Research Proposal - (Assignment)

RQ: Has the author, through using a transformational leadership approach, empowered the team to implement Medicines Optimisation in Care Homes

Running head:RESEARCH PROPOSAL
Research Proposal
Name of the Student
Name of the University
Author Note

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Indicative Review of Literature
Keywords
The keywords to be used for the purpose of the literature search would be –
Transformational Leadership, Medicine Optimisation, Care Homes, Pharmacy, Healthcare,
Transformational leadership+medicine optimisation, Transformational leadership+healthcare.
Literature Search Strategy
An extensive literature search would be conducted over the course of multiple days.
The databases that will be used for this purpose are as follows-
 CINAHL (Current Nursing and Allied Health Research)
 MEDLINE (Via the use of PubMed)
 Cochrane Library
 ProQuest
The search is going to be focused on these databases as these are considered to be the best
databases for searching the nursing information and studies. CINAHL is considered to be an
excellent source to be searching for systematic reviews related to nursing (Wright, Golder
and Lewis-Light 2015). Cochrane is considered to be a reliable source to search for nursing
evidence and systematic reviews as well (Kicinski, Springate and Kontopantelis 2015).
MEDLINE is also considered to be a good source for biomedical information as well (Karaa
et al. 2016). ProQuest is one of the best databases to find studies relating to social sciences.
An important reason behind using these databases, in particular, is that Cochrane Library and
Medline are already free databases, and ProQuest and CINAHL has a subscription-based cost
which is already available to the researchers.

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Any current study or review relevant to the topic is selected, that is any paper
published in 2014 or later is considered. The keywords will be searched multiple times in
each of the databases and all the relevant papers will be rounded up. After rounding up the
papers from the databases, another search will be conducted on the bibliographic search
engine Google Scholar in search of good studies. If any good quality studies or papers are
located apart from those that have already been rounded up, they will be included in the
literature review.
Any paper published before 2014 will not be considered. Any paper where the
information is not clearly extractable or for which the full paper could not be obtained was
excluded from the literature review.
Each paper will be examined thoroughly and notes will be taken. The citations,
authors and year of publication will be kept track of.
Key Themes
By examining multiple studies, it has been seen that implementing the process of
transformational leadership in the medical field, the experience has generally been positive
for both the leader as well as the followers (Fischer 2016). In general, it resulted in a better
organisation of the work. The nurses were sure of what to do and how to approach a problem
in a better way. Even though there was no direct evidence of the effect of transformational
leadership on the satisfaction in the job environment, it was said to create a more positive
work environment definitely and enabled the nurses to become more focused on the patients
as the common aim was to provide good quality medical care to them. This resulted in better
patient outcomes in general. This probably had a positive effect on many medical staff who
were more motivated to learn and give better patient care (Brewer et al. 2016). In a cross-
sectional study conducted at primary care facilities in the United States, it was said that in

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most organisations, the nurse did not share proper or needed information among all the
members of the team. This, in turn, hampered the team mindset, which resulted in a less than
ideal work environment and less knowledge. In the facilities where the nurse leaders applied
transformational leadership, the medical staff had a better work environment in general
(Poghosyan and Bernhardt 2018). They were also prone to asking more questions which
made them more knowledgable in terms of medications. It was seen that clinics led by nurses
who applied transformational leadership had better patient outcomes (Gousy and Green
2015).
In the field of medicine, the need for a strong leader is very obvious. It was seen that
facilities having strong leadership framework resulted in better patient safety (Saravo, Netzel
and Kiesewetter 2017). Patient safety is related to many aspects that include administration of
proper medicine, providing of personalised care to each patient by the nurses and other
factors that directly related to an efficient nursing leader (Ammouri et al. 2015. It has been
seen that an efficient nursing leader, especially one who implements the principles of
transformational leadership properly, indirectly affects the level of job satisfaction for a
nurse. Better job satisfaction and motivation of the medical staff have a very obvious level of
influence on the patient outcomes and patient safety (Boamah et al. 2018). Effective
leadership is indispensable in relation to patient safety (Murray, Sundin, and Cope 2018).
On the other hand, patient safety is largely related to the proper prescription of
medicine. Giving medicine is the most common type of medical intervention and thus the
medicine that has been prescribed must be the correct one. Over-prescription of medicine is a
very common problem in many facilities mainly due to ‘defensive medicine’ (He 2014) or
over-diagnosis (Braithwaite 2014). Medicine optimisation is a recent concept that is based on
the idea that medicine should be prescribed on evidence-based information and only those
that are needed by the patient should be given (Shah, Lehman and Richardson 2014). This is

