006). Servant leaders act to generate team success as opposed to personal development. They enhance the team’s capability to develop and improve performance. The leadership strategies that servant leaders put in place enhance the group-performance. For instance, servant leaders will apply measures that enhance team work when caring for the old to promote effectiveness. Team work originates from nurse-nurse as well as patient-nurse cooperation. Porter-O’Grady and Malloch (2008) deduce that evidence-based leadership is related to the development of favourable working environments that replaces fragmentation or departmentalisation in decision making. Instead, evidence-based leaders apply collaboration and team work when seeking an agreement for a common agenda among the members. Evidence based leadership is concerned with the formulation of the necessary infrastructure and behaviour that promotes the implementation of the agreed goals. The characteristics associated with this form of leadership include innovation, thinking, planning and implementation (Porter-O’Grady and Malloch, 2008). The global societies, especially those in the World Health Organisation (WHO) European region, are aging. Older people are faced by multiple debilitating diseases such as dementia and osteoporosis (Ferri et al., 2005). Therefore, care needs for the old are required at all illness stage trajectories; not just waiting for the terminal phase of the condition. This calls for a need to not only prevent diseases, but also improve the quality of life among old population. The science of health and nursing care provides strategies that can be applied in improving care giving in various settings such as nursing hospitals and nursing homes. The nursing science provides the technicalities suitable in supporting the aged population through creating awareness on various diseases, introduction of care services and supporting the affected family members. The industry already has clinicians and physicians and the only thing that is preventing them from performing well is the absence skills. The personnel require sufficient skills on the application of the new technology and establishment of cooperation and team work with other leaders as well as their followers. The required skills can be promptly through focus on the scientific concepts that guides on the health care delivery. Effective delivery of nursing care and services promotes satisfaction among health care receivers as well as givers. Additionally, application of the nursing care promotes a feeling of wellbeing and establishes a therapeutic culture. Improvement of service requires focus on the individual or teams, their working environment and care processes. Any health organisation that is mindful of the future should prioritise the tradition of perfect leadership. Improving leadership will involve training the new leaders on effective application of the new technology and instilling the required leadership capabilities. Leaders in the health sector should learn the most effective methods of management in order to promote the industry into the greater heights. Contribution to service development is normally dependent on the personal attributes of the subjects. Some of the personal attributes of the carer that enhances service improvement include professional competency, commitment to the job, possession of effective interpersonal skills and the clarity of the beliefs and attitudes. Some of the leadership activities that enhances delivery of health care for the old include condoning and respecting the patient’s beliefs and practices, provision of the holistic care, sharing of decision making, inclusion of sympathy and engagement. Factors affecting motivation among the health care workers stems from individual, institutional and community level. The prominent individual level motivation component of a nurse is the intrinsic motivation. However, the intrinsic motivation may not sustain motivation for a long time especially if the worker is time-intensive or demanding. The extrinsic factors affecting motivation among nurses include pre-service background and education. At the institutional level, the nurse’s motivation is affected by factors related to human resources, working conditions, compensation and opportunities for career enhancement. The compensation factor that influence individual motivation and performance is money. Professionals that are offered better remuneration terms have a higher productivity compared to the ones with low salaries. Work environment also determines employee motivation and performance. For instance, working environment characterised by fairness enables the work force to perform their obligations depending on responsibilities. The role meaning update is also crucial through the provision of information on jobs and results. Health workers should also be provided with the freedom to undertake their roles. At the community level, factors that a leader should be wary about include the community acceptance and support for nurses and the stigma that may be directed to them due to caring for people that may be infected with HIV/AIDS (Li, 2007:258-263). Part