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In delivering healthcare, an effective teamwork can positively enhance patient outcome and safety. The necessity for functional teams is growing as a result of increasing comorbidities as well as proliferating complexity of patient care specialisation. Babiker et al. (2014) define a team as an identifiable set of two or more individuals who interact adaptively, interdependently, and dynamically towards a shared and valued objective. In the context of healthcare and patient safety, an effective team is where team members, including patients, interact with one another and combine their decision-making responsibilities, expertise, and observations, to optimise patient care. Richardson & Storr (2010) presented a study on teamwork, patient safety and doctor/nurse collaboration. The key findings suggested that teamwork enhances care coordination which helps ensure that the preferences and needs of patients are understood. Additionally, those requirements are shared among families, patients, and providers to prevent wastage or abuse of prescribed treatments as well as conflicting patient care plan.
In another study conducted by Babiker et al. (2014), an effective teamwork improves the overall healthcare by enhancing decision making. Babiker et al. (2014) argue that collective decision making is a moral obligation and that the notion of informed consent is founded upon the intrinsic rights of patients to be actively involved in judgements which influence their overall wellness. Additionally, individuals that take part in their care tend to make more cost-effective decisions and show better health outcomes than those who are not involved. Another impact of teamwork is realised in health informatics. The emergent of digital capacity, as well as simulation of infrastructure development, has led to opportunities for facilitation and promotion of team-based care. Health informatics can support the operations of teams (such as shared work, group training, process improvement, and communication). For instance, an electronic health record system that is designed with teams in mind can enable easy flow of information among the team members through team charting.
What Role Does Nursing Leadership Play in The Delivery of Safe Patient Care?
Effective nursing leadership guarantees a high-quality care system that consistently affords efficient and safe care. Researchers (Richardson & Storr, 2010; Boamah, 2017) have linked effective nursing leadership to several functions. These functions are system performance, attainment of health reform objectives, system efficiency and integrity, and delivery of timely care. Richardson & Storr (2010) in their study established that nursing leadership played a crucial function in developing conditions for work activities and, ultimately, safe patient care. The authors found out that nurses considered their role in the delivery of patient safety as safeguarding the patient and intervening to enable or prevent particular occurrences. An example of these events is task double checking, where nurses prevent clinical issues via personal actions rather than by proactive assessment and solving of underlying system issues.
The above-mentioned study finding is consistent with another research conducted by Boamah (2017) on the role of nursing leadership. Boamah (2017) asserts that nursing leadership can impact the positive outcome and change through building healthy work environments which allow all the nurses to offer quality and safe care. Nursing leaders can develop conducive work settings which allow staff nurses to feel more self-efficacious and autonomous to partake actions and utilise novel techniques to patient care hence leading to better results for patients. Such leaders put much emphasis on quality improvement of staff nurses and also encourage them to realise their potential via offering opportunities and support. In effect, fellow nurses get to improve their skills as well as knowledge, that eventually can enhance the quality of safe patient care provided to sufferers. Boamah (2017) stresses that empowering workplace settings makes majority of the nurses to realise the power of their voices and use their influence to improve relationship among each other. Consequently, standards of quality and success are created within the establishment to accomplish the objectives of safe patient care. Therefore, a conducive work environment is important in that it supports nursing leaders in their role by collaboratively inﬂuencing and improving clinical practice in the delivery of safe patient care.
What Challenges Are Outlined in The Delivery of Safe Patient Care?
According to Richardson & Storr (2010), nurses identified the following perceived challenges to the delivery of safe care: workloads, blame culture, staffing levels, and suitability of admissions. In the study (Richardson & Storr, 2010), nurses proclaimed concerns regarding inappropriate workload levels and the impact it has on stress, job satisfaction, morale, and safety. The healthcare practitioners suggested that workload levels do not necessarily imply high workload, but the disconnect between the type of personnel and available skill-mix. Kentischer, Kleinknecht-Dolf, Spirig, Frei & Huber (2017) contend that where workload levels are high, several vital things get missed in relation to patient safety since nurses have to prioritise regularly. As such, primary care such as hygiene and nutrition get dropped from the priority list.
