Gibb's Reflection Model - Coursework Example

?Running head: LEADERSHIP COMMENTARY Leadership Commentary (school) Leadership commentary Introduction Reflection and commentaries helprefocus the thoughts and activities of health professionals while caring for their patients. This paper shall be a commentary or reflection on my practice placement, reviewing my placement based on Gibbs’ Reflection style. It shall describe the incident subject of this reflection, my feelings and thoughts on this incident, evaluation, analysis and conclusion, as well as my action plan on leadership participation. Gibbs’ Reflection Model Description of Incident The incident subject of this reflection happened when I was looking after six patients with my mentor and a health care assistant in a surgical ward. My mentor asked me to take the lead in managing the patients. One of my patients was going to have surgery that day. All patients were endorsed to me by the night staff. I decided to prioritize the patients based on their needs. One of my patients was going home that day so I did not have to prioritize him as yet. I decided to prioritize my patient who was about to undergo surgery, to monitor her, to make observations, and to review her check lists and everything else she would need before the surgery. I asked who wanted to do the other tasks, including the washing of the patients, and making of their bed. I assigned tasks to the appropriate staff members. I then successfully transferred the patient to surgery. The other patient who was supposed to go home that day was not happy because his discharge summary as well as pertinent medication details were not prepared. I overheard him talking angrily with his health care assistant. I approached the patient and went on to explain the reason for my decision. Feelings/Thoughts While handling the situation, I feel like I have approached it in a democratic manner and I feel relatively good about that my decisions. I feel like I have been fair as a leader and have carried out a two-way communication with the staff in order to carry out the tasks. I also feel like I have found it difficult to ask my mentor to print the discharge summary for the other patient for his discharge home. This event sticks in my mind because I was very much conscious of my actions as a leader. Other people made me feel self-conscious as a leader and I felt pressured to deliver well in this regard. The event however turned out well and I was able to deal with the situation despite my misgivings as a leader. In retrospect, I feel that there are still improvements I can incorporate into my leadership skills and I could have used my theoretical learning as tools in the trade; moreover, the assistance of my mentors could have helped me in gaining better outcomes. Evaluation What was good about the experience was that it helped me enhance my leadership skills. It placed me in a situation where I was prompted to manage several things at one time, and not have any of my tasks or my patients compromised. It allowed me to apply my prioritization skills as well as my democratic and fair management of competing tasks. What was bad about the experience was that in the process of prioritization, I encountered patients who were not particularly pleased by my prioritization decisions. I was also able to observe others taking charge of their patients. I was able to review and read up on nursing theories and other relevant journals. I was also able to follow my mentor while she was looking after her patients, learning how she handled the patients and how she communicated with them. I was also able to establish a plan with my mentor, especially on the plans and decisions I needed to do in relation to the prioritization of patients and health needs, and the essential communication skills I needed to ensure adequate patient care. Analysis In the application of leadership skills in this situation, I was able to apply prioritization of patients. Prioritization is an important component of the practice because it allows multiple tasks to be prioritized according to urgency and needs (White, 2005). In this case, the patient who was about to wheeled in to surgery had the most urgent concerns as compared to other patients. She needed to be prepped for surgery and adequately assessed and monitored before the surgery. Failure to care for her needs would like cause delays in her surgery which may endanger her life (Stannard and Krenzischek, 2011). The patient who was about to be discharged had needs which were not urgent and therefore caring for his concerns could be postponed for the time it would take to care for the patient who would be wheeled into surgery. Nursing prioritization is also based on the triage principles, principles which imply the prioritization of care for those whose lives are in the most danger and who have the chance of surviving if given immediate care (Lake, 2005). This prioritization of needs is an important skill which all nurses must learn and master because in the current health care practice, there will always be an overflow of patients and a shortage of nurses (Miller, 2006). Not all patients can be cared for by the nurse adequately especially when patients numbers far exceed the number of nurses available, however, knowing which patients to prioritize can help in the management of patient numbers (Ferrario, 2003). Moreover, as a leader, the prioritization process must be justified by the nurse; in other words, it must be rationalized. The rationalization process can help provide reasons for the prioritization and help reduce the impact for those who are not given priority (Ferrario, 2003). It would also make the prioritization process easier and less burdensome on the part of the practitioner. Maslow’s hierarchy of needs is also often proposed as useful tool in the prioritization of needs. Based on Maslow’s theories, a table of high priority, intermediate priority, and low priority needs can be established and each need must also contain a rationale (Lipe and Beasley, 2003). Discussions on prioritization point out that it is important for nurses to understand the relationship between the varying needs of a person. Moreover, in most cases, emergency physiological needs have the highest priority over other needs (Lake, 2005). Physiological needs mostly relate to needs which pertain to the systems of the body, the environment, values, and culture. The plan of care must be based on the prioritized needs and on the anticipated management of other patients (Rigolosi, 2005). In this case, the prioritization of the patients was based on their physiological needs, with the patient needing surgery being prioritized first. For a leader, the basis of prioritization must be on sound health and nursing principles. Maslow’s Hierarchy of needs is one of the favored means of prioritizing health needs because it is known to provide a strong rationalization for each need included into the prioritization process (Rakowski, 2011). As a result of the favorable application of prioritization principles, the patient who was about to wheeled into surgery was adequately prepared for the procedure. In the process however, the other patient who did not have immediate or high priority needs felt neglected. This can sometimes happen in the prioritization process, and the role of