However, we recognise that senior input is not always immediately available, that patients can deteriorate following a touch point with a senior, and that more junior and less experienced health professionals should be responsibly empowered to act when presented with a patient with evidence of physiological derangement in the context of infection. Identify the one most suited to your clinical area, look through it as you listen to the podcast, and prepare to use it to help you to reach decisions which will be supported by the UK Sepsis Trust and by NICE.
Remember, if your clinical judgement is telling you that the tool is reaching the wrong conclusion, trust your instinct and ask a senior colleague. We request that you please complete and agree to our terms and conditions prior to use. Kinship Care Creating a Family Offers resources such as blog posts, factsheets, interviews, and more to help caregivers learn about their options when considering kinship care.
The resources can help relatives and others make the transition to becoming a parent easier. Kinship Care Is Better for Children and Families Epstein American Bar Association Center on Children and the Law Presents an overview of kinship care, including a discussion on how it minimizes trauma, improves well-being, increases permanency, improves behavioral and mental health outcomes, promotes sibling ties, and preserves identity for children and youth.
Sometimes, the arrangement referred to as "kinship care" is an informal, private arrangement between the parents and relative caregivers; in other situations, the local child welfare agency is involved. This factsheet is designed to help kinship caregivers--including grandparents, aunts and uncles, other relatives, and family friends caring for children--work effectively with the child welfare system.
Army leaders must embody these values and inspire others to do the same. Character is essential to successful leadership. Army Values - Values are principles, standards, or qualities considered essential for successful leaders. Values are fundamental to help people. The Army has seven values to develop in all Army individuals: loyalty, duty, respect, selfless service,. The rater will assess the rated Soldier's performance in fostering a climate of dignity and respect and. This assessment should identify, as appropriate, any significant actions or contributions the.
Promoting the personal and professional development of subordinates;. Ensuring the fair, respectful treatment of unit personnel; and. Establishing a workplace and overall command climate that fosters dignity and respect for all members of the unit.
Empathy - The propensity to experience something from another person's point of view. The ability to identify with and enter into another person.
The desire to care for and take care of Soldiers and others. Discipline - Control of one's own behavior according to Army Values; mindset to obey and enforce good orderly practices in administrative,. The impression a leader makes on others contributes to his success in leading them. Leaders illustrate through their presence that they care. There is no greater inspiration than leaders who routinely share in.
Being where subordinates perform duties allows the leader to have firsthand knowledge of the real conditions Soldiers and Army. Civilians face. Presence is a critical attribute leaders need to understand. It is not just a matter of showing up; actions, words and the manner in which leaders. Military and professional bearing - Possessing a commanding presence. Projecting a professional image of authority. Fitness - Having sound health, strength, and endurance that support one's emotional health and conceptual abilities under prolonged stress.
Confidence - Projecting self-confidence and certainty in the unit's ability to succeed in its missions. Demonstrating composure and outward calm.
Resilience - Showing a tendency to recover quickly from setbacks, shock, injuries, adversity, and stress while maintaining a mission and. Conceptual abilities enable effective problem solving and sound judgment before implementing concepts and plans. They help one think creatively and reason. Leaders must anticipate the second- and. Mental agility - Flexibility of mind; the ability to break habitual thought patterns. The MR leaders may then appear as indecisive because they are weighing up options and considering options from a variety of positions.
Socratic questioning would be an unaffordable luxury. In educational settings that focus on competency and skill acquisition, rooted in instrumental rationality and biomedicine, MR runs counter to the need for learning procedures, processes and facts.
It also runs counter to the epistemology of much of evidence based practice rooted as it is in often taken for granted empiricism. They may well delude themselves it is for the good of others.
They are outcomes driven, over and above issues of value and consensus. These outcomes must align however with their own interests. They do not consider it useful to think about what other people think of them or their action. If the AR does not have this political-philosophical 'bank' they operate within their own interests and ethical standpoints that support them. The AR can be a leader for change, they can be disruptive of social orders, they don't consider the emotional needs of others necessarily as relevant.