Concerning blame culture, Richardson & Storr (2010) reported that many nurses admitted to working in a culture in which they would be ridiculed or blamed for making a mistake. In another study conducted by Kleinknecht-Dolf, Spirig, Frei, & Huber (2017), some nurses reported feeling constrained by the bullying culture for making an honest mistake. Hence, nurses become disempowered, unmotivated, discouraged, and unable to challenge poor decision making and unsafe practice. The other challenge was unsafe staffing levels, which was identified as a source of anxiety (Richardson & Storr, 2010). According to Kleinknecht-Dolf, Spirig, Frei, & Huber (2017), increased anxiety levels among nurses decreases the quality of standard of care.
Nurses also expressed concerns over the appropriateness of hospital admissions due to the pressures of achieving targets and a perception that many patients were unsuitably referred from primary care. Also, Kleinknecht-Dolf, Spirig, Frei, & Huber (2017) identified an inappropriate location of patients as a challenge in the delivery of safe patient care. Examples included the confinement of psychiatric patient in the emergency department, devoid of any psychiatric nursing support, placing of adolescent patients suffering from mental health issues to paediatrics, and admission of pregnant adolescents and medical patients to obstetrics. Additionally, nurses argued that on several occasions, medical patients with urine infection or leg ulcer get placed in surgical wards, resulting in the potential for cross-infection.
Why Is It Important for Nurses to Lead Improvements in The Delivery of Safe Patient Care?
Leadership does not occur in a political or social vacuum. As Young, Landstrom, Rosenberger, Guidroz & Albu (2015) note, the fast pace of change can be realised only if it is associated with leaders who can implement and sustain innovative ideas. Establishing innovative, safe patient care models requires nurse leaders to create ideas, body makes decisions, and approach management within the social, economic, and political context. Richardson & Storr (2010) attest that a paradigm shift must occur that allow nurses to perceive their responsibility as caretakers. Further, the author states that nurse leaders are required to participate and lead in the current reforms of the system, to advocate for policy change, to become full partners in the healthcare team, and to interpret research findings into the practise environment.
A more recent research by Landstrom, Rosenberger, Guidroz & Albu (2015) allude to the idea that instead of utilising a conventional top-down technique of leadership, nurses ought to lead by engaging all members of the healthcare workforce in an environment of mutual respect and interprofessional collaboration. The research advocates for nursing educators, nursing associations, healthcare organisations, and all nurses to seek, support, and create opportunities for leadership and collaboration in every practice setting and all levels. Outcomes improve when nurses collaborate with other health care practitioners (Richardson & Storr, 2010). For instance, Rosenberger, Guidroz & Albu (2015) report that when nurses are left to lead improvements in the delivery of patient care, through collaboration with other disciplines leads to effective and safe care in hospitals (e.g., avoiding overdose, allergic reactions, adverse drug reactions, and medication errors). In the same study (Rosenberger, Guidroz, & Albu, 2015), nurse leadership of teams was related to improved safety and quality in that nurse leaders fully comprehend and have exhibited experience and expertise with innovative models of safe patient care, as well as the political, technical, and financial savvy to close financial and clinical loopholes in a healthcare delivery system. Therefore, nurses can effectively run an interdisciplinary safety program within their units to improve the delivery of safe patient care.
Boamah, S. (2017). Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment. Canadian Journal of Nursing Research, 50(1), 9-19. http://dx.doi.org/10.1177/0844562117732490
Kentischer, F., Kleinknecht-Dolf, M., Spirig, R., Frei, I., & Huber, E. (2017). Patient-related complexity of care: a challenge or overwhelming burden for nurses - a qualitative study. Scandinavian Journal of Caring Sciences, 32(1), 204-212. http://dx.doi.org/10.1111/scs.12449
Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., & Webb, C. et al. (2013). Core principles and values of effective team-based health care. Journal of Interprofessional Care, 28(1), 79-80. http://dx.doi.org/10.3109/13561820.2013.820906
Richardson, A., & Storr, J. (2010). Patient safety: a literative review on the impact of nursing empowerment, leadership and collaboration. International Nursing Review, 57(1), 12-21. http://dx.doi.org/10.1111/j.1466-7657.2009.00757.x
Young, J., Landstrom, G., Rosenberger, S., Guidroz, A., & Albu, A. (2015). Leading Nursing into the Future. Nursing Administration Quarterly, 39(3), 239-246. http://dx.doi.org/10.1097/naq.0000000000000107
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