The Role of Nurses in the Delivery and Monitoring of Quality of Care to Patients - Literature review Example

The Role of Nurses in the Delivery and Monitoring of Quality of Care to Patients Nursing has a responsibility to contribute to health planning and policy, and to the coordination and management of health services (ANON. 2000, para. 1 ). Nurses take on various roles and functions when they provide care to clients. Nurses provide care for three types of clients: individuals, families, and communities (KOZIER, B., ERB, G., BERMAN, A. & SNYDER, S. 2004, p.8). Oftentimes, nurses perform these roles at the same time. A nurse is considered as “caregiver, communicator, teacher, client advocate, counselor, change agent, leader, manager, case manager, research consumer”, and in many expanded career roles such as a “nurse practitioner, clinical nurse specialist, nurse midwife, nurse educator, nurse researcher, and nurse anesthetist.” These wide arrays of nursing functions open the doors of nurses to “greater independence and autonomy.” It is the responsibility of a nurse to deliver and monitor the quality of care to its clients. Since nurses serve as caregivers, their end should be that their patients must achieve relief of their disease condition In every disease condition, the nurse should give the best form of nursing care she could possibly provide. If one method is ineffective to a particular patient, the nurse as change agent must implement “change” in the quality of care to make it successful. The positive and negative outcomes of a patient’s condition could therefore be attributed to the management and leadership qualities a nurse possesses in implementing change. In today’s changing times, management has taken a new phase. Managers do not necessarily need to abandon the traditional ways of delivering care, but they must welcome new and enhanced skills in upgrading the quality of care they provide their clients. These challenges have a great influence on nurse managers. Thus the advent of progressing knowledge and technology imposes some alterations in the way we carry out nursing care. It is up to the nursing leaders inside the ward to select the best nursing care method to apply in a particular case. Nursing care management requires power, control, direction, and a viable strategy. Therefore it requires leadership. There are several leadership styles and management techniques adopted by organizational leaders and managers. Each style has its own strengths and weaknesses. Moreover, each of these systems executes leadership in their own ways. Some leadership styles being used in various organizations include transformational and transactional leadership, and the autocratic, democratic, and laissez-faire styles. Let me state a brief overview of these leadership styles. A person with a transformational leadership style is “a true leader who inspires his or her team constantly with a shared vision of the future. Transformational leaders are highly visible, and spend a lot of time communicating. They don’t necessarily lead the front, as they tend to delegate responsibility amongst their team. While enthusiasm is often infectious, they generally need to be supported by details people” (ANON., n.d., Leadership Styles). Meanwhile, the transactional style of leadership “starts with the idea that team members agree to obey their leader totally when they take on a job: the ‘transaction’ is (usually) that the organization pays the team members in return for their effort and compliance. You have the right to ‘punish’ the team members if their work doesn’t meet the pre-determined standards” (ANON., n.d., Leadership Styles). Oftentimes, both transactional and transformational leadership are required in organizations. The transactional leaders guarantee that regular functions are accomplished constantly, while the transformational leaders handle worthwhile plans and programs. “Autocratic leadership is an extreme form of transactional leadership, where leader has absolute power over his or her employees or team. Employees and team members have little opportunity for making suggestions, even if these would be in the ream or organization’s interest” (ANON., n.d., Leadership Styles). A democratic or participative leader makes the final decision. But although this is the case, “he or she invites other members of the team to contribute to the decision-making process. This not only increases job satisfaction by involving employees or team members in what’s going on, but it also helps to develop people’s skills. Employees and members feel in control of their own destiny, such as the promotion they desire, and so are motivated to work hard by more than just a financial reward” (ANON., n.d., Leadership Styles). Lastly, laissez-faire is a French phrase which means “leave it be.” In this type of leadership, the “leader leaves his or her colleagues to get on their work. It can be effective if the leader monitors what is being achieved and communicates this back to his or her team regularly. Most often, laissez-faire leadership works for teams in which the individuals are very experienced and skilled self-starters. Unfortunately, it can also refer to situations where managers are not exerting sufficient control” (ANON., n.d., Leadership Styles). For this particular patient condition, leadership style should be a combination of democratic, transformational, and transactional. Since we are focusing on a holistic plan of care wherein the roles of other staff nurses and the significant others are important, there must be democratic or participative leadership. In this leadership, each one is free to voice out his or her suggestions during decision-making. In other words, there is due process within the group. At the same time, the nurse manager, through transactional leadership, uses rewards to motivate the participation of the members. Altogether, the transformational style is also applied as the leader broadens and raises the interests of his or her members, build awareness and recognition of the nursing goals as well as the entire task of the group not only for their own self-interest. In the case at hand, the nursing goal is to increase the weight of the patient and the nursing plan included a “protected meal time” in the ward. In other words, all clinical activities are restricted during lunch and dinner times and are directed towards nutrition. Applying Kurt Lewis’s (1951) Change Theory, the following Force Field Analysis Diagram is proposed. In this type of analysis, the improvement of the probability of success will either be: to reduce the strength of the restraining forces or to increase the driving forces. To carry out the