Nursing Leadership and Management - Assignment Example

Nursing Leadership and Management Introduction Nursing leadership and management is one of the most important aspects of the nursing practice. It is an element of the nursing practice that often dictates the effectiveness of the nursing interventions, treatment, and health procedure. In order to ensure an encouraging future for the nursing practice, nurse leaders and managers need to consider different opportunities in the various areas of practice where they can advance the contribution of nursing and influence of nursing and nursing management. This paper shall consider two of these opportunities in the operating theatre where nurse managers and leaders can advance the contribution and influence of nursing and nursing management in the future. This paper is being undertaken in order to come up with a comprehensive assessment of the subject matter and in order to establish a clearer understanding of nursing management and leadership. Discussion There are different possible opportunities in the operating theatre where nurse leaders/managers can advance the contribution and the influence of nursing and nursing management in the future. For purposes of this study, two possible opportunities considered are infection control and efficient coordination between members of the health care team. Infection control Based on literature, nurse managers/leaders can carry out successful infection control measures in order to advance the contribution of nurses and nursing management in the future. In a study by Chen and Qian (2008, p. 4), the authors emphasized that in order for nurse managers to improve infection control, they had to improve their management of the operating room environment. In their study, they sought to evaluate the environmental scenario of the operating room and to evaluate regulatory measures in this environment (Chen & Qian, 2008, p. 4). After three years, total quantification rates of the air registered at 98.1%; of the object surface at 90.2%; and of the hands at 96.5% and the trend registered at an increase for each year (Chen & Qian, 2008, p. 4). In effect, the study revealed that in order to implement adequate infection control measures in the operating room, nurse managers and leaders have to improve quality management of the OR environment through disinfection, through the implementation of different management systems including precaution standards among the OR staff, and through the strict control of people going in and out of the OR (Chen & Qian, 2008, p. 4). The strict implementation of these infection control measures by the nurse was also supported by another study which emphasized that such measures helps guaranteed that the environment in the OR would improve in quality and the incidents from hospital infection during surgery would be reduced or minimized (Stahl, et.al., 2006, p. 717). Infection control in the operating room can also be improved by nurse managers through the imposition of safety precautions and processes in the handling of sharp devices in the OR. In a paper by Clarke, Shubert, and Korner, (2007, p. 473), the authors conducted their study in an attempt to compare the injury rates involving sharp devices among hospital staff nurses in four Western nations. Studies in the US revealed that with improved awareness and implementation of safer technologies and regulatory measures, injury rates involving sharp devices were reduced (Clarke, Shubert, & Korner, 2007, p. 473). In Germany, the implementation of safety devices has been slow – hence their higher injury rates. Through this study, it is implied that the more widespread implementation of safety measures and devices can help reduce occupational safety in the OR. In effect, the protection here is focused on the possibility of OR staff being infected through sharp-devices in the OR (Ghofranipour, et.al., 2009, p. 191). This study was able to reveal that the nurse manager can implement the latest safety measures and devices in the use of sharps in the OR in order to reduce the possibility of OR infection. Larson and Lusk (2006, p. 52) discuss that it is important for nurse managers to enforce proper hand washing techniques in the OR. Their discussion points out that there is a need for nurse managers to establish the importance of hand washing in the OR among surgical staff and the different techniques employed in hand washing. The study also points out that nursing leaders have to consider the way the hands are washed as well as how often the hands are washed (Larson & Lusk, 2006, p. 52). Washing hands in the proper way and as often as possible before operative procedures in the OR has to be fully controlled and managed by the nurse managers. Bacteria which is transmitted during the operative process is a common source of infection for patients undergoing surgery. In a study by Rui, Guangbei, and Jihong (2007, p. 793), the authors were able to establish that improving air flow pattern can minimize particle deposition on surfaces in operating rooms. Their study covered two operating rooms during two surgeries – surgical stitching of fractured mandible and a joint replacement surgery. For the study, two bacteria collecting agar dishes were placed in different areas in the two ORs in order to calculate particle trajectories during the operation (Rui, Guangbei, & Jihong, 2007, p. 793). They were able to establish that consistent bacteria patterns were found in both ORs but, such patterns can be modified by improving air flow patterns, controlling foot traffic in the OR, and limiting closing and opening of OR doors (Lynch, et.al., 2009, p. 49). Similar studies were able to stress the importance of air control flow in the OR in order to prevent infection (Sutherland & van den Heuvel, 2006, p. 278). Glove perforation in the OR is one of the least desirable