Final Exam NURS3720

Management

• Getting the job done & ensuring people have resources to get their job done

• Requires practice knowledge to know their pt. population

• Set goals & objectives & achieve withing timelines & budgets

relational leadership

• Building positive relationships w/ interprofessional team & supporting a positive workplace environment

• Characteristics:

  • others-oriented

  • caring

  • active listening

  • Approachable & authentic

  • Ethical decision maker

  • Nurtruing

  • Open to feedback

• Benefits

  • Builds trust with team members

  • Builds a supportive & engaged team

  • Leads to improved patient outcomes

  • Increases job satisfaction

• Leadership approaches

  • Authentic leadership

  • Servant leadership

  • Transformational leader

Followership

• Engaging w/ others who are leading or managing by contributing to the works that needs to be done

• Involves actively participating & challenging leadership decisions

Personal Attributes needed to Lead, Manage & Follow

• Sense of ethical responsibility

• Code of ethics

• Patient-centered care

• Emotional intelligence

• Appreciative Inquiry

• Resilience

• Mindfulness

Emotional intelligence

• ability to know oneself and others

• Characteristics

  • Self-awareness: emtotional awareness, accurate idea of self and self-confidence

  • Self management: self-control, adaptability, initiative, achievement drive

  • Social awareness: empathy, organizational awareness, service orientation

  • Relationship management: inspirational leadership, developing others, influence, change catalyst, conflict management, building bonds & teamwork

Appreciative Inquiry

• Ongoing continuous study of what gives life to a human system when it is functioning at its best

• Focuses on what is working, strengths and successes

Nursing Managers

• Ensures task are completed efficiently & effectively

• Oversees day-today operations & enforces policies

• Relies of structured, evidence based decision making

• Delegates responsibilities & monitors performance

• Task-focused to enforce organizational and regulatory policy & procedures

• Meeting deadlines & adhering to standards

Nursing Leaders

• Inspire & motivate team towards shared vision & team goals

• Encourage collaborative & creative problem solving

• Builds relationships & empowers team members

• Future-focused, fostering growth & adaptation

• Communication, inspiration & emotional intelligence

Leadership Theories

1. Trait leadership

2. Style leadership

3. Situational-contingency leadership

4. Transformational leadership

5. Authentic leadership

Trait leadership Theories

• The Great Man Theory

• Leaders have certain set of physical & emotional traits crucial for inspiring other

• Debate on whether these traits can be learned or are born w/

• Application: Self-awareness of traits is useful to assess personal strength and apply them

• Leadership theory

• Traits Classified

  • Cardinal: rare; dominating personality

  • Central: personality not as dominating; honest, shy, etc.

  • Secondary: attitudes & personality preferences; anxiety & impatience

Style Theories

• Focuses on how leaders behave

• Based on task & relationship behaviors

• Leaders need to be develop competences in completing task & maintaining relationships to be successful

• Leadership Theory

• Styles of leadership include:

  • task-oriented

  • People-oriented

  • Country club

  • Status quo

  • Dictatorial

Situational Contingency Theory

• Leadership effectiveness depends on situational factors

• Patho-goal theory: leader’s behaviors should be dependent on the task & followers characteristics

• Leaders should asses each situation differently & determine appropriate actions

• Leadership theory

• Factors that impact a leader:

  • Type of company

  • Size of company

  • Innate leadership style

  • Customer feelings/satisfaction

  • Marketplace

Transformational Theory

• Leaders inspire & motivate workers to embrace change

• relationship focused leadership

• Fosters workplace accountability, ownership & autonomy

• Leaders have 4 attributes

  • Idealized & charismatic

  • Inspirational motivators

  • Intellectually stimulating

  • Considerate

• Example: Uses effective communication skills to build trust & establish a shared vision around a culture of safety where everyone understands their role in working to protect patients.

Authentic Leadership Theory

• Leaders are aware of own values & morals & are align their actions to match their values

• Self-aware, transparent, genuine, ethical

• Fosters trust & respect

• Team members feel comfortable providing honest feedback

• Examples: Champions initiatives to improve patient safety, openly shares concerns about staffing shortages & actively participates in team discussions to adrdress challenges

Management Theories

• Taylor founder of scientific management & efficiency movement

  • Introduced concepts: labour division & specialization, systematic analysis of relationship between workers & assigned task, written standardized procedures, close supervision, shared manager-worker responsibility for goal achievement, etc.

