Clinical Leadership to Develop Nursing Practice

Running head: CLINICAL LEADERSHIP TO DEVELOP NURSING PRACTICE
CLINICAL LEADERSHIP TO DEVELOP NURSING PRACTICE
Name of student:
Name of university:
Author Note:

1CLINICAL LEADERSHIP TO DEVELOP NURSING PRACTICE
I am a registered nurse working in the emergency department. Our nursing challenges involve
to improve patient satisfaction and quality of health care. A patient Julie has been admitted
with injuries due to road traffic accident. She has developed infections at the injury site and
received antibiotic administration after a gap of 8 hours post presentation. This resulted in
serious consequences with manifestations of sepsis and cellulites due to lack of
communication and team work coordination in transitional care. I have performed research
on transitional care errors; I will discuss that evidence based practice can benefit health care
professionals to increase patient outcomes by improving patient safety and reducing
treatment accidents. Accurate nursing practice is brought about through transformational
leadership skills in nursing profession, which can bring significant improvement in patient
health quality (Beckett et al., 2013). I will provide a summary and analysis of evidences
unfolded during my literature research. Finally, I will provide an implementation plan on new
nursing practice with the help of transformational leadership qualities to minimize the
transitional care errors.
In Julie’s case, she reported with injuries in face, legs and jaws in the emergency
department where she underwent a delay in antibiotic administration and shifted to a medical
ward. She was manifested with sepsis and cellulites. At the point of emergency admission,
there was a delayed approach by the health care staffs. Adequate immediate supportive
therapy to manage the accidental trauma was lacking; a generalised evaluation approach was
performed by the emergency management team. The patient was thereafter shifted to the
general ward and prescribed antibiotics to relieve associated fever and infections.
How ISBAR communication tool can improve communication between
multidisciplinary nursing team ensuring patient safety and improved patient outcome in
transitional care shifts as compared to generalized unstructured handover practice? This is the
PICO question I have developed to address my research.
P Population, Nursing professionals particularly shift
nurses
I Intervention SBAR communication toola
C Comparison Generalized or unstructured handoff

2CLINICAL LEADERSHIP TO DEVELOP NURSING PRACTICE
practice
O Outcome Improved nurse-physician
communication and relation and
improved patient outcome
I have searched Google Scholar to identify and support my research evidences. I have
read through the associated references of my evidence based articles. I have considered
Patient-centred care pyramid to advance through my research (Lusk & Fater, 2013). I have
refined my research within the last 5 years and also included peer-reviewed articles. I will
discuss the analysis of literature search that I have selected.
As evidenced by Storm et al. (2014), elderly patients during admissions and discharge
in hospital settings face multiple problems in care offered by the health professionals. The
involved healthcare personnels show an efficient caring approach during transfer of care
services in different care levels. Lack of information exchange between care givers in care
levels and also between patient family and involved personnels have resulted in serious
consequences for elderly patients during discharge. This has led to rehospitalisation cases.
Lack of familiarity among physicians and nursing professionals with the legal measures
during discharge, reduced staffing in between clinical transfers, information gap between
health personnels and patient family during admission and discharge facilities, difficulty in
understanding among care personnels during multiple transfer care services have shown
adversity among patient outcomes.
Thomas et al. (2013) has shown that in his evidence based study selecting n=459
incidents from Australian Health service reporting system, significant proportion of errors in
clinical handover services have been encountered in inadequate patient transfer in different
care levels, the reported percentage being 28.8%. 26.9% error has been found in clinical
mismatch while patient handover from one clinical personnel to another in care levels.
Mismatch in clinical documentation is another significant error with 24% reported rate.
14.2% error has been reported due to omission of clinically important details from patient
treatment care plan, which has led to adverse health conditions in patients generating patient
dissatisfaction.

3CLINICAL LEADERSHIP TO DEVELOP NURSING PRACTICE
The systemic review performed by Roughead et al. (2016) showed that medication
errors leading to adverse drug reactions among patients are concerned areas where proper
interpretation and improved efficiency are necessary to reduce deterioration of patients’
health quality. Medical drug errors are due to inefficient knowledge and lack of
communication among health care staffs operating at different health care levels. Lack of
well documented approach on medication during discharge of patients has been significantly
higher. Medication errors during a patient’s stay in hospital has therefore resulted in
considerable increase in medication costs.
Considering the reviews of Allen et al. (2014), database search and literature reviews
have shown that transitional care inefficiency has resulted in rehospitalisation of patients;
patients have to stay for longer periods during rehospitalisation. There was lack of
involvement of patients and their families during decision making regarding patient
assistance. Lack of coordinated and collaborative efforts among nursing officials and
involved multidisciplinary team have resulted in inefficient multiple transfer care facilities.
Evidence based nursing practice to improve patient care during transitional care shifts
is to implement SBAR communication tool to enable a collaborative communication strategy
among health care teams (DeMeester et al., 2013). Collaborative communication and
efficient coordination among a multidisciplinary team are essential for successful treatment
care and patient safety. Lack of communication among health care team members during shift
transfers is a major cause for patients’ health adversity (Robinson & Dearmon, 2013). SBAR
communication tool gives a description of the situation (S) with which the patient has been
reported in hospitals. The background (B) section of the tool gives a description of medical
details of the patient relating to current medical issue and the assessment (A) section
determines the patient health status in current scenario and new assessment data. (R) section
provides a recommendation in terms of treatment changes, consultation requirements or
transfers (Martin & Ciurzynski, 2015). This communication handover tool bridges the
communication gap between physician and nurse in a multidisciplinary assistance. The
SBAR handoff tool maintains a continuous flow of information during multiple transfer
activities (Cornell et al., 2014). The SBAR method of communication increases the
confidence of the nurses in between shift transfer and enable them to have a detailed
knowledge of individual patient. This eliminates adverse patient outcomes by reducing
medication errors and improving timed management of patient care by shift nurses.