analysis, each force is assigned a score, from 1 (weak) to 5 (strong). Goal or proposed change: To implement “protected meal time” in the ward to enhance patient’s weight gain Driving Forces (the pro’s) Restraining Forces (the con’s) Patient gains weight (4) Patient may be uncooperative with the plan; patient will not eat (4) Interest in the problem has been expressed by the patient’s son (2) Vital signs and normality of values (CBC, FBS, etc.) cannot be constantly monitored (3) The nurse manager along with other the staff nurses support the plan (holistic care) (3) Participation in nursing care plan takes time (2) Increase job satisfaction (1) Limited access to more knowledge and creative work (2) Nursing care team members are compensated for their services (1) Unsupportive significant others (2) Total: 11 Total: 13 Note: The numbers in parenthesis correspond to the scores assigned. Forcing change may be the first and major problem change agents may encounter at the onset of a change plan or proposal. In this case, the patient may be uncooperative if change in her routine activities will be altered. We have to understand that ill patients are not in their best condition. Oftentimes, they are irritable and patience is certainly not their best attribute. If the above-mentioned diagram is to be implemented, the analysis might suggest a number of changes in the opening plan: Constant and effective communication (increase support system by 1) may convince the client to be cooperative in the care plan which is “protected meal time” (reduce uncooperativeness of patient by 2) It would be useful to show patient that change is necessary in order for her to gain weight (patient gains weight, +1) Vital signs and other tests will be run right after lunch time and supper time to monitor patient’s condition (decreases non-monitoring by 2) Make a timetable of activities to achieve goal the shortest possible time (new force in favor +1), decreases the long time allotted for nursing care by 1 Knowledge and creativity can be enhanced through participative activities (job satisfaction +2); decreases limited access to more knowledge and creative work by 1) Constant communication with significant others (new force in favor, +2); decreases uncooperativeness of significant others by 1 These changes would make the balance from 13:11 (against the plan), to 6:16 (in favor of the plan). Abraham Maslow, a leader in the development of humanistic psychology, assumes a hierarchy of motives ascending from the basic biological needs present at birth to more complex psychological motives that become important only after the more basic needs have been satisfied (SEVILLA, C., ROVIRA, L., & VENDIVEL JR., FORTUNATO G., 1984, p.226). Maslow’s hierarchy of needs (in ascending order) includes physiological needs, safety needs, belongingness and love needs, esteem needs, cognitive needs, aesthetic needs and the need for self-actualization. In relation to the case at hand, the physiological needs of the patient including food, water, air, and so on must be met first. The patient must cooperate and adhere to the “protected meal time” plan and eat the right food in order to gain weight and achieve the ideal weight in the shortest possible time. Safety needs must be met next which includes the patient’s security inside the ward thereby freeing herself from harm or danger. Belonging and love needs involve the participation of the significant others (SO). This can be done through constant communication with SO regarding patient’s condition so that they will understand their roles in the delivery of the care plan. Once the patient starts to gain weight, she will meet her esteem needs thus she will feel competent and strong. The SO must show approval and recognition for her achievement. As soon as she will know and understand what she is going through and accept her condition, she will then meet her cognitive needs. Furthermore, if she is healthy, she will feel better and begins to look at the brighter side of life. This time, she meets her aesthetic needs. Finally, when she gains back her health completely, she will find self-fulfillment upon completing the “protected meal time” plan. This is self-actualization or the realization of one’s potential. She will then resume her activities of daily living and will live a normal life once again. In conclusion, there is no perfect leader. However, there can be a good leader. In delivering and monitoring the quality of care to patients, the nurse plays a very critical role because the success of the nursing care plan solely depends on how he or she manages the patient. The nurse manager and the nursing care team should set aside their self-interest in order to achieve their nursing goal which is to regain the patient’s health back to normal. References BOLMAN, L. & DEAL, T. 1991. Reframing organizations. San Francisco: Jossey-Bass. BURKE, W.W. 1994. Organizational development, a process of learning and changing. 2nd ed. Addison-Westley Publishing Company. CUMMINGS, T.G. & WORLEY, C.G. 1997. Organization development and change. 6th ed. Ohio: South-Western College Publishing. Force field analysis. 2001. Extension to Communities. [Online]. Available: http://www.extension.iastate.edu/communities/tools/forcefield.html [1 May 2007]. Force field analysis. 2007. [Online]. Available: http://www.accel-team.com/techniques/force_field_analysis.html [1 May 2007]. Force field analysis. 2007. [Online]. Available: http://en.wikipedia.org/wiki/Force_field_analysis [1 May 2007]. Force field analysis. n.d. [Online]. Available: http://www.mindtools.com/pages/article/newTED_06.htm [1May 2007]. FRENCH, W.L. & BELL, C.H. 1995. Organization development. Behaviour science interventions for organization improvement. New Jersey: Prentice Hall. GRIFFIN, R.W. 1987. Management. 2nd ed. Boston: Houghton Mifflin Company. KOTTER, J.P. 1979. A force for change, how leadership differs from management. New York: The Free Press, A Division of Macmillan, Inc. Leadership. n.d. [Online]. Available: http://www.mindtools.com/pages/article/newLDR_84.htm [1 May 2007]. Leadership: An overview. n.d. [Online]. Available: http://web.cba.neu.edu/~ewertheim/leader/leader.htm [1 May 2007]. LEWIN, K. 1943. Defining the “field at a given time.” Psychological Review, 50: 292-310. Republished in Resolving Social Conflicts & Field Theory in Social Science, Washington, D.C.: American Psychological Association, 1997. Management of nursing and health care services. 2000, [Online]. Available: http://www.icn.ch/psmanagement00.htm [1 May 2007]. ROBBINS, S.P. 1998. Organizational behavior, concepts, controversies, applications. 8th ed. New Jersey: Prentice Hall International. Read More