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Reflective portfolio
Introduction
A reflective portfolio highlights an individual’s experiences and insights as a learner from practical case scenarios. In this context, I have highlighted my nursing experience considering a clinical case while working in a nursing home. I have discussed my nursing skills and abilities by referring to leadership theory so that I can analyse my competency in developing my nursing career as a nurse leader. Moreover, I have reflected on my nursing experience by including the Gibbs Reflective Cycle in this portfolio so that I can describe and present my analysis efficiently and effectively.
Critical analysis of an event with respect to leadership and management theory
In order to highlight the significance of leadership in nursing practice and to state my leadership competencies, I would like to share my personal experience regarding an incident while working in the care home as a registered nurse. This incident took place during my initial journey in this nursing home as a registered nurse. By discussing the incident, I would like to reflect on my capabilities as a nurse leader that can help in my career and professional development processes. Referring to the care home incident, I would like to change the name of the patient and his family members in order to protect confidentiality. The patient’s name is Martin who is 67 years old and was admitted to the nursing home in the general medical ward with pneumonia. Martin is married to Caroline who is 64 years of age and by profession, both of them are retired, chemical engineers. Martin was diagnosed with vascular dementia two years ago from the date I am discussing this incident. Moreover, after the diagnosis of dementia, Martin’s health and the symptoms of the disease have worsened since then. Caroline was the chief carer of Martin and she was supported by their children, one daughter and one son. The daughter lived in her parents’ home and was a school teacher, while the son lived a few hours drives from his parent’s place as he was a Professor in the City College. Martin and Caroline were married for about 45 years and since then; they lived in their own home.
Martin’s symptoms related to dementia were mainly dysfunction and memory loss, fatigue, apathy, withdrawal, communication difficulties and similar others. Martin was associated with social activities at his local club and sometimes Caroline also spent time with him in the club. Going for a morning walk and shopping at the local market were some daily activities of Martin. Caroline helped Martin with most of his daily living activities after he was diagnosed with dementia. Martin’s appetite had decreased and additionally, he needed assistance with hygiene, dressing and different self-care activities. Caroline helped him to manage the medication and drug dosages. Martin had a history of hypertension for which he took anti-hypertensive medication.
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Martin developed pneumonia after he suffered a viral infection and hence, he was admitted to the nursing home with pyrexia, dyspnoea, dehydration and increased confusion. He was provided treatment in the general ward where I had carried out my responsibility as the registered nurse. During his stay in the general ward, he was reviewed by the mental health team, occupational therapist, medical team and social work committee. He responded well to the treatment of pneumonia concerning the antibiotic drugs and he also received assistance and nutritional supplements so that he could carry out his daily living activities efficiently.
Being a registered nurse, I primary care for Martin by monitoring his health, administering medications, updating his records, consulting with healthcare providers and educating Martin and Caroline regarding the disease and post-discharge care. In this regard, I learned that I have the competency to become a nurse leader in the future days. I would share my experience with Martin during his stay in the nursing home in the later part of the discussion but before that, I would like to throw light on the importance of nursing management and leadership while providing person-centric care to the patients. My caring responsibilities towards Martin were a patient-centric approach and hence, I would like to highlight the leadership and management skills a nurse must possess to acquire successful outcomes in clinical settings.
Nursing management in this contemporary era is viewed as a profession that requires enormous special skills, training and characteristics. Effective nurse management is considered to be significantly important to healthcare systems as it is a crucial element to drive a healthcare team’s motivation, job satisfaction and clinical performance. Based on this logic, the nurse managers become capable to identify and understanding their individual nursing leadership styles and approaches. This is believed to be important to manage their respective team and unit, thereby, improving patient outcomes. Miles and Scott (2019, p. 5) stated that the most efficient leadership style in nursing management considers the significance of teamwork that can benefit both nursing staff and the patients as a whole. It is essential for nurse leaders to understand the various types of leadership styles and approaches in nursing management in order to realise the importance of healthcare teamwork (Siren & Gehrs 2018, p. 36). In this context, suggested that once a foundational concept concerning leadership styles in healthcare is developed, nurse leaders can embrace personal inventory to bring healthcare efficiency with improved outcomes.
