Clinical Leadership and Gibbs Learning Cycle - Essay Example

Clinical Leadership Table of Contents Introduction 3 Gibbs Learning Cycle 3 Personal Reflection 4 of the Situation 5 Evaluation of Feeling 6 Evaluation of Experience 7 Assessment to Make Sense of the Experience 9 Alternative Action 12 Action Plan 14 Conclusion 16 References 17 Introduction In this essay, I reflected certain significant aspects based on a practical situation of cardiac care. The reflection was selected in order to underpin the significance of teamwork and leadership in nursing relating to the background of cardiac care. The activities undertaken during the cardiac care have been described in the essay by using a reflective model. Reflection is a vital tool for every healthcare professional. It enhances the skills and assists in understanding the choices that one make in real life practices. Reflective learning comprises evaluation and re-evaluation of norms. Critically reflecting an event constantly improves the understanding and knowledge base. Reflection also makes healthcare professional aware of different activities, inspires analysis and enhances self-awareness with respect to individual skills (Somerville & Keeling, 2004). The skills in this reflection were based on my leadership practices as a part of clinical effectiveness. The essay will primarily focus on defining a situation in cardiac care. During my course of action in cardiac care, I have changed certain practices in order to enhance the situation. Gibbs Learning Cycle There are various models of reflection and one of the most significant amid them is Gibbs reflective model. This model comprises six phases in order to complete one cycle. This model is able to enhance my skill through learning and gaining experiences of deriving better clinical outcomes. The learning cycle according to Gibbs model, begin with description of situation, followed by evaluation of feeling. The third phase is evaluation of experience and the fourth phase is assessment to make sense of the experience. The fifth stage is related with drawing conclusion comprising alternative action and the sixth and final phase is action plan that denotes making preparation in case such situation appear again (Oelofsen, 2012). Rose & Best (2005) provided certain reasons regarding the requirement of reflective practices. These authors described that reflection helps to generate awareness and assists in raising capability towards getting adjusted with new conditions, improving self-confidence, improving satisfaction level of the patients, progressing organisational value and developing effective professional practices. Nevertheless, Siviter (2004) stated that reflection is identifying when to improve, learning from mistakes, observing at the viewpoints of other employees and patients, being self-cognisant and enhance a particular critical situation. Personal Reflection I work as a band 7 charge nurse in cardiac care. My role is multifaceted and I perform as a clinical expert, role model and mentor. I have been employed as a cardiac specialist nurse for several years. My role is to diagnose and treat conditions that influence cardiovascular system. I also concentrate on preventive medicine and education of patients. At times, I also assist doctors with diagnostics and different specialised tests. My role also comprises providing education to junior nurses. It is my responsibility to motivate and empower the employees as well as the patients along with their families. I have enrolled in leadership course, during which I have learned that leadership is vital for nurses and without proper leadership, it could lead towards raising conflicts in workplace and would generate confusion and disruption in work procedure. Following is a practical situation, which I had experienced in cardiac care. The reflection demonstrates the importance of leadership and teamwork in nursing environment and the lesion I learned during the work procedure. Description of the Situation In cardiac care, critical transfer of patients can occur at any point of time. During critical transfer, it is essential for the nurses to perform cooperatively in order to ensure patients’ safety as well as deriving better healthcare outcome. During my work practice, I faced coordination problem during quick transfer of a patient. A patient with ‘segment–elevation (ST) myocardial infraction’ was in critical position and required transfer to a hospital. However, on the way of critical transfer, I identified that two of the nurses were unaware regarding what to do for safe and speedy transfer of patient. This certainly caused certain disagreements between me and the nurses, as any delay could cause serious harm to the patient. The two nurses were basically unsure regarding essential activities that require to be taken during critical transfer. However, instead of leading them through making them aware about the transfer procedures step by step, I myself took over the situation, concerning patient’s safety as myocardial infraction represents considerable amount of deaths (McDermott & et. al., 2008). As a general fact, there are several aspects that result in delay transfer of patients with myocardial infraction. These aspects entail triplication of patient evaluation by nurses and ineffective performance of medical employees as well as cardiac care team. In order to minimise the components of delay, fast track admission system has been developed in cardiac care. In fast track system, patients with myocardial