This module, you will find articles of interest around the following areas: endocrine system diseases, the musculoskeletal system, and integumentary system diseases. These systems govern our physical and emotional place in the world, and can impact us accordingly if we were to suffer from any of these diseases. Think about how these disorders can impact how a person lives day-to-day.

Overview

This module, you will find articles of interest around the following areas: endocrine system diseases, the musculoskeletal system, and integumentary system diseases. These systems govern our physical and emotional place in the world, and can impact us accordingly if we were to suffer from any of these diseases. Think about how these disorders can impact how a person lives day-to-day.

Instructions

1. From the list of selected readings below, choose two with topics that you know the least about or are most interesting to you.

2. Then search for, read, and incorporate other readings of your choice in your area of interest that focus on endocrine system diseases, the musculoskeletal system, and/or integumentary system diseases. You might include:

· 1-2 journal articles or websites

· Book chapters (past textbooks may be good options)

· Your goal is to have a total of at least 60 pages of content read.

3. Your summary of each reading should be at least one paragraph (100-200 words) and include the following information:

· All references must be cited using APA Style format. Please refer to the CCCOnline APA Citation Toolkit.

· Number of pages read

· Keywords you used to find the reading

· A link to the reading

· Why you selected the reading

· The main point of the reading

· Describe how the health deviations you read about alter normal physiology.

· Provide your key takeaway from the reading. This could be something that made you pause, changed your thinking, supported your thinking, or made you question something.

4. In your post, identify how the specific conditions discussed in each reading could impact a person’s connection to the world. List the prognosis of the condition and how you, as a future medical professional, would provide support to your patient.

5. Selected Readings

Choose two readings. All readings are available through the CCCOnline Library in CINAHL Plus With Full Text.

· Abdel-Motleb, M. (2012). The neuropsychiatric aspect of Addison’s disease: A case report. Innovations in Clinical Neuroscience, 9(10), 34-36.

· Access this article through the CCCOnline Library permalink.

· Berge, L. I., & Riise, T. (2015). Comorbidity between Type 2 Diabetes and Depression in the Adult Population: Directions of the Association and Its Possible Pathophysiological Mechanisms. International Journal of Endocrinology, 2015, 1–7.

· Access this article through the CCCOnline Library permalink.

· Bishop, S. M., Walker, M. D., & Spivak, I. M. (2013). Family presence in the adult burn intensive care unit during dressing changes. Critical Care Nurse, 33(1), 14-24. doi:10.4037/ccn2013116

· Access this article through the CCCOnline Library permalink.

· Won, J. Y, Hwang, H. B., & Chung, S. K. (2015). A case of corneal cystinosis in a patient with rickets and chronic renal failure. Indian Journal of Ophthalmology, 63(10), 785-787. doi:10.4103/0301-4738.171509

· Access this article through the CCCOnline Library permalink.

· McMaster, M. E., Lee, A. J., & Burwell, R. G. (2015). Physical activities of patients with adolescent idiopathic scoliosis (AIS): Preliminary longitudinal case – control study historical evaluation of possible risk factors. Scoliosis, 10(1), 1-10. doi:10.1186/s13013-015-0029-8

· Access this article through the CCCOnline Library permalink.

· Schwanke, J. (2010). Birthmarks in newborns can signal later problems. Contemporary Pediatrics, 27(7), 24-26.

· Access this article through the CCCOnline Library permalink.

· Walker, P. (1996). Port wine stains: Laser treatment and nursing management. British Journal of Nursing, 5(20), 1235-1240.

· Access this article through the CCCOnline Library permalink.

 

Access code S01613748, number of pages read must be at least 60

Describe an effective transformational leader that you know and an effective servant leader. How does these leaders exemplify the principles of each leadership style and French and Raven’s sources (bases) of power (influence)? 

1) Describe an effective transformational leader that you know and an effective servant leader. How does these leaders exemplify the principles of each leadership style and French and Raven’s sources (bases) of power (influence)?

2) Evaluate the strengths/limitations of the specific leadership style of that person in the situation they were in.

3) Based on this analysis, what leadership style will be most effective for you in the role you are preparing to do and why?

Answer should be one page long, cite references (APA), use in-text citation

Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it.

Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it.

Aggression Case Study

Christopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him. Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation.

1. What phase of the aggression cycle is Christopher in at the beginning of this scenario? What phase is he in at the end the scenario? (State the evidence that supports your answers).

2. What interventions could have been implemented to prevent Christopher from escalating at the beginning of the scenario?

3. What interventions should the nurse take to deescalate the situation when Christopher is refusing to open his door?

4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the nurse to remember?

SCHOLAR NURSING ARTICLE>>>APA FORMAT>>>

Write for your organization a 3–5-page impact report regarding the  health concerns of a new immigrant population.

Write for your organization a 3–5-page impact report regarding the  health concerns of a new immigrant population. Describe the population’s  health concerns and issues, explain current pharmacological treatments,  and explain how culture and traditional practices may affect use of  pharmacology. Identify evidence-based strategies for the organization  and nursing staff to use to educate the population and promote health  and wellness.

Imagine the county health department notifies your organization that a  large number of immigrants are expected to be resettled in your area.  The organization, wanting to be prepared to handle any health concerns  of the population, tasks each department with readying for the influx of  immigrants. Your supervisor asks you to prepare an impact report on the  pharmacological needs of the population that can be shared with other  departments.

Preparation

Complete the following as you prepare for your impact report:

  1. Choose one of the global areas below as the area from which the population will be coming.
    • Sub-Saharan Africa.
    • India.
    • China.
    • Dominican Republic.
    • Guatemala.
    • Jamaica.
    • Bangladesh.
    • Saudi Arabia.
    • Pakistan.
    • Mexico.
  2. Research the most common health concerns and issues for  immigrants from your chosen global area, the pharmacological treatments  that will likely be prescribed, and any cultural values or traditional  practices that may impact patient outcomes.

Requirements

Once you have identified the population you will be using for this assessment, include the following in your impact report:

  • Describe the health concerns and issues for the population.
  • Describe current pharmacological treatment regimens for the main health concerns and issues.
  • Explain any traditional beliefs and practices associated with the  health concerns and issues. Does the population engage in culturally  based methods of treating the health concern?
  • Explain how cultural values and traditional practices might  affect acceptance and use of prescribed pharmacological treatments. Be  sure to consider the relationship between quality patient outcomes,  patient safety, and the appropriate use of pharmacology.
  • Identify evidence-based, culturally sensitive strategies the  organization can use to educate the population about the correct use of  the pharmacology treatments.
  • Identify evidence-based, culturally sensitive strategies the  nursing staff can employ with the population to promote health and  wellness.

Write this assessment as an impact report formatted as other  reports of a similar nature in your organization or an organization with  which you are familiar. Include a title page and reference page and  follow APA guidelines for your in-text citations and references.

Additional Requirements

  • Number of pages: 3–5
  • At least 3 current scholarly or professional resources.
  • Times New Roman font, 12 point, double-spaced font.

Essentials of Nursing Leadership and Management

• Sally A. Weiss and Ruth M. Tappen • • •

• • • • • • • • ••• • ••• • ••• •••••••••• • ••••

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. Essentials of Nursing Leadership and Management

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Essentials of Nursing Leadership and Management

SIXTH EDITION

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Essentials of Nursing Leadership and Management

SIXTH EDITION

Sally A. Weiss, MSN, EdD, RN, CNE, ANEF Professor of Nursing

Nova Southeastern University Nursing Department Fort Lauderdale, Florida

Ruth M. Tappen, EdD, RN, FAAN Christine E. Lynn Eminent Scholar and Professor

Florida Atlantic University College of Nursing Boca Raton, Florida

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F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015, 2010, 2007, 2004, 2001, 1998 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor, Nursing: Megan Klim Developmental Editor: Laurie Sparks Director of Content Development: Darlene D. Pedersen Content Project Manager: Echo Gerhart Electronic Project Editor: Katherine Crowley Design and Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treat- ments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from appli- cation of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infre- quently ordered drugs. Library of Congress Control Number: 2014945714 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rose- wood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Report- ing Service is: 978-0-8036-3663-7/15 0 + $.25.

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v

Dedication

To my granddaughter Sydni and my grandson Logan, who remind me how important it is to nurture our young nurses

and help them learn and grow. —SALLY A. WEISS

To students, colleagues, family, and friends, who have taught me so much about leadership.

—RUTH M. TAPPEN

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vii

Preface

We are delighted to bring our readers this Sixth Edition of Essentials of Nursing Leadership and Management. This new edition has been updated to reflect the dynamic health care environment, safety initiatives, and changes in nursing practice. As in our previous editions, the content, examples, and diagrams were designed with the goal of assisting the new graduate to make the transition to professional nursing practice.

The Sixth Edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as an integral member of the interprofessional health- care team and manager of patient care. Issues related to setting priorities, delegation, quality improve- ment, legal parameters of nursing practice, and ethical issues are updated for this edition.

This edition focuses on the current quality and safety issues and initiatives impacting the current health-care environment. We continue to bring you comprehensive, practical information on develop- ing a nursing career. Updated information on leading, managing, followership, and workplace issues continue to be included.

Essentials of Nursing Leadership and Management provides a strong foundation for the beginning nurse leader. We would like to thank the people at F. A. Davis for their assistance and our contribu- tors, reviewers, and students for their guidance and support.

—SALLY A. WEISS —RUTH M. TAPPEN

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Contributor PATRICIA BRADLEY, MED, PHD, RN Coordinator, Internationally Educated Nurses Program Faculty, Nursing Department York University Toronto, Ontario, Canada

Reviewers

WENDY GREENSPAN, MSN, RN, CCRN, CNE Assistant Professor Rockland Community College Suffem, New York

PAULA HOPPER, MSN, RN, CNE Professor of Nursing Jackson Community College Jackson, Mississippi

CLAIRE MEGGS, MSN, RN Associate Professor Lincoln Memorial University Harrogate, Tennessee

LUISE SPEAKMAN, PHD, RN Adjunct Faculty, Nursing Cape Cod Community College West Barnstable, Massachusetts

JENNIFER SUGG, RN, BSN, MSN, CCRN Nursing Instructor Wayne Community College Goldsboro, North Carolina

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Table of Contents

unit 1 Professional Considerations 1 chapter 1 Leadership and Followership 3 chapter 2 Manager 17 chapter 3 Nursing Practice and the Law 27 chapter 4 Questions of Values and Ethics 49

unit 2 Working Within an Organization 69 chapter 5 Organizations, Power, and Empowerment 71 chapter 6 Communicating With Others and Working

With the Interprofessional Team 87 chapter 7 Delegation and Prioritization of Client Care 103 chapter 8 Dealing With Problems and Conflict 121 chapter 9 People and the Process of Change 133

unit 3 Career Considerations 145 chapter 10 Issues of Quality and Safety 147 chapter 11 Promoting a Healthy Work Environment 173

unit 4 Professional Issues 203 chapter 12 Your Nursing Career 205 chapter 13 Evolution of Nursing as a Profession 225 chapter 14 Looking to the Future 235

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xii ■ Table of Contents

Appendices appendix 1 Codes of Ethics for Nurses 247

American Nurses Association Code of Ethics for Nurses Canadian Nurse Association Code of Ethics for Registered Nurses The International Council of Nurses Code of Ethics for Nurses

appendix 2 Standards Published by the American Nurses Association 249

appendix 3 Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 251

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unit 1 Professional Considerations

chapter 1 Leadership and Followership

chapter 2 Manager

chapter 3 Nursing Practice and the Law

chapter 4 Questions of Values and Ethics

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3

chapter 1 Leadership and Followership

OBJECTIVES After reading this chapter, the student should be able to: ■ Define the terms leadership and followership. ■ Discuss the importance of effective leadership and

followership for the new nurse. ■ Discuss the qualities and behaviors that contribute to

effective leadership. ■ Discuss the qualities and behaviors that contribute to

effective followership. OUTLINE Leadership Are You Ready to Be a Leader? Leadership Defined What Makes a Person a Leader? Leadership Theories

Trait Theories Behavioral Theories

Task Versus Relationship Motivation Theories Emotional Intelligence Situational Theories Transformational Leadership Moral Leadership Caring Leadership

Qualities of an Effective Leader Behaviors of an Effective Leader Followership Followership Defined Becoming a Better Follower Managing Up Conclusion

Nurses study leadership to learn how to work well with other people. We work with an extraordinary variety of people: technicians, aides, unit managers, housekeepers, patients, patients’ families, physi- cians, respiratory therapists, physical therapists, social workers, psychologists, and more. In this chapter, the most prominent leadership theories are introduced. Then, the characteristics and behaviors that can make you, a new nurse, an effective leader and follower are discussed.