Bagheri and Akbari (2018, p. 28) stated that the dynamic of complicated relationship development in driving change requires significant approaches for healthcare innovation. In this regard, Nilsen et al. (2016, p. 153) highlighted different methods for studying complicated leadership and their interactions. This is based on micro-interactions, such as daily interactions concerning real-time experience and participant-observation actions. Moreover, it can be meso interactions, where social network analysis is carried forth for weeks or it can be macro interactions where health event history evaluation can be carried out for several months. On the other hand, Bender, Williams and Su (2016, p. 400) revealed that effective nurse executives embrace both leadership and management skills to acquire the requisite goals. Thus, I understood that leadership is a subsystem of the principles underlined in a management system. Therefore, in some instances, the term ‘leading’ is replaced by the term ‘directing’ as a crucial function of management. Thus, in such cases, motivation and communication are considered to be key elements of leadership. On the other hand, I have learnt that management consists of written plans, well-documented analysis, detailed reports and similar others. Nurse Managers who sometimes act as leaders can utilise such sources to enhance employee performance and productivity in the long run.
Manning (2016, p. 438) stated that there are certain insights that can modify our understanding of leadership styles so that a leader can work efficiently to bring organisational productivity. The insights involve leadership knowledge that must be followed by action, leading people is difficult, leadership must be considered as a discipline, leadership requires skill sets and motivation. The secondary insights include relationship-oriented leadership where both hard and soft skills need to be maintained. On the other hand, every leader must attain certain core masteries at a reasonable level of competency (Morsiani, Bagnasco and Sasso 2017, p. 119). This includes personal mastery, team mastery, culture and systems mastery, and interpersonal mastery. Thus, I believe a nurse must carry out a personal assessment considering her leadership style, emotional intelligence, life purpose, preferences, vision and values, and capability to influence others. Moreover, from my personal experience as a registered nurse, I can say that effective communication is needed between nurse and patient, as well as between the nurse and her team so that healthcare outcomes are improved. Additionally, I also believe that active listening skills, problem-solving ability, conflict management and critical thinking capability are certain masteries a nurse must adopt. From my experience, I can highlight that healthcare outcomes can be successfully achieved if a nurse knows how her team works, what are needs and requirements of the team members are, how information is passed on to other nurses and how efficient teamwork can bring healthcare success. Besides this, I believe that culture and systems mastery is required so that an aspiring nurse leader can understand the correlation between organisational culture and systems dynamics.
The most important nursing leadership style is transformational leadership (Wang et al. 2018, p. 358). This is because transformational leaders are capable to mobilise their subordinates by emphasising the welfare of the individual, as well as humanising the extensive technical work environment. Transformational leadership motivates employees to take ownership of their individual roles and perform extensively to achieve organisational profitability. In this regard, Poghosyan and Bernhardt (2018, p. 1066) highlighted that when the workplace environment is humanised, individuals feel empowered and valued as a part of the team. This leads to successful organisational outcomes. Hence, Echevarria, Patterson and Krouse (2017, p. 167) stated that in nursing, empowerment leads to improved patient care, decreased absenteeism, and reduced attrition. A transformational nurse leader consists of nursing subordinates who are satisfied with their job responsibilities, thereby, decreasing the nurse turnover rate in the long run. Nurse leaders usually act as buffers for nursing staff. In this regard, they protect constituents from external and internal pressures of work. Thus, I believe that nurse managers are also important to reduce barriers to clinical nurses. Therefore, my experience to date as a registered nurse suggest that an amalgamation of leadership and management approach is necessary to become an efficient nurse leader, thereby, improving healthcare outcomes.
Reflective framework
In order to share my experience while caring for Martin, I would like to consider Gibbs Reflective Cycle to sketch all the phases of it, namely description, feelings, evaluation, analysis, conclusion and action plan (Reljić, Pajnkihar and Fekonja 2019, p. 61).
Description: Martin’s physical health improved during his stay in the nursing home and the medical team gave permission for his discharge. It was decided that Martin would be discharged along with community nursing involvement. On the contrary, due to Martin’s degenerative condition, one of the registered nurses of our team responsible for caring authority objected to the discharge plan. She stated that his discharge plan must be reconsidered as Martin had become extensively dependent on his carer due to dementia. In this regard, a case conference along with a multidisciplinary review took place so that Martin’s discharge plan could be reviewed concerning his physical and mental health conditions. In the discussion board, it was decided that Martin should stay in a care home closer to his home as he was extremely dependent on his carer and also due to his increasing debilitation. It was decided that the care home selected would be capable to generate quality care to Martin, thereby, valuing and respecting his needs and requirements. The nursing home closer to his home was selected so that Caroline could visit him regularly. However, when Caroline was informed regarding the place of care of Martin after his discharge, she became upset. She wanted to take care of Martin herself at their home so that Martin did not feel lonely in the care home.
