Effective Leadership And Teamwork in Nursing Essay

Effective leadership and teamwork in nursing, with particular reference to psychiatric (mental health) nursing, within the context of professional practice and client (patient) perspectives

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As part of the campaign to deliver effective health and social care, the Government’s modernisation agenda focuses on strengthening nursing leadership and developing inter-professional teamwork. It is proposed that having good quality clinical leadership skills among all health professionals is perceived as vital to the provision of high-quality, effective patient-centred care, as well as for the development and future of the National Health Service (NHS) (Department of Health (DOH), 2000, pp59-71). Nurse leadership has developed significantly over the past decade and now nurses can become nurse consultants, nurse practitioners, and modern matrons or run nurse-led units. It is debated that high calibre nurse leadership can produce more motivated and effectual staff, reduce the risk of errors in drug management, decrease staff turnover and rates of sickness, result in fewer patient complaints and most importantly improve patient care (Williams et al, 2001, pp1-3). This essay will critically analyse effective leadership and teamwork in nursing, especially within a mental health nursing context, with respect to professional practice and patient perspectives.Effective Leadership And Teamwork in Nursing Essay

As mentioned leadership skills have for a long time been acknowledged as a solution to the provision of good health care. In order to achieve first-rate health care, healthcare personnel especially senior nurses must be able to effectively lead teams, particularly across professional, clinical and organisational boundaries (Taylor, 2007, p30). Two of the key roles of a lead nurse or senior nurse manager are that of supporting staff and overseeing nursing in the provision of patient care (Castledine, 2004, p119).Effective Leadership And Teamwork in Nursing Essay

It is proposed that meeting staff needs improves satisfaction, productivity and efficiency and it is debated that productivity is now an important concept within health and social care sectors. It is suggested that productivity within the healthcare industry is defined by the quality of patient care. Arguably, productivity is not exclusively dependent upon how hard and well individuals work, but about meeting staff needs and support from leaders and colleagues (Moiden, 2003, p19). Debatably, where team leaders or managers are concerned about the needs and objectives of their staff, and are aware of the social and physical conditions that affect their working environments, productivity and efficiency will improve. It is possibly that a lack of working environments that support staff affects the quality of care for patients. It is suggested that it is vital that the nurse manager has leadership skills that allow a team to work together effectively (Moiden, 2003, p19). Nurse leaders should be seen frequently by those they lead as high visibility could ensure that support is obtainable when most needed. Similarly, nurse leaders must ensure that staff skills are used in such a way that patients’ obtain the greatest benefit from their abilities. This can be achieved by the nurse leaders enabling others to act and giving positive responses to work-related performance. This will facilitate motivation, increasing job satisfaction and promoting better patient care (Clegg, 2000), p44).

Within a psychiatric nursing environment whether it is in the community or in a mental health unit teamwork is imperative for both the staff and the service users. In the field of psychiatric nursing, nurses work as a team with other professionals such as psychiatrists, clinical psychologists, occupational therapists and social workers. Therefore, responsibility for the service users is shared across the whole multi-disciplinary team and each service user relates to several team members (Williams, 2005, p39). Arguably, the team approach to patient care within mental health nursing has advantages in terms of reducing dependency on team members, and reducing levels of burnout. It is debated that teamwork is vital in order to provide a safe and therapeutic environment that respects the service user’s dignity while promoting independence and preparation for life in society. The team approach can be supportive and creative but it is not without its problems (Machin, 1998, p17).Effective Leadership And Teamwork in Nursing Essay

Onyett et al (1997) studied a sample of four hundred and forty-five team members across various disciplines working in fifty-seven Community Mental Health Teams (CMHTs). Emotional exhaustion, low personal accomplishment, depersonalisation, job satisfaction and sick leave was examined in relation to the perceived clarity of the role of the team, personal role clarity, identification with one’s profession and the team, caseload size, composition and the frequency with which users were seen. Excessive emotional exhaustion was reported, predominantly among consultant psychiatrists, social workers, nurses and psychologists. High job satisfaction, high individual achievement and “low depersonalisation” were also found. Job satisfaction was associated with “team role clarity” and identification with the team. Effective Leadership And Teamwork in Nursing Essay Caseload size, assemblage and the frequency with which service users were seen were not associated with job satisfaction or burnout. Important disparities were found between disciplines on all variables except sick leave. Therefore, on the evidence presented it could be argued that team membership has different implications for different disciplines. Debatably, greater attention is needed to the composition, training and leadership of CMHTs rather than hope that the disciplines will spontaneously work effectively together. It is important to note that the research used here of evidence of effectiveness of teamwork has various limitations. Firstly, the small sample size makes it not viable to relate the findings to all CMHTs in the United Kingdom. Secondly, the questions asked in the study might be seen to be leading questions and this makes the study unreliable. Thirdly, this study does not take into account the personal views of the members of the team. The individual views on the effectiveness of multi-disciplinary teamwork from the nurses, occupational therapists and social workers could make this research more valid as relationships and issues of skill mix between the disciplines could have been explored within the context of patient care.Effective Leadership And Teamwork in Nursing Essay

