The current assignment focuses on the leadership styles and theories and their implications within a given healthcare scenario. The case study reflects upon the implementation of transformational leadership style in dementia care. Here, a 84 year old woman living under dementia care had been subjected to negligence and atrocities within the care procedure. The woman was in a progressive stage of vascular dementia which affected her me memory and decision making abilities. However, she insisted on having a certain degree of freedom and independence. The lack of sufficient knowledge and insufficient policies and guidelines further affected the quality of the care services which were being delivered to her.
She insisted on travelling alone and when disapproved with often depicted violent or aggressive behaviour. This made the handling and management of her condition difficult. Later she was put under isolation, where she was locked in a separate room and was not allowed to interact freely with other inmates as before. She was also chained around her arms and legs which resulted in several injuries to her. Therefore, the some of the effective guidelines such as mental health capacities act and the policies of informed decision making were violated over here. Additionally, there were several loopholes within the care delivery processes such as lack of effective team working and effective governance form the s supervisors in managing the serious health conditions of the patients, which hampered the standards of the support and care services.
Nursing approaches plays a pivotal role in the planning and delivery of the care services. The patterns of support care have been further extended to provide person-centred care to the ones with chronic illness. For the current study we have tried to focus upon the leadership approach used in caring for a patient with dementia. Here, Emily is an 84 year old lady living with vascular dementia. I was appointed as the centre in charge of the local dementia care unit where Emily was receiving the support and care services. A transformational leadership style was adopted by me for discharge of my duties as a supervisor and settlement of disputes within the healthcare delivery process. The adoption of the particular leadership style helped me in filling the gaps within the already existent care processes by focussing upon the need for change. The adoption of the approach would also help me in maximizing the productivity of any team of which I would become a part in the future.
Emily had become increasingly hostile or aggressive towards her support carer and would hardly listen to their advices. She wanted to be in her own house and stay within the company of her friends and family and disapproves of the care agency. However, she hardly had anyone who could look after her care concerns. Provided she had dementia, her thinking and decision making abilities were affected making her more dependent over support services (van Charante et al., 2016). However, she wanted to have sufficient freedom in managing her day-to-day activities.
Emily narrated about the time that she used to spend with her friends and family. She was free and could perform all her activities with little or no assistance. However, her present condition does not allow her to roam around freely or alone. During my tenure as the supervisor, I had to interact with some of the prior support carer’s of Emily. They had informed me that at times Emily would become hostile and want to go out of the care home alone at the middle of the night. Emily would often insist that she would take a walk on the road and that she could manage all by herself.
However, Emily was affected with dementia which made travelling alone unsafe for her. This would often result in dispute between Emily and her support carers who found it increasingly difficult to handle her. Thus, owing to the volatile behaviour depicted by Emily she was put into isolation where she was put in a separate room and all her activities were strictly monitored by the care support staff. As per the Mental Health Capacity Act (2005), the autonomy of the service users needs to be respected (Wong, Cummings & Ducharme, 2013). However, the restrictions imposed upon Emily were clearly against the guidelines of mental health capacity act.
Additionally, days later when Emily was found in her room she had bruises in her arms and legs which clearly seemed to have originated from chains tied on to her hands and feet so that she cannot move around freely. The discoveries made called for an immediate change of staffs and management along with the implementation of improved healthcare standards and policies. This called for the implementation of a person-centred approach which places the support users at the centre of the care services (Lin, MacLennan, Hunt & Cox, 2015).
For the chosen case scenario a transformational leadership style had been applied. Here emphasis was placed upon the implementation of a person –centred approach in caring for the patient. Recent studies have highlighted the need for dementia care mapping, which is an internally accepted standard for successful treatment of dementia (Hutchinson & Jackson, 2013).
As commented by Day & Brownie (2014), patients are looking for effective and efficient care personnel which place importance upon imparting of necessary skills to the nursing staff. As per the current situation Emily was suffering from vascular dementia which impaired her decision making and problem solving skills. Therefore she was dependent upon her support carers for managing her day –to- day activities. In this respect, the privacy concerns as well as the autonomy of the support user need to be taken care of. Therefore, the support carer need to be empathetic in their approach at the same time should be able to access the health condition of Emily effectively. Therefore, the implementation of a person centred approach would help in resolving the disputes within the care processes.
