Transformational Leadership in Haematology Nursing

The report emphasizes the significance of training nurses in transformational leadership to deliver their best to patients. In a haematology ward, nurses must handle diverse tactics to care for cancer patients, making transformational leadership essential. Adequate opportunities and motivation are crucial for nurses to manage leukemia, thalassemia, and other cancers effectively.

REFLECTIVE PAPER

Table of Contents
INTRODUCTION ..........................................................................................................................1
PART A...........................................................................................................................................1
1. Leadership example.....................................................................................................................1
1.1 Example in clinical practice.............................................................................................1
2. Describing leadership approach...................................................................................................2
2.1 Identification of leadership approach...............................................................................2
2.2 Key characteristics of this approach.................................................................................2
2.3 Reflection of the characteristics.......................................................................................4
3. Reflection on selected leadership approach.................................................................................5
3.1 Role of healthcare professional, carer and patient............................................................5
3.2 Its contribution to quality health care...............................................................................5
3.3 Opportunities of developing skills for the nurse..............................................................6
PART B............................................................................................................................................7
1. Reflection on aspiring nursing role....................................................................................7
2. Important factors for transition in new role........................................................................9
CONCLUSION ...............................................................................................................................9
REFERENCES..............................................................................................................................11

Illustration Index
Illustration 1: Transformational leadership .....................................................................................3

Index of Tables
Table 1: Activities map for 12 to 24 months...................................................................................7

INTRODUCTION
Nursing forms an indispensable part of clinical practice; where nurses assumes
responsibility of ensuring proper care of the infirm and sick. As a part of Haematology,
Oncology and Bone Marrow Transplant ward; I have gained adequate experience & valuable
insights of nursing practices. Nurses in this ward are engaged in taking care of patients who are
suffering from any blood related illness. The report focusses upon different leadership
approaches that are adopted by registered nurses at junior/senior level in the respective ward. In
this ward; patients do not only feel physically weak; but are also emotionally exhausted. Nurses
in this ward do assume huge responsibility of getting patients healed with proper care. They are
supposed to be on toes every time since treatment many-a-times is highly painful in nature. It is
effective leadership style that helps nurses in overcoming various situations faced over the period
of time. Furthermore, the report ponders upon different characteristics of transformations
leadership approach; that mostly applies in the ward during the placement which includes, team
efforts, continuous learning and development etc. In the end, a 12-24 month plan discussed is
framed to develop individual skills as a nurse.
PART A
1. Leadership example
1.1 Example in clinical practice
An effective leadership skill set should necessarily be possessed by nurses in health care
setting.. Nurses in Haematology, Oncology, and Bone Marrow Transplant ward are specialised in
taking care of the patients who are suffering from blood related illness such as, cancer,
leukaemia, myeloma, sickle cell anaemia etc. They have to nurture their patients; so as to
strengthen them physically & emotionally. It is through proper guidance that senior nurses can
encourage their subordinates to perform their task in a better and effective manner.
As a part of nursing ward, a situation mostly arises is getting patient ready for treatment
through chemotherapy. Once, a patient who was not so aware of his disease arrived for
chemotherapy with his family. When he was told of the treatment to be done, he panicked and
started resisting. His family tried to console him for 2 hours; and finally; time was getting
shortened of. Looking to the scenario, a nurse ward took the case into her hand. She asked her
family to leave him all alone. Initially, with a high level of authority; she calmed down the
patient. Thereafter, she has presented him with his disease history, potential consequences,
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symptoms & an easy way to cure. She also provided him evidences from the past where the
disease has been cured through this therapy. In her tactful way; she consoled the patient for
getting hospitalised & starting a chemotherapy.
In Haematology, Oncology and Bone Marrow Transplant ward; patients undergo various
critical treatment. In order to support patients; nurses should built up their emotional strength.
Further, they should be very much efficient in dealing with stress that arises every now & then
into the ward. In order to develop interpersonal skills & emotional strength of nurses; various
development programmes are organised from time-to-time. These development programmes help
them in dealing with high level of stress level and burnouts (Jones and et.al, 2013). This activity
has also proved helpful in reducing stress level from both personal and professional lives.
Further, they were more rejuvenated to work and were able to happily support patients during the
course of treatment. It has increased sense of belongingness of nurses towards the organisation as
well. Working in this department requires proper management of the reports and blood samples
as there is a dependence on the past records of the patients as well. Hence, the health
professionals tried to teach them quick management practices that can be adopted by them to
make their work easy and hassle free (Hunsaker and et.al, 2015).
