PeerS Responses

  1. Explore the national initiatives and determine if these approaches have meaning within your community and can offer a positive solution to some of the healthcare issues facing your community.
    1. In Homestead, Florida, diabetes, frequent mental distress, and obesity are the three healthcare issues affecting the community. On a national scale, these are some of the same diseases disturbing health outcomes. The National Diabetes Prevention Program is one of the initiatives to reduce diabetes mellitus incidence and improve quality of life. This program has been implemented by the Center for Disease Control and Prevention to partner with healthcare providers to provide tools and educational resources for patients (“National Diabetes Prevention Program | Diabetes | CDC,” 2021). For frequent mental distress, the National Institute of Health created a National Institute of Mental Health. On the website of this Institute, patients can access valuable information, education, and recommendations to provide a positive view of their disorders (“NIMH » Education and Awareness,” 2021). One of the goals of healthy people 2030 is to reduce the overweight and obesity statistics, help people eat healthily, and increase their activity levels. In the obstetrics world, the goal is to increase the number of women with a healthy pre-pregnancy weight; this goal is getting worse (“Increase the proportion of women who had a healthy weight before pregnancy — MICH‑13 – Healthy People 2030 | health.gov”, 2021). Finding initiatives to improve patient outcomes is not tricky, but finding the time and reimbursement to educate patients is challenging. Value-based healthcare should be the goal for private insurance and federal programs like Medicaid and medicare.
      2. Discuss which strategies you would use to engage your local policymaker in discussing these national initiatives to advocate for change. Remember the excellent resources to determine national healthcare goals are at the NIH or Healthy People 2020 websites.
      After creating this partnership, I will invite this legislator to health fairs and events to support our patients. I will request an interview with the legislator and summarize the benefit of implementing these programs in our communities. I will gather all available information to demonstrate the need of citizens in our area for this initiative. I would offer my constitutional support and contribute to post their picture on my private practice website as a supporter for the health of our community.
      3. Compose a Tweet that describes how the Global Burden of Disease is impacting your community. Remember to be concise, as Twitter only allows 140 characters. Share your Tweet in the discussions.
      Mental Health, Obesity, and Diabetes are all affecting our communities at levels above the rest of the nation. Please join the city mayor Steve Losner and me this Saturday at 9 am at Losner Park to receive more information on these diseases and how you can be prevented or improve it #healthyhomestead.
      4.  Finally, what are your thoughts on how Dr. Riley did with Congressman Aiken? What did she do correctly, and what could she have improved? As you consider your initial meeting with a Congressman, would you have prepared additional information or in a different way? Share your thoughts and perspectives.
      Dr. Riley was assertive and concise. She addressed her concerns without hesitancy and portraited herself with confidence. The congressman was impressed by Dr. Riley’s knowledge. Too much pressure in an initial meeting could cause the congressman to feel uncomfortable and refuse to see Dr. Riley again.

      -Danay Sosa

      References
      Increase the proportion of women who had a healthy weight before pregnancy — MICH‑13 – Healthy People 2030 | health.gov. (2021). Retrieved 13 October 2021, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-proportion-women-who-had-healthy-weight-pregnancy-mich-13
      National Diabetes Prevention Program | Diabetes | CDC. (2021). Retrieved 13 October 2021, from https://www.cdc.gov/diabetes/prevention/index.html#:~:text=The%20National%20Diabetes%20Prevention%20Program,risk%20of%20type%202%20diabetes.
      NIMH » Education and Awareness. (2021). Retrieved 13 October 2021, from https://www.nimh.nih.gov/get-involved/education-awareness ReplyReply to Comment

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Introduction

Leadership consists of
various qualities, skills and aspects relating to the action of leading an
organization or a group of individuals (Ennis et al, 2013). The focal point of
the NHS is to enable cultures that provide safe, compassionate and high-quality
care (West et al, 2015). Furthermore, leadership has an impact on a number of
different aspects such as mortality levels, patient satisfaction, staff
well-being, financial performance and generally, the quality of care (West et
al, 2015). The Francis report discussed the importance of distributed
leadership, whereby all healthcare professionals are enabled to think freely,
make decisions and take control themselves. It leads to the provision of
high-quality care (Francis, 2013). This piece of work will assess effective
leadership and why it is a necessity within nursing practice.

Communication

Ennis et al (2013) implemented
a study in order to assess the communication characteristics needed for good
leadership within nursing. Interviews were carried out, outlining how effective
communication is key in order to provide high quality care, develop as a
professional and to harbor working relationships (Ennis et al, 2013). The study
produced the following themes: choice of language, listening skills, relevance,
non-verbal communication and relationships. Participants outlined that good
leaders have the knowledge to choose the type of language used and can adapt it
to any scenario that they are faced with. In addition, they suggest that an
effective leader considers the outcome and consequence of each conversation
(for example, whether further support was needed) (Ennis et al, 2013). When
leadership is successful, it enables excellence and ethical and
patient-centered care (Ennis et al, 2013).

