Caring Interventions and Collaboration

Nurse-initiated intervention:

is an autonomous action based on scientific rationale that a nurse executes to benefit the patient in a predictable way related to the nursing diagnosis and projected outcomes. 

• Interventions do not require an order. 

• Interventions should address factors causing/contributing to the patient's problems.

Nursing interventions should be: 

• Valued, whenever possible, by the patient and family.  

• Appropriate in terms of the diagnosis/patient problem and related patient outcomes, safe, and efficient.  

• Consistent with research findings and standards of care.  

• Realistic in terms of the abilities, time, and resources available to the nurse and patient. 

• Compatible with the patient’s values, beliefs, and cultural and psychosocial background. 

• Compatible with other planned therapies. 

Four concepts common in nursing theory that influence and determine nursing practice are:

(1) the person (patient), (2) the environment, (3) health, and (4) nursing. 

Descriptive nursing theories:

describe a phenomenon, an event, a situation, or a relationship. They further identify the properties and components of each of these as well as the circumstances in which it occurs.

Prescriptive nursing theories:

address nursing interventions and the consequences of those interventions; they are designed to control, promote, and change clinical nursing practice.

Leadership:

has been described as the ability to direct or motivate a person or group to achieve set goals.

Explicit power:

is authority granted by a formal position or title.

Implied power:

is influence earned through personal qualities, relationships, and trust, not official rank.

Leadership qualities: 

• Most people admire a charismatic, dynamic, enthusiastic, visionary leader who is poised, confident, and self-directed. 

• Values learning and must be knowledgeable. 

• Understands culture in the environment. 

• Has emotional intelligence 

Emotional Intelligence: 

the ability or skill to be intelligent about emotions, our own and those of others. 

Autocratic leadership (directive leadership or authoritarian leadership):

involves the leader assuming control over the decisions and activities of the group. 

• Staff and team members have limited opportunity to contribute suggestions and participate in organizational decisions. High staff turnover and burnout are more common with this style of leadership. 

Democratic leadership (participative leadership):

is characterized by a sense of equality among the leader and other participants. Decisions and activities are shared. 

• Increases group satisfaction and motivation 

• May slow decision making 

Laissez-faire leadership (nondirective leadership):

the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. 

• Encourages independent activity by group members. 

• Only useful when all staff members are experts. 

Servant leadership: 

is a leadership philosophy where leaders prioritize the growth, well-being, and needs of their team members above their own, fostering personal and organizational development. 

Quantum leadership theory:

views an organization and its members as interconnected and collaborative—a helpful approach when unpredictable events and changing environments present themselves. 

Transactional leadership style:

is based on a task-and-reward orientation. Team members agree to a satisfactory salary and working conditions in exchange for commitment and compliance to their leader. 

- Leaders maintain control by rewarding good behavior and punishing behavior they perceive as detrimental or negative. 

- Employees have minimal opportunities for creative thinking and involvement in organizational decisions, and employer and employee may not share a common vision. 

Transformational leadership:

can create revolutionary change. Often described as charismatic, transformational leaders are unique in their ability to inspire and motivate others. 

- This style of leadership is a key component of organizations that achieve Magnet status. 

Magnet status/Magnet hospitals:

They attract and retain professional nurses who experience a high degree of professional and personal satisfaction through their practice. 

- These institutions used a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. 

- Magnet status is awarded for 4 years, after which organizations must reapply. 

The magnet recognition program empowers organizations to: 

• Attract and retain top talent. 

• Improve care, safety, and satisfaction. 

• Foster a collaborative culture. 

• Advance nursing standards and practice. 

• Grow business and financial success. 

Research and surveys provide evidence that Magnet hospitals have:

better patient outcomes, shorter lengths of stay, higher patient satisfaction, and higher nurse job satisfaction and nurse retention than hospitals without this governance style of leadership. 

How has the implementation of “Just Culture” changed health care?

• Improved accountability and safety.

• Increased the amount of open communication which turned into opportunities for improvement.

What is expected from nurse managers?

• Manage their unit budget within prescribed constraints

• Deliver a high level of quality care to patients on the unit

• Develop and serve as mentors for junior staff

• Comply with regulatory requirements

• Be experts at human resource management. 

What is the role of management?

The plan, organize, direct, and control available human, material, and financial resources to deliver quality care to patients and families. 

Centralized management structure:

senior managers generally make decisions. Those further down in the hierarchy of the organization are often responsible for implementing decisions into which they had little input. 

