Throughout this entire assignment I am going to critically appraise others and my very own practice as a collaborative worker via personal reflections and encounters of collaborative working, through experience in professional practice. I try to link service customer improvement and cooperation defining the value of these both. Furthermore, explaining the various authority models clarifying why they are important and needed within a health care team. I will plan to describe and critically examine an event with the motive to market positive benefits for the service environment. Also then identifying something improvement plan, in cases like this planning a 15minute time management healthy graph for patients with dementia.
Service improvement
The BW Quality & Protection (2007) identifies service improvement, stating it is a combined and frequent effort from everyone, including healthcare experts, patients and their families, analysts, payers, etc. The changes need to lead to better patient effects, better quality attention and better professional development (see appendix 2). The aim of all healthcare systems make an effort to provide safe and good quality healthcare, improve patient activities, tackle efficiency and revise practice in the light of facts from research (RCN 2015).
Critical examination of own performance from the Interprofessional potential framework (2009) section OC3/L2, I determined myself as level 2 (see appendix 1). During my district nursing positioning, collaborative working is an integral when being truly a nurse in the community. During my positioning I interacted with various health professionals across various organisations. I made certain I was knowledgeable about the information I had been moving over and I usually opted directly into getting together with the other experts to build my assurance.
Collaborative working
The King Finance (2014) recently released a new policy report about "time for change' taking ideas together from all industries to help change medical care and improve collaborative working. The Royal College of Nursing (2004) states collaboration is diverse, ranging from intra-disciplinary groups on a person setting to multi-agency working practices. Collaboration covers the procedure of researching, evaluating, planning, applying and analysis (Thomas 2014).
Critical research of my own performance from the Interprofessional Functionality Platform (2009) section R2/L2, I recognized myself as level 2 (see appendix 1). In multi-disciplinary conferences (MDT), I had been co-operative, willing and knowledgeable about the patients. I had been anxious and asked questions throughout the MDT. I asked question you should definitely understanding and I noticed as though the health care professionals respected me as a student because I showed an interested rather than doubting my very own knowledge. Weaknesses exhibited as I thought more nervous to question a health care provider if I didn't have the statement was correct. Nevertheless, opportunities to talk about and discuss activities with area for improvements are valued within medical health care system (RCN 1995). On top of that, critically analysing another Interprofessional Functionality (2009) section CAEP1/L2. I discovered myself as level 2 (see appendix 1). Through collaborative working I could achieve this ability by engaging myself in conversations about cultural beliefs and understanding, during MDT meetings and general discussion between different industries, therefore enabling to get knowledge about the problems within communities of practice.
Service consumer and collaboration
The Journal of Medical Management (2010) cited by Francis (2010, p400) commitment, compassion and effective teamwork donate to the welfare of patients and really should be valued. Both nursing and medical personnel are entitled to effective cooperation, one of the primary worth of Interprofessional working should be about respecting the individuals within the team (Barnes 2012). Collaborative practice between disciplines, patients and family lead to the highest quality of care and strengthens healthcare systems, proposing that Interprofessional education is the way forward to producing a "collaborative-practice" ready workforce (Goodman 2010). Reflecting on my first position, collaborative practice was shown poorly within the team and there was little talk made throughout the team. This managed to get difficult for important information to be passed on effectively.
Critically analysing my own performance from the Interprofessional Capabilities Platform (2009) section CW/L2, I recognized myself as level 2 (see appendix 1). Effective communication is one of the principal barriers when working to ensure safe, constant and excellent patient health care (Baird 2012). A location of weakness once i talk to patients is posture, from self-analysis I have pointed out that on some occasions I become uncomfortable and am unsure where to stand or how to be seated before a patient. Ideally, through self-realisation I am in a position to improve in this area on my future location.
Leadership
The NHS healthcare system is subject to a pressure of change, throughout these changes the health care commercial requires nursing market leaders with special traits, therefore identifying market leaders who are able to guide the vocation into a positive future (Sofarelli 1998).
The frameworks that will be critically analysed are The NHS Leadership platform (2011) and NHS Change Model (2013). The NHS Authority platform (2011) to gather leadership key points and best practice instruction. The framework delivers a reliable approach to leadership development for personnel in health insurance and good care throughout the NHS. The NHS Management framework is made up of nine control styles (see appendix 3). The command behaviours are shown over a four-part scale which range from "essential" through "proficient' and "strong" to "exemplary'.