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Feelings: My feelings were usually of empathy with Caroline who desperately wanted Martin’s post-discharge phase care to be carried out in their home. She was also concerned about his health, safety and well-being in the care home he was going to be shifted to. Caroline wanted to take care of Martin; however, due to her age, she was unable to take care of him single-handedly. During Martin’s stay in the nursing home, I had developed a good bond with Martin and Caroline. I really felt helpless when Caroline asked me for a way so that she can change the decision of the nursing home medical authority. However, I also strongly felt that the medical team would know better what is right or wrong for Martin and hence, Caroline must stay out of it. On the contrary, I also felt the need of consulting with Martin regarding his preferences to stay in a care home post-discharge, which was not followed by the authority. Martin had poor communication ability; however, he was aware of the circumstances and surroundings. Hence, I believed that the multidisciplinary team should have tried to understand his preferences regarding shifting him to the acre home after discharge. I felt that the multidisciplinary team only focussed on his health conditions rather than considering him as an individual with different thoughts, emotions and feelings. Thus, I was not satisfied with the decision taken by the multidisciplinary team.
Evaluation: The positive experience included the knowledge I acquired from the multidisciplinary team conference. In the case conference, I found that it is important to be a patient and active listener so that an effective decision for the caring plan Martin could be carried out. Besides this, it was also important to be an active speaker so that you could disclose your point of view regarding Martins’ discharge plan. The most important thing I learned from this conference is that every medical team member was focused to generate the best treatment plan for Martin so that his health and well-being were maintained after the discharge phase. The multidisciplinary team was indulged in developing the care plan for Martin by considering his mental and physical well-being, safety, as well as Caroline’s well-being.
On the contrary, there were certain negative aspects of this incident. This is mainly related to the exclusion of Martin and Caroline from the decision-making process. Moreover, the discussion forum did not include any family member of Martin such as daughter or son. Additionally, there was a lack of presence of Martin’s General Practitioner or any community nursing member who knew Martin and Caroline efficiently and was aware of their home circumstances. In the discussion forum, it was clear to me that no one in the multidisciplinary team had any clue of the home circumstances of Martin. Hence, I felt that before authorising the caring responsibility to the care home, the multidisciplinary team should have spoken with Martin or Caroline regarding their home environment and circumstances.
Analysis: I analysed that providing care for a dementia patient is challenging and difficult, as the disorder affects different aspects of the individual’s life. In order to provide quality care for a dementia patient, the person-centred approach must be considered and the individual needs and social well-being must also be evaluated. However, as dementia patients are likely to suffer from concurrent health problems, generating quality care to meet their needs can be difficult.
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On the other hand, Walsh (2020, p. 54) stated that many healthcare professionals ignore the preferences of dementia patients concerning their ability to take care of themselves at home. In Martin’s case, he was excluded from the decision-making process and I believed that Martin was judged based on his current mental and physical health status rather than considering his social circumstances. The medical team decided to sent Martin to a care home, however, they were unaware of the fact that he was functioning well in his home prior to his admission. Although he needed little assistance for his daily needs, he could be easily discharged from home other than shifting him to a care facility. A qualified carer could also be helpful in assisting Martin in his daily living activities. Thus, I found that the process of discharge planning was not up to the mark as the multidisciplinary team did not analyse all possible options for health, safety and well-being of Martin.
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Conclusion: I found that I must indulge in effective interaction with my team so that I have the opportunity to ask questions related to the clinical decision-making process and care-based decisions even if I am new to the healthcare system. In Martin’s case, I felt helpless and disempowered and thus, could not help Caroline to improve her emotional state. However, now I have understood that I must have stood beside Caroline to help her get involved in the decision-making process so that she could make her stand concerning her husband’s post-discharge care. On the other hand, I have also come to the conclusion that the multidisciplinary team must focus on al living aspects of an individual before making a clinical decision. In Martin’s case, the team only focused on his health issues and completely ignored his social and living status. In this context, I believed that I should have remained proactive in raising my voice regarding the post-discharge plan. However, the thought of being a junior nurse and a new employee in the organisation prevented me from taking such steps as I could have lost my job owing to the consequences of interrupting the decision-making process. On the other hand, I also believed that the multidisciplinary team must have reviewed the available guidelines for a critical decision-making approach of the medical council so that the discharge planning could have become easier and favourable for everyone.
Action Plan: The Action Plan is designed so that I can handle a similar situation in my future days without losing my management or leadership competencies.
