Nursing Leadership Case Study 2022

Running head:NURSING
Nursing Leadership Case Study
Name of the Student
Name of the University
Author Note

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With the increasing world population, the need for efficient and widespread
healthcare is increasing continuously. The major healthcare personnel are the nurses who
work closely with the patients and provide them with the best possible healthcare. Registered
nurses are the highest designation among the nurses and thus have a high degree of
responsibility as well. According to the NMBA Registered Nurse Standard of Practice, they
are responsible for providing the best possible patient-centred care in a facility, collaborate
with the patients, check their vitals and monitor them as well
(Nursingmidwiferyboard.gov.au, 2020). Apart from that, they have the added responsibility
of leading and supervising the enrolled nurses and nursing assistants and delegating tasks to
them as well. Strong clinical leadership is indispensable for administering quality healthcare
to the patients and ensure the best possible outcomes (Boamah 2018). Clinical leadership can
be described as a way to influence nurses in the team to work towards the same goal- that is
good quality patient care both on an organizational level and individual level (Joseph and
Huber 2015). In the current scenario, Konstantina (Connie) Galonos is a seventy-nine-year-
old patient currently admitted for a lower leg amputation. The aim of this essay is to pinpoint
the role of the Registered Nurses with respect to this case study, in terms of clinical
leadership, patient care and as a part of a collaborative healthcare team.
According to the Clinical Reasoning Cycle (Utas.edu.au, 2020), the first steps are to
describe the patient situation and collect patient cues. Here, Connie is a widow who has been
admitted for lower limb amputation due to large ulcer on her heel and gangrenous toes. That
ulcer is likely caused by her long history of Insulin Dependent Diabetes Mellitus, also called
Type I Diabetes Mellitus (Weledji and Fokam 2014). She also suffers from chronic renal
failure and hypertension. Ten years ago she underwent a hemicolectomy for her bowel cancer
and hence had a permanent colostomy since. She has been coming to the outpatient
department for colorectal, diabetes and renal care. As for the cues she has been reported to be

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mediocre in English and from her history of regularly visiting the church, she may be
religious. It is also observed that she is in visible distress even though her daughter has
consoled her. By processing these cues and information, the areas of priority regarding
administering healthcare to her can be identified. The first priority of care is to make sure the
gangrene in her toes does not spread to fast before amputation and prepare her for the surgery
physically. Often, amputation is the foolproof way to treat gangrene. Before that, antibiotics
should be administered to the patient to make sure that the spread is minimal before the
patient undergoes surgery (nhs.uk, 2020). The Registered nurse must conduct all necessary
assessments like nutritional assessment and screening for MRSA. Her vitals should be taken
and recorded as a part of the process to make sure she is ready for the operation (Ruff 2015).
Patients with diabetes or other comorbidities have a higher chance of developing
complications; hence all the possible tests, including blood pressure, blood glucose,
electrolytes must be taken (Virani et al. 2015). This ensures patient safety and is a major
responsibility of the registered nurses. Postsurgical prosthetics if required, must also be
planned out beforehand (O'Keeffe and Rout 2019). Physiotherapy must also be considered
(Dekker et al. 2018). Since the patient also has chronic renal failure and hypertension, it
should be made sure that she is kept under close monitoring. If she requires dialysis or
emptying the colostomy bag, that should be done as well.
Another major priority is to make her feel safe and psychologically prepare her for her
amputation, and Registered Nurse plays a major role in the process. It must be remembered
that while she is familiar with the outpatient department, she has not really been admitted
often. She is mediocre in English, and it is possible that she is feeling uncomfortable and not
being able to completely express herself. She often relies on her family and friends for
support, but she appears to be visibly distressed even after her daughters attempt to console
her. She might be feeling trapped even. Patients undergoing amputation often feel distressed

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in general; some even feel some sort of grief. These issues may also be related to body image
and self-identity (Hanna 2019). Connie is religious, so it is possible that he might have some
additional stress. So, the nurse must support her and make her feel safe. She must also be
educated on why it is important to amputate and how she must take care of it. Patient and
family education is the most important part of pre-amputation preparation (Virani et al.
2015). The registered nurse must also formulate a care plan to manage Connie's condition and
teach her the necessary ways to manage her anxiety. She and her family should also be taught
of the fall risk she may have after the amputation. The registered nurse must be culturally
competent while speaking to Connie as she is Greek, and she must not feel that her mediocre
English or culture is affecting her healthcare. It is also important that the nurse makes sure
that she understands everything being told to her because that is the fundamental requirement
of patient education and support. The nurse must be coherent, clear, as well as respectful in
this process. The actions taken for both the priorities fall under the scope of practice of
Registered Nurses (Smolowitz et al. 2015).
All of these responsibilities fall on the Registered Nurse, and she must provide
healthcare to the patient and lead her team to do the same. She must delegate the tasks like
assessing the patient and giving antibiotics to the nurses and focus on patient education. She
must oversee the whole process and the come up with the care plan. Since this is a long plan,
it requires a number of nursing professionals from a multi-disciplinary team. The registered
nurse must involve all the professionals required. For example, she needs to come up with the
care plan prior to starting the process. She must appoint a nurse specifically to take her vitals
and to support her as well. It is usually the job of the Registered Nurse to speak with the
family. In this case, the Registered Nurse must speak with the daughter of the patient Anna. It
is necessary to explain the pre-amputation precautions must be taken, the post-amputation