The NHS Change Model (2013) has a similar aspect about control with slight differences as it has been released recently (see appendix 4). The management framework also promotes staff members at all levels over the NHS to become leader and the primary aim for this construction is to encourage everyone working in the NHS to become a head of change, forcing for everyone's viewpoints to gather a general scope of the primary issues in the health care. So how do leaders inspire staff to participate? Staff members have to be able to be independent, guaranteeing they can widen their selection of skills (Western & Dawson 2012). This allows greater job satisfaction.
Leadership is important when influencing a group of individuals to accomplish a specific and obtainable goal. The style of the leader is vital when influencing change and looking to achieve a high quality of good care. Within leadership there are several types of command styles which, depending on your personality, determine which style you will obtain. Collective control is known as typically the most popular authority style used within NHS professional medical. This style is based upon building connections with the other health service users, the individual is strong and has interest to support and increase the team (Jackson 2007). This type of style influences and motivates other customers, facilitating the introduction of robust, radiant and reproductive research cultures (Russell & Rock 2004). The decisions are made within the whole team predicated on the organisations ideals and ideals. On top of that, authoritarian leadership is where all the decisions are made without consenting any of the other staff members, negative encouragement and abuse is often used to enforce guidelines. This sort of style is utilized when the average person feels ability and generally withdraws from the team. The positive aspect about this style is the fact in an disaster situation little discourse is made and this then enables jobs to be completed immediately. I believed that during first position authoritarian command style was used mainly. This was due to too little staff and popular from the patients. This style seers to be the best for this kind of situation but it addittionally entails negative details.
Critically analysing my own performance throughout placement, I personally believe that I am going towards learning to be a transformational leader, which is very similar to the collective leader. During my first third yr placement, I had developed the chance to lead a small group of team members that were caring for the patients I was responsible for. I needed to make certain I put charisma and confidence, ensuring I motivated the other staff members and allowing me to construct interactions with the team. At first I felt embarrassed and unconfident because of my experience in comparison to others, although after learning the team and displaying commitment and knowledge, it allowed taking charge easier because I had fashioned more respect from the team.
SECOND SECTION
During placement periods as student nurses, we all experience different encounters and various routines determined by the ward allocated to us. Throughout this portion of the assignment, I will discuss a location ward in which I felt there must be a location of change. The reflective model I've chosen to use is Bortons model (Barton 1970). Bortons model simply places three simple questions to be asked of the knowledge to be mirrored on; What?, Just what exactly?, Now what? The model will be designed into the representation to accomplish critical thoughts, relating theory to practice.
In my first calendar year of becoming a nursing scholar, I was located on a good care of older people ward for dementia specialising in Parkinson's, with around about 26 medical mattresses. This ward was very fast paced and constantly busy. Throughout the placement, I discovered the patients suffering from severe dementia got various nutritional needs. Fat loss is common in individuals experiencing dementia, brought on by poor urge for food. This may be due to a number of problems including communication, depression and pain (Alzheimer's culture, 2013). I noticed that occasionally some patients would not have eaten throughout all day every day or even hardly drank fluids anticipated to refusing at meal times; this therefore becomes the patient's program because food isn't included to their daily activity. The main concern with this ward was time management because of the popular of patients and service needed. This occasionally showed to truly have a damaging influence on various patients that needed more good care and time. PDSA circuit plan is to create a period chart which specifies that a minimum of 15 minutes one-to-one time, must be spent with a particular patient. This will then hopefully enable the individual to become acquainted with you as the good care giver throughout their meal time.
It occurred to me when over a dementia ward that the patients often go by familiarity despite their memory. For example, some patients would only take in diet and fluids when their comparative was around despite not knowing who they are. Therefore, maybe with my change of plan being set up, if a member of staff is allocated specific patients for your day and every food time the care-giver spends quarter-hour with the individual during the period, the likelihood of the patient consuming even a small amount of food is higher than when the individual was not receiving enough quality time.
Additionally to help implement the service improvement, structures known as process mapping and the PDSA circuit (plan, so, research, act) are utilized. Process mapping permits health professionals to fully capture the certainty of the individual experiences, following their whole journey to help identify the primary trouble spots for change. An example of an activity map performed is shown in (appendix 5), planning a process map really helps to identify the precise problem, which provides clear evidence a service improvement plan is needed. In this case, an activity map had not been necessary for this service improvement plan. Alternatively the PDSA routine is utilized to provisionally trail a change used, allowing the team members and patients to evaluate the impact of the change before putting into action it into practice.
