Risk Management and Patient Safety in a Hospital

Risk Management and Patient Safety in a Hospital This essay will present an interaction that took place in practice that captured the multi-disciplinary team discussing a service user. This interaction shows the concept of risk management, patient safety and leadership within a hospital setting. These concepts will be explored and critically reviewed to establish how important leadership and advocating for a service user is. It will also demonstrate how important a good multi-disciplinary team can work together for patient safety with least restrictive practice. Interaction in practice A mixed 20 bedded ward in acute mental health for adults aged 18 to 65 received an informal admission which is lease restrictive practice (Scottish Government, 2006). The service user has a diagnosis of borderline personality disorder who was known to staff on shift. As it was a weekend none of the service user’s medical team was on shift, which meant they would meet with the duty doctor, and duty consultant. The duty consultant arrived and went to one of the interview rooms to chat with the service user. On return the consultant stated that the service user would stay until they met with their own team. When asked about passes off the ward the consultant said nurse escort passes only. The coordinating nurse then stated that this would not be acting in the service user’s best interest and history has proved this to be non-beneficial. The nursing multi-disciplinary team (MDT) then proceeded to state the service user was informal and attended voluntary. This will cause di stress and anxiety to service user when staff cannot facilitate the time off the ward. The consultant stood by his recommendation but the coordinating nurse got in touch with the coordinating charge nurse (CCN) and pursued the decision. It was then talked over by the coordinating nurse, consultant and CCN as well as the staff on shift. After the MDT had discussed the matter the result ended with the service user gaining 15 minutes passes which worked out well over the weekend for the service user. Leadership The definition on leadership is one in a position or function as a leader to direct or guide a group or party (Waite and Soanes, 2007). Nicolson et al, (2011) states there is more ramification with being a leader such as: communication, emotions, and the relationship between followers and the leader. However if professionals in a leadership role are not performing to the high standard this can impact on the team reducing their commitment to the care and treatment of service users (Kilfedder, Power and Wells, 2001). Researchers have not only been tasked with finding a definition for leadership but also evidencing the characteristics that make a good leader. (Wangensteen, Johansson, Nordstrom, 2008) state that an individual constantly producing a high level of practice above recommended standards as well as displaying a caring interest in other colleagues performance, and sharing information or guidance at the correct time has all the characteristics of a leader. Professional socialization according to (Clearly et al. 2011) states leaders will engage in conversation to explore values, beliefs and attitudes of individuals they work with as well as initiating team building interactions and offering support towards the team members. Alimo-Metcalfe (2003) states that individuals are most effective when they are competent and confident and aware of their own strengths and behaviours and can work well with other team members. This was displayed in the scenario as the coordinating nurse was confident and showed their strength by pursuing the matter with the backing of the MDT. (Hogan, 1994) states leadership is persuading colleges to set aside individual concerns for a short period of time to support a mutual goal or responsibility for safety and welfare of a group. On the other hand (Fowler, 2012) states leadership is projected through role modeling. Role modeling according to (Fowler, 2012) is an individual who is â€Å"good at their job† and competent within their role with the ability to carry out tasks with ease. However there are some clinicians that practice on the edge within ethical dilemmas that could be deemed unprofessional therefor would not make good role models. (Bosman et al. 2012) also agrees with role modeling and its importance with leadership and states there are four aspects that experienced members of a team lead from. These are inspiration and motivation, self-efficacy reinforcing junior’s beliefs to achieve more. Learning by example of real life practice situations and a support for other members of the team. The leadership skills displayed in the scenario above was to advocate for the service user and be their voice. This took confidence and knowledge with a compassionate and empathetic approach so the service user would not be distressed or agitated over the weekend. It also demonstrates how connected the team was to get involved in the discussion to reinforce the initial statement. By displaying communication