the nurse is to reduce or minimize the negative impact of prioritization (Gehrt, et.al., 2010). Being a leader also means having strong decision-making skills. It was important to make the tough decisions during my placement because all the patients had different needs and it is difficult to decide which patients would receive care first. However, arming myself with the knowledge of the clinical practice and care helped to relieve the negative burden of my decision (Woolf, et.al., 2005). The majority of information which patients need is already available in the internet, and for health practitioners, this accessibility of data must be fully taken advantage of. All decisions must be based on sound principles and practices and the information highway must not be the only source of information (Woolf, et.al., 2005). What is crucial in the process of making decisions is for the nurses to establish a justification for their decisions and to stand by such decisions when challenged or questioned. It is also important for the nurse to weed out the data which is available, and to consider whether or not such data is accurate, important, and relevant to the decisions of the nurse (Woolf, et.al., 2005). The decision-making process can also be assisted through decision aids, and these aids may include decision boards, videos, and audio-guided workbooks. These aids are meant to clarify choices and treatment options (Woolf, et.al., 2005). Decision aids have been known to improve patient participation and reduce conflicts and indecision in the decision-making process. In this case, I was not able to use sufficient decision aids, however, I was able to outline a plan of care with my mentor. This plan was logically drawn out and justified based on sound theories and well-supported information, the bulk of which is based on priority health care needs. My decision may not have been favored by the other patient who was about to be discharged, however, I was able to stand firm and own up to my decisions. This is another crucial element to the decision-making process – taking responsibility for one’s decision and the consequences of one’s decision (Thompson and Dowding, 2001). Taking responsibility portrays the message that owning up and standing firm on one’s decision, no matter how unpopular it may be is part of the leadership process (Thompson and Dowding, 2001). Even in the face of negative consequences arising from the decision, part of leadership is about taking responsibility for both the negative and the positive consequences of one’s decisions. As a nurse-leader facing the situation, I also saw the importance of communication. Communication requires various elements to make it complete. In this case, the communication is between the patients and the health staff and also between the health professionals. The communication process with the patient needed to be established, especially with the patient who was about to be discharged. The importance of explaining to him the delay in his discharge is a significant aspect of his care. He was not adequately informed of the situation and this caused him to feel neglected and therefore to be dissatisfied with the hospital services. Communication with other staff members is also an important part of the leadership process. By communicating adequately, accurately, respectfully with the health staff, it is possible to achieve favorable patient outcomes (Travelbee, 2006). As a leader, I was able to communicate well with other staff members. I was able to give clear instructions and orders, and to do so in a respectful manner. The open lines of communication with the health staff also helped to secure favorable communication patterns. Conclusion This experience was able to teach me about my capabilities and my weaknesses as a leader. It taught me about the gaps in skills I have and the importance of filling in these gaps. I was able to learn that in the process of prioritization of health needs, some people may be pleased and some others may not favor the prioritization decisions which have been established by the leader. This reflection actually gave me a better appreciation of the difficulties which nurse leaders go through in their practice (Jasper, 2003). In considering my experiences in this study, I believe that I should have also explained adequately to the other patient why his discharge is going to be delayed. Better yet, I would have delegated another nurse to handle his discharge. Action Plan If I would encounter this event again, I would first prioritize again the patient being wheeled into surgery, and then I would go to each patient who have to wait for their turn and explain to them about the delay in their care. I would also indicate a time where they would have to wait to be cared for. I would also assign other nurses to care for them. I would still prioritize the surgery patient because he has the most ominous need, but I would still implement other remedies to the other patients while they are waiting. This would help reduce their anxiety and their distress. Conclusion Based on the above reflection, I assess my actions and decisions to be relatively adequate. I also believe that I performed like an adequate leader in handling and managing the situation. There are however learning points in the incident and I need to consider these learning points in relation to future incidents. This reflection has served its purpose in enlightening my practice and my actions as a nurse and as a leader. Works Cited Ferrario, C. G. (2003). Experienced and less-experienced nurses' diagnostic reasoning: implications for fostering students' critical thinking. International Journal of Nursing Terminologies and Classifications, 14(2), 41-52. Gehrt, S., Riley, S., & Cypher, B. (2010). Urban Carnivores: Ecology, Conflict, and Conservation. New York: JHU Press. Jasper, M. (2003) Beginning Reflective Practice – Foundations in Nursing and Health Care. New York: Nelson Thornes. Lake, S. (2005). Nursing prioritisation of the patient need for care: tacit knowledge of clinical decision making in nursing. Victoria University of Wellington. Retrieved 27 October 2011 from http://researcharchive.vuw.ac.nz/bitstream/handle/10063/22/thesis.pdf?sequence=6 Lipe, S. & Beasley, S. (2003). Critical thinking in nursing: a cognitive skills workbook. Philadelphia: Lippincott Williams & Wilkins. Miller, J. (2006). Opportunities and Obstacles for Good Work in Nursing. Nurs Ethics, 13(5), pp. 471-487. Rakowski, N. (2011). Maslow's Hierarchy of Needs Model - the Difference of the Chinese and the Western Pyramid on the Example of Purchasing Luxurious Products. Germany: GRIN Verlag. Rigolosi, E. (2005). Management and leadership in nursing and health care: an experiential approach. New York: Springer Publishing Company. Stannard, D. & Krenzischek, D. (2011). PeriAnesthesia Nursing Care. Philadelphia: Jones & Bartlett Publishers. Thompson C. & Dowding, D. (2001). Clinical decision making and judgement in nursing. New York: Elsevier Health Sciences. Travelbee, J. (2006). Interpersonal aspects of nursing. Philadelphia: F.A. Davis. White, L. (2005). Foundations of nursing. California: Cengage Learning. Woolf, S., Chan, E., Harris, R., & Sheridan, S. (2005). Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making. Ann Intern Med., 143: pp. 293-300. Read More