- I would assure that the patient and their carers are involved in the case conference related to discharge planning. I would also ensure that their preferences, opinions and experiences were sought prior to authorising the clinical decision-making process.
- Besides this, I will also gather all available guidance, policies and governance documents relevant to Martin’s case. Additionally, I would also seek significant evidence concerning the patient’s care so that the decision-making process benefits both the medical team and Martin.
- Moreover, I would also make sure that the community health practitioners who were engaged with martin’s case since his time of admission were also included in the case discussion forum related to discharge planning. This would ensure a realistic picture of the overall case of Martin.
- On the other hand, I would adequate information regarding an alternative care plan for Martin so that post-discharge he could receive the necessary health and social care support. The alternative care plan would include realistic evaluations of necessary resources that might have a significant influence on the current care provision.
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Summary
In this reflective portfolio, I have provided a detailed outline of my clinical experience while working as a registered nurse in a nursing home. Through this portfolio, I have highlighted my viewpoint regarding nursing leadership and management and what must be done when a nurse encounters a critical clinical situation. This was elaborately discussed considering the Gibbs Reflective Cycle, where I have highlighted my experience with a patient named Martin. This incident has helped me to understand the true role of a nurse manager who holds the potential to become an efficient nurse leader.
Personal Development Plan
A personal development plan helps an individual to know where he or she is headed and how to achieve the goals efficiently and effectively (Rimmer 2018). In this regard, the individual must possess clarity regarding what he or she actually needs in life. This will provide the person with immense opportunities to think in the right direction to achieve success in the long run. Additionally, efforts will feel significantly deliberate and decisions will become easier, therefore, helping the individual to set a clear benchmark.
The personal development plan will help me to reach my goals in the near future so that I can successfully emerge as an efficient nurse leader. However, in this context, I need to enhance the skills and competencies that a leader must possess to acquire success in the long run. I have discussed previously that transformational leadership is the best approach for a nurse leader. A transformational leader helps motivate people in taking up their ownership and performs efficiently, thereby, achieving organisational efficiency (Hamdani 2018, p. 26). However, there are certain loopholes in this kind of leadership style. Transformational leadership in nursing can be ineffective in specified stages of ad-hoc situations or initiatives (Lin, Scott & Matta 2019, p. 1556). Thus, this type of leadership needs an existing framework so that future development and growth can take place, which can turn negative for a new healthcare facility.
My personal experience with Martin reveals that the healthcare team must introduce certain changes in their decision-making process. One such thing is the inclusion of the patient and his family members in the discussion forum regarding clinical decision-making. However, in the current leadership and management protocol, this aspect of the decision-making process is absent. Thus I would like to focus on my abilities of a leader concerning democratic leadership style. The democratic leadership style encourages communication and input from the team while making any decisions. In Martin’s case, the multidisciplinary team reviewed the decision of higher authorities of the specific medical team. It did not consider the ideas and decisions of other team members who were closely engaged with Martin’s caring responsibilities. Thus, I feel that as a registered nurse I must upgrade my leadership skills and capabilities regarding the efficiency of a democratic leader (Jan DeBell 2019, p. 6). This will help me to value different relationships within the team and hence, the team will feel motivated and comfortable to share their ideas, concerns and opinions efficiently and effectively (Yunarsih et al. 2020, p. 352). In Martin’s case, no feedback or ideas were taken from his carer. I believe if this would have happened, Martin would be discharged home and not for a care home. Democratic leadership style helps a nursing leader to maintain organisational transparency so that the team members can share and exchange their ideas to bring organisational success. I believe this will maintain the clinical efficiency of the nursing staff.
In order to highlight my personal development plan, I would like to outline my strengths, weaknesses, opportunities and threats that can create a barrier in my career and professional development.
Table 1: SWOT Analysis
Strengths
|
Opportunities
|
Weaknesses
|
Threats
|
(Source: Created by the learner)
Personal development plan for the next 12 months
Table 2: Personal Development Plan (PDP)
| Goal | How | Status |
| To obtain certification course in emergency expertise, ICU expertise and old-age care expertise |
|
Within 12 months |
| To obtain training for maintaining EHR (Electronic Health Record), smart beds and automated IV pumps |
|
Within 12 months |
| To manage my emotions during a critical clinical case |
|
Within 6 months |
| To strengthen my interaction competencies with my team members |
|
Within 8 months |
| To enhance my leadership skills |
|
Within 10 months |
| To improve my health and well-being |
|
Within 3 months |
(Source: Created by the learner)
Reference List
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