Plan
To firstly start my plan of change I created it into the multi-disciplinary team meeting. This allowed me to help steer and co-ordinate the involvement as well as review my process with the team. Therefore bringing every one of the health care experts together can then get a stake in the outcome and we can all work to attain the goal. Clarke (2008) thinks that groups without nurses are assured to fail. Also tears led by nurses and therapists, however successful, often lack control; therefore doctors must be a part of the team. This change of plan has been designed strictly through observation within my first year placement. Speaking to various service users and family I gathered jointly a concern for the patient's dietary needs. As well as realizing a pressure on the staff I thought assembling an alteration of plan will ease the team and prevent stress, hopefully having collaborative practice mutually.
Additionally when applying an idea of change there will be controversy. Lewin (1951) designed a power field research, a tactical tool used to understand what is needed for change in both corporate and personal environments. For instance Kurt Lewin (1951) states directly " A concern is health in balance by the conversation of two opposing units of causes - those wanting to promote change, known as the driving a vehicle forces and the ones attempting to maintain the status quo (restraining causes). Throughout change there will be individuals willing to donate to make an alteration happen, nevertheless you will see restraining forces that resist.
To assist with the leadership section for my plan of change, the strategy I will use is the transformational style. This will allow me to bring everyone mutually creating a conversation on everyone's thoughts and feelings about the plan. It is very important that the idea set out is arranged by a lot of the individuals, because the program of change will cost a tiny amount from the NHS budget, which means change must be beneficial to the NHS. The Institute for Technology and Improvement (2013) areas presently in the NHS were facing an unpredictable problem to improve quality and decrease the cost. Collecting the correct data both quantitative and qualitative at consistent intervals over expanded periods allows medical experts to make an uniformed decision about if the change is moving the NHS in the right direction. To permit my plan of change to happen/work I will need to ensure I've the involvement of various team members. Therefore allowing the patients to find the specified 15minutes one-to-one time, definitely nurses and healthcare assistants are going to be my main priority.
Do
To test whether this change of plan is a good idea I will perform a pilot review. A pilot review is a methodological benefits, the aim is to develop, adapt and check the opportunity of the methods working for my service improvement plan (Foster 2013). To check this idea firstly, I talked about the service improvement with people of staff from other wards and family to gain an over-all scope of ideas about plan. I performed this because the ward used for my service improvement plan, staff didn't work collaboratively therefore I didn't feel as if I'd gain an optimistic outcome. Nevertheless I made a decision to use questionnaires with the complete team on the ward. This allowed me to accumulate the positives and negatives together and analyse whether I've achieved the service improvement. Also collecting the info allows me to forecast how long the procedure will take because of the amount of workers that are 'for" my service improvement. Main source of data has result from research and questionnaires utilizing a qualitative research approach. Qualitative research is conducted in a realistic environment, generally used from research that is accumulated through interviews and observation (Cleary 2014). Reflecting upon this I am able to look back again at the data collected and weigh out the professionals and negative aspects of my service improvement. I gained responses from the patient's family as well as staff on the ward and on other wards. I feel that I have used a number of sources to gain a precise and reliable result.
Study
Merging most of my information/research along my main concern was to attain a listing of the results. I used a matrix platform to bring designs together from the info I collected. This way I could lay out the data in a variety of categories to help make the research basic. Furthermore with the information, I distributed this verbally during multi-disciplinary conferences to place the service improvement plan across a variety of health professionals, getting a professional reviews. Also talking about the service improvement with family family, increasing more of an outside view from individuals that don't work in the health care. This type of research allowed me to get precision and reviews from different areas.
Act
Unfortunately as I am unable to actually perform this service improvement, therefore I have to understand this service improvement plan hypothetically. Critiquing changes of my service improvement plan I am totally aware that service improvement plan is only going to work if the ward works collaboratively. Consequently the ward chosen for this, need to aim to improve their management skills and their collaboration between your other sectors. To help implement this plan effectively I will firstly introduce this course of action into breakfast food times, allowing me to boost small areas better and then eventually start this course of action out to all or any meals. Overall I believe allowing 15 minutes one-to-one time, whether that is during all meals times or maybe breakfast time will improve patient's nutritional needs, specifically for dementia patients it allows time for familiarity for the patients.
Conclusion
Concluding the complete assignment along prioritising the primary issues in this assignment, I feel collaborative practice needs to be used as daily activities within medical care system. It has been clearly shown how essential it is to collaborate in a team and ensure command is prioritised. Planning something improvement plan was a great experience and I now feel confident critiquing services and planning a change, it includes helped me appreciate how much you actually notice during practice placement and the advancements which i, as an individual, can actually make. Overall, l I now hold a greater knowledge about team dynamics, areas of good and bad practice and service individual involvement.