Leadership

Are You Ready to Be a Leader? You may be thinking, “I’m just beginning my career in nursing. How can I be expected to be a leader now?” This is an important question. You will need time to refine your clinical skills and learn how to function in a new environment. But you can begin to assume some leadership functions right away within your new nursing roles. In fact, leadership should be seen as a dimension of nursing practice (Scott & Miles, 2013). Consider the following example:

Billie Thomas was a new staff nurse at Green Valley Nursing Care Center. After orientation, she was assigned to a rehabilitation unit with high ad- mission and discharge rates. Billie noticed that admissions and discharges were assigned rather hap- hazardly. Anyone who was “free” at the moment was directed to handle them. Sometimes, unlicensed as- sistant personnel were directed to admit or discharge residents. Billie believed that this was inappropriate because they are not prepared to do assessments and they had no preparation for discharge planning.

Billie had an idea how discharge planning could be improved but was not sure that she should bring it up because she was so new. “Maybe they’ve already thought of this,” she said to a former classmate. They began to talk about what they had learned in their leadership course before graduation. “I just keep hearing our instructor saying, ‘There’s only one manager, but anyone can be a leader.’ ”

“If you want to be a leader, you have to act on your idea. Why don’t you talk with your nurse manager?” her friend asked.

“Maybe I will,” Billie replied. Billie decided to speak with her nurse manager,

an experienced rehabilitation nurse who seemed not

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4 unit 1 ■ Professional Considerations

only approachable but also open to new ideas. “I have been so busy getting our new electronic health record system on line before the surveyors come that I wasn’t paying attention to that,” the nurse manager told her. “I’m glad you brought it to my attention.”

Billie’s nurse manager raised the issue at the next executive meeting, giving credit to Billie for having brought it to her attention. The other nurse manag- ers had the same response. “We were so focused on the new electronic health record system that we overlooked that. We need to take care of this situa- tion as soon as possible. Billie Thomas has leadership potential.”

Leadership Defined Successful nurse leaders are those who engage others to work together effectively in pursuit of a shared goal. Examples of shared goals in nursing would be providing excellent care, reducing infec- tion rates, designing cost-saving procedures, or challenging the ethics of a new policy.

Leadership is a much broader concept than is management. Although managers need to be leaders, management itself is focused specifically on achievement of organizational goals. Leadership, on the other hand:

. . . occurs whenever one person attempts to influence the behavior of an individual or group—up, down, or sideways in the organization—regardless of the reason. It may be for personal goals or for the goals of others, and these goals may or may not be congru- ent with organizational goals. Leadership is influ- ence (Hersey & Campbell, 2004, p. 12).

In order to lead, one must develop three important competencies: (1) diagnose: ability to understand the situation you want to influence, (2) adapt: make changes that will close the gap between the current situation and what you are hoping to achieve, and (3) communicate. No matter how much you diag- nose or adapt, if you cannot communicate effec- tively, you will probably not meet your goal (Hersey & Campbell, 2004).

What Makes a Person a Leader?

Leadership Theories There are many different ideas about how a person becomes a good leader. Despite years of research on this subject, no one idea has emerged as the clear

winner. The reason for this may be that different qualities and behaviors are most important in dif- ferent situations. In nursing, for example, some situations require quick thinking and fast action. Others require time to figure out the best solution to a complicated problem. Different leadership qualities and behaviors are needed in these two instances. The result is that there is not yet a single best answer to the question, “What makes a person a leader?”

Consider some of the best-known leadership theories and the many qualities and behaviors that have been identified as those of the effective nurse leader (Pavitt, 1999; Tappen, 2001):

Trait Theories At one time or another, you have probably heard someone say, “She’s a born leader.” Many believe that some people are natural leaders, while others are not. It is true that leadership may come more easily to some than to others, but everyone can be a leader, given the necessary knowledge and skill.

An important 5-year study of 90 outstanding leaders by Warren Bennis published in 1984 identi- fied four common traits. These traits hold true today:

1. Management of attention. These leaders communicated a sense of goal direction that attracted followers.

2. Management of meaning. These leaders created and communicated meaning and purpose.

3. Management of trust. These leaders demonstrated reliability and consistency.

4. Management of self. These leaders knew themselves well and worked within their strengths and weaknesses (Bennis, 1984).

Behavioral Theories The behavioral theories focus on what the leader does. One of the most influential behavioral theo- ries is concerned with leadership style (White & Lippitt, 1960) (Table 1-1).

The three styles are:

1. Autocratic leadership (also called directive, controlling, or authoritarian). The autocratic leader gives orders and makes decisions for the group. For example, when a decision needs to be made, an autocratic leader says, “I’ve decided that this is the way we’re going to solve our

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chapter 1 ■ Leadership and Followership 5

problem.” Although this is an efficient way to run things, it squelches creativity and may reduce team member motivation.

2. Democratic leadership (also called participative). Democratic leaders share leadership. Important plans and decisions are made with the team (Chrispeels, 2004). Although this appears to be a less efficient way to run things, it is more flexible and usually increases motivation and creativity. In fact, involving team members, giving them “permission to think, speak and act” brings out the best in them and makes them more productive, not less (Wiseman & McKeown, 2010, p. 3). Decisions may take longer to make, but once made everyone supports them (Buchanan, 2011).

3. Laissez-faire leadership (also called permissive or nondirective). The laissez-faire (“let someone do”) leader does very little planning or decision making and fails to encourage others to do it. It is really a lack of leadership. For example, when a decision needs to be made, a laissez- faire leader may postpone making the decision or never make the decision at all. In most instances, the laissez-faire leader leaves people feeling confused and frustrated because there is no goal, no guidance, and no direction. Some mature, self-motivated individuals thrive under laissez-faire leadership because they need little direction. Most people, however, flounder under this kind of leadership.

Pavitt summed up the differences among these three styles: a democratic leader tries to move the group toward its goals; an autocratic leader tries to move the group toward the leader’s goals; and a

laissez-faire leader makes no attempt to move the group (1999, pp. 330ff ).

Task Versus Relationship Another important distinction is between a task focus and a relationship focus (Blake, Mouton, & Tapper, 1981). Some nurses emphasize the tasks (e.g., administering medication, completing patient records) and fail to recognize that interpersonal relationships (e.g., attitude of physicians toward nursing staff, treatment of housekeeping staff by nurses) affect the morale and productivity of employees. Others focus on the interpersonal aspects and ignore the quality of the job being done as long as people get along with each other. The most effective leader is able to balance the two, attending to both the task and the relationship aspects of working together.

Motivation Theories The concept of motivation seems simple: we will act to get what we want but avoid whatever we don’t want to do. However, motivation is still sur- rounded in mystery. The study of motivation as a focus of leadership began in the 1920s with the historic Hawthorne studies. Several experi- ments were conducted to see if increasing light and, later, improving other working conditions would increase the productivity of workers in the Haw- thorne, Illinois, electrical plant. This proved to be true, but then something curious happened: when the improvements were taken away, the workers continued to show increased productivity. The researchers concluded that the explanation was found not in the conditions of the experiments but in the attention given to the workers by the experimenters.

table 1-1

Comparison of Autocratic, Democratic, and Laissez-Faire Leadership Styles Autocratic Democratic Laissez-Faire

Amount of freedom Little freedom Moderate freedom Much freedom Amount of control High control Moderate control Little control Decision making By the leader Leader and group together By the group or by no one Leader activity level High High Minimal Assumption of responsibility Leader Shared Abdicated Output of the group High quantity, good quality Creative, high quality Variable, may be poor quality Efficiency Very efficient Less efficient than autocratic style Inefficient

Source: Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and democracy: An experimental inquiry. New York: Harper & Row.

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6 unit 1 ■ Professional Considerations

Frederick Herzberg and David McClelland also studied factors that motivated workers in the work- place. Their findings are similar to the elements in Maslow’s Hierarchy of Needs. Table 1-2 summa- rizes these three historical motivation theories that continue to be used by leaders today (Herzberg, 1966; Herzberg, Mausner, & Snyderman, 1959; Maslow, 1970; McClelland, 1961).

Emotional Intelligence The relationship aspects of leadership are also the focus of the work on emotional intelligence and leadership (Goleman, Boyatzes, & McKee, 2002). From the perspective of emotional intelligence, what distinguishes ordinary leaders from leadership “stars” is that the “stars” are consciously addressing the effect of people’s feelings on the team’s emo- tional reality.

How is this done? First, the emotionally intel- ligent leader recognizes and understands his or her own emotions. When a crisis occurs, he or she is able to manage them, channel them, stay calm and clearheaded, and suspend judgment until all the facts are in (Baggett & Baggett, 2005).

Second, the emotionally intelligent leader welcomes constructive criticism, asks for help when needed, can juggle multiple demands with- out losing focus, and can turn problems into opportunities.

Third, the emotionally intelligent leader listens attentively to others, recognizes unspoken concerns, acknowledges others’ perspectives, and brings people together in an atmosphere of respect, coop- eration, collegiality, and helpfulness so they can direct their energies toward achieving the team’s goals. “The enthusiastic, caring, and supportive leader generates those same feelings throughout the team,” wrote Porter-O’Grady of the emotionally intelligent leader (2003, p. 109).

Situational Theories People and leadership situations are far more complex than the early theories recognized. Situa- tions can also change rapidly, requiring more complex theories to explain leadership (Bennis, Spreitzer, & Cummings, 2001).

Instead of assuming that one particular approach works in all situations, situational theories recog- nize the complexity of work situations and encour- age the leader to consider many factors when deciding what action to take. Adaptability is the key to the situational approach (McNichol, 2000).

Situational theories emphasize the importance of understanding all the factors that affect a par- ticular group of people in a particular environment. The most well-known is the Situational Leader- ship Model by Dr. Paul Hersey. The appeal of this model is that it focuses on the task and the follower.

table 1-2

Leading Motivation Theories Theory Summary of Motivation Requirements

Maslow, 1954 Categories of Need: Lower needs (listed first below) must be fulfilled before others are activated. Physiological Safety Belongingness Esteem Self-actualization

Herzberg, 1959 Two factors that influence motivation. The absence of hygiene factors can create job dissatisfaction, but their presence does not motivate or increase satisfaction.

1. Hygiene factors: Company policy, supervision, interpersonal relations, working conditions, salary 2. Motivators: Achievement, recognition, the work itself, responsibility, advancement

McClelland, 1961

Motivation results from three dominant needs. Usually all three needs are present in each individual but vary in importance depending on the position a person has in the workplace. Needs are also shaped over time by culture and experience.

1. Need for achievement: Performing tasks on a challenging and high level 2. Need for affiliation: Good relationships with others 3. Need for power: Being in charge

Source: Adapted from Hersey, P., & Campbell, R. (2004). Leadership: A behavioral science approach. Calif.: Leadership Studies Publishing.

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chapter 1 ■ Leadership and Followership 7 The key is to marry the readiness of the follower with the tasks at hand. “Readiness is defined as the extent to which a follower demonstrates the ability and willingness to accomplish a specific task” (Hersey & Campbell, 2004, p. 114). “The leader needs to spell out the duties and responsibilities of the individual and the group” (Hersey & Campbell, 2004).

Followers’ readiness levels can range from unable, unwilling, and insecure to able, willing, and confi- dent. The leader’s behavior will focus on appropri- ately fulfilling the followers’ needs, which are identified by their readiness level and the task. Leader behaviors will range from telling, guid- ing, and directing to delegating, observing, and monitoring.

Where did you fall in this model during your first clinical rotation? Compare this with where you are now. In the beginning, the clinical instructor gave you clear instructions, closely guiding and directing you. Now, she or he is most likely delegat- ing, observing, and monitoring. As you move into your first nursing position, you may return to the needing, guiding, and directing stage. But, you may soon become a leader/instructor for new nursing students, guiding and directing them.

Transformational Leadership Although the situational theories were an improve- ment over earlier theories, there was still something missing. Meaning, inspiration, and vision were not given enough attention (Tappen, 2001). These are the distinguishing features of transformational leadership.

The transformational theory of leadership emphasizes that people need a sense of mission that goes beyond good interpersonal relationships or an appropriate reward for a job well done (Bass & Avolio, 1993). This is especially true in nursing. Caring for people, sick or well, is the goal of the profession. Most people chose nursing in order to do something for the good of humankind; this is their vision. One responsibility of nursing leader- ship is to help nurses see how their work helps them achieve their vision.

Transformational leaders can communicate their vision in a manner that is so meaningful and excit- ing that it reduces negativity (Leach, 2005) and inspires commitment in the people with whom they work (Trofino, 1995). Dr. Martin Luther King Jr. had a vision for America: “I have a dream that

one day my children will be judged by the content of their character, not the color of their skin” (quoted by Blanchard & Miller, 2007, p. 1). A great leader shares his or her vision with his followers. You can do the same with your colleagues and team. If suc- cessful, the goals of the leader and staff will “become fused, creating unity, wholeness, and a collective purpose” (Barker, 1992, p. 42). See Box 1-1 for an example of a leader with visionary goals.