skills and introducing an outside party to evidence reasons why this would be the best course of action for the service user the pass was granted, and there were no incidents over the weekend involving the service user. However the service user could have went out on pass and not returned and the scenario could have been much worse even disastrous. But the staff member had evidence based knowledge about the individual and practical experience with care and treatment for the service user. Although there was a risk with this scenario all parties were following the 10 essential shared capabilities (ESCs) by working in partnership, promoting recovery, providing service user centred care, making a difference and positive risk taken (Anderson and Burgess, 2009) this guided all members to reach a decision. Kean and Haycock-Stuart (2011) argue that policies and interactions put in place to deliver a high standard of care can suggest that the individual in the leadership role is solely responsible for its success. This singular approach fails to report the relationship between the leader and followers and the prevalence of the followers contributions (Kean and Haycock-Stuart, 2011). The Scottish Government (2009) acknowledges that the leadership development for National Health Service (NHS) Scotland is achieving its goal. This is regarded as a priority for (NHS) Scotland and is prioritized at a local level (The Scottish Government, 2009). This has been introduced to insure healthcare professionals can practice nationally and local with leadership qualities and behaviours to deliver a high standard of care that is safe and effective. Policy within (NHS) Scotland states all employees are made clear and understand exactly what their role is. As they have a duty of care to provide the best care possible, and leaders have the responsibility to ensure this is happening to the correct standards but allow participation in the decision making process (The Scottish Government, 2009). The NHS has a model (Leading Better care, 2011) that can direct leaders to consider leadership qualities and develop positive attitudes and set out goals. How leaders behave within National H ealth Service (NHS) Scotland can make or break their agenda for health care. Research suggests that an effective leader can have a positive impact on service user care. There has been many cases of bad practice in healthcare that has been publicized for the public such as; The Mid Staffordshire NHS Foundation Trust which produced the Francis Inquiry (Nolan, 2013) which explored what happened and were the trust failed. The report stated that all healthcare workers working within the health care system will be held accountable for their actions and the care they provide. The report addressed staff from all positions especially senior positions who neglected their basic leadership skills (Nolan, 2013). (Blegen and Severinsson, 2011) state mental health nurses are always advancing their practice with change while working in environments that are challenging. By developing leadership skills that are motivating and encouraging colleagues to work responsibly and respectively with service users. This demonstrates the importance that leadership skills have when tasking or directing a colleague to have reassurance the task will be carried out correctly (Cleary et al. 2011). This can depend on the relationship of the followers and the leaders as this has an important bearing on the success of the healthcare environment. However (Kean and Haycock-Stuart, 2011) states that the followers are over looked as the framework for leadership focuses on the leaders as individuals. Kean and Haycock-Stuart (2011) state there is more to being a follower than following a leader, if judgements are made that disagree with a leader this can make or break the relationship of leader and follower. Good leaders hip takes opinions into consideration and work with reciprocity built on trust (Kean and Haycock-Stuart, 2011). Along with leadership is patient safety as described in paragraphs above leadership has been the emphasis for NHS Scotland locally and nationally but these two concepts work in partnership with each other (The Scottish Government, 2010). The Nursing and Midwifery Council (NMC) acknowledge the importance for individuals to continually update skills and experience in leadership and patient safety and working in partnership with universities have implemented a new domain constructed for leadership. This domain will be part of student competencies that will be expected to be adhered to when they become registered nurses. Registered nurses must now lead and challenge in a bid to improve services to provide the best possible care (NMC, 2010). Patient Safety Safety is the most important part of the healthcare service, safety for service users and safety for healthcare professionals. The drive for safety within the healthcare services are one of the three ambitions by the Scottish Government which will strive to deliver and support safe and effective healthcare. All service users will receive care and