infraction are recognised by paramedic employees and staffs of emergency division before reaching hospital. However, I have observed that the nurses possess limited knowledge about the applicability to the system (Pell & et. al., 1992). In fast tracking of patients with myocardial infraction, critical transfer is a key aspect. Fast tracking of myocardial infraction can only become superior if performed in a timely way, keeping in mind that it frequently necessitates dislocation of patients and their respective families (Henry & et. al., 2014). Critical occurrences are common during the transfer of patients and most of these incidents are possibly preventable. The critical occurrences in cardiac care are normally supported by several aspects and one of such aspects is low level of collaboration along with confusion (Moss & et. al., 2005). After evaluating the situation, I identified two key areas that require improvement. In this regard, one of such areas is need or forming better collaboration and the other one is making changes in the operational procedure of the hospital particularly in critical transfer situation. Evaluation of Feeling The capability to quickly identify patients with (ST) myocardial infraction and speedily transfer them to hospital is critical for survival. It is worth mentioning in this similar context that hospital procedures are vital predictors of quicker transfer of patients. An enthusiastic reperfusion plan as well as procedure is required for minimising any sort of confusion, which appears in critical transfer (Glickman & et. al., 2011). In cardiac care, critical transfer is a routine practice. With growing importance of safety during critical transfer, there lays significant evidence that in certain circumstances, quick transfer to proper medical facility is apparently designated. Proper and effective uick transfer often results in improved outcome for patients with (ST) myocardial infraction. Thus, for my team, successful transfer requires extensive understanding between various activities and collaboration that were missing during the process (Iwashyna & Courey, 2011). However, in my opinion, letting myself to take in charge of transferring the patients seems to be little inappropriate. Irrespective of taking complete control of the situation, I must allow the nurses to complete the critical transfer with me by providing them proper supervision. Furthermore, it would also be beneficial to encourage them regarding the procedure of transfer such as in the form of providing morphine to a patient for pain relief. Although my action was obvious relating to the condition of critical transfer, it led towards frustration of the two nurses. I could have handled the situation better by speaking with the two nurses who were involved in critical transfer of the patient. Thus, the key issues in this context that I identified for improving the situation were teamwork and leadership. Evaluation of Experience From the experience that I have gathered, I strongly believe that in order to ensure the formation of a culture of effective teamwork, there lays the need of promoting effective communication. Since my team perform in high-risk areas where there lay no space for any mistake in healthcare procedure, collaboration is required to deliver quality healthcare services to the patients (McCarthy & Blumenthal, 2006). Failure of communication can be duly regarded as one of the key causes of confusion, which took place amid the two nurses. Although healthcare is provided by multiple team members, quality and superiority has historically been structured on the performance of individual nurses. In my case, formal training and education was largely absent, which resulted in increased level of confusions. Such confusions could lead towards providing unintentional harm to the patients. Effective teamwork is aimed for the creation of common mental model and making every individual to be involved in attaining the similar objective. Equally significant is the creation of such environment, which can make the team members safe to speak up during the conduct of any safety related activity (Leonard & et. al., 2004). There are several aspects that support conflict such as communication problem, complex organisational structure, role disagreements, misinterpretation and lack of commitment among others. Conflict situation has been appeared in my case due to antagonistic position of the two nurses, resulting in disagreement of thoughts and awareness. There were both positive as well as negative sides of the conflict. The positive side was that the conflict resulted in making certain improvements in the working procedure and the negative one can be ascertained as that it resulted in making low motivation for the employees. In the regular working routine, nurses are the intermediary of any healthcare team in several situations (Schraagen & et. al., 2010). From my experience, I believe that individuality of nurses along with diversity of attitudes and thoughts eventually triggered professional conflicts. However, it is worth mentioning that leadership is responsible for mediating conflicts in diverse work settings (Blake & Young, 2014). As a cardiac specialist nurse, along with other duties, I also require recognising, evaluating and dealing with such conflicts and cooperatively prevent intrusions persisting within the healthcare services (Spagnol & et. al., 2011). According to my viewpoint, transformational leadership is best suited for dealing with any sort of conflict