Three The most prominent that would be applicable in the adoption of strategies to challenge nursing practice in relation to old people are situational, path-goal and transformational. The situational leadership is characterised by the change in leadership styles depending on the nature of the task and maturity of the followers (Northouse, 2004). Effective leaders in the public health sector should apply strategies that promote achievement of goals rather than the nature of the task itself or relationships (Appendix 3). Situational leadership theory focuses on developing followers for effective task completion. Some of the skills that situational leaders apply in health care industry include delegating and participation. Application of the skills ensures success in processes. Situational leaders apply both follower-oriented and leader-oriented and skills in adapting to various leadership styles corresponding to their professional situations. However, role strategies changes may confuse the health care workers. Situational leadership is based on assumptions; that people are ready to learn new as well as enhance their skills which is not always the case. The four leadership styles applied by situational leaders include directing, delegating, supporting and coaching (Goodwin, Gruen and Ives, 2006). The situational theory is closely associated with the Path Goal Theory. Leaders applying the path-goal theory are flexible and adapt to the changes occurring in the health sector (Northouse, 2004: Appendix 1). The theory alludes that effective leadership is not inherent; it is a product of the experiences that a potential leader faces. The experiences equip them with skills required for offering directives and advice that characterise leadership. The situations depend on the nature of the obligations as well as the social and physical working environment. Transformational leadership theory harnesses the relationship between a leader and the followers. According to Antonakis and House (2002), the theory focuses on the morals and ethics of various team relationships and teamwork (p. 7). Leaders that apply transformational theory are able to win their followers’ trust and loyalty. There are four components of transformational leadership theory; intellectual stimulation, individualized consideration, inspirational motivation and idealised influence (Appendix 2). Factors affecting health improvement ranges from economic, social, legal, environmental and technological. These factors act on the environment that a person is born, live, work and age. Legal factors include policies, programs and institutions. Policies made by the government and other non-governmental organisations in the society have paramount significance in the health of the populace i.e. they can have both positive and negative impacts. The social factors are also inclusive of the social structures, government and private sectors dealing with health care (Zerwekh and Garneau, 2011). The social structure encompasses the community in which the health strategies are applied; cultural attitudes, norms and expectations. The physical environment can harm or improve the individual health. For instance, inclusion of aesthetic features such as proper lighting and trees improves the health conditions of the community. Alternatively, the physical environment can impede the efforts of attaining health improvement. For instance, old people may be exposed to toxic substances as well as stress producing factors especially noise. Technology has led to enhanced process efficiency. Modern nursing is characterised by the prevalence in traditional features such as education, training, professional organisations, offering services to the society and a code of ethics (Fell and Hallett, 2012). The code of ethics articulates the ethical principles, standards, duties and principles that nurses adhere to irrespective of their roles, position or duty set-up. According to ANA (2010), the provisions provided in the code addresses the profession’s fundamental values and commitments, the limitations of the duties and loyalty as well as other obligations of the nurses that assist in the enhancement of health care attainment. The code of ethics defines the conditions required for a nurse to be self accountable and directs that nurses’ behaviour should be based on the moral principles and respect for the dignity and worth of the patients. The code of ethics lays emphasis on the nurse’s duty to oneself and others as necessary and obligatory. In ANA (2010:19), nurses are required to practice with the “wholeness of character” and integrity. This helps them to maintain and enhance competence. The wholeness of character includes the nurses’ liberty to express their moral opinions on the profession even when they have low success chances or if they differ with those of the other people. The provisions contained in the code of ethics are non-negotiable even when the integrity of the person is threatened. Nurses are obligated to know and use the ethical principles of the profession. This is because they are essential for development of competence and show of compassion when undertaking