Leadership in Clinical Practice: Communication, Roles and Services

This essay provides an analysis of leadership principles in clinical practice, focusing on communication through the lens of Transactional Analysis (TA). It examines a video depicting a mentor-student nurse interaction, dissecting the communication dynamics using Berne's ego states (Parent, Adult, Child) and types of transactions (crossed, complementary, ulterior). The essay identifies communication gaps, such as a lack of empathy and ineffective feedback, and suggests improvements through clear communication strategies, shared vision, and communication skills training. It also explores the qualities of effective clinical leaders and the importance of honesty and openness within healthcare organizations. The author reflects on the importance of communication in building relationships, preventing conflict, and enhancing team performance, and proposes a plan to implement improved communication practices within a healthcare system. This includes assessing current communication levels, analyzing data, and recommending strategies to foster efficient communication between healthcare providers and patients.

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LEADERSHIP IN CLINICAL PRACTICE
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Introduction
Health care professions are of great importance to the general population. There is need
to keep health care professionals in check in whatever they do. Nursing, as a profession, forms
an integral part of the health care professions and has developed a well-informed idea about
mentorship and clinical supervision (Butterworth and Faugier 2013). According to American
Psychological Association, (2015) a seven pillar supervision guideline was developed to inform
training and education in order to realize a competent base of supervision. This consist of
competence of a supervisor, their multiplicity, relationships, proficiency, legality, ethics,
drawbacks of professional competence, monitoring and evaluation and regulations. The
supervisor and the supervisee have to have a cordial relationship for good clinical supervision to
be realized as this has a range of benefits to the patient and health institution and the health
workers (Martin and Milne 2018). Over last two and a half decades, major developments in
clinical supervision have been reviewed, and compared to how it was in its early stages of
initiation (Bernard 2014). Mentorship is a pivotal role in the nursing sector. A good mentor
should be able to envision, prod and challenge the person they are mentoring (American
Psychological Association, 2015). Nowell et al. (2015) see mentorship as an important tool to
attract, train and retain nurses in addition to maintaining quality education curriculum. Nurse
mentor and student nurse is the earliest contact towards achieving a good mentoring environment
in the profession.
Analysis of Leadership Principles
Communication is a two way traffic between the sender and the receiver. It involves
exchange of information and thoughts using either verbal or non-verbal cues. Good
communication is an integral part of any profession. When it comes to the health care system,

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good communication between the nurses and patients enhances success of nursing care of each
patient assigned to them. This is according to Kourkouta and Papathanasiou, (2014). In nursing
profession, communication is necessary in all tiers of interventions like preventive medicine,
curative therapy, rehabilitation and even health promotion. Barnlund, (2017). Describes the
transactional analysis (TA) model of communication. In the analysis, verbal cues used as means
of communication assigns a meaning to the matter being discussed. TA is a powerful tool that is
used to psychoanalyze communication between individuals. A structural analysis aspect of this
model focuses on personality development of an individual as a driver towards the type of model
someone will gear towards.
Keshavarzi et al. (2016) analyzes how transaction analysis program affects emotional
regulation on adolescents. The authors say that personalities are made up of three ego states.
They include parent (P) adult (A) and child (C). Each ego state has a unique set of behaviors,
thoughts and feelings. Parent ego state is initiated into an individual through the feelings,
behaviors and thoughts they learnt from their parents during the childhood days. A parent can be
of the controlling type or nurturing type. Controlling parent (CP) is usually judgmental and view
mistakes as blunders. The nurturing parent (NP) is usually understanding, advices the child and
accepts them the way they are. The child ego relates to one’s personality as part of their
childhood emotions and thoughts. It is further subdivided into free child (FC) and adapted child
(AC). The free child is usually oblivious of the rules and will do anything not thinking of its
consequences. The adapted child usually grows into a community where there are social norms
and has to conform to them, thus always aware of the rules. This type of personality proceeds
cautiously when doing things. The last ego state is the adult one. The adult ego deals with facts,
they are rational and unemotional when handling problems, which they easily identify.

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The video provided provides a good scenario of the type of communication interaction
between the mentor nurse and the student. Communication must have a sender and a receiver,
and the senders should have certain words and gestures that will have a good effect on the
receiver (Wong, Yee and Turner 2017). In the video, both the mentor nurse and the student are
senders and receivers. But according to the TA model, the communication interaction between
them is such that the mentor nurse, as a parent is a sender and the student nurse as a child is the
receiver. The mentor is domineering and orders the student to take the blood pressure and vital
signs of the patient, and the student willingly responds to that. Ego states of both mentor nurse
and her student have been depicted in the video. The mentor nurse has the parent ego which is
commanding and judgmental. She orders the student to take the vital signs of the patient without
considering that she (the student) is not conversant with the automatic blood pressure machine.
When the mentor nurse realizes that the student is unable to do the task, she judges her harshly
that she is does not know how to do the procedure and that she is not up to the task. The student
nurse in this case is the child. With the training in the nursing profession she chooses to obey the
mentor nurse orders and even after failing to perform her task, she asks for an apology.
Keisler (2017) vividly describes TA. Transactions are made up of a stimuli that initiates a
response. They are grouped into crossed, complementary or ulterior (Boden 2015).
Contemporary transaction is an example of adult to adult communication. In this model, the
agent receives the response they expect and communication is smoothly processed. Crossed
transactions show a parent to child model. It results when the respondent does not produce the
expected stimuli thus communication is not smooth. Ulterior transaction, on the other hand
results from surface message with a hidden meaning. This results from an ulterior stimuli that
elicits ulterior response. In the video, the type of transaction is a crossed one. The student nurse

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handles the vital signs in a way that the mentor nurse did not expect. She admits that she is new
in the facility and does not know how to use the automated blood pressure machine. The mentor
expected her to be able to perform the task but this is not the case.
Good communication skills lack between the mentor nurse and her student. From the
beginning, the mentor commands the student to take the patient’s vital signs rather than
requesting her in a polite way to do so. This makes the student nervous and afraid of doing any
mistake. She then leaves the room instead of supervising her (the student nurse). When she
comes back and finds the work not done, the mentor throws tantrums at the student on how she is
incompetent. The student had admitted that she cannot handle the machine. At this point a good
bond is expected and the two are supposed to work in tandem to help the student learn. Another
mistake in their communication skills is quarreling in front of the patient. They should have done
this in a private room. Anderson et al. (2015) discuss clinical handover of a patient to be done in
a private place. Some patients feel that negative impact on handover is influenced by their
presence, as depicted by the stroke patient in the video. Another weakness in communication
between the two is the fact that it is marred by one sided conversation by the mentor nurse who
rudely interrupts the student in her conversation. The two do not engage their patient in
communication before taking his vital signs as a requirement. The duo however are able to
communicate both verbally and with nonverbal cues like gestures.
Improving communication at work place is a necessity to help realize health care goals.
One way to improve this is through clear and efficient communication. Gausvike et al. (2015)
suggests that efficient communication leads to patient and health care provider satisfaction. The
discordance between the two can be improved by engaging in efficient communication strategies
like role playing and appropriately using verbal and non-verbal cues. Another way of improving

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this is by setting a shared vision and this is possible through multidisciplinary work. Aligning a
team towards a common goal also aids in improving communication. The mentor nurse and her
student should have a shared goal of both delivering quality care to the patient and learning from