Leadership and Management for Nursing Practice - Essay Example

Leadership and Management for Nursing Practice Rachna Jalan Leadership and Management for Nursing Practice Mental health is considered to be that important parameter which defines the wellbeing of not only one single individual but also the entire nation as a whole. The escalating needs of the mentally challenged being acutely diverse necessitate the rearing of change in the mental health service spectrum. Among the various changes that have been recommended in this specified area aiming to facilitate the release of best possible services for meeting the clients’ satisfaction, the primary care field has been identified as the predominant area of change which affects not just the mental health services but the entire health service system. A new model of primary care that has been introduced from the learning of Primary Care Strategy (A Vision For Change2006c) illustrates shared mental health model which aims the provision of all round services with the aid of amply developed resources through nicely integrated endeavours. This restructuring is positively stimulated with the needs of the clients in relation to mental health in Ireland which may be receipt of high quality profession by equitable accessibility to user friendly services, protection of their rights and dignity, receipt of community based services, their active participation, receipt of multidisciplinary services, adoption of recovery perspective, access to psychological therapies, etc (A Vision For Change 2006a). The principles of change management and leadership theories for strategising and implementing any reform should be practiced by setting clear and practical targets, overcoming fears and meeting the needs of the clients. For leading the change as a nurse, my efforts would be to provide out of hour services, to encourage psychological therapies, thereby complementing the change through up gradation of skill, hence providing diverse services for the overall rehabilitation of my clients. Observance of nursing service in mental health nursing practice Studies reveal that intellectually challenged persons may suffer from mental health problems too. Due to their susceptibility to adapt to the changes in their environments, patients of this category need to be handled with special care and attention. They deserve an intuitive and respectful service to emancipate from their infirmities. However, the services for catering to the needs are too meagre to meet their requirements. The guidelines laid down for their treatment are the same for the conduct in all other fields of mental health. Though recent discoveries have revealed a positive response in regards to the improvement of this service sector, the mental health service providers are still lagging behind in terms of pace for meeting the requests of this ultra sensitive group of patients. The intellectually disturbed patients are predominantly looked upon by voluntary sectors and agencies which do not belong to the government. The execution of agreements for providing psychiatric services is the result of negotiations between these voluntary groups and HSE (A Vision For Change 2006d). As these agencies are not substantially funded, they fail to provide quality services particularly in the catchment areas. Majority of these voluntary groups do not comprise of multidisciplinary team, and even in places where they do have MHID teams, they fail to operate on the specialist needs of the intellectually deficient service seekers. Staffing Profile Details A well-serving mental health agency requires the designing of exceptionally talented team of MHID which comprises of professionals with unfathomable skills and expertise. This high level of proficiency accompanied with practical experiences goes all the way for performing all round activities. The mental health professionals are expected to deliver sensitive and affectionate services to this vulnerable class of patients. The following staffing profile has been recommended by the new document of A Vision For Change (2006h): One consultant psychiatrist One doctor in training Two psychologists Two clinical nurse specialists (CNS) and registered nurses with specialist training Two social workers One occupational therapist Administration support staff Service Recipients and Service Remit Details The service recipients in the mental health field that encompass all ages from children and adolescents to adults rely on the remittance of flexible and congenial services for the recovery of the mental health sufferers. Community-based service is the principle code for meeting the needs of mental deficiencies. For children and adolescents suffering from mental health domiciliary, day hospital and outpatient setting is recommended, whereas for meeting the needs of mentally weak adults, inpatient, outpatient, day hospital handling is well thought-out. Rehabilitation beds and respite arrangements are encouraged to foster a continuous flow of quality services to this sector. ‘Intensification of Primary Care’: A change in mental health nursing practice responsive to client need and service demand and consistent with the goals of the health strategy Quality and Fairness (2001) Several amendments have been recommended in the mental health service spectrum to facilitate the release of best possible treatments for meeting the clients’ satisfaction. The ‘Primary Care’ field has been identified as the predominant area of change which affects not just the mental health services but goes on to meet the four goals of Health Strategy proposed by Quality and Fairness (2001a) which are as follows : 1. Better health for everyone which highlights health centred public policy by improving overall health and elimination of health inequalities by aiming premium quality of life. 2. Fair access which requires clear definition of eligibility criteria of service providers which needs to be expanded to assure equitable accessibility for all types of clients. 3. Responsive and appropriate care delivery which ensures patient centred services to provide suitable services and care at the suitable time and settings. 