duties and obligations. The ethics of care is characterised by four fundamental principles; beneficence, nonmaleficence, autonomy and justice (Guido, 2010). Beneficence defines the ethical obligation of committing an action that is morally beneficial. Nonmaleficence is the principle asserting that a care taker is obligated to do no harm through understanding and respecting the patient’s beliefs and circumstances. This is especially crucial when handling old people because most of them uphold and respect the societal beliefs and the way of life. The principle of autonomy analyses the importance of respecting the decision-making ability of patients. The principle of justice instructs that nurses should provide services and care without discrimination. Team work is a crucial aspect of promotion of the nursing practice. Team work improves productivity. This is because all team members take responsibility of the output and greater responsiveness to the patient needs. Other merits accrued from team work include increased respect among the team members, effective and efficient resolution of conflict and role clarity within the team. Some of the strategies that can enhance team work include undertaking intervention studies and field studies that examine the linkages between team factors, processes and outcomes. An intervention can occur in the form of service, method, approach or any strategy applied within a health care setting to foster collaboration. Interventions can be carried out within the practice level or organisational levels where leaders are involved. At the practice level surveys on the standards and performance measures on team effectiveness should be developed, formulation of practice sessions for team building and problem solving, interdisciplinary rounds, self-managing and team training (McSherry and Warr, 2010). Some of the interventions that can be undertaken at the organisational level include leadership workshops, establishment of the protocols and guidelines on roles and responsibilities and providing support to teams through identification of goals and implementation of resources. Some of the practice level factors that affect team work include collaboration process, individual values and norms core competencies involved in the collaboration, structures that support team work and the articulation of the team task (McSherry and Warr, 2008). Team work at the organisational level can be improved through the establishment of efficient structures that dictates and outlines the team objectives, roles and responsibilities of the members, the coordination mechanisms for the activities carried out by the team and staffing as well as the mechanisms involved in decision making. Caring for the old should not be viewed as a burden; everyone is ageing and each will require such services. Therefore, the health care workers should serve patients according to the way they would like to be treated when they become old. Additionally, the focus on perfect care reduces health complications among the old; complicates leadership in health care. Conclusion There is no doubt that health care leadership is at stake. Any health organisation that is mindful of the future should prioritise the tradition of perfect leadership. Improving leadership will involve training the new leaders on effective application of the new technology and instilling the required leadership capabilities. Leaders in the health sector should learn the most effective methods of management in order to promote the industry into the greater heights. Leaders should ensure that the context and concept in which nursing care is provided is appropriate for improved care. Some of the strategies that enhance improved care include appropriate mixing of skills, creation of the systems that facilitates shared decision making, facilitating staff relationships and establishment of systems that are supportive to the work force (Kislov, Walshe and Harvey, 2012). Effective leadership should also be ready to share power and have the potential for innovation and risk taking. Continual professional development requires skills in the application of practice development approaches. Such skills and approaches help to implement change in the practice, promoting individual experience in health care and promoting team work. Aged people are faced with numerous health complications that require enhanced and superior strategies to guarantee efficient care. The prominent approaches that are applied include technical practice development and emancipatory practice development. Dewing (2008) deduce that the application of the technical practice development involves focus on a range of activities geared towards development of a specific aspect of nursing care. Practice development is defined as a continual process involved in the development of person-centred cultures. Practice development brings transformation among individuals and teams through blending of the personal qualities with practical skills and wisdom. Effective practice development involves application of three key principles namely; inclusion, collaboration and participation (Dewing, 2008:93-107). Technical