Chapter 1: Leading, Managing, and Following

Chapter 1: Leading, Managing, and Following Introduction - The Canada Health Act: sets out 5 criteria for standards of healthcare delivery - public administration, comprehensiveness, universality, portability, and accessibility - Social determinants of health: education, housing, transit etc. influence an individuals quality of life - The organization for Economic Cooperation and Development (OECD) maintains a health database of health and health systems statistics across many member countries, including Canada - Looks at spending, quality of life, access to care, obesity rates etc. - Leadership: the process of engaging and influencing others - Management: is about getting the job done and ensuring that people have the necessary resources to get the job done - Followership: involves engaging with others who are leading or managing by contributing to the work that needs to be done Personal Attributes and Behaviours Needed to Lead, Manage, and Follow - Emotional intelligence (EI): individuals are aware of their own emotions and can regulate and control their emotions, particularly in response to stressful or challenging situations - Appreciative Inquiry (AI): how we question and problem-solve. It engages people in identifying and accentuating positives within a context, such as a practice environment - Resilience: an attribute associated with surviving or thriving in the aftermath of an adverse or tragic event. Resilient individuals are able to bounce back - Mindfulness: a mindful person has increased awareness of what is happening in the present moment Theory Development in Leading, Managing, and Following - Trait theories: the view that people are born with the traits that make them leaders - Great man theory - Style theories: style theories consider how leaders behave, leaders much adapt their response to the situation at hand - Situational-contingency theories: proposes that leadership effectiveness depends on the given situation - Fiedler's contingency model - Vroom and yetton’s normative decision making model - House and Mitchells path-goal theory - Hersey and Blanchard's situational leadership theory - Transformational theories: - Transformational Theory - Transactional theory - Authentic leadership: authentic leaders are aware of their own convictions and are constantly realigning their actions to match their values The Promise of Complexity Science - Complexity science: it views systems holistically, it considers the whole to be greater than the sum of its parts - Networking - Attractors - Emergence - Systems thinking - Butterfly effect Yes, this chapter was useless Chapter 2: Developing the Role of Leader The Importance of Leadership in Nursing - Leadership: being able to see the present for what it is, see the future for what it could be, and then take action to close the gap between today’s reality and the preferred future of tomorrow - Leadership is extremely important in healthcare The New Competencies for Nurse Leaders - Essential skills include emotional intelligence, judgement and decision making, negotiation, critical thinking, people management, complex problem-solving, data management, competence in technology, and political acuity - Chunharas and Davies propose the new agenda on leadership in nursing should encompass the following: - Interactive leadership, which includes different actors within the health systems - Empowerment of operational leadership to look at new mechanisms and build a learning health system - Involvement of communities, patients, and families in the health dialogue - Increasing evidence and research to understand leadership in health systems - Imposter phenomenon: self-doubt in one’s ability to function adequately in one’s role - This may prevent nurses from taking advantage of leadership opportunities because of feelings of inadequacy Leadership, Health Informatics, and Social Media - The 6 P’s of social media use: 1. Keep it positive 2. Maintain the privacy of others 3. Keep it professional 4. Keep it person free (no specific reference to others) 5. Protect your professionalism 6. Always pause before posting Different Leadership Styles - Autocratic leadership: an autocratic leader is often described as being close-minded, controlling, and seeking power. These leaders to not accept input from others and negative reinforcement, blame, and punishment are common - Laissez-faire and instrumental leadership: uses a hands-off approach allowing others to do the leading. Often responses are left for others and responses are reactive and not proactive. - Emotional intelligence leadership: this type of leader can manage and reflect on their emotions and engage in rational decision making to effect cooperation and change in the work environment by building collaboration and teamwork - Resonant leadership: based on mindfulness and emotional intelligence, present in the moment, and open and responsive without judgment. - Participatory leadership: considers the opinions of individuals and communities and their skills, experience, and knowledge. It is based on respect and aims to optimize the collective strengths of the people - Agile leadership: the agile leader has the ability to anticipate the need for change and take effective action in conditions never witnessed. - Diplomatic leadership: there are 9 essential attributes of a diplomatic