Teamwork appears to be more effective in enabling first-class patient care within hospital based mental health units. Flockhart and Moore (2002, p96) assessed the effectiveness of teamwork on patient care at the psychiatric intensive care unit that is part of the Maudsley NHS Trust in South London. The unit admits some of the most challenging patients who cannot be safely managed on general wards. Many patients suffer from paranoid schizophrenia or bipolar affective disorder and can be violent or aggressive, suicidal, harming themselves or be abusing various substances. Patients are only admitted on the unit for clinical reasons, not for safety. The main ethos of the unit is to help the service users achieve their maximum level of functioning so that they can be cared for with the fewest possible restrictions. It is important therefore that in this unit and in others like it in the United Kingdom the nurses need to be good team workers and be able to deal with issues calmly. Patient involvement and collaborative working has been addressed by joint care planning with the family and other key disciplines such as social workers, probation officers and various psychiatric and psychology therapists and this had led to rapid improvements in patients’ mental state and behaviour. The collaborative teamwork that focuses on the patients’ safety has improved team communication and effectiveness. Arguably, this particular unit has an efficient team that has empowered and enabled the staff to provide the best and most effective care for the service users. This is because the team is organised, supported and valued by each of the other members and the skill mix is ideal for improving patients’ mental health.Effective Leadership And Teamwork in Nursing Essay

It is also important to note that this unit has one dedicated team leader or co-ordinator that provides a consistent approach that meets all the needs of the service users and staff. Routine physical proximity appears to contribute to constructive working relationships and this has been illustrated by the effective interprofessional working relationships observed in this unit. Debatably, in contrast, within a community setting each discipline will have its own team leader or manager and this might lead to inconsistencies, differences and confusion in policy and decision making.Effective Leadership And Teamwork in Nursing Essay

In reviewing the literature for this essay the author would like to propose the following recommendations. Debatably, more evidence based research is needed on how effective leadership leads to enhanced practice and improved patient care, especially within mental health nursing. There appears to be some literature on the effectiveness of teamwork within the mental nursing profession. Arguably, this is because the provisions needed by mental health service users are wide and varied and historically multi-disciplinary teams have always been the solution to providing care and support for service users whether that care was deemed to be of good quality or of inferior quality. However, there is room for more evidence-based literature on the effectiveness of teamwork within mental health nursing. Similarly, it is suggested that there is a need for more evidence-based literature on the effectiveness of teamwork in nursing in general. Correspondingly, there is little or no evidence-based literature that expounds service user’s perspectives about how efficient teamwork improves their care.Effective Leadership And Teamwork in Nursing Essay

From the evidence presented it can be said that many factors lead to better team performance and arguably, one of the most significant is that of team leadership. Good quality leadership skills are the solution to enabling teams to provide high quality effective patient care. Effective team leadership improves satisfaction among team members and patients and improves productivity. In order to be effective as a leader the team leader must be visible and approachable. Team working within a hospital setting is generally more effective in delivering good quality patient care than that often achieved within a community setting where multi-disciplinary teams are involved. The stress on team members in CMHTs is related to the standard of leadership as well as the composition and training of the team. Experience in the Maudsley NHS Trust illustrates the importance of good team working and leadership in determining the quality of outcomes for patients. Evidence in the literature studied is presented from the perspective of staff in healthcare teams while there is little or no evidence of the views of service users on the subjects of leadership and teamwork.Effective Leadership And Teamwork in Nursing Essay

Effective Leadership and Management in Nursing
NUR/492: Leadership and Management
July 9, 2012
Instructor: Janet Bailie Effective Leadership and Management in Nursing Leadership and management are essential to any health care organization, balancing patient care, employees, physicians, and the organization. Nursing is founded on interpersonal relationships. As a people-oriented profession, nursing leadership styles are influenced by humanism. The mission, attitude, and behaviors of a health care organization begins with its leadership, which creates the direction and purpose of the organization. The purpose of this paper is to differentiate between leadership and management, describe views of leadership, and explain the…show more content…
Through trusting interpersonal relationships staff members are empowered to discuss openly concerns and proposed solutions without consequence from the leader. It is important that followers feel comfortable with approaching the leader with complaints or concerns. Leadership demonstrating a neutral position and maintaining a non-judgmental attitude when faced with difficult situations is much easier to approach. Effective Leadership And Teamwork in Nursing Essay
Effective Leadership Leading a health care organization comes with immense responsibility and is not an easy task. Transformational leadership has proven to be an effective leadership style in the nursing profession, demonstrating a clear mission, a commitment to excellence, and the ability to motivate and lead others to higher levels of achievement (Schwartz, Spencer, Wilson, & Wood, 2001). Characteristics and qualities of an effective leader include
• Communication skills- able to openly communicate, easy to approach, and listens
• Compassionate- kind, caring, and respectful of others
• Dependable-reliable, consistent Effective Leadership And Teamwork in Nursing Essay

Globally, health care systems in the developed world continue to struggle with escalating demands for services and escalating costs. Service design inefficiencies, including outmoded models of care contribute to unsustainable funding demands.1 An example is the continuing practice in many settings to look to hospital emergency departments to provide what are essentially, primary health care services. While some progress and reforms have been achieved, numerous experts point to the need for further system change if services are to be affordable and appropriate in the future.2 They note that