Moral Leadership A series of highly publicized corporate scandals redirected attention to the values and ethics that underlie the practice of leadership as well as that of patient care (Dantley, 2005). Moral leadership involves deciding how one ought to remain honest, fair, and socially responsible (Bjarnason & LaSala, 2011) under any circumstances. Caring about one’s patients and the people who work for you as people as well as employees (Spears & Lawrence, 2004) is part of moral leadership. This can be a great chal- lenge in times of limited financial resources.

Molly Benedict was a team leader on the acute geri- atric unit (AGU) when a question of moral leader- ship arose. Faced with large budget cuts in the middle of the year and feeling a little desperate to f igure out how to run the AGU with fewer staff, her nurse manager suggested that reducing the time that unlicensed assistive personnel (UAP) spent ambulating patients would enable UAPs to care for 15 patients, up from the current 10 per UAP.

This is leadership on the very grandest scale. BHAGs are Big, Hairy, Audacious Goals. Coined by Jim Collins, BHAGs are big ideas, visions for the future. Here is an example: Gigi Mander, originally from the Philippines, dreams of buying hundreds of acres of farmland for peasant families in Asia or Africa. She would install irrigation systems, provide seed and modern farming equipment, and help them market their crops. This is not just a dream, however; she has a business plan for her BHAG and is actively seeking investors. Imagination, creativity, planning, persistence, audacity, courage: these are all needed to put a BHAG into practice. Do you have a BHAG? How would you make it real?

box 1-1

BHAGs, Anyone?

Adapted from Buchanan, L. (2012). The world needs big ideas. INC Magazine, 34(9), 57–58.

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8 unit 1 ■ Professional Considerations

“George,” responded Molly, “you know that inactiv- ity has many harmful effects, from emboli to disori- entation, in our very elderly population. Let’s try to f igure out how to encourage more self-care and even family involvement in care so the UAPs can still have time to walk patients and prevent their becom- ing nonambulatory.”

Molly based her action on important values, par- ticularly those of providing the highest quality care possible. Stewart and colleagues (2012) urge that caring not be sacrificed at the altar of efficiency (p. 227). This example illustrates how great a chal- lenge that can be for today’s nurse leaders. The American Nurses Association Code of Ethics (2001) provides the moral compass for nursing practice and leadership (ANA, 2001; Bjarnason & LaSala, 2011).

Box 1-2 summarizes a contemporary list of 13 distinctive leadership styles, most of which match up to the eight theories just discussed.

Caring Leadership Caring leadership in nursing comes from two primary sources: servant leadership and emotional

intelligence in the management literature, and caring as a foundational value in nursing (Green- leaf, 2008; McMurry, 2012; Rhodes, Morris, & Lazenby, 2011; Spears, 2010). While it is uniquely suited to nursing leadership, it is hard to imagine any situation in which an uncaring leader would be preferred over a caring leader.

Servant-leaders choose to serve first and lead second, making sure that people’s needs within the work setting are met (Greenleaf, 2008). Emotion- ally intelligent leaders are especially aware of not only their own feelings but others’ feelings as well (see Box 1-1). Combining these leadership and management theories and the philosophy of caring in nursing, you can see that caring leadership is fundamentally people-oriented. The following are the characteristics and behaviors of caring leaders:

■ They respect their coworkers as individuals. ■ They listen to other people’s opinions and

preferences, giving them full consideration. ■ They maintain awareness of their own and

others’ feelings. ■ They empathize with others, understanding

their needs and concerns. ■ They develop their own and their team’s

capacities. ■ They are competent, both in leadership and in

clinical practice. This includes both knowledge and skill in leadership and clinical practice.

As you can see, caring leadership cuts across the leadership theories discussed so far and encom- passes some of their best features. An authoritarian leader, for example, can be as caring as a democratic leader (Dorn, 2011). Caring leadership is attractive to many nurses because it applies many of the prin- ciples of working with patients and working with nursing staff to the interdisciplinary team.

Qualities of an Effective Leader If leadership is seen as the ability to influence, what qualities must the leader possess in order to be able to do that? Integrity, courage, positive attitude, ini- tiative, energy, optimism, perseverance, generosity, balance, ability to handle stress, and self-awareness are some of the qualities of effective leaders in nursing (Fig. 1.1):

■ Integrity. Integrity is expected of health-care professionals. Patients, colleagues, and

1. Adaptive: flexible, willing to change and devise new approaches.

2. Emotionally Intelligent: aware of his/her own and others’ feelings.

3. Charismatic: magnetic personalities who attract people to follow them.

4. Authentic: demonstrates integrity, character, and honesty in relating to others.

5. Level 5: ferociously pursues goals but gives credit to others and takes responsibility for his/her mistakes.

6. Mindful: thoughtful, analytic, and open to new ideas. 7. Narcissistic: doesn’t listen to others and doesn’t

tolerate disagreement but may have a compelling vision.

8. No Excuse: mentally tough, emphasizes accountability and decisiveness.

9. Resonant: motivates others through their energy and enthusiasm.

10. Servant: “empathic, aware and healing,” (p. 76) leads to serve others.

11. Storyteller: uses stories to convey messages in a memorable, motivating fashion.

12. Strength-Based: focuses and capitalizes on his/her own and others’ talents.

13. Tribal: build a common culture with strong sharing of values and beliefs.

box 1-2

Distinctive Styles of Leadership

Adapted from Buchanan, L. (2012/June). 13 ways of looking at a leader. INC Magazine, 74–76.

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chapter 1 ■ Leadership and Followership 9

employers all expect nurses to be honest, law-abiding, and trustworthy. Adherence to both a code of personal ethics and a code of professional ethics (Appendix 1, American Nurses Association Code of Ethics for Nurses) is expected of every nurse. Would-be leaders who do not exhibit these characteristics cannot expect them of their followers. This is an essential component of moral leadership.

■ Courage. Sometimes, being a leader means taking some risks. In the story of Billie Thomas, for example, Billie needed some courage to speak to her nurse manager about a problem she had observed.

■ Positive attitude. A positive attitude goes a long way in making a good leader. In fact, many outstanding leaders cite negative attitude as the single most important reason for not hiring someone (Maxwell, 1993, p. 98). Sometimes a leader’s attitude is noticed by followers more quickly than are the leader’s actions.

■ Initiative. Good ideas are not enough. To be a leader, you must act on those good ideas. No one will make you do this; this requires initiative on your part.

■ Energy. Leadership requires energy. Both leadership and followership are hard but satisfying endeavors that require effort. It

is also important that the energy be used wisely.

■ Optimism. When the work is difficult and one crisis seems to follow another in rapid succession, it is easy to become discouraged. It is important not to let discouragement keep you and your coworkers from seeking ways to resolve the problems. In fact, the ability to see a problem as an opportunity is part of the optimism that makes a person an effective leader. Like energy, optimism is “catching.” Holman (1995) called this being a winner instead of a whiner (Table 1-3).

■ Perseverance. Effective leaders do not give up easily. Instead, they persist, continuing their efforts when others are tempted to stop trying. This persistence often pays off.

■ Generosity. Freely sharing your time, interest, and assistance with your colleagues is a trait of a generous leader. Sharing credit for successes and support when needed are other ways to be a generous leader (Buchanan, 2013; Disch, 2013).

■ Balance. In the effort to become the best nurses they can be, some nurses may forget that other aspects of life are equally important. As important as patients and colleagues are, family and friends are important, too. Although school and work are meaningful activities, cultural, social, recreational, and spiritual activities also have meaning. You need to find a balance between work and play.

■ Ability to handle stress. There is some stress in almost every job. Coping with stress in as positive and healthy a manner as possible helps to conserve energy and can be a model for

Qualities

Behaviors

Integrity

Courage

Initiative

Energy

Optimism

Perseverance

Balance

Ability to handle stress

Self-awareness

Think critically

Solve problems

Communicate skillfully

Set goals, share vision

Develop self and others

Figure 1.1 Keys to effective leadership.

table 1-3

Winner or Whiner—Which Are You? A winner says: A whiner says:

“We have a real challenge here.”

“This is really a problem.”

“I’ll give it my best.” “Do I have to?” “That’s great!” “That’s nice, I guess.” “We can do it!” “That will never succeed.” “Yes!” “Maybe . . .”

Source: Adapted from Holman, L. (1995). Eleven lessons in self- leadership: Insights for personal and professional success. Lexington, Ky.: A Lesson in Leadership Book.

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Rocio Quintana

 

10 unit 1 ■ Professional Considerations

others. Maintaining balance and handling stress are reviewed in Chapter 11.

■ Self-awareness. How sharp is your emotional intelligence? People who do not understand themselves are limited in their ability to understand people with whom they are working. They are far more likely to fool themselves than are self-aware people. For example, it is much easier to be fair with a coworker you like than with one you do not like. Recognizing that you like some people more than others is the first step in avoiding unfair treatment based on personal likes and dislikes.

Behaviors of an Effective Leader Leadership requires action. The effective leader chooses the action carefully. Important leadership behaviors include setting priorities, thinking criti- cally, solving problems, respecting people, commu- nicating skillfully, communicating a vision for the future, and developing oneself and others.

■ Setting priorities. Whether planning care for a group of patients or creating a strategic plan for an organization, priorities continually shift and demand your attention. As a leader you will need to remember the three E’s of prioritization: evaluate, eliminate, and estimate. Continually evaluate what you need to do, eliminate tasks that someone else can do, and estimate how long your top priorities will take you to complete.

■ Thinking critically. Critical thinking is the careful, deliberate use of reasoned analysis to reach a decision about what to believe or what to do (Feldman, 2002). The essence of critical thinking is a willingness to ask questions and to be open to new ideas or new ways to do things. To avoid falling prey to assumptions and biases of your own or others, ask yourself frequently, “Do I have the information I need? Is it accurate? Am I prejudging a situation?” ( Jackson, Ignatavicius, & Case, 2004).

■ Solving problems. Patient problems, paperwork problems, staff problems: these and others occur frequently and need to be solved. The effective leader helps people identify problems and work through the problem- solving process to find a reasonable solution.

■ Respecting and valuing the individual. Although people have much in common, each individual has different wants and needs and has had different life experiences. For example, some people really value the psychological rewards of helping others; other people are more concerned about earning a decent salary. There is nothing wrong with either of these points of view; they are simply different. The effective leader recognizes these differences in people and helps them find the rewards in their work that mean the most to them.

■ Skillful communication. This includes listening to others, encouraging exchange of information, and providing feedback: 1. Listening to others. Listening is separate

from talking with other people; listening involves both giving and receiving information. The only way to find out people’s individual wants and needs is to watch what they do and to listen to what they say. It is amazing how often leaders fail simply because they did not listen to what other people were trying to tell them.

2. Encouraging exchange of information. Many misunderstandings and mistakes occur because people fail to share enough information with each other. The leader’s role is to make sure that the channels of communication remain open and that people use them.

3. Providing feedback. Everyone needs some information about the effectiveness of their performance. Frequent feedback, both positive and negative, is needed so people can continually improve their performance. Some nurse leaders find it difficult to give negative feedback because they fear that they will upset the other person. How else can the person know where improvement is needed? Negative feedback can be given in a manner that is neither hurtful nor resented by the individual receiving it. In fact, it is often appreciated. Other nurse leaders, however, fail to give positive feedback, assuming that coworkers will know when they are doing a good job. This is also a mistake because everyone appreciates positive feedback. In fact, for some people, it is the most important reward they get from their jobs.

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chapter 1 ■ Leadership and Followership 11 ■ Communicating a vision for the future. The

effective leader has a vision for the future. Communicating this vision to the group and involving everyone in working toward that vision generate the inspiration that keeps people going when things become difficult. Even better, involving people in creating the vision is not only more satisfying for employees but also has the potential to produce the most creative and innovative outcomes (Kerfott, 2000). It is this vision that helps make work meaningful.

■ Developing oneself and others. Learning does not end upon leaving school. In fact, experienced nurses say that school is just the beginning, that school only prepares you to continue learning throughout your career. As new and better ways to care for patients are developed, it is your responsibility as a professional to critically analyze them and decide whether they would be better for your patients than current ones. Effective leaders not only continue to learn but also encourage others to do the same. Sometimes, leaders function as teachers. At other times, their role is primarily to encourage others to seek more knowledge.

