Identification of an Incident Where I Was Required to Take a Leadership Role in the Nursing Area - Case Study Example

Reflective Leadership Report of Your Full of Contents Overview of Issues 3 Identification of Key Factors 4 Analysisof Feelings and Factors 5 Analysis of Professional/Contextual Factors Influencing Practice 6 Synthesis 8 Evaluation 10 Significance of self-awareness in nursing 11 Recommendations 11 References 13 Overview of Issues Acute Renal Failure (ARF) is an abrupt seizure of kidney function which leads to the retention of urea and other toxic bodily waste in the body (Lifton, Somlo, Giebisch, & Seldin, 2010). In most cases, ARF is a procedural situation and it comes with continuous deterioration of the ability of the liver’s renal function and this causes some metabolic disorders that are problematic to the patient (OConnell Smeltzer, Bare, Hinkle, & Cheeve, 2013). There is a mortality rate of 50% of patients who suffer ARF and an 85% death rate for those who suffer complicated versions of the disease (Thomas, 2014). However, depending on the nursing care and the quality of treatment, some patients are able to get regain their normal kidney function and get a normal life (Thomas, 2014). The main approaches to renal treatment include a family-centred approach that provides physical and emotional support to the patient throughout the corrective process (Thomas, 2014). What has become known as Renal Nursing refers to a specialised approach towards the monitoring of patient’s emotional and physical situation, participation in therapy and renal replacement (OConnell Smeltzer, Bare, Hinkle, & Cheeve, 2013; Lifton, Somlo, Giebisch, & Seldin, 2010; Thomas, 2014). Mr. JW is a 57-year old patient who holds an executive position in his field of work. He has a sedentary lifestyle and has a major drinking and smoking habit that has been part of him since his teenage years. He was diagnosed of potential kidney problems recently due to the deterioration of his kidney functions. However, he was warned to maintain temperance in his smoking and drinking habits over 20 years ago. He claims that he has tried his best but there are times he goes through stress and drinks and smokes excessively. Recently, he was rushed to the hospital with ARF symptoms. The ambulance got to the hospital at a time when there were few medical doctors available and our team was somewhat confused and was unsure of what to do. There was also a language barrier with the only person who could provide useful information. Mr. JW divorced his wife of 22 years seven years ago (Mrs JW X). He is now married to a young Brazilian woman (Mrs. JW Brazil) with whom he has two children aged 5 and 3. He had two other children from his previous marriage, but they are older and are both successful professionals living independently. Mrs JW Brazil has a limited ability to speak English since she speaks Portuguese with Mr JW all the time. There were issues with emergency activities at a time when all doctors were busy and the only available doctors were on their way after being called in a particularly hectic week. Also, the inability to take details from Mrs JW Brazil was problematic. Mrs. JW X who had detailed information about her ex-husband’s condition was also unavailable. There were issues with log-in protocols to access relevant information of Mr. JW to provide immediate assistance. Therefore, leadership competencies and organisational matters had to be carried out by the team immediately. Identification of Key Factors Creatinine, the metabolic waste product excreted by the kidneys filters the waste products and prepares them for excretion. When the kidney fails, there is no creatinine secreted by the kidney. The body’s wastes are pumped onward to the other bodily functions of the patient and this includes toxic as well as appropriate bodily nutrients. Therefore, there were toxins introduced to the body of the patient in an inappropriate manner. In a situation of this nature the fundamental obligation was to ensure that the condition of the patient is known (Parker, 2009). And once that is deduced, there is the need for an immediate stabilisation of the patient and the introduction of an optimal dosage of trimethoprim and cimetidine to inhibit onward movement of waste into the body and enhance serum creatinine levels to help the patient’s toxic waste move towards the excretion tubes. However, in this situation, Mr. JW’s situation was not known and there were few experts to do the deduction. Most of my colleagues were arguing that we should just take bodily functions and wait. I knew the patient was going to die if we do so. Therefore, I told everyone to calm down and 1. Get part of the team to ensure that a doctor comes to Mr JW’s aid as soon as possible; 2. Acquire Mr. JW’s medical history immediately; 3. Communicate with Mrs JW Brazil as soon as we can and 4. Get information from Mrs JW X and 5. Figure out an appropriate medical procedure in the case This was to be done in no more than 10 minutes because the medical situation looked dire and dangerous. I therefore had to move in and institute a contingency leadership system at that time (Wanxian, Xinmei, & Weiwu, 2008). This is where I defined myself as a leader and this was where my self-awareness begun. Self-awareness is defined by Peck as a stage where a person values stakeholders around him or her and work to achieve the most relevant goals with the people around (2014). I therefore put my personal desires on halt and desired to achieve higher and ultimate goals as a leader to ensure that our patient lived (Chen, Chun-Hsi, & CHun, 2013). Analysis of Feelings and Factors The main process in this case was that my colleagues feared that they could make a mistake and cause complications for Mr. JW. Of course, in medical ethics, it was illegal and wrong for a medical professional of any level to introduce any kind of care