[…] further change is still needed, despite years of progress in the quality of health care around the world. This transformation will require leadership – and that leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles. Clinicians not only make frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery.Effective Leadership And Teamwork in Nursing Essay

Effective clinical leadership has been linked to a wide range of functions. It is a requirement of hospital care, including system performance, achievement of health reform objectives, timely care delivery, system integrity and efficiency, and is an integral component of the health care system.2–4 Though most people are provided with health care within the community setting, hospital care continues to garner the bulk of funding and attract considerable attention in relation to care quality and related concerns. Indeed, hospitals are very costly and diverse environments that vary in size and complexity, determined in part by their overall role and function within the larger health care system. The services provided by individual hospitals are determined and driven by a number of mechanisms, including government policy, population demographics, and the politics and power of service providers.Effective Leadership And Teamwork in Nursing Essay

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However, regardless of the differences, the clinical areas of the hospital are critical to all health care organizations, given that it is at this level where consumers principally engage with the hospital system. It is at this point where consumers are recipients of hospital care and where they witness and experience how the system functions, observing the strengths and inefficiencies of the health care system and conflict and collegiality between and among groups of health professionals. It is also at this point that clinicians, defined as any frontline health care professionals, have opportunities to fulfill leadership roles. For consumers of health care to achieve optimal health outcomes and experience optimal hospital care, many believe effective clinical leadership is essential.

In this paper, we discuss clinical leadership in contemporary health care, definitional issues in clinical leadership, roles of hospitals in contemporary health care, preparation for clinical leadership roles, and the facilitators and barriers to effective clinical leadership in the hospital sector.Effective Leadership And Teamwork in Nursing Essay

Clinical leadership in contemporary health care

The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and various government reports.6–8 Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to improving quality and safety.9 As one Australian example, a key priority nursing recommendation of the Garling Report was that Nurse Unit Manager (NUM) positions be reviewed and significantly redesigned “to enable the NUM to undertake clinical leadership in the supervision of patients […] to ensure that for at least 70% of the NUM’s time is applied to clinical duties.”8 The remaining time could be spent on administrative and management tasks. In the more recent Francis report7 from the UK, a recommendation was made for similarly positioned ward nurse managers to be more involved in clinical leadership in their ward areas. In the United States, clinical leadership has also been identified as a key driver of health service performance, with the Committee on Quality of Healthcare suggesting considerable improvements in quality can only be achieved by actively engaging clinicians and patients in the reform process.Effective Leadership And Teamwork in Nursing Essay

However, leadership in health care is often very complex, and some authors claim it faces unique contextual challenges. For example, Schyve5 claims aspects of governance are sui generis in health care, noting

healthcare organizations also have a rather unique characteristic. That is, the chief executive is not the only part of the organization’s leadership that is directly accountable to the governing body. In healthcare, because of the unique professional and legal role of licensed independent practitioners within the organization, the organized licensed independent practitioners – in hospitals, the medical staff – are also directly accountable to the governing body for the care provided. So the governing body has the overall responsibility for the quality and safety of care, and has an oversight role in integrating the responsibilities and work of its medical staff, chief executive, and other senior managers into a system that that achieves the goals of safe, high-quality care, financial sustainability, community service, and ethical behaviour. This is also the reason that all three leadership groups – the governing body, chief executive and senior managers, and leaders of medical staff – must collaborate if these goals are to be achieved (Schyve 2009:35).Effective Leadership And Teamwork in Nursing Essay

While nursing is not specifically named in the above quote, we believe nursing to be implicit and integral to leadership in hospitals. There is recognition of the challenges associated with health care governance, evidenced by significant investment internationally in building systems for leadership development in health care.5,11 For example, the UK advanced leadership programs have been instituted and run for clinical leaders since 2001 by the National Health System Leadership Centre,12 and there are some similar innovations in other countries (see, for example, Ferguson et al13). This points to the realization that the cost and consequences of poor clinical leadership greatly outweigh the costs and potential benefits of provision of formal programs to enhance clinical leadership capacity ideally in a multidisciplinary health care team context.Effective Leadership And Teamwork in Nursing Essay

Indeed, across the health care sector, evidence exists of the need for clinical leadership to optimize care delivery. In addition to challenges associated with resources and demand, episodes of poor patient outcomes, cultures of poor care, and a range of workplace difficulties have been associated with poor clinical leadership,8,9,14 and these concerns have provided the impetus to examine clinical leadership more closely.Effective Leadership And Teamwork in Nursing Essay

Definitional issues in clinical leadership

Within the health care system, it has been acknowledged that clinical leadership is not the exclusive domain of any particular professional group.15 Rather, all members of the health care team are identified as potential leaders.16 Like “leadership,” the concept of clinical leadership can be defined in a range of ways; and while a standard definition of clinical leadership providing absolute agreement on meaning is not crucial to progress and is likely to prove difficult,17 it is useful to consider the various ways clinical leadership is conceptualized and presented in the literature. While effective clinical leadership has been offered up as a way of ensuring optimal care and overcoming the problems of the clinical workplace, a standard definition of what defines effective clinical leadership remains elusive.15,18 Indeed, in some ways it is easier to consider what constitutes poor or ineffective clinical leadership.Effective Leadership And Teamwork in Nursing Essay