• Mintzberg: focused on organizational structures & process contributing to management theory

  • Proposed coordination mechanism to complete complex task, standardization of work processes outputs, worker skills & knowledge, etc.

Complexity Science

• the study of complex systems: how they are sustained, self-organize, relationships within them & how outcomes emerge

• Nurses must be flexible & dynamic to keep up w/ changing systems of people, health care, public policy, & human relationships

• Achieve through networking, attractors, emergence, systems thinking & the Butterfly effect

• Followship Theory

Competencies for Leadership & Management

• Managing the business

• Leading within

• Leading people

Self Leadership (check textbook)

• Journey of understanding who you are

• Learning skills & abilities to guide personal leadership path

• Strength based approach

• Develop internal self-control, self-determination & self-regulation

• rooted in emotional intelligence

• Core characteristics

  • Understanding one’s values and how they influence decisions

  • Self-awareness, self control, self regulation

  • Knowing strengths & weaknesses

  • Growth mindset

  • Goal setting

  • Coaching oneself

  • Embrace failure

Group vs Team

• Group: collection of people aware they belong together & have social ties

• Team: collection of people who are working together to achieve a set goal

Interdisciplinary Team

• Composed of members from different clinical disciplines with specialized knowledge, skills & abilities

• Ex: nurses, surgeon & physiotherapists working together for the needs of a pt. receiving postoperative care after orthopedic surgery

Intraprofessiona team

• Composed of individuals withing the same profession

Interprofessional Team

• comprised of different health or social professions working together toward common goals to meet the needs of a patient population

• Work is divided based on scope of practice

Canadian Interprofessional Health Collaborative Competency Framework

1. Relationship-focused care/service

2. team communication

3. role clarification & negotiation

4. Team functioning

5. Team differences/disagreements processing

6. Collaborative leadership

Relationship Focused Care/Service CIHC Framework

• All members of team will collaborate, create purposeful relationship among & between care/service partners & persons participating in or receiving care/services

• Reflect on value & diversity of thoughts, beliefs, talents, literacy & experiences into designing, implementing & evaluating care/services

• Develop & continuously cultivate trusting relationships

Team Communication CIHC Framework

• All members of a team will communicate w/ each other in cooperative, responsive & respectful manner while paying attention to context & relational elements of communications

• Foster open & authentic communication and address potential communication barriers

Role Clarification & Negotiation CIHC Framework

• All members of team understand & negotiate their own role & roles of all while using their knowledge & skills appropriately to achieve collaborative relationship-focused care

• Seek to understand knowledge, skills and values of team members & including person participating in or receiving care service

Team Functioning CIHC Framework

• All members of team understand nature of interprofessional teams

• Team members work interdependent & bring shared perspectives to cooperate, coordinate & collab towards shared goal

• Optimize efficiency & effectiveness of all members time, expertise & contributions

Team Differences/Disagreement Processing CIHC Framework

• Establish a safe enviro. to express opinions & develop level of consensus among different views

• All members must actively engage constructively in addressing disagreements

• Acknowledge, recognize & value potential positive nature of differences in team

Collaborative Leadership CIHC Framework

• All members of team value each other ‘s knowledge, skills & expertise

• Acknowledge eveyone contributes different strengths & perspectives

• Value & support each other in sharing decision-making, accountability, & responsibilities to achieve common goals

Synergy

• phenomenon where an effective team works together to produce results & achieve a common goal that couldn’t be achieved by any one individual

• To create synergy team requires

  • Clear purpose

  • Active listening

  • Compassion

  • Telling the truth

  • Flexible

  • Committing to resolution

Positive Communication Model

• When humans are distressed, disengaged or have emotional reactions to situation or blame they respond with blame judgement or demand

• Reacting at feeling level = unconsciously; blame so by taking accountability for these feeling you move out of blame & focus on “I feel”

• Trapped in distress or reaction = judgement; so by being compassionate you can respond with “I think”

• Distress = make unreasonable demands; so by calming oneself we can find respect & make a request “I want”

Communicating During Conflict 4 Steps

1. Stop: considering the situation can prevent regretful interaction, collect/organize thoughts & time to think how response

2. Think: analyze situation; how do you want to change the other person, situation, or yourself

3. Listen:

4. Communicate

   • Linear: focus on goals, purpose & intention of message

   • Transactional: focus on process of communication; allows conflict to not be one-sided

STOP5: Critical Event Debrief

• Stop for 5 minutes

• Start w/ intro

  • Is everyone okay?