leader: culture development, collaboration, connection, centeredness, clarity, communication, candor, consistency, and curiosity - Embodied leadership: individuals learn ways to deepen awareness of the mind and body as an interdependent system to remain grounded, engaged, and open. - Shared leadership: people see themselves as leaders despite their lack of formal positional power. - Eg. informal leaders The Impact of Leadership - Patient outcomes: patient satisfaction, patient safety - Nurse outcomes - Practice setting outcomes Chapter 5: Patient Focus Safe, Competent and Ethical Practice - Nursing regulatory bodies, among various duties, are responsible for establishing, monitoring, and enforcing the professional standards that govern the practice of nursing - Professional standard: an “authoritative statement that sets out the legal and professional basis of nursing practice” - Standards commonly include statements regarding accountability and - responsibility, the competent application of knowledge, continuing competence, ethics, nurse-patient relationships, and interdisciplinary collaboration Code of ethics: a statement of set of values that help guide nurses in ethical practice - CNA Code of Ethics Patient-Centered Care - The main focus of healthcare is the patient, but in the past the organization or health care providers have been put above the needs of the patient. - Patient or client-centered care: is an approach in which the patient is viewed as a whole person; it is not just about delivering services and involves advocacy, empowerment, and respecting the patients autonomy, voice, self-determination, and participation in decision making - The RNAO identified 4 themes that form the foundation of patient-centered care: - Establishing a therapeutic relationship for true partnership, continuity of care, and shared decision making - Care is organized around, and respectful of, the person - Knowing the whole person (holistic care) - Communication, collaboration, and engagement - Client-centered care is the foundation of nursing education and practice. For example, the competencies required for entry-level care registered nurse practice are based on the principle of client-care to prepare nurses to provide safe, competent, and ethical care Collaborative Practice - Being able to effectively work in a collaborative practice means that nurses need to be able to understand their role and that of others, communicate effectively with other team members, and know how to resolve conflicts Patient Safety - Adverse effect: an event that results in unintended harm to the patient and is related to the care and services provided to the patient, rather than the patient’s underlying condition - 36% of adverse events are preventable - Harmful events: an unintended outcome of care that may be prevented with evidenceinformed practices and this is identified and treated in the same hospital stay - Harmful events are grouped into 4 categories: - Health care/medication-associated conditions - Health care-associated infections - Procedure-associated conditions - Patient accidents - Patient safety: the absence of preventable harm to a patient during the process of healthcare - Culture of safety: the focus is on effective systems and teamwork to accomplish the mutual goal of safe, high-quality performance - When something goes wrong the focus is on what (or how) rather than who is the - - problem. The intent is to bring process failures and system issues to light, and to solve them in a non-biased non-threatening way The attributes of common features found in a culture of safety: - Leadership commitment to safety - Open communication founded on trust - Organizational learning - A non-punitive approach to adverse event reporting and analysis - Teamwork - Shared belief in the importance of safety The canadian Patient Safety Institute (CPSI) was established in 2003 by Health Canada to support improvements in patient safety and quality Nursing-Sensitive Outcomes - Nursing-sensitive outcomes: is the phrase used to describe patient outcomes that are sensitive to nursing practice or interventions - Broad categories of patient outcomes: - Functional status: patient’s perceptions of their day-to-day functioning (eg. ADL’s) - Self-care: patient’s perceptions and abilities to manage their care. (eg. medication administration, healthy eating) - Symptom management: how well symptoms are managed (eg. pain, fatigue) - Adverse patient outcomes: occurence and types of adverse events (eg. nosocomial infections, patient falls, medication errors) - Patient satisfaction: patient satisfaction with nursing care - Mortality rates: rates of death for specific, often preventable causes (eg. 30-day mortality rates, hospital standardized mortality ratio) - Information about patient outcomes can be used to design strategies or change policies, advocate for resources or staffing, design better care plans, or evaluate interventions - The Canadian Institute of Health Information (CIHI) collects and analyzes information on the health care system, including data collected from health care organizations, to support decisions that will improve the health system Conclusion As you read this book, keep in mind that student and registered nurses need to maintain a patient focus. Some means of maintaining a patient focus include asking yourself questions about how