The implementation of a transformational leadership would help in development of talent for meeting the needs of the future (Ross, Fitzpatrick, Click, Krouse & Clavelle, 2014). The incorporation of a transformational leadership approach helps in maintaining a positive work culture. The patient generated trends further dictate the care pathways (Hutchinson & Jackson, 2013). The transformational leadership can be further divided into several different aspects such as – emphasizing upon intrinsic motivation and positive development, establishment of moral standards, clearly differentiating the priorities of the care plan, development of integrity and moral perception within the care personnel. The transformational leadership approach helps in focussing upon common good (Banks, McCauley,, Gardner & Guler, 2016). The particular leadership style can be divided into four specific components such as:
Idealized influence- under this the leader is treated as the role model for the rest of the group
Inspirational motivation- the leader should be able to motivate the staffs for doing good work by providing them sufficient appreciation
Individualized consideration- the transformational leaders should be considerate to the feelings of others who are involved with the care process as part of the organization.
Intellectual stimulation- as a leader one need to provide sufficient chances for performance enhancement to the staffs
Transformational Leadership approach
(Source: Hutchinson & Jackson, 2013)
Focussing upon the current scenario Emily would often become hostile and violent when her support carers would disagree to grant her wishes. This made handling and management of the patient even more difficult. Additionally, lack of supervision form the management and inadequate policies and guidelines underlining the care processes, further degraded the quality of the healthcare services. The support carers looking after the care needs of Emily failed to implement a person centred approach. Additionally, no attempt had been undertaken by them to inform the family members of the patient regarding the care services which are to be delivered to the patient. This is clearly against the policies of informed decision making, where consent is taken from the patient and their respective family members before the incorporation of specific changes within a healthcare plan. On accessing the case scenario of Emily one could clearly decipher that there was a lack of sufficient intervention and awareness approaches from the management.
Additionally, lack of team working contributed to the poor quality of the care services. On further investigation it was found that there were shift changes happening within the care centre and the staff who would take over the duties from the next shift onwards were often not communicated the exact condition of the patient. Thus, the communication gap further deteriorates the standards of the healthcare services (Mannix, Wilkes & Daly, 2015). The lack of an effective leader failed to motivate the staffs for working harder. This further resulted in a huge number of absenteeism and layoffs. For enhancing the quality of care services a number of changes need to be implemented by the management such as provision of performance bonus or incentives. Additionally, sufficient training sessions helps in the intellectual stimulation of the staff (Tyczkowski et al., 2015).
Some of the effective measures which could be implemented over here include use of therapeutic communication for dealing with patients like Emily. Therefore, she should feel a part of the care team and not isolated from them. This would help in the development of a trustworthy bind between the patient and the support service providers. As commented by Webster (2014), use of therapeutic communication helps in the establishment of a person centred approach. One of the important aspects of transformational leadership is proper implementation of organizational policies and procedures, which forms the basis of the change management within the organization and helps in the establishment of a positive work culture (Rokstad, Vatne, Engedal & Selbæk, 2015). In this respect, the policy of informed decision making and Mental Health Capacities Act, 2005, are some of the important policies or guidelines which need to be followed. Technical training forms another crucial aspect of the care plan where technological literacy helps in implementation of alternative care plan and approaches (Ericson?Lidman, Larsson & Norberg, 2014).
Some of the other leadership approaches could also be discussed over here such as – breakthrough leadership, servant leadership, and congruent leadership. The breakthrough leadership is based upon development of an effective team which lies at the core of the services delivery (Lynch, McCance, McCormack & Brown, 2017). As commented by Szpak & Kameg (2013), the success of a team is governed by the bonds or the level of trust the team members hold for one another. The servant leadership style on the other hand places much emphasis on the values and the apathy with which the services are delivered. The congruent leadership approach is based upon drawing a match between the values, actions, beliefs and the leadership style (Knapp, Iemmi & Romeo, 2013). Therefore, in order to deal with the gap within the team working skills the breakthrough leadership approach can be adopted.