Anderson, Manno, O’Connor, and Gallagher (2010) invited five nurse managers from Penn Presbyterian Medical Center who had received top ratings in leadership from their staff to participate in a focus group on successful leadership. They reported that visibility, communication, and the values of respect and empathy were the key elements of successful leadership. The authors quoted participants to illustrate each of these elements (p. 186):

Visibility: “I try to come in on the off shifts even for an hour or two just to have them see you.”

Communication: “Candid feedback” “A lot of rounding.” (Note: this could also be visibility.)

Respect and Empathy: “Do I expect you to take seven patients? No, because I wouldn’t be able to do it.” (punctuation adjusted).

These three key elements draw on components from several leadership qualities and behaviors: skillful communication, respecting and valuing the individual, and energy. Visibility is not as pro- minent in many of the leadership theories but

deserves a place in the description of what effective leaders do.

Followership

Followership and leadership are separate but com- plementary roles. The roles are also reciprocal: without followers, one cannot be a leader. One also cannot be a follower without having a leader (Lyons, 2002).

It is as important to be an effective follower as it is to be an effective leader. In fact, most of us are followers: members of a team, attendees at a meeting, staff of a nursing care unit, and so forth.

Followership Defined Followership is not a passive role. On the contrary, the most valuable follower is a skilled, self-directed professional, one who participates actively in deter- mining the group’s direction, invests his or her time and energy in the work of the group, thinks criti- cally, and advocates for new ideas (Grossman & Valiga, 2000).

Imagine working on a patient care unit where all staff members, from the unit secretary to the assistant nurse manager, willingly take on extra tasks without being asked (Spreitzer & Quinn, 2001), come back early from coffee breaks if they are needed, complete their charting on time, support ways to improve patient care, and are proud of the high-quality care they provide. Wouldn’t it be won- derful to be a part of that team?

Becoming a Better Follower There are a number of things you can do to become a better follower:

■ If you discover a problem, inform your team leader or manager right away.

■ Even better, include a suggestion for solving the problem in your report.

■ Freely invest your interest and energy in your work.

■ Be supportive of new ideas and new directions suggested by others.

■ When you disagree, explain why. ■ Listen carefully and reflect on what your leader

or manager says. ■ Continue to learn as much as you can about

your specialty area. ■ Share what you learn.

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12 unit 1 ■ Professional Considerations

Being an effective follower not only will make you a more valuable employee but will also increase the meaning and satisfaction that you get from your work.

Managing Up Most team leaders and nurse managers respond positively to having staff who are good followers. Occasionally, you will encounter a poor leader or manager who can confuse, frustrate, and even dis- tress you. Here are a few suggestions for handling this:

■ Avoid adopting the ineffective behaviors of this individual.

■ Continue to do your best work and to contribute leadership to the group.

■ If the situation worsens, enlist the support of others on your team to seek a remedy; do not try to do this alone as a new graduate.

■ If the situation becomes intolerable, consider the option of transferring to another unit or seeking another position (Deutschman, 2005; Korn, 2004).

There is still more a good follower can do. This is called managing up. Managing up is defined as “the process of consciously working with your boss to obtain the best possible results for you, your boss, and your organization” (Zuber & James quoted by Turk, 2007, p. 21). This is not a scheme to mani- pulate your manager or to get more rewards than you have earned. Instead, it is a guide for better understanding your manager, what he or she expects of you, and what your manager’s own needs might be.

Every manager has areas of strength and weak- ness. A good follower recognizes these and helps the manager capitalize on areas of strength and compensate for areas of weakness. For example, if your nurse manager is slow completing quality improvement reports, you can offer to help get them done. On the other hand, if your nurse manager seems to be especially skilled in defusing

conflicts between attending physicians and nursing staff, you can observe how he handles these situa- tions and ask him how he does it. Remember that your manager is human, a person with as many needs, concerns, distractions, and ambitions as anyone else. This will help you keep your expecta- tions of your manager realistic and reduce the dis- tance between you and your manager.

There are several other ways in which to manage up. U.S. Army General and former Secretary of State Colin Powell said, “You can’t make good deci- sions unless you have good information” (Powell, 2012, p. 42). Keep your manager informed. No one likes to be surprised, least of all a manager who finds that you have known about a problem (a nursing assistant who is spending too much time in the staff lounge, for example) and not brought it to her attention until it became critical. When you do bring a problem to your manager’s attention, try to have a solution to offer. This is not always possible, but when it is, it will be very much appreciated.

Finally, show your appreciation whenever pos- sible (Bing, 2010). Show respect for your manager’s authority and appreciation for what your manager does for the staff of your unit. Let others know of your appreciation, particularly those to whom your manager must answer.

Conclusion

To be an effective nurse, you need to be an effective leader. Your patients, peers, and employer are depending on you to lead. Successful leaders never stop learning and growing. John Maxwell (1998), an expert on leadership, wrote, “Who we are is who we attract” (p. xi). To attract leaders, people need to start leading and never stop learning to lead.

The key elements of leadership and followership have been discussed in this chapter. Many of the leadership and followership qualities and behaviors mentioned here are discussed in more detail in later chapters.

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chapter 1 ■ Leadership and Followership 13

Study Questions

1. Why is it important for nurses to be good leaders? What qualities have you observed from nurses that exemplify effective leadership in action? How do you think these behaviors might have improved the outcomes of their patients?

2. Why are effective followers as important as effective leaders? 3. Review the various leadership theories discussed in the chapter. Which ones especially apply to

leading in today’s health-care environment? Support your answer with specific examples. 4. Select an individual whose leadership skills you particularly admire. What are some qualities

and behaviors that this individual displays? How do these relate to the leadership theories discussed in this chapter? In what ways could you emulate this person?

5. As a new graduate, what leadership and followership skills will you work on developing during the first 3 months of your first nursing position? Why?

Case Study to Promote Critical Reasoning

Two new associate-degree graduate nurses were hired for the pediatric unit. Both worked three 12-hour shifts a week, Jan on the day-to-evening shift and Ronnie at night. Whenever their shifts overlapped, they would compare notes on their experience. Jan felt she was learning rapidly, gaining clinical skills, and beginning to feel at ease with her colleagues.

Ronnie, however, still felt unsure of herself and often isolated. “There have been times,” she told Jan, “that I am the only registered nurse on the unit all night. The aides and LPNs are really experienced, but that’s not enough. I wish I could work with an experienced nurse as you are doing.”

“Ronnie, you are not even finished with your 3-month orientation program,” said Jan. “You should never be left alone with all these sick children. Neither of us is ready for that kind of responsibility. And how will you get the experience you need with no experienced nurses to help you? You must speak to our nurse manager about this.”

“I know I should, but she’s so hard to reach. I’ve called several times, and she’s never available. She leaves all the shift assignments to her assistant. I’m not sure she even reviews the schedule before it’s posted.”

“You will have to try harder to reach her. Maybe you could stay past the end of your shift one morning and meet with her,” suggested Jan. “If something happens when you are the only nurse on the unit, you will be held responsible.” 1. In your own words, summarize the problem that Jan and Ronnie are discussing. To what extent

is this problem due to a failure to lead? Who has failed to act? 2. What style of leadership was displayed by Jan, Ronnie, and the nurse manager? How effective

was their leadership? Did Jan’s leadership differ from that of Ronnie and the nurse manager? In what way?

3. In what ways has Ronnie been an effective follower? In what ways has Ronnie not been so effective as a follower?

4. If an emergency occurred and was not handled well while Ronnie was the only nurse on the unit, who would be responsible? Explain why this person or persons would be responsible.

5. If you found yourself in Ronnie’s situation, what steps would you take to resolve the problem? Show how the leader characteristics and behaviors found in this chapter support your solution to the problem.

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14 unit 1 ■ Professional Considerations

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Korn, M. (2004). Toxic Cleanup: How to Deal with a Dangerous Leader. Fast Company, 88, 17.

Leach, L.S. (2005). Nurse executive transformational leadership and organizational commitment. Journal of Nursing Administration, 35(5), 228–237.

Lyons, M.F. (2002). Leadership and followership. The Physician Executive, Jan/Feb, 91–93.

Maslow, A.H. (1970). Motivation and personality (2nd ed.). New York: Harper & Row.

Maxwell, J.C. (1993). Developing the Leader Within You. Tenn.: Thomas Nelson Inc.

Maxwell, J.C. (1998). The 21 Irrefutable Laws of Leadership. Tenn.: Thomas Nelson Inc.

McClelland, D. (1961). The Achieving Society. Princeton, NJ: D. Van Nostrand.

McMurry (2012). Be a caring leader. Managing People at Work. Retrieved from www.managingpeopleatwork .com/article.php?art_num=3982

McNichol, E. (2000). How to be a model leader. Nursing Standard, 14(45), 24.

Pavitt, C. (1999). Theorizing about the group communication-leadership relationship. In Frey, L.R. (Ed.), The Handbook of Group Communication Theory and Research. Thousand Oaks, Calif.: Sage Publications.

Porter-O’Grady, T. (2003). A different age for leadership, Part II. Journal of Nursing Administration, 33(2), 105–110.

Powell, C. (2012/May 21). The general’s orders. (Features) (Excerpts) from book, It worked for me: In life and leadership. Harper Collins Pub. Newsweek, 40–44.

Rhodes, M.K., Morris, A.H., & Lazenby, R.B. (2011). Nursing at its best: Competent and caring. Online Journal of Issues in Nursing, 16(2), 10.

Scott, E., & Miles, J. (2013) Advancing Leadership Capacity in Nursing. Nursing Administration Quarterly, 37(1), 77–82.

Spears, L.C. (2010). Character and servant leadership: Ten characteristics of effective, caring leaders. Journal of Virtues & Leadership, 1(1), 25–30.

Spears, L.C., & Lawrence, M. (2004). Practicing Servant- Leadership. New York: Jossey-Bass.

Spreitzer, G.M., & Quinn, R.E. (2001). A Company of Leaders: Five Disciplines for Unleashing the Power in Your Workforce. San Francisco: Jossey-Bass.

Stewart, L., Holmes, C., & Usher, K. (201

Ego Integrity Presentation

Ego Integrity Presentation

Based  on what you have learned so far in this course, create a PowerPoint  presentation that addresses each of the following points/questions. Be  sure to completely answer all the questions for each bullet point. Use  clear headings that allow your professor to know which bullet you are  addressing on the slides in your presentation. Support your content with  at least two (2) sources throughout your presentation. Make sure to  reference the citations using the APA writing style for the  presentation. Include a slide for your references at the end. Follow  best practices for PowerPoint presentations related to text size, color,  images, effects, wordiness, and multimedia enhancements. Review the rubric criteria for this assignment.

  • Imagine  you are working as a charge nurse in an assisted living facility. Your  unit houses twenty older adults. The residents of this unit are  cognitively functional without evidence of cognitive decline. The  residents are elderly and do require varying degrees of physical  assistance with ADLs. Create a PowerPoint outlining:
    • Strategies  to incorporate in the assisted living facility to promote ego integrity  for the residents for group and individual activities to incorporate.
      • Title Slide (1 slide)
      • Objective Slide (1 slide)
      • Strategies to Promote Ego Integrity
        • Group Activities (2-3 slides)
        • Individual Activities (2-3 slides)
      • References (1 slide)

Assignment Expectations:

Length: 7-9 slides total

Structure: Include a title slide, objective slide, content slides, and reference slide in APA format

Speaker Notes not required

References:  Use appropriate APA style in-text citations and references for all  resources utilized to answer the questions.  A minimum of two (2)  scholarly sources are required for this assignment.

Discuss how you can incorporate the skills for investigating a challenge or new opportunity in your current role as patient advocate (registered nurse).

Discuss how you can incorporate the skills for investigating a challenge or new opportunity in your current role as patient advocate (registered nurse).

Successful development of a direct observation program to measure health care worker hand hygiene using multiple trained volunteers

Major article

Successful development of a direct observation program to measure health care worker hand hygiene using multiple trained volunteers

W. Matthew Linam MD, MS a,*, Michele D. Honeycutt BSN, RN, CIC b, Craig H. Gilliam BSMT, CIC c, Christy M. Wisdom BSN, RN, CIC b, Shasha Bai PhD d, Jayant K. Deshpande MD, MPH e

a Pediatric Infectious Diseases Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR b Infection Prevention and Control Department, Arkansas Children’s Hospital, Little Rock, AR c Infection Prevention and Control Department, St. Jude Children’s Research Hospital, Memphis, TN d Biostatistics Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR e Departments of Pediatrics and Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR

Key Words: Quality improvement Performance measurement Patient safety measures

Background: Direct observation of health care worker (HCW) hand hygiene (HH) remains the gold stan- dard, but implementation is challenging. Our objective was to develop an accurate HH observation program using multiple HCW volunteers. Methods: HH compliance was defined as correct HH performed before and after contact with a patient or a patient’s environment. HCW volunteers from each unit at our children’s hospital were trained by infection preventionists to covertly collect HH observations during routine care using an electronic tool. Questionnaires sent to observers in February and December 2014 recorded demographic characteris- tics, observation time, and scenarios assessing accuracy. HCWs were surveyed regarding their awareness that their HH behavior was being recorded. Results: There were 146 HH observers. The majority of observers reported making 1-2 observations per shift (65%) and taking ≤10 minutes recording an observation (85%). Between January 2012 and December 2014 there were 22,484 HH observations (average, 622 per month), including nurses (46%), physicians (21%), and other HCWs (33%). Observers correctly recorded HH behavior more than 90% of the time in 5 of the 6 scenarios. Most HCWs (86%) were unaware they were being observed. Conclusion: A direct observation program staffed by multiple HCW volunteers can inexpensively and accurately collect HCW HH data. © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier

Inc. All rights reserved.

