n part 3 Flashcards
describe about Great man theory (Galton 1869)
and big bang theory
- great leaders are born into great families
- leadership is inherited
- divine creed: ‘right’ breed
- all other must be led
- great events create great leaders of otherwise ordinary people
- world wars, personal events, local events
- the situation and the followers create the leaders
describe about Trait theory
- its the ‘man’ - not the game
- person is more important than the situation
- characteristics or traits distinguish successful leadership
- assumes a passive follower role
describe the style theory
‘it is how you play the game’
- how leaders behave, what they do , how they interact, how groups respond
- based on beliefs, values, preferences and organisational culture
- relationship between concern for people and concern for results
describe the styles of management and leadership between 1960 -1990s
- autocratic (directive, has a right to manage)
- paternalistic (overprotective, interfering)
- democratic (Discussion, debate and shared vision)
- Laissez- fair (easy- going , no directions for followers)
(more leadership theories based on style )
- charismatic
- participatory
- situational
- transformational
- authentic
- servant
what is transformational theory?
theory developed (1970s- 2014) in response to the confusion between management and leadership
- links MOTIVES of leaders and followers
- attends to the needs of followers, increase motivation of both
- challenge to the status quo
- challenge context of work
what are the 4 themes associated with Transformation leadership
- vision
- communication
- trust
- self-knowledge
what are the negative aspects of transformational leadership?
it is widely adopted in the caring professional
HOWEVER
- without robust critical
review or empirical evidence - limited examination of passive forms of leader avoidance
- feasible that transformational leaders can lack integrity
- extreme self- confidence can be a feature of narcissistic personality
what is transactional leadership
- opposite to transformational
- focus on the purpose of the organisation
- ‘run a tight ship’
- reward/punishment motivation
- manage routines and tasks
- keeps organisation on the right tract
congruent leadership
application of leadership to your clinical situations
what are the ACN Nurse Leadership model
- Org structure
- Recruitment retention
- improved Pt outcomes
- Cost & productivity
Leadership vs Management
according to Warren Bennis,
leaders are people who do the right thing
managers are people who do things right
why do we need leadership in health care?
- because health professions need to be responsible for quality and safety
- clinical leaders are in an ideal position, ideally situated to support other clinicians to develop health services
- need to recognise the ability. to be change agents
clinical leadership is putting the clinician at the heart of shaping and running clinical services, so as to deliver excellent outcomes for patients and population,,,,
what does leadership in nursing look like currently?
transformational leadership
found in positions called leadership
have hierarchical or titled position
fill a leadership role or position
what is supportiveness
- build team
- sustain effective teams
- emotional intelligence
what terms the de-escalation approaches?
- non verbal
- verbal
- protective
- seclusion
- legal force
- debriefing
- continuation
why the de-escalation skills important for nurse?
as professional healer nurse require communication skills that enable use to de-escalate people therapeutically.
nurse in ethical framework including values such as:
- human beings are inherently valuable
- obligation not to harm others intentionally
- respect for authority
- justice regarding equal distribution of burdens and benefits
truthfulness
when is de-escalation skills needed?
- distress
- anger
- verbal aggression
- passive aggression
- physical aggression
- criminality
what the case of Phinese Gage exemplified?
Phinese Gage- a metal poll went through his frontal lobe but he lived being continue and his personality changed.
it showed that brain’s adaptability and there are different parts of brain with different function
what is psychological approach?
interpersonal physchological approach suggest that the way people relate is linked to their past interpersonal experience and often linked to attachment styles developed during childhood
central to this approach is the idea that each person is an expert regarding their own life but not everything we know conscious
it is crucial for nurses using this approach to adopt a posture of unknowing
assist the person to feel understood and guide then towards self identification and ownership of challenges
use open ended questions to explore challenges and identify desires/goals
assist the person to identify and understand problem- solving strategies
coach the person towards the development of new coping skills/behaviours that allow then to end experience more appropriate and satisfying ways of relating to others
what are the components of IPT model of attachment
secure
- self competent people are, dependance, safe
preoccupied
- not self competent.
- anxious (ex: I cant cope alone)
fearful
- people inflict pain need to control (ex: I am garbage)
dismissing
- people are understandable
- depressed
(secure)
what are the strategies for de- escalation techniques?
- notice and non verbal techniques
- notice when people might escalate people
- it is essential to listen carefully and respectfully to what the person is saying, especially during periods of anger and aggression
- use traditional listening skills (tone of voice, eye contact, nodding etc)
- be aware of your body posture
- avoid physical contact
- minimize movement - verbal techniques
- stay calm under fire
- acknowledge subjective distress without aquiescing
- lower your voice and keep your tone even
- present options
- don’t talk or shout over the top if verbally aggressive
- speak clearly
- use “present tense talk”
- you may need to seek help
- you may need to exit quick - protective strategies
(the worst case scenario)
- know who to call and how to call help
- use emergency alarm
- stay outside of the ‘hit zone’
- protect your body
- leave the situation
what are the trends in the management of death and dying in western societies
- the institutionalisation of death and dying; many people dying in hospital or long term care
- professionalisation of death and dying, such as certificate of death by the medical profession and disposal body by the funeral industry
- increasing use of medical technology for prolong life
cause of death in Aus?
- coronary heart disease
- dementia
- cerebrovascular disease
- chronic obstructive pulmonary disease
- cancer
what increase the development of life-limiting illness
lifestyle factors
occupational exposure to chemicals
biological
genetic defects
where people mostly die at?
- 54% die in hospital
- 32% in residential aged care
- 14%of people die at home
what is good health
- to have an idea of when death is coming and who can be expected
- to have control of pain and other system
- to have reasonable choice and control over when health occurs
- to be able to leave when it is time
- to have time to say good bye and to arrange important things
what are the common exist for people with life- limiting illness?
- management of physical and psychological symptoms
- need for social support
- culturally specific need
- spiritual and existential concerns
- info and communication
clinicians need to provide information in a way that assists patient/ families
to make appropriate decisions
be informed to the level that they wish
to set goals and priorities
to cope with their situation
what are the barriers to discussing prognosis and end of life issues?
lack of time stress lack of training fear of upsetting the patient and fam hopeless by unavailability of further curative treatment
describe the key recommendation : PREPARED
Prepare fore the discussion Relate to the person Elicit patient and caregiver preferences Provide information Acknowledge emotion and concerns Realistic hope Encourage question document
what is palliative care ?
a philosophy of care that all health professionals can implement
more than just end of life care
what communication skills are required to have communication to establish goals of care?
and what are the strategies ?
listening and enquiring:
- what are u hoping now
- what is important to you ?
what do you need to accomplish/ complete?
checking and clarifying:
goals may change as their illness progresses
strategies:
- family meeting- patient may or may not included depending on the situation
- family members and health care team exchange and impove communication
- provide opportunity for th fam to express and share their feelings in a safe and structured context
advance care directives:
- contain instructions that consent to or refuse specified medical treatments.
- has legal status
- clearly states patient care and preferences
what is Advance Care Planning? (ACP)
process of planning for future medical care
exploration and documentation of values, goals during which patients,,
determination of proxy decision- maker
how do we know someone is dying?
- bedfast
- unable to eat or drink beyond sips of fluids
- no longer able to take oral medication
- changes in respiratory pattern and peripheral shutdown
what are the clinical priorities in care in the terminal phase?
- revise the end of care plan
- need to communicate: with family and staff
- stop investigations : obs, blood tests etc
- manage symptoms
what are the care of the family
- respond to any questions
- keep the family informed of any changes
- erasure families