4. High performance which aims consistent quality system supported with evidences. The primary care provides a comprehensive series of facilities ranging from allocation of problem, diagnosis, screening, testing, rehabilitation and numerous other valuable services which are targeted for the over-all well-being of the patient. Primary care level is the initial stage in which the problem of the patient is first addressed in the mental health field. Almost 90% of the problems in mental health service offers are solved in the primary care level only without the need to seek aid from the specialists. Due to this degree of enormity of services, important amendments have been advocated in the document Primary Care: A New Direction which can be studied as follows: (Quality and Fairness 2001b) Formation of inter-disciplinary primary care team The new model proposes to create a primary care team which comprises of experts from all disciplines of health services to ensure improved and prompt services for the needy. The primary care team thus consists of general practitioners (GPs), nurses, midwives, physiotherapists, home assistants, social workers and many more who will serve a small population of about 3,000 to 7,000. This will serve up the achievement of goal no.1 of the strategy which aims improvement of health. Formation of primary network An extensive range of professionals from primary care level of other fields of health services has been intended to facilitate the remittance of diverse skills and expertise, thereby setting up a multipurpose service network to meet any need of the client, hence attaining goal no.2 of the strategy which stresses on providing services to all types of patients and their diverse needs. This network consists of psychiatrists, community palmists, dieticians, dentists, speech and language therapists, and many more. This reform responds to the needs of the service users in receipt of a variety of services from a properly integrated multidisciplinary team. It goes to compliment the implementation of the Health Strategy which proposes introduction of integrated work-force strategy on a national basis. Registration with GP All the mental health service seekers including those who are in long-stay wards are appealed to register themselves with the primary care team or GP for acknowledging superior grade of care and services. Merging of primary care and specialist mental health services Primary care services should be merged with specialist mental health services which aids in providing a lot of amenities like straight-cut contact with diagnostic centres, formulation of discharge plans, referral procedures and much more. Developing coordinated primary care Emphasis has been given on the improvement of coordinated primary care so that the clients can be offered 24-hour service. The commitment of the GPs to provide out-hour services has been encouraged. This will go on to meeting the goal no.3 which speaks of suitable dispatch of services at apt time and setting. Tie-up with CMHT for suggestions and negotiations Exchange of thoughts should take place between primary care and community based mental health teams by creating a formal link between them. Both should consult each other regarding any procedure and policy, like the scheming of discharge policy. This should be made possible through easy communication and interaction between the two. Following a uniform system based on evidences highlight goal no.4 of the strategy. Conducting programs for supplying appropriate training to staff Various programs for providing the staff with skills and expertise which trains them how to provide service in case of crisis, how to prevent problems, how to rehabilitate, and so on, have been proposed to be designed frequently. The Progress Report of the National Primary Care Steering Group has highlighted a number of actions to compliment these efforts (A Vision for Change 2006e). Reviewing the educational and training skills of GPs The educational and training qualifications of the GPs should be assessed carefully to ensure the best possible knowledge through which they are expected to serve. This will aid the accomplishment of goal no.2 of the strategy which proposes clearly defined eligibility framework. The ICGP is preparing an innovative curriculum for imparting training skills to the GPs and ensuring out-of-hour services in consequence to the SWAHB study in which 70% of GPs expressed training needs (A Vision for Change 2006f). Offering various incentives schemes Incentives should be provided for the GPs so that they can be encouraged to participate actively for the eradication of the problems that arise in the primary care services. Provision of one particular centre of contact by local CMHT For offering valuable advice and suggestions in case of emergency, the local community based mental health teams should address only one particular centre of contact for the primary care division so that the latter can provide optimum service. The importance of local community based services will meet the interests of the service consumer by providing them service in close proximity to where they live. Updating infrastructural facilities Improvements in the fields of communication and information technologies have been proposed for the prompt and convenient delivery of quality services. The new infrastructure requirement base for mental health of intellectual disability CMHT has been estimated to be 26 units (A Vision for Change 2006k) Respond of the change with service user’s needs complimenting the implementation of the health strategy Quality and Fairness (2001) We have identified the strengthening of the primary care field as a transformation in the delivery of mental health services which goes on to respond to the requirements of the service users. The new policy and objectives for mental health services for meeting the needs of the service users proposes integration of specialized mental health concerns with primary care. In short, the system calls for best practice, evidence based treatment involvement and services in an integrated way through community based multidisciplinary teams. For the execution of the Mental Health Act, 2001 the Mental Health Commission was proposed to be established by the end of 2001. To facilitate added rejuvenation of the mental health services a national policy framework renewing Planning for the Future (Quality and Fairness 2001e) has been prepared. A framework of the service user’s needs which stimulates this amendment is as follows: Active participation of the service users in the chart for his well-being and recovery as well as in the decision making and offering plans