Accurate measurement of hand hygiene behavior by health care workers (HCWs) is crucial to improvement efforts.1,2 Covert direct observation of hand hygiene practices during routine patient care remains the gold standard, but it presents a number of challenges, including significant cost and time investment.3,4 In addition, direct observation programs usually only capture a small sample of all hand hygiene opportunities, may not accurately measure the hand hygiene events, and may be biased due to Hawthorne effect.3-8

Despite these challenges, direct observation is currently the only strategy capable of measuring all 5 key indications for hand hygiene and evaluating technique. It is also among the few strategies that can differentiate compliance by HCW type.4 Electronic applications have been developed capable of assisting observers and reducing the time requirementsof directobservation.9,10 Attemptstoobtainamorerep- resentative sample of hand hygiene data and reduce observation bias have resulted in the development of a number of different auto- mated hand hygiene monitoring systems.4,9 Unfortunately, these systems often require significant cost to install and maintain.4,9 In ad- dition, because situational context is not accounted for, data may be biased toward lower compliance.11 A direct observation program capable of inexpensively collecting a representative sample of HCW hand hygiene data and minimizing bias is needed.

Our objective was to develop a hand hygiene observation program using multiple trained HCW volunteers capable of accurately mea- suring hand hygiene behavior and minimizing Hawthorne effect.

* Address correspondence to W. Matthew Linam, MD, MS, Pediatric Infectious Diseases Section, Department of Pediatrics, University of Arkansas for Medical Sciences, 1 Children’s Way, Slot 512-11, Little Rock, AR 72202-3500.

E-mail address: wlinam@uams.edu (W.M. Linam). Financial support: None. Presented in part at the Association for Professionals in Infection Control and

Epidemiology 41st Annual Conference, Anaheim, California, June 7-9, 2014. Conflicts of interest: None to report.

0196-6553/© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.12.019

American Journal of Infection Control 44 (2016) 544-7

Contents lists available at ScienceDirect

American Journal of Infection Control

j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g

American Journal of Infection Control

 

 

METHODS

This program was developed at Arkansas Children’s Hospital, a 370-bed tertiary children’s hospital. There are 14 inpatient units, including 4 critical care units and a hematology–oncology unit.

Appropriate hand hygiene practices of HCWs were defined based on published guidelines.1,2 Hand hygiene compliance was defined as correct hand hygiene performed before and after contact with a patient or a patient’s care area. For patients on transmission- based isolation precautions, hand hygiene was required before donning and after doffing personal protective equipment.

HCW volunteers from day, night, and weekend shifts were re- cruited from each inpatient unit, with a goal of at least 4 observers on each unit. In general, the identities of the observers remained secret. Hand hygiene observers were trained by infection preventionists (IPs) before recording hand hygiene observations. A single hand hygiene observation required the ability to witness the hand hygiene practices of the HCW both before and after contact with a patient or a patient’s care environment. Partial observa- tions were aborted. Each observer was expected to make at least 10 observations each month. Observations were to be collected on a variety of HCW types. All observers were required to complete annual retraining and attend quarterly observer team meetings.

As part of the ongoing education and interrater reliability as- sessment, a 16-item electronic questionnaire was sent to each hand hygiene observer in February and December 2014. Questions in- cluded observer demographic characteristics and time spent making observations. The questionnaire also included 6 scenarios repre- senting common observation situations and assessed the accuracy of their observations. Correct responses for the scenarios were com- pared by 2-sample proportion test (February vs December). P values < .05 were considered significant. All statistical analysis was per- formed using SAS 9.4 (SAS Institute Inc, Cary, NC), or R version 3.1.2 (R Foundation for Statistical Computing, Vienna, Austria).

A separate electronic questionnaire was sent to all HCWs during April and May 2014 to assess their level of awareness that their hand hygiene behavior was being recorded by observers. HCWs rated their awareness that their hand hygiene behavior was being recorded at the time it was being observed using a Likert scale (never aware, rarely aware, occasionally aware, frequently aware, always aware, or not sure). Data were summarized as frequencies and percentages.

Hand hygiene observations were recorded electronically on touch screens located throughout the units. Additional data collected in- cluded date, time and shift of the observation, unit location, HCW type, and patient’s transmission-based isolation status. Observa- tion data were transmitted real-time to an electronic data visualization program that was available to all staff and was capable of sorting the data in a variety of ways to better inform improve- ment efforts. A run chart was created using Microsoft Excel (Redmond, WA) to display monthly hand hygiene compliance over time and annotated to show the relationship between interven- tions and the monthly hand hygiene compliance. Because hand hygiene compliance has been shown to be higher when measured by unit-based observers compared with data from nonunit-based observers, we compared hand hygiene compliance data from unit- based and nonunit-based observers.12

RESULTS

Hand hygiene observers

Of the 146 hand hygiene observers, 101 (69%) completed the questionnaire during December 2014. The HCW hand hygiene ob- servers were mostly nurses (90%) and represented all inpatient units. Most (65%) reported being hand hygiene observers for more than

12 months. The majority of observers reported making 1-2 obser- vations (65%) or making 3-5 observations (30%) during a single shift. A single hand hygiene observation required 10 minutes or less for 85% of the observers. The remaining observers required 11-15 minutes. Eighty percent of the 102 observers in February com- pleted the survey. Responses were similar.

Observer interrater reliability

Hand hygiene observer responses on the validation question- naire in February and December 2014 are shown in Table 1. Observers recorded hand hygiene behavior correctly more than 90% of the time in 5 of the 6 hand hygiene scenarios. Scenario 6 had the fewest number of correct responses (36% in February and 47% in December). This scenario involved a HCW briefly entering a patient room without touching the patient or patient care environment. Al- though observers were asked to record this scenario in a specific way (abort the observation), depending on interpretation, any of the responses could be considered correct. Ongoing education resulted in an 11% improvement.

Hawthorne effect

There were 681 HCWs (63% nurses, 15% physicians, and 23% other HCW types) who completed the separate observation awareness questionnaire. Most (86%) were never aware or rarely aware that their hand hygiene practices were being observed at the time the observation was being made.

Hand hygiene observation data

Between January 1, 2012, and December 31, 2014, there were 22,484 complete hand hygiene observations recorded with an average of 622 observations per month. This included the obser- vation of the hand hygiene behavior of 10,323 nurses (46%), 4,692 physicians (21%), and 7,469 observations (33%) of other HCW types (eg, patient care technicians, respiratory therapists, and various an- cillary staff). Almost one-third (28%) of the hand hygiene observations were recorded for patients on transmission-based isolation pre- cautions. Half the observations (53%) were recorded during day shifts and 24% of the observations were recorded during weekend shifts. The annotated run chart shows the change in hand hygiene com- pliance over time (Fig 1). Hand hygiene compliance gradually increased from a baseline of 75% to sustained compliance of 95%. Hand hygiene compliance averaged 9% higher for unit-based ob- servers compared with nonunit-based observers (range by year, 4%-12%).

DISCUSSION

We successfully developed a program to directly measure HCW hand hygiene compliance using more than 100 trained HCW ob- servers. Observations were collected on all units, shifts, and HCW types. In general, HCWs were not aware that they were being ob- served. Thus, Hawthorne effect was minimized.

Compared with other measurement strategies, direct observa- tion of hand hygiene behavior provides the greatest detail regarding HCW hand hygiene, which allows tailoring of improvement efforts.3,4

Despite these benefits, there are important limitations. Direct ob- servation programs reported in the literature rarely describe details of observer training and whether interrater reliability is assessed.4,13,14

The time and associated costs required for employees to monitor hand hygiene limit the number of observations that can be made. At best, direct observation programs only collect 1%-3% of hand hygiene opportunities.4,8,15,16 Unfortunately, this may not accurately

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Table 1 Hand hygiene observer responses during February and December 2014 on an electronic questionnaire assessing the accuracy of their hand hygiene observations

Scenario Key point(s) February response December response P value*

1. The HCW enters a room and performs hand hygiene with ETOH gel. The observer is called away and unable to observe whether or not hand hygiene is performed upon exiting the room

The observer must be able to witness hand hygiene behavior both before and after contact with the patient or patient care area. Otherwise the observation should be aborted

Compliant: 0 (0) Noncompliant: 0 (0) Abort: 88 (100)

Compliant: 1 (1) Noncompliant: 0 (0) Abort: 99 (99) Missing: 1

.99

2. The HCW is observed entering a patient room. No hand hygiene is performed. A surgical wound is examined. The HCW performs hand hygiene with the ETOH gel upon exiting the room

Correct hand hygiene must be performed both before and after contact with a patient or patient care area to be considered compliant

Compliant: 0 (0) Noncompliant: 83 (94) Abort: 5 (6)

Compliant: 1 (1) Noncompliant: 96 (95) Abort: 4 (4)

.86

3. The HCW performs hand hygiene with soap and water upon entering a patient’s room. A paper towel is used to turn off the faucet. A physical exam is performed. The HCW performs hand hygiene with the ETOH gel upon exiting the room

An HCW does not need to use the same hand hygiene product for before and after contact with the patient or patient care area. If an HCW washes his or her hands with soap and water, the faucet must be turned off without recontamination of the hands

Compliant: 86 (99) Noncompliant: 1 (1) Abort: 0 (0) Missing: 1

Compliant: 98 (99) Noncompliant: 1 (1) Abort: 0 (0) Missing: 2

.99

4. The HCW enters the room of a patient on transmission-based isolation precautions. Hand hygiene is not performed before PPE is donned. The HCW administers a breathing treatment. PPE is removed and hand hygiene is performed using the ETOH gel upon exiting the room

Hand hygiene should be performed before donning and after doffing personal protective equipment

Compliant: 2 (2) Noncompliant: 80 (92) Abort: 5 (6) Missing: 1

Compliant: 2 (2) Noncompliant: 94 (93) Abort: 5 (5)

.99

5. The HCW enters a patient’s room to silence an intravenous pump alarm. No hand hygiene is performed before entering or exiting the patient’s room to silence the alarm

An HCW must perform hand hygiene both before and after contact with the patient care area even if there is no contact with the patient

Compliant: 1 (1) Noncompliant: 84 (95) Abort: 3 (3)

Compliant: 5 (5) Noncompliant: 92 (93) Abort: 2 (2) Missing: 2

.28

6. The HCW enters a patient’s room to relay information regarding scheduling of a diagnostic imaging procedure. No contact is made with the patient or the patient’s care environment. No hand hygiene is performed before entering or exiting the patient’s room

If an HCW enters a patient care area and makes no contact with the patient or the patient care area, the observation should be aborted

Compliant: 35 (40) Noncompliant: 21 (24) Abort: 32 (36)

Compliant: 36 (36) Noncompliant: 17 (17) Abort: 47 (47) Missing: 1

.28

NOTE. Values are presented as n (%). Correct responses are in boldface type. ETOH, alcohol; HCW, health care worker; PPE, personal protective equipment. *Significant at P < .05.

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Final Values

Median

Goal

Month

P er

ce n

ta ge

H an

d H

yg ie

n e

C o

m p

lia n

ce

Hand hygiene improvement project ini�ated. Mul�ple interven�ons implemented.

Interven�on Interven�on

Fig 1. Run chart showing health care worker hand hygiene compliance by month, January 2012-December 2014.