2. Describing leadership approach
2.1 Identification of leadership approach
There are various types of leadership approaches; that can be adopted by an individual to
act as a successful leader in the nursing unit. The main leadership approaches include: Laissez-
Faire, Autocratic, Participative, Transactional and Transformational. Every approach has its own
set of benefits and can be adopted at the workplace in one or the other way. One of the most
important leadership style that can be adopted at the clinical workplace is the transformational
leadership. Adoption of this type of leadership in Haematology, Oncology, and Bone Marrow
Transplant ward has an important role in both treatment and supportive care for the patients.
According to Antonakis and House (2013), this approach has proved to be helpful in guiding the
patient throughout their diagnosis and treatment programme. It is also useful in handling multi-
disciplinary team of nurses, specialists, nurse clinicians and co-ordinators of bone marrow
transplant in the department. The job requirement of nurses in Haematology, Oncology, and
Bone Marrow Transplant ward is highly diverse in nature. It is through transformational
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leadership style; that the nurses at senior level are able to come up with proper solutions in
different scenarios. Since, a health care sector is highly dynamic in nature, a transformational
leadership approach is considered to be suitable.
2.2 Key characteristics of this approach
The main features of this type of leadership approach are that; it helps in developing
internal motivation due to high level of participation. Nurses can easily get adaptive to the
prevailing environment. They are able to provide friendly environment to both staff and the
patients. It is in the transformational leadership style that allows leaders to work in co-ordination
with subordinates; so as to identify the change that is required & lays down path to bring forth
that change. They tend to act as an inspiration and visionary; which helps in development of the
organisation. Haematology department has to abide by proper infection control standards in
order to save patients from any sort of infection. It requires concern on part of the nurses; since
the immunity level of patients suffering from blood illness is quite low. Appropriate actions are
taken in the ward to provide clean and safe environment to the patients. The features of a
transformational leadership are based on 4’s model.
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Illustration 1: Transformational leadership
(Source: Transformational Leadership explained with
examples, 2016)

 Idealised influence: In the transformational kind of leadership; leader is regarded as a
role model for followers. Subordinates follow path laid down by the leader; so as to help
him/her achieve the set vision. A sense of commitment on part of the senior nurse helps
in better performance of the juniors as well. The patients admitted in intensive care units
require extra care; henceforth, a nurse should be made available all the time. Nurses with
effective leadership skills tend to inculcate sense of belongingness among patients
(Northouse, 2015). Working in a haematology ward, the nurse had the responsibility to
care for chronic patients and was required to observe commitment and patience while
supporting them. A transformation leadership approach entails that nurses should have
an idealised influence on patient’s health so as to
 Intellectual stimulation: One of the feature of transformational leader is to encourage
learning and growth in the clinical environment (Day and et.al., 2014.). The senior nurses
are trained by the healthcare professionals to perform chemotherapy as it is prescribed as
a treatment protocol to the cancer patients. Further, the nurses are taught to constantly fill
evaluation sheet of the patients which is to be revised on a day-to-day basis. The
evaluation criteria includes, temperature, pulse rate, blood pressure, rate of respiration,
fluid monitoring etc. Nurses are given adequate knowledge to handle pulse oximeter
which helps in measuring the level of oxygen in the blood in the patients.
 Individualised consideration: A leader acts as a mentor to the people working under
him. Leaders make sure that every opportunity of growth is provided to nurses at the
workplace. The nurses, based on their performance, are given several opportunities to
learn. They are introduced to process of blood and platelets transfusion; which is required
by the patients suffering from anaemia. It helps them to handle emergency cases in a
single handed manner. Nursing team whereby transformational leadership is adopted is
considered to resolve every issue with high level of individual involvement. This in turn
helps in supporting fast recovery of patients.
 Inspirational motivation: Nurses should have a clear understanding of their aspirations
and goals at work-place to achieve them in an effective manner. They are given enough
opportunities to work with different kind of patients. They also perform the task
counselling the patients so that they are aware their interest which may lie in clinical and
non-clinical practices of the ward. A team of nurses guided by senior, who is adopting
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transformational leadership approach, is expected to be highly inspired towards serving
patients with positive attitude.