  • explain purpose

  • participation not compulsory

  • confidential

S:summary of the case

T:things that went well

O: Opportunities to improve

P:points to action and responsibilities

TAKE STOCK: Hot debrief Tools

Take an instruction sheet

Ask if everyone is okay

Know if anyone needs a break

Equipment issues?

Summaries the event

Things that went well

Opportunities to learn

Cold debrief necessary?

Know who is present

Hot/clinical debriefs

• Structured interactive team discussion that occur immediately after a clinical event

• Addresses immediate concerns, calm emotions & make sense of event

• Facilities reflection identifies strengths & areas improvement, and promotes learning

Why do a Clinical Debrief?

• Improves healthcare performance

• Leads to better patient outcomes & safer healthcare

• Opportunity to discuss, experience & learn for each other & better collaborate

• Manage stress, emotions, & strengthen resilience from challenging events

• Identify system issues & implement change

Active Listening Guideliness

• Be compassionate

• Tell the truth

• Be flexible

• Manage emotions

Communication Pitfalls

• Give advice

• Make the other feel wrong

• being defensive

• judging

• patronizing

• false assurances

• asking why

• blaming others

Resonant Leadership

• Relationship focused leadership

• High emotional intelligence

• Effective in conflict resolution

• Collab & solution focused

• Encourages team to work at highest potential

• Example: actively seeks & incorporates feedback from nurses acknowledges staff burnouts & implements flexible work arrangements.

Transactional (Autocratic) Leadership

• Task completion leader

• Sets standards for performance & task

• Seeks obedience, loyalty & strict adherence to rules

• Effective in high pressure or crisis situation where clear directives are needed

• Bring structure & clarity to team roles & responsibilities

• Rewards staff w/ recognition or bonuses for achieving targets

• Can lead to low team morale, frustration, stifles creativity & creates dependence

• Example: during a code decisions must be made quickly, the nurse takes control of decision-making due to limited time to collab & discuss.

Laissez-Faire Leadership

• Task completion leadership

• Hands-off approach

• Autonomy for highly-skilled & self-motivated teams

• Team members work independently w/ minimal supervision or guidance

• Works well in creative environments

• May lack sense of direction or accountability

• May lead to difficulties if team members lack initative or need more guidance, supervision or structure

• Example: allow a team of experienced nurses to manage daily task & pt care w/ minimal direction

Democratic Leadership

• Encourages collab, diverse input, & shared discission making

• Works to reach consensus

• Time consuming

• Conflicts & disagreements can arise

• Ineffective in emergencies or w/ inexperienced teams

• Example: staff meet, a nurse manager invited input from team on how to improve shift handover processes. After reviewing everyone suggestions, they collectively decide on a new & efficient protocol.

Servant leadership

• Fosters culture of care, empathy & community

• High level of team satisfaction & patient trust

• Strong sense of selflessness

• Prioritize needs & well-being of others, emphasizes service & development of team members

• Less likely to work well where strict protocols, timeliness & accuracy are required

• Example: prioritizes the well-being of the team by ensuring adequate breaks during long shifts & mentoring junior staff to help grow professionally

