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Greater commitment and in-depth knowledge are required for performing the crucial roles of leadership and management in the field of nursing. The leadership actions have direct influence or impact the patient's mental and physical health. This essay will identify and evaluate some relevant theories or models of leadership and management in the context of the case study (Erdal, et al., 2017). The styles that apply to the case study will also be discussed and the discussions will be supported with recent policies and nursing experiences(Erdal, et al., 2017). The concepts of collaboration, MDT and inter-professional working will be identified along with their impacts on the case study. The leadership effectiveness will also be determined along with demonstrating the self-awareness as a qualified nurse (Weiss et al., 2019).
The case study includes a story of a 35-years old lady, Natasha who is being suffered from depression and mental health services. Despite being having a caring husband and four children, she is not been able to come out of mental depression and not be able to take proper care of her children. She has been given with the medications of Sertraline 50 mg as she has tried to commit suicide. She used to have appointments with the doctor but due to her disengagement into the mental health services, she has been discharged from the perinatal services. After her discharge, she was found in her room where she has taken the overdose of 30 mixed tablets and multiple cuts on her wrist that again shown the suicidal ideations. She was then rushed to the emergency department in an ambulance by her husband and was placed in a cubicle. After reviewing the health and mental checks of Natasha, doctor recommended 1:1 monitoring so that she can be safe and get a complete as well as the proper medication review.
Leadership in nursing refers to the practice of leading towards favourable initiatives through which the nursing practices and outcomes can be improved. Some significant roles are being performed by the nurse leader such as motivating and inspiring the team members of the nursing department so that high-quality practices can be performed by them and they can apply appropriate methodologies for ensuring proper care of patients (Erdal et al., 2017). Nurse leaders are also responsible for executing new policies for patient care by focusing on strategic planning and collaborating with the staff members of nursing. On the contrary, Weiss, et al., (2019)viewed nurse management as the process of directing the team members of the nursing and maintaining the best practices or policies of patient-care. The capable nurses are to be hired, recruited, staffed and reviewed by the nurse managers. It is also been said by Erdal, et al., (2017), that the management roles of nursing highly depends upon leadership skills, but the managers work directly with all the patients. Both the concepts of nursing leadership and management play an important role in making the entire team of nursing successful (Kantanen, et al., 2017).
The case is sensitive and needs strict surveillance and implementation of policies. Management theories are reviewed in the context of the above case study. The classical management theory involves three subfields, scientific theory that thrives at attaining maximum efficiency by close supervision and providing proper resources to nurses so that they are able to carry their work hassle-free (Murray, 2017). Training nurses to improve serving quality and achieve goals is used in this theory. The next subfield is a bureaucratic management theory that suggests following top to the bottom communication channel (Weiss, et al., 2019). In this theory, messages are communicated and accountability and responsibility are given without any ambiguity. This theory follows the impersonal approach of communication and rules and regulations are explicitly determined and delivered. This is suitable for lifetime career services and is recommended for nursing jobs. The third and the last subfield is the administrative theory that suggests principles of management and emphasizes on 'POSDCORB' to be implemented on the premises. In nursing, planning for the nursing, organising resources, staffing of proper nurses, directing these nurses, coordinating the team and resources, reporting the progress and performance of the patient and budgeting for the whole plan (Balik, 2018). The other theory is more flexible and encompasses the behavioural approach to drive the workforce towards the goal. Human Relation Management Theory focuses on informing the nurses about the service to be rendered and how their job will benefit society and their personal development. This theory integrates the skills and intellect of nurses with the goal (Murray, 2017). Empowering nurses by motivating and controlling them through informing and effective leading is used in this theory. This theory uses the phenomenon of changing the behaviour towards the work. In the context of the above theory, the best approach to deal with the patient the leader needs to adopt the Human Relation Management Theory. Here, the patient is suffering from a mental illness that is very sensitive to anything that goes against the patient (Gerogianni, et al., 2019). The classical theory is more authoritative that might create complexities in healing the patient. A depressed person does not use his/her rational to understand what is wrong and what is right. Being authoritative and playing by rules will not make the serving effective. Nurses need to change the thought process and it is one of the difficult tasks in nursing services(Balik, 2018). The best approach to implement this theory is to adopt participatory communication. When the person starts feeling comfortable, he/she is able to let his/her guard down and express his thoughts comfortably. This is a slow process to change someone's perception takes more time than healing a physical wound(Murray, 2017). The medications and other services to be rendered to the patient need to be properly taken care of and for this reason, discipline is a necessary trait of nursing(Erdal, et al., 2017). This does not mean that classical theory is more suitable. Even in human relation management theory, discipline is a vital aspect. Depression and suicidal thoughts are grave situations and one cannot determine the agony of such a patient. Therefore, determining the perfect plan is not possible the leader/nurse needs to change his/her style according to the situations(Polikandrioti, et al., 2018).
