You have Five Associate Managers in your team. You have just read an Interesting article: Lynch B.M., Mc Cormack B., & Mc Cance T. (2011). Development of a Model of Situational Leadership in Residential Care for Older People.
Practice development refers to the process of “developing person-centered cultures” (Manley et al., 2013). Practice development is gaining momentum as health care providers intend to use a systematic approach to transform work-based culture to deliver person-centered care. Person-centered care involves respect for clients, connecting with individuals and valuing the individual contributions (McCormack et al., 2013). There is a difference between practice development generally and specific activity. The former means over all development in practice whereas the later deals with the development of specific activity in nursing practice (say patient-centered care). The aim of the assignment is to examine the theory and concepts of practice development and consider their relevance to a context of nursing practice. The assignment discusses the philosophic premises of practice development. Further, the essay discusses the practice development Activity method- transformational practice. It aligns with Situational leadership model, which was found to be effective in enhancing patient centered care in my workplace and is demonstrated in essay. The essay describes the workplace situation of nurse unit manager for application of the theories. The objective is to enhance the person-centered care in personal practice. I will work with the team of five associates as the nurse’s team leader.
According to Healy (2014), critical social theory underpins practice development. The theory assumes that society and the community are shaped by social structures and collective culture. Within the health care system, the cultural and linguistic barriers impede the effective communication between care providers and patients (Lynch, 2015). This hampers the process of decision making for the improvement of patient care. Practice development, however, helps the patients and carers actively engage in meaningful conversation to make clinical decisions. This process will better help clinicians and nurses to understand, challenge and change the culture to improve patient care. Eventually, the health care professionals become active participants in the change process.
Practice development process requires Clinical leadership skills. The clinical leader can ensure effective teamwork through effective communication and collaboration (Démeh & Rosengren, 2015). In this process, all the members get equal opportunity to give their opinions. The opinions and ideas of each member are respected and valued. Together an effective decision is made on improving patient care focusing on the quality of the health care. Clinical leadership does not always mean the collaboration is initiated by the leader. For example, in nursing leadership, all the team members should collaborate with each other and the health practitioners to bring change (Démeh & Rosengren, 2015). According to Chinn & Kramer (2013), individual nurses should cultivate the leadership skills to excel in the clinical care.
According to Lind e al. (2016), the service delivery model is appropriate for practice development. This model involves a person-centered approach. The model has an emphasis on relationship-based interventions and has an interdisciplinary focus. As per the study undertaken by Mill et al. (2016), the service delivery model is appropriate for creating a change in the organisation. To initiate a change in any organisation, transformational leadership theory is applied. It involves the components of intellectual stimulation, inspirational motivation, individual consideration and idealised influence (Ross et al. 2014). This leadership is the main skill for nurses holding the key to patient-centered practice development. Situational leadership refers to use of different leadership styles in different situations. So, there might be some situations where only transformational leadership can be used. Therefore, situational leadership framework is best suitable for creating change in the organisation while working as a team. (McCleskey, 2014). In a team different nurses may work with different perspectives, therefore, using situational leadership skills will help deals with issues of individual nurses in the delivering the patient centered care (Leigh et al. 2017).
Every mission statement has a philosophy. For the development of the person centered care in nursing practice, I believe in the philosophy- “strive for excellence in meeting the holistic needs of the patients in a caring and healing environment, while valuing the essential contribution of each member of staff”. This type of philosophy is a theoretical construct that requires a service delivery structure (Lowe, 2017). This philosophy is justified, as the aim is to enhance person-centered care. In the next section, the transformational practice development method is discussed.
