Preparation for professional practice.

INTRODUCTIONThe aim of this essay is to critic every(prenominal)y analyse the passe- dissociate verboten roles of qualified nurses, their accountability, collaboration and their responsibilities when taking attr exerciseshiphip and managerial roles at all expresss in their c atomic number 18r. This essay bequ flowh be structured in two partsPart 1 leave behind focus on the process of the ope account onward motion plan during unmatched of the fountains practice session placements in an wishlelike guard and refers to the recommended depart which the author intends to implement. The plan for variety is based on protecting endurings meal sequences. First, brief definitions impart be given and an exploration of the concepts of focussing and drawship result be undertaken. Part 2 of this lite leave focus on the professional evolvement of the author upon qualification as a round nurse in spite of appearance a few months which leave alone be discussed under th e section on committee. SMARTER theory has been determine in this easy as learning need plenteousy. In accordance with the nurse and obstetrics Council enactment of Professional Conduct (NMC, 2008) all names and places in this essay will be replaced with pseudonyms.PART 1 DEFINITION OF MANAGEMENT correspond to Huber (2010) management in the context of breast feeding has been identified as involving the use of deputised authority within formal governmental, settings, to co-ordinate, organise, direct and control responsible subordinates. In the same context, Mckimm and Held (2009) expound management as the process of bringing together or working with individuals, groups and different resources to follow through organisational goals. Scott and carry offss (2005) estimate management as directing and compulsory a group of individuals for the purpose of co-ordinating and harmonising those groups towards achieving goals. Tormey (2009) illustrated the distinguishing characteris tics of management and leadinghip. (Cheery and Jacobs, 2005) state that a manager is one who is ap focalizeed to formal positions of organisational authority and uses legitimatised power to command, reward or penalize the workforce. On the other hand, a drawing card is one who will be able to sink, gain commitment, facilitate convince and achieve results through efficient and inventive means, with his/her followers despite the absence of the formal position of power (Huber, 2010).Leaders seek the active involvement of those around them to achieve mutually concord goals attracters as well seek the collective will of all involved, establishing contact with leading other clinicians (Hersey et al., 2001). Crevani et al. (2010) suggest that drawing cards is an adventure requiring a pioneering spirit and leaders attainments and affable skill which differs from person to person Yoder-Wise (2011) states that the work of nurses is based on management in that respectfore, nurses contract better leadership skills and management skills which are considered to be a major(ip) factor in improving direct person-centred interventions, achieve goals, objectives and close making for quality care pro tidy sum. In order to achieve the goals and objectives, managers of the organisation must(prenominal) be involved in the activities which include being able to analyse matters, establish objectives, formulate goals, plan strategies, communicate effectively, expeditiously handle change, conflict, as tumefy as evaluate the ever-changing situation situation (McCrimmon, 2011) . Rosener (1990) cited in Barker, 2009) identified two types of leadership which include transactional and transformational leadership. Bass (2008) suggests that transactional leader focuses on management labor movements and will non identify the shared values of the aggroup however, the transactional approaching is orientated and finish be effective when conflict deadlines or in an emergency. Cummings et al. (2008) concluded that the transformational leader recognises her/his followers potential and takes active interest in them and their development. The transformational leader inspires, promotes excellence beyond mere task, encourages employees to become autonomous and solution foc employ, stimulates interest among followers to view work from a fresh perspective, generates an awareness of vision towards which the police squad is headed, develops followers to higher levels of ability and potential ((Rolfe, 2011). LEADERSHIP STYLESHersey et al. (2001) on the other hand identified different leadership way of lifes however, for the purpose of this easy the author here will focus on triple calls which include autocratic, democratic and laissez-faire. Hersey et al. further state that rightful(prenominal) ab aside concourse are able to combine the three styles of leadership and adopt a style to match the situation at hand. The autocratic leader is believably to trad e name closings on his or her own and give orders this style evoke buoy create antagonism and reliance which might hold back originality and advancement (Bass, 2008). representative leaders are more drawn towards alliances they encourage group discussions and seek consensus where e real decision make is agreed by the whole group (Hersey et al., 2001). This style of leadership may be slow because of every member of the group being considered however, it is a favourite leadership style among the nursing profession (Grint, 2005). According to Hersey et al. (2001) the laissez-faire leadership style promotes comp allowe freedom and is known to allow upkeepts to take their own course this is because in that location may never be a clear decision. Again Hersey et al. further state that in that location is no one style which is better than the others as they all take on their own advantages and disadvantages. As qualify previously, the situation will determine the styles to be utilise to achieve the goals (Hersey et al., 2001).IMPROVEMENT intentThe improvement plan was formulated during the authors recent practice placement in the Psychiatric Intensive Care Unit (PICU) which allows intensive care management run for individuals who are disturbed and exhibiting extremely violent and truculent behaviour. According to Allan (1988), virtually(prenominal) patient brought to this whole of measurement must be on section of the rational Health Act (MHA, 1983), apart from the severity of an individuals illness, in order to qualify for admission to the ward. During this placement, the author of this essay discovered that there had numerous and ongoing interruptions and arguments between nigh patients and staff during mealtimes. In conferition, staff members who were supposed to assist during mealtimes frequently claimed to be very busy. This untenable situation prompted the author to suggest introducing Protected Mealtimes to the team. The rationale for choosing this improvement plan was because some of the patients on that ward were not encouraged or pledgeed by staff member during mealtimes, main(prenominal)ly those elderly patients who were finding it very difficult to eat and drink unassisted. Many patients were on medicament that was causing them serious side-effects such as dehydration and constipation, so they needed to be encouraged to have satisfactory and healthy dietary intake. The author therefore had a discussion with their wise man and