power and responsibility are shared with the patient; how input is actively encouraged from the patient and how communication is shared; whether a patient’s individuality, cultural needs, values, and life issues have been taken into account; what efforts are being made to include patients who are not presenting for care at the expected care points; and what is being done to enhance prevention and health promotion Chapter 13: Caring and Communicating in Nursing with Technology Electronic health records: computerized patient records provide nurses and health professionals with an electronic way of documenting client care and relevant health information - Patients are able to access part or all of their health record Personal health records: a health record owned and maintained by the individual patient’s themselves, without health professional access Nursing Informatics - Nursing informatics: nursing informatics science and practice integrates nursing, its information and knowledge and their management with information and communication technologies to improve the health of patients and families worldwide - Helps improves nurses decision-making, - Practice-based evidence - Data - Information - Knowledge - Wisdom Electronic Health Record Systems - Hospital information system (HIS) - Clinical information system (CIS) - Electronic medical record (EMR) - Electronic health record (EHR) - Includes: nursing documentation, computerized provider order entry, electronic medication administration record, barcode medication administration, care planning, and clinical decision support systems - Patient portals: technologies that provide patients with electronic access to all or part of their health record, along with other functions, such as booking appointments or communicating with a health professional - Telehealth: the use of telecommunications and information technologies for the provision of health care to individuals at a distance and the transmission of information to provide that care Blah blah blah be good with your documentation and use of technology to give good patient care or whatever Chapter 20: Building Teams Through Communication and Partnership Groups and Teams - Group: a number of individuals assembled together of who have a unifying relationship - Eg. U of A Nursing students - Team: a number of individuals who work closely together toward a common purpose and are accountable to one another - Eg. health care workers on the same unit - Teams have defined objectives, ongoing relationships, and a supportive environment and are focused on accomplishing specific goals - Types of teams: - Manager-led team: the manager is the team leader and controls the agenda, decisions, direction, and outputs of the team - Self-managing team: the manager sets the overall direction and defines the goal and outcome of the team. The members of the team determine the direction, strategies, and focus of the team to achieve the goal - Self-directed team: the manager identifies the outcome, and the team members determine the direction, strategies, methods, and focus to achieve the outcome. Often these teams function in quality improvement initiatives to address quality challenges and opportunities - Self-governing team: this team is a collection of individuals who come together to create something new or to address an opportunity or a challenge. The team determines appropriate membership, sets its own direction, defines the outcomes, and then manages team performance and outcomes - Interdisciplinary team: comprises members from different clinical disciplines who have specialized knowledge, skills, and abilities. The often work alongside one another and may or may not collaborate closely on patient care - Interprofessional team: comprises different healthcare disciplines working together towards common goals to meet the needs of patient population. Team members divide the work based on their scope of practice; they share information to support one another’s work and coordinate processes and interventions to provide a number of services and programs - The Centre for Interprofessional Education, Toronto Health Science Network developed the Interprofessional Care Competency Framework and Team Assessment Toolkit. This framework addresses 6 domains: - Patient / client / family / community centered care - Communication - Role clarity - Conflict - Team functioning - - Collaborative leadership 5 characteristics of highly effective teams: 1. Have trust 2. Debate positively 3. Mission oriented 4. Results focused 5. Work within and sustain a culture of leadership Team Development - When a team begins to develop it is essential to establish ground rules for the team as well as build trust in the team, both of which are essential to collaboration, creativity, and achieving the desired goals - Ingroups and outgroups - if you do not feel like a valuable member of the team you are more likely to work alone and withdraw from teamwork and engage in self-defeating behaviours - Power - 6 key sources of power: - Legitimate: the power one holds by virtue of their role - Reward: getting access to benefits - Coercive: having the ability to punish - Expert: based on competence and unique knowledge - Referent: based on a person’s appealing qualities - Informational: based on individual’s extent of knowledge - Using, developing, and being appreciated for skills