There are mainly three types of leadership styles in managing the patient by nurses. By evaluating the case, assessing the three leadership in context with the problem was necessary to determine which leadership style will best suit the case(Kantanen, et al., 2017). In the authoritarian leadership style, the nurse will exert her/his power on the patient and command his/her order to be followed by the patient. Natasha is a very vulnerable patient as she gets suicidal ideas very often and is becoming increasingly unmanageable(Gerogianni, et al., 2019). Exerting power will only worsen the condition. Authoritarian leadership style will be needed if the patient is not co-operating at all and the management has tried every possible way to treat her. This is a very risky approach and not recommended in this case. Free-reign leadership style is when the patient is given full freedom to choose and make decisions. This type of leadership is the least suitable approach because if the patient was able to make rational decisions, the need for medical treatment would not be necessary. The last and the best style of leadership to be adopted by a nurse in such a case is a democratic leadership style. In a democratic or participatory leadership style, communication flows from both ways/parties (Kantanen, et al., 2017). Natasha needs to converse her feelings and emotions more and open herself to the treatment. In a democratic leadership, the nurse makes the patient take part in decision making and choosing among the alternatives present to make a rational and effective decision (Gerogianni et al., 2019). Natasha needs to feel secure with her communication and gaining the trust of such patients is not an easy job. By a democratic leadership style, a nurse can make communication engaging and comfortable. Communication is not just an exchange of messages, ideas or thoughts; it is an art to influence the other person in the way the speaker perceives the idea. Medical team management must focus on the patient's behaviour and all the possibilities of her actions to decide the leadership style (Weiss et al., 2019). The leadership style can also be a blend of all the three approaches to make it flexible according to the situations. Natasha must feel the change within and try to rely lesser on medication. Authoritarian leadership style can increase the negative thoughts of Natasha and she might never get healed mentally. Nurse in charge can ask her to take her medicines politely rather than commanding her. Mental illnesses take time to heal and this is a normal phenomenon (Polikandrioti et al., 2018). Slow progress is also progress and that is why the most suitable approach for the nurse is a democratic leadership style. Gradually with effective participation, Natasha will show positive results in her thought process and perception about life (Siren and Gehrs, 2018).
Nursing as a profession is highly rated for ethical standards and honesty. Despite this fact, nurses are not allowed to participate in the managerial task of decision making. nurses are undoubtedly the best source of knowledge and information of patients and their conditions. Mertens et al (2019) opine that the need for inter-professional collaborator practice is becoming more vital to make the treatment of patients effective. To manage and lead collaborative efforts is an opportunistic approach by which nurses can integrate their abilities with physicians and other healthcare members (Murray, 2017). Several organisations have come forward to assist the development of structures that includes nurses to lead and manage patient's treatment plan and innovate new means to develop healthcare treatments. Like in the case of Natasha, the nurse who will take care of her will have the best knowledge about her condition and how to communicate with her. The other benefit of inter-professional collaboration is an improvement in patients care and health (Goldsberry, 2018). It also eliminates medical errors due to the efficiency of the nurse. Nursing is a very noble profession and requires full dedication and discipline of the practitioner. In the words of Mertens et al., (2019), this is a reason why nurses can be dedicated towards patient's health and care and reduce chances of errors. Inter-professional collaboration is also beneficial in providing job-satisfaction to nurses(Goldsberry, 2018). When nurses involve themselves in the treatment, they get motivated by seeing positive changes in the patient. Managerial costs and other inefficiencies are reduced to a large extent by involving nurses in managing and leading practice. The inter-professional collaboration of nurses has been proved to make the treatment speedier and effective.
With the numerous benefits of inter-professional collaborations come to some challenges too. The most common challenge is the ignorance towards other professions (Homeyer, et al., 2018). Collaboration with other profession needs good knowledge about their profession. Nurses lack confidence due to accountability and responsibility attached to the treatment plan. Some of the organisational barriers that nurses face while inter-professional collaboration consists of the absence of appropriate knowledge and lack of motivation due to the absence of appreciation of professional roles of other team members (Goldsberry, 2018). The ineffectiveness in making attractive arguments and decision making is also a challenge for inter-professional collaboration. Financial hurdles and regulatory constraints to not allow inter-professional collaboration to work effectively and legal issues also restrict the practice and liability of inter-professional collaboration (Homeyer, et al., 2018).