2.3 Reflection of the characteristics
A key characteristic of transformational leadership is to help in growth and development
of the subordinates and work as a team to achieve organisational objectives. It is the leadership
style whereby employees bring charisma at their work place. A clinical practice example
discusses the situation where a patient was not ready to get into chemotherapy practices. The
nurse convinced him by explaining its benefits through her experience which finally convinced
him to undergo the treatment. (Hoffman and et.al. 2013). The way in which nurse handled the
patient was authoritative yet considerate. She possesses the skills of nurturing patient and
handling a situation which has arisen unexpectedly. Her proactive behaviour and caring nature
towards the patients resolved the issue faced within a ward. Chemotherapy is an important
practice which is required to be taken by the patient if he is suffering from cancer. The expected
side effects of the treatment include, Nausea and vomiting. It may prove to be painful for some
patients. However, nurse, in order to calm him down assured him that he will be given mild
sedatives; so that its side effects can be reduced. Availability of nurses to take care of the patients
and help them to recover reflects their caring and motivation towards the task. The ability of
communicating with the patients in hassle situations and possessing adequate skills to deal with
them has been reflected by the nurse who diligently handled that case. Therefore, different
characteristics of transformational leadership possessed by the nurse in displayed clinical
scenario are as follows:
 Efforts of the team and teamwork to handle the patients
 Communication practice adopted by the nurse helped to sort out the hassle situation
 Motivation to work and inspiration to the team to finish the given task in full swing.
 Willingness to work
 Skills to handle a situation
 Problem solving skills as and when a difficult situation arises.
 A motherly behaviour that nurtures patients to overcome emotional and physical
weaknesses.
 An ability to take control of the situation in hand.
 Assuming responsibility of providing effective treatment to patient.
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 An extra-ordinary capability to handle emotional stress of patient; without being affected
herself on emotional grounds.
The nurses are reqired to build up their emotional strength and reduce their stress level ;
so that they can deliver the best to the patients. They must develop new ideas so that they can
effectively handle the patients and help them in their treatment process. (Jones and et.al., 2013).
While taking these steps the key characteristics of transformational leadership includes:
 Giving inspiration to get treated to the patients
 Willingness to learn new ideas in order to handle different kind of patients
 Understand the perceptions of patients and provide suggestions based on it.In this
manner, clinical practices can get directly linked to transformational leadership.
3. Reflection on selected leadership approach
3.1 Role of healthcare professional, carer and patient
Role of health care professional (organization centred and carer centred)
Health care professionals play an important role in developing positive attitude in the healthcare
environment. The approaches adopted by him/her are organisational centred as well as carer
centred.
 The role is to train the nurses in a certain manner which tends to be appropriate for the
patients. A nurse in haematology department must be well versed with performing and
evaluating blood samples. She must also be aware of giving symptomatic treatment in the
absence of the doctor; so that the life of person can be saved in case of emergency.
 Nurses are also made responsible to take care of medications that are to be given to the
patient time to time during day and night. All the important aspects are taught by the
health care professional.
 Nurses are made capable of taking their own decisions to run the ward effectively and
without any difficulty.
 Another important role of healthcare professional is to develop good communication
skills; so that nurses can interact with the patients in the ward.
 Haematology department require taking proper history from the people as major
dependence of further treatment is on the past history of the patient. Hence, the nurse
must be aware of this tactic through which she can get all the important stuff which will
be required by the doctor.
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 They set vision of the department and take every possible measure that can help in
providing quality services to the patient.
Role of carer (person centred)
The role of nurse is a patient - centred and to provide the best possible facilities to the
patients. The roles are as follows
 Blood transfusion department require constant support of a nurse as patients are under
continuous evaluation of heart rate, blood pressure and monitoring the fluid that has been
given to the patient during the process.
 She acts as a counsellor to the patient as psychological aspect of the patient has direct
impact on the way his body reacts to the treatment.
 The motivation and encouragement received by a nurse from the health professional can
be transferred to the patient as well.
Role of patient (Person centred)
The roles of a patient are as follows:Cancer patients come for their treatment in oncology
wards who require constant support and motivation from the people working there.
 The nurses are made available with patients so that she can extend emotional and
psychological support to the patient.
 The nurses are kept up to date with the developments in the field of nursing in this ward
so that best practices and policies can be adopted by them during their treatment.
 It helps in strengthening the practices of the team and providing the services with higher
dedication.
 To cooperate with the nurses while they are providing treatment to them.
Hence, transformational leadership is an effective approach adopted by health care
professional, carer and the patient. It is also an important approach for the overall development
of the organisation.
3.2 Its contribution to quality health care
Transformational leadership is a positive approach; hence, it brings positivity in mind and
heart of the people (Vandyk and et.al., 2012). It has major impact on the quality of nursing
provided to the patient. Transformational leadership helps in delivering the best to the
department and contributes towards the quality of functioning in following way:
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 Personal Accountability: Transformational leadership helps in personal accountability
which is established in the department by making nurses responsible towards duties to be
been performed. This approach has helped in making them honest and dedicated towards
the work.