incidents a member of the surgical team can experience. It is an incident which can increase the risk of surgical site infection (SSI) and which can also expose the surgeon or nurse to infection. In a study Misteli, et.al. (2009, p. 553), the authors were able to establish that SSI rates which were related to glove perforation were at 4.5% in a review of about 4000 surgical procedures. This study implies that nurses have to ensure that the surgical team conducts proper hand washing and aseptic precautions before each surgery. This would help ensure that even when gloves are perforated, SSI would not occur. It is also important for nurses to ensure that surgical antimicrobial prophylaxis is taken by the patient before the operation in order to the risk of SSI through glove perforation (Misteli, et.al., 2009, p. 553). Double-gloving is also recommended for the surgical team for highly infectious cases (Lefebvre, Strande, & Hewitt, 2007, p. 113) Nurse managers also need to consider the implementation of ultraviolet lighting in the OR in order to reduce the risk for infection. A study by Ritter, Olberding, and Malinzak (2007, p. 1935) set out to compare infection rates in the OR with and without the use of ultraviolet lighting. They covered about 5000 joint replacement surgeries and they were able to establish that the odds of infection were 3.1 times higher for procedures without ultraviolet lighting (Ritter, Olberding, & Malinzak, 2007, p. 1935). It is therefore prudent for nurses to consider the implementation and the widespread adoption of ultraviolet lighting in order to reduce the risk of infection in the ORs. Hedrick, et.al., (2007, p. 425) set out to establish whether or not the implementation of a protocol which targets risk factors in the OR can reduce the risk of SSI related to intra-abdominal surgery. In the process of their research, they were able to establish that the strict implementation of OR protocol was able to reduce incidence of hypothermia, and to reduce the incidence of SSI (Hedrick, et.al., 2007, p. 425). All in all, in terms of nursing practices, nurse managers can improve the role of nursing management in the future through the implementation of preventive protocols which reduce SSI in the OR. These protocols are cost effective measures and have major long-term benefits for the patients in reducing morbidity due to infection. Demir (2009, p. 1741) sought out to evaluate the infection control practices in the prevention of SSIs in operating theatres and to relate this to evidence-based practice guidelines. The author interviewed charge nurses in 24 ORs in 11 hospitals in Izmir, Turkey. The author was able to establish that there seems to be no adherence to the guidelines on infection control and at the most, compliance was seen in the use of surgical gowns, drapes, and in hand washing procedures (Demir, 2009, p. 1741). Based on this study, it can be drawn that nurse managers have to impose better infection control measures in the OR. Such measures must also be based on evidence-based practice in health care. Research on EBP guidelines therefore needs to be constantly updated and reviewed by nursing managers and leaders. Nurse managers also need to consider the host factor in order to achieve infection control in the OR. In a study by Fry and Fry (2007, p. 1), the authors pointed out that there are about 30 million surgical procedures being carried out on a yearly basis in the US and in these procedures, SSIs are still considered to be a common postoperative complication. However, even as SSI seems to be a common occurrence for patients, the factor of host’s responsiveness to the bacteria is still considered to be a major factor in SSI. It is therefore important for nurse managers to ensure that the patient’s physiological condition can help prevent SSIs. Initiatives for perioperative nurses include the use of supplemental oxygen, maintenance of patient’s core body temperature, and the management of blood sugar levels (Fry & Fry, 2007, p. 1). Nurse managers need to consider the widespread adoption of supplemental oxygen in the perioperative setting and the monitoring of the patient’s temperature, as well as blood sugar levels. Coordination The coordination of the members of the surgical team and all other departments which are involved in ensuring a successful surgery is a job for the OR nurse manager or leader. In the process of coordination, the nurse/manager can carry out pre-operative interviews and observation in order to improve the quality of nursing services. In the study by Li (2006, p. 3), the authors set out to review the impact of pre-operative interviews in the ORs in order to improve the quality of nursing care. In the process, they were able to establish that pre-operative interviews were more effective when done by the OR nurses a day before the surgery. This would help them detect the possible issues and patient needs which have to be coordinated earlier with different departments (Li, 2006, p. 3). The importance of establishing better interactions between OR personnel is important in improving patient safety. Nurses therefore have to assist in the development of a team-training curriculum. In a study by Halverson, et.al., (2009, p. 107) the authors sought to establish and implement a team-training curriculum among OR physicians, nurses, technicians, and other personnel. After six months in implementing team training, the compliance with preoperative briefings was increased and improved perception of teamwork among participants was also seen (Halverson, et.al., 2009, p. 107). In effect, the study established the importance of implementing team training programs in order to increase compliance with the demands of the OR work. Paige, et.al., (2009, p. 138) also discusses the importance of OR teamwork in the safe delivery of patient care. In their study they