Management Report

Executive Summary

This management report focuses on the improvement in the quality of patient care in the National Healthcare System, especially care provided by nurses as part of the nursing process. Several areas in which this care needs to be improved are identified and addressed including: the need for better communication, the need for shift handover care improvement, the need for a more patient centered approach to treatment, and the need for improvement in the level of patient mobility. The factors which contribute to these shortcomings in these areas are discussed as well as the negative impact of these shortcomings on the quality of patient care. Next, ways to improve upon these areas is discussed, included the management style changes that need to be implemented to facilitate these improvements. Implementing these changes will help to improve upon the quality of patient care that is currently being provided in the hospital setting.

Introduction

The National Healthcare System in the United Kingdom has areas in which care can be improved upon to provide better outcomes for patients and cut down on healthcare costs. One of the main areas in which patient care can be improved is that of communication. Communication, which has been should to improve patient acre, is currently being neglected between nurses and patients. Patient communication can be improved through the better management practices with a focus on the lower grade nurses with most patient interaction facilitating communication with patients. In addition to communication, shift handover, which is currently connected to a number of adverse events, needs to become a focus of nurses and medical professionals to reduce the likelihood of these events. This can be done through both a coordination with technology and a change in management style which allows bedside nurses to play a more active role. A patient centered care approach, orchestrated through the implementation of a transformational leadership approach can also help to improve communication and facilitate better patient treatment. Moreover, an increase in patient mobility as a result of all participants taking responsibility for encouraging patient mobility can reduce adverse incidents in patients such as pressures ulcers.

Analysis of Change Needed

Need for Better Communication

Good communication is crucial in any medical setting, and vital in the administration of medication and treatment. According to “Communication Between Nurses and Their Patients” appearing in Nurse Education Today, the establishment of a close relationship between the nurse and the patient is required from the effective implementation of the nursing process. There are four stages in the nursing process in which good communication is considered to be vital. These four stages include: “assessment of the patient, the planning of care for the patient, the implementation of care, and the evaluation of the care delivered. All four stages mean close contact with the patient and therefore require the nurse to take communication with patients more seriously”. Upon conducting a review of relevant literature concerning the nursing process and patient communication, the evidence suggested that improving the communication process at every stage of patient treatment resulted in an improvement in patient well-being and recovery.

The study found that the amount of interaction between nurses and patients and the length of interaction time were both lacking. Of the different grades of nurses, the learner nurses were most likely to interact with patients. Furthermore, the average length of the interaction by all grades of nurses was one minute and 30 second. “The findings for this study suggest that verbal interaction by all grades of nursing staff is not satisfactory in either quantity or quality. Only 31 percent of all the interactions were considered effective. The remainder were under two minutes in length and were noted by the observer to be short with often only one or two words being spoken”. From these results, teaching communication skills should be incorporated into the basic nurse education curriculum.

Need for Better Time Management

One of the most significant barriers to good communication in the National Healthcare System today is that of effective time management. Time management is important in the busy modern National Health System (NHS Jobs 2015).

Need for Verbal Shift Handover Report Improvement

Shift handovers are a routine part of nursing care which “can be described as a process that involves the passing and acceptance of responsibility for some or all aspects of care for a patient, or group of patients, and the sharing of relevant information. Shift handovers are a regular feature of healthcare work, taking place between oncoming and outgoing staff when there is a shift change”. The frequency of shift handovers is increasing as a result of doctors working shorter hours. These handovers have been connected to adverse events by a number of studies which have been conducted concerning their effect. There are a number of organizational factors which influence the shift handover process; these factors include: design of the coverage schedule, the information technology infrastructure, and the organisational culture. Two important aspects which contribute to the adverse events connected with handover the lack of a protected time for handover, and having a large number of patients that need to be handed over. According to “The Importance of the Verbal Shift handover Report: A Multi-Site Case Study,” the verbal handover report is very important for shift handover and technology should be put in place to support the verbal handover process.

Need for Patient Centered Care

Patient centered care is now a core National Healthcare System value. For effective patient centered care, there needs to be a relationship between the patient and the professional and between professionals who play a role in the patient’s care. According to “Bedside Information Technology to Support Patient-Centered Care” which appears in the International Journal of Medical Imformatics, “safe patient-centered care should be provided to all, but for many reasons this goal can be easier stated than achieved in acute care hospitals. The environment is dynamic, fast paced and complex. Many barriers exist that lead to communication breakdown. Poor communication and the lack of involving patients in their own care are two significant problems that lead to deficiencies in promoting safer health care for patients”. Patient centered care is facilitated by better communication and greater patient involvement. This type of care focus will allow patients to receive care which is better tailored to suit their individual needs as patients.

