Applying Nursing Theory to a Practice Problem free essay sample

Shared governance is having staff involved with making decisions related to unit operations. Staff looks at professional practice, staff development and orientation, quality improvement initiatives, and research. We created a three tiered governance model that included a unit council, specialty senate, and nursing congress. This model was implemented; however some units and departments had more success than others. Four years later, I was asked to gather a group of clinicians across the organization to look at how we could enhance the governance model to be an interdisciplinary model. We included clinicians from respiratory therapy, dietetics, clinical therapies, case management and discharge planning, pastoral care, lab and radiology services, pharmacy, and advanced practice nurses. This model was also implemented with varying levels of success. Prior to each implementation, and annually thereafter, the organization provided education to the staff leaders of these unit councils and specialty senates. Educational material varied from year to year, but included how to run a meeting, how to create an agenda, conflict resolution, change management, etc. Teams were included when planning the annual educational sessions. The practice problem I would like to review is how managers lead in a shared governance environment. I feel that it has been difficult for some managers to give up control of making all the decisions on their units. When looking at the units that are successful in the shared governance model, the manager’s leadership style adapted to this model and they were supportive of their staff becoming empowered to make decisions related to their unit operations. Changing eadership styles and / or decision making styles is an important step for managers to be successful when implementing a shared governance model. Managers need to learn how to transition from an autocratic leader to a democratic leader. The manager’s learning curve is as steep, if not steeper, than the staff learning curve. (Brooks) I have read through the literature to identify a nursing theory to guide me in developing strategies to look at this problem, however at this point, I do not have an exact theory to use. I am looking at a borrowed theory that supports shared leadership and staff empowerment and motivation. An organizational and work theory or a systems theory may be an option as well. Application of a Middle Range Theory to Problem As I continued my search for a theory to guide the development of strategies for managing in a shared governance model, I found a middle range nursing theory, Theory of Interpersonal Relations, by Hildegard Peplau. This theory is also known as Psychodynamic Nursing, which is the understanding of one’s own behavior, (Current Nursing). Peplau was the first published nursing theorist since Florence Nightingale. Peplau was born and raised in Pennsylvania. She began her career in nursing in 1931 and worked as a staff nurse in Pennsylvania and later in New York City. She then became a school nurse at Bennington College in Vermont where she earned a bachelor’s degree in Interpersonal Psychology in 1943. Pepau worked in a private psychiatric facility where she studied psychological issues with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan. Peplau’s work was largely focused on extending Sullivan’s interpersonal theory for use in nursing practice. (Forchuk) Her career continued into the military where she was stationed in England working with British and American psychiatrists. After the war, Peplau worked to reshape the mental health system in the United States through the passage of the National Mental Health Act of 1946. Peplau was an educator, public speaker and trainer. She is known for her writing, workshops and seminars on interviewing techniques, interpersonal concepts, and group therapy in psychiatric hospitals. Peplau believed that the nurse-client relationship was the foundation of nursing practice. Peplau’s theory focuses on the interpersonal processes and therapeutic relationships that develop between the nurse and the client. This theory stresses the importance of the nurse’s ability to understand their own behavior to help others. Peplau developed four phases of the nurse-client relationship. These phases can be linked to the nursing process. 1) Orientation (Assessment) – problem defining phase. The client seeks assistance, asks questions, and shares needs and past experiences (data collection). The nurse responds and helps identify concerns and available resources and services. 2) Identification (Planning) – both the nurse and the client have factors that influence their relationship. These include values, culture and beliefs, past experiences, expectations, and preconceived ideas. The end result is mutually setting goals. 3) Exploitation phase (Implementation) – problem solving, client feels part of the solution, client and nurse explore and understand the underlying problem, plans initiated. 4) Resolution phase (Evaluation) – problem resolved, relationship is terminated. This theory was applied to a client that had a diagnosis of intervertebral disc prolapse. The client was in severe pain. 1) Orientation phase; the client was initially reluctant to talk due to her pain. 2) Identification phase; the client expresses the need to get relief from pain. The nurse educates the client on the pain scale to measure pain. 3) Exploitation phase; client informs nurse that there is relief from pain when she is in the supine position. 4) Resolution phase – client’s pain was reduced and tolerable. To apply this theory to managing in a shared governance organization, I will define the nurse as the manager, and the client as the unit staff. The organization has asked all managers to improve their patient satisfaction scores in the next fiscal year. The manager will use the unit council (shared governance structure) to assist with this goal. 1) Orientation phase – the manager shares the organization goal of improving patient satisfaction scores and shares current patient satisfaction scores and patient comments with the unit council. The unit staff asks questions, share past experiences, and seek resources to assist with gathering data. The manager and unit staff discuss bias and limitations of the unit council. Roles of the unit council and the manager are defined. 2) Identification phase – the manager and unit council set a mutually acceptable goal for this project. This will include a timeline for the project and a communication plan. 3) Exploitation phase – Unit council has identified an action plan for improving patient satisfaction. The action plan has been communicated and agreed upon by the manager. Education has been completed with the unit staff and the action plan is implemented. 