Indigenous Leadership

• Not hierarchal or linear

• Holistic, shared & determined by community

• Address issues that affect the collective

• 4-inter-related lenses

  1. Individual leader: skills used to contribute to community well-being

  2. Leadership through culture: actions driven by communities cultural values

  3. Leadership through processes: distributed leadership & collective desicion making involving the community

  4. Leadership through integration: leadership as a communal activity

Key Points in Nursing Leadership

1. Understand personal leadership style & how you will use in nursing practice

2. Consider how you engage w/ your team from a lens of leadership

3. Use a blend of different leadership styles depending upon the situation

4. As you grown & gain experience & confidence as RN you might adjust your leadership approach over time

LEADS in a Caring Environment Framework

• Approach to developing Leadership ability

• Lead self

• Engage others

• Achieve results

• Develop coalitions

• Systems transformation

Strengths-based nursing & health leadership

• Approach to developing Leadership ability

• 6 core values

  • Healing & Health: restoring wholeness

  • Uniqueness: everyone has different strengths

  • Holism & embodiment: all aspects are interconnected & interrelated

  • Subjective reality & created meaning: understanding/interpretations affect reactions/responses

  • Self-determination: take charge, making choices, feelin in control

  • Person environment: goodness-of-fit between environment demands & values, needs, goals, strengths

Horizontal/lateral violence

• hostile and aggressive behavior among colleagues

• workplace bullying, relational aggression or exclusion

Vertical violence

• hostile and aggressive behaviors between individuals at different levels of hierarchical system

Beneficence

• Actions and intentions are aimed at doing “good”

• Provide high-quality, holistic & responsive nursing care based on competent and ethical practices

• Nurses should be educated in accredited nursing programs and maintains competencies in active practice & continuing professional education

• Nursing manages have the obligation to support staff to continue professional education & grow & maintain own clinical competencies.

Autonomy

• Freedom & right to choose what will happen to one’s own person

• Informed consent gives the patient the ability & infomration about options to make decisions

• Patients have the right to be involved in decisions to the extent they are able

• Nurses have obligation to consider the unique needs, opinions and preferences for care.

• Respect for autonomy of one individuals should not come at the expense of another’s

Veracity

truthfulness

Ethnocentrism

• Form of cultural bias

• Individual applies one’s own culture or ethnicity as a frame of reference to judge other cultures, practices or beliefs.

• Places own culture and ethnicity as #1

Acculturation

• Assimilating to a different culture

Confidentiality

• ethical obligation to uphold privacy and security of privately held personal information

• legal obligation to protect personal information & not release information without patient consent

ethical violations

• actions or failures to act that breach fundamental duties to the person receiving care or to colleagues & other HCP’s

• Due to neglect of moral obligations & breach of duty

justice

• Address fairness in regards to how individuals are treated

• Subjective, dependent on situations, decisions, views & process

• Nurses must go above & beyond to support justice by engaging in good & right actions to ensure justice

  • Examples

    • Advocating for vulnerable patients to ensure they receive the best care

    • Reporting unsafe practice

    • Nursing managers evenly distributing workloads

3 Types of Justice

• Distributive justice: how benefits & burdens are allocated; should be equally distributed in society

• Procedural justice: how laws, rules & policies are created & applied

• Substantive justice: how decisions are made about fairness of rules

moral distress

• Knowing the right things to do but system structures or personal limitations prevent doing the right course of action

• Creates feelings of guilt, concerns, frustration, professional dissatisfaction, weakened moral sensitivity, poor mental & physical health, reduced morale, leaving the profession

moral residue

• consequence of moral distress

• When situations of moral distress are unresolved it creates feeling of powerlessness & compromise of self or personal values which can embed into one’s self conflict

moral resilience

• positive result of experiencing moral distress

• Individuals are able to find positive guidance and hope after experiencing situations that are morally distressing

moral uncertanity

• a situation where there are conflicts between one or more values and there is uncertainty about correct course of action

• Resolve through discussion with patient, colleagues, and HC team members

nonmaleficence

• all actions and intentions must “do no harm”

• Requires competence, awareness of safety concerns & anticipation of potentional risk

• Explore what patients believes and perceives as “harm” to respect autonomy

social justice

• Fair distribution of society’s benefits, responsibility & consequences

• Focuses on the relative position of one social group in relationship to others in society and root causes of disparities and actions to eliminate them

• Nurses should explore inequities and address contributing factors, social structures & systems

3 Guides for ethical nursing decisions & actions

• Law: criminal laws, protection laws, nursing regulatory acts, natural laws & labour laws