treatment in a clean, safe environment free from preventable harm or injury in any NHS Scotland healthcare facility (Scottish Government, 2010). Patient safety is the foundation that nurses construct their practice around and is a professional value that the Nursing and Midwifery Council stipulate is a requirement with the code of conduct (NMC, 2015). All registered nurses must safeguard the health and well-being of all individuals for as long as there are receiving care (NMC, 2008). Ferguson et al. (2007) states when patient safety is compromised and errors transpire the role of the clinical practitioner can be scrutinized when there are numerous factors that threaten patient safety. Some factors such as; work load pressures and staff shortages can count for miner mistakes happening within the healthcare system. However (Ferguson et al, 2007) also states good communication within a positive and motivated working team are factors that are effective in building a good safety culture. General hospitals are subjected to the same safety risks with patient safety as in a mental health hospital such as; pressure sores and medication errors. However, additional risks to staff and patients are unique in the mental health area (Bark and Tingle, 2011).The management of violence and aggression and the use of seclusion are to support patient safety as mental health hospitals use restraining techniques which can increase the service user’s vulnerability. However mental illness can cause individuals to become suspicious, disorientated, paranoid or delusional that can cause anger or difficulty with instructions (Bark and Tingle, 2011). This can generate a more complex case for patient safety even though risk assessments are carried out daily within mental health wards. Staff predicting and planning for every preventable event that could happen, due to human behaviour is only effective with the information they possess at that time (Tate and Feeney, 2012). Langan (2010) states that violence in a mental health facility with service users were a risk may be prevalent to themselves or to staff, argues that this can exacerbate anxiety and increase pressure that is required when assessing a service users risk. Service users can be unpredictable when first presenting and with lack of knowledge of what is happening for that service user at that time presents numerous changeable factors that can transpire (Langan, 2010). There has been many attempts to build an assessment tool for mental health services but they have failed to reach the standard required (Langan, 2010). (NHS Lothian, 2012) state that the policy within mental health for risk assessments must be carried out for every service user that is admitted to hospital and becomes an inpatient this should be in conjunction with the service user. When filling out the risk assessment current information should be included such as; relevant history, associated behaviours, clinical diagnosis and information from the service user’s perspective as well as information from family this will ensure a robust risk assessment and support patient safety (NHS Lothian, 2012). A risk assessment is always being amended and is never complete it is an ongoing procedure that is effective at the time it is carried out (Tate and Feeney 2012). Risk assessments that are updated daily support patient safety. The mental health setting can highlight complexities with patient safety and emphasises how staff work in partnership with service users and using reciprocity keep patients safe (Tingle and Bark, 2011). When managing patient safety within the scenario this can present challenges as the coordinating nurse was basing her evidence on previous history but had a good knowledge and rapport with the service user. By working in partnership with the service user and promoting recovery on previous admissions the nurse already had a basic plan for a risk assessment and was thinking of patient safety and what could have transpired if the passes were not granted. However ever admission is different so nothing should be assumed for example; that last admission the service user got aggressive, that does not mean this will happen this admission. Conclusion The scenario that was introduced was not uncommon at the week end for an inpatient in mental health services. The service user could have had a different scenario if that individual was not on shift advocating for the patient and displaying leadership qualities. By checking legislation, frameworks, local policies and training which is available to support staff to deliver a high standard of care and ensure patient safety. By understanding what traits aid with leadership and just how important the skills to lead are and developing and nurturing them to provide a high standard of care from you and your team. Patient safety will always be identified as an important part of healthcare and by carrying out risk assessments will insure service user receive the best care for them. For more complex situation within mental health settings staff must follow polices and legislation and support each other fully as a team and with proper planning and applying daily risk assessments can support in minimizing harmful events from transpiring. References Waite, M., Soanes, C. (2007) Oxford dictionary and thesaurus (2nd ed.). Oxford: Oxford University Press. Alimo-Metcalfe, B.