During my tenure as a supervisor of the dementia care unit looking after Emily and patients like here I had come across many shortcomings. There was a lack of clear policy and guidelines which resulted in erroneous planning and implementation of the care services. Additionally, the lack of effective management also hampered the standards of the healthcare services. The lack of sufficient awareness and evaluative measures resulted in poor skills development within the healthcare staff (Lai, 2016). Moreover, there was a clear violation of the health care policies such as the policy of informed decision making. The family members of Emily were not consulted with before putting her in isolation or chaining her.
This was also in violation of the Mental Health Capacities Act (2005), which states the health and support service users should be given equal freedom in participating in the treatment process or choosing their suitable care options (“Mental Health Legislation and Human Rights | Australian Human Rights Commission”, 2017). Therefore, the goal was to provide sufficient autonomy to the care and support service users in choosing their care plans and treatment methods. I could use the policy of informed decision making over here which stated that the care plans and interventions had to be discussed with the patient and their respective families highlighting the benefits of the implementation of the same.
Thus, the management and the staff failed to inculcate the wishes of the patient and her respective family in drafting of the care plan. In the absence of an effective leadership there was also lack of motivational spirits in the staff who would look at the duties levied upon them as an additional level of burden. Therefore, I would need to ensure as a healthcare supervisor that the staffs are sufficiently motivated and willing to contribute towards the utmost benefits of the support services users.
Therefore, training and feedback sessions can be incorporated within the healthcare services for improving the skills of the staff as well as allow them to work upon their weaknesses. Some of motivational methods which could be used by me over here alongside imparting training and provision of feedbacks to the healthcare staff are providing them with performance bonus and incentives. I would also like to develop upon the skills of therapeutic communication which would help me in to correlate with the staff and patients on a personal level.
Conclusion
The reflection through the clinical scenario helped me in understating the loopholes and strengths of different leadership approaches. On reflecting upon the current scenario it was found that some of the objectives of the transformational leadership were not followed such as individual consideration and intellectual stimulation. The rights of the support user to participate in the decision making had been violated over here. Similarly, lack of training along with gaps within policies and procedures deteriorated the standards of the heath and support services.
References
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Day, G. E., & Brownie, S. (2014). Rising to the challenge: Nursing leadership via nurse-led service provision for chronic disease management and prevention. Nursing and Health, 2(2), 30-34.
Ericson?Lidman, E., Larsson, L. L. F., & Norberg, A. (2014). Caring for people with dementia disease (DD) and working in a private not?for?profit residential care facility for people with DD. Scandinavian journal of caring sciences, 28(2), 337-346.
Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), 11-22.
Knapp, M., Iemmi, V., & Romeo, R. (2013). Dementia care costs and outcomes: a systematic review. International journal of geriatric psychiatry, 28(6), 551-561.
Lai, C. Y. (2016). Training nursing students’ communication skills with online video peer assessment. Computers & Education, 97, 21-30.
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Mental Health Legislation and Human Rights | Australian Human Rights Commission. (2017). Humanrights.gov.au. Retrieved 31 December 2017, from https://www.humanrights.gov.au/our-work/disability-rights/publications/mental-health-legislation-and-human-rights
Rokstad, A. M. M., Vatne, S., Engedal, K., & Selbæk, G. (2015). The role of leadership in the implementation of person?centred care using Dementia Care Mapping: a study in three nursing homes. Journal of nursing management, 23(1), 15-26.
Ross, E. J., Fitzpatrick, J. J., Click, E. R., Krouse, H. J., & Clavelle, J. T. (2014). Transformational leadership practices of nurse leaders in professional nursing associations. Journal of Nursing Administration, 44(4), 201-206.
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van Charante, E. P. M., Richard, E., Eurelings, L. S., van Dalen, J. W., Ligthart, S. A., Van Bussel, E. F., … & van Gool, W. A. (2016). Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. The Lancet, 388(10046), 797-805.
Webster, D. (2014). Using standardized patients to teach therapeutic communication in psychiatric nursing. Clinical Simulation in Nursing, 10(2), 81-86.
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