Nurses as Leaders in Health Care Settings - Term Paper Example

Nurses as Leaders in Health Care Settings Introduction Leadership in the nursing care setting is one of the most difficult tasks to undertake. Not everyone can be effective at it, and it is a quality which requires a skill, dedication, and personal charisma. Leadership is an important quality for nurses because the health and well-being of patients rely on the initiated care administered by nurses. In instances when a nurse’s professional ethical standards are challenged, leadership is also an important quality to assume. Such leadership qualities can often be challenged in instances when paternalism is applied by nurses in the practice. This study now seeks to explore and relate paternalism in relation to the Australian Nursing Midwifery Council (AMC) Code of Ethics for Nurses in Australia and one of the leadership theories within this paternalism case. This study shall revolve around the case of a young adult patient who, as a result of an accident, has been left quadriplegic and for whom paternalistic attitudes have been taken on by staff nurses. Ethical discussions shall be specified by this study in relation to the code, and transformational leadership. Body Paternalism: Paternalism in nursing basically refers to the “father knows best” concept. It is defined simply as “treating one in a fatherly way, taking decisions on an individual’s behalf, just like a father who knows better than his child what is in his child’s best interest” (Kirch, 2008, p. 1086). In its broadest application, paternalism applies when the state or any individual interferes with the actions of another person, even against the latter’s consent, triggered by better intentions or to protect the latter from harm (Dworkin, 2010). The application of this principle on patients does not preclude the advocacy required of the nurse in behalf of the patient, as well as the latter’s autonomy which must be preserved as much as possible for the patient. In this case study, paternalism is apparent from the actions of the nurses in acting seemingly in the best interests of the patient, but ignoring his personal choices in relation to his care. There is a belief of benevolence or of thinking it is for the patient’s best interests to act in the way they are acting, but in fact, their actions are already ethical violations of nursing practice (Yeo, 2010, p. 113). There is a thin line between doing what is best for the patient, and what is best based on one’s personal preferences. Based on standards of care, paternalism may or may not be considered as the best action for the patient. In assessing the standard of paternalism in this case, there is a negative quality to the paternalistic attitude of the staff nurse who seems to be applying “care” in a non-therapeutic manner. Code of Ethics Two of the Value Statements relevant to this case include: nurses value respect and kindness for self and others; and nurses value a culture of safety in nursing and health care. Nurses value respect and kindness for self and others It is important for nurses to value respect and kindness for self and others. In relation to this case, such respect must lie within the parameters of appropriate care, as well as valuing the patient’s right to make his own decisions regarding his care (ANMC, 2002, p. 2). Valuing respect for self and others is also about placing a value on the worth and dignity of oneself and of others. It also includes the importance of respecting a patient’s personal ethics and values in the health care setting (ANMC, 2002, p. 6). Kindness is about manifesting care and consideration. It is about reducing the imbalance between the caregiver and the patient, ensuring that the care administered is in the best interest of the patient, not as a means to appease a nurse’s sympathy for her patient. In relation to the self, valuing respect includes the recognition of a person’s worth, as seen in all aspects of a person’s identity. Self-respect therefore is about supporting a person’s well-being and actions in instances which develop a person’s self-worth (Funnell, et.al., 2008, p. 140). In effect, it includes the maintenance of one’s health, as well as one’s strengths and limitations, and developing qualities which support effective relationships. Respect for the person or the health consumer, in this case, the patient, includes the recognition of their ability to be active and informed participants in health care. Respect for the patient includes the preservation of the patient’s dignity through kindness and by acknowledging the vulnerability of the patient’s in their care (Harris, 2005, p. 332). There is after all an inherent vulnerability seen in the sick patient. The patient may also feel out of power because he does not possess as much knowledge and he does not have experience with pain and illness. In this case, the nurses must respect this vulnerability and not abuse their power over the patient. The patient’s need for assistance and experiences of pain and fear make him vulnerable and from this, an imbalance of power becomes apparent. In assessing the application of this value statement, it can be assessed that the nurses did not afford respect to the person – to the patient. They took advantage of his vulnerability and set forth interventions which took away the patient’s right to choose as well. Their paternalism is akin to a condescending attitude on the patient’s ability to facilitate his own recovery. In the end, they did not respect the patient and his ability to decide his care and to be respected in his bid for an independent life. Although the nurses displayed kindness for the patient as they applied a paternalistic attitude towards the patient, such display of kindness were not in the best interests of the patient who was willing and eager to undergo rehabilitation in order to regain independence and mobility. There is therefore a need for the NUM to call the attention of the nursing staff and to instruct them to cease their paternalistic attitude towards the patient, and instead to guide him in making important and independent decisions on his care and his rehabilitation. Nurses value informed decision making Another value statement which applies to this case that nurses value informed decision-making. It is important for nurses to value the interests of individuals in ensuring free and informed decisions, and this includes the opportunity to support the meaning and implication of the decisions which are being considered for their care (ANMC, 2002, p. 2). The decision-making process is an important aspect of nursing care and is often impacted by elements outside an individual’s control. In relation to self, nurses make informed decisions in their practice within the bounds of their professional roles and in relation to the minimum ethical and legal requisites of the nursing practice (Staunton and Chiarella, 2007, p. 27). Nurses have to do this without facing pressure of any kind and these nurses must carry out these decisions according to current and relevant information. In relation to patients, nurses give importance to the legal and moral activities of the people, including the children, to be involved in all decisions in relation to nursing care and interventions; and later, to help them make informed-based decisions. In these instances, there is a need to ensure effective communication with