They do not require the validation of others before they act. Their thinking is self- referential, that is they refer to themselves for judgment as to the worth of acting. They may use manipulative measures to steer other people into action that meets the AR's interests.
Coaching and counselling skills would be very useful to the AR in meeting their own ends in this regard. Students who display AR may have experienced criticism, and chastening during their education, as they don't play by the rules just because they are rules. The AR may have developed a thick skin, and may act according to whatever rules they see as right.
They will require validation by other people before acting. They consider how any action will affect other people, and the opinions of other people become very important. They are consensus seekers and value this over and above outcomes or values. They refer and may defer to others' thinking and action and will not readily rock the boat.
Mentors may look favourably upon a CR if the boat is not being rocked. They are particularly open to professional socialisation and developing the consensus of professional identity. A person working in a toxic clinical environment may well feel unease, but if their CR is dominant they may be very reticent to challenge and fall back on post hoc rationalisation for action that may be sub optimal.
Values, consensus or outcome thinking is secondary to personal survival in an uncertain world. The FR requires someone to lead them, to look after them, to tell them what is right. If they are 'high functioning', self caring and independent living, they may require a good deal of supervision and control to prevent harm to themselves and to others. Internal Conversations.
So, we have internal conversations. Our inner speech is rapid and often contracted into single words or phrases that contain a rich complexity of meaning.
This eases the sharing of inner conversations because we all share that idiosyncratic meaning. Hence we talk in short cuts, in jargon, half sentences. This might be what Tuckman referred to as the norming and performing stage of team dynamics. For a young professional confronted with new decisions, such as her role and function in a new clinical placement, this contextual continuity is a resource. How should I speak to patients or seniors? For those who learn that their inner conversations make sense only to themselves, attempts at expressing inner conversations may then be rebuffed by incomprehension or misunderstanding.
Efforts at making oneself clear may involve self exposure, continued failure to communicate may well be hurtful and result in defensiveness. One may resort to withdrawal. It might well be that the AR will resist the misunderstanding and the rebuffs and continue to answer her inner conversations in her own way albeit within the very real constraints of power, not the least of the mentor.
What is your inner voice saying? Positive comments of the student's practice by mentors are not necessarily, and always, oriented to evaluations of the students' leadership capacities.
For example, already mentioned is a consideration of status, role set and organisational context. When exercising clinical leadership, it may assist personal and professional development to consider what their inner conversations actually are, to lead them rather than be led. Similarly, if there is a tendency to act without the consideration about the impact of that action on others and self, then personal development may be required. Are we able to identify educational practices and practices in the clinical environment that foster certain modes?
Are student nurses able to develop self analysis of this nature and then work on this understanding to communicate better in the clinical and personal environment? To what degree do you agree with the following statements?
I often act before really thinking about how my actions will be interpreted. I often think about how my gender should act in a situation. When I know how my colleagues interpret my actions, I still go ahead. I really value what my colleagues, peers and family think of me and this can restrain my action. I often wonder why colleagues say and do the things they do. It is very important that the team gets along and works together. MR AR CR AR These questions are for discussion only.
Gender issues. It is a truth too obvious to mention, except that it needs thinking about. Health care teams are a mix of people who come with different class backgrounds, different nationalities, ethnicities, religions and of course of gender.
They are characterised by a variety of cultural assumptions and of values. These assumptions and values can impact on professional interaction in subtle and not so subtle ways. We have to note the gendered nature of professions. Historically, medicine has been a male occupation, while nursing still is dominated by females. In the UK women are as numerous in the junior doctor ranks but as seniority increases, the numbers of men increases.
It is the same in hospital management, and for nursing management. Class, ethnicity, nationality and gender intersect to create a complex social milieu. Porter used participant observation to study doctor-nurse interaction in an intensive care unit and a medical ward. Unproblematic subordination: 2. Informal overt decision 4. Models 1, 2 and 4 were rarely seen. As this study is old and was small scale, further research is needed to establish whether model 4 in the current era is any more common.