In a team, the most common challenge is to measure purpose clearly and state the mutual objectives of the nursing plan. Ambiguity in leadership and determining the roles of each member of the team is also so a cumbersome task in collaboration (Siren and Gehrs, 2018). The corporation between professionals is not smooth and needs proper attention to make inter-professional collaboration work. To combat these challenges, nurses can be educated by the way of training and holding workshops. Despite numerous challenges, with collaborative organizational and individuals' efforts, inter-professional collaborations can be fruitful and show remarkable results. In the above case, nurses must be involved in leading and managing the plan as she is the closest to the patient from the whole medical team (Nilsson et al., 2020).
A Multidisciplinary Team consists of general practitioners, practise nurses, community health nurses and collaborates with other professionals to treat a patient. MDT involves inter-professional collaboration to deliver proper treatment by using each member's efforts and capabilities (Nilsson, et al., 2020). Health educators and allied health professionals such as psychologists, dieticians and social workers spreading awareness about mental health work together for the cause. The multidisciplinary team is beneficial for both patient and the team members as it exploits all the benefits of inter-professional collaboration (Ellis and Sevdalis, 2019). To understand other profession and increase knowledge by nurses is facilitated by MDT. In the above case, nurses, psychologists and community health nurses along with health educators can create a great team. The main challenge is to maintain harmony and coordination among the members from different professions (Balik, 2018). Transformational leadership style will be great to facilitate MDT as it leads the members to involve in the treatment and management with determination and are motivated to keep team's goal ahead of individual's goal (Giddens,2018). For a nurse, it is important to maintain cordial relation with each team member. A nurse must be able to determine the role of service users, carers and other medical professionals and must be able to communicate with family members and the patient with utmost patience and engagement (Nilsson, et al., 2020).
The case also suffers from lack of attention from the medical team as they stopped treating the patient after a few attempts. In such a case, the team must inform her husband because family members are closer to the patient and know how to handle and communicate with the patient. Nurses are required to be disciplined and keep reporting the performance of the patient to the family member to maintain accountability and become more responsible towards the patient's need (Giddens, 2018). Human relation approach of leadership includes effective dialogue between all the team members and family members. MDT is a requirement in the case of Natasha as the behaviour of the patient is not easy to assess by one professional alone. Science has made advancements in assessing the human body and its organs but to assess the cause of different feelings that the patient is feeling, open communication is necessary (Nieuwboer et al., 2019).
Natasha might not be able to discuss her thoughts due to lack of communication efforts by nurses. NHS trusts and non-medical managers are required to assist MDT to make necessary arrangements to inform, motivate and plan treatment in the most effective way (Ellis and Sevdalis, 2019). In the nursing profession, leading and managing the plan or treatment has become crucial over the past few decades. This noble profession enables the practitioner to serve society by sacrificing his/her own needs and goals (Siren, and Gehrs, 2018). World Health Organization has also determined the benefits of MDT and inter-professional collaboration for reducing medical errors and making the treatment more effective by researches and studies (Nieuwboer et al., 2019).
The different approaches that inform inter-professional working and collaboration have many benefits to all the members. It increases self-awareness of nurses and the medical and non-medical team members. In the case of Natasha, depression is chronic and will consume a lot of time for permanent results (Polikandrioti et al., 2018). Therefore, the team must not lose hope in the middle of the treatment and use different approaches of leadership styles and inter-professional collaboration to suit the situation. When the patient starts responding favourably, nurses can be lenient and when the patient gets out of control, the authoritative approach can be undertaken to control the situations. The aim must be to reduce the dependency of the patient on medications gradually and increase treatment. Different approaches to inter-professional collaboration have involved the abilities and skills of different professionals in varying degrees.
Where communication and human relations are necessary, the role of nurses increase and where medical treatment is required like assessing medication requirements, doctors lead the treatment. But it is seen in many mental health cases that nurses are required in the majority of situations to make the treatment successful (Nieuwboer et al., 2019). Community health nurses keep check on the basic requirements and making necessary arrangements whereas a dedicated nurse is required to create a bond and make communication and medications along with diet plans effective. Assessing performance is also a task performed by a nurse. A nurse is required to take all the aspects of the treatment under consideration to assess and evaluate the performance of the patient and the requirement in the plans. Multi-agency working is an invincible force of the treatment as this patient is suffering from chronic mental illness (Polikandrioti et al., 2018).
