Nursing Care Management - Essay Example

?Nursing Care Management -Factors that determine the effectiveness of the team and programmes of care have been not discussed-please do so. -no plagirism in the essay please. Introduction Based on the Nursing and Midwifery Code, like most professionals, nurses must secure their personal and professional development, understanding their experiences through reflection, research, and feedback. These nurses must also be self-aware, mostly in terms of their values and their goals for their practice. As leaders in the health practice, they are also significant actors in ensuring quality and efficient applications of their work. Moreover, nurses are also prompted and guided by the Code of Professional Conduct as laid out by the NMC, as well as the general provisions of the National Health Services provisions for health workers. This paper shall consider one care management episode from practice, assessing and evaluating the ways by which patient care is affected by negotiated, team performance, and multi-agency collaboration. It will discuss the impact of team work and the MDT on patient care. It will also discuss variables which impact on the efficacy of the team and the different programs of care. This paper will also analyse the ways by which my reflections and analysis will impact on my personal contributions for the team as a registered practitioner. The patient’s confidentiality will be protected at all times with assumed names assigned to individuals involved during my placement. The subject of this paper is Mrs. P, admitted to the hospital due to discomfort from her pubic catheter which already increased to moderate pain. She had one carer seeing her daily to manage her daily activities; but she got worse, and needed an increased care package as the carer could no longer manage her well. The fact that she was also asthmatic made the management more complicated. She stated that she needed 24 hour care and could no longer manage being alone at home. Originally, before her current admission, staff members contributing to her care in the hospital included the GP who had to be updated regularly, nurses, doctors, pharmacist, community nurses who gave her medications and assessed her catheter regularly, social services, and a physiotherapist. She was later discharged with a supra-pubic catheter which caused abdominal discomfort and pain. She was again sent home with pain medications and antibiotics which still did not do much to relieve her symptoms. Prior to her discharge, the pharmacy helped sort out her medications, with the doctor assessing her condition on a regular basis and assessing if she was stable enough to be discharged. These professionals also organized her discharge letter. The nurse attended to her daily needs and monitored her vital signs, as well as her symptoms. The physiotherapist evaluated her mobility and her daily activities. Social services also participated in her care in order to help manage her home needs by assigning carers before her discharge. Being a student nurse involved in the nursing management process, my role was to assess the patients assigned to me in terms of routine nursing roles. Nursing care also involves the evaluation of individual patient needs (Gaberson and Oermann, 2010). In patients with identified health issues, the management process would often include the assistance of the multidisciplinary care team. Teamwork in the hospital setting is very much important because it helps ensure the efficient management of the patient’s illness, often allowing their effective transition into the community setting, and preventing readmissions (Komatsu, et.al., 2011). Teams are individuals working with each other using similar tools and methods, seeking common goals via group efforts, and eventually establishing services which are more complete and superior in quality (Komatsu, et.al., 2011). In the hospital setting, there are various health professionals working with each other and sharing information with each other. Factors affecting the success of care programmes include efficient communication and collaboration between teams. Efficient communication must therefore be secured under these conditions. Teams share goals and objectives and each member usually has designated roles or tasks (Kadmon and Barak, 2009). Collaboration within the team refers to individuals working with each other to ensure an orderly and coordinated practice. According to Nosbusch, et.al., (2011), discharge planning is very much significant in guaranteeing effective recovery as well as minimizing hospital readmissions. The discharge planning process has to be managed with the assistance of the whole team especially as the patient may have different needs. In the discharge planning process, with the assistance of the staff, I was able to review the plan with the patient, especially in relation to her medication intake and other specific medical orders. I also note that the physiotherapist wanted to have weekly sessions with the patient in order to assist her in her daily activities. The social worker also recommended assistance to the patient in the community setting, especially in relation daily needs, including grocery shopping, cooking, and other household activities. A carer was also arranged by the social worker, especially one who would be staying with the patient 24 hours a day. According to Taylor, et.al., (2012) teamwork is an effective means of accomplishing complicated and multiple activities. Communication among the different members of the team is essential in ensuring teamwork. As discussed by Taylor and colleagues (2012) communication is important in establishing, building, and sharing data between the