Problem Outlined
The central issue presented in the paper is the need to provide a seamless critical pathway for the ventilator-dependent patients given their multiple complex care needs who were about to be discharged to home. Also, there was a problem with some of the physicians who arrogantly refused to follow the critical pathway developed by Witte calling it a concocted “cookbook.” Further, instead of the dietary representative taking charge of the dietary protocols for the patients, they forward this mandate to the nurses –this adds more work to Witte and her nurses. Ultimately, the local home health care was indisposed because, amidst their plans to move, they get notified that the JTC was scheduled for inspection in three months. Hence, the home health care group could not come to team meetings or communicate with the nurses to plan on the implementation of the critical pathway.
To be a leader means taking responsibility for one’s objectives and other individuals implicated by the objectives. As such, since Nurse Witte was in charge of developing the critical pathway and consolidating a team to achieve this objective, all the problems mentioned above implicated or reflected on her. It was also Sunrise Hospital’s problem if its staff failed to provide care for the ventilator-dependent patients. This would tarnish its image and would have fallen out of favor with the nursing guidelines or code of ethics regarding non-maleficence or not harming patients, as stated by (Kadivar et al., 2017).
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Nurse Witte Actions and Communications
Essentially, a nurse needs to collaborate with other health professionals to promote health. Further, the nurse has the accountability, authority, and responsibility to make decisions and take actions geared towards providing optimal patient care. As such, Nurse Witte should seek to solve the issue with the physicians as they are in a better position professionally to provide and maintain the ventilator-dependent patients’ health through treatment. Regarding the dietary representative, Witte should consult with them and request for an agent or a different representative from the dietary department that can oversee the patients’ diets.
As for the patients, developing a critical pathway is in order. First, Witte needs to determine how the patients will transition from the clinical setting to ambulatory or home setting as a strategy for providing respiratory care. Further, the nurse should outsource other home health care services other than the indisposed local one where she can implement telemedical technologies that will aid in promoting patient supervision and reduce general visits to practitioners, (Kastrup et al., 2017). Additionally, scheduling regular physician visits to the patients at home or assigning a physician to the new local home in charge of providing services to the patients will help in tracking the health progress of the patients. Also, maintaining a medical file in a respiratory center and carrying out follow-ups by nurses after physician consultation is crucial to keeping track of the patients’ health and their outcomes.
One mode of communication by Witte should be the use of instructions on how the critical pathway for the patients should be implemented and what roles the physicians, the dietary representatives, the home health care group, and nurses should play. Further, she should use moderate language rather than authoritative, especially when dealing with the physicians who have already expressed their resentment. Also, she should employ vertical communication to the management in reporting her challenges with other professionals and give feedback to the patients regarding their progress.
Steps to Ensure a Clear Message
According to Kastrup et al. (2017), telemedical technologies such as teleconferencing are essential in promoting patient supervision and consultations. Thus, since Witte has to outsource home health care services from a different home group, this would ensure clear messaging regarding patient progress without needing to travel. Furthermore, maintaining an electronic health record for the patient in an ambulatory respiratory center by nurses helps provide real-time data regarding the patients’ medical progress. As such, Witte can give appropriate feedback to the hospital management as well as the physicians in determining their prognosis. Moreover, to ensure that she does not sound authoritative to the physicians, Witte needs to practice role-playing and active listening when inquiring from the physicians and dietary representative as to why they are reluctant to support the suggested critical pathway.
Communication with Participants
According to Akel & Elazeem (2015), unresolved conflicts can compromise the ethical duty of healthcare professionals to proffer patient care further jeopardizing the therapeutic nurse-client relationship. As such, the first group Witte should communicate with is the physicians in the bid to resolve their conflict. The critical pathway implementation implicates nurses, hospital management, physicians, dietary representatives, and a home health care group. As such, all these parties need to be involved in the communication flow.
Leadership and Management Strategies
According to Skully (2015), as much as leadership ensures health policy and nursing practice by showing others what pathway to take, leadership in nursing needs to be concurrent with management. As such, though Nurse Witte is a leader by being the Nurse in charge, she needs to manage her team which includes the physicians, other nurses, and dietary representatives in the realization of the developed critical pathway. Other than management, Witte needs to employ engagement as a cohesive strategy towards achieving the critical pathway objectives. Here, Witte needs to become a transformational and servant leader, where she portrays herself as an equal to the other involved professionals rather than being above them as the nurse in charge. Ultimately, she should employ delegation as a management strategy to ensure that each party understands its role in the developed critical pathway.
References
Akel, D. T., & Elazeem, H. A. (2015). Nurses and physicians point of view regarding the causes of conflict between them and the resolution strategies used. Clinical Nursing Studies , 3 (4), 112. DOI: 10.5430/cns.v3n4p112
Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient’s safety: a clinical case report. Journal of Medical Ethics and History of Medicine , 10 . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150915/pdf/JMEHM-10-15.pdf
Kastrup, M., Tittmann, B., Sawatzki, T., Gersch, M., Vogt, C., Rosenthal, M., ... & Spies, C. (2017). The transition from in-hospital ventilation to home ventilation: process description and quality indicators. GMS German Medical Science , 15 . DOI: 10.3205/000259
Scully, N. J. (2015). Leadership in nursing: The importance of recognizing inherent values and attributes to secure a positive future for the profession. Collegian , 22 (4), 439-444. DOI: https://doi.org/10.1016/j.colegn.2014.09.004