The factors include medical and non-medical treatment of the patient. In such cases, regular motivation is required by the patient to coordinate with the team and make treatment progressive. Leadership and management are not just a task but a way of conducting activities. In complex cases involving intellectual quotient of nurses, education and training can be beneficial to create an effective MDT (Ellis and Sevdalis, 2019). Different approaches are undertaken to develop the treatment plan and inform the need for inter-professional and multi-agency working have led to the widespread use of MDT and integrating multiple profession and medical and non-medical services to make treatment qualitative. It is because of the effective integration of different professions that innovation and creativity in the field of nursing have been possible. To assess the degree of authority to be exercised on the patient based on different situations has only been possible by inter-professional collaboration (Gerogianni et al., 2019).
To deduce the effectiveness of leadership and management skills of nurses, the report has presented many critical arguments. Managing mental illness cases is a complex task and needs the proper allocation of resources and use of proper skills of different professionals and doctors. By the way of Inter-professional collaboration by creating MDT, this has become possible. Different leadership approaches and styles have different merits and demerits that must be assessed before exercising power or communicating with the patient. Effective communication with proper deployment of skills can make treatment successful.
Balik, B., 2018. Joy in work: the vital role of nursing leadership. Nurse Leader, 16(4), pp.220-223.
Ellis, G. and Sevdalis, N., 2019. Understanding and improving multidisciplinary team working in geriatric medicine. Age and ageing, 48(4), pp.498-505.
Erdal, A., Flo, E., Selbaek, G., Aarsland, D., Bergh, S., Slettebo, D.D. and Husebo, B.S., 2017. Associations between pain and depression in nursing home patients at different stages of dementia. Journal of affective disorders, 218, pp.8-14.
Gerogianni, G., Babatsikou, F., Polikandrioti, M. and Grapsa, E.J.I.U., 2019. Management of anxiety and depression in haemodialysis patients: the role of non-pharmacological methods. International urology and nephrology, 51(1), pp.113-118.
Giddens, J., 2018. Transformational leadership: What every nursing dean should know. Journal of Professional Nursing, 34(2), pp.117-121.
Goldsberry, J.W., 2018. Advanced practice nurses leading the way: Interprofessional collaboration.
Homeyer, S., Hoffmann, W., Hingst, P., Oppermann, R.F. and Dreier-Wolfgramm, A., 2018. Effects of interprofessional education for medical and nursing students: enablers, barriers and expectations for optimizing future interprofessional collaboration-a qualitative study. BMC nursing, 17(1), p.13.
Kantanen, K., Kaunonen, M., Helminen, M. and Suominen, T., 2017. Leadership and management competencies of head nurses and directors of nursing in Finnish social and health care. Journal of research in Nursing, 22(3), pp.228-244.
Mertens, F., De Gendt, A., Deveugele, M., Van Hecke, A. and Pype, P., 2019. Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care. Journal of Clinical Nursing, 28(19-20), pp.3680-3690.
Murray, E., 2017. Nursing leadership and management: for patient safety and quality care. FA Davis.
Nieuwboer, M.S., van der Sande, R., van der Marck, M.A., Olde Rikkert, M.G. and Perry, M., 2019. Clinical leadership and integrated primary care: A systematic literature review. European Journal of General Practice, 25(1), pp.7-18.
Nilsson, U., Gruen, R. and Myles, P.S., 2020. Postoperative recovery: the importance of the team. Anaesthesia, 75, pp.e158-e164.
Polikandrioti, M., Koutelekos, I., Vasilopoulos, G., Gerogianni, G., Gourni, M., Zyga, S. and Panoutsopoulos, G., 2018. Anxiety and depression in patients with permanent atrial fibrillation: prevalence and associated factors. Cardiology research and practice, 2018.
Siren, A. and Gehrs, M., 2018. Engaging Nurses in Future Management Careers: Perspectives on Leadership and Management Competency Development through an Internship Initiative. Nursing Leadership (Toronto, Ont.), 31(4), pp.36-49.
Weiss, S.A., Tappen, R.M. and Grimley, K., 2019. Essentials of nursing leadership & management. FA Davis.
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