How does leadership culture impact on the delivery of quality patient care - Free Essay Example

Sample details Pages: 7 Words: 2207 Downloads: 3 Date added: 2017/06/26 Category Medicine Essay Type Analytical essay Did you like this example? What can a nurse do, in this context, to ensure that patients needs are met? The importance of leadership is now widely recognised as a key part of overall effective healthcare, and nursing leadership is a crucial part of this as nurses are now the single largest healthcare discipline (Swearingen, 2009). The findings of the Francis Report (2013) raised major questions into the leadership and organisational culture which allowed hundreds of patients to die or come to harm and further found that the wards in Mid Staffordshire, where the worst failures of care were found were the ones that lacked strong and caring leadership, highlighting the crucial role of nurses in leadership. Research into nursing leadership has shown that a culture of good leadership within healthcare is linked to improved patient outcomes, increased job satisfaction, and lower staff turnover rates (MacPhee, 2012). Don’t waste time! Our writers will create an original "How does leadership culture impact on the delivery of quality patient care?" essay for you Create order Although the NHS currently faces many challenges such as financial constraints and a growing elderly population, leadership cannot be viewed as an optional role. Previous research by Swearingen (2009) has suggested that educational programmes for nurses do not fully prepare them for leadership roles, and this gap between the demands of clinical roles and adequate educational preparation can result in ineffective leadership in nursing (Feather, 2009). It is important to recognise the critical role that nurses and nurse leaders play in establishing leadership for patient care and the overall culture within which they work (Feather, 2009). Themes explored in this essay will include defining leadership, leadership in nursing, factors that contribute to nursing leadership, and leadership preparation as part of nursing education. What is leadership and culture? Leadership can mean many different things and has clearly evolved in meaning over time (Brady, 2010). Common qualities associated with leadership are influence, innovation, autocracy, and influence (Brady, 2010, Cummings, 2010). A key factor which has remained part of leadership during its evolution has been the ideas that leadership can involve the influence of behaviours, feelings, and actions of other people (Malloy, 2010). Culture is different, and refers to the implicit assumptions that each member of a group or organisation perceives and reacts to different things (Malloy, 2010). Culture is often regarded as a good reflection of what an organisation values most: if compassion and safety are highly regarded, staff will assimilate this (Hutchinson, 2012). Interactions by leaders at all levels of an organisation have been identified as the most important aspect/component of establishing and maintaining a culture of leadership (Malloy, 2010, Hutchinson, 2012). The most senior lev el of leadership within NHS trusts often comes from the board of directors, who have overall responsibility for the overall leadership strategy (Brady. 2010). Nursing leadership Although there are many research articles and books about leadership and management, there has been relatively little research until recently into what nursing leadership entails. Cummings (2008) found that perceptions of nursing leadership were different from general leadership because it placed a greater emphasis on nurses taking responsibility for and improving and influencing the practice environment. Brady (2010) reported that anytime a nurse had recognised authority, they were providing leadership to others. By this argument, student nurses are leaders to their patients, a staff nurse is a leader to student nurses and patients, and the leader to all team members is seen in the ward manager (Brady 2010, Sanderson, 2011). It is also important to distinguish between a manager and a leader (Brady 2010, Sanderson, 2011). Mangers are seen to be those who administer, maintain, and control, whereas leaders are those who are seen to innovate, develop, and inspire (Sanderson, 2011). Wh ilst there is obvious need for managers within the health service, it is vital to realise that there is a clear distinction in the roles of managers and leaders (Sanderson, 2011), and that there are areas where these roles may not overlap (Sanderson, 2011). One of the key challenges facing the NHS is to nurture a culture which allows the delivery of high quality healthcare (MacPhee, 2012) and one of the most influential factors which can impact the delivery of quality patient care is leadership: ensuring there is a clear distinction between management and leadership, and that leaders are equipped with the necessary tools to inspire others to follow their example (Jackson, 2009). Factors which contribute to nursing leadership The systematic review by Cummings (2008) demonstrated that research into nursing leadership falls into two categories à ¢Ã¢â€š ¬Ã¢â‚¬Å" studies of the practices and actions of nursing leaders including the impact of differing healthcare