other multidisciplinary team members regarding this issue and they all supported the need for a meeting to resolve the above issue.Initially, the author felt very nervous closely introducing this new approach to the team members, due to lose of confidence and knowledge. The key point of the change was rationalizeed to all the patients. A proposal was put forward after the meeting regarding and defining the topic, namely Protected Mealtimes and the patients on the ward were give n the prospect to voice their own opinions on what they thought ab come break through of the closet the new proposal. The patients gave a positive verdict on the proposal. The National Catering and Nutrition Specification (2008) specify protected mealtimes as a period when all non-imperative activities and treatments must stop, in order to allow patients to eat and enjoy meals without being interrupted by any other performance on the ward. It should be a period during which staff members need to encourage the adequate consumption of dietary intake and provide an milieu which is very conducive to eating and is friendly and hygienic. It is to a fault a time when staff members need to ensure that mealtimes are a pleasant and relaxing social experience for all patients (Royal College of Nursing, 2007). The author took on the role of a democratic leader which according to Hersey et al. (2001) looks more towards relationships which encourage group discussion, consensus and group dec isions, rather than the leader alone making the decision when introducing change. According to Greenhalgh and Heath, 2010) therapeutic relationship, engagement, nameening skills and effective talk skills played an important role during the meeting detailed above, because the team members, as well as the patients were all equally convinced that the issues raised by the author were pertinent and essential, in terms of the patients satisfaction.It was agreed in the meeting that, during mealtimes, there would be no drug round, no activities by occupational therapy staff, no visitors allowed on the ward during mealtimes, and no domestic work carried out. All the televisions would be switched off, dormitories, mean solar day modes, shower get ons and activity rooms should be locked. All the staff members and patients on the ward must be present in the dinning area during mealtimes, in order to avoid distraction as advised by (RCN, 2007). The change was implemented within a few days of the meeting. Initially, it was not easy, but within a few days everybody on the ward adjusted. more thanover, some patients who normally isolated themselves from group activities on the ward now began to interact and engage well in conversation during mealtimes. Staff members were supporting/encouraging and showing compassion to all the patients, mainly some of the elderly patients, with unplayful dietary intake which showed catch care for patients. Such changes had a significant effect on the provision of ward services. According to Age UK (2010), appropriate nutritional care for patients in the infirmary is very important, because it decreases the risk of malnutrition, obesity and its associated complications.CHANGE MANAGEMENTAccording to Christie and Robinson (2009), it is essential to have a plan for how things will be unadulterated when implementing a change in any clinical setting. Change management in a nursing setting means observing things that happen or are throug h differently for the benefit of the patients. Braine (2006) stressed that for a change to be implemented successfully, there must be an awareness of the need to change, a desire to support and get in in the change, the knowledge to change, the ability to implement the change and the resources to maintain the change. OConnell et al. (2008) advised that as a change management model for protected mealtimes, simple implementation would focus on the need for nurses to engage, motivate and participate in the change. Allan (2007) identified three stages for the change process which include unfreeze, change and refreeze. Allan underline that during the unfreeze stage, a proposed change needs a clear aim, so that the individuals planning it will have no doubt why, know the rationale and the benefit will be explained to others.The National Institute of Clinical Excellence (2007b) has identified some barriers that stay change management within the multidisciplinary team, many of whi ch were evident in this particular example. These include the financial and political environment which can affect a professionals ability and motivation to change. Garon (2012) concluded that a deprivation of awareness and understanding in an organisations nursing management theories have shown that the way in which an organisation is managed can affect nurses confidence to communicate the need for change. Maddock (2002) argued that the approaches to change and the proposal thereof may be ineffective un little(prenominal) individuals management strategies are put in place to develop leaders. ACCOUNTABILITY/ businessAccording to marquess et al. (2009) one of the legal requirements of a registered nurse is accountability. Scrivener et al. (2011) identified that accountability involves the ability of the nurse to define every action he/she carries out. The (NMC, 2008) emphasised that accountability is seen as being of great importance and a qualified nurse is accountable for his/h er own actions such as supervision, committee, creative acts, intervention, assessing a situation or follow-up concerns. NMC (2008) further explained that the entire health care professionals are accountable and responsible for any action, error or omission made in practice. Huber (2006) states that as members of a multidisciplinary team, nurses must maintain their professional accountability. Nurses should also be able to use their communication skills to make complicated information understandable, explain choices, offer reassurance, look out for side-effects and liaise with medical colleagues about the subsequent progress of individuals with mental health problems (Garon, 2012). This was seen as a critical aspect of the operating room here with regular reviews being planned to evaluate the success of the change and to amend the program where appropriate.Furthermore, if a nurse is meant to delegate care to another professional or support worker, she/he must delegate effectively and should be accountable for the appropriateness of the delegation. During one of the authors practice placements in the acute ward, a saucily qualified nurse delegated the task of security nurse to an agency staff who was very new on the ward. This agency staff let one of the patients out of the ward, not knowing that the patient was on level 1 observation restricted to the ward and the patient absconded from the unit. This resulted in an investigation which revealed that the newly qualified nurse did not delegate the task properly and did not communicate effectively. This raised the question of accountability and function.The specifics of the nurses role are identified as being responsible for assessment, planning, the delivery of care and the evaluation of nursing care for their patients (NMC, 2008). According to RCN, 2011), nurses are accountable and responsible, on a nonchalant basis, dealing out patient care most of the time and acting as care provider. Nurses have the res ponsibility for communicating the germane(predicate) information required for the patient to receive their full nursing care provision (NMC, 2008).