A secondary analysis of studies exploring organizational wrongdoing in hospitals highlighted the nature of ineffectual leadership in the clinical environment. The focus of the analysis was on clinical nurse leader responses to nurses raising concerns. Three forms of avoidant leadership were identified:

placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant.Effective Leadership And Teamwork in Nursing Essay

These forms of leadership failure were all associated with negative organizational outcomes. Similarly, McKee et al employed interviews, surveys, and ethnographic case studies to assess the state of quality practice in the National Health Service (NHS); they report that one of the most important insurances against failures such as those seen in the Mid-Staffordshire NHS Trust Foundation is active and engaged leaders at all levels in the system.14,19

Despite the definitional uncertainty, a number of writers have sought to describe the characteristics, qualities, or attributes required to be an effective clinical leader. Synthesis of the literature suggests clinical leadership may be framed variously – as situational, as skill driven, as value driven, as vision driven, as collective, co-produced, involving exchange relationships, and as boundary spanning (see Table 1). Effective clinical leaders have been characterized as having advocacy skills and the ability to affect change.20,21 As well, effective clinical leaders have been linked to facilitating and maintaining healthier workplaces,22,23 by driving cultural change among all health professionals in the workplace.24 To achieve these positive outcomes, clinical leaders need to be seen as credible – that is, be recognized by colleagues as having clinical competence18,25–27 and have the skills and capacity to effectively support and communicate with members of multidisciplinary clinical teams.Effective Leadership And Teamwork in Nursing Essay 18,25 Taking an individual perspective, effective clinical leaders require personal qualities that reflect positive attitudes toward their own profession, have the courage and capacity to challenge the status quo, effectively address care quality issues, and engage in reflective practice.18,14 Pepin et al found that clinical competence, the capacity to lead a team, and being prepared to challenge the status quo were necessary skills for clinical leaders in one Canadian study.28 In an Australian study, findings indicated that student nurses want clinical leadership attributes from their clinical preceptors to include being supportive, approachable, and motivating, while being effective communicators.29 Table 1 summarizes the characteristics of clinical leadership and the attributes of clinical leaders distilled from the literature.Effective Leadership And Teamwork in Nursing Essay

Despite acknowledging the lack of a standard definition of clinical leadership, the authors in one literature review identified common themes:

[…] the ability to influence peers to act and enable clinical performance; provide peers with support and motivation; play a role in enacting organizational strategic direction; challenge processes; and to possess the ability to drive and implement the vision of delivering safety in healthcare.Effective Leadership And Teamwork in Nursing Essay

Many articles assert that clinical leadership is leadership provided by clinicians often recognized as clinical leaders. Indeed, an important driver of the move toward models of clinical leadership is the notion that clinical leaders “are the custodians of the processes and micro-systems of health care.”31 Stanley has contributed a summary of seven clinical leadership characteristics which includes factors such as expertise, direct involvement in patient care, high level interpersonal and motivational skills, commitment to high quality practice, and empowerment of others.32 In contrast to managerial leadership, which operates through hierarchical superior–subordinate organizational relationships, clinical leadership has a collegiate orientation and a focus upon the patient or service interface.11 While some clinical leaders may hold positions of positional authority, primarily the influence of clinical leaders stems from characteristics such as clinical credibility and the capacity for collaboration. While transformational leadership positions the leader as a charismatic shaper of followers,33 clinical leadership is more patient centered and emphasizes collective and collaborative behaviors.Effective Leadership And Teamwork in Nursing Essay

It is apparent that the “theory” of clinical leadership is in an early stage of development, and like leadership in general, in health there is very limited empirical support for specific approaches to enacting effective models. Edmonstone notes following the implementation of numerous clinical leadership programs in the UK the little research undertaken has largely focused on program evaluation, rather than the nature or outcomes of clinical leadership.35 As the body of evidence continues to develop, some definitional clarity may be achieved.Effective Leadership And Teamwork in Nursing Essay

Role of hospitals in contemporary health care

Globally, hospitals are under increased strain and scrutiny. Increased demands and fiscal pressures have increased the pressures on all health professionals as well as clinical and non-clinical staff. Hospitals, once seen as representing “health care,” are now recognized as dangerous places, particularly where the most vulnerable, such as children and older people, are exposed to the risk and actual adverse clinical events. A number of nationally and internationally influential reports6–8 have resulted in changes in visibility, scrutiny, and accountability in relation to hospital care. This scrutiny has increased the emphasis on the role of health professionals, including nurses, in monitoring standards, developing and evaluating better ways of working as well as advocating for patients and their families; and led to a substantial momentum in the quality and safety agenda, including the promotion of various strategies such as promoting evidence-based practice.Effective Leadership And Teamwork in Nursing Essay