Is medicine a dominant profession because it is superior in its approach and knowledge, more highly valued than nursing by society why? A few studies from seem to support the contention that interaction between nurses and doctors retain elements of game playing and the positioning of nurses into subordinate roles especially when it comes to decision making.
Changes in the nursing profession has not been as far reaching as hoped by many in their attempts to professionalise it, and thus game playing arises still Tame We need to consider whether the situation has changed in the past 4 years. Many factors could come into to play to change the nature of discussions and interactions that doctors and nurses experience. Interprofessional education could be one of those factors, The changing balance of males to females in medicine could be another.
Subject Positions Theory. At least a possibility of notional choice is inevitably involved because there are many and contradictory discursive practices that each person could engage in Davies and Harre, , p. There can be interactive positioning in which what one person says positions another. This can be done through agenda setting and the acceptance of certain words, ideas and concepts as more valuable than others.
Note that it is very easy to project superiority in discussing clinical cases or when discussing management processes, by using exact medical and management terminology. Just think about what that means. Of course, the other person can accept that position or reject it and through language try to claim a different status. We also use larger discursive frames which also position who we think we are and what we think the proper course of action should be.
We can frame Public Health within a biomedical frame of reference e. The self is then positioned in relation to the stories that we use for those categories for example as wife, not husband, or good wife and not bad wife. Note how the language changes when teams go out to socialize and different subject positions are adopted. Thus the language used by medical staff can position nurses, and other people, into subordinate positions.
See Grant and Goodman for a fuller discussion on the nature of communication, especially chapter The reason symptoms are not easily recognised as cardiac in women, is that the language of cardiac symptomology e. This could explain the statistical over representation of mental health problems of BME people. Poststructuralism discusses how decisions are made through language use and the relationship between knowledge and power. It studies how we construct meaning in an encounter with each other, how the power relationship between the professional and the person can affect what meaning is constructed by us.
Feminist Poststructuralism adds the gender dimension to this in that is suggests that there are patriarchal discourses, patriarchal social institutions and power relationships that can marginalise and even oppress women and their perspectives. There is an argument that there are gendered dimensions to knowledge and understanding and clinical practice Sundin Huard There are differing epistemologies, that there is a feminine psychology e.
Gilligan These differences also affect what the goals of care are. Men can adopt female thinking and vice versa. An argument is that two main health care professions are gendered in their epistemologies and this is mirrored in the management — nursing relationship. We're not stagnant beings. That is to say, keep picking up his socks and someday he might just pick up yours.
There is a suggestion that men and women approach leadership from very different values and behaviour patterns. Two basic constructs to describe leadership behaviour based on the Ohio State approach are: 1.
Consideration: friendly and interpersonally supportive supervisory behaviour. Creating a supportive environment of warmth, friendliness and helpfulness, by being approachable, looking out for the welfare of the group, doing little things for subordinates and giving advance notice of change. Initiating structure: emphasis on assigning tasks, specifying procedures to be followed, clarifying expectations of subordinates, scheduling work to be done.
It is suggested that leaders can be placed on a continuum between consideration and initiating behaviour Stogdill in van Emmerik et al There is belief that women adopt consideration behaviour and men adopt initiating behaviour.
Women may adopt more interpersonal styles but only in female industries, in male industries they may adapt their behaviours or because they are selected by men in those industries. They found that where there are relatively higher numbers of female managers this is associated positively with consideration behaviours, male managers in organisations with more female managers tend to engage less in initiating structure, but this does not hold for women.
They conclude that individual differences gender are more important than organisational societal differences when explaining leadership behaviours. However care has to be taken not to extrapolate to all cultures and more work has to be done to explore other variables modernity, economic wealth, political systems.