(2003) Leadership Stamp of Greatness. Health Service Journal 113 (5861) 28-32 Kean, S., Haycock-Stuart, E. (2011) Understanding the relationship between followers and leaders. Nursing Management. London 18 (8) 31-35 Scottish Government (2009) Delivering Quality through Leadership: NHSScotland Leadership Development Strategy. Available from: http://www.scotland.gov.uk/Resource/Doc/289816/0088790.pdf [accessed 9 Apr 2015] Kilfedder, C., Power, K., Wells, T. (2001). Burnout in psychiatric nursing. Journal of Advanced Nursing, 34 (3) 383-396 Hogan, R. (1994) what we know about leadership. American Psychologist, 49 (6) 493-504 Fowler, J. (2012) Professional development: From staff nurse to nurse consultant. Part 6: Importance of role models. British Journal of Nursing, 21 (5) 311 Bosma, N., Hessels, J., Schutjens, V., Praag, M. V., Verheul, I. (2012) Entrepreneurship and role models. Journal of Economic Psychology, 33 (2) 410–424 Wangensteen, S., Johansson, I. S., and Nordstrom, G. (2008) the first year as a graduate nurse—an experience of growth and development. Journal of Clinical Nursing, 17 (14) 1877–1885 Cleary, M., Deacon, M., and Hunt, E. (2011) Mental health nursing role models. Journal of Psychosocial Nursing and Mental Health Services, 49 (8) 6–7 Cleary, M., Horsfall, J., Mannix, J., O’Hara-Aarons, M., and Jackson, D. (2011) Valuing teamwork: Insights from newly-registered nurses working in specialist mental health services. International Journal of Mental Health Nursing, 20 (6) 454–459 Anderson, J. and Burgess, H. (2009) Essential shared capabilities for the whole of the mental health workforce: Bringing the educators into the frame. The Journal of Mental Health Training, Education and Practice, 4 (3) 21-29 Kean, Susanne; Haycock-Stuart, Elaine. (2011)Understanding the relationship between followers and leaders Nursing Management. 18 (8) 31-35 Nolan, P. (2013). (2) The Francis Report. Nursing Ethics, 20 (7) 840-842. Cleary, M., Horsfall, J., Deacon, M., and Jackson, D. (2011). Leadership and Mental Health Nursing. Issues in Mental Health Nursing, 2011, 32 (10) 632-639 Scottish Government (2010). The healthcare Quality Strategy for NHSScotland. Available from: http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf [accessed 9 Apr 2015] Ros Moore. (2011). LEADING BETTER CARE incorporating releasing Time to Care. Available: http://www.evidenceintopractice.scot.nhs.uk/media/150149/lbc incorporating rtc report.pdf. Last accessed 28th April 2015. Nursing and Midwifery Council (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. Available from: http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf [accessed 9 Apr 2015] Nursing and Midwifery Council. (2010) Pre-registration nursing education in the UK. Available from: http://standards.nmc-uk.org/Documents/Pre-registration%20nursing%20education%20in%20UK%20FINAL%2006092010.pdf [accessed 9 Apr 2015] Ferguson, L., Calvert, J., Davie, M., Fallon, M., Fred, N., Gerbach, V., and Sinclair, L. (2007) Clinical leadership: Using observations of care to focus risk management and quality improvement activities in the clinical setting. Contemporary Nurse, 24 (2) 212-224 Tate, L. and Feeney, A. (2012) the principles of risk assessment. Medicine, 40 (11) 574-576 Bark, P. and Tingle, J. (2011) Psychological aspects of patient safety. In Patient Safety, Law Policy and Practice. (64 84). Routledge: London, UK. Scottish Government (2006) The New Mental Health Act Whats it all about? A Short Introduction. Available from: http://www.gov.scot/Publications/2004/01/18753/3168 [accessed 9 Apr 2015] Nursing and Midwifery Council (2015) The Code: Preserve safety. Available from: http://www.nmc.org.uk/standards/code/read-the-code-online/ [accessed 9 Apr 2015] Preserve safety

Dance, the Art of Movement Essay

Dancing is the rhythmical movement of the body, usually with music, to express an idea or emotion, to narrate a story or simply to enjoy and take pleasure in the movement itself. It can be traced that Dance as an art started from the moment it was harnessed to a rhythm, probably the stamping of the feet and clapping of the hands. Dance of the earliest times differ from those of the present times; the dances of the barrio folks differ from those of the city. There are primitive and non primitive dances. Indians dance to give thanks for a harvest, the Mexicans to celebrate a religious festival, teenagers dance at parties, both young and old go discoing and children everywhere dance because it is pleasurable to express joy through bodily movement or language. Origin and Function of the Dance Dancing has primitive beginnings. It can be deduced from the behavior of primitive tribes surviving today that the rhythm that spurred on the dances mostly came from the beat sustained through the stamping of the feet on the