In the hospital sector, the demands placed upon leaders have become more complex, and the need for different forms of leadership is increasingly evident. To derive cost efficiency and improve productivity, there has been intense reorganization. Coupled with these reforms has been increasing attention upon improving safety and quality, with programs instituted to move attention beyond singular patient–clinician interpretations of safety toward addressing organizational systems and issues of culture.36 Arising from these reforms has been growing recognition that many assumptions of common leadership models are not well suited to delivering change at the point-of-care delivery or to assuring increased clinician and patient engagement in decision making.3 Accordingly, there have been calls for a transition to a new phase of hospital leadership, one that places the clinical frontline and clinicians as crucial to leadership within organizations.13,37 This transformational shift in the conceptualization of leadership has seen debate move from managerial, senior leader, or singular leader interpretations of leadership to a focus upon clinical leaders and clinical leadership. In part, this shift has been in response to growing recognition that while designated leaders in positions of formal authority within hospitals play a key role in administration and espousing values and mission, such leaders are limited in their capacity to reshape fundamental features of clinical practice or ensure change at the frontline.Effective Leadership And Teamwork in Nursing Essay

There is considerable evidence to suggest nurses may experience dissatisfaction with the working environment in hospitals,38 with poor work environments impacting negatively on the delivery of clinical care and patient outcomes.39 In seeking to understand this dissatisfaction, work engagement among nurses and other health professionals has been explored from the perspective of burnout and emotional exhaustion40–42 with work engagement conceptualized as a positive emotional state in which employees are emotionally connected to the work roles.43 While such studies have examined engagement with work from an emotional perspective, engagement can also be understood as a broader concept that includes an employee’s relationship with their professional role and the broader organization.44 This broader view on employee engagement ties in with the concept of organizational citizenship behavior, which captures discretionary behaviors that are not formally rewarded within the organization that help others, or are displays of organizational loyalty or civic virtue.Effective Leadership And Teamwork in Nursing Essay

The thrust of much recent attention upon attaining reform in hospitals through clinical leadership has positioned clinical leadership as a vehicle for improving clinician engagement in not only their own work, but also the care delivery microsystems in which they operate. This type of work engagement requires forms of citizenship behaviors that are focused upon improving clinical systems and practices. For individual clinicians, broader engagement within the organization with systems and processes requires the capacity for citizenship behaviors that are clinically focused and motivated, both at the level of one’s own work and also the broader network of relationships and systems. These forms of “clinical citizenship behaviors” require a fair and just work culture in which individuals can openly identify issues and work together toward solutions.Effective Leadership And Teamwork in Nursing Essay

Importantly, given that clinicians may not necessarily be employees of the hospital in which they work but self-regulated and independent professionals who operate with a level of independence from typical employer–employee relationships, and who may have lower levels of commitment to the institution, understanding clinician engagement beyond the level of engagement with one’s own work, toward engagement with the broader clinical quality and safety agenda within the organization has important implications for the success of clinical leadership agendas.46 A small sample study of head nurses in a large academic hospital47 reported the development of clinical leaders improved the quality of the nursing work environment through enhanced communication, increased responsibility and empowerment, improved patient-centered communication, improved clarity and structure, and improved interdisciplinary collaboration.Effective Leadership And Teamwork in Nursing Essay

Hospitals are complex socio-political entities, and the ability for engagement and leadership among clinicians can be hampered by power dynamics, disciplinary boundaries, and competing discourses within the organization. The tension inherent between clinical and administrative discourses is evidenced in the findings from the evaluation of clinical directorate structures in Australian hospitals, with close to two thirds of medical and nursing staff surveyed reporting the primary outcome of such structures was increased organizational politics.48 At the same time as there have been growing calls for clinical leadership, there is evidence from Australia that reform and restructure within hospitals has resulted in a loss of nursing management roles and functions.49 Despite a policy agenda to foster clinical leadership, there are reports that managerial imperatives can instead primarily focus upon fiscal efficiency or organizational political imperatives, with various factors colluding to silence concerns of clinicians.Effective Leadership And Teamwork in Nursing Essay

Edmonstone11 cautions that without structural and cultural change within institutions, the move toward clinical leadership can result in devolution of responsibility to clinicians who are unprepared and under resourced for these roles. Evidence emerging from the NHS suggests particular value in leadership coalitions between managers and clinicians.19 Further, strong clinician representation at Board level has been reported to make a difference to clinical engagement. Effective Leadership And Teamwork in Nursing Essay

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Medical Treatment Of Criminals Nursing Essay.

 

The hospitals in the State of Hawaii have patients admitted into their inpatient wards for various ailments and injuries. Always, within these inpatient areas of care nursing staff work diligently to provide a direct line of care to the admitted patients per the orders of the doctors of the patients. The nursing-staff, which is employed to take care of the patients, not only have orders from the doctor based on subjective thought, the nursing staff also use a lot of their own objective care with these patients. The patients, while seen in the hospital setting are patients and these patients come from all lifestyles. The focus of this research proposal is to see whether patients with a known criminal background receive fair treatment compared to the treatment that a patient with no criminal history would receive. The researcher will be using a vignette-based survey using the five point Likert scale to assess whether or not all patients receive equal treatment. The literature review will touch on what already is known about the topic and the ethical issues involving direct patient care. In addition, the discussion of the expectation and implication of the surveys will be discussed.Medical Treatment Of Criminals Nursing Essay.

