Case Study, Chapter 3, Developing Effective Leaders to Meet 21st-Century Health Care Challenges

An experienced registered professional nurse has just been promoted as the nurse manager of a nursing unit. The nurse had been a very effective leader on the unit prior to the promotion of becoming the nurse manager. The new nurse manager is making a list of essential characteristic of effective leaders.c

1. What are factors that are driving the need for innovative and transformational leaders in health care for the 21st century?

2. What are essential characteristics of an effective leader that the new nurse manager needs to incorporate into the nursing unit culture?

3. The nurse manager is reviewing the strengths and weaknesses of three leadership models: transactional, transformational, and complexity. What are the essential characteristics of the three leadership models? Which model do you think is most effective to use in leading a nursing unit? Why?  

             

 

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The question is posted below regarding nursing ethics. The text to be referenced and rubric is attached (Cherry, B., & Jacob, S. (2016). Contemporary nursing: Issues, trends, and management (7th ed.). St. Louis: Mosby Elsevier. ISBN: 0323390226). 

The assignment must be in APA format. This should be a 1-2 page paper. Turn it in report is requested.

SCENARIO

You have been working as a nurse in the adult oncology unit for the past year. You have developed a close relationship with many of your patients, but Mr. Newcomb has a special place in your heart. He has been diagnosed with stage 4 pancreatic cancer and has undergone aggressive chemotherapy. Each day his wife has come to the unit to be with her husband. They have been married for over 40 years and share a deep love.

Mr. and Mrs. Newcomb have made the decision to no longer continue with treatment and have decided that hospice care is needed. Over the past few days, you have watched Mr. Newcomb’s health decline, and you can tell from your experience that he does not have much time left to live. Mr. Newcomb has been very open about discussing his death, and you have had the opportunity to learn about his life and the legacy he will leave behind.

While you are completing your rounds, you stop in Mr. Newcomb’s room to see how he is doing. You ask, “Is there anything else I can do for you?” Mr. Newcomb has rarely asked for anything, but today he has one request. Mr. Newcomb states, “Before I die, I would like to see my mistress one more time. Mrs. Newcomb is always here. Do you think you could tell her that I will be busy for a few hours tomorrow so I can make arrangements to see my mistress one more time?”

Reflect on the following questions before you begin working on this task:

•  What would you do in this scenario?

•  How can your knowledge of ethical principles be utilized to determine your response to Mr. Newcomb?

•  How would this affect you as a nurse and direct provider of care for Mr. Newcomb?

REQUIREMENTS

A.  Summarize how the principles of beneficence, non-maleficence, autonomy, and justice apply to the scenario by doing the following:

1.  Describe how you would respond to Mr. Newcomb’s request.

2.  Evaluate how you applied the principles of beneficence, non-maleficence, autonomy, and justice to the scenario.

3.  Examine how personal beliefs and values influenced your response to the scenario.

4.  Describe three strategies to promote self-care.

B.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

C.  Demonstrate professional communication in the content and presentation of your submission.

 

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 Complete all five of the evidence appraisals using the the correct appraisal form. There are two different appraisal forms. The appropriate one should be used for the specific article.  There are five articles that need to be appraised. I provided in the attachments the different appraisal forms, and the five articles.

 

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                                  I need this project completed in 4-5 hours

Description: 

Reflect on the research articles you have reviewed to date that relate to your clinical question. Please refer to all the unit resources (e.g., readings, recordings, announcements, etc.) to facilitate this process. With these thoughts in mind, post your thoughts on the following:

1. In the articles you have reviewed, what statistical tests are being used for data analysis?
2. Are the statistical tests being used appropriately for the type of data being produced and the question being asked?
3. Do the authors appropriately indicate implications of the data analysis, or do they overstretch?

In the articles that have I reviewed listed below, I need to know what statistical tests are being used for data analysis?

· A key study for my PICOT project is titled “How Accurate are Self-Reports? An Analysis of Self-Reported Healthcare Utilization and Absence When Compared to Administrative Data” (Koerner & Zhang, 2017).  The authors evaluated the data using Pearson’s correlation and multivariate logistic regression models. 