 Trust: Patients suffering from thalassemia have to undergo blood transfusion after a
specific period based upon the intensity of the disease. Nurses must therefore possess the
ability to develop trust among patients regarding treatment being prescribed by the
doctor. Further, developing the trusts of the nurses towards the department helps to bring
the sense of belongingness and they tend to work in an effective manner.
Communication: Nurses are responsible to inform the patient and his family members
regarding the pros and cons of the disease. A polite, humble yet clear communication is
required on part of the nurses.
 Cooperation: Sometimes patient diagnosed with leukaemia may resist commencement
of the treatment immediately. Cooperating with them and convincing them for treatment
is another role extended by the nurse on duty. A high level of co-operation is required on
part of nurses to not only support patients; but also overcome resistance shown by them.
 Risk management: Adoption of risk management practise helps in dealing with the
problems such as work load in the ward in advance. Sometimes, there is a position in the
ward where availability of nurses as compared to patients is quite low. They are taught to
handle the situation and deal with it calmly.
 Decision making: Contribution of nurses in the decisions of the department helps them
to develop the skill of decision making. Unavailability of the doctor in the ward make
the nurse responsible to take adequate decisions in order to save life of the patients. At
that point of time, nurse should have the ability to take appropriate decisions.

The leadership approach adopted also made continuous evaluation of patients managed
which is an important aspect of haematology department. Hence, transformational leadership
helped in overall development of the department and services provided to the patients. In
haematology & oncology ward, patients are not sure of their life. This in turn creates a sense of
insecurity & emotional distress among them. It is therefore necessary to create a positive
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environment whereby healing takes place with high level of energy. It is the responsibility of
staff members to deliver a soothing experience during treatment through extra care.
3.3 Opportunities of developing skills for the nurse
Transformational leadership provides adequate number of opportunities to graduate
nurses to develop their leadership skills. They are able to indulge in continuous development
process while working in the department. Hence, they are able to learn leadership skills that can
contribute to their development. Nurses are provided with adequate amount of sessions through
which they can learn and master upon the subjects in Haematology, Oncology, and Bone Marrow
Transplant ward. They are able to learn appropriate steps through which patients can be handled.
They are able to assess different equipment available in the ward, such as, blood pressure
machine, heart rate calculator, pulse oximeter, respiratory rate monitor. This approach helps in
continuous development and growth of nurses as well as the department.
Another contributing factor of transformational leadership towards the development is
taking arrange individual nursing sessions so to understand their barriers and providing them
with appropriate suggestions. Graduate nurses are able to develop their learning and apply better
practices in handling their patients. They are given practical exposure through which they
interact with the patients and understand their condition, they are also taught art of compiling
medical history. Understanding the psychological behaviour of the patients so that they do not
resist to the treatment. A comprehensive approach regarding the diseases and appropriate
knowledge to it is an important aspect of nursing. Graduate nursing are made aware of the
common cases that generally come to the ward. Nurses are provided equal chances of decision
making which helps in making them efficient to single headedly handle the patients of the ward.
Another motive of transformational leadership is to enhance communication skills of the
graduate nurses. Graduate nurses are taught about different types of infections and reactions,
dosage management of medicines etc. It helps in making them well versed with the concepts and
handling the emergency situation in the absence of the doctors.
PART B
1. Reflection on aspiring nursing role
I enjoy the profession of nursing since serving patients makes me feel a sense of
achievement. The aspiring role for me is to work as a paediatric nurse in Haematology,
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Oncology, and Bone Marrow Transplant ward. In this department, I intend to work as a
registered nurse involved in taking care of infants, children and adolescents. The first step is to
complete my graduation and then apply for national licensing program which will help in
becoming registered paediatric nurse. In this department, I shall be responsible to conduct the
following function:
 Administrating Chemotherapy
 Blood and platelets transfusion
 Venesections
 Administration of medicines
 Bone marrow aspirations
 Taking blood samples and evaluating them
 Reviewing of the treatment given by the doctor and taking actions according to it
The department which I am planning to join is assumed to be highly stressed & hectic;
but will help me in enhancing my present skill sets. I am very well aware that I have to build up
my skill set before joining the respective ward. Some of them are mentioned below:
 Understanding the diseases through which children and infants commonly suffer.
 Develop active listening.
 Effective communication in oral or written format.
 Developing the ability to monitor my performance; so that I can improve it accordingly
 Proper judgement with respect to the disease from which the children must be suffering.