for the promotion of mental health. For uplifting the awareness for mental health field of services implementation is being carried out by establishing regional advisory panels or coordinating committees comprising of both client and server in all health board areas. Protection of civil and human rights and maintenance of dignity and respect for clients. Support services of autonomous clients will be motivated and aided. Community based services for facilitating treatment in the local areas of service users. Dependence on psychological and social therapies rather than merely medication. Investment schemes have been prepared in acute psychiatric units for enhancement of services, thereby facilitating the execution of the health strategy which aims better health for everyone. Programs for the prevention of suicide will also be implemented. Allocation of properly defined funds which supports the execution of the strategy too. Receipt of high standard services. For enhancing positive looks towards mental health service field programs are being executed. Equitable accessibility to user friendly services as needed by the clients. Consideration of other aspects of life such as housing, employment, education, etc. Development of community services such as family support, day hostels, home nursing. Provision of funds in these areas has been declared for implementing the strategy. Filling up the gaps in services for specific groups with mental health problems like children and adolescents, older persons, homeless people, persons with eating disorders. The suggestions of the First Report of the Review Group on Child and Adolescents Psychiatric Services are proposed to be implemented and for understanding the requirements of children aged between sixteen and eighteen Review Group on Child and Adolescents Psychiatric Services is being reviewed. This Review Group on Child and Adolescents Psychiatric Services is supposed to prepare reports on people with eating disorders. Further development of services for older people and those who can be assisted from alcohol treatment programs is being carried out. Proposed change supported with further evidences, research backing and examples In the Primary Care Strategy the model for shared mental health care has been proposed (A Vision for Change 2006g). In 1981, a research work was carried on for evaluating the progress of psychiatric services which did not reveal a standard performance (A Vision for Change 2006b). The World Health Organization has taken up improvement in the mental health field and well being of the people as crucial sector of consideration and the World Health Reports 2001 and 2002 were full devoted to the topic (A Vision for Change 2006i). According to WHO 33.4 million people in European Regions are victims of depression (A Vision for Change 2006j). Due to the implementation of the Health Strategy, the somewhat meeting of the client’s satisfaction by way of receiving out-of-hour services can be cited as an example of this change. Implementation of the change in mental health area in accordance to change management and leadership theories For enabling any transformation to take place, a competent manager is expected to discharge his change management and leadership skills. The five fundamental principles supporting such theories are: (Change Management) 1. Different individuals show diverse reactions to change The scale of change represents stability at one end while change at the other. Persons who dislike transformation stand on the stability side and those who are inclined towards modification are placed on the change side. Matter of concern arises when their places are interchanged. The consequences are off-putting mind-set for the change loving people, discontent, resistance, tension and inability to think logically. 2. Individuals exhibiting basic requirements that should be met Individuals have three elementary needs to be met i.e. needs to control, add and reveal, the omission of which will result in failure in the implementation of change. Hence, the need to have control over the change in the environment, to have inclusion in the change process and to have exposure of information by the managers or leaders should be met to overcome all resistances. 3. Defining of hopes at practical level It is very important to specify only those expectations which can be practically met. The over- stating of expectations without a realistic confirmation of achievement will only misguide the individuals resulting in opposition and failure. 4. Overcoming fears With the thought of implementation of any change, people often tend to think illogically considering the consequences of the change to be negative. Such fears and pessimistic assumptions should be eradicated from people’s mind by drawing them towards a positive outlook for change. 5. Experiencing the “loss curve” Individuals may face loss due to a change. The extent of this loss can be understood by the “loss curve” which depends upon aspects like the initial stage where the change is not felt, the realization phase when the curve goes deeper and the tuning-up phase which requires adjustment with the implemented change. With the adoption of these theories the implementation process for bringing change in the mental health area has become much simpler. The execution process for primary care includes: (Quality and Fairness 2001c) Implementation of new model of primary care will be done on a phased basis over two to ten years, the details of which have been provided in Primary Care: A New Direction. This document is circulated among the stakeholders who follow the principles for proceeding by conducting regular discussions with each other. Establishment of National Primary Care Task Force is done which comprises of a small group of full-time task force, Steering Group, Department of Health and Children and representation from stakeholders, unions, GPs, nurses and other primary care service providers. The task force is responsible for implementing the new model of primary care as per the guidelines of the strategy, scheming out the fund requirement, staff requirement, and community and information technological requirements, making way for expansion of GP co-operatives on a national basis along with defining the remittance schemes and operational methods and allocating areas for executing projects. The steering group is responsible for setting a wider network