4) Resolution Phase – patient satisfaction scores are reviewed. Action plans are adjusted and reinforced as needed to meet the improved patient satisfaction goal. I believe this theory can assist the manager in releasing â€Å"control† over a project. By using these steps, the manager and unit council can have mutually agreed upon goals, a timeline for implementation, and a communication plan. Shared governance has proven that when staff implements changes and educate their peers, there is increased accountability within the unit to adhere to the changes. It is important to be successful as organizations are implementing a shared governance model to build trust between the staff and the managers. Application of Borrowed Theory to Problem Rosabeth Moss Kanter created a structured theory on organizational empowerment that managers can utilize to improve success when implementing a shared governance model. This theory is a social change process and a borrowed theory for nursing. Kanter was born and raised in Cleveland, Ohio. She studied sociology and English literature at Bryn Mawr College then continued her education at the University of Michigan where she received her MA and PhD in sociology. Her training in sociology influenced her thinking and subsequent research in business. She is currently a tenured professor of business at Harvard University. Kanter’s empowerment theory has five concepts that if implemented in the work environment will guide staff in being empowered. The first concept is opportunity. Staff needs to have the ability for growth, mobility and the chance to increase their knowledge and skills. This can be accomplished by offering educational sessions, allowing staff to plan educational sessions for the department, and providing opportunities to learn. The second, third and fourth concepts are the structure of power, access to resources, and access to information. The staff needs to have access to resources, information, and support within the organization to get the job completed. In shared governance, typically there is a liaison that is invited to the unit council meetings. This liaison’s role is to provide guidance to the team so they have the necessary information, resources, data, supplies, personnel, etc. to develop action plans and make decisions. The final concept is support, (Nedd). The teams need to receive feedback from their peers, liaison, and supervisors to enhance their effectiveness and development. Open communication between the team and administration is very important to be successful. Kanter’s theory has had many applications within the health care environment. One study linked structural empowerment to factors identified as important to retaining nurses, including job satisfaction, (Laschinger, 2003). Massachusetts General Hospital applied this theory to demonstrate how active participation on a Collaborative Governance committee can promote empowerment, along with enthusiasm and confidence, while implementing the committee’s mission. Staff from Massachusetts General Hospital shared that since the implementation of shared governance; they feel dedication and excitement in their jobs. The committees have made a positive impact on their careers, (Larkin, 2008). As with the middle theory, I believe this theory can assist the manager in releasing â€Å"control† and empowering the staff to be successful in a shared governance model. Applying the five concepts of Kanter’s borrowed theory of organizational empowerment, the manager will have a structure to support themselves as well as the unit council. I will use the same situation of improving patient satisfaction scores to demonstrate this theory. 1) Opportunity – the manager will share the organizational goal of improving patient satisfaction scores with the unit council. 3) Access to resources and information – the unit council receives current patient satisfaction scores and patient comments from the manager. The unit council asks clarifying questions, shares past experiences and gathers additional information and resources as needed. 4) Structure of Power – the manager and unit council define their roles and develop mutually agreed upon goals and timelin es. 5) Support – the manager is available to assist the unit council as needed. The unit council develops a plan to improve patient satisfaction scores. This includes actions, implementation plans, monitoring for staff compliance of the action plan and the evaluation process. The plan is reviewed with the manager prior to implementation. Through the partnership with the manager, the unit council receives feedback from the manager on the action plan. Modifications to the plan may be made, but the unit council will decide if there will be changes to the plan based on the manager’s feedback. Education is completed with the unit staff and the action plan is implemented. The manager provides updated data on patient satisfaction scores throughout the process and the unit council reinforces and/or adjusts the action plans as needed. The unit staff is responsible for monitoring the actions of their peers and holding each other accountable during and after implementation. Staff can coach one another when opportunities arise to improve interactions and manage expectations of the patient and family. By incorporating these concepts, the manager and staff can create a work environment that is trusting, respectful and successful in a shared governance structure. In addition to the five concepts above, Kanter has identified four guiding principles that can be adapted in order to have a successful shared governance model in an organization. These principles are: Equity, Ownership, Partnership, and Accountability. The manager and unit council must have mutually agreed upon goals, equity. The unit council understands that their success with improving patient satisfaction scores reflects on the organization, ownership. When the staff and the manager respect one another, effectively communicate and collaborate, they will be partners in this process. Finally, both the manager and staff need to be accountable for the success of this project. (Larkin, 2008) Conclusion I believe that both theories, Peplau and Kanter, can be used simultaneously to assist the manager in implementing a shared governance model on the unit. As previously stated, by incorporating these concepts and principles, the manager and staff will be able to define goals, define the roles of the team members, create a communication plan and a timeline for implementation and be successful in implementing a plan to improve patient satisfaction scores or other projects on the unit. When staff is involved with decisions that impact their work environment and the organization, there is increased success within the unit resulting in improved staff satisfaction scores as well as improved retention of the existing staff. Care must be taken that the manager does not get too involved with the unit council. Staff may feel intimidated and not speak up in meetings if the manager is present. One way to overcome this is to have a liaison attend the meetings that can assist the team with resources, additional information, etc. This liaison can guide the team through the complexities of an organization, but is a silent partner during the meetings. The liaison can be used in both theories. The manager must also try not to influence the unit council with how they would like to make changes. The manager is there to support the team, not tell the team what to do. This can be very difficult, but if the team and manager have developed a respectful, trusting relationship, everyone should be able to provide feedback without a negative impact on the process. I firmly believe that with the changes in manager roles in the healthcare setting, staff needs to be involved with the practice and operations on the unit. Managers are no longer working on the units and don’t manage the unit day to day operations as they did in the past. In addition, as shared governance grows and develops within the organization, staff can be mentored by the manager or liaison to look at an evidenced base practice model to improve unit and organizational operations and clinical practice. References Anthony, Mary K. (2004). Shared Governance Models: The Theory, Practice, and Evidence.