Furthermore, it was
noted that good leaders needed to be able to listen, be affable and have
patience (Ennis et al, 2013). One participant outlined that listening should be
first and foremost, valuing its importance and showing great interest in what
the patient has to say (Ennis et al, 2013). Respondents noted the need for
effective communication across all aspects of nursing; with junior staff,
between healthcare professions and when directly caring (Ennis et al, 2013).
Good clinical leaders need to be able to communicate to a high level, adapting
to enable all patients to understand, noting body language, non-verbal cues and
avoiding medically complex terms as much as possible (Ennis et al, 2013). The
study notes the link between effective communication and the amount of
influence that leader has, the team’s performance and their development of
staff member relations (Ennis et al, 2013). Guidelines by NICE also emphasize
the importance of effective communication to enable high quality care (NICE,
2016). Non-verbal communication is also key; effective leaders need to note
their body language and level of eye contact, assessing not only their own
non-verbal cues, but also those of the patient or fellow professional (Ennis et
al, 2013). This will enable them to judge the scenario and to foresee any
issues that may arise (Ennis et al, 2013). Within the study by Ennis et al,
(2013) respondents outlined that good leaders had excellent people skills,
building a good rapport with everyone. To do so, respect and treating each
person as an individual is key (Ennis et al, 2013). It is also vital to ensure
that no judgements are made and that support is offered when needed (Ennis et
al, 2013). Effective leaderships can only be implemented when these areas are
adhered to, building work relationships and providing high quality,
patient-centered care (Ennis et al, 2013).

Emotional intellect

Emotional intellect is
a key aspect to adhere to when managing situations and caring for patients
(Powell et al, 2015). Controlling emotions and self-awareness are both vital
components of emotional intellect (Powell et al, 2015). Doing so decreases the
risk of burnout and ensures that patients are receiving high quality care
(Powell et al, 2015). In addition, being aware of one’s emotions enables a
collaboration that is needed to meet the needs of individuals within the
complex and increasingly technical NHS system (Powell et al, 2015).

The qualities of a leader

The main traits of a
good leader were assessed by Yukl (2013). They consist of a high level of
energy, stress coping mechanisms, confidence, control, maturity, integrity, as
well as being a high achiever, with low needs for affiliation. Nursing leaders
need to be empowering, promote independence, encourage a critical and effective
work environment and remain positive (Jukes, 2013). They should enable fellow
healthcare professionals to build resilience, enabling them to make their own
decisions yet providing protection when needed (Jukes, 2013). In order to
achieve structural change for the provision of high-quality care, the following
should be adhered to: promoting inclusive team work, maintaining trust, seeking
contribution, using personal authenticity, valuing relationships, enabling
learning and challenging any issues that arise (Cleary et al, 2011). Patients
need support and care which cannot be carried out without effective leadership
(Cleary et al, 2011). If a nurse does not show effective leadership skills,
they often retreat towards more traditional methods of behavior (more
documentation and relying on medicine), instead of promoting patient-centered
care (Jukes, 2013). Furthermore, leaders need to support any professionals that
they are responsible for in following the nursing and midwifery code at all
times (Nursing and Midwifery Code, 2015: 18).

The qualities of a manager

Managers oversee a
certain area, supervising fellow staff and ensuring that patient care is
upheld, in addition to administrative aspects (Jukes, 2013). Concerns are
addressed through their specialized nursing experience, good communication and
the ability to take the lead (Jukes, 2013). Good communication is key when
assessing any risks, managing plans, delegating work and ensuring the effective
and safe provision of resources (Jukes, 2013). Delegating work is an integral
part of effectively leading, encouraging active learning, whilst freeing up
more time for aspects that cannot be delegated (Weir-Hughes, 2011). Delegation
is a necessity, especially when staff numbers reduce and pressures rise
(Griffin, 2016). Managers also demonstrate excellent leadership skills by
improving nurse confidence and upholding morale (Timmins, 2011). They need to
ensure that staff are communicating effectively, in order to provide high
quality, safe care (Timmins, 2011). This can be carried out by implementing an
open leadership style, listening to the nurses and involving the team when
making decision (Timmins, 2011). Gilmartin and D’Aunno (2007) outline how nurses prefer managers who are
emotionally intelligent, facilitate change and who actively participate.
Further stating that this leads to cohesion, a sense of empowerment and reduces
stress and burnout (Gilmartin and D’Aunno,
2007). Management and leadership can only be improved by adhering to the
following: ensuring a good set of qualities and knowledge, a supportive environment,
an adequate number of managers and ensuring rewards or acknowledgement for good
practice (World Health Organization, 2007).