The argument here tends to focus on those positions where authority in established leadership positions are formally acknowledged a form of managerial leadership. Clinical leadership exercised at peer to peer levels may not manifest as quite so gendered.
Killeen et al focuses on aspirations and how men and women see themselves as leaders. The study uses the auto industry as an exemplar of a male industry and clothing as a female industry. In line with 'Role Congruity theory', females regarded managerial careers more positive in the clothing industry and males the reverse. This does not extend to the CEO level where either gender would regard this as positive although unlikely.
In Spain, where they suggest that the status of women as employees is not as high as in the US, men evaluated the managerial roles more positively than women, whereas in the US there was no difference. They conclude that women in both countries have a weaker sense of possibility, rooted in a belief that leadership roles may cause problems for close relationships which they value more highly.
In both cases women took into account the future changing world as giving women more opportunities and access to leadership roles in an era of increasing gender equality. There, however, remains a sense for women that there is a trade-off between powerful occupational roles and achieving good close relationships.
And that this probably represents other Spanish hospitals. In a medical context women are underrepresented: 1. On research ethics committees 3. On editorial boards of major medical journals In a law was passed for gender equality to enable opportunities for both genders. This paper suggests that there is a long way to go still. Van Edwards argues that men and women tend to have two distinctly different leadership styles that shape how they manage there teams: Females are Transformational Leaders while men are indeed Transactional Leaders Burke and Collins Why is there this difference?
This is put down to physiological differences as well as social expectations. How men and women lead differently? It describes the structuring of a society the basis of the family. Traditional families pass on lineage through fathers. On this basis fathers are considered have primary responsibility for the welfare of the family.
There is a hierarchy in the family and thus in society. Sweet and Norman undertook a selective literature review of the nurse-doctor relationship in the context of the history of patriarchal relationships. They concluded that, while much has been written generating anecdote and opinion, there had been little empirical work to establish an evidence base around the impact of patriarchy on this relationship.
They cite some empirical work, Heenan and Mackay , which suggested dissatisfaction and poor working relationships amongst nurses resulting in negative consequences for patients, but much is of this is over 20 years old since publication. They argue that the relationship is characterised by each profession having ideal expectations of each other which are not always met. A rather outspoken friend theorises that they have to be either perverts or women haters.
Misogyny has always run rife in medicine, says she, because of a patriarchal society that suppressed women. Physicians were traditionally men with power and status not much change there, then. Women, when not keeping house and churning out offspring, did the grotty jobs like cleaning, laying out the dead, and of course, nursing. Today I saw nine women in morning surgery, all harping on about fairly nebulous symptoms.
There was nothing to get your teeth into and actually treat, like good old conjunctivitis or an ingrowing toenail. At a bit of a loss, it was all too convenient to cop out: "It's your hormones, luv, we're all slaves to them. My busy, practical side wanted to deal with these patients sharpish and get on, but my feminist side was ashamed at trivialising their complaints.
For, as my friend points out, demanding women are easily dismissed as hormonal. Medical statistics show that women make up the vast majority of patients attending general practice.
So are women a bunch of hypochondriacs with too much time on our hands? The Ancient Greeks blamed everything on the uncontrollable, wandering womb and then that crackpot Freud came along and diagnosed all women as hysterical. Women probably do come to surgery more than men, but not necessarily because they are ill. They frequently consult for health-related matters, like contraception or smears. Often they are the only adult who is available to accompany a child, so indeed we do see many female customers in this job.
If unwell, women often request female doctors. Perhaps they expect them to naturally be more empathetic, especially with matters "down below". Not necessarily so. A female GP I know totally rejects the possibility of PMS, considers post-natal depression to be the punishment of wimps and generally hates seeing women patients.
And are these decisions purely based on medical science? Does culture play a part? Theobold et al raise the importance of gender analysis and of understanding patriarchal values and assumptions.