and resources - one of the most powerful indicators of a successful , supportive work environment is to remove fear of mistakes. When fear exists in the workplace it decreases the opportunities for innovation and change and has consequences on employee performance and overall goal achievement - A good team leaders should make sure everyone feel recognized, encouraged, and utilized to the fullest potential - Ground Rules and Team Charters - one of the most helpful tools in team development is to have team members come to agreement about the ground rules involving their relationships with one another. The rules may stay the same or change over time. An essential success factor for these tema agreements is the willingness of members to be accountable for upholding the agreements and to give feedback when the agreements have been violated. - Trust - the belief in the loyalty, veracity, reliability, strength, etc. of a person or thing. Trust is fundamental to well-working teams. Leaders model trust through behaviours such as setting ground rules and agreements by which the team will function and holding themselves and the team members accountable. Once destroyed, trust is a hard thing to re-establish. Qualities of a Team Member 1. Honest and straightforward 2. A person who shares the load 3. 4. 5. 6. 7. Reliable Fair Compliments other’s skills A person with good communication skills A person with a positive attitude Creating Synergy - Synergy: Effective teams are ones in which people work together to produce results and achieve a common goal that could not have been achieved by any one individual. - Working cooperatively, and effective team produces results that non one team member could have achieved alone - Synergy cannot occur when one team member becomes a self-proclaimed expert who has the “right” answer. Nor can synergy occur when people refuse to communicate. - Dualism: means that most situations are viewed in terms of two opposing positions (right or wrong; yes or no), thus limiting the broad spectrum of possibilities that exists between Generational Differences Among Team Members - To have effective teams, there is a need to understand the common and unique generational needs within the current and future workforces - Understanding the diversity of team members is crucial at all stages of development, but in particular during the formation of the team and when the team may encounter challenges and difficulties Conflict and Teams - Conflict: who or more competing responses to a single event. It is a problem to be solved when differences exist between and among individuals or groups - Focus on the mission, a willingness to cooperate, a commitment to the team, and a commitment to address concerns that arise in the team is needed Communication - Communication is the most important component in teams. It is essential to clinical practice, building teams, and leadership. - Communication: the sending and receiving of messages that leads to a process of creating meaning in our interactions and relationships - Can be verbal or non-verbal - Communication is learned from watching others - Whenever people are distressed, disengaged, or have an emotional reaction to a situation or the actions of another it often leads to blame, judgement, or demand - In order to stop this, use the words “I think”, “I feel”, and “I want” - Communicating during a conflict: Stop, think, listen, then communicate - Factors that hinder effective communication: - Stress - Communication barriers: - - Distractions - Inadequate knowledge - Poor planning - Differences in perception - Emotions and personality Factors that enhance effective communication: - Active listening - Compassion - Telling the truth - Be flexible Managing Emotions - Self awareness: the ability to recognize one’s own strengths, weaknesses, values, and goals and their impact on others - Self-management: emotional self-control and adaptability to situations - Self-awareness: includes empathy and emotional awareness - Relationship management: includes the ability to work in a team and manage conflict as well as to coach and mentor Chapter 32: Nursing Students as Leaders Introduction - There are 4 domains of student leadership: 1. Career planning and development 2. Academic community 3. Research engagement 4. Professional practice Career Planning and Development - Engaging in career planning and development will help you reach your personal career and leadership related goals - Scanning - conduct environmental scans of your academic and clinical placement environments to learn about leadership opportunities available. - Assessing - continually assessing your personal strengths and areas for development is essential for student leadership. Being self-aware of these aspects can help you maximize your personal strengths and explore strategies to further develop and grow - Visioning - visioning is taking a blank canvas and envisioning yourself as the type of leader you wish to become - Planning - once you develop a vision you need to develop a strategic plan to help guide you in achieving your leadership goals - Marketing - marketing yourself is an integral part of career planning and development. You can establish networking skills, social media, find a mentor, highlight leadership in your resume, professional development activities, search for leadership opportunities Academic