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Introduction

When going into a hospital, people expect that they will receive a certain amount of care to treat whatever ailment or illness they may have. Care provided is assumed, no different from a similar like illness or disease that any other human being in that hospital has. However, what if that person, example, post surgery of an appendicitis, was admitted to your inpatient ward on your evening shift. Feeling that it is just another patient, and will get the same quality care, you give all your patients. An hour later, you recognized that this new admit was on the 6:00 nightly news last night as having just been released from prison after spending 15 years for child sexual assault. The question now, will you, the nursing staff, apply the same amount of care and treatment as previously given the hour before you remembered about the patient’s criminal history, or will some bias present itself in your care?

The question the researcher is hypothesizing about is do known criminals, former, and current, receiving care by nursing staff within an inpatient hospital setting receive different care when compared to the treatment of non-criminal patients? The researcher theorizes that hospital in-patients with a known criminal background receive less care from hospital staff compared to a “normal” patient without any criminal history.Medical Treatment Of Criminals Nursing Essay.

The researcher first would like to give personal knowledge as to why the interest in this topic originated. The researcher enlisted in the U.S. Army as a Medic and as a Health Care Specialist, has served, thus far, eight years in the healthcare profession, in many different aspects of the health care field. Initially the researcher was assigned to a Combat Support Hospital (CSH), an eighty-four bed field unit, and deployed to Iraq in support of Operation Iraqi Freedom (’05-’07). While deployed, the researcher worked at the Intermediate Care Ward (ICW), similar to a hospital ward or unit where patients would stay overnight, many times for many nights. While in Iraq, the researcher cared and treated over 2,000 coalition forces, contractors, local nationals, and enemy forces. The care provided was universal; there was no discrimination to the individual receiving treatment or care. Other areas in the health care field the researcher experienced includes, Tripler Army Medical Center (TAMC), Pacific Regional Medical Command (PRMC) -initially the researcher worked on a inpatient ward for one and one half years (’08-’09), then a hospital clinic (’09-’11), and as of currently, working at another clinic still located at TAMC (’11-present).

We should care because not only can the medical field be subjective, which according to the labeling process subjectivity is a need to satisfaction for the quality of life (Rosenfield, 1997), the healthcare industry can also be a very objective field, where the decision of care relies on the nursing staff providing that care. Ethics has a lot to do with one’s own moral values, and when there is a choice of how to care or how much care to give there may be conflicts of interest (Monahan, 1980). Examples of this type of care can involve the type of medication certain providers prescribe, or the amount of rehabilitation the therapist asserts into bettering the patient. There are countless amounts of discretion left to the caregiver. Bottom line, and up front, we should care about this proposal because the care provided to individuals should be universal and not just for a select few, regardless of past mistakes. Every person deserves a chance at a healthy life and if hospitals can provide that benefit to keep people healthy than they should. Medical care should not be selective or objective, it needs to be subjective for everyone.Medical Treatment Of Criminals Nursing Essay.

Literature Review

The study of the medical treatment of a patient with a known criminal background has never been attempted. Therefore, the researcher would like to utilize two approaches to this topic discussed in the literature review giving need to why this topic warrants future study. Those two approaches are the nursing ethics and the labeling theory.

Nursing Ethics

Nursing means to nourish, treat and care for the sick and maintain the health and welfare of their patients until their death (Royal College of Nursing, 2003). Therefore, nursing ethics has a vital role in the care and treatment of patients. So, because of the nurse’s moral values of taking care of their patients, nurses are required to take on extremely difficult roles in the care of their patients, both professionally and personally. Like the Emergency Medical Treatment and Active Labor Act dictating by law that hospital emergency rooms and the physicians must see all patients who enter an emergency room (Zibulewisky, 2001), not to mention the Hippocratic Oath taken by providers at their graduation ceremonies from medical school, swearing an allegiance to treat their patient (Hulkower, 2010). Nurses also take part in an oath called the Nightingale Pledge (similar to the Hippocratic Oath), it is the nursing proclamation that nurses will be true to their profession and live up to the standards of nursing (Egenes, 2009). All respects consider the pledge, named after Florence Nightingale, the founder of modern nursing (Egenes, 2009).Medical Treatment Of Criminals Nursing Essay.

Ethics is very important in all medical professions (Gillon, 1986), Monahan (1980) suggests that psychologists take an ethics course and that it should be part of the curriculum and made mandatory as its own separate class (16). The researcher agrees that ethics should be mandatory and all professions in the medical field go through an ethics course including nursing staff because of their hands on approach with any patient. Ethics classes discusses what is right both morally and legally which includes many things such as conflict of interest, patient rights, and privacy, plus a multitude of other ethical issues nursing staff can face (American Nursing Association Committee on Ethics, 1994).