evaluated the application of high fidelity simulation in increasing teamwork competency. After implementing the simulations, the teams were able to achieve higher scores in role clarity, anticipatory responses, cross monitoring, team cohesion, and interaction (Paige, et.al., 2009, p. 138). In effect, this study implies that in order for nurses to achieve better coordination and teamwork in the OR, the nurse managers must implement high fidelity simulated trainings for their staff and if possible, all the members of the surgical team. Nurse managers also need to evaluate the frequency of delays in the ORs because they are good indicators of the efficiency and coordination of the OR teams. In a study by Wong, et.al., (2010, p. 189), the authors set out to evaluate data on perioperative system delays and in the process, they were able to establish that in about 1500 surgeries, delays were the most common types of errors and more than half of the cases incurred atleast one delay. Equipment failure was the most common cause of OR delays and such delays often caused the subsequent surgeries to be held up (Wong, et.al., 2010, p. 189). It is crucial therefore for nurse managers to prevent such delays by coordinating with the members of the surgical team and all units involved in the surgery. By preventing such delays, the patient flow and resource utilization can improve OR efficiency. The importance of nurse-surgeon coordination was also highlighted in the study by Zheng, Taylor, and Swanstrom (2009, p. 497) where the authors set out to observe surgeon-nurse coordination during laparoscopic surgeries. The study revealed that the scrub nurse spent more time watching the surgery and less time performing surgery related activities (SRAs). The more experienced nurses spent less time watching the surgeries, and had more anticipatory movements than the less experienced nurses (Zheng, Taylor, & Swanstrom, 2009, p. 497). This study implies that nursing managers need to assist lesser experienced nurses in anticipating movements and needs of surgeons. The more experienced nurses can actually help in this training in order to ensure efficient performance, coordination and communication with the surgeons. The importance of preoperative briefing was also highlighted as an important element in improving OR coordination. The study by Einav, et.al., (2010, p. 443) sought to establish the importance of preoperative team briefings in order to improve patient safety and identify details in relation to the patient and the surgical procedure. The study established that the conduct of preoperative briefings reduced the number of nonroutine events by 25%. The members of the OR team also expressed that the briefings helped improve their coordination with other surgical staff and consequently, improved patient safety (Einav, et.al., 2010, p. 443). Nurse managers need to participate and coordinate with the members of the surgical team in order to set-up these briefings and thereby also improve patient safety. Wei, et.al., (2005, p. 11) were also keen to highlight the role of OR head nurses in the coordination of doctor-nurse relationship in the OR. The authors set out to evaluate the characteristics of doctor-nurse relationships and the possible sources of contradictions and problems in the relationship. The study revealed that the nurses and the surgeons need to understand that they have to work together in order to achieve effective management of OR needs (Wei, et.al., 2005, p. 11). Head nurses therefore have to give openings for the nurses and the surgeons in the OR to work together – during preoperative briefings and in the actual perioperative set-up. Conclusion Two opportunities where nurse managers can advance the contribution and influence of nursing in the operating theatre include infection control and coordination. Based on studies, nursing managers can improve infection control by ensuring that the patient has adequate antibiotic usage before surgery. Also, the nurse manager has to ensure that adequate hair removal is implemented on the patient as well as an adequate OR environment or air management is set in place. Therefore, the nurse manager must also implement a strict control of the people going into and out of the OR. The nurse also needs to coordinate with OR personnel and the sterile processing unit in order to ensure that adequate infection control measures are in place. Safety processes on the handling and the use of sharp devices in the OR also have to be set in place. The nurse also has to implement strict hand washing procedures for OR staff, as well as strict OR protocols for surgical staff. In order to improve coordination, the nurse managers have to conduct preoperative interviews and evaluation to ensure that needs are anticipated and provided before surgeries. Teamwork between and among the members of the surgical team also has to be improved through preoperative briefings, meetings, and trainings. Simulations can also help implement better coordination, communication, and teamwork. The nurse manager can implement such improvement measures in the OR in order to ensure patient safety and ensure the place of nurses in the future health practice. Works Cited Chen, X. & Qian, X. (2008) Environment Disinfection Situation and Regulatory Measurement in Operating Room, Chinese Journal of Nosocomiology, volume 4, number 44, p. 4 Clarke, S., Shubert, M., & Korner, T. (2007) Sharp-device injuries to hospital staff nurses in 4 countries, Infection control and hospital epidemiology, volume 28, number 4, p. 473 Demir, F. (2009) A Survey on Prevention of Surgical Infections in Operating Theaters, Worldviews on Evidence-Based Nursing, volume 6, number 2, p. 1741 Einav, Y., Gopher, D., Kara, I., Ben-Yousef, O., Lawn, M., Laufer, N., Liebergall, M., & Donchin, Y. 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