practice development approaches are short term and normally focused on the results rather than the strategies used in the achievement of those results. This approach is task based and specific to the project e.g. the inclusion of a new policy in nursing practice or acquiring new skills and competencies. However, this approach is currently ineffective because it involves the application of contemporary top-to-down approach of implementing change. The best alterative to the technical approach is the emancipatory practice development. Application of this strategy by the nurses involves focusing on the practices that improves health care practice through the development of sustainability and person centred cultures (McCormack et al., 2010). Chin and Hamer (2006:126-44) refer to the approach as improvement of skills of the nurses as well as health care while enhancing person centred ethos. Practice development enhances professional development. This is through strategies such as skilled facilitation, development of the local evidence and new insights on nursing development and improving the relationship with patients to understand their problems better (Sellman and Snelling, 2010). Practice enables care givers and leaders to identify the accepted norms and cultures as well as the professional challenges that are taken for granted. Practice development also helps in building on the existing knowledge; incorporate the articulated beliefs in practice and acquiring of skills according to evidence based process (Royal College of Nursing, 2007). References American Nurses Association (2010) Nursing’s social policy statement: the essence of the profession, Silver Spring, MD, Nursebooks.org. Chin, H. & Hamer, S. (2006) ‘Enabling practice development: Evaluation of a pilot programme to effect integrated and organic approaches to practice development’ Practice Development in Healthcare, vol. 5, no. 3, pp. 126-44. Dewing, J. (2009) ‘Moments of Movement: active learning and practice development’ Nurse Education in Practice, vol. 10, no. 1, pp. 22-26. Fell, A.S. & Hallett, C.E. (2012) First World War nursing: new perspectives. Ferri, C.P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L. & Ganguli, M. (2005) ‘Global prevalence of dementia: A Delphi consensus study’ Lancet, vol. 366, no. 9503, pp. 2112-7. Goodwin, N., Gruen, R. & Ives, V. (Eds.) (2006) Managing Health Services, Berkshire, Open University. Guido, G.W. (2010) Legal and ethical issues in nursing, Boston, Pearson. Kislov, R., Walshe, K. & Harvey, G. (2012) Managing boundaries in primary care service improvement: A developmental approach to communities of practice (BioMed Central Ltd.) BioMed Central Ltd. Li, L., Lin, C., Wu, Z., Wu, S., Rotheram-Borus, M.J. & Detels, R. et al. (2007) Stigmatisation and shame: Consequences of caring for HIV/AIDS patients in China AIDS Care, vol. 19, no. 2, pp. 258-263. McCormack, B., Dewing, J., Breslin, L., Coyne-Nevin, A., Kennedy, K., Manning, M., Peelo-Kilroe, L., Tobin, C. & Slater, P. (2010) ‘Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people’ International Journal of Older People Nursing, vol. 5, no. 2, pp. 93-107. McSherry, R. & Warr, J. (Editors) (2008) An introduction to excellence in practice development in health and social care, Maidenhead, McGraw- Hill. McSherry, R. & Warr, J. (Editors) (2010) Implementing excellence in your health care organisation: managing, leading and collaborating, Maidenhead, McGraw-Hill. Nielsen, K., Yarker, J., Brenner, S.O., Randall, R. & Borg, V. (2008) ‘The importance of transformational leadership style for the well-being of employees working with older people’ Journal of Advanced Nursing, vol. 63, no. 5, pp. 465-475. doi: 10.1111/j.13652648.2008.04701.x. Northouse, P.G. (2004) Leadership: theory and practice, Thousand Oaks, Calif, Sage. Porter-O’Grady, T. & Malloch, K. (2008) ‘Beyond myth and magic: The future of evidence-based leadership’ Nursing Administration Quarterly, vol. 32, no. 3, pp. 176-187. Royal College of Nursing (2007) ‘Workplace Resources for Practice Development’ Royal College of Nursing Resource File, London. Sellman, D. & Snelling, P. (Editors) (2010) Becoming a nurse: a textbook for professional practice, Harlow, Pearson. Shirey, M.R. (2006) ‘Authentic leaders creating health work environments for nursing practice’ American Journal of Critical Care, vol. 15, no. 3, pp. 256-267. Thorne, M. (2006) ‘What kind of leader are you?’ Topics in Emergency Medicine, vol. 28, no. 2, pp. 104-109. Zerwekh, J.A.G. & Garneau, A.Z. (2011) Nursing today: transition and trends, St. Louis, Saunders. Appendices Appendix 1: Path Goal Theory Source: http://catalog.flatworldknowledge.com/bookhub/5?e=carpenter-ch10_s03 Appendix 2: Transformational Leadership Theory Source: http://www.managementstudyguide.com/transformational-leadership.htm Appendix 3: Situational Leadership Theory Source: http://leadingforwardblog.wordpress.com/2012/10/05/understanding-contingency-and-situational-theory/ Appendix 4: Influence of The Healthcare Delivery System On The Community Health Workers’ (Chws) Performance Motivation. Source: http://bmjopen.bmj.com/content/2/5/e001557/F3.large.jpg Read More