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extremely important to ensure better patient outcomes and safety. Many studies have shown
an evident positive influence of the transformational leadership style regarding educating the
nurses about medication safety. Medicine optimisation is of utmost importance and must be
given a high priority in the clinical field (Vaismoradi et al. 2016).
Information relating to research
The literature review provides detailed knowledge of what transformational
leadership stands for and how it has been applied in the medical context, especially in clinical
settings. There was ample information on the topic of transformational leadership by nursing
leaders and most of them pointed towards the better organisation and better care provided by
the medical staff. Even though multiple studies confirmed the positive outcomes of the
transformational leadership qualitatively, there was a significant lack of studies that directly
related the aspect of patient outcomes and medication optimisation with that of
implementation of transformational leadership (Poghosyan and Bernhardt 2018). While the
need for medicine optimisation can be understood, it is unclear how the leadership style
affects medicine optimisation and whether it can direct benefits or not. This research aims to
fill this clear gap in the literature in order to establish if the transformational nursing leader
has inspired their staff to implement a medicine optimisation program in a care home to
ensure better patient outcomes.
Methodology and Methods
Personal Stance
From a personal point of view, the implementation of transformational leadership
style at our current care home as proved to be immensely beneficial. This has been achieved
by holding weekly discussion sessions with the medical staff about what policies and
practices need improvement in our current facility and encouraging the medical staff to share

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any reservations or opinions they had about any patient and medications. The nurses have
been encouraged to seek help in case they are not sure with the medication or any procedure
and it has been emphasised time and time again that the supervisors are there to help them
whenever needed, no matter how trivial the problem may seem. So far, the nurses seem more
open to seeking help and applying their own knowledge regarding administering medicines to
the patients. An overall apparent increase in better nursing care has been observed on
listening to the patient opinions and better patient outcomes have been expected. So it is very
likely that implementing transformational leadership had a positive effect on the medicine
optimisation and care of patients, ensuring better patient outcomes and safety.
Key Features of Proposed Methodological Approach
The main aim of this study is to gather and analyse data about medicine optimisation
as brought on by the implementation of transformational leadership. This can be analysed by
measuring the thoughts of the medical about the leadership method, the process following
which they administer the medications in the care home and how much did leadership affect
that. It is also important to gather data from the patients about the medications they have been
receiving and how they are feeling.
Hence the data collection process must have some specific features. For starters, the
data collection must be consensual, and the participants must not feel coerced or threatened.
Since it involves busy medical professionals and patients, the process to be implemented
must be rapid and easy to answer. The process must be easy to understand so that it does not
put pressure on either the patients or nurses. The nurses must not get distracted from their
work and the patients must not be disturbed. The process should be meant for gathering
maximum data with minimum time and effort. Lastly, the process should be someone
anonymous so that both the nurses and students feel comfortable answering and being a part
of the study.

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Paradigms
The interpretivism paradigms can be used in this research as it aims to collect
qualitative data from the nurses and patients. For the research, this means that the data
collection methods to be used are going to be collecting qualitative data by collecting
responses from the patients and nurses and then analysing them. These data are then going to
be analysed to come to a conclusion.
Research Methods for Data Collection
Working with the three main objectives of the paper, the literature review portion has
already been covered in detail (See ‘Literature Search Strategy’).
For the collection of quantitative data from the nurses and the patients, a method that
follows the above requirements should be used. The method that will be used are
Questionnaires, where questionnaire will be distributed above consenting, willing and fully
informed participants. Two sets of questionnaires will be prepared. Logical reasoning will be
used for coming up with precise and targeted questionnaires that will be focused on the
aspects of the paper the participants can relate to (Song, Son and Oh 2015). This will improve
the quality of data collected.
The set prepared for the nurses will contain questions about the current leadership
style, whether it is better than previous styles that have been implemented, whether it had a
positive or negative impact on their work, and whether it has positively or negatively affected
the medicine optimisation process. This will also include whether they are fully informed
about the medicine optimisation process or not.
Another set of questionnaires will be distributed among the patients who are willing
to participate in the study. This will contain questions that relate to nursing care starting from
the time period when the transformational leadership has been implemented. It will contain

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questions about the medicine that has been administered to them and how they feel after
taking them. It will also include questions about any changes in medication that has been
implemented after that time frame.
Finally, a personal interview will be taken of some randomly selected nurses who
agree to give their honest opinion and who are off their shift. The interview will not be
completely structured, but it will contain questions relating to the current leadership structure
and medicine optimisation.
Data Analysis Method
The data collected by the questionnaire will be analysed to come up with the results
by the use of statistical tools. The analysis will be carried out by making use of SPSS Version
22. It may also be done with the help of Microsoft Excel 2013 as these have been proved to
be reliable in similar studies in clinical settings (Wang et al. 2019).
Strengths and Limitations
There are certain strengths and limitations to the proposed research methods. The
strengths include the anonymity of the questionnaire pattern, which will encourage more
honest and clear answers from both the patients. The questionnaire method is very reliable
and precise, which leads to proper data collection that is easily understandable and easy to
analyse. Nursing is a busy profession, and using is a questionnaire is also rapid and less
distracting that conducting a full-fledged interview (Siedlecki, Butler and Burchill 2015). The
interview at the end will be conducted among nurses who agree to attend the interview apart
from their shift timings.
The limitations include the possible bias that may occur from conducting such a
questionnaire-based method. It may be possible that only nurses and patients who have had a
positive experience are willing to share their opinions and fill up the questionnaire. Another

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limitation is the possibility of the participants lying on their answers or not understanding the
questions fully. The availability of the nurses may also pose as a possible limitation.