when the result would be worse than that of the previous situation of the patient. Our qualifications were on the line if we skipped channels and introduced anything that was inappropriate to the patient. Some of my colleagues were asking that we just stand aside and wait for a doctor to come. However, I knew it might be too late. And we had an obligation to protect this man. His wife was in some kind of a shock and it appeared that she had nothing more than Mr. JW. She was sobbing and could not communicate with us in English. Therefore, there was the need to do something and we had to do it quickly. I thought of taking action in a preliminary manner to ensure that we turn our evidence in, the moment a doctor appeared. This would get him to act quickly on the right pointers without issues. Analysis of Professional/Contextual Factors Influencing Practice The actual cause of kidney failure is not known, however, most authorities postulate that it is due to “dysregulated fibrosis, drug toxicity or progressive “chronic allograft nephropathy”” (Sellarés, et al., 2011). This means that there is some kind of inability of the kidney to sort out waste or toxic materials from foods and drinks consumed by a patient. And this situation occurs in ways where they get out of hand and there is ARF reported in the most extreme form and manner. Data of patient can show important trends and processes in the growth of the situation (Tangri, et al., 2011). It might start in a minor form that the patient might not notice. And then get to an extreme one day when the patient has to be rushed to the hospital. However, in other cases, there might be some warning signs that the patient might fail to heed which might lead to a major situation like the case of Mr. JW. Studies indicate that the risk is far higher for older patients on treatment than younger patients (Hemmelgarn, James, Manns, O’Hare, & Muntne, 2012). Therefore, Mr. JW with his age and situation falls into the category of high-risk patients and individuals. This was something that I knew as an individual and most of the details about Kidney Failure were known to me since I had known people who had suffered it personally. Consistency of treatment and disease management is important, any breakages can be fatal and problematic (Da Silva-Gane, et al., 2012). This was exactly the situation relating to Mr. JW. This is because he had been previously diagnosed and was going through some form of treatment. And the implication was that he might have stopped taking it or fallen into a pattern of lifestyles that was against the ARF management plan he was put onto. In emergency cases, relief of obstruction is key and vital to ensure kidney function can be commenced (Fry & Farrington, 2009). This is because where treatment is not carried out and emergency relief services and procedures are not carried out on the patient, there is a risk that the patient might lose his life. Emergency procedures require the prevention of iatrogenic injury and the provision of nutrients to help the patient to recoup losses and avoid the spill of toxic waste into the body (Sinert & OConnor, 2013). Oxygen and IV access with IV fluids (Weisberg, 2008) as well as constant monitoring of changes in blood pressure and breathing patterns (Mitchell & Brady, 2012). The major signs of kidney failure include muscular pain and discoloured urine as well as nausea and the inability to move. This had occurred to Mr JW in his home in the presence of his wife, Mrs. JW Brazil. She was terrified and shocked and had called the ambulance. Mr. JW collapsed after having a hectic day and was rushed to the hospital. At the hospital, there was no doctor to diagnose it on sight. The paramedic team was inexperienced and could only provide basic relief services. This put the onus on our team of nurses to provide immediate relieve services or lay the foundations. The wife of Mr. JW could not provide any meaningful background, because she was stressed and had limited command over the English language. Hence, she had to be reassured and put in a shape and form where she could make meaningful contributions to the situation at hand. Finally, and more complicating was the lack of access to Mr. JW’s medical history since members of the team were not in the position to do so. Therefore, a remedial plan had to be put together to go around the situation and find out the best way of dealing with the matter and all we had as a group of 5 nurses was 10 minutes. And outside that 10 minutes, it was most likely that we would lose Mr. JW. Synthesis The situation was daunting. It was due to the fact that we were all aware that we stood a risk of losing our jobs if we made the wrong choices. So someone had to stand in and move the group within this situation and take initiatives and gather synergy for the entire group. Codes bound professions like nursing had ethics and failure to observe these ethics could lead to revocation of license when there are serious breaches (Urden, Stacy, & Lough, 2012). This meant we had to be careful and balance a lot of things in this ethical dilemma. However, there was the need for someone to lead and put everything in the right perspective for the achievement of the best results. We had all encountered sections of our studies that showed that strict ethical rules can be relaxed when there are major disasters where we failed to take action (Tirkkonen, Olkkola, Tenhunen, & Hoppu, 2015). Therefore, in this case, monitoring the situation was the main obligation we had in our level of practice and within the strict letter of the rules (Alspach, 2013). On the other hand, we also knew and jointly realised that doing nothing was worse than adhering to the strict letter of the rules. Engagement of staff members is important and vital and promotes emergency procedures (Sawatzky & Enns, 2012) Therefore, being a person with in-depth knowledge in kidney failures