546 W.M. Linam et al. / American Journal of Infection Control 44 (2016) 544-7

 

 

capture hand hygiene behavior, which frequently varies by day, shift, location, and HCW type.2,17,18 Observer bias, which can occur when unit-based staff preferentially observe HCWs who are being com- pliant or give coworkers the benefit of the doubt, results in overestimation of hand hygiene compliance. In 1 study, hand hygiene data of unit-based observers were 22.8% higher than nonunit- based observers.12 Finally, the Hawthorne effect, which describes a subject’s tendency to alter his or her behavior based on the awareness that they are being observed, can also affect the accu- racy of direct hand hygiene observations.5-7,19 Hand hygiene compliance often increases the longer an observer remains in a par- ticular location,6 and this can occur as early as 15 minutes into an observation period.20

Our direct observation program addressed many of these limi- tations. By using more than 100 trained HCW observers, we were able to collect a large amount of hand hygiene data, including all days, shifts, units, and HCW types while limiting the time require- ment of individual observers. Although our number of observations likely represented a small percentage of all hand hygiene oppor- tunities, the distribution of observations by shift and HCW type was similar to published data recording HCW hand hygiene opportunities.8 Minimizing observation time also allowed the ob- server team to be sustained by HCW volunteers at no added cost. The IP leading the observation program development spent 20% of her time during the first 3 months and then 5% or less of her time afterward maintaining the observation program. Ensuring that hand hygiene data are recorded consistently is a challenge for any direct observation program, especially with a large number of observers. We developed a standardized process to provide initial and ongoing training for our observers. Data from our validation survey showed most observers recorded hand hygiene scenarios correctly, and this persisted over time, suggesting that, overall, our training process was effective. The exception to this was scenario 6. Despite some improvement with education, inconsistent interpretation of this sce- nario persisted. Hand hygiene scenarios that are less clear-cut may require more training to ensure they are recorded accurately. Because most observers made only a few observations per shift during routine care, the majority of HCWs were unaware they were being ob- served. This suggests the Hawthorne effect was limited. Finally, the use of electronic data collection tools streamlined data collection and allowed for real-time feedback to staff.

There were some limitations with this program. Our hand hygiene observation program was implemented in a single children’s hos- pital and may not be easily spread to other settings. We only measured moments 1, 4, and 5 of the World Health Organization “My Five Moments for Hand Hygiene.”2 Despite ongoing training, our validation assessment suggests that some observations may have been recorded incorrectly. Most of the incorrect responses were related to scenario 6. Excluding scenario 6, an average of 96% and 95% of observers answered the remaining 5 scenarios correctly in February and December, respectively. It is possible that responses may have differed between HCWs completing the questionnaires and those who did not. Similar to other studies, we found in- creased compliance reported by unit-based observers compared with nonunit-based observers, but this was less than seen in other reports.12 Although HCWs reported minimal awareness of being ob- served, it is still possible their hand hygiene may have been positively affected.

CONCLUSIONS

We developed a direct observation program staffed by a large number of HCW volunteer observers that inexpensively collects a representative sample of HCW hand hygiene data with minimal Hawthorne effect. A standardized process for ongoing training is

essential to maintain data accuracy and minimize observer bias and should be tailored over time to address drift and misinterpreta- tion. Because many health care organizations continue to struggle to collect accurate HCW hand hygiene data, our hope is that this program may provide a framework that can be successfully adopted at other hospitals.

Acknowledgements

The authors thank the numerous HCW volunteers who make the hand hygiene program possible. The authors also thank the members of the Systems Development Group at Arkansas Children’s Hospi- tal for their assistance in development of the electronic data collection and observation programs and Angela Green, PhD, RNc, CPHQ, FAHA, FAAN, for providing editorial support.

References

1. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Infect Control Hosp Epidemiol 2002;23(12 Suppl):S3-40.

2. Pittet D, Allegranzi B, Boyce J. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611-22.

3. Haas JP, Larson EL. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:6-14.

4. Boyce JM. Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control Hosp Epidemiol 2011;32:1016-28.

5. Eckmanns T, Bessert J, Behnke M, Gastmeier P, Ruden H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931-4.

6. Stone S, Fuller C, Michie S, McAteer J, Charlett A. What is the optimal period for measuring hand hygiene compliance: are longer periods better than 20- minute periods? Infect Control Hosp Epidemiol 2012;33:1174-6.

7. Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infect Control Hosp Epidemiol 2009;30:222- 5.

8. Fries J, Segre AM, Thomas G, Herman T, Ellingson K, Polgreen PM. Monitoring hand hygiene via human observers: how should we be sampling? Infect Control Hosp Epidemiol 2012;33:689-95.

9. Ward MA, Schweizer ML, Polgreen PM, Gupta K, Reisinger HS, Perencevich EN. Automated and electronically assisted hand hygiene monitoring systems: a systematic review. Am J Infect Control 2014;42:472-8.

10. Hlady CS, Severson MA, Segre AM, Polgreen PM. A mobile handheld computing application for recording hand hygiene observations. Infect Control Hosp Epidemiol 2010;31:975-7.

11. Swoboda SM, Earsing K, Strauss K, Lane S, Lipsett PA. Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Crit Care Med 2004;32:358-63.

12. Dhar S, Tansek R, Toftey EA, Dziekan BA, Chevalier TC, Bohlinger CG, et al. Observer bias in hand hygiene compliance reporting. Infect Control Hosp Epidemiol 2010;31:869-70.

13. Gould DJ, Chudleigh J, Drey NS, Moralejo D. Measuring handwashing performance in health service audits and research studies. J Hosp Infect 2007;66:109-15.

14. Jeanes A, Coen PG, Wilson AP, Drey NS, Gould DJ. Collecting the data but missing the point: validity of hand hygiene audit data. J Hosp Infect 2015;90:156-62.

15. van de Mortel T, Murgo M. An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions. Am J Infect Control 2006;34:95-9.

16. Marra AR, Moura DF Jr, Paes AT, dos Santos OF, Edmond MB. Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices. Infect Control Hosp Epidemiol 2010;31:796-801.

17. Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283-94.

18. Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection control program. Ann Intern Med 1999;130:126-30.

19. Hagel S, Reischke J, Kesselmeier M, Winning J, Gastmeier P, Brunkhorst FM, et al. Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. Infect Control Hosp Epidemiol 2015;36:957-62.

20. Yin J, Reisinger HS, Vander Weg M, Schweizer ML, Jesson A, Morgan DJ, et al. Establishing evidence-based criteria for directly observed hand hygiene compliance monitoring programs: a prospective, multicenter cohort study. Infect Control Hosp Epidemiol 2014;35:1163-8.

547W.M. Linam et al. / American Journal of Infection Control 44 (2016) 544-7

 

  • Successful development of a direct observation program to measure health care worker hand hygiene using multiple trained volunteers
    • Methods
    • Results
      • Hand hygiene observers
      • Observer interrater reliability
      • Hawthorne effect
      • Hand hygiene observation data
    • Discussion
    • Conclusions
    • Acknowledgements
    • References

List three examples of plagiarism and discuss how plagiarizing as a student affects the integrity of a baccalaureate degree, the public perception of the nursing profession, and evidence-based practice. Describe two things you will do to ensure academic integrity in your work.

List three examples of plagiarism and discuss how plagiarizing as a student affects the integrity of a baccalaureate degree, the public perception of the nursing profession, and evidence-based practice. Describe two things you will do to ensure academic integrity in your work.

Please read below for more information.

Introduction

Academic nursing research is crucial to providing quality nursing care because it gives the foundation for evidence-based practice (EBP) that is often the catalyst for changes that impact patient outcomes. Learning to navigate databases to acquire sound evidence is the foundation for writing academic prose that illustrates the learner’s grasp of concepts. It is equally essential for RN-BSN students to learn to format academic writing properly, as well as understand how to avoid plagiarism and its repercussions. In addition, learning how to write without plagiarizing upholds the principle of trustworthiness that is a central element to the professionalism of nursing. Understanding academic research, literature review, scholarly writing, academic integrity, and academic dishonesty are the framework for a baccalaureate education, which also contribute to the professionalism of nursing. Additionally, learning to research relevant nursing topics forms critical-thinking skills necessary to provide excellent patient care.

Case StudyJulia, a 52-year-old nurse, returned to school for the first time in 30 years to get her bachelor’s degree at the prompting of her employer. Unfamiliar with writing papers, she had difficulty settling into the academic world. With the help of the university librarian and an online academic writing tutorial, she finished her first three online courses. Because she did not know how to find applicable articles or how to format her papers properly, she barely passed her first course. After completing the third course, the school contacted her to discuss one of her papers. After investigation, the university determined that Julia’s paper was largely plagiarized. An incident report was filed, placing Julia on academic probation. Devastated, Julia admitted that she was not certain what plagiarism truly was, but she certainly had no intention of doing anything dishonest. Julia said that many of her colleagues have spoken about getting papers and advice online and did not see the harm in it or consider it cheating. After thorough counsel from the faculty, Julia learned that the repercussions of such behavior go far past failing courses. She began to understand that plagiarism has a stark impact on the nursing profession and that dishonesty in academia can lead to dishonesty as a professional nurse. Such behavior jeopardizes patient care and can threaten the nursing license that she worked so hard to earn. Julia committed herself to learning how to avoid plagiarism and finding guidance on constructing strong academic papers for the rest of her baccalaureate education to help her uphold and model the principles key to the nursing profession.

Academic Writing

Academic writing is the analysis of material and the ability to express understanding in an eloquent and informative way while properly acknowledging sources (Hunker, Gazza, & Shellenbarger, 2014). Nonacademic writing does not use scholarly sources to substantiate claims made within the writing and is written at a more informal level that is easy for any reader to understand. Basics of academic writing, such as style, formatting, spelling, grammar, punctuation, and vocabulary, are often considered common knowledge. These concepts are also worth reviewing if they have faded from memory. In order to feel more prepared to tackle writing assignments with confidence, students often state the need for frequent review of such topics, particularly in the area of applying style and formatting according to the APA Style Manual (O’Brien, Marken, & Bennett Petrey, 2016). In fact, O’Brien, Marken, and Bennett Petrey (2016) discovered that the incorporation of mini studies on basics of writing throughout the length of a course led to improved writing and improved overall student perception related to writing assignments. This echoes the significance of exposure to the fundamentals of scholarly writing to set up students for success early in the academic process.

The figure shows a woman working on her laptop.A well-written, scholarly paper requires more than basic structure; it also needs an educated description of the topic that reflects the student’s critical thinking and comprehension (Borglin, 2012). Such comprehension is a stepping stone to formulating an evidence-based argument to support clinical reasoning in nursing practice and advocate for changes. Another key to this process is the students’ ability to evaluate relevant articles to support and substantiate the claims within their writing. Locating relevant articles is not sufficient; students must also be able to examine and fully understand the articles’ purpose and how it supports their writing (Hunker et. al., 2014). Blended together, these components contribute to the development of scholarly writing that is expected of students attaining a baccalaureate degree.

Tools for Success

The proper use of online databases is crucial to obtaining relevant data that can be used to support the students’ work. Grand Canyon University (GCU) has an online library system that allows for ease of access to such databases, including CINAHL and Ovid. The GCU Student Success Center contains a wealth of knowledge, providing detailed step-by-step processes instructing students on how to conduct effective database searches. Locating credible articles is crucial to substantiating claims made within pieces of academic writing. Information literacy can be defined as the learner’s ability to search for, access, and evaluate peer-reviewed articles (Brettle & Raynor, 2013). Peer-reviewed articles are research studies that have been evaluated by experts in the field prior to publication.

Becoming information literate is a crucial skill for students to master early on to lay a framework for success throughout the baccalaureate program. Throughout the program, students will be challenged to expand their knowledge and expertise by investigating new research and demonstrating their understanding of key concepts through scholarly academic writing and elaboration of ideas in discussion forums. When the basics, such as information literacy, are learned early, the process of academic writing becomes seamless and achievable. Not only is this helpful throughout the program, but it also contributes to the nurse’s ability to understand EBP and its impact on patient care. By learning how to evaluate articles for relevance and credibility, baccalaureate students will have the opportunity to understand EBP changes they see in their daily work during and after their baccalaureate experience.

Searching Databases

All nursing databases can be found in the “Find Journal Articles” and “Find Databases by Subject” section of the library under “Nursing & Health Sciences.” CINAHL Complete, PubMed, OVID Nursing Essentials, Cochrane Library, Nursing and Allied Health Collection, and ProQuest Nursing & Allied Health Source are recommended nursing databases; of these databases, CINAHL is the most widely recommended. The strategy when conducting research is to first identify the main concepts or keywords in the topic. Enter each concept in a separate search box. Then, add synonyms where possible to retrieve more search results. There are three Boolean operators that are used when searching in most library databases: AND, OR, and NOT. AND is used between each search box to connect different concepts. When using AND in a search, it will return results that use all keywords. OR is used to add synonyms, or similar keywords, to the search. Using OR in a search will return results that use at least one of the keywords provided. NOT is used to exclude keywords. Using NOT in a search will exclude the keyword provided from the results. When searching databases, using the truncation symbol (*), commonly referred to as an asterisk, can also be helpful in narrowing down search results. Truncation is used to include all possible endings on the end of the root word. For example, complian* will return results with the keywords compliance and compliant. Nurs* will return results that use the keywords nurse, nursing, nurses.