·  Correlation is a statistical method used to assess a possible linear association between two continuous variables, while Pearson’s correlation coefficient is a test statistics measuring the statistical relationship, or association, between two continuous variables (Mahan, Clark, Anderson, Koller, & Gates, 2017).. Pearson’s correlation coefficient (r) is a measure of the strength of the association between the two variables; it is the best method of measuring the association between variables of interest because it is based on the method of covariance, and covariance is a measure of the joint variability of two random variables (Koerner et al., 2017). If the data is normally distributed, in other words, bell-shaped, and symmetrical about the mean, tests such as the histogram, and normality tests may be used to evaluate if the distribution is normal (McCrum-Gardner, 2008). 

· Are the statistical tests being used appropriately for the type of data being produced and the question being asked?

· The majority of studies may be evaluated with the proper evaluation of over 100 statistical tests to choose from. Tests are chosen depending on the type of research questions being asked, the type of data being analyzed, and the number of data sets or groups being evaluated.

· The first question to be asked is what scale of measurement the data will be, nominal, ordinal, or interval. The study in question involves interval data. The second question is the reason for the analysis; as an example, paired groups or independent groups? 

· Yes, the statistical tests are appropriate for the type of data being produced, and for the type of questions being asked.

· Do the authors appropriately indicate implications of the data analysis, or do they overstretch? 

· Based on our readings and videos, I saw no evidence of data-stretching. For example, data was collected over two calendar years, a lengthy, non-selective inclusion period. A potential confounding factor was that all participants had to have been enrolled in the company health insurance program a minimum of 320 days as a condition of inclusion in the study. Another potential confounding factor was that only hourly employees were included in the two-year study. In addition, pregnant employees were excluded from the study, as these employees are atypical of the general employee population in that their healthcare utilization would be temporarily altered. These factors may have influenced the results, by excluding participants with different reporting habits. After recognizing these potential limitations, their findings mirrored multiple studies previously conducted. 

· The authors also noted potential improvements for future studies, including inclusion of a more diverse employee population, and examining why there exists a difference in self-reporting based on participant sex.

                                                                          References

· Koerner, T. K., & Zhang, Y. (2017). Application of linear mixed-effects models in human neuroscience research: A comparison with pearson correlation in two auditory electrophysiology studies. Brain Sciences, 7(3), page 26. doi:http://dx.doi.org.prx-usa.lirn.net/10.3390/brainsci7030026

· Mahan, K.R., Clark, J.A., Anderson, K.D., Koller, N.J., & Gates, B. J. (2017). Development of a tool to identify problems related to medication adherence in home healthcare patients. Home Healthcare Now, 277-82. doi: 10.1097/nhh.0000000000000539

· McCrum-Gardner, E. (2008).  Which is the correct statistical test to use? British Journal of Oral and Maxillofacial Surgery 46 (2008) 38–41 

· Short, M., Goetzel, R., Pei, X., Tabrizi, M., Ozminkowski, R., Gibson, T., & … Wilson, M. (2009). How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. Journal of Occupational & Environmental Medicine, 51(7), 786-796. doi:10.1097/JOM.0b013e3181a86671

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Types of Statistical use

           There were six articles retrieved on my PICOT question, (3) were quantitative research, (1) is a mixed method, (2) qualitative research, and (1 )integrative review. The (3) quantitative research were critically appraised and used the following statistical analysis; central standard tendency (mean, median, mode), a probability value to test the significance of results, binomial regression, and binomial distribution, chi-square test, Fisher’s exact test, and measures of standard deviation. Lastly, a study about changing Intensive Care Unit (ICU) culture to reduce CAUTI the research study used statistical process control charts to see the process of improvement in the reduction of catheter-associated infection post-implementation (Maxwell, Murphy and McGettigan, 2018). 

Appropriateness of the statistical test 

The purpose or hypothesis of the study is in the introduction of each literature. The research question aims to evaluate the effectiveness of the CAUTI bundle in the pediatric intensive care unit and adult intensive care unit. To provide patient safety, the use of an appropriate statistical tool in research is essential. According to McCrum-Gardner (2007), using the right scale of measurement will convey accurate results in research.  One research study use sample size is 390 (nominal) children ages from 1 month to 18 years old and admitted in the ICU for 48 hours that needed foley catheter insertion. The exclusions are positive urine culture and less than 48 hours of ICU admission. In addition, the Categorial variable is analyzed using X2 or Fisher exact test. The prevalence rate was calculated using the number of disease within the specified time over the population under risk x 100. The research study shows Foley catheter utilization was calculated by dividing the total number of device days by the total number of patient days (Sönmez Düzkaya, Bozkurt, Uysal, and Yakut,2016). Moreover, the three quantitative research use an appropriate tool and results show that daily CAUTI BUNDLE implementation and changing ICU culture regarding the standard practice showed a significant reduction of catheter-associated urinary tract infection in pediatric ICU and adult ICU.