ground. Soon, dance was used for purposes of affecting the whole tribe; hunting dance to depict the capture or a prey or a warlike dance to show the defeat of enemy. There were dances of thanksgiving for a good harvest, good weather and wanted rain. Rain dances have survived in some parts of the world until today. In biblical dances, the Old Testament attests that Miriam, the sister of Moses, led the women in a dances of joy after Israelites escaped from Egypt. King David danced before the Ark of the Covenant to express thanksgiving. Psalm 149 says, â€Å"Let them praise HIS name in the dance. † The Bible tells us when people danced, but it does not tell how they danced. The Hebrew religion forbade the making of images. Thus there are no paintings or statues to help reconstruct the dances of Miriam or David. In earlier times, supplications t Gods was the beginning of the religious aspect of dancing. In the West, the most sophisticated of professional dancers put their art at the service of religion taking part in celebrations in great cathedrals or in humble churches. It is believed that the more grotesque kinds of dancing in plays and spectacles were developed by the Romans. In the East as well as in the West, dancing was developed as a social grace. Various kinds of religious, social and theatrical dances evolved slowly in the dances today. Generally, western dance techniques are based mostly on footwork, while the Eastern forms of art dance, depending upon footwork to sustain the rhythm, derive their greatest beauty and subtle meanings from the infinite variety of delicate movements of the upper part of the body, especially the head, neck and hands. In the East as in the West, dance was indigenous to religious ceremony, and was used for entertainment. Plato, the great Greek Philosopher demanded a place for the dance in his ‘’ideal republic’’ saying that it would help towards acquiring noble, harmonious and graceful attitudes. The implication is that dance was already appreciated for its own sake, as an expression of beauty and movement. The domination of the Roman Catholic Church in Europe, after the fall of Rome, virtually extinguished theatrical dance, but it was reborn together with other art of Italy.

The Philosophy of John Locke Essay - 1221 Words

Johnathan Robert’s life has been characterized by a keen ability to self teach. At two years old, he suffered an accident that broke his femur. Within weeks of his caste being removed, he relearned the skill of walking. At no older than six years old Johnathan had received numerous ear surgeries yet refused to allow his speech to reflect any of his hearing loss. By the age of seven, he had effectively taught himself how to read and write. According to the philosophy of John Locke, Johnathan’s knowledge did not come from innate ideas or principles, but rather from experiences and sensations. Although John Locke’s thoughts were monumental, flaws exist in the rejection of innate ideas. John Locke begins his argument with a weighty†¦show more content†¦Doubting, believing, reasoning, and knowing, all constitute differing forms of reflection. When the two separate concepts purposed by Locke are combined, the result is a claim that experiences shape human knowledge and ideas. Following the discussion of knowledge, Locke delves into a separation of two distinct forms of ideas. Initially, simple ideas are scrutinized. A simple idea is one that may be examined singularly. For example, when a person views a tangerine the citric scent and the orange color are simple ideas. An individual’s five senses are what compose simple ideas. Colors, weight, smell, taste, texture, are individual simple ideas. Before moving on to complex ideas, Locke differentiates between qualities that compose ideas. The two qualities are primary and secondary qualities of an object. A primary quality is anything that is, â€Å"inseparable from the body, in what state soever it be; and such as in all the alterations and changes it suffers, all the force can be used upon it, it constantly keeps† (Stumpf and Fieser, 197). Solidity, extension, figure, and mobility are considered by Locke to be primary qualities. Secondary qualities, on the other hand, consist of traits that ex ist within the minds of the persons perceiving the items. â€Å"Bulk, figure, texture, and motion of their insensible parts, as colors, sounds, tastes, ect. These I call secondary qualities,† Locke stated (Stumpf and Fieser, 197-198). Finally John Locke concludes hisShow MoreRelatedJohn Locke : Philosophies And Contributions Essay1414 Words   |  6 Pagestheir own philosophies of education and changed the way we look at learning. Whether it is educating the children of today or bringing religion into the stream, our curriculum is always changing with their ideas in mind. John Locke and Erasmus provide extremely different philosophies when it comes to the curriculum of education although they have both impacted the way we teach today dramatically. 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Essay about Explication of Dulce Et Decorum Est by...