and knew how it occurred, I had the expert power to split members of group into teams. I dispatched one member of the team to get a doctor. I got another member of the team to get someone from the IT unit to allow emergency access to Mr. JW’s file to enable us to understand his condition and prepare to help him. Two other members of the team provided emergency processes to ease Mr. JW’s situation and also guide the paramedics on how to move around and deal with things and get him settled. I had a basic understanding of Spanish and some Portuguese. However, I do not consider myself anywhere near fluent. New technology is permitted to ease life loss and dangerous situations like these (Holden, 2011). And due to the fact that I had access to technology, I had to make the best of a translation software on my phone. I approached Mrs. JW Brazil and first entered details in English asking her to calm down and relaxed. It was quickly translated to her in Portuguese and I asked her what had happened to Mr. JW. She explained that he had just fallen off and in the process, he had soiled himself. This came with urine of a different colour that he was not used to. Then she explained that he could not breathe. These were classical symptoms of kidney failure. In therefore asked if he had any complications in the past. She mentioned his ARF management plans and also mentioned heart failure and other complications. This gave me the basis to order the two nurses who took Mr. JW to the hospital bed to prepare for oxygen and IV fluids to be prepared for Mr. JW. I ordered the third member of the team who was back with the IT professional on duty to prepare medication for obstruction of toxic substances from the liver and ensure wastes were cleared. This was in a simple form that most junior nurses of that category could do. The IT professional gave me access to Mr. JW’s medical history and I could deduce the main form of Kidney Failure he might have. The next step was to enquire through the translation software what Mrs. JW Brazil knew about his lifestyle at the current period and what major changes had occurred. She gave me information that suggested he had not stuck to his ARF management plan. As the medication was being prepared, Mrs. JW X came and asked about Mr JW with their old child. Mrs JW X was very helpful and I asked her about Mr JW’s medical history. She told me a lot that could enable me to deduce the kind of condition he had and I added some instructions to the preparation of the preliminary medication. In 7 minutes, a specialist came and I briefed him orally for 30 seconds. He checked Mr JW in another 30 seconds and told me my diagnosis was perfect. He administered the medication and Mr. JW’s conditions were stabilised. He told me I had done the right things and the leadership techniques and skills I put together were necessary to achieve the right goals and ends that saved Mr. JW’s life. He said if I had delayed by 3 more minutes, we could have lost him. Evaluation Leadership is necessary and essential for successful treatment of situations in Advanced Nursing. Nurses might be barred from carrying out certain activities in their own right, but in cases where there are no options, leadership and the consolidation of effort of the team can lead to the best results (Clements, Curtis, Horvat, & Shaban, 2015) Leadership is not always conferred by the rules of the medical facility. Sometimes, it might come as a result of contingent situations and measures that put one person in a given position (Ford & Mazzafero, 2012). I was not the senior-most nurse on duty that day. However, due to my knowledge of kidney failure and my ability to organise the situation, I was able to put things in order on the eventful day. This means that contingency is a more practical approach to leadership. However, for more stable results, there is the need to consider a regular authoritative leadership approach to situations (Lin, MacLennan, Hunt, & Cox, 2015). Significance of self-awareness in nursing Self-awareness is the most important and most fundamental aspect of nursing practice (Wong, Cummings, & Ducharme, 2013). This is because a nurse will have to understand her position in the entire process or event. This will get him to understand her obligations and position herself for the attainment of the right results Another pointer is that risks are part of ethical dilemmas. In situations where a nurse is faced with a dangerous situation, there might be no other options and in such contexts and cases, there is the need for a nurse to take risks and this comes with the choice of doing things that might not be within the scope of a person. However, in situations where there are risks, there is the need for compensating events to be conducted by a nursing professional. This is because taking decisions that are not within the ethical scope might have consequences. And when that happens, there will be the need to show evidence that the nurse acted in good faith. Therefore, in this case, I became a leader and I went great lengths to ensure that I had all the evidence and had gathered all information that was humanly possible to come up with the best decisions. Recommendations Decisions of an ethical nature have to be made in a careful and considered manner to avoid negative consequences and also provide evidence of good faith in situations where the letter of the rules are not followed. This calls for some leadership abilities and competencies of at least one of the people present at the situation. There is the need for all efforts to be made to achieve the right thing. When all this is done and no results are achieved, a leader can collectively make choices that might not be within the rules. And this might be logical and impending. References Alspach, J. G. (2013). Core Curriculum for Critical Care Nursing. London: Elsevier. 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