Ineffective leadership

Ineffective leadership
can lead to the unsafe provision of care (Nicolson et al, 2011). This was portrayed
during the 1990s, in which nurse Beverly Allitt
murdered children by injecting them with insulin. She was not supervised and
the deaths were not challenged by management (Nicolson et al, 2011). More
recently, the investigation into the Airedale NHS trust found nurse Anne
Grigg-Booth to be providing dangerous care. Many patients died under her care,
which was noted as an abundance of failures in which dangerous actions were not
acknowledged by management (Nicolson et al, 2011). Within the Mid Staffordshire
Foundation Trust, a lack of leadership and supervision detrimentally impacted
upon the lives of many, with high mortality rates (Nicolson et al, 2011). The
Francis Report identified various issues such as, call bells not being
answered, patients lying in their own urine and left without water or food
(Francis, 2013). Saving money was a priority and management preferred to meet
targets than deal with individual needs and thus leadership was poor (Nicolson
et al, 2011). Ineffective management has not only led to unsafe care but cost
more than £16m in legal fees and implementation costs (Calkin, 2013).

Transformational leadership

Transformational
leadership encourages nurses to provide a high level of care by making
influential changes (Cleary et al, 2011). It involves the following actions:
building trust with fellow healthcare professionals, showing integrity,
inspiring team members, offering intellectual inspiration, adhering to the
needs of each individual and providing support (Malloy and Penprase,
2010). With this leadership style, professionals provide clear aims and a
pathway for their work, prioritising mutual respect,
working together, gaining nurse autonomy and upholding staff morale (Cleary et
al, 2011). Doing so prevents burnout, improves job satisfaction and a sense of
commitment (Cleary et al, 2011). Transformational leadership can be contrasted
with the transactional style in which leaders focus upon meeting targets (it is
not creative, reflective and prevents emotional connection) (Cleary et al,
2011).

Support for the transformational leadership
style

A study was
implemented by Malloy and Penprase (2010) on 122
nurses in order to assess their supervisor’s leadership style. The following
leadership styles were analysed: transactional,
transformational, exceptional-active, exceptional-passive and laissez-faire
(Molloy and Penprase, 2010). The study concluded that
aspects of transformational leadership were connected with 17 out of 37 areas
within the working environment, as calculated by the Copenhagen Psychosocial
questionnaire (Molly and Penprase, 2010). Leaders
implementing the transactional style also made positive contributions, but
fewer than that of a transformational style (Molly and Penprase,
2010). In addition, the laissez-faire, exceptional-passive and
exceptional-active styles all negatively impacted the nursing environment
(Molly and Penprase, 2010). Corrigan et al (2002)
carried out a mental health study, consisting of 236 leaders who had
responsibility for 620 staff members. Leaders who noted themselves as high on
the transactional style, had staff outlining low transformational scores. In
comparison, leaders who noted high levels of inspirational and stimulatory
aspects were likely to have staff who felt that their style was transformative
(Corrigan et al, 2002). Lastly, staff members who stated that their leader has
a transformational style experienced less burnout, a better working environment
and support, adhering to conclusions by Malloy and Penprase
(2010). In a time of uncertainty, healthcare budget cuts, policy changes and
financial strain, transformational leadership is key (Cleary et al, 2011). It
encourages staff to treat patients with respect and dignity, promoting patient-centred care and upholding values (Cleary et al, 2011).
Many argue however, that there needs to be more evidence into whether
transformational leaderships enable better care, improved quality of life and
patient satisfaction (Holm and Severinsson, 2010).

NHS leadership review

The government
published findings in order to analyze leadership within the NHS (Department of
Health, 2015). It noted three main areas of concern: a lack of vision, poor
management and leadership and the need for clear pathways in regards to NHS
management careers (Department of Health, 2015). The key recommendations
include: refreshing the NHS graduate scheme, the transfer of NHS leadership
Academy to Health Education England as those responsible for training and
introducing a minimum term on some senior management contracts. In addition,
managers should be supported and have their knowledge updated regularly in
order to prevent ‘skill fade’ (Department of Health, 2015: 53). The report
concluded that, ‘the NHS as a whole, lacks a clear, consistent, view of what
‘good’ or ‘best’ leadership looks like’ (Department of Health, 2015: 20). The
recommendations focus upon training, management, support, performance
management and bureaucracy (Department of Health, 2015).

Conclusion

To conclude, effective
leadership is necessary in order to provide a high level of safe care. It leads
to patient-centered care, excellent communication skills and high quality care.
Leaders need to communication well, have emotional intelligence, distribute
work and implement a transformational style. Whereas poor leadership can lead
to death or severe harm, as took place in the independent investigation into
the Airedale NHS trust. Ineffective leadership was also a main aspect of why
the detrimental acts of Anne Grigg-Booth went undetected by managers (Nicolson
et al, 2011). To emphasise, leadership is a key area
of the NHS and so it is vitally important to ensure that behaviours,
communication skills, qualities, skills, leadership styles and strategies are
focused upon to improve (West et al, 2015). Without doing so, the lives of many
will be affected.

 

 

 

 

 

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