of primary care professionals, synchronizing the progresses of the change, submission of strategy recommendations to the Department of Health and Children, health boards and others, allocation areas for setting up of educational centres of primary care as a key source for providing various procedures, developing scopes for integration with secondary care spectrum on a national basis and assessing growth along with preparing annual report as per the specified action marker. Execution of implementation projects A target of developing 40-60 primary care teams on a national basis over the next two to four years has been set. Allocation of areas for implementing the projects in each sector of mental health board is proposed. Areas exhibiting fine tuning up of primary care and mental health services will be given first preference. Evaluation of these executed projects will provide data which will go on to strengthen the primary care teams in other parts of the country. Funding for expansion of GP cooperatives and other schemes For provision of valuable out-of-hour services throughout the nation GP cooperatives are being promoted nationally. In addition, schemes are being carried out for accumulating further personnel, up-to-date equipments, infrastructural facilities, communication and I.T. The uses of leadership theories go a long way in facilitating the intensification of primary care services. The Transformational Leadership Theory, in this context needs to be mentioned (Leadership Theories). The leaders for bringing in change among the staff make them conscious by giving substance to their high-quality acts; make them identify their needs for improvement and progress along with encouraging them to toil for the overall target of the organization rather than to work merely for their individual targets. In reference to these theories, the executors of the new model of primary care are the daring leaders who should act as changing agents and be competent to accept challenges. They (steering groups) should guide and motivate their subordinates (task force) to implement the change (new model of primary care) to meet the desired targets i.e. provision of high quality mental health services. The ways by which the implementation problems can be overcome may be guided by the principles of changed management and leadership theories which are as follows: (Change Management) By providing appropriate information to the individuals and not setting impractical targets. By offering choices and being frank with the consequences. By eradicating fear of loss by providing something to substitute the loss. By offering opportunities to individuals to exhibit their worries and advices. By regulating superior organization observance. By analyzing and guiding people to cope up with their “loss curve”. Personal endeavours to lead the implemented change As a leader in context to strengthening the primary care spectrum, my target would be to ensure provision of high quality mental health services to meet the needs of all clients’ demands no matter how diverse their problems are. I would like to provide persistent stress on out of hour services are delivered to the clients anytime even in the case of acute emergency or crises. The GPs and other professionals of primary care services should be made aware of what importance do their services bear for the patients in needs. The dealing of theses professionals with intellectually disabled persons should be extremely sensitive at the same time tactful to ensure love and self respect for these clients. My recommendation for treating intellectually disabled clients would chiefly be the application of various psychological therapies that have been introduced in the new model of primary care rather than the over-dependence on medication. Being economical and clinically effective the cognitive behaviour therapy and the interpersonal therapies should be practiced. Being a leader my aim should be to ensure overall well being of all my clients by coordinating all endeavours by way of conspicuously coaching my personnel and lucratively applying all other available resources. From all the above explanations we draw a conclusion that the diverse needs of the clients have necessitated an urgent introduction of change in the mental health spectrum followed by the formulation of the Health Strategy in Quality and Fairness 2001. Primary care, being the prime gamut of mental health service provision befalls to be our target area to apply the framework of change. Primary Care: A New Direction is the document for providing detailed information about the new model of primary care. The main essence of this change lies in strengthening of the primary care in the mental health area through primary care teams and networks by interdisciplinary services, multidisciplinary services, alliance with CMHTs, development of all resources like human, capital, communication, technological, etc to ensure the dispatch of the very best possible services to meet the needs of clients of all age groups. For the implementation of this change the Health Strategy has specified the appointment of full-time work-forces leaded by the steering group and representatives from each group of professionals of primary sector. The execution process has already begun with the target of achieving a target of 400-600 teams by covering up almost two-thirds of the population by 2011(Quality and Fairness 2001d). The use of change leadership theories guides the executors to handle the transformation as changing agents by setting up realistic targets in front of people and enabling them to come out of their fears of this change. The indomitable spirits and glaring efforts of the change executors as well as the service providers to ensure high quality services determines the emancipation of this vulnerable sector of the society. References Department of Health and Children (2003-2005a). Report of the Expert Group on Mental Health Policy: A Vision For Change (2006). 9. Retrieved March 29, 2006, from http://www.dohc.ie/publications/pdf/vision_for_change.pdf?direct=1 Department of Health and Children (2003-2005b). Report of the Expert Group on Mental Health Policy: A Vision For Change (2006).ch 6. 54. Retrieved March 29, 2006, from http://www.dohc.ie/publications/pdf/vision_for_change.pdf?direct=1 Department of Health and Children (2003-2005c). 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