Two Ways in which Consumers can Actively Participate in Shaping Health Service Delivery
The Australian Charter of Healthcare Rights establishes that consumers have a right to participate in health care decision making (Australia Commission, n.d). By participating in healthcare decision making, consumers facilitate patient-centered care. According to the Victorian Quality Council (VQC) (2005a), consumers can participate in healthcare delivery through two main ways: Involvement in direct care and co-design of healthcare.
Direct Care. Consumers help other people visit healthcare centres for check-ups, treatment, and follow-up (Olsen, Saunders, & Yong, 2010). They also participate in patient safety weeks to create and spread awareness concerning a particular condition. In addition, consumers can engage in health literacy education and training. As patients, consumers can participate in health service delivery by discussing their experiences on the health care services delivered by the health professionals (Self Care Victoria [SCV], 2017).
Co-Design. Consumer engage in activities such as the creation of pamphlets or articles that guide other consumers through the healthcare continuum (SCV, 2017; VQC, 2006b). For instance, consumers can create blog articles informing patients on what constitute specific diseases such as Alzheimer, when to seek medical attention, post-operative home care, and self-management skills for persons with diabetes and other chronic conditions. Consumers can also develop correspondence and feedback forms that patients can use to rate the health care services delivered (VQC 2006a; VQC, 2006b).
How I can increase Consumer Participation in the Planning, Implementation, and Evaluation of the Care I Deliver as a Registered Nurse
As a registered nurse (RN), I can increase consumer participation in healthcare delivery by providing the patient with the information and resources they need to be involved in healthcare decision making. SCV (2017) indicate that well informed and supported patients can effectively participate in the planning, implementation, and evaluation of healthcare because they are knowledgeable of the services they need.
Planning. Adequately informed consumers can use their knowledge to plan for the health care they need and want (Johnson, 2001; SCV, 2017; VQC, 2005b). These plans include treatment, diagnosis, screening opportunities, and home-based care. As an RN, I am mandated to provide patients with all the information they need to participate in their healthcare planning.
Implementation. To facilitate implementation of the care I deliver, I would inquire from patients if the proposed mode of treatment is effective and appropriate for their situation (VQC, 2005a; VQC, 2005b). Similar to planning, implementation of proposed care plans is dependent on my ability to respect patient preferences, values, belief systems, and engage the individual in every phase of the implementation process (SCV, 2017).
Evaluation. SCV (2017) indicates that consumer can participate in healthcare evaluation by sharing their experiences in the course of receiving treatment. As a registered, I am mandated to guide the patient when feeling consumer satisfaction forms. My engagement is, however, limited to guidance, without influencing decisions made. Whether the consumer was satisfied or not, I am responsible for ensuring that the consumer’s views and perceptions are included in the evaluation of the facility’s performance (Graffigna & Vegni, 2017).
One of the 10 standards from the National Safety and Quality Health Service Standards
The Identified National Safety and Quality Health Service Standard (NHQHSS) is the Medication Safety Standards (NSQHSS, 2017).
The Major Risk Associated with the Standard
On most occasions, treatment is delivered through medications (NSQHSS, 2017). The prescribed drugs are intended to improve the health of the individual. However, medications can also be harmful. If the practices provided by the NSQHS are not adhered to, medication errors are bound to occur. These medication errors can be a result of manufacturing formulation errors, prescribing faults, dispensing, and administering (Aronson, 2009). Manufacturing issues refer to issues such as the production of wrong dosages, misleading/wrong packages, and adulterants (Aronson, 2009). Prescribing errors include ineffective prescriptions, overprescribing, under-prescribing and prescribing wrong drug/dosages. Dispensing issues arise when a wrong drug, wrong label, or wrong formulation is dispensed. Lastly, administered errors refer to the wrong patient, wrong dose, wrong route, wrong duration, wrong dosage, and wrong frequency. Failure to adhere to established standards can also result in monitoring errors where the healthcare provider fails to alter medication as and when required or commits an erroneous alteration (Aronson, 2009).
The Incidence/Prevalence
NSQHSS (2017) indicate that the prevalence of medicine-based admissions accounts for 2-3% of all hospital readmissions. On annual basis, 230,000 people are admitted to the hospital because of medication errors. The prevalence is higher in certain populations. For instance, 12% of medications admissions occur in people aged 65 years and above. Also, approximately 40-50% medication errors occur in residents of aged care facilities. Generally, approximately 8.5-12% of Australian patients have reported adverse side effects from medications in the last six months (NSQHSS (2017).
How Medication Safety Risks affect Patient Outcomes
Medication errors can result in adverse drug reactions (ADRs) that may harm the patient (Aronson, 2009). From hospital readmissions and resulting medical expenses to worsening the condition, triggering an allergic reaction, and even death.