(RCN, 1992) also states that with an ontogenesis in the level of responsibility and accountability, nurses need adequate training and competence to develop these changes. It is the responsibility of the nurses to make sure that patients are suitably dressed and eat their meals, while also managing their welfare powerfuls and dealing with individuals psychological distresses theses roles have to be carried out in conjunction with running organisational demands (RCN, 2011).INTER-PROFESSIONAL COLLABORATIONOrchard et al. (2005) draw inter-professional collaboration as a combination of different professionals working together in a partnership in order to achieve common goals, establish a therapeutic relationship, showing respect for others and the skilled therapeutic use of self. On the other hand, inter-professional collaboration means t he adoption of multi-disciplinary and multi-agency working as the most effective route towards all-round(prenominal) mental healthcare (Audrey, 2003). However, Garon (2012) states that when talking about change in inter-professional collaborative team work, it is important to consider how staff members would need to be motivated to accept and welcome this change. It is also very important to select the right leader, which was a key advantage of this approach, to implement the change and involve all team members in the change process, as well as considering the caoutchoucty of the patients, their comprehensive care and the stress the change might cause (NICE, 2007b). polishDuring this implementation of Protected Mealtimes, all the team members on the ward worked collaboratively, demonstrated excellent communication skills, showed motivation and were very enthusiastic and committed to the plan.Word count 2,200.PART 2THE PROFESSIONAL DEVELOPMENT PLAN (PDP)The purpose of writing this professional development plan is to estimate and reflect on a facet of the professional development experienced by the author during their three-year course. It will also enable the author to work expeditiously and effectively in their areas of weakness and help to sustain areas of strength, as well as developing delegation skills in the nursing environment, upon qualification. In order to accomplish these goals, a plan utilising SMARTER theory (Specific, Measurable, Realistic, Timely, Ethical and Recorded/ Reflective (Appendix 1) is proposed. During the three years of nursing training, the author of this essay has utilised Gibbs Reflective Cycle (1988), as a framework for reflection on day-to-day actions, strengths and weaknesses. According to Brechin (2000), reflection means not only thinking about a situation, but also using it as a form of systematic appraisal of the events that have occurred and as an examination of an individuals ability to learn from the experience and cul tivate future practice.During this placement in the acute ward, the author discovered that delegating duties to staff when co-ordinating shifts was a far more complex issue than originally anticipated. The RCN (2006) described delegation in nursing as a process of en avering or allocating responsibility to another person who is seen as being able to carry out such a task. The Nursing and Midwifery Council (2008) states that a nurses job cannot be completed or carried out without delegating some part of the care functions to others, as it is highly impossible to deliver total care for different patients with different care needs. Barr and Dowding (2008) in their research emphasised that delegation is a critical leadership skill that must be learned.This became evident when considering a situation which emerged when dealing with a violent patient in a ward environment. In order to delegate tasks relating to this individual it was necessary to use confidence, communication, courate, c ompassion, competence and care. On the whole this was doen relatively well by myself however it was build that the newly qualified staff nurse is more likely to be unfamiliar with the procedure delegated to him and this made communication a more vital so that guidance could be obtained. Having identified a weakness in the authors ability to delegate, this communication between the two parties in the case mentioned above was used as a clear example of how greater comfort from the process of delegation could be obtained. This would in turn improve confidence.By watching delegations within the ward environment it became apparent to the author that there were greater difficulties when the manager used the autocratic style and this a good deal created hostility amongst other staff and may hinder creativity and improvement. This brought the managers delegation skills into question. There was also an increased danger that the more junior member of staff would find themselves unsupervised in an inappropriate and unacceptable way according to RCN (2011). This leadership style as described by Bass 2008 as creating difficulties. Where better delegation communication were used the author was much more comfortable with the delegation process as they were aware that the process would be used appropriately and would be successful. With this in caput the PDP going forward would focus on risk management and controlling the process without chase an autocratic style which would lead to loss of control when delegating.CONCLUSIONThe author of this essay has learned from undertaking this naming that delegation not only saves time, but is also an essential skill which a registered nurse must posses it is also requires grievous leadership and is an important role for every nurse involved in health care delivery. Through this Personal Development project (PDP), personal areas of weakness have been identified which the author is currently striving very hard to correct. REFERENCE LISTSAllan, E., 2007. Change management for school nurse in Scotland. Nursing Standard. 21, (42) 35-39.Allan, E., 1988. Planning a psychiatric intensive care unit. Intensive Care for people with serious mental illness. Hospital and Community Psychiatric, Vol- 39.Bass, B.M., 2008. The Bass vade mecum of leadership Theory, Research and Managerial Applications. 4th ed. New York Free Press.Bass, B.M., and Avolio, B.J., 1994. Improving organizational effectiveness through transformational leadership. capital of the United Kingdom Sage.Braine, M., 2006. Clinical formation applying theory to practice. Nursing Standard. 20, (20) 56-65.Brechin, A., 2000. Introducing critical practice. In Brechin, A., Brown, H. Eby, M., eds. Clinical practice in Health and Social Care. capital of the United Kingdom SageCummings, J., 2012. Developing a Vision and Strategy for Nursing, Midwifery and Care- Givers, tinyurl. Com/c89xe4x Last accessed whitethorn 2 2012.Cherry, B., and Jacobs, S., 2995. Contemp orary Nursing Issues trends and management. 3rd ed. Elsevier Health Science.Christie, P., and Robinson, H., 2009. Using a communication framework at handover to boost patient outcomes. Nursing Times, 105,(47) 13-15.Crevani, L.,Lindgren, M., Packendororff, J., 2010. leaders, not leaders on the study of leadership as practices and interactions. Scadinavavian Journal of Management. 