Explication of Dulce Et Decorum Est by Wilfred Owen ?Dulce Et Decorum Est? belongs to the genre of sonnets, which expresses a single theme or idea. The allusion or reference is to an historical event referred to as World War I. This particular poems theme or idea is the horror of war and how young men are led to believe that death and honor are same. The poem addresses the falsehood, that war is glorious, that it is noble, it describes the true horror and waste that is war, this poem exhibits the gruesome imagery of World War I, it also conveys Owens strongly anti-war sentiments to the reader. He makes use of a simple, regular rhyme scheme, which makes the poem sound almost like a childs poem or nursery rhyme. Owens use of†¦show more content†¦Another tool in developing the effectiveness of the poem is the use of compelling figurative language in the poem helps to reveal the reality of war. In the first line, the metaphor, ?Bent double, like old beggars under sacks,?(1) shows us that the troops are so tired that they can be c ompared to old beggars. Also, the simile coughing like hags(2) helps to depict the soldiers? poor health and depressed state of mind. Owen makes us picture the soldiers as ill, disturbed and utterly exhausted Another great use of simile, ?His hanging face, like a devils sick of sin,?(20) suggests that his face is probably covered with blood which is the color symbolizing the devil. A very powerful metaphor is the comparison of painful experiences of the troops to vile, incurable sores on innocent tongues.?(24) This metaphor emphasizes that the troops will never forget these horrific experiences. As you can see, Owen has used figurative language so effectively that the reader gets drawn into the poem. The most important means of developing the effectiveness of the poem is the graphic imagery. The images in this poem are so graphic that it could make the reader feel sick. The images in this poem can draw graphic pictures in the readers mind, such as in these lines: ?If you could hear, at every jolt, the blood/ Come gargling from theShow MoreRelatedPoetry Explication : Dulce Et Decorum Est1039 Words   |  5 PagesPoetry Explication: Dulce Et Decorum Est To die for one’s country is horrible and wrong. For now, this may seem like a mistake, like this is all a mistake, and that the statement itself cannot possibly be what is meant to be written in the first sentence of this page. But it is supposed to be there, because there it is, bold and right. The poem â€Å"Dulce Et Decorum Est† is truly bold and right in its horrifying descriptions of what it is actually like to die for one’s country. It not only proves aRead MoreExplication of Dulce Et Decorum Est1268 Words   |  6 PagesExplication of Dulce Et Decorum Est SITUATION The poem doesn’t really tell a story, but walks through all the dreadful situations through the eyes of an innocent and shell-shocked soldier. It is told through a WWI veteran’s point of view in second person. By examining this â€Å"war† poem and Wilfred Owen’s background, it is reasonable to believe that Own is talking about his experience during war. Therefore making the speaker, he himself. Owen is talking to everyone that does not know the realistic