other members of the team. The Department of Health established the Patients’ Charter to serve as guidelines for patients in relation to their rights to clear data about their care, or any other treatment, including associated risks. In this incident, a staff nurse and a student nurse was involved and my role mostly related to the assessment of the patient’s vital signs, including pain levels and signs of infection. Health education was also crucial to the discharge planning, and the education referred to proper diet, looking for signs of infection, pain management, medication intake, and signs which may indicate complications (Coory, et.al., 2008). I also reviewed the patient’s knowledge about her catheter, what she can and cannot do, and precautions she can take in order to prevent complications. The staff nurse carried out independent nursing interventions, including pain management, administration of prescribed pain medications, as well as changing the catheter (Taylor, et.al., 2010). The staff nurse worked with the GP, especially in terms of carrying out the GP’s orders and consulting with the GP on deliberate interventions for the patient. The GP also used the nurse’s notes and reports in order to track the patient’s progress, asking the nurse’s general condition and any other additional needs. The GP ordered further diagnostic tests to determine the cause of the pain as well as detect signs of infection. With the efficient communication between the professionals, effective healthcare and improved outcomes were generally achieved for this patient (Taylor, et.al., 2010). I observed during my placement that the lines of communication were open between the doctors and the patients, between the patients and other healthcare professionals, and finally between the different healthcare professionals. Issues seen were mostly related to the limited information which the doctors often transmitted to their patients. In assessing this case, Mrs. P had limited opportunities to communicate with her GP, even during discharge as the staff nurse and the student nurse were the ones who briefed the patient on her discharge plan. Even the medication prescribed was not explained to the patient as the pharmacist was the one who explained the medication intake to the patient. Although the pharmacist clearly carried out her role in managing the patient, the support of the GP was also essential in order to support patient education and improve outcomes (Leo, et.al., 2007). Mrs. P was also evaluated by a physiotherapist because she had limitations in her mobility, and often needed help in getting up from bed, in walking, in going up and down steps, and in carrying out her daily activities. Based on the NHS long term care model, she was on level 2 because she had specific needs, as well as numerous long-term issues. As such, the patients under this category needed the assistance of the multi-disciplinary team (Carrier, 2009). The goal of the model is to manage health of patients suffering from long-term diseases. This can be reached through sustained and long-term support from health professionals. The physiotherapist’s role is to manage the patient’s movement and functions, mostly as a means of preventing injuries (Carrier, 2009). The physiotherapist also taught the patient how to strengthen her muscles and how to safely get up from a lying position or from a sitting position. The physiotherapist also taught various exercises applicable to the patient’s condition. Physiotherapists are independent health professionals who would help in the rehabilitation and recovery of the patient, thereby reducing the incidence of injury and readmission. As discussed by Belbin (2010), there are different team roles and the members of the team perform specific roles in order to achieve patient objectives. The goals are specifically set for patients, in this case, to gain patient recovery, prevent hospital readmissions, as well as secure patient independence. The members of the team perform specific functions in order to achieve these objectives (Blazeby, et.al., 2006). The team leader of this team would be the GP who directs the other members of the team on specific orders based on patient needs. This leader also supports the decision-making of the members of the team; moreover, he delegates properly to the members of the team who can actually carry out the task (Blazeby, et.al., 2006). There are moments when dislike can build up because of over-delegation of tasks to staff members; however, when the process is carried out appropriately and fairly, delegation can be a means of improving patient outcomes (Stalfors, et.al., 2007). In the end, this is the primary objective of healthcare services delivery. The team leader GP, in most ways, was able to delegate well, however his personal contact with the patient was minimal; nevertheless, he was able to communicate well with the team and to encourage them in their tasks. According to Lamb et.al., (2011) effective communication between the members of the team has various benefits; admittedly, the relations of the doctors and patients can be a complicated matter especially as the interaction can sometimes be limited due to time constraints on the part of the GP. Following the discussion with Mrs. P, she eventually understood what she needed to do in order to avoid repeat hospital visits and in order to recover from her illness. She was also assured by the fact that a carer would be assigned to her in coordination with the social worker. She understood the treatment better and was more inclined to cooperate in her treatment. Patient understanding can increase patient compliance and cooperation especially as they would now be more aware of their condition, their