26 (1)77-86.Cummings, G., Lee, H., Macgregor, T., 2008. Factors contributing to nursing leadership a systematic review. Journal of Health Services. Research and Policy. 13(4) 240-248. department of Health, 2008. Code of Practice Mental Health Act 1983. London DoH.Doran, G.T., 1981. Theres SMART way to write managements goals and objectives. Management Review. 70, (11) 35-36. fodder in Hospitals National Catering and Nutrition Specification, 2008. Last accessed on 30 May 2013.Garon, M., 2012. Speaking up, being heard registered nurse perceptions of workplace communication. Journal of Nursing Management. 56, ( 2) 35-39.Green, T., Heath, I., 2010. criterion Relationship. London The Kings blood.Gibbs, G., 1988. Learning by doing A Guide to Teaching and Learning Methods. Oxford Further Education Oxford.Hersey, P., Blanchard, K.H., and Johnson, D.E., 2001. Management of organizational behaviours leading benignant resources. 8th ed. Upper Saddle River, NJ Prentice- Hall.Huber, D.L., 2010. leading and nursing care management.4th ed. Maryland Heights Saunders Elsevier.Huber, D.L., 2006. Leadership and Nursing Care Management. 3rd ed. Lowa. The University of Lowa The University of Lowa.Maddock, S., 2002. Making modernization work new narratives change strategies and people management in the public sector. International Journal of public Sector Management. 15, (1) 13-43.Marquis, B.L., and Huston, C.J., 2009. Leadership roles and management functions in nursing theory and applications. 6th ed. London Wolters Kluwer Health/ Lippincott William and Wilkins.McConnell, C.R., 2007. The effective He alth care Supervisor. 6th ed. Sudbury, MA Jones and Bartlet Publishers.McKimm, J., and Held, S., 2009. The Emergency of Leadership Theory From the Twentieth to the Twentieth-First Century. In McKimm, J., and Phillips, K., eds. 2009. Leadership and Management in Integrated Services. Exeter Learning Matters. Ch1.National Institute for Clinical Excellence, 2007b. How to change practice. London NICE.National Institute for Innovation and returns, 2013. NHS Change Model Our overlap Purpose. Tinyurl, com/bwefn79 Last accessed May 2 2013.National Patient Safety Agency 2007.Protected Mealtimes review Findings and Recommendations Report.Nursing and Midwifery Council, 2008. The Code Standards of Conduct, Performance and Ethics for Nursing and Midwives. London NMC.OConnell, B., Macdonald, K., and Kelly, C., 2008.Nursing handover time change. Contemporary Nurse. 30 (1) 2-11 Creating a Culture for Interdisciplinary.Orchard, C.A., Curran, V., Kabene, S., 2005. Creating a Culture for Interdiscip linary. Collaborative Professional Practice. Medical Education.Rolfe, P., 2011. Transformational leadership theory What every leader needs to know. Nurse Leader. 9, (2) 54-57Royal College of Nursing. 2012b Health and Social Care Act 2012. Tinyurl.com/HealthSocialCareAct2012 Last accessed May 9 2013.Royal College of Nursing, 2011. Accountability and Delegation What you need to know. Royal Collage of Nursing. London RNC.Rosener, J.B., 1990. Ways women lead. Harvard Business Review. In Barker, P., 2009. Psychiatric and Mental Health Nursing. The Craft of Caring. 2nd ed. London Hodder Arnold.Scrivener, R., 2011. Accountability and Responsibility Principles of Nursing Practice. Nursing Standard, 25, (29) 35-36.Scott, L., and Caress, A.L., 2005. Shared governance and shared leadership meeting the challenges of implementation. Journal of Nursing Management, 13(1) 4-12.Tomey, A.M., 2009. Guide to nursing management and leadership. 8th ed. St Louis, MO Mosby/ Elsevier.Yoder-Wise, P., 2011. Leading and Managing in Nursing. 5th ed. St Louis Elsevier Mosby.APPENDIX- 1 S.M A.R.T.E.R PLAN SPECIFICSWithin six months of the preceptor-ship course, there will be a need to build better confidence that will improve communication skills which will support the author in their nursing career. MEASURABLEHow can one as received that the intended outcomes have been achievedThe learning outcomes will be gained via the professionals consultants, occupational therapist, staff nurses and preceptor-ship mentor involved. The author is footsure that these professionals have the necessary assertive skills that will help achieve the desired learning outcomes. AchievableThe intention is to attend training courses, discuss any difficulties experienced with the preceptor-ship mentor or manager of the ward or any member of staff, and integrate the proposal as advice. REALISTICWithin three months of completion of the nursing course, it is anticipated that the author will be able to demonstrate effective leadership, delegating tasks properly, and entrusting responsibility to a person who is perceived as being able to carry out these tasks by utilising ones newly gained assertiveness skills. TIMELY Within three months of registration, an evaluation of achievements will be carried out and competencies will be quizd frequently by the preceptor-ship mentor. The aim is to be constantly monitored by members of the team and to reflect upon performance and the impact of these actions. If there are any obstacles to achieving these goals or any concern from the team about the authors approach, these issues will be discussed with the preceptor-ship mentor or ward manager, as this will facilitate the development of ongoing skills. ETHICALBeing knowledgeable about ethical issues such as social and cultural, rights, confidentiality and being aware of how this might impact on ones practice. As a nurse there is a need to ensure that the patients autonomy is respected. RECORDED/REFLECTIV EReflection on personal strengths, weaknesses, opportunities and threats ( debone), on a regular basis. Appendix 2 SWOT Analysis MY STRENGTHSThe SWOT analysis has helped me to develop, maintain a learning environment in which both education and lifelong learning are seen as integral to clinical setting, to work and focus on the goals and strategies, enable me to grab the opportunities I would love to achieve and work very hard to reduce my weakness and increase my strength.With the aid of SWOT analysis, I have been able to identify my strength as being a effectual team player, good listener, a good communicator and interacting well with my colleagues and patients. Showing compassion to my patients and having the ability to work under pressure. I like taking the lead and I am always happy when people appreciate me, it makes me happy and also motivates me. MY WEAKNESSI identify my weakness as being easily distracted, tending to carry out many tasks at a time and I am a lways fearful of making mistakes. I also felt that there are some areas I lack leadership skills such as being a good delegator because Barr and Dowding (2008) in their research emphasised that delegation is a critical leadership skill that must be learned. I find it complex to delegate duties when coordinating shifts. OPPORTUNITIESMy opportunities are to update my knowledge in relation to the new pre-registration courses which include be educational, personal and professional career development within the establishment. During this my practice placement I also had the opportunity to learn and share ideas with my colleagues, had the opportunity for questioning and openhanded feedback. THREATSMy threatsare whilst on this practice placement, I found some areas very stressful. I discovered that some of the mentors were unfamiliar with the new- pre registration programme and unaware of the needs of the nursing students in relation