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Reference
Ammouri, A.A., Tailakh, A.K., Muliira, J.K., Geethakrishnan, R. and Al Kindi, S.N., 2015.
Patient safety culture among nurses. International nursing review, 62(1), pp.102-110.
Boamah, S.A., Laschinger, H.K.S., Wong, C. and Clarke, S., 2018. Effect of transformational
leadership on job satisfaction and patient safety outcomes. Nursing outlook, 66(2), pp.180-
189.
Braithwaite, R., 2014. Evidence suggests massive overdiagnosis and, by extrapolation,
overprescription of antidepressants. BMJ: British Medical Journal (Online), 348.
Brewer, C.S., Kovner, C.T., Djukic, M., Fatehi, F., Greene, W., Chacko, T.P. and Yang, Y.,
2016. Impact of transformational leadership on nurse work outcomes. Journal of advanced
nursing, 72(11), pp.2879-2893.
Fischer, S.A., 2016. Transformational leadership in nursing: a concept analysis. Journal of
advanced nursing, 72(11), pp.2644-2653.
Gousy, M. and Green, K., 2015. Developing a nurse-led clinic using transformational
leadership. Nursing Standard (2014+), 29(30), p.37.
He, A.J., 2014. The doctor–patient relationship, defensive medicine and overprescription in
Chinese public hospitals: evidence from a cross-sectional survey in Shenzhen city. Social
Science & Medicine, 123, pp.64-71.
Karaa, W.B.A., Ashour, A.S., Sassi, D.B., Roy, P., Kausar, N. and Dey, N., 2016. Medline
text mining: an enhancement genetic algorithm based approach for document clustering.
In Applications of Intelligent Optimisation in Biology and Medicine (pp. 267-287). Springer,
Cham.

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Kicinski, M., Springate, D.A. and Kontopantelis, E., 2015. Publication bias in meta‐analyses
from the Cochrane Database of Systematic Reviews. Statistics in medicine, 34(20), pp.2781-
2793.
Murray, M., Sundin, D. and Cope, V., 2018. The nexus of nursing leadership and a culture of
safer patient care. Journal of clinical nursing, 27(5-6), pp.1287-1293.
Poghosyan, L. and Bernhardt, J., 2018. Transformational leadership to promote nurse
practitioner practice in primary care. Journal of nursing management, 26(8), pp.1066-1073.
Saravo, B., Netzel, J. and Kiesewetter, J., 2017. The need for strong clinical leaders–
Transformational and transactional leadership as a framework for resident leadership
training. PloS one, 12(8).
Shah, C., Lehman, H. and Richardson, S., 2014. Medicines optimisation: an agenda for
community nursing. J Community Nurs, 28(3), pp.82-85.
Siedlecki, S.L., Butler, R.S. and Burchill, C.N., 2015. Survey design research: A tool for
answering nursing research questions. Clinical nurse specialist, 29(4), pp.E1-E8.
Song, Y., Son, Y.J. and Oh, D., 2015. Methodological issues in questionnaire design. Journal
of Korean Academy of Nursing, 45(3), pp.323-328.
Vaismoradi, M., Griffiths, P., Turunen, H. and Jordan, S., 2016. Transformational leadership
in nursing and medication safety education: a discussion paper. Journal of nursing
management, 24(7), pp.970-980.
Wang, Z., Wang, S., Zhang, Y. and Jiang, X., 2019. Social media usage and online
professionalism among registered nurses: A cross-sectional survey. International journal of
nursing studies, 98, pp.19-26.

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Wright, K., Golder, S. and Lewis-Light, K., 2015. What value is the CINAHL database when
searching for systematic reviews of qualitative studies?. Systematic reviews, 4(1), p.104.

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Appendix
All the key terms were searched on the selected databases. The number of initial hits has been
recorded, which will be further refined to meet the inclusion criteria. The literature will be
narrowed down by defining the dates, relevancy and critically appraising them.
 PubMed:
Transformational Leadership= 980
Medicine Optimisation= 1961
Transformational Leadership + Medicine Optimisation= 0
Transformational Leadership + Healthcare= 374
Pharmacy= 431563
 CINAHL:
Transformational Leadership= 10267
Medicine Optimisation= 239115
Transformational Leadership + Medicine Optimisation= 107
Transformational Leadership + Healthcare= 3389
Pharmacy= 742255
 Cochrane Library:
Transformational Leadership= 47
Medicine Optimisation= 82
Transformational Leadership + Medicine Optimisation= 1

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Transformational Leadership + Healthcare= 9
Pharmacy= 26
 ProQuest:
Transformational Leadership= 20405
Medicine Optimisation= 18636
Transformational Leadership + Medicine Optimisation= 12514
Transformational Leadership + Healthcare= 9874
Pharmacy= 2342