Scholarly writing requires students to support their research with current evidence published in reputable sources. When searching a database, students should click on the box limiting the search to only peer-reviewed journals. Students can limit search results to specific ranges of publication years as well. Typically, it is best practice to use articles that are no more than 5 years old; however students should check with their instructors to learn of any course specific requirements in terms of acceptable publication years.

Common Research Topic ExamplesTopic: Hand hygiene compliance to reduce the rate of infection1st Search Field: hand wash*2nd Search Field: AND compliant*3rd Search Field: AND infectionAnother way to search for this topic could include the following terms and operators:1st Search Field: hand hygiene2nd Search Field: AND adherence3rd Search Field: AND infectionTopic: Preventing diabetes through patient education1st Search Field: diabet*2nd Search Field: AND prevent* OR reduc*3rd Search Field: AND educat*Topic: Nurse shift reports to increase patient safety1st Search Field: nurs*2nd Search Field: AND shift report* OR handoff OR hand off OR bedside report*3rd Search Field: AND safe*

Review of the Abstract

After searching, the student can begin looking through the results to select which articles are most relevant to their topic of interest. Reading the subject line of each article is not enough to understand whether the article has the type of material the student may need. This is when reviewing the abstract comes in handy. The abstract gives a brief overview regarding the article’s content and design. In this way, students can get a basic understanding of whether this article is a good fit to support their topic.

Figure 1.1
Abstract Example

The figure provides an example of what an abstract looks like for a journal article in an online database, including a summary of the background, method, results, and conclusion.

Writing and Editing

Once the appropriate articles are found, they must be read and reviewed for topics and facts that can be used to support the paper’s main points. Finding just the right words to express ideas on a given topic can be difficult, particularly when unsure about how to best explain challenging concepts, properly cite sources, or correctly format the information according to APA style (O’Brien, Marken, & Bennett Petrey 2016). The greatest guidance possible for a student is to use every resource offered to help make the writing process easier. GCU’s Writing Center offers resources for students preparing to write an academic paper, including a step-by-step overview of writing academic papers, and example papers for reference. Learning to write scholarly papers enables students to demonstrate their understanding of concepts while growing in their ability to communicate effectively. Students concerned about the amount of writing required in a baccalaureate program can rest assured that most students acclimate to the challenge and are eventually able to write excellent academic prose.

Frequently reviewing and editing content helps students ensure that they are developing readable content that conveys the information as intended. Tools such as Microsoft Word’s grammar and spell check can help students to catch typos and grammatical errors; however, repeatedly reading and reviewing the content will ensure errors are located and fixed before submission. Reviewing the content also ensures that topics and paragraphs flow and transition from one to the next. Peer review is also an excellent way of fine-tuning completed work and eliciting ideas that can make for a more well-developed paper. The expertise of knowledgeable peers can give students a new perspective on the topic, broadening their understanding and helping to add depth to their prose (Doncliff, 2016).

Example of a Well Written ParagraphThe evidence regarding the effectiveness of clinical education models for undergraduate nursing programs is notably limited due to a lack of high quality studies and a lack of important student learning outcome measures. This systematic review found limited evidence that the clinical facilitator model is preferable to the preceptor model based on students’ preference and learning outcomes. It is evident that CEU model provided greater engagement and an enhanced learning environment compared with a standard facilitation model. However, this finding should be applied with caution due to the quality of the included studies. There is clearly a need for well-planned high quality studies to examine the effectiveness of different clinical placement models to provide best evidence-based practice in nursing education. (Jayasekara et al., 2018)

Formatting

Formatting documents according to the APA manual is crucial for students. APA is a writing style developed as a best practice for academic papers and is commonly required for use when writing papers in collegiate programs (Purdue Online Writing Lab, n.d.). Students should use the GCU library resources and GCU’s APA Style Guide, located on the Student Success Center. The APA manual includes information on how to format elements of a paper, such as headings, spacing, and indentations, as well as how to correctly reference, cite, and paraphrase sources of information. Omitting citations and poorly paraphrasing sources happens frequently and often leads to unintentional plagiarism. Plagiarism is a growing concern in education and has high incident rates in nursing education (Smedley, Crawford, & Cloete, 2015). Though colleges are using plagiarism prevention platforms, such as Turnitin, to check students’ work for plagiarized material, plagiarism remains a significant issue.

Academic Honesty

The issue of integrity is central to the world of nursing. Nurses are looked to as esteemed members of health care and society. Nurses are trusted to provide holistic and professional care to members of the community who are at their most vulnerable. In fact, according to an annual Gallup survey (2016) that looks at public trust in professionals, nurses have been ranked Number 1 as the most trusted profession for 15 years in a row (Norman, 2016). Integrity and honesty are crucial elements in upholding that reputation (Glasper, 2016). These defining characteristics are built during the education process. With that in mind, it becomes clear that academic integrity is the pathway to professional integrity as a nurse (Glasper, 2016).

The figure shows a signpost that has four signs pointing in different directions indicating &quot;Ethics,&quot; &quot;Integrity,&quot; &quot;Honesty,&quot; and &quot;Respect.&quot;It is essential to understand and recognize academic dishonesty because academic behaviors lay the framework for upholding professionalism as a bedside nurse. Lack of integrity and dishonesty has been shown to lead to poor decision making at the bedside, which leads to poor patient outcomes and decreased patient satisfaction (Morgan & Hart, 2013). In fact, studies have found a direct correlation between not upholding academic integrity and dismissing professional policy in the workplace (LaDuke, 2013). This link cannot be overlooked, as it directly correlates to attributes required and expected of professional nurses. Additionally, it supports the thought that ethical behaviors are learned early on and affect behavior at the bedside, directly impacting patient care and outcomes (Coffey, Zitzelsberger, & Anyinam, 2014). For instance, if students see no fault in committing plagiarism throughout their educational journey, they may see no fault in falsely documenting assessment data or details of a patient interaction. The repercussions of omitting sensitive assessment data within the patient chart could lead to a complication going unnoticed that could ultimately lead to harmful complications for the patient.

Going back to the case study at the beginning of the chapter, it had been many years since Julia was in school. She was working full time as a bedside nurse and going to school, all of which added stress and pressure to her personal and professional life. This could also be a determining factor for why plagiarism occurred. Typically, in cases of plagiarism, the student is extraordinarily remorseful and fully committed to rectifying the situation. Despite these alarming statistics and inquiries, providing resources to students to help avoid this dilemma becomes the correct focus.

Patient with Acute Kidney Injury

At the end of the shift, a nurse was working to complete patient charts, including one patient’s hourly urine output. The nursing assistant emptied the patient’s Foley catheter but did not record the number or tell the nurse what she projected the urine output to be. The nurse is tired after a long shift, so she decides to make up a number so she can finish charting and get home. She lies and documents the total urine output for the shift as 500cc. The physician making rounds notes the output and sees no issue. When the nurse returned to work the following night, the patient is being placed on hemodialysis. The nurse from the previous shift told her the patient’s urine output was critically low, only 5–8cc per hour all day, and the patient’s blood urea nitrogen (BUN) and creatinine levels continued to rise despite best efforts to aggressively rehydrate him.

The situation could have had a much different outcome if the nurse had taken it upon herself to document the appropriate assessment findings accurately instead of lying. Though seemingly rare, such circumstances may occur more often than realized. These outcomes lead to a lack of trust from the public and diminished perception of the nurses’ professionalism.

Plagiarism

Plagiarism is the use of another’s words or ideas without clear identification of the source (Price, 2014). Plagiarism can occur intentionally and unintentionally. Intentional plagiarism involves a person who knowingly copied the work of another individual and purposefully omitted credit to the original author to take credit for the ideas. Unintentional plagiarism usually involves ignorance and poor writing, paraphrasing, and referencing skills (de Souza, 2016). In general, cheating is seen as common among college students, and many do not see it as wrong (LaDuke, 2013).

Studies have shown that plagiarism, particularly among nursing students, is a growing concern and has a host of repercussions that do not solely affect the education process. Nursing is a profession based on ethics, integrity, and trust; committing plagiarism is a direct insult to such an esteemed profession. Plagiarism can affect student performance and impact EBP created to affect change in patient care (LaDuke, 2013). Such behaviors are contrary to the Code of Ethics for Nurses, which summarizes the importance of maintaining and modeling exemplary behaviors such as honesty and integrity.

Table 1.1
Plagiarism Example

Source

Heinich, R., Molenda, M., Russell, J. D., & Smaldino, S. E. (1999). Instructional media and technologies for learning. Upper Saddle River, NJ: Prentice-Hall.

Original Source Material

Constructivism is a movement that extends beyond the beliefs of the cognitivist. It considers the engagement of student in meaningful experiences as the essence of learning. The shift is from passive transfer of information to active problem solving. Constructivists emphasize that learners create their own interpretations of the world of information.

Plagiarized Version

Constructivists do not hold views entirely opposed to those of the cognitivists. The position of constructivists extends beyond the beliefs of the cognitivist.

Reference

Heinich, R., Molenda, M., Russell, J. D., & Smaldino, S. E. (1999). Instructional media and technologies for learning. Upper Saddle River, NJ: Prentice-Hall.

Correct Version

Constructivists do not hold views entirely opposed to those of the cognitivists. The position of constructivists “extends beyond the beliefs of the cognitivist” (Heinich, Molenda, Russell, & Smaldino, 1999, p. 17).

Reference

Heinich, R., Molenda, M., Russell, J. D., & Smaldino, S. E. (1999). Instructional media and technologies for learning. Upper Saddle River, NJ: Prentice-Hall.

Note. Adapted from “How to Recognize Plagiarism” by Indiana University Bloomington, School of Education, 2014. Copyright 2014 by the Indiana University Bloomington, School of Education.

Why Do Nursing Students Plagiarize?

The figure is a student who looks stressed out while reading a textbook, while in the background the words &quot;Projects,&quot; &quot;Work,&quot; &quot;Essays,&quot; and &quot;Finals&quot; represent her concerns.Studies have found that plagiarism among nursing students is usually the result of their unfamiliarity with writing and the pressure they feel to get work completed while balancing a full plate of responsibilities (Morgan & Hart, 2013). Research has discovered that up to “94% of nursing students have seen another student cheat,” (LaDuke, 2013, p. 402). Other studies have indicated a connection to online programs and the lack of face-to-face interaction as a direct factor in upholding academic integrity (Morgan & Hart, 2013). Also, the amount of work expected within the nursing program is staggering; one study indicated that, “in nursing, there is a higher proportion of essay material required for students to produce than in other types of healthcare courses,” (de Souza, 2016, p. 19). Most RN-BSN students continue to work full time, attend classes, and balance a full family/home life, which can lead to an elevated level of anxiety that could then lead to unethical academic behavior (Hidle, 2014). These elements all contribute to the rise of unethical student behaviors in nursing education.

Paraphrasing

One of the most significant contributors to plagiarism is the ineffective use of references and paraphrasing (Hunker, et al., 2014). Merriam Webster defines paraphrasing as, “a restatement of a text, passage, or work giving the meaning in another form” (Paraphrase, n.d.). Paraphrasing is putting something found within a source into one’s own words versus directly quoting the work. While the use of paraphrasing may seem straightforward, it has become apparent that its misuse can be a big contributor to plagiarism (Rogerson & McCarthy, 2017).

Paraphrasing is a useful skill and can beautifully convey the writer’s understanding of a topic; however, changing a few words or using synonyms and expecting the result to be considered paraphrasing is insufficient. Proper paraphrasing involves synthesizing the given material and being able to reiterate in a way that exemplifies its meaning as well as giving credit to the original author with proper citation. Summarization is similar, requiring proper credit to the original work’s author but may reflect a more basic overview of the material (Eberle, 2013).

Table 1.2
Poor vs. Correct Paraphrasing

Original Quote

“New tracks aside, the challenge is at the bare minimum to bring light and air into this underground purgatory and, beyond that, to create for millions of people a new space worthy of New York, a civic hub in the spirit of the great demolished one, more attuned to the city’s aspirations and democratic ideals” (Kimmelman, 2012, para. 10).

Poor Paraphrase

Besides replacing the railroad tracks, the toughest part is to at least bring air and light to Penn Station. Millions of people in New York are deserving of a new civic hub, constructed in the same essence of the one that was leveled so many years ago. Moving forward with such a development ties in with the city’s enthusiasm for beauty and architecture

Effective Paraphrase

One of the biggest issues facing Penn Station’s revitalization is developing a brighter, airier space. It is an abysmal “underground purgatory,” (Kimmelman, 2012, para. 10) and with so many New Yorkers and tourists traveling in and out of its doors every day, it should be reconstructed to better reflect the endeavors and passions of the city.