to the learning opportunities or activities.Appendi x 3 Service Improvement Activity Notification Form Student DetailsStudent SID issue forth 0820968 Details of student pledge on which the proposed improvement is based. I must treat individuals kindly and considerately. I will provide a high banal of practice and care at all times. I will respect individuals confidentiality. I must show compassion and unconditional positive regard to my clients. I must disclose information, if I believe some one may be at risk of harming him/her self in line with the law of the body politic in which I am practising. I must listen to individual in my care and respond to their concerns and preferences. Details of proposed service improvement project/activityThe service improvement initiative is to facilitate Protecting Patient Meal Time in the Psychiatric Intensive Care Unit (PICU). The purpose of this service improvement is to help and manage mealtimes without unnecessary and avoidable interruptions. Mealtimes are not only a vehicle to provide p atients with adequate nutrition, but also provide an opportunity to support social interaction amongst patients. Reason for developmentDuring my practice placement in the PICU. I discovered that there have been a people of interruptions and argument between some patients and staff during meal time and also staff members who supposed to assist during meal time always claimed to be very busy. This made me choose to introduce to the team about Protected Mealtimes. This development is to support those patients who were finding it very difficult to eat or drink. Time worn out(p) on the project/activityThe service improvement lasted for the period four weeks because I first and foremost had the meeting with the multidisciplinary team members before introducing the change to the patients. Resources used National Health Service (NHS boarder) Evidence on topic relating Protecting Meal TimeInformation from in the profit.Policy and regulation from the trust textual matter bookSome informati on from dietician. Who will be involved? The ward consultantMy mentor as a nursing staff,Occupational therapist staffSupport workerThe ward managerThe dieticianMyself( a student nurse) Future plansThe future plans are for me to distribute leaflets to the other professionals for them to read it in the internet and be awareness of the protecting meal time.Date discussed with clinical staff in placement areaPreparation for Professional Practice.?IntroductionWhilst on the unit I became concerned when I noticed some service users were being discharged without proper education on how to manage their self-medicament regime. This concerned me as it appeared to be a vicious cycle as I witnessed some service users being discharged without having a proper follow-up education on self-medication which in certain cases led to non-adherence to their medication which consequently sometimes led to their slide by. For this cycle to be broken, I have realised that a proper education system, which w ould necessitate simple terminologies or understandable statements for service users to understand and learn how to manage their self-medication regime, should be put in place.Accordingly, this assignment will explain management and leadership styles related to a service improvement in the clinical area where I commenced my management placement. Applying management and leadership theory to practice, I will explain the reasons for my actions and will identify my strengths and weaknesses in terms of my leadership and management skills used whilst on placement.Adhering to the Nursing and Midwifery Council (NMC) Code of Professional Conduct (2008) and general good confidentiality prudence, all names and places mentioned in this assignment have been changed to a pseudonym.?Leadership Styles & Management?In the mental health nursing profession, the management role cannot be averted, whether it is in managing a unit or improving services. Management is widely considered to be concerned wi th controlling, organising, planning, and problem-solving (Kotter, 1996 cited in Kings Fund, 2011). Yoder-Wise (2007) goes further on this point and states that management is concerned with the work of any individual who guides others through a series of routines, procedures or predefined practice guidelines. Moreover, leadership like management, has become a arctic component of National Health Service (NHS) policy. This policy has on the most part been driven by the rising expectations of citizens who are now demanding to see an improvement in the quality of the services given to the service users and their families. Although management and leadership are somewhat different, both actions tend to overlap each other in terms of governing employees and organisation.Foster (2001) points out that management depends solely on the managers understanding of working with people of different backgrounds, having a good perception of situations and being able to aspire. On the other hand, le adership is an even more critical requirement within the NHS setting this enables clinicians to demonstrate their leadership skills at all stages in health care provision and in new changes of services. Barker (2003), identifies leadership is a role of importance, emphasing that the role of a leader is subordinate on his orher effective interpersonal skills. Oliver (2006) elucidates further by providing a list of qualities that are generally considered to define leadership, asserting that leaders must be receptive of exploring personal and team motives and beliefs that can bring about change or perceived vision of success.Ellis and Hartley (2005) in agreement with Oliver (2006), state that leaders carry out this process by being ethical, respecting values, educate, motivate and direct the followers towards their objectives and goals. Consequently, leadership is required to be much more than just mere management skills that require getting the job done (Kings Fund, 2011 what page ?). Over time, it has been posited that individuals are born either natural leaders or that they learn the qualities that are necessary for effective leadership roles (Hawkins &Thornton, 2002 Austin et al., 2003). There are a number of leadership styles but I will now focus on the main types.Autocratic leadership styles can range from benevolent to very rigid (Likert, 1967). In extremis, the use of authoritarian leadership, communications and activities can occur in a closed system. Autocratic leaders are considered to make all the decisions themselves and allow subordinates no influence in the decision-making processes (Grohar-Murray & Dicroce 1997). They will exercise their power, sometimes coupled with coercion, and are indifferent to personal needs of their subordinates. Failure to meet such leaders goals can result in punishment. Autocratic leaders are known to be insistent, firm, self-assured and dominating, be it with or without actual intent.Such leaders feel little confid ence or trust in their workers and as such, workers will fear theses leaders, whom they will feel have little in common. McGregor (1960) has produced what is perhaps considered the most famous description of such attitudes assumed by autocratic leaders stating thatsuch a style of leadership excludes subordinates from the process of decision making and will assign work without consulting subordinates or