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care, including the possible options and paths of rehabilitation that may be taken
(Ouh.nhs.uk, 2020).
The role of the Registered Nurse in a collaborative team is to ensure that everyone is
on the same page about the patient. The registered nurse usually leads the team and oversees
the care. Stable and efficient clinical leadership is extremely important to ensure the best
patient outcome. This is done by supervising the nurses on how exactly to improve their care.
The Registered nurse, in this case, the leader, must discuss Connie's condition and the distress
she is facing in terms of her amputation. They should discuss the care plan that has been
come up with and make sure that everyone on the team has agreed with it. If anyone in the
team has any improvements to suggest, they can talk about that, and the nursing leader should
consider it. After everyone in the team has agreed on a plan, the task delegation will be done
so that the care can be administered. It is also important that the Registered Nurse must
collaborate with the patient effectively. While talking to the patient during educating and
supporting her, the nurse must ensure that Connie is on board with every step that is being
taken. If she is apprehensive about anything, she should be explained why that step is
important. It will also be a good idea to discuss her care plan with her. The talk about post-
amputation care such as prosthetics must be discussed or at least touched upon prior to the
procedure. Only this will ensure successful collaboration and teamwork, which will ensure
desired patient outcome (Bosch and Mansell 2015). This will signify a better quality of
healthcare.
According to the principles of clinical leadership, the major focus should be on patient
care in order to ensure the best quality of care and the best outcome (Mianda and Voce 2017).
In this context, this means the Registered Nurse planning out the priority goals, care plan for
the patient with active collaboration from Connie and Anna and successfully carrying out the
plans. This also adheres to NMBA standards of practice for Registered Nurses, according to

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which they are required to administer the best quality patient-centred care and actively take
part in the whole healthcare process (Nursingmidwiferyboard.gov.au, 2020). The principle of
clinical leadership also states that a successful clinical leader should take the front role in
providing healthcare to the patient, no matter their position or designation in the healthcare
system. These duties include orienting the direction of care, encouraging co-workers to work
towards a set goal, promote professional cooperation and teamwork, standard practice and
collaboration between the nurses and the patient (Bosch and Mansell 2015). They must also
ensure that the facility has all the resources needed for the best possible patient care. Lastly, it
also includes continuous medical education. This signifies high contribution towards
administering patient care and is very important to build team spirit (Mianda and Voce 2017).
In this case, it means that the nursing leader must be constantly available to guide the nurses
in Connie's case and patiently answer any questions that the nurses or Connie or Anna might
have. For example, Connie has a colostomy. Some nurses may not be experienced with
colostomy bags so the Registered Nurse must guide them. They must also make sure that
there is a plan in place for post-operative therapies required for Connie, like referrals for
prosthetics if she wishes for them.
From working with Connie during her amputation and post-amputation care, there is a
vast opportunity for reflection and nursing. This case can be helpful to both the Registered
Nurse and the nursing team in general as a learning opportunity. Connie had a number of
comorbidities, and it is possible that many of the nurses may not be experienced with either
colostomy or renal failure or gangrene. This case will help them gain experience and learn
how to care for similar patients. From a nursing leader point of view, it contributes to the
experience on how to care for an elderly patient like Connie. It provides useful insights on
patient communication as Connie is not a native English speaker, is religious and distressed.
According to the NMBA Standards of practice, communication and patient education are one

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of the most important aspects of a Registered nurse's practice
(Nursingmidwiferyboard.gov.au, 2020). So, this case study provides an opportunity for
culturally competent communication to an elderly patient and provides insight on how to
carry out conversations that may be psychologically distressing to the patient (Smith 2017).
Overall, this case study requires that the nurse strictly adheres to the NMBA standards of
practice for Registered Nurses and ensure best quality patient care for Connie
(Nursingmidwiferyboard.gov.au, 2020).
From this essay, it can be concluded that the principles of clinical leadership are vital
in caring for a patient, and the case study of Connie is a perfect example of that. The NMBA
standards of practice for the Registered Nurses align with the principles of clinical leadership,
in the context of administering best patient-centred care, working and encouraging the co-
workers, collaborating with the patient and communicating and supporting the patient
throughout the process. In Connie's case, using the clinical reasoning cycle, his care priorities
were selected, which included taking care of the gangrene and assessing the patient before
amputation and providing psychological support for the patient. The major points here was
the need for cultural competency and coherence for the patient. The Registered nurse
communicated with the patient Connie and her daughter Anna in order to make sure that they
were okay with the whole procedure. Post-amputation care was also planned. The whole
procedure adhered strictly to the NMBA guidelines and thus ensures best quality patient care
and desired patient outcomes.

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