medications, and the interventions which would be implemented for them (Bower, et.al., 2003). As discussed by Lamb, et.al., (2011) managing, supervising, and deploying teams efficiently is a significant aspect of the healthcare delivery process. Within healthcare settings, teamwork is crucial because various resources are needed in order to guarantee services and quality care (Lamb, et.al., 2011). As pointed out by Fleissig, et.al., (2006) effective teamwork improves performance of groups, including patient safety; it also decreases length of stay in acute health settings. According to Hulvat, et.al., (2009) leadership is crucial in attaining success in one’s practice. The leadership theory highlights the elements of effective teams and recognizes the fact that leaders cannot generally assess and then efficiently function in order to secure goals without having a clear understanding of the outcomes (Hulvat, et.al., 2009). The team leader also coordinates the activities of the team, suggesting and implementing different strategies and guiding them throughout the entire process. In a study by Blumanthal, et.al., (2007) the authors revealed that effective leaders must participate with their teams in order to secure goals, promote a collaborative network as well as build the confidence of team members. Based on a behaviour based assessment, effective leaders cite the importance of learned behaviours (Hartley and Benington, 2010). Basic studies of teams established three different styles of leadership, including the autocratic, democratic, and laissez-faire leadership (Hartley and Benington, 2010). For the autocratic leadership, the motivation comes from power and authority imposed on members, with decisions being made by the leader (Hartley and Benington, 2010). This is very much in contrast with the democratic style where the motivation is internal, based on drives and a desire for participation (Borkowski, 2009). Finally, the laissez-faire leadership focuses on the fact that the motivation for people is their instinct and would need independence in making their decisions. This is even more permissive than democratic leadership (Borkowski, 2009). The bureaucratic leadership mostly focuses on the fact that as in autocratic leadership, the motivation of individuals comes from the outside. It is a type of leadership which focuses on policies and set standards in order to achieve outcomes. In order to achieve effective health goals, effective leadership is very much significant. It is also a type of leadership based on protecting and supporting personal beliefs and principles (Jasper and Jumaa, 2008). Transactional leadership is founded on social exchange theory which includes leaders and followers and their relations based on political and social elements and rewards. These leaders control tasks as well as the system of reward and punishment. It is a type of leadership supported by change for organizations gearing towards organization, not personal goals (Jasper and Jumaa, 2008). Jasper and Jumaa (2008) discuss that the decision-making process is a personal and a managerial activity. The decision-making process is complex and highly cognitive as it helps guide the next step of activity. Solving problems includes the decision-making process and under these conditions, options are analysed in order to establish effective solutions. Critical analysis is often applied in order to sift through various options and implement the most effective solution. This is very much a part of the nursing practice. Multidisciplinary teams provide significant benefits for all members of the team, and in this case, also the patients. Rowitz (2013) points out that MDTs allow for efficient communication and delegation. It also decreases number of days in the hospital, allows for quicker and more efficient implementation of interventions. They also allow for effective post-hospital care especially achieved through effective communication processes with the community members (Rowitz, 2010). Four stages make up the group dynamic theory which supports the applications of MDTs. The first stage includes the establishment of group development with individuals working together to secure specifically designed groups (Rowitz, 2013). This is followed by storming where members of the group establish roles and interactions. The norming phase follows; it is the phase which secures goals and rules (Burke and Freedman, 2011). Finally, the performing phase allows for members to agree to the basic goals which would be implemented for the team. Effective teams are important in order to ensure effective patient outcomes and recovery. Mrs. P needs physical, emotional, as well as social assistance. She has various members of the team caring for her, including the physiotherapist who has scheduled various sessions with her. The physiotherapist is providing physical support to the patient in order to eventually assist in securing independence in her daily activities. She has a 24 hour carer with her in order to monitor her condition and to ensure that her needs are met. Psychological support is also available to the patient, through the psychological help she is increasing her feelings of general wellness and reducing the incidence of depression (Wright, et.al., 2007). The trust is also built with improved psychological support. The staff nurses also provided support for the patient, especially as they provided emotional and moral support for the patient. Teamwork can have various meanings depending on the individual involved; but as members share the goals of the team, they can also secure improved patient outcomes (Wright, et.al., 2007). Strong results from a team come from the accumulation of skills from