knowing their inclinations and desires. The leader is in complete control and gives no room for subordinates to participate or offer opinions no matter how it may benefit (Daniels, 2004).Contrary to the autocratic style, democratic leadership involves the leader allowing employees to participate in decision making and at the same time provides guidance and direction (Anne, 1992). The most important finding arising from this work is that this leadership behaviour directly influences the climate and productiveness of employees (Anna, 1992). A second important theme is that overall, t he democratic leadership style has been known to be one of the most successful approaches because as initially stated, it allows employees to participate in decision making while at the same time supports, guides and counsels the followership (Anna, 1992.) However, critics have stated that on the basis of production, things move at a sulky pace and this may lead to frustration amongst employees, especially those who tend to work faster in decision making process (Marquis, 2000). Notwithstanding, this democratic leadership sedate produces a high quality input from employees. This leadership builds trust amongst leaders and employees which then produces a cooperative team working relationship and builds high team spirit in the work environment.Accordingly, the democratic leadership approach should therefore not be used enough when urgent decision making matters rebel, for example decisions on issues of staffing, budgeting etc. In this situation it is more effective if a senior man agement makes the decision as this would be swift and the cost would be less as the business of any organisation cannot afford to make mistakes. Here, it is demonstrated how different leadership styles are required for different tasks and how in some positions certain leadership styles are more appropriate.The laissez-faire leadership is at the extreme opposite end of the spectrum from autocratic styles of leadership. Under a laissez-faire style of leadership the attitude is one of both permissiveness or ultra-liberalism in which there is a lack of control or centeral direction. . Thus, in different situations the same leader avertedly can use leadership of different styles. If a leader manages to combines all the leadership styles that have been mentioned than it is known as a situational leadership style. A situational leader adjusts styles of functioning depending on a particular position at that point of time and this is said to be another effective leadership style (Murthy 2 005). This can be attributed to the Path-Goal theory approach. The Path-Goal theory supports the situational theory as it gives emphasises on the same leader using different types of leadership approach (Murthy, 2005). This theory was developed to examine the method in which leaders encourage their employees to achieve set goals (Murthy, 2005). It is important for leaders to have a sense of maturity to their staff as this approach builds a less task focussed approach and into a relationship focused orientated (Forster, 2001).According to McGuire & Kennerly (2006) transactional leadership is a technique of leading an organisation through routine transactions such as rewards and discipline that are applied to the task after getting accomplished. Thus, it is almost completely based on the transactions that are conducted between the leader and the subordinate staff members because it is grounded on a theory that such workers can be and are motivated by rewards and discipline. A transac tional leader will generally not look ahead whilst strategically guiding an organisation to a position of market leadership alternatively such leaders are exclusively concerned with making sure everything flows smoothly (McGuire & Kennerly, 2006). The attributes of transactional leadership is that the nurse leader has authority over the employee by following organisation policies and regulation. Employees comply and follow directives and rewards are given in form of salary. This style of leadership essentially identifies itself repeatedly with the autocratic approach of the leader often responsible for creating staff commitment and building staff morale, as well as utilising intellectual stimulation and consideration of others. For this leadership approach to be effective, the leader depends on the loyalty of the employees (Marriner-Tomey, 2004).With all these styles of leadership and management now considered. I will now utilise these to analyse and explain my self-medication obser vations and theory.?Self-medication Information?As discussed this assignment is focussed on improving the method in which self-medication information is carried out with service users. The reason for this decision is to promote self-medication management and help reduce the rate of non-compliance in medication and relapse. This approach will support service users as well as improve their knowledge of medication and it will prepare them for a healthy discharge. Information on self- tribunal of medicines is incredibly useful as it enables service users to manage their intake and promote their adherence to medication.The NMC Guidelines for the Administration of Medicines (2002a) states that the NMC supports self-administration of medicines and medicine administration carried out by carers, whenever appropriate. However, the safety and storage arrangements must be considered when necessary procedure is put in place. The nurse in charge therefore must carry out a decision on the basis o f professional conduct that adheres with the NMC Code of Proffesional Conduct (2008), as the nurse would be accountable for their informed decision and omissions. When administering medication or supporting servicesto users who oversee their own self-medication regime the nurse must exercise their professional judgement and use effective skills and follow trust policy and regulations.Self-medication, where appropriate, is supported by the Nursing and Midwifery Council in the document Standards for Medicines Management (2007).It is apparent that the process of self-medication has made clear that it can help make service users become more familiar, confident and have better self-esteem by managing their own medication regime. The opportunity for service users to learn about medication through health education will ultimately improve their medication concordance before and after discharge.According to Nicklos (2010), change management is a organized way of dealing with a change, bot h from the view of the organisation and on to the individual. Although an ambiguous term, change management has at least three different aspects, including bu adapting to change to an area of professional practice, controlling change, and effecting change. A proactive approach to dealing with such change is undeniably at the core of all three of these aspects. Fred (2010), goes even further to state that change does not always come from within organisations but could be from legislation or current national guidelines which have been passed as a law and become enforced making it mandatory..Changes to services and organisation may impact on the position, role and even the status of individuals and therefore can test levels of self-confidence as well as confidence in others. Change requires new clinical responsibilities, time for training and development