Every patient [has rights] and is entitled to privacy per the Health Information Portable and Accountability Act (HIPAA) (United States Department of Health and Human Services, 2003). Hawai’i created the Privacy of Health Care Information Act reflecting HIPAA, it states, “Individuals have a constitutional right to privacy with respect to their personal health information and records, and with respect to information about their medical care and health status” (Sutton, 2001). In other words, just because a patient has a criminal history in their background, they have a right to medical treatment and it is private and cannot be discussed openly with others, unless it is pertinent to their treatment. It is as said, it is on a need to know basis.Medical Treatment Of Criminals Nursing Essay.

Unfortunately, the researcher feels that nursing staff and the medical community sometimes forgets about ethics and patient rights. This forgetfulness can sometimes be due to labeling or the stigma carried by certain patients.

Labeling Theory

When another person labels someone, it is the same as having a stigma placed against someone, which also can cause negative consequences against the labeled person (Rosenfield, 1997). This is where the labeling theory comes into play. Not only the person labeled receives negative attention, people who encounter labeled individuals apply negative attention to those labeled as well (Ascencio & Burke, 2011). Rosenfield (1997) narrates about the change in behavior of subjects that received an article regarding someone with violent tendencies, whom after reading the article the subjects reacted negatively about the person mentioned in the article when compared to the control group (pg 290-291) who had no reaction.

The labeling theory posits that society will react differently to committers of unlawfulness; meaning, society will react to the individual who broke the law as though that individual will always be unlawful and therefore, based on the behavior of society that individual will remain to act out unlawfully (Williams, 1976). This type of reaction signifying the label, alone, implies stigma (Rosenfield, 1997) and can further impede the individual’s road of rehabilitation. As labeled “criminal” a person’s chances to recovery or have success in life become slim (Williams, 1976). In addition, that person will face stigma wherever they go and treated more as an outcast (Williams, 1976). The researcher presumes that this will lead into any facet of society, to include, when meeting others, including receiving healthcare from nursing staff in an inpatient ward in a hospital in the State of Hawai’i. The patient label as criminal will cause a reaction from nursing staff, whereby the patient will be avoided more often, not forgotten, just avoided.

For purposes of this study, the researcher will focus his attention on patients with a violent criminal history where the definition of violent crime is anyone who commits the following: homicide, attempted homicide, aggravated assault, common assault, robbery, threatening behavior, harassment, arson, and sexual crime (Fazel & Grann, 2006). The researcher believes that these crimes will attract the most attention of the labeling theory.

Consider the following, a twenty-seven year old woman hospitalized for failed suicide attempt; she will be there for a number of days because of her self-inflicted wounds to her wrists; the size of the wound requires attention and she lost a lot of blood. However she did succeed in infanticide, she killed an infant (Spinelli, 2004), she successfully drowned her 3-month-old baby before trying to take her own life. You are a nurse who is assigned to watch her on your shift. Will you be able to treat this patient no different from another patient with no criminal background? The infant whose life she had taken depended on her for survival, and now the law demands retribution (Spinelli, 2004), but now this woman depends on you for survival, can you be indifferent? The researcher is trying to prove that there is a slight possibility that this woman might not be treated the same in the hospital. However, nursing staff need to realize that the patient is not in prison where it is not sensible for her treatment (Monahan, 1980) to her wrists, and psychological impairment.Medical Treatment Of Criminals Nursing Essay.

Methodology

To conduct this study the researcher will use two five-point Likert scale surveys with a vignette (scenario) based questionnaire on each survey and a certain set of matching codes. Both surveys used will be involving two different mock patients, one for each survey. A third party individual will deliver the surveys to every hospital with an inpatient ward; each ward will receive fifty surveys. This is to account for the researcher wanting to make available to every nursing staff member a survey. The researcher will seek permission from the top executive or board members at each hospital with an inpatient ward informing them of the researcher’s intent to conduct this survey. The nursing staff will not know the underlying reason for the study. The researcher does not want the knowledge about the survey to affect the answers for the treatment of patients with a criminal history. The only information given to the nursing staff is that this will be a survey about patient treatment. The third party individual will act as the intermediary between the researcher and the nursing staff at the inpatient wards at the participating hospitals. In fact, the third party will only be referred to as “Third Party” they will have no distinguishing name to be identified with. The researcher will only interact with the board or top executive officer of the hospital. This will help with the anonymity of nursing staff.

This research will be on a longitudinal study over the course of one month. On the first day of the month, the third party will deliver the first set of surveys to the inpatient wards. This survey will consist of one mock patient without any criminal background, asking those surveyed for their employment information and ten vignette questions. The questions asked on both sets of surveys will be about patient care and treatment only. The demographical questions will attempt to narrow the findings to see if there is a certain age group, gender, etc. that may discriminate more to patients with criminal backgrounds, if there is any discrimination to be found. On the last day of the month, the third party will deliver the second set of surveys. The second survey will have a mock patient with a criminal background. This second survey will be identical to the first excluding the patient type, non-criminal or criminal. Also, to help alleviate from any other discriminatory or labeling factors the researcher has decided that both mock patients will be a 37 year old white male, older in age from majority of actual criminals and the patient is white, the least discriminated against ethnicity in America, also the gender is male, the least discriminated against gender.