Two Strategies that I may Employ as a Registered Nurse to Improve Patient Outcomes for the Medication Safety Standards
As a registered nurse (RN), I can improve patient outcomes of medication safety standards by participating in productive patient-provider communication and using technology to facilitate information recording and transfer (Australia Commission, n.d). According to NSQHSS (2017), patient information is a prerequisite to medication safety. That is because the patient provides relevant information pertaining to their disease, allergies, and adherence to medications.
Technology has revolutionized healthcare delivery by providing adequate and the much needed support (Sing & Sittig, 2015). I would ensure that the prescribed medicine aligns with the information contained in the medication order-entry module and the dispensed drug from the pharmacy management system. Then, I would reevaluate the patient’s electronic health records (EHR), patient safety, and the medication order system to ensure that the right medication was prescribed for the right patient, right condition, dosage, and route of administration. In case of any uncertainties, I would use the clinical decision support system of my practice (Singh & Sittig, 2015). The system contains all the information needed to facilitate medication safety standards.
Leadership and Management
Two Leadership Skills that Registered Nurses must bring to their Role
I consider effective teamwork and integrity as the most important leadership skills an RN should have. According to Bawafaa, Wong, and Laschinger (2015), healthcare delivery teams, whether interprofessional or multidisciplinary, are associated with high patient outcomes and satisfaction because care is provided at the patient level. Therefore, RNs have to be good in team activities for effective teamwork. Good team players share information and make decisions mutually. Every team member adheres to the established team rules and values and alterations or deviations from established standards is discussed in advance and with all members. Additionally, good team players invest in the well-being of the patient by ensuring that patient-centred is delivered (Bawafaa et al., 2015; Wong, Cummings, & Ducharme, 2013).
I also consider nursing integrity, characterized by honesty, fairness, and possession of high moral principles, important (Wong et al., 2013). The nursing practice is full of many challenges such as being forced to work overtime, dealing with stressful patients, and being understaffed. Therefore, RNs should always exhibit honesty, forthrightness, confidentiality, and trustworthiness to deliver high-quality care that is safe, appropriate, effective, and efficient (Health Workforce Australia, 2013). To achieve nursing integrity, RNs must develop their personal code of ethics, justice, honesty, and morals, and always act in accordance with their established rules.
One Skill that I Would like to Further Develop
One of the leadership skills I will like to develop is working within in teams, in particular taking leadership and involving the right people in time of need (National Health Service [NHS], 2012; Victorian Quality Council [VCQ], 2005). Being a quiet person, I often feel intimated by more outspoken people, especially those with higher education status or longer working experiences than me. Despite my quiet nature, I am well versed in nursing and emergency responses, unlike most of the nurses I work in the department. Therefore, I feel I need to take more leadership roles so that I can help my health centre in times of emergency and develop at the personal and professional level (NHS, 2012).
Strategies to Achieve the Skill
First, I will work on my communication skills and volunteer information during clinical rounds with the clinical nurse leader (NHS, 2012). I will use the knowledge I have gained to provide health care plans for individual patients. Second, on occasion, the CNL gives one registered nurse an opportunity to lead the team. In the next round, I will volunteer to lead the team, showcasing my team leader/player skills and expertise pertaining to patient care and safety (Victorian Quality Council [VCQ], 2005). Third, I will participate in leadership fares, workshops, and seminars to gain comprehensive knowledge on how I can a transformation and democratic leader (Health Workforce Australia, 2013; VCQ, 2005). Fourth, every month, I will assess my progress in leadership and cultivate my next plan of action that will help meet the unmet goals and objectives.
Organisational Culture
The Defining Characteristics of a Learning Culture
A registered nurse (RN) can identify a culture of learning in an organization by checking for the following characteristics:
Values. An organization invested in a learning culture promotes values such as critical thinking, innovation, and initiative (Gershon, Stone, Bakken, & Larson, 2004). In that facility, nurses exercise creative thinking, participate in research, and take leadership positions in times of need.
Management/Nursing Leadership Support. Managerial and nursing leadership support are a defining characteristic of a learning culture because it allows for the aforementioned values to be exercised (Bawafaa et al., 2015). The support ensures continued learning by providing its nurses with opportunities such as workshops, seminal, conferences, research, and advanced studies. Without management support, a learning environment is not possible.
Resources. A culture of learning is characterized by the availability of resources that enable learning across all levels (Gershon et al., 2004). These resources are also used to enhance care provision through evidence-based medicine. Therefore, employed RNs should ensure that they request for access to the hospital’s resource centre for their own growth and professional development.
Performance Orientation. Organizations that commit to performance organizations indicate an established culture of learning. The company goals and vision are visible to all employees. New and novel RNs are oriented to the organization mission, vision, and established standards of practice. Afterwards, it is up to the RN to commit to learning and engage in professional development.
Ways I May Contribute to a Culture of Learning within My Organization as a Registered Nurse
Critical Thinking. The NHS (2012) establish that critical thinking is an essential leadership skill. Creative thinking facilitates endorsements of people who are innovative and able to think outside the box. As an RN, I will endeavour to be a creative thinker and sharing my innovative ways with other healthcare providers.