They examine gender across a range of health policy and system contexts. Do we therefore have to retrain, re educate, men and women about male assumptions and values in health care management? There is a large literature on the nature of team and team working and so it is to this topic we now turn.
Teamworking As just stated this topic appears a good deal in the literature, the focus is on ensuring good team work to improve patient outcomes. There are descriptions about what makes a team, what holds teams back from working effectively, how we develop a team and what the proper role for team members may be. However we also need to think critically about our teams in actual practice. Is teamworking myth or reality in clinical practice?
Chase had previously examined teamworking in critical care environments and observed two parallel hierarchies consisting of medics and nurses. The suggestion here is that clinical teams may divide along professional lines and are not teams at all but are merely groups.
Does it matter that we are a group rather than a team? The theory about team working, rather than just being a group, is that we get better outcomes, creativity and productivity…what is the evidence?
Can you think of examples of good or poor team working that led to better or worse patient outcomes? Team Dynamics Within health care teams, and their relationship with other professions and management, there are various barriers to team development. Tuckman outlined a typology for group dynamics and argued that teams went through various stages of development. The implication here is that if a team gets stuck at one stage they will not get to optimum performance.
He believed as is a common belief today that these stages are inevitable in order for a team to grow to the point where they are functioning effectively together and delivering high quality results. The adjourning stage is when the team is completing the current project.
They will be joining other teams and moving on to other work in the near future. For a high performing team, the end of a project brings on feelings of sadness as the team members have effectively become as one and now are going their separate ways. How are new members integrated into the team - by being proactive or passive? Social dynamics implies that it is the everyday experience of working with people that individuals get to know what is required and what their place is.
How do you help to get your team to the performing stage? Team Role Theory Meredith Belbin. Belbin suggested various team roles which if brought together will support effective team working. Consider then how we overcome barriers and move from being a group to becoming a team.
What individual and group, organisational actions need taking? So far we have examined how cultures shape working practices, how individual professionals work together and how gender may shape leadership.
Team working is seen as an important aspect of care delivery. We now turn to a goal of care delivery, enhancing or improving the quality of patient care. Quality 1. Clinical leadership might be focused on improving service delivery and the quality of patient care. In order to do this leaders need some tools to help them.
How do we go about Quality Improvement? Brocklehurst has suggested a number of approaches to quality improvement. Data Based approaches: Data collected and used to construct quantitative indicators of performance. League tables being the commonest. Tend to be negative and can be de-motivating 4.
System or Process Focused Approaches. Quality is also a function of organisational rather than individual performance. The concept of Total Quality Management TQM stresses the importance of leadership and organisational culture to quality improvement, and focuses on the use of a range of tools to examine and change processes of care.
These have much in common, may overlap or be used concurrently. Provide a brief description of examples of each in your clinical area. Identify your role in any of these approaches. Think about the provision of personal care and the food offered to people when they are in-patients. You already know what is important to people from talking and listening to them. Does your clinical environment identify clearly what people might consider to be a quality service?
Continuous Quality Improvement. CQI has been found to work effectively in manufacturing industries and now also in healthcare. The core concepts of CQI are: 1. CQI aims to improve process and system. CQI aims to eliminate unwanted outcomes 5. PDSA So, how might we put this into practice? This includes 3 key questions and then a process for testing change using Plan Do Study Act PDSA cycles Answering the questions helps bring the problem or issue into FOCUS Find a process that needs improvement Organise a team that knows the process Clarify the current knowledge of the process Understand the variation in the process Select a process for improvement The model starts with 3 basic questions: 1.
Then, the PDSA cycle: Plan — set the objective, make predictions, plan to answer the questions who, where, when collect data to answer the questions. Do — carry out the plan, collect the data, begin analysis of the data. Study - Act — want changes are to be made to the next cycle. Can the change be implemented? The aviation industry provides a model for health care, based on the fact that errors can very quickly result catastrophe.
Critical care environments may share similar experiences in that errors could lead quickly to even more severe illness or death.
0コメント