and require bleakness to different ways of doing things and as such requires letting go of a previous practice. Such challenges make the planning of the change process a demand for success (Michele, 2010). Accordingly, it is vital to comprehend the importance of change management as it gives a both positive and negative picture of what a change can bring.When I was thinking of my service user initiatives I had to consider some things such as time, as this allowed me to see if my change was realistic. My placement was on a rehabilitation unit where the recovery star tool was used to support service users in identifying their needs. Using the recovery ladder of change, a course of action was set in place to support service users care plan. The purpose of the rehabilitation unit was based on a form of rehabilitation that focused on helping service users to recover lost skills in coping with the demands of everyday lives.In the management of their medication in the rehabilitation unit, the nurses in charge are there to support and guide the service users in knowing what they are taking and when they should take the ir medication. By supporting and guiding service users to self-manage their medication improves both independence and helps them for forthcoming discharge.Before self-administration starts for service users, qualified nursing staff, or preferably pharmacist, should educate when, how and what is needed to be done. There are three stages at which service users can come to managing their medication. Stage 1 involves medications being stored in the medicine cabinet and at the right time the nurse in charge opening the cabinet and prompting service user to take their medication.At stage 2 the nurse in charge is accountable and responsible for the safe storage of the medication cupboard. During administration of medication the service user will ask the nurse in charge to open medication cupboard without prompting. The service user would then administer the medication under the supervision of the nurse in charge.Stage 3 would then be when the service user accepts full responsibility for ma naging the storage and administration of their medications. The nurse in charge then assesses and observes the service users verbal response and medication compliance. Once there is full clarity and positive observations of the service users self-medication management, they can get discharged back into the community. A problem I faced was how I would actually communicate this change to staff in the unit. To communicate is a transactional action where is sharing of ideas, beliefs and knowledge (Sen, 2007).Effective communication is an important skill all leaders should have because in a way of introducing something new and if done properly, it can allow staff to accept and receive change. Communication also gives room for staff for feedback and criticism (Sen, 2007).Another essential practice in a care setting is collaborative working. This allows professional to share their decisions and opinions (David et al, 1996). Within a team their views and shared ideas are important in an eve nt of proposing change.In this assignment I have come to understand that the roles of leaders and managers is not merely just about giving orders but requires vital skills in communication, behaviour and approach to produce positive result. I requires telling people what to do but also making sure that it is within their competency level and realistic, is necessary for an effective working environment NMC (2008). My identified weakness was in the area of delegation as I needed to be more assertive. This is a skill that I hope to improve in my career as qualified mental health nurse. Professional Development PlanIn this assignment, I will reflect on my weakness in terms of delegation which was an area in which I had to develop. Delegation has been defined as the process by which responsibility and authority for promoting a task (function, activity, or decision is transferred to another individual who accepts that authority (Sullivan & Decker, 2009, p135). However, Marquis & Huston (2009) have also defined it simply as getting work done through others. Regardless, it is worth noting that responsibility and accountability are not and do not mean the same thing. Whilst a delegator is entirely accountable to the task, the delegate will also be accountable to the delegator for the responsibilities assumed (American Nurses Association (ANA) and National Council of estate Boards of Nursing (NCSBN) (2005), cited in Gopee & Galloway, 2009 Sullivan & Decker, 2009). The Nursing and Midwifery Council expects all nurses to acknowledge any limits of personal knowledge and skill and take steps to remedy any relevant deficits in order effectively and appropriately to meet the needs to service users and clients (NMC, 2005).Yoder-Wise (2011) notes thatif delegation is to occur, there should be mutual acceptance between both the delegator, who has the accountability, and delegate, who assumes the responsibility for performing the tasks and is consequently empowered (Sullivan & Decker, 2009). However, Sullivan & Decker have clarified that while responsibility is an obligation to successfully completing a task, accountability also means judge the overall outcome whether it be failure or success of the task. Further, illustrating this, Yoder-Wise (2011) explains that when two registered nurses work are to work together sharing a task, then delegation does not occur. It is also important to explain that tasks can only delegate tasks for which we are responsible (Sullivan & Decker, 2009 Yoder-Wise, 2011).Sullivan & Decker have also noted that, once a delegate gains confidence, they become motivated and as such will begin to see their morale boosted to actively take on new challenges. They also expand add that although delegation can be learned, it essentially promotes teamwork and improves efficiency. Applying this to nursing, it is stressed that appropriate level of supervision has to be put in place to the delegate to ensure that tasks that have been delegated are completed effectively and safely (NMC, 2008b). The best interest of the patient should always be the overriding consideration when delegating tasks rather than saving time or money (Royal College of Nursing, 2011). Delegation has increasingly become an essential aspect of nursing in the United Kingdom because of staff shortages and high turnover in the face of ever-mounting demand for a variety of skills in health care (Curtis & Nicholl, 2004).With regard to my clinical management placement experience, I found I was less assertive when instructed by my mentor to delegate tasks as part of my learning. I freely admit that my timidity stemmed from being raised in a foreign country and as such the I felt intimated when delegating.As English is not my native language there have been occasions when some of my colleagues, and even fellow students at university, have informed me that they are indeed unable to understand my accent. I realise that this is unacceptable because I am pass judgment and will be required to be clear, concise and detailed when describing the objective, limits, expectations and outcome of the tasks to my delegates (Currie, 2008 Sullivan & Decker, 2009). Moreover, as a student nurse, I have often felt fright when delegating tasks to other staff who I considered to be better