and improving adverse situations persisting within healthcare services. Transformational leadership can motivate the nurses by appealing to higher thoughts and moral worth (Doody & Doody, 2012). In my job, I faced multiple challenges and out of which the most significant was the requirement of transforming the way patients obtain quality as well as affordable healthcare services. Thus, improving the nurses who deliver hand-on care is a vital part for successful competition of this transformation. In this similar context, I would like to mention that the focus of transformation leadership should be on observing faults as learning opportunities and valuing innovation. My greatest fault in this context was to not providing proper training to the nurses regarding their job roles, which resulted in raising conflicts. Furthermore, I did not provided proper guidance to the nurses about constantly improving the healthcare services. Thus, transformational leadership can mitigate the existing faults and transform the job procedure along with provide better patient care (Habel & Sherman, 2014). In my opinion, the key principle of effective teamwork is that it allows employees to develop their respective performance. If effective relationship is developed, then it might generate better synergy amid the workforce (Walton, 2005). Assessment to Make Sense of the Experience The incident or the case made me to understand about what could be done in future for preventing such conflicts in workplace and most vitally enhancing the working conditions. As a matter of fact, conflict is integral in any profession and it occurs due to the differences prevailing in the ideas along with the feelings of the members among others. Conflict resolution, in this context is agreed not merely as a method for dealing with differences of ideas, but also as an approach, which enable changes towards reactive and reasonable organisational system (Hendel & et. al., 2005). By playing a role of transformational leader, I can foster a shared determination, which connects individuals together and generate shared self-interests for the beneficial of the team. There also lays the requirement of developing cooperative team objectives in order to encourage open communication. Transformational leadership is also effective as it can help my team members to develop group norms that largely support supportive conflict management. Specially mentioning, transformational leadership is characterised by delivering a purpose, which transcends the self-interests of the employees. There are five aspects of transformational leadership that I require to be taken into concern for motivating the nurses. These aspects include identification and articulation of vision, acceptance of group objectives, anticipation of high performance, personalised support and logical stimulation (Zhang & et. al., 2011). By reviewing social identity model, I learned that leadership performance is vital in communicating relevant information to the individual team members. More specifically, it can be affirmed that transformational leadership, which is characterised by team supporting activities can improve individual team members’ emotional attachment and develop collective understanding by a considerable extent. Such understanding would certainly provide the team members with increased level of motivation and foster them to remain much committed towards making better cooperation (Rouzbahani & et. al., 2013). Therefore, in my case, use of transformational leadership can inspire the team members to prioritise the activities that are required to be performed during the critical transfer procedure. Based on my understanding, team member’s belief regarding their objectives is associated greatly with communication and conflict management. Conflict management is a win-lose situation, where one individual’s activity interfere with other’s behaviour, thereby complicating the entire operational process. In this context, it can be stated that cooperative activities are fostered by transformational leadership. Furthermore I would also like to mention that where team members possess mutual consideration they can effectively develop integrative solutions to any problem that they face during clinical procedure (Advancing Health in America, 2003). Being a leader, I also require focusing on attaining team objectives that probably entail supportive behaviours. As a consequence, whenever in future team members face disagreement on certain operational issues, they will be encouraged to consider and incorporate the opposing opinions of the team-mates and incorporate the most reliable choice to deal with a specific situation. It would be vital to mention that when a team is directed by transformational leadership, the identification of the potential team members assist in chasing their individual objectives without obstructing the ambition of entire team. Additionally, they become less motivated to follow a competitive approach while facing argument, as they will not be satisfied for conducting such activity. In such case, transformational leadership will permit them to discuss their desperate opinions directly and openly in order to make mutually favourable solutions (Zhang & et. al., 2011). In relation to the situation that I have faced, I would like to mention that for the nurses, team performance is an essential part of clinical practice. Nevertheless, in this circumstance, the key reason, which I identified for low self-confidence of employees in the cardiac