Encourage System Thinking. Arnold and Wade (2015) posit that as the health care system and patient population increase in complexity, they create a need for system thinkers to tackle the complex. These system thinkers work in interdependency- having a common language and framework for knowledge, expertise, and experience sharing. As an RN, I will commit to being a system thinker by perceiving patients as whole persons and not just the disease they present with. I will exercise system thinking by always considering other team members thoughts, preferences, cultures, and values. I will ensure that my team has a means of communicating, sharing ideas, and knowledge for more effective healthcare delivery.
Professional Practice
Role Ambiguity
Role ambiguity refers to unclear or uncertain personal expectations in one’s employment (Mahfouz, Abood, Mohamed, & AbdelHameed, 2013). Role ambiguity is common in newly employed registered nurses (RNs) as they struggle to find a sense of direction, adapt, and perform in accordance with the organization standards (Dyess & Sherman, 2009). Also, organizations undergoing change are likely to induce role ambiguity in nurses. These nurses may struggle with the change and uncertainties pertaining to their roles may emerge (Mahfouz et al., 2013).
Impact of Role Ambiguity on a Registered Nurse
Role ambiguity affects an RN’s work performance and job satisfaction (Dyess & Sherman, 2009). Not knowing one’s responsibilities or having an unclear plan of action results to under-performance which can affect a person’s morale. An under-performing RN may also lack job satisfaction (Australian Nursing & Midwifery Council., 2010). Additionally, role ambiguity can cause nursing burnout which intensifies existing issues such as lack of motivation, work stress, job tension and dissatisfaction (Dyess & Sherman, 2009; Mahfouz et al., 2013). The overall impact is reduced low-quality nursing care which may be detrimental to patient safety.
Two self–care strategies that I will employ to facilitate My Emotionally and Physically Wellbeing
Task Prioritization. Nursing is a demanding profession. As a new RN, I am likely to feel overwhelmed with many responsibilities that need my attention (Dyess & Sherman, 2009; Mahfouz et al., 2013). However, I feel that task prioritization can reduce the pressure associated with my work. By prioritizing orders, I can gain clarity on which roles to fulfil first and why they are given priority. Prioritizing also ensures that I able to perform all my roles as expected or needed.
Delegation and Division of Labour. Because each task in the prioritization risk has a time frame, I will commit to effective management so that I do not over-engage or under engage in particular activities. I will work on my speed and outsource activities so that I can work with my schedule (Dyess & Sherman, 2009). For instance, I can ask one of the junior nurses to collect patient charts for me so that I can access and compare notes with their individual electronic medical records (EMRs). When dispensing medicine, I can outsource the work to a medication nurse and let the licensed nurse handle EMRs. That way, I will have ample time to handle more stressful conditions such as patients with complicated conditions or clinical protocols that need review and approval.
References
Arnold, R.D., & Wade, J.P. (2015). A definition of system thinking: A system approach. Procedia Computer Science, 44, 669-678. doi:10.1016/j.procs.2015.03.050
Aronson, J. K. (2009). Medication errors: what they are, how they happen, and how to avoid them. QJM: An International Journal of Medicine, 102(8), 513-521. doi:10.1093/qjmed/hcp052. Epub 2009 May 2
Australia Commission Safety and Quality in Health Care (n.d).The Australian Charter of Healthcare Rights: A guide for healthcare providers.
Australian Nursing & Midwifery Council. (2010). A nurse’s guide to professional boundaries. Author.
Bawafaa, E., Wong, C. A., & Laschinger, H. (2015). The influence of resonant leadership on the structural empowerment and job satisfaction of registered nurses. Journal of Research in Nursing, 20(7), 610-622. https://doi.org/10.1177/1744987115603441
Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228–231. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748543/
Dyess, S. M., & Sherman, R. O. (2009). The first year of practice: New graduate nurses’ transition and learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-410.Happell, B. (2010). Facilitating consumer participation: an approach to finding the ‘right’consumer. Collegian, 17(3), 125-130. Retrieved from https://www.collegianjournal.com/article/S1322-7696(10)00018-1/fulltext
Gershon, R. R., Stone, P. W., Bakken, S., & Larson, E. (2004). Measurement of organizational culture and climate in healthcare. Journal of Nursing Administration, 34(1), 33-40. Retrieved from https://pdfs.semanticscholar.org/a9ff/e522e9b2cce15d78f479cb10fc0f813bb8ff.pdf
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Mahfouz, E.M, Abood, S., & Mohamed, F.R., & AbdelHameed, E. (2013). Effect of role conflict and role ambiguity on nurse’s performance. Retrieved from https://www.researchgate.net/publication/236209262_Effect_of_role_conflict_and_role_ambiguity_on_nurse%27s_performance
National Safety and Quality Health Services Standards. (2017). Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2017/11/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
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Singh, H., & Sittig, D. F. (2015). Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BioMed Journa; Quality Safety 25(4), 226-32. doi:10.1136/bmjqs-2015-004486
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724. doi:10.1111/jonm.12116
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