informed, better qualified and more experienced in nursing than me. Indeed, such fears were confirmed when, during one shift recently, whereI attempted to delegate a task (see Appendix 2). This is an area that I intend to improve upon.ReferenceBarker, M.A. 1992. Transformational Nursing Leadership A vision for the future. Thompson Publisher. London.Currie, P. (2008) Ask the experts Delegation considerations for nursing practice, in Critical Care Nurse, 28(5), (pp27-28)Curtis, E. & Nicholl, H. (2004) Delegation A key function of nursing, in Nursing Management, 11(8), (pp26-31) subdivision of Health (2000) The NHS Plan A Plan for Investment. A Plan for Refor m, London The Stationery OfficeDepartment of Health (2001) NHS Leadership Qualities Framework, Available online at http//www.dhleadershipqualities.nhs.uk Accessed skirt 20 2013Department of Health (2008) High Quality Care for All NHS Next Stage, Available online athttp//www.dh.gov.uk/en/Consultations/Liverconsultations/DH_085812Accessed 20 March 2013Ellis, J.R and Hartley, C.L., 2004. Nursing in todays world trends, issues & management 8th edition Lippincott Williams and Wilkins.Faugier, J. & Woolnough, H. (2002) National nursing leadership programme, in Mental Health Practice, 6 (3) (pp28-34)Gopee, N. & Galloway, J. (2009) Leadership and Management in Healthcare, London SageHersey, P., Blanchard, K.H. & Johnson, D.E. (2001) Management of Organisational Behaviours Leading Human Resources, (8th edn), Upper Saddle River, NJ Prentice-HallHuston, C., 2006. Professional Issues in Nursing. Philadelphia Lippincott Williams and Wilkins. USA.Huber, D.L. (2006) Leadership and Nursing Care M anagement, (4th edn), Maryland Heights Saunders ElsevierKings Fund (2011) The future of leadership and management in the NHS No more heroesReport from The Kings Fund Commission on Leadership and Management in the NHSLambert, R. & Githens-Mazer, J. (2010) Islamophobia and the Anti-Muslim Hate Crime UK Case Studies 2010, Exeter University of ExeterMarquis, B.L. & Houston, C.J., 2000. Leadership Roles and Management Functions in Nursing. 3rd edition. Lippincott Williams and Wilkins publishers. USA.Norman, I. &, Ryrie, I., 2009 Art and Science of Mental Health Nursing A Textbook of Principles, Berkshire Open University Press/McGraw-hill EducationNursing and Midwifery Council. 2002a. The Code of Professional Conduct. London NMC.Nursing and Midwifery Council. 2008. The Code of Professional Conduct Standards for conduct, performance and ethics- Protecting the public through professional standards. London Nursing and Midwifery Council 2009. http//www.nmc-uk.org.Oliver, S. (2006) Leadership in health care, in Musculoskelet Care 4(1), (pp38-47)Royal College of Nursing (2011) Accountability and delegation What you need to know, Available online athttp//www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_final.pdf Accessed November 15 3012Sullivan, E.J. & Decker, P.J. (2009) Effective Leadership and Management in Nursing, (7th edn.), London Pearson International EditionYoder-Wise, P.S., 2007. Leading and Managing in Nursing 4th edition. USA. Mosby Inc.Yoder-Wise, P.S. (2011) Leading and Managing in Nursing, (5th edn), St. Louis Elsevier Mosby.http//education.exeter.ac.uk/dll/studyskills/harvard_referencing.htmUse this link to learn how to Harvard reference properly. Your referencing is inconsistent and you need to list pages when quoting or referring to a specific point. As a general rule though, the main trick with referencing is continuity, so make sure your references and bibliography are consistent.Appendix 1 SMART Goal Delegation skills de velopment Specific Measurable Achievable Realistic Time To prioritise all my tasks and manage time effectively and efficiently in all shifts.Commuting between London and the university has taught me the value of time management. Time management will enable me to carry out other tasks and achieve goals.More to the point, time management will provide me with personal organisation and self-discipline, as recommended by Yoder-Wise (2011)Time management will be measurable as I will be able to identify whether the tasks set out on a specific shift have been successfully completed on time whenever Im taking over handover from night shift team members.Prioritisation is achievable by use of my diary which will contain all the tasks that need to be completed by the end of the day.Furthermore, prioritising will help me schedule tasks in the order of urgency. This will leave me room to tackle emergency situations that arise during the shift.Prioritisation is realistic because I realise that as a newly-qualified my responsibility will be to ensure that the shift runs smoothly.My diary will also be laborsaving as it will keep me reminded of the tasks I have to carry out and those which are still pending. In the case of pending tasks, being organised will give me sufficient time to involve staff who will be doing the next shift staff to complete them.Prioritising is an ongoing skill that I will have to keep learning during the first six months of qualifying and for the rest of my nursing career. Confidence and assertiveness while delegating tasks to other members of staff.Once a delegated task has been successfully completed and goals achieved confidence in allocating tasks to members of staff will have worked for me.By receiving feedback and constructive criticism from members of staff once they have successfully accomplished the delegated tasks.Being organised and maintaining a therapeutic relationship with fellow members of staff will increase my feelings of certainty t hat the shift will run smoothly relationship with staff.At the start of every shift I will allocate tasks to members of staff who have the competence, knowledge, time and willingness to carry them out and complete them. This is realistic because it will be my responsibility to manage shifts on the ward once I qualify.It will also be my duty to allocate or delegate tasks to members of staff.Likewise, during handover, I will ensure that I brief incoming staff on how the shift went and what remains to be done when they will be on shift.Based on my experience, so far, Im very hopeful that I will achieve this goal within six months after I qualify.Appendix 2. Service Improvement Activity- Notification Form Contact Details Student SID Number 0914451 Details of service improvement project/activityService user Rehabilitation unit managing self medication. Reason for developmentTo improve independent skills in managing medication for patients in rehabilitation centre so as to reduce the risk of relapse and to provide person centred care as well as empowering the service users. Time spent on project activityThe time spent on self medication informative project was about six weeks. Resources usedThe Trust policy, The risk assessment form, The patient consent form, The patient withdrawal form, self- administration monitoring form (stages), self- administration patient record chart. Who was involved Nursing staff, doctors (MDT), Pharmacist , student (myself) and the service users. Future plans To review the self- administration if it is effective at a set time. Nurses involved in supervision of the programme must be registered nurses.Date discussed with clinical staff in placement area (seen and agreed by my mentor Lorna Newton). And discussed with my IBL Facilitator Justin Nathan.