care, was the shortage of workforce. It was the high level of conflicts that resulted in increased turnover of nurses in cardiac care. Thus, in order to ensure better service quality, there lays the need of retaining the nurses to the maximum level. One might assume that lack of interest is the cause of turnover in nursing profession, however, as per my opinion, most of the nurses love their work and believe that their activities can contribute significantly to the healthcare segment. Thus, there are other factors that might cause the nurses to leave the profession, making the turnover rate extremely high. According to my analysis, one of such factors can be the nurses might feel that they have made little contribution to the operation of clinical care and the second one is that nurses feel low level of control over the problems, which they face during any critical process. This feeling of subjection at times causes the nurses to visualise administrators, doctors and other team members as oppositions and therefore generate conflicts. Thus, it is my responsibility to understand the nature of conflicts and provide solutions about how to nurture appropriate conflict management approach. These will certainly help to retain the nurses and reduce the shortage of workforce by a certain extent (Elcock & Sharples, 2011). The way nurses try to resolve conflicts during the operational process not only disrupt the performance but also dishearten them, leading towards quitting jobs. As I stated earlier, conflict is inevitable in every organisation. Thus, what is vital in this case is not to avoid conflicts, but to seek solutions for mitigating such conflicts in a productive way. Specially mentioning, I learned that conflicts in any organisation can be solved through five ways namely withdrawal, force, appeasement, cooperation and confrontation (Kupperschmidt, 2006). However, relating to the current scenario, I would like to state that cooperation might be regarded as one of the appropriate conflict resolution strategies, which can help in dealing with the concern of workforce shortage. Apart from this, there also lays the requirement for increasing the awareness of nurses regarding the problems that they face, providing effective training to them concerning conflict resolution in more conductive manner and forming along with preserving stable relationship. Most significantly, nurses are also required to be trained about effective communication in order to foster trust and honesty in the profession (Ferguson, 1993). Basically, strong teamwork necessitates a supportive climate, which was missing in my case. Therefore, providing training to the nurses for better management of conflict and development of open communication can enhance work climate. Alternative Action In order to enhance the working environment and most importantly to minimise challenges faced by the nurses, it would be beneficial if I provide them education regarding how a team is developed and perform. I acknowledge that each nurse has their own way of performing duties. However, they also must be taught regarding how to perform as a better team member. Healthcare organisations are dramatically transforming the ways they operate in this present day context, because of the initiatives taken towards enhancing productivity and raising the quality of services delivered. Such initiatives are forcing healthcare organisations to halt the old rigid hierarchical system and move towards the formation of a team-oriented environment. Due to this particular reason, nurses are no longer performing on specific divisions as a usual subordinate role, rather they are finding themselves in new roles. Nurses are presently regarded as participating members of a multidisciplinary team who are liable for overall delivery of healthcare services (Hiemer, 2007). Therefore, it would be better if I prepare them for equipping themselves with better coordination and teamwork. I could have provided them simulation training, which is quite vital for nurse education particularly in emergency situations such as critical transfer of patient. This particular training program not only provides teaching regarding theoretical knowledge and practical procedures, but also enhances the abilities of nurses with respect to handling the patient with (ST) myocardial infraction effectively. It is anticipated that simulation training would permit proper clinical practice in critical situations that occur infrequently. In such critical situations, quick utilisation of skill and knowledge is essential. Thus, in order to make the nurses perform effectively in critical situations, I could also provide video oriented training, which might provide additional advantages in terms of making effective decisions delivering immediate decision-making. The central benefit of simulation method is that unlike actual crisis situation, a controlled situation can be established wherein multiple involvements can be used and associated. It would provide experimental opportunity to the nurses and therefore permit them to understand the importance of team performance. When critical transfer situation occurs, the action of first responder is essential. Furthermore, a coordinated, quick and effective exchange of information is also vital for smooth operation of clinical practices. In cardiac care, the first responders are the nurses and they often hesitate regarding the essential activities during transfer situation. In my case, it would be unwise to conclude that the nurses lack