Decentralized management structure:

decisions are made by those who are most knowledgeable about the issues being decided. Nurses are thus intimately involved in decisions concerning patient care. 

Conflict management:

is a process to work through conflicts in a way that minimizes negative effects and promotes positive consequences. 

Conflict engagement:

teaches skills to help nurses perform well in the face of conflict instead of finding a work-around to avoid conflict. 

This approach is recommended for conflict engagement:

PEARLA — stands for Presence, Empathy, Acknowledgment, Reflect (or Reframe), Listen openly, and Ask questions. 

Avoiding (Conflict resolution strategies):

There is awareness of the conflict situation, but the parties involved decide to either ignore the conflict, or avoid, or postpone its resolution.

Collaborating (Conflict resolution strategies):

This is a joint effort to resolve the conflict with a win–win solution.

Competing (Conflict resolution strategies):

This approach results in a win for one party at the expense of the other group.

Compromising (Conflict resolution strategies):

For this technique to be effective, both parties must be willing to relinquish something of equal value.

Cooperating/Accommodating (Conflict resolution strategies):

One party makes a conscious decision to let the other group win.

Smoothing (Conflict resolution strategies):

Smoothing is an effort to compliment the other party and focus on agreement rather than disagreement.

Lewin identified three stages of change: 

Unfreezing, moving, and refreezing.

Unfreezing stage (Lewin):

The need for change is recognized.

Moving stage (Lewin):

Change is initiated after a careful process of planning.

Refreezing stage (Lewin):

Change becomes operational.

Planned change:

is a purposeful, systematic effort to bring about change.  

- Nurse managers most often implement planned change. 

- There are eight steps in the process of change, which are somewhat similar to the steps of the nursing process. 

- Skipping any of the steps can result in the vision being sabotaged. 

People resist change for several reasons: 

• Threat to self. 

• Lack of understanding. 

• Limited tolerance for change. 

• Disagreements about the benefits of change. 

• Fear of increased responsibility. 

Nurses acting as change agents find the following guidelines helpful for overcoming resistance to change: 

• Explain the proposed change to all affected people in simple, concise language. 

• List the advantages of the proposed change. 

• Relate the proposed change to the person’s or group’s existing beliefs and values. 

• Providing opportunities for open communication and feedback. 

• If possible, introduce change gradually. 

These are the two most common management strategies:

the SWOT analysis and SOAR strategic planning.

SOAR analysis (Strengths, Opportunities, Aspirations, and Results):

is a strategic planning technique that helps organizations focus on their current strengths and opportunities and create a vision of future aspirations and the result they can bring. 

SWOT analysis:

You will identify Strengths, Weaknesses, Opportunities, and Threats. 

Strengths-based leadership:

focuses on the development or empowerment of strengths as opposed to weaknesses or areas of needed growth. 

• the strengths-based team is understood as a team of talented and different individuals who are known for their strengths, and they compensate for the shortcomings of each other. 

Appreciative leadership:

focuses on the recognition of strengths in others and, using relational processes and methods, builds on these strengths to collectively make things happen. Thus, it is about recognizing potential in others and supporting them to accomplish more. 

There are 5 strategies of appreciative leadership: 

• Let people know they belong. 

• Let people know they are valued. 

• People need to know where the organization is headed. 

• Excellence is expected and depended on. 

• People need to know they are contributing to the greater good. 

Thought leadership:

applies to a person who is recognized among their peers for innovative ideas and who demonstrates the confidence to promote those ideas. Thus, thought leadership refers to any situation in which one individual convinces another to consider a new idea, product, or way of looking at things. 

The management process involves:

Planning, organizing, staffing, directing, and controlling.

Planning (management process):

encompasses determining philosophy, goals, objectives, policies, procedures, and rules.

Organizing (management process):

includes establishing the structure to carry out plans.

Staffing (management process):

consist of recruiting, interviewing, hiring, and orienting staff.

Directing (management process):

motivating, managing conflict, delegating, communicating, and facilitating collaboration.

Controlling (management process):

include performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.

Interactional theory:

is that leadership behavior is generally determined by the relationship between the leader’s personality and the specific situation. 

Transactional leader:

The traditional manager, concerned with the day-to-day operations. 

Transformational leader:

The manager who is committed, has a vision, and can empower others with this vision. 

Full-range leader:

a leader who could apply principles of three specific styles of leadership at any given time: transformational, transactional, and laissez-faire.