settings, and the effects of different educational backgrounds of nurse leaders. The conclusion from the systematic review by Cummings (2008) suggests that leadership from nurses can be developed by a stronger emphasis placed on leadership in education, and by modelling leadership styles on those which have been seen to be successful in the workplace. Several studies also highlighted personal characteristics which were deemed to promote leadership qualities, such as openness and the motivation to lead others (Jackson, 2009, Brady 2010, Sanderson, 2011). Marriner (2009) also showed that contrary to popular belief, age, experience, and gender did not seem important factors when considering the effectiveness of leadership, and that interpersonal skill s were more important than financial or administrative skills. However this focus on financial and managerial skills seems to suggest an overlap between management and leadership, which has previously been shown to be two different areas (Richardson, 2010, MacPhee, 2012). They also showed that leadership was perceived to be less effective when leaders had less contact with those delivering care, highlighting the importance of nurses on the ward to also be effective leaders (Richardson, 2010, MacPhee, 2012). The emphasis which has been placed on interpersonal skills and relationships between healthcare workers is strongly suggestive that this is an important leadership skill, and could be a key part of leadership development programmes (Malloy, 2010). A recent review of the role of emotional intelligence and nursing leadership highlights the need for emotional intelligence in effective leaders and has been shown to be highly influential on healthcare cultures (Hutchinson, 2012). A lthough the impact of these factors can suggest how best to promote leadership in nursing, it is clear that a thorough understanding and overview of their interactions are needed to fully understand their effectiveness. Sorensen (2008) suggested that these effects can also be promoted through educational programmes, particularly at undergraduate level. Education It is clear that leadership is considered to be fundamental to nursing, and that nurses are now expected to act as leaders across a wide variety of settings (Richardson, 2010). If nurses are expected to undertake such roles it is important that they are adequately trained and prepared for this (Sanderson, 2011). Studies have found that many undergraduate nursing courses now view organisation and management to be fundamental parts of autonomous nursing practice, and it is widely part of the curriculum (Richardson, 2010, Sanderson, 2011). However it is unclear what is actually taught, and much of the content appears to be focused on the transition period from student to qualified nurse (Sanderson, 2011). However it seems that current expectations of leadership within the NHS are not suitable to be taught as isolated elements within the curriculum, and should instead be embraced throughout training and beyond (Richardson, 2010, Sanderson, 2011). The development of leadership skills sh ould also be continued through a nurses career to continually promote the importance of leadership, and to develop newly-qualified nurses into role models for others (Jackson, 2009). Collective leadership In collective leadership there are both individual and collective levels of accountability and responsibility (Cummings, 2008). There is a strong emphasis on regular reflective practice which has been shown to improve the standard of care given by nurses, and strives to make continuous improvement a habit of all within the organisation (Cummings, 2008, Cummings, 2010). This is in contrast to a command and control style of leadership, which displaces responsibility onto individuals and leads to a culture of fear of failure rather than a desire to improve (Feather, 2009). Leadership comes from both the leaders themselves and from the relationships among them and with other members of staff. Key to leadership is also the idea of followership à ¢Ã¢â€š ¬Ã¢â‚¬Å" that everyone supports each other to deliver high quality care and that the success of the organisation is the responsibility of all (Hutchinson, 2012). It is important to recognise that good leadership does not happen by chance , and that collective leadership is the result of consciously and purposefully identifying the skills and behaviours needed at an individual and organisational level to create the desired culture (Hutchinson, 2012). This is in contrast to more traditional leadership development work, which has focused on developing individual capacity whilst neglecting the need for developing collective capability (Cummings, 208, Cummings, 2010). This style of leadership has been linked to poorer patient outcomes, decreased levels of job satisfaction, and higher levels of staff turnover (Sorensen, 2008). The challenge of recruiting and retaining leaders at all levels must be recognised, as there is need for clinical leadership at every level (Cummings, 2010). Research has shown that where leaders and relationships between leaders are well developed, there is an increased quality of care due to all staff working towards the same goals and a well-established culture of caring (Sanderson, 2011). In addition to this, there is also an increasing drive to form leadership partnerships with patients (Sanderson, 2011, Hutchinson, 2012). Collective leadership with those receiving care functions in a similar way to multidisciplinary team working as this style of leadership with patients needs a redeployment of both power and decision making in addition to a change in thinking about who should be included in the collective leadership community (Hutchinson, 2012). Several authors (Cummings, 2008, Jackson, 2009, Malloy, 2010) recommended that NHS leaders should work with those seen as patient leaders to facilitate the changes outlined in the Francis Inquiry report (2013).   