different members of the team, and in this case patient satisfaction can be secured through improved access to care, effective communication between health care team members, as well as the effectiveness of interventions, and the efficiency of treatment (Houssami and Sainsbury, 2006). In this incident, the teamwork for Mrs. P’s care was effective as an efficient discharge plan was established for the patient, supported by the contributions of the MDT. Teamwork is related to effective patient outcomes and is favourable for patient outcomes as well as service providers. Kalisch and Lee (2010) evaluated how staff nurses involved in hospital care applied teamwork. The study revealed that teamwork was able to provide organized and quick interventions for the patient. Nurses had previous experiences working in teams and understood the concept of teamwork well (Kalisch and Lee, 2010). This study was able to reinforce the notion that communication, respect, openness, and regular meetings are important elements of effective teamwork in the hospital setting. In another study, the results indicated that the focus on preventive care was able to establish results which were favourable towards gaining improved patient outcomes (Butz, et.al., 2013). Changes in the hospital practice including preventive medicine implied improved outcomes for patients. In general, the success of the MDT in managing Mrs. P can be evaluated further. Mrs. P was already discharged initially however was readmitted for pain. While caring for the patient, I note her pain symptoms which basically limited her movements and general recovery. I also note that during her second discharge, she was a bit more enlightened about her condition. I believe that the work of the team was successful during her current admission; and in general, improved patient outcomes were gained. The Nursing and Midwifery Council (2010) highlights the significance of teamwork, mostly for student nurses who must be allowed to apply team-work in order to gain more skills in nursing. There are various standards which these nurses must eventually gain. These standards are based on the NMC (2010) guidelines for pre-registration as well as the Essential Skills Clusters standards (2007). In general, the NMC declares that nurses must be sufficiently knowledgeable about teamwork and also understand the multiprofessional settings for work. They must also understand the impact of other members of the team. Moreover, feedback from other team members is also crucial for nurses as these can help support professional development. Registered nurses must therefore be equipped with the skills in order to be effective leaders. Personal contributions from the incident refer to a critical analysis which was mostly seen from other staff nurses and health professionals. The patients’ needs may not always match their preferences, however, it is possible to negotiate with the patient. The nurses must apply critical analysis in these instances in order to manage personal risks. The Health Professions Council (2008) and the Nursing and Midwifery Council (2008) have established codes of professional practice in order to protect and ensure safety in nursing care. The NMC (2010) has also recognized the importance of applying various treatment options and the new nurses must be critical about these choices. Ethical issues in the practice must also assessed, especially where there are conflicts in the interventions and possible patient preferences (NMC, 2010). To conclude, this incident of care allowed me to understand the impact of the multidisciplinary team in securing improved patient outcomes. Personal input gained from my placement was significant in terms of general knowledge and skills, especially in terms of MDT. I also learned the importance of improving my communication skills as well as my critical analysis skills. I also established the importance of MDT, especially in managing patients in the hospital. Based on the studies cited herein, critical analysis and communication are both important in achieving efficient teamwork. Where the professionals do not communicate well with each other, the goals of care would not be reached. Assessment during practice, including supervision is significant for student nurses in order to reduce medication errors as well as to allow for the confident application of interventions. Other learning points from this placement allowed me to learn from my experiences and skills in the clinical setting. The NMC (2009) indicates that it is important to work with other health professionals in order to secure the health of patients under one’s care. Teamwork is essential in attaining these goals. Within the hospital setting, one health professional cannot care for the patient having various and complicated needs. The contribution of the team is therefore necessary. The team would not be able to gain success without the strong leadership of a leader and the nurses must assess and manage the patient’s needs, from the physical to the social aspects, including the emotional needs. As a registered nurse, I am eager to apply my communication skills in order to provide quality care for patients. Based on my observation of the patients in the hospital, including the health professionals involved in their care, the patients are often not aware about their condition, including their needs and essential interventions. Patients are individuals with specific needs and it is important for nurses to assess these patients as individuals in order to provide patient-centred care. The Department of Health (2004) highlights effective communication, including the transmission of accurate data. 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