Note. Adapted from “An Example of an Effective Paraphrase” and “An Example of a Poor Paraphrase” by EasyBib. Copyright EasyBib.

Students should also take caution when searching the Internet for tools or websites that may help develop paraphrasing material. The explosion of technological advancements and ease of access to these types of programs has made the opportunity for cheating or plagiarizing more appealing to students (Rogerson & McCarthy, 2017). Often these types of sources lead to plagiarizing and high similarity scores when papers are submitted to plagiarism prevention software such as Turnitin (Price, 2014). The best practice is for students to comprehend fully what scholarly writing involves and work to master the skill of writing scholarly papers, including accurately paraphrasing and avoiding plagiarism of material (Hunker et al., 2014). Avoiding plagiarism begins with understanding what it is, the consequences of the offense, and how it impacts the nursing profession.

Online Learning Platforms

As technology continues to advance and shape the future, it is evident that education will be affected along with it. Online learning has become commonplace, and its development continues to grow exponentially as the demand for flexible higher education choices continues to flourish. With that in mind, students must be mindful of the risks that online education delivers. Access to a large variety of sources through the Internet makes plagiarism and unethical academic practices easier than ever before. While acts of intentional plagiarism are less frequent, it is not uncommon for students to attain work from each other and even opt to purchase papers from sources providing such services. While the thought is reprehensible to some, the prospect of passing courses and getting through what may be considered an obligatory degree may prompt these behaviors. These acts are not only dishonest, but also a direct reflection of personal morality and the overall integrity of the nursing profession (Ganske, 2010).

Plagiarism Prevention Software

The figure is a graphic showing a student using online resources, such as messaging, videos, and e-mails, to conduct her online learning. Flow lines establish the inter-connectivity of these resources.As universities acclimate to the growing trends seen in education, there has been an influx of the use of plagiarism prevention software, such as Turnitin. These programs aim to reduce the incidences of plagiarism by comparing material submitted to existing works to catch gross negligence before students submit their assignments. While these types of programs are helpful to avoid large errors, they are not to be used in place of individual edits and review. These platforms are notorious for their inability to identify basic synonym replacements, as well as an inability to determine the use of an online paraphrasing tool within the work, both of which can constitute plagiarism (Rogerson & McCarthy, 2017). Students should understand that there are limitations to technology and review their work and have it peer reviewed for clarity and errors that can be edited before final submission.

Nurses are members of a profession in which being an expert is essential to providing thorough care (Glasper, 2016). Plagiarism and/or inappropriate use of paraphrasing may indicate a lack of understanding of the material, suggesting that the student may not fully grasp the concepts presented (Eberle, 2013). This, in turn, could lead to a population of nurses who may have achieved a baccalaureate degree without fully appreciating or applying the knowledge they worked so hard to attain. Also, the inability to thoroughly evaluate and understand presented concepts may lead to an inability to appreciate latest EBP and its implications for nursing practice.

EBP: Implications for Nursing Practice

EBP uses the latest evidence to drive change to patient care policies and procedures to optimize patient outcomes (Brower & Nemec, 2017). A proper understanding of EBP and its influence is critical for nurses to make decisions that fully impact patient care; therefore, it is evident that scholarly writing influences the nursing profession.

EBP is the driving force behind many practice revisions and updates in nursing (Stevens, 2013). From the time nursing students begin their education, the concept of EBP and its vital necessity in nursing practice is reiterated time and again. EBP drives nurses to increase their critical-thinking skills, observing and processing information as they practice and brainstorming ideas to make improvements. EBP takes nurses from being task-oriented to being educated problem solvers who use the scientific process to make relevant changes that impact their patients’ care and outcomes (Brower & Nemec, 2017). A report from the Institute of Medicine (IOM) (Olsen, Aisner, & McGinnis, 2009) stated that, “by 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information and will reflect the best available evidence,” (p. 9). Following the IOM recommendations, most facilities base their patient care protocols on EBP to render optimal patient care outcomes. EBP is essential to nursing practice and is at the forefront of improving patient care.

Quality Improvements and Patient Outcomes

EBP is the foundation on which quality improvements are made, thus directly impacting patient outcomes. Experienced nurses can see these changes regularly occurring in their daily practice. EBP has the power not only to increase positive patient outcomes, but it also gives nurses a voice and the ability to help create sustainable changes in nursing. The ability to understand EBP’s importance and how its integration impacts nursing is an element of critical thinking that can be attained by learning to construct scholarly papers and being able to glean and apply knowledge presented throughout the baccalaureate program. The correlation and impact of these elements and what they mean for nursing cannot be overlooked. These skills are the foundation for fully appreciating knowledge gained in higher education (Stevens, 2013).

Application of Evidence in Nursing Practice

After evaluating evidence, it became apparent that making small changes for ventilated patients decreased their overall rates of acquiring pneumonia. A ventilator acquired pneumonia (VAP) prevention protocol was created and implemented that included small practice changes such as maintaining the patient’s head of the bed at 30 degrees at all times, administering a chlorhexidine mouthwash twice a day, and administering a peptic ulcer prophylactic medication daily. These implementations led to a remarkable decrease in the occurrence of VAP, thus markedly improving patients’ overall outcomes (DeJuilio, Rivera, & Huml, 2012).

Leadership

Leadership is a defining factor in nursing. Nurses assume the responsibilities of a leader in day-to-day practice regardless of formal role. Nurses lead by delegating tasks to other members of the health care team, as well as managing their patients overall care throughout a given shift. Effective leadership is rooted in ethical behavior; therefore, the element of academic integrity is a stepping stone to becoming an effective nurse leader. Hallmarks of nursing, including honesty, integrity, morality, and professionalism, are all traits of leaders as well. Nurses also have the continued opportunity for growth and career advancement into formal leadership roles such as nurse managers and supervisors. It is essential that nurses consider their ethical behavior and use it as a framework for their developing career as a nurse (Morgan & Hart, 2013). Doing so contributes to personal growth as well as the development of professionalism in nursing.

Reflective Summary

Scholarly writing is not just another hurdle to get through during the education process. Scholarly writing plays a significant role in the learning process and the overall comprehension of knowledge and has a direct effect on the nursing profession. The development of necessary skills, including formatting, are necessary to become a more proficient writer and effective communicator. Essential in this process is the understanding of plagiarism and cheating and its direct impact on the professional integrity of the nursing profession. Given the proper guidance and tools, students can overcome these academic challenges and become effective writers who succeed in advancing their professional goals.

Key Terms

Academic Dishonesty: The use of unauthorized assistance to complete assignments or deceive faculty and colleagues to pass a course or complete a program of study.

Academic Integrity: The upholding of moral and ethical values, such as honesty and integrity, when completing assigned academic work.

Citation: Method of attribution writers use to identify the source of information being used in their own work.

Database: A large collection of data organized especially for rapid search and retrieval.

Ethical: Concepts and beliefs regarding right, good, law-abiding, honest, and respectable behaviors; regarding moral values.

Evidence-Based Practice (EBP): The integration of clinical expertise, the most up-to-date research, and patient’s preferences to formulate and implement best practices for patient care.

Integrity: The quality of being honest and having strong moral principles; moral uprightness.

Literature Review: Evaluative report of scholarly articles that support the primary subject of the work being written.

Nursing Research: A detailed systematic study of a problem in the field of nursing. Nursing research is practice- or discipline-oriented and is essential for the continued development of the scientific base of professional nursing practice.

Online Learning: Formalized teaching method using technological platforms to deliver content to students.

Paraphrasing: To express content written by another writer using different words, especially to achieve greater clarity.

Peer-Reviewed Articles: Research studies that have been evaluated by experts in the field prior to publication.

Plagiarism: The practice of taking someone else’s work or ideas and passing them off as one’s own.

Professionalism: The competence, skills, and exhibited behavior of a set of trained workers (e.g., nurses, doctors, engineers).

References: Crediting scholarly sources within written work and within the reference section or bibliography of a scholarly paper.

Scholarly Writing: The process of writing based on careful thought, research, and applying learned concepts.

Summarize: To give a brief statement of the main points of something.

Technology: Methods, systems, and devices that are the result of scientific knowledge being used for practical purposes.

References

Purdue Online Writing Lab. (n.d.). APA Style Workshop. Retrieved from: https://owl.english.purdue.edu/owl/resource/664/1/

Borglin, G. (2012). Promoting critical thinking and academic writing skills in nurse education. Nurse Education Today, 32(5), 611-613. doi:10.1016/j.nedt.2011.06.009

Brettle, A., & Raynor, M. (2013). Developing information literacy skills in pre-registration nurses: An experimental study of teaching methods. Nurse Education Today, 33(2), 103-109. doi:10.1016/j.nedt.2011.12.003

Brower, E. J., & Nemec, R. (2017). Origins of evidence-based practice and what it means for nurses. International Journal of Childbirth Education, 32(2), 14-18.

Coffey, S., Zitzelsberger, H., & Anyinam, C. (2014). Academic integrity leads on to ethical practice. Nursing Standard, 29(4), 68.

de Souza, J. (2016). The plagiarism problem—reflections on plagiarism and nursing students. HLG Nursing Bulletin, 36(1), 18-23.

DeJuilio, P. A., Rivera, S. J., & Huml, J. P. (2012). A successful VAP prevention program. RT: The Journal for Respiratory Care Practitioners, 25(6), 26-29.

Doncliff, B. (2016). The peer-review process in scholarly writing. Whitireia Nursing & Health Journal, 23, 55-60.

Eberle, M. (2013). Paraphrasing, plagiarism, and misrepresentation in scientific writing. Transactions of the Kansas Academy of Science 116(3-4), 157-167. doi:10.1660/062.116.0310

Ganske, K.M. (2010) Moral distress in academia. OJIN: The Online Journal of Issues in Nursing, 15(3). doi: 10.3912/OJIN.Vol15No03Man06

Glasper, A. (2016). Does cheating by students undermine the integrity of the nursing profession? British Journal of Nursing, 25(16), 932-933.

Hidle, U. (2014). The lived experience of associate degree nursing students intending to pursue the RN-BSN. International Journal of Nursing Education, 6(1), 249-253. doi:10.5958/j.0974-9357.6.1.051

Hunker, D. F., Gazza, E. A., & Shellenbarger, T. (2014). Evidence-based knowledge, skills, and attitudes for scholarly writing development across all levels of nursing education. Journal of Professional Nursing, 30(4), 341-346. doi:10.1016/j.profnurs.2013.11.003

Jayasekara, R., Smith, C., Hall, C., Rankin, E., Smith, M., Visvanathan, V., & Friebe, T. (2018). Review: The effectiveness of clinical education models for undergraduate nursing programs: A systematic review. Nurse Education in Practice, 29, 116-126. doi:10.1016/j.nepr.2017.12.006

Kimmelman, M. (2012). Restore a gateway to dignity. The New York Times. Retrieved from http://www.nytimes.com/2012/02/12/arts/design/a-proposal-for-penn-station-and-madison-square-garden.html.

LaDuke, R. D. (2013). Academic dishonesty today, unethical practices tomorrow? Journal of Professional Nursing, 29(6), 402-406. doi:10.1016/j.profnurs.2012.10.009

Morgan, L. & Hart, L. (2013). Promoting academic integrity in an online RN-BSN program. Nursing Education Perspectives, 34(4), 240-243. doi: 10.5480/1536-5026-34.4.240

Norman, J. (2016). Americans rate healthcare providers high on honesty, ethics. Retrieved from: http://news.gallup.com/poll/200057/americans-rate-healthcare-providers-high-honesty-ethics.aspx

O’Brien, S. P., Marken, D., & Bennett Petrey, K. (2016). Student perceptions of scholarly writing. The Open Journal of Occupational Therapy, 4(3). doi: http://dx.doi.org/10.15453/2168-6408.1253

Olsen, L., Aisner, D., & McGinnis, M. (Eds.). (2009). The learning healthcare system: Institute of Medicine roundtable on evidence-based medicine—Workshop summary. Washington DC: National Academies Press.

Paraphrase. (n.d.). In Merriam-Webster’s online dictionary (11th ed.). Retrieved from https://www.merriam-webster.com/dictionary/paraphrase

Price, B. (2014). Avoiding plagiarism: guidance for nursing students. Nursing Standard, 28(26), 45-51.

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The Connection Between Academic and Professional Integrity

The Connection Between Academic and Professional Integrity

 

write a 2- to 3-paragraph analysis that includes the following:

Explanation for the relationship between academic integrity and writing
Explanation for the relationship between professional practices and scholarly ethics
Cite at least two resources that support your arguments, being sure to use proper APA formatting.
Use Grammarly and SafeAssign to improve the product.
Explain how Grammarly, Safe Assign, and paraphrasing contributes to academic integrity.