Once both surveys are complete, the third party will pack up the raw data and match the code of the first survey to the code of the second survey to ensure completion. The third party will not ask for names just the two coded tabs and after receiving the tabs, give the nursing staff that participated and completed the survey in its entirety a $100 Visa Gift Card.Medical Treatment Of Criminals Nursing Essay.

The reason for the month lapse in surveys, the researcher is attempting to allow enough time between the first and second survey so the respondents cannot remember the answers to the questions from the original survey when they are answering the second survey since each survey has identical vignette questions. The reason for the identical questions is to help narrow in whether or not the patient with a criminal background is being labeled or there is any possibility of unethical maltreatment.

The research site used will be all hospitals in the State of Hawai’i with an inpatient ward. An inpatient ward is conceptualized as any patient who spends at least one over night (11:59p.m.-12:00a.m. is considered overnight) stay in a hospital bed located on an inpatient ward. The researcher would also like to clarify that the emergency room (ER), even though a patient is checked in at the ER does not mean they are admitted into the hospital as an inpatient.Medical Treatment Of Criminals Nursing Essay.

The researcher, using a non-probability quota sampling, will target all nursing staff working in an inpatient ward at each hospital in the State of Hawai’i. The reason for the non-probability quota sampling is the target population will only consist of nursing staff employed strictly to the inpatient wards. Therefore, the researcher will also not be able to generalize the results either because, as said before, it is not representative of the entire population of nursing staff.

The inclusion set will be all adult inpatient wards and nursing staff employed there. Nursing staff that work on the inpatient wards that will be targeted are the Registered Nurse (RN), Licensed Practicing Nurse, or Licensed Vocational Nurse (LPN/LVN), and the Certified Nursing Assistant (CNA). In addition, the reason for the inclusion of strictly this area, the researcher feels that patients, regardless of background, remain there longer, allowing the opportunity for the nursing staff to develop labels about the patients and possibility for any discrimination against the patients is higher.

The excluded areas from this survey will be all of the following: pediatric wards, neonatal intensive care units (NICU), pediatric intensive care units (PICU), psychiatric wards, outpatient clinics, nursing homes, and hospice care. These areas will have the least amount of adult patients or patients that do not remain in this facility long enough to harbor much resentment or build any lasting labels by the nursing staff. Individuals excluded from this survey is any nursing students or students in training, head nurse, assistant head nurse, Non-Commissioned Officer in Charge (NCOIC) or similar individual as compared to the civilian sector like a supervisory position, ward clerks, doctors, and specialists (i.e., physical therapy, speech, audiology, social work, food servers, etc…). These individuals do not remain with patients long enough to build any resentment or label.

The independent variable to this study is the nursing staff of the inpatient wards; this will include any of the following, 4 yr Registered Nurse (BSN), 2 yr Registered Nurse (ADN), Licensed Practical Nurse, Licensed Vocational Nurse (LPN/LVN), Certified Nursing Assistant (CNA). Other independent variable that can affect this study will be the age of the nursing staff, length of employment, what time of day do they work (night shift, day shift, or swing shift), number of usual patient workload in a day, number of staff, and leadership. In addition, some other independent variable in this study is the type of inpatient ward they work at, a ward (medical oncology (MEDONC), ortho/neuro/vascular (ONV), surgical ward (SURG), etc…), intensive care unit (ICU), progressive care (PROG), and are they part time or full time. The last independent variable is the criminal background of the patient that is conceptualized as a patient who has been convicted of any violent crime, homicide, attempted homicide, aggravated assault, common assault, robbery, threatening behavior, harassment, arson, and sexual crime.

The researcher will do a quantitative data analysis utilizing the Statistical Package for the Social Sciences (SPSS) to analyze and manage future data.Medical Treatment Of Criminals Nursing Essay.

All ethical consideration of the nursing staff is taken into account for anonymity and confidentiality regarding this survey. The researcher will also ensure an understanding from nursing staff that answering this survey is giving consent, but it is also voluntary. The researcher nor the third party will ask for names of the participants nor the hospital they work at. Data will be stored in a vault, which only the researcher has the combination. After the study is complete and the data is gathered the researcher will destroy all documents related to this study, except the overall results. In addition, the researcher or the third party will not disclose their own names for protection.

Please see appendix A and B for operationalization.

Discussion

The expectations that the researcher is hoping to find is that there is definitely maltreatment of patients with a criminal background. Furthermore, the researcher expects that there will be a big lack of proper ethical nursing happening on inpatient wards. The researcher understands this research has never been done, and hopes that implications for an expanded study to a national level is held to help ensure the ethical treatment of patients with a criminal background is held to the same standard as everyone else. In addition, this study will help with future enforcement of ethical treatment of all patients. The researcher feels that education is paramount to patient care and that classes in unbiased opinion/non-discrimination are necessary to ensure proper treatment of all patients. In addition, ethical classes need to be made mandatory. Nursing staff also need education in the legal ramifications of not making ethical decisions and not only labeling their patient as a criminal but treating them as a criminal as well.Medical Treatment Of Criminals Nursing Essay.

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