Need for Increasing Patient Mobility

Another key problem that is faced by the National Health care System today is the lack of patient mobility. According to a 2007 study, patients in the hospital spend an average of 18 minutes a day standing or sitting. This can have a significant effect on the patient. Older patients can lose 1 – 5% of their muscle mass after just 24 hours in bed. To prevent this occurrence for happening, patients need to be encouraged to get out of bed and walk around and not to rely on physiotherapy. One reason that patients lack mobility in a hospital setting is that they often believe that sitting in bed is the best way to make them better. The immobility of patients in the hospital setting has a significant effect on patients as well as the National Healthcare System as a whole. Pressure ulcers commonly occur in patients who do not have the ability to reposition themselves to relieve pressure. The high incidence of pressure ulcers that occur in immobile patients contributes a significant cost to the National Healthcare System; the annual cost of pressure ulcer management to the National Healthcare System is approximately £ 1.4 to £ 2.1 billion. This is equivalent to approximately 4% of the total healthcare expenditure of the United Kingdom. From this data, it is apparent that patient mobilization is integral to achieving safe and effective healthcare which improves the quality of patient’s lives.

Plan of Action and Evaluation Strategy

Improved Communication

Improved communication between nurses and patients and nurses with other nurses and medical professionals is essential for the improvement of patient care. Implementing a strategy for improved communication requires the utilization of proper management techniques. Because the nursing grades that interact with the patient the most are not the higher level grades, a congruent leadership approach to managing communication with patients can be implemented to encourage better patient communication. The learner nurses and the next grade of nurses can work together with patients to facilitate better communication. Furthermore, the teaching of communication skill can be emphasized in the learner nurses’ educational curriculum with self-evaluations being taken concerning the amount of time that the nurse interacted with the patient and the effectiveness of the communication. Instructors cab evaluate can evaluate the nurses’ self-assessments and give feedback to encourage better communication as these nurses go further into the nursing field.

Improvement of Verbal Shift Handover Report

Due to the problem of adverse events being connected with patient handover, improvements in the management of patient handover need to be implemented. According to “Medication Communication Between Nurses and Patients During Nursing Handovers on Medical Wards: A Critical Ethnographic Study” appearing in the International Journal of Nursing Studies, the management of this process needs to be changes to facilitate better results. “Because nurses spend most of their time at the patient’s bedside, they should have a profound influence on patient care and decision-making. Nurse coordinators need to relinquish organizational control of the handover practice and appreciate the contribution of bedside nurses to patient information exchange, in the group handover and following patient transfers across different wards”. Thus, the current leadership model needs to be changes with regard to patient handover so that the input of bedside nurses is placed in higher regard. This can be done by nursing coordinators delegating more of this responsibility to bedside nurses. “Patients’ Perspectives of Bedside Nursing Handover” appearing in the Collegian states that there should be an emphasis on the partnership model of patient care to improve patient outcomes and reduce adverse events.

Focus on Patient Centered Care

In order to help alleviate these presented by the Nation Healthcare System today, there needs to be a focus on patient and family centered care. The heart of family centered care is the belief that healthcare staff and the family are partners, working together for the best needs of the patient. One issue that seems to be arising frequently in practice is that patients and families do not feel that they have enough input when it comes to the care that they are receiving; they are not aware of the plan of their day and they do not get their requests heard. A shift toward more patient centered care can be implemented with transformational leadership.

“Transformational leadership is a theory where the interdependence of followers and leaders is linked. As such, it has found favour in care-related and teaching fields… Transformational leadership is strongly connected to the process of addressing the needs of followers, so that the process of interaction increases the motivation and energy of others. Thus, transformational leadership requires that all participants ‘transform’ their approach to leadership in order to facilities change with a focus on the patient. The nursing staff should devise points and strategies to incorporate into their routine to encourage a patient centered focus.

Improvement in Patient Mobility

Due to the significant occurrence of pressure ulcers in immobile hospital patients, steps need to be implemented to improve patient mobility to reduce these incidents. This can be done by increasing the frequency of interaction between nurses and patients with a focus being places on preventing these types of occurrences. Utilizing the transformational leadership approach, nurses should be taught to have a change of mindset when it comes to preventing the occurrence of pressure ulcers, making it the responsibility of everyone who is involved in the patient care process to prevent this occurrence.

Conclusion

There are significant areas of improvement that need to and can be made in the nursing care process to improve the efficiency of the National Healthcare System. Improvement in communication is important to providing better treatment of patients. Both quality and quantity of communications between nurses and patients is currently lacking but care be improved through initiatives being taken by lower grade nurses who have the most patient interaction. The adverse incidents connected with patient handover also needs to be reduced and can be reduced though the use of verbal patient handover reports supported by technology. In addition, bedside nurses can also play a more vital role in this process. Furthermore, a patient centered care approach should be implemented to improve patient care and treatment. This can be implemented through a transformational leadership approach in which all participants move the focus toward patient centered care. As part of the patient centered care approach, nurses need to take steps to increase patient mobility and decrease the incidents of pressure ulcers that occur in hospital settings. This can be done by a concerted effort between all the nurses to focus on encouraging patient mobility for the purpose of preventing pressure ulcers.

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