As per the literature review, a key practice development activity method, which can be discussed in this context, is the transformational practice development. The rationale for choosing this method is it is a critical inquiry process (Manley et al., 2013). This method is appropriate to initiate change. To implement and instil the culture of the patient-centered care, this approach is appropriate. According to Ross et al. (2014), transformational practice is relational, discursive and embodied. Bringing such changes in the practice or in clinical leadership style for improving the quality of care, there is a need of generating new knowledge and insights into research, while change occurs simultaneously. The transformational practice development emphasises use of collaborative, inclusive and participatory approaches. Thus, for developing the person-centered care the transformational leadership style is effective. However, when working within team not all the members may be in same page. Therefore, situational leadership model is adopted where some of its elements align with transformational leadership style.
In the situational leadership style, there are four levels of maturity in the followers. M1 is the bottom level of the scale. In this stage, the followers lack the skills; knowledge and confidence to work. The followers need to be pushed by the leader to act towards change. In the M2 level, the followers have some willingness to work on the task. However, the followers in this stage lack the skills to complete it successfully and achieve the common goals of team. In M3 level, the followers are ready and are willing to do the task. Followers at this stage have more skills than the followers of M2 group. At this stage, the followers are still not confident in their capabilities. In M4, followers are highly confident and committed to task. Therefore, the leader focuses less on the relationship with and the support over the followers (Lynch, 2015).
I will be using situational leadership model for person-centered care development activity because this method uses the participatory communicative spaces for knowledge and learning creation. I will assess the maturity level of each nurse in my team and lead her. The implications for practice using this approach requires the nursing team members (for this context) to have skills and courage. The nurse leaders must be skilled in guiding emancipatory and participatory processes for the staff members. It aligns with the transformational leadership style (Manley et al., 2013). I will be self-reflexive and critically mindful of the other nurses during patient care. It will ensure the authenticity of the work being performed. While initiating the change, I will ensure the social justice and well-being for all to flourish. Thus, I would implement the situational leadership framework and adopt the mentioned skills to enhance person-centered care attitude among team members in my workplace.
As per Leigh et al. (2017) the methodology of the transformational practice development is useful to identify the current practices and the values at the ward unit level. This method provides a basis to challenge practices and aligns with the situational leadership model (for followers of M4 level). The nurses can challenge the workplace cultures that will enable them the new ways of working, which should be evidence-based.
The aim of developing the person-centered care can be initiated in many ways. Let us consider a scenario in my practice. I work as Associate nurse unit manager and has been assigned to lead the word as ANUM in absence of my manager. I am the in-charge and hold responsibility to ensure that the staff are admitting patients correctly and the patients are being cared for well. The nurses in my ward are providing inpatient care for the management, treatment and review of patients with complex, chronic and multiple health care conditions, generally associated with ageing. The unit operates within an interdisciplinary framework with medical, nursing, pharmacy and allied health staff providing goal orientated individualised patient care. While I was leading the team of junior nurses, I have observed that they fail to implement patient-centered care. My aim is to collaborate with my team associates to implement the culture of patient-centered care. My objective is to teach them to respect the patients and deal with them in the way that will not compromise their dignity.
The person-centered theory can be well integrated with the situational leadership theory for personal practice . It is the useful framework to identify the level of support required for the associates in my team throughout the process of empowerment and enlightenment to that of the transformative action (McCleskey, 2014). When implementing the situational leadership model, the goal would be to initially analyse the needs of each of the associates in my team. My leadership style would vary from one team member to other depending on the competencies of each of the associate in their tasks and the level of commitment. Different leadership styles of situation leadership model are discussed in subsequent sections.
For the above-mentioned scenario, the situational leadership style is most appropriate In this scenario, my team associates are in the M3 stage. For this maturity level of followers, the most appropriate leadership style is the “Participating/supporting” (Lynch, 2015). I will give less direction on what should be the patient-centered care attitude. My actions will demonstrate high support on implementing the Monash Health Nursing and Midwifery Governance Framework to strengthen consistency in accountability and responsibility across the profession. I will focus more on establishing strong relationship with my teammates to explain them factors that may hamper a patient’s respect or dignity. I will address their concerns on patient’s assessment by providing evidence-based solution. Currently, I find myself to be cautious contributor of the team. Considering the personal development level and the followers’ maturity level, this leadership style is appropriate.