Conclusion

           The implication of the research study indicates that prevention of CAUTI with the use of CAUTI bundle checklist and application of process improvement had a significant impact on the decreasing morbidity, mortality and healthcare cost. Also, the length of study allowed the researchers to see a significant, consistent change in the reduction of CAUTI.  

References

Maxwell,M.,Murphy, K., and McGettigan, M. (2018)Changing ICU culture to reduce catheter-associated urinary tract infections. Canadian Journal of Infection Control,33 (1) ,39-43 . Retrieved from https://ipac-                   canada.org/photos/custom/pdf/Marcia%20Maxwell_Spring2018.pdf

McCrum-Gardner, E. (2007). Which is the correct statistical test to use?British Journal of Oral and Maxiofacial Surgery, 46, 38-41. Retrieved from https://class.esa.edu/bbcswebdav/institution/USA1/201830/MSN/IPE_7050/readings/McCrumGardner_Which_is the_correct_ statistical_test_to_use_pdf        

Sönmez Düzkaya, D., Bozkurt, G., Uysal, G., & Yakut, T. (2016). The effects of bundles  on catheter-associated urinary tract infections in the pediatric intensive care unit.Clinical Nurse Specialist: The Journal For Advanced Nursing Practice, 30(6),341-346. doi:10.1097/NUR.0000000000000246

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To prepare:

• Review the Learning Resources for this week, focusing on the role of nurse managers in making financial decisions.
• Conduct additional research in the Walden Library and other relevant sources, to identify three emerging trends that are affecting health care today.
• Select one trend to discuss in detail and evaluate its implications for the delivery of care from the perspective of doctors, nurses, and patients.
• Reflect on how this trend might impact quality of care.

By Day 3

Post a brief description of three emerging trends that are affecting health care today. Evaluate the implication of one of these trends on the delivery of health care from the perspectives of doctors, nurses, and patients. Explain how this trend might impact the quality of care.

 

Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.
Chapter 2, “Four Things the Healthcare Manager Needs to Know About Financial Management Systems” (pp. 11–20)
This chapter focuses on the overall financial management system within an organization and identifies the basic system elements.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.

Chapter 1, “The Context of Health Care Financial Management” (pp. 1–23)
This chapter offers differing perspectives on the causes of a “health care system in distress.” The chapter explores the factors behind rising health care costs, the efforts to control costs, and the ethical issues that affect both.
Note: This eBook is accessible through the Course Readings List located in the Course Materials section of the Syllabus.

Sanford, K. (2011). The case for nursing leadership development. Health care Financial Management, 65(3), 100–104, 106. 
Retrieved from the Walden Library databases.

This article details the costs of ineffective management and leadership to a health care organization. Management and leadership are defined as “a discipline” and “an art,” requiring commitment to the organization’s goals, to the team, and to the patient.

Waldman, D. (2014). The health of healthcare, part V: Is the very freedom of providers at risk? The Journal of Medical Practice Management: MPM, 29, (6), 366-368.
Reprinted by permission of Greenbranch Publishing via the Copyright Clearance Center.

This article discusses how U. S health providers lose their fiduciary responsibility to patients when compliant with the Affordable Health Care Act.

Studer, Q. (2010). Do your nurses speak finance? Health care Financial Management, 64(6), 80–84.
Retrieved from the Walden Library databases.

This article discusses the importance of nurses understanding finance in a health care organization. The article stresses the importance of teaching clinicians the skills necessary to understand and make a difference in the current financial system of health care.

King, M. (2012). Health reform: Special report. Health reform turns two: After passage of the Affordable Care Act, the work—and the criticisms—persist. State Legislatures, 38(3), 12–17.
Retrieved from the Walden Library databases.

This article discusses the Affordable Care Act and details changes that still need to be implemented. The article also examines how the legislation has altered the way state legislatures handle health care in the United States.

Harris, J. L., & Ott, K. (2008). Building the business case for the clinical nurse leader role. NurseLeader, 9(1), 28–31.
Retrieved from the Walden Library databases.

This article stresses the need for nurses and physicians to “take the lead” in teaming up with business and financial leaders in their organizations to make improvements. The author describes the benefits both business and financial leaders will reap from their enhanced relationship.

 

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