Community - Participate and join student leadership groups - Take initiative and organize an event - Collaborate with others Research Engagement - Participate in research studies - Take on research assistant positions - Join research ethics boards - Applying research to practice Professional Practice - Attending professional development workshops and presentations - Embracing learning opportunities - Becoming an effective follower - Advocate for nursing - Advocating for patients and families Articles 5 Ways to Incorporate Systems Thinking into Healthcare Organizations 1. Apply a holistic approach to solving problems - In essence, systems thinking consists of looking at a whole instead of the parts. That which may appear to be an isolated problem may be an interconnected network of related issues, and systems thinking can recognize this dynamic. 2. Define approaches to evaluating and understanding system-wide effects - A systems-thinking approach can help decode complexities within a healthcare organization and use this understanding to design and evaluate interventions that maximize system performance and patient safety. 3. Identify and nurture great systems thinkers - Systems thinkers exhibit the following characteristics: - Acute awareness of the current system - Appreciation of the structures behind events - Willingness to challenge the current systems boundaries - Ability to to players at all levels of the hierarchy - Understanding how system elements interact - Understanding how relationships play out before making a decision - Conceptualizing the attributes of an improved and successful system state - Possessing the courage and energy to challenge the status quo and seek improvements 4. Apply a proactive approach to identify leverage points - A key component to incorporating systems thinking into a healthcare organization is to identify possible leverage points. Leverage points—places that are most effective in resolving problems—exist within each healthcare organization's structure. Far too often, healthcare organizations wait until an incident occurs to retrospectively identify problems in their systems. - A systems-thinking approach encourages healthcare organizations to recognize situations as specific patterns of events rather than isolated events. Within each pattern of events, areas in the system (i.e., leverage points) exist for which small changes can have considerable positive ramifications. 5. Create a culture of systems thinking - To reap its benefits, systems thinking must become an integral part of the practices within a healthcare organization. The result of a great systems-thinking project is not identifying a set of cause-effect relationships; instead, it's culminating a new capacity for reflective dialogue, deep insight, and shifting entrenched mental models. The Innovation Cycle and The Nursing Process Go Together - - Design thinking is similar in that it is also a stepwise process that includes understanding the problem through the process of empathy, defining the problem based on the needs of the stakeholders, ideating possible solutions, creating prototypes of the solutions, and then testing those solutions. Whereas the research process can take years from conception to implementation, the design thinking approach allows for rapid creation and testing of solutions in weeks to months, instead of years. Employing Design Thinking Methods in Nursing to Improve Patient Outcomes - - - the Agency for Healthcare Research and Quality Innovation Exchange defines health care innovation as "the implementation of new or altered products, services, processes, systems, policies, organizational structures, or business models that aim to improve one or more domains of healthcare quality or reduce health care disparities." Similar to nursing, the design thinking framework is person or “patient” centered in its approach. Design thinking purposefully puts aside potential solutions to explore and identify the problem from the perspective of those that are intimately involved in the problem space. In general, nurses providing direct care had minimal input in device development and evaluation and were not typically involved until a product had been released into the market. Nurses on the front line of health care delivery have an incredible opportunity to meet patient needs through the development of products and services. Involvement in product and service development can optimize connections between nursing science - - and industry and provide opportunities for nurses to use their expertise to impact products and services that touch patient lives every day, even when the nurse is not present. The design thinking process uses five fluid steps that result in a solution built around the needs of “users” and “stakeholders.” - 1. Empathize - 2. Define - 3. Ideate - 4. Prototype - 5. Test Once nurses are in the workforce, strategies to develop or support innovation for nurses within the health care system are lacking. This lack of education and structure to implement innovation creates an obstacle for nursing participation in the translation of an idea into product, service, process, system, policy, or organizational structure change that may widely benefit patient populations, providers, and the health care system. There are more articles in the syllabus but I left them out because a lot of them are dumb.