knowledge and skills to deal with critical transfer situations, rather I would like to state that the nurses failed to interpret their knowledge and skills in timely and effective manner. I could have also done better if I provide training to nurses regarding how a team is developed. The procedure of team building is of particular important for any healthcare organisation. It can determine the quality of performance of team members. From the experience gathered, I learned that high performance team is characterised by proper negotiation and leadership qualities. According to my observation, lack of leadership and weak teamwork has certainly resulted in poor outcomes in my team. Clear leadership is related with effective cooperation in team, or else the team performance will suffer. Thus, it can be affirmed that irrespective of adequate knowledge, the nurses were unable to make a successful attempt to deal with the clinical situation. In addition, there lays a requirement for better information sharing and low level of conflict in order to develop any successful team (Hunziker & et. al., 2011). Action Plan In order to improve the situation, I have organised a workshop for providing training to every employee by observing at his or her educational requirements, roles along with responsibilities and conflict management during work. In this context, it is worth mentioning that improvement in the work practices necessitate certain changes in the organisational culture. During the course, I learned lot about change management theories. For example, the change management theory presented by Kurt Lewin states that changes in clinical environment involve three particular phases namely unfreezing phase, moving phase and refreezing phase. In unfreezing phase, the requirement for change is identified and the procedure of creating attentiveness for change is started. In the moving phase, the requirement for change is acknowledged and applied. In the refreezing phase, the change is made permanent (Mitchell, 2013). On the other hand, Lippitt’s change theory is based on the role of change agent based on which effective changes can be implemented. According to Lippitt, changes in nursing environment involve seven particular phases such as analysis of the problem situation, evaluation for motivation for change, evaluation of change agent’s motivation, selection of progressive change matters, selection of change agent role, maintenance of change and dissolution of helping relationship. In this similar context, it can be stated that the first three phases correspond with unfreezing phase and the next two phases are related with moving phase and the last two phases are associated with freezing phase (Ziegler, 2005). Then again, according to Havelock’s change management theory, there are six phases of changes that can be related within nursing environment. These entail establishment of relationship, diagnosis of problem situation, collection of resources, selection of solution, accomplishment of approval for change and self-renewal (Swansburg & Swansburg, 1995). In my case, I planned to follow the change theory of Lippitt. I realised that establishing a strong team is crucial for developing a positive work environment. On the other hand, positive environment can only be created by changing the existing way of work and involving nurses in every critical activity. As a change agent, I would have various roles to play such as counsellor, facilitator and mediator. As a counsellor, I will attempt to change the attitudes and the behaviour of employees towards conducting more cooperative practices. As a facilitator, I will improve the operational procedures in order to allow people to proceed through change. On other hand, as a mediator, I will manage conflicts by observing every situation from different viewpoints. Basically, my role would be to nurture profitable interpersonal relationship and also encouraging the employees to perform together in order to solve real life problems and any sort of conflict (Royal College of Nursing, 2009). Another important aspect, which I have added on my action plan list, is developing a teaching session for nurses in which every kind of emergency scenario will be presented along with the options for addressing the problems. They will be trained about the suitable options to be adopted in emergency scenario along with the rationale for selecting such options. In such circumstance, key strengths of mine such as my motivational ability and decision-making capability will certainly prove to be quite helpful for promoting change in workplace. However, I require additional skills such as interpersonal and communication skills in order to enhance the work environment. To summarise my action plan, I decided to incorporate the aspect of staff training & support in order to develop team skills and perform constant professional development exercise for facilitating improvement in the workplace (Royal College of Nursing, 2009). Conclusion This reflective essay illustrates my experiences and practices during the practical scenario that I experienced in cardiac care. I have used the Gibbs reflective cycle as a framework for my reflection during the work experience. I have described the situation, my feelings and understanding in the reflective essay. Furthermore, I also came up with an action plan in order to improve the situation in future. Reflection is quite effective in self-development in the area of nursing. 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