• Ethical principles: autonomy, justice, beneficence, nonmaleficence, social justice

• Professional accountabilities: code of ethics, standards of care & organizational policies

Ethics

• evaluates whether actions and intentions are “right” or “wrong”

• 3 branches: Meta-ethics, normative ethics & applied ethics

Morality

• code of conduct accepted by a society, group or individual

• Reflected in individual, cultural & professional values

• Based on ideas about right or wrong

Meta-ethics

• explores broader theory & meaning of morality

• Foundation of moral values words & theories

Normative ethics

• focuses on standards most people use to guide behaviors

• Ex: murder is wrong, stealing is wrong, helping others is good

Applied Ethics

• Involved how to apply ethical principles to resolving real-life ethical challenging situations

• Ex: how to provide ethically competent nursing care & how to engage responsible conduct of research involving human participants

Bioethics

• Branch of applied ethics focusing on science and human life

• Considerer principles such as autonomy, justice, beneficence & nonmaleficence

Relational ethics

• Focuses on ethical actions within relationships

• What should I do? What should I do for others? How do my actions affect those around me?

• Core Elements

  • Engagement

  • Mutual respect

  • Embodied knowledge

  • Uncertainty

  • Vulnerability

  • Interdependent environment

Engagement: Relational Ethics

• Participating in engaging interactions that promote interprofessional and patient-nurse relationship

• Nursing leaders have the role as communicator, counsellor, teacher and decision maker.

• Examples of Actions & Behaviors

  • Participate in team meetings

  • Foster/facilitate nurse-patient therapeutic relationships

  • Identifies need for additional supports

  • Provides ongoing professional development opportunities for staff and patients

  • Engaged w/ ethics or advisory committees

Mutual Respect: Relational Ethics

• Nursing leaders have the role as negotiator, team builder and patient advocate

• Examples of actions & behaviors

  • Participate in patient rounds

  • Facilitates IP team meetings

  • Addresses challenges in the team & provides support to work through issues

  • Participates in care discussions w/ patients and families

  • Establishing & maintaining therapeutic relationships

Internal & External factors for Supporting Ethical Relationships

• Internal: fatigue, moral residue, moral distress or values conflict

• External: high rates of turnover, casual nursing staff, staff shortages, high workloads, unhealthy or hostile work environments and poor staff morale.

Conscientious objection

• an instance where a nurse has a personal objection to practicing in certain types of situations or certain procedures due to personal values do not align permitting the nurse to step back.

• Example: medical assistance dying, blood transfusions or situations which accessible care is being refused

Embodies knowledge: Relational Ethics Framework

• Nurses roles:

  • Researcher

  • Coordinator of care

  • Professional development supporter

  • Policy and procedure administrator

  • Expert clinician

• Examples of Actions & behaviors

  • Participates in scholarship and engages in research

  • Takes time to understand unique needs of patients and families

  • Remains current by attending conferences and engaging in the literature

  • Engages with institutional policy and procedure committees

Vulnerability

• Roles as nursing leaders

  • Advocate

  • consultant

  • Risk Manager

• Examples of Actions & behaviors

  • Engages in the literature and with multidisciplinary expert clinicians

  • Helps develop policy and procedures

  • Consults appropriately with allied health care team members, and local experts Advocates for quality care for all

Interdependent environment: Relational Ethics Approach

• Roles as nursing leaders

  • Team leader

  • advocate for social justice

• Examples of Actions & behaviors

  • Applies code of ethics, values, and principles to practice

  • Actively participates in professional associations

  • Actively participates in policy development

CNA Code of Ethics: Nursing Values & Ethical Responsibilities

• Providing safe, compassionate, competent & ethical care

• Promoting health & well-being

• Promoting and respecting informed decision making

• Honoring dignity

• Maintaining privacy and confidentiality

• Promoting justice

• Being accountable

Steps in Ethical Decision Making

1. Clarify the need

2. Identify all involved

3. Arrange a meeting

4. Select a facilitator or chair: must be impartial

5. Identify areas of agreement

6. Identify areas of disagreement

7. Offer resources

8. Seek outside advice if necessary

9. Make a decision

10. Implement the decision