There have been frequent reports that staff working in healthcare settings are often overwhelmed by the workloads required and are unsure of their priorities, sometimes because there are too many priorities identified by senior managers (Cummings, 2008). This can result in stress and poor quality care for patie nts (Cummings, 2008, Cummings, 2010). Whilst mission statements about efficient and high quality care can be helpful for staff, they are only helpful when translated into objectives for individuals (Jackson, 2009). Establishing and maintaining cultures of high-quality care relies on continual learning and improvements in patient care from all members of staff, and thus taking responsibility for improving quality (Jackson, 2009, MacPhee, 2010).   Where there is a well-established mentality of collective leadership, all staff members are more likely to work together to solve problems, to ensure that the quality of care remains high, and to work towards innovation (MacPhee, 2012). Conclusion The importance of effective leadership to the provision of good quality care is firmly established, as is the central role that leadership plays in nursing (Cummings, 2008). It is now also clear that leadership should be found at all levels from board to ward and it seems obvious that the development of leadership skills for nurses should begin when training commences and should be something which is honed and developed throughout a nursing career (Feather, 2009). For health care organisations to provide patients with good quality healthcare there must be a culture that allows sustained high quality care at multiple levels (Francis Report, 2013). These cultures must concentrate on the delivery of high quality, safe health care and enable staff to do their jobs effectively (Jackson, 2009, Francis Report, 2013). Part of this is ensuring that there is a strong connection to the shared purpose regardless of the individuals role within the system and that collaboration across profession al boundaries is easily achieved (Cummings, 2010). Nurses can be a key part of this by using collective leadership to establish a culture where all staff take responsibility for high quality care and all are accountable (Malloy, 2010). This may require a shift in mentality of the way many see leadership à ¢Ã¢â€š ¬Ã¢â‚¬Å" from seeing leadership as a command-and-control approach, to seeing leadership as the responsibility of all and working together as a team to work across organisations and other boundaries in the best interests of the patient (Brady, 2010). References Brady, P. (2010). The influence of nursing leadership on nurse performance: a systematic literature review. Journal of Nursing Management, 18(4), pp.425-439. Cummings, G. (2008). Factors contributing to nursing leadership: a systematic review. Journal of Health Services Research and Policy, 13(4), pp.240-248. Cummings, G. (2010). The contribution of hospital nursing leadership styles to 30-day patient mortality. Nursing Research, 59(5), pp.331-339. Feather, R. (2009). Emotional intelligence in relation to nursing leadership: does it matter? Journal of Nursing Management ¸ 17(3), pp.376-382. Hutchinson, M. (2012). Transformational leadership in nursing: towards a more critical interpretation. Nursing Inquiry, 20(1), pp.11-22. Jackson, J. (2009). Patterns of knowing: proposing a theory for nursing leadership. Nursing Economics, 27(1), pp.149-159. MacPhee, M. (2012). An empowerment framework for nursing leadership development: supporting evidence. Journal of A dvanced Nursing, 68(1), pp.159-169. Malloy, T. (2010). Nursing leadership style and psychosocial work environment. Journal of Nursing Management, 18(6), pp.715-725. Marriner, A. (2009). Nursing leadership and management effects work environments. Journal of Nursing Management, 17(1), pp.15-25. The Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. London: Stationery Office (Chair: R Francis). Richardson, A. (2010). Patient safety: a literature review on the impact of nursing empowerment, leadership, and collaboration. International Nursing Review, 57(1), pp.12-21. Sandstrom, B. (2011). Promoting the implementation of evidence-based practice: a literature review focusing on the role of nursing leadership. Worldviews on Evidence-Based Nursing, 8(4), pp.212-223. Sorensen, R. (2008). Beyond profession: nursing leadership in contemporary healthcare. Journal of Nursing Manag ement, 16(5), pp.535-544. Swearingen, S. (2009). A journey to leadership: dsigning a nursing leadership development program. The Journal of Continuing Education in Nursing, 40(3), pp.113-114.