 Ability to solve complex issues arising in the ward (Hunsaker and et.al., 2015).
 A proper balance one emotional front; so that I can nurture patient without having any
impact on my internal peace.
 I need to be strong yet considerate towards patients.
Development in these areas will help in better handling of the issues that are expected to
arise at the work place. A nurse plays an important role in this department as he/she is
responsible to handle and care children and infants. I will be responsible to interpret the
behaviour and reactions as the infant may be so small to communicate his circumstance to me.
Moreover, it will be important for me to understand side effects and infections through which the
patient may suffer. Another important skill that I must possess is time management. I shall also
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be responsible for arrangement of pre bone marrow transplant test; so that operation can be
smooth and successful. Hence, I must be aware of the technique through which pre-operative
condition can be managed. Dealing with cancer patient that too in such a tender age requires high
level of patience. Hence, on this factor I need to work upon so that I can earn success in this
field.
Table 1: Activity map for 12 to 24 months
Activities Duration (in weeks) Description
Seminar on assessing the
behaviour and reaction of child
4 weeks This seminar will help in
learning an infants' behaviour
and reactions; through which it
can be assessed that if he goes
through some pain or not.
Children may not able to
communicate their problem to
the doctor all the time. So,
understanding their behavior is
considered to be quite essential
element.
Training session on taking
history from patients
3 weeks It will help in developing the
art of compiling a medical
history of the patient; so that
the problem of the patient can
be assessed.
Developing oral and written
communication skills
4 weeks It will help in communicating
the case scenario of the patient
to doctors and other nurses on
duty.
Problem solving skills 3 weeks Developing problem solving
skills will help in taking wise
decisions for the patients
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without any hassle.
Sessions for positive thinking 4 weeks In a ward where we are
supposed to heal kids; it is
essential to be positive in
nature. I think behaviour of
nurse is highly important
during treatment process. A
child suffering from such a
critical disease needs proper
care. Further, nurses are
expected to nurture patients so
as to heal them emotionally &
physically. In such a context, I
shall develop a power to
spread positivity among
environment. Since, I have
heard that “though is a seed for
action”; I am planning to
attend sessions for developing
positive thinking.
Joining hospital as an intern 6 weeks It will help in getting practical
knowledge in advance which
can be applied after
placements.
2. Important factors for transition in new role
Being a registered nurse in Haematology, Oncology, and Bone Marrow Transplant ward
is entirely different and hence it requires a certain kind of skill set to be possessed. These nurses
specialise in caring the patients suffering from blood related illness such as, cancer, leukaemia,
myeloma, sickle cell anaemia etc (Itano and et.al., 2015). Responsibilities includes,
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understanding the condition of a child through his behaviour and reaction. Hence, two important
factors for transition in new role are as follows:
 Experience, patience and empathy: As the patient in this ward are admitted for long
term due to their chronic conditions. I must be aware of the time when the situation is to
be reported to the senior doctors. Hence, it important for me understand the intensity of
the situation. It is an important aspect of nursing while dealing with children. Moreover,
handling the child suffering from cancer and
 Motivation and encouragement: Keeping them motivated and playful is main role of
the nurse in the ward. Another important skill that a nurse must possess in the
department is to having a problem solving ability so that I can deal in the case of
emergency without any hassle. I must also have adequate knowledge of handling
equipment which are used in this ward.
There are considered as an important role to be possessed by me as they will help me
deliver best services to the patient in the ward. Further, these will help the patients to deal with
their problems as well. I also have to possess some other qualities which includes, managing the
time appropriately, proper diagnosis report of the patient for extending proper treatment and
analysing the quality of facilities being provided in the ward (Hematology nurse job description,
2017). It will help the patient as well to recover faster. Possessing appropriate knowledge helps
in delivering the best to the clients. These skills can be possessed with regular practice and
training sessions.
CONCLUSION
Based on the above report, it can be concluded that a nurse must be trained in such a
manner that he/she can deliver his/her best to the patients. Working in a Haematology,
Oncology, and Bone Marrow Transplant ward, a nurse must be aware of handling different
tactics in order to handle the cancer patients. Transformational leadership was adopted by health
care professional in the ward in order to satisfy the needs of nurses as well as patients . Adequate
opportunities to the nurses’ helps in keeping her motivated which helps her to deal with
leukaemia, thalassemia and other cancer patients. Hence, an appropriate set of skills must be
possessed by the nurse so that she can deliver her duties in rightful manner. A nurse within this
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department should be highly assertive in nature & possess ability to have a positive influence
over patients & their family.
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