In “Telling/directing” leadership style, a leader supervises the followers closely and may focus highly on the task. In this leadership, style there is little room for building a strong rapport with the followers. In this style of leadership, the leader defines the role of the team associates and communication is usually one-way (McCleskey, 2014). I will apply this style if any of my associates are enthusiastic but lack competence to deliver patient-centered care. In the “selling and coaching leadership” style, a leader has high focus on the relationship with the followers as well as task. A two-way communication system is used for making decisions. Decisions are based on the ideas and suggestions from the follower. I will apply this leadership style for the associates who have poor commitment but demonstrate good competence in the work. In this situation, my role as a team leader will be to support and praise the team member to enhance their self-esteem. I will involve them in decision making related to ward to restore their commitment towards patient-centered care (Peus et al., 2013). I will emphasise on more direction and supervision for followers who are relatively inexperienced.
There is other leadership style for the followers who are in M4 level as per situation leadership model. If followers are in this level, my aim will be to focus less on nursing tasks and on relationship with the nurses. I will be involved in the decision-making and problem solving with them. I would ensure that the team associates gain confidence to refer to me only in serious dilemma regarding nursing care. I will use this leadership style with followers who are highly competent and committed towards patient centered care (Lynch, 2015).
The philosophy of “striving for excellence” can be used in workplace by incorporating organisational values and the situational leadership framework. Organisational values are human dignity, justice, compassion, quality and advocacy. The nurse manager must support and empower the nurses in the team as they impart the knowledge, skills and attitudes (Auld & Bishop, 2015). I would implement this philosophy to build a strong rapport with my team. While implementing this philosophy, different leadership style will be used in different situations. Having enthusiasm and positive attitude encourages a holistic client-centered approach to care. I can also turn other associate in my team to be positive in their actions. By making them aware of the organisational goals and my personal philosophy, I will help them take independent actions wherever necessary. It will help the nurses to take autonomous actions in providing patient-centered care, which aligns with the coaching leadership style situational model (Bjarnadottir et al., 2015).
The team members through involvement in the difficult conversation can implement the change in care towards the patient. It will help to set the new goals. Each member should engage in the process of critical analysis and support the ongoing development in care. I will engage in difficult conversation with the team associates to resolve the issues hampering the work (Masters, 2015). Nurses and the team leaders can evaluate the change by considering how the behaviours, systems and processes applied aligns with the person-centered culture. My strategy will be to evaluate if the practice aligns with the values nurse associates have identified for person-centered practice (Arnold & Boggs, 2015).
Conclusion
The essay discussed the concept of the practice development in the context of nursing. Various theories underpinning the practice development is discussed. Emphasizing on establishing the patient-centered culture in the hospital; I will work with the team of five associates as the nurse’s team leader. An effective leader should be versatile in moving around the matrix as per the situation. I believe that there is nothing called right leadership style that will be applicable in all situations. Dealing with the team members with each one at different level of maturity demands to apply the situational leadership style. I will use the most appropriate leadership style with the aim of taking each of my associates to a level where they will be highly competent and committed towards common goal of patient-centered care. This will ensure the transformative practice development. The philosophy of “striving for excellence” can be used in work by incorporating the organisational values. It is concluded from the overall discussion that the nursing team as a whole should be able to facilitate the pre and post-registration nurse members in developing the nursing practice to promote patient-centered care. For development in the clinical setting, it will better promote the team members to liaise with the Nurse Education Centre, to put forward the education and training needs. It will contribute to different multidisciplinary projects. It can be interdisciplinary projects, policies, and Student Nurse Education programmes. It will help produce tools that the staff needs to improve practice. It will help introduce curriculum changes or changes in the protocol for patient care for different illness (McCormack et al., 2013). Lastly, the nurses and the team leaders can evaluate the change in the practice by considering how the behaviours, systems and processes applied aligns with the person-centered culture.
References
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