the patient in terms of language. Nurses must also engage with the patient in shared decision-making, considering their feelings and their preferences in the administration of care and interventions. Patients restricted by incapacity, disability, and other similar affectations must also be informed about the important details of their care, giving them a chance to decide on their own on the interventions which are to be implemented in their behalf (ANMC, 2002, p. 2). It is the responsibility of nurses to be knowledgeable of the circumstances which facilitate the function of family members and friends who can help in the decision-making process. In relation to this case study, the paternalistic attitude which was applied by the nurses to the patient is not in line with the value of informed decision-making. The actions of the nurses were unilateral, and with the knowledge of the patient’s condition, their actions were not consulted with the patient. There was no informed decision making attributed to the patient in this case study because the nurses were acting paternalistic towards the patient further taking unsolicited liberties in the patient’s care (Staunton and Chiarella, 2007, p. 28). The NUM must therefore call the attention of the staff nurses and inform them of the dangers of their actions and of the need for them to inform the patient of the relevance of their interventions. Their paternalistic actions must be dissected with the NUM in order to properly inform the staff of the significance of their actions, and the implications of these actions to the patient’s care. This choice is justified for this case because the patient was not given the chance to refuse care, and even if the intentions of the nursing staff were positive and caring, the overall implications of these actions were not beneficial for the patient. This value emphasizes the importance of independence and patient autonomy, which must be hand in hand with the respect owed to the patient in general. Leadership theory Discuss transformational leadership theory Transformational leadership is considered as a kind of leadership style which causes favorable changes among those who follow. In this type of leadership, the leaders are full of energy, are enthusiastic, and very passionate. They are involved in the process, and they are also involved in helping the members of the group succeed (Cherry, 2011). This type of leadership was also initially started by James MacGregor Burns; according to him, leaders and followers help each person advance to different levels of motivation. With the vision and personality, these leaders are able to inspire their members to improve their expectations and motivations in order to work towards favorable goals (Cherry, 2011). The elements of transformational leadership include intellectual stimulation where the leaders challenge the usual practices and encourage creativity among members and followers. The leader would also support followers in establishing new ways of conducting activities as well as new opportunities to learn (Cherry, 2011). Individual consideration is also another element of transformational leadership as it includes the process of giving support to the various members. In order to ensure supportive effective relationships, transformational leaders ensure that lines of communication are open; in effect, followers are free to share their ideas and can recognize the unique contributions of the followers. Inspirational motivation is also an element of transformational leadership with transformational leaders having a clear vision which they can express to their followers (Ellis and Hartley, in Harris, 2009, p. 7). In effect, the leaders are also able to support followers, and help them feel passion and motivation in the fulfillment of their goals. Finally, idealized influence is an element of transformational leadership which is the role model for followers. Since followers support their leaders, they also imitate their leaders. Discuss how NUM can transform paternalistic attitudes of staff In order to transform the paternalistic attitudes of the staff towards the patient, the transformational leader must be passionate and engaged in the achievement of the goals of his leadership. An assessment of the staff and their awareness in their actions shall also be carried out. Such assessment will help determine the extent of their attitude and their paternalism towards the patient. The NUM would also have to challenge the nursing staff on the improvements in the care that they administer to the patient (Bleich in Yoder-Wise, 2011, p. 56). Transformational leadership also includes individual considerations. This would be seen in the considerations given the patient in terms of his choices of care and his preferred applications in these interventions. A clear vision on the implementation of care must also be relayed to the nursing staff. This vision must define the type of care which the patient would need to reach full recovery (Hein, 1998, p. 299). It must also explain the pitfalls of paternalism and its impact on the recovery of the patient. As a transformational leader, it is also important for the leader to ensure that the members or, in this case, the nursing staff would follow his lead in terms of attitudes and interventions. The leader must not therefore herself employ or display a paternalistic attitude. She must be able to set the limits of care and benevolence to ensure its therapeutic nature as well in the actual practice and in this current case. Transformational leadership as applied by the NUM would therefore take on a more active participation and in the patient’s care, not allowing the wrong practices of other nurses to be carried out. Transformational leadership aims to transform the actions of the staff nurses, to ensure that they would act in the proper clinical, legal, and ethical ways, and that they communicate richly with each other (Prentice Hall, n.d, p. 123). The staff members must also be transformed in their actions and their activities, by acknowledging their wrong actions, and by ensuring that these actions are eliminated or are changed for the better. Conclusion Paternalism in this case study refers to the act of acting in the seeming best interests of the patient – it is an act which interferes with the patient’s choices and self-determination. The nurse’s actions were paternalistic towards the patient and this against the nursing value principles, including the fact that nurses value respect and kindness for self and others; and the culture of safety in nursing and health care. These values when applied to this case establish that the nurses did not apply these value statements. In order to resolve this situation the NUM needs to apply transformational leadership. This type of leadership would help reform the nursing staff and ensure that they would be able to secure effective nursing care for the patient. Works Cited Australian Nursing and Midwifery Council (2002), Code of ethics for nurses in Australia. Bleich, M. & Kosiak, C. (2006). Managing, Leading, and Following. In P. Yoder-Wise (Ed.), Leading and managing in nursing, 4th Edition (3-25). St. Louis: Mosby Burns, J. (1978), Transformational leadership theory, New South Wales: Elsevier Health Sciences. Cherry, K. 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(2007), Nursing and the Law, Sydney: Elsevier Australia. Read More