Nineteen Shades Of Grey Sexual Abuse And Abasement Essay

According to sexology, sex is a foundational part of what it means to be human; it is as much a basic need as eating or sleeping (Connell 9/13). Because sex is highly prioritized in the human mind, creators of media often utilize sex to captivate audiences and advance their own agendas—after all, it has been proven sex sells. A notable example of a sex entertainment phenomenon is the novel-turned-film Fifty Shades of Grey. Despite its global success, the movie was largely criticized by sex scholars who expressed concern with the film’s glorification of abusive sexual relationships, exemplified by the two main characters. By examining Fifty Shades of Grey through the lens of a feminist sex theory, one can better understand the unhealthy ways in which the narrative surpasses the sexual eroticism and experimentation of BDSM, and creates a world in which sexual abuse and abasement is romanticized. Fifty Shades of Grey depicts the relationship between college-student Anastasia Steele and billionaire businessman Christian Grey. The two meet when Anastasia assists her sick roommate by driving to Seattle to interview Christian for their college newspaper. After their first interaction, it is apparent Anastasia and Christian feel drawn to one another. Christian pursues Anastasia and their whirlwind relationship begins. She becomes immersed in his world, entirely unprepared for the discoveries she ultimately makes about Christian. Not only is he exceptionally wealthy, but he also uses

Nvq Health and Socail Care Level 3 Assignment204 a Free Essays

Abuse Physical Abuse What is physical abuse? Physical abuse is any abuse involving the use of force, this can be: Punching, hitting, slapping, pinching, kicking, in fact any form of physical attack Burning or scalding Restraint such as tying up or tying people to beds or furniture Refusal to allow access to toilet facilities Deliberate starvation or force feeding Leaving the individuals in wet or soiled clothing or bedding as a deliberate act to demonstrate power and strength of the abuser Excessive or inappropriate use of medication A carer causing illness or injury to someone he or she cares for in order to gain attention Signs and symptoms associated with Physical abuse Pepper pot bruising-small bruises, usually on the chest, caused by poking with the finger or pulling of the clothes tightly. Finger-marks-often on arms or shoulders. Bruising in areas not normally bruised such as inside of thighs and arms. We will write a custom essay sample on Nvq Health and Socail Care Level 3 Assignment204 a or any similar topic only for you Order Now Marks on wrists, upper arms or legs which could be from tying to a bed or furniture. Burns or scalds in unusual areas such as soles of feet, inside thighs. Ulcers, sores or rashes caused by wet bedding or clothing. Becoming withdrawn or anxious. Loss of interest in appearance. Loss of confidence. Sleeping problems. Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Sexual abuse What is sexual abuse? Sexual abuse is the act in which sexual act have taken place without the persons consent. This can consist of: Sexual penetration of any part of the body with a penis, finger or any object Touching inappropriate parts of the body or any other form of sexual contact without the informed agreement of the individual Sexual exploitation Exposure to, or involvement in, pornographic or erotic material Exposure to, or involvement in, sexual rituals Making sexual related comments or references which provide sexual gratification for the abuser Making threats about sexual activities. Signs and symptoms associated with Sexual abuse Marks on wrists, upper arms or legs which could be from tying to a bed or furniture. Becoming withdrawn or anxious. Loss of interest in appearance. Loss of confidence. Sleeping problems. Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Unusual sexual behaviour. Blood marks on underclothes. Recurrent genital/urinary infections. Emotional/psychological abuse What is Emotional/psychological abuse? All the other forms of abuse also have an element of emotional abuse. Any situation which means that an individual becomes a victim of abuse at the hands of someone he or she trusted is, unavoidably, going to cause emotional distress. However, some abuse is purely emotional – there are no physical, sexual or financial elements involved. This abuse can take the form of: Humiliation, belittling, putting down Withdrawing or refusing affection Bullying Shouting or swearing Making insulting or abusive remarks Racial abuse Constant teasing and poking fun. Signs and symptoms associated with Emotional/psychological abuse Becoming withdrawn or anxious. Loss of interest in appearance. Loss of confidence. Sleeping problems. Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Becoming afraid of making decisions. Flinching or appearing afraid of close contact. Financial abuse What is financial abuse? Many service users are very vulnerable to financial abuse, particularly those who may have a limited understanding of money matters. Financial abuse, like all other forms of abuse, can be inflicted by family members and even friends as well as care workers or informal carers, and can take a range of forms such as: Stealing money or property Allowing or encouraging others to steal money or property Tricking or threatening individuals into giving away money or property Persuading individuals to take financial decisions which are not in their interests Withholding money, or refusing access to money Refusing to allow individuals to manage their own financial affairs Failing to support individuals to manage their own financial affairs. WHERE HAS IT GONE Signs and symptoms associated with financial abuse Becoming withdrawn or anxious. Sleeping problems. Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Missing cash or belongings, or bank accounts with unexplained withdrawals. Missing bank account records. Sudden change in attitude to financial matters. Institutional abuse What is Institutional Abuse? Institutional abuse is a type of systematic and organised abuse that mostly goes on in residential and hospital settings However, individuals can be abused in many other ways in settings where they could expect to be cared for and protected. For example: Individuals in residential settings are not given choice over day-to-day decisions such as mealtimes, bedtimes, Freedom to go out is limited by the institutional Privacy and dignity are not respected Personal correspondence is opened by staff The setting is run for the convenience of staff, and not service users Excessive or inappropriate doses of sedation/medication are given Access to advice and advocacy is restricted or not allowed Complaints procedures are deliberately made unavailable. â€Å"Do you what Me? †Ã¢â‚¬Å"Just reach for me† â€Å"You can’t Reach† â€Å"tough luck then I will just sit here† Signs and symptoms associated with Institutional abuse Becoming withdrawn or anxious. Sleeping problems. Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Self-Neglect What is Self-Neglect? Many people neglect themselves when they are ill or depressed and unable to make the effort or some people neglect themselves as they feel incapable of looking after themselves. Working out when someone is neglecting themselves can be very difficult. Self-neglect can show in many of ways: Lack of personal hygiene Lack of care about appearance and clothing Failure to eat, or to buy food Failure to maintain a clean living environment Not bothering or refusing to obtain medical help Unwillingness to accept any support with daily living Unwillingness to see people or to go out. Signs and symptoms associated with Self neglect Sleeping problems. Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Appearance Neglect by others What is Neglect by Others? This occurs when either a care worker or an informal carer fails to meet the care needs of a person. Neglect can happen because those responsible for providing the care do not realise its importance, or because they cannot be bothered, or choose not, to provide it. As the result of neglect, individuals can become ill, hungry, cold, dirty, injured or deprived of their rights. Neglecting someone you are supposed to be caring for can mean failing to undertake a range of care services, for example: Not providing adequate food Not providing assistance with eating food if necessary Not ensuring that the individual is adequately clothed Leaving the individual alone Not assisting an individual to meet mobility or communication needs Failing to maintain a clean and hygienic living environment Failing to obtain necessary medical/health-care support Not supporting social contacts Not taking steps to provide a safe and secure environment for the individual. Signs and symptoms associated with Neglect by others: Becoming withdrawn or anxious. Sleeping problems Change in eating habits. No longer laughing or joking. Feeling depressed or hopeless. Appearance What you should do if you suspicions that an individual is being abused. As a carer you would record any signs or symptoms of an individual being abused to the line manage, your line manager may ask you to fill in a body chart indicating the location and description of the injuries which would be kept in the office copy of their care plan, you would not document it in the running report in their home as this can be read by anyone. As a carer your observations may add to other observations noticed by other carers or members of the team this will help to safeguard the service user as the line manage will have documentation to refer to the social workers to help this erson What you should do if an individual alleges that they are being abused. You must assume the person is tell the truth, You must be careful not to ask any leading questions e. g. ‘and did he punch you? ‘ you just ask ‘ and what happened? ’ you use your communication and listening skills so that the individual knows that they can trust you, then you would record exact ly what the individual says and the details of the situation, you would not write this in the running report it would be documented on a separate document E. g. iece of paper then you would sign and date it and report it to the line manager and you would give them the statement, so that they can take responsibility. If the individual ask you to keep it to yourself, You would explain to them that you have to report this to your line manager as it is your duty of care under to NO SECRET policy and that the only people who will know are people who can help. Identify ways to ensure that evidence of abuse is preserved. You should always record details of the alleged/suspected abuse on a separate piece of paper and sign and date it, if any witnesses were present you should ask for their details e. . name and contact details and have them sign your document, if you have permission take photographic evidence of any physical injuries, collect all reports e. g. financial records, running repo rts, dietary reports and give it to you line manager so the information can be put into their care plan in a filing cabinet in the office and documented on the computer system National policies to safeguard individuals * Government Department of health – No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect Vulnerable adults from abuse POVA Policy is there to prevent unsuitable people from working with vulnerable people. Local and organisational systems for safeguarding Care Quality Commission (CQC, have a role in safeguarding. It is there to monitor care setting are followed policies and procedures correctly. If you feel that your company is not following these, you have the right to contact CQC and report them. Disclosure and Barring Service DBS was formed by merging together the functions of the Criminal Records Bureau (CRB) and the Independent Safeguarding Authority (ISA) under the Protection of Freedoms Act 2012. It started functioning on 1 December 2012 and it is there to help prevent unsuitable people from working with children and vulnerable adults Different agencies/services in safeguarding and protecting individuals The importance of commination between different care providers is very important to safeguarding an individual, there can be a lot of different care providers involved in the service user life, this are origination such as:- * social services e. g. social workers, care assistants, the police * health services e. g. Gps, nurses, health visitors * voluntary services e. g. NSPCC, Age UK All origination involved in a service user life, will appoint a person from the health and social care setting to oversee the safeguarding assessment and its outcome, they also inform the police regarding all safeguarding incidents; chairing meetings, including the agreement of responsibilities; actions and time scales; co- coordinating and monitoring investigations and overseeing the convening of safeguarding case and providing information and outcomes to the safeguarding co- predicator. Identify sources of information and advice about own role in safeguarding and protecting individuals from abuse. As a carer you would get information and advice from your manager, you would go on training course every 12 months. you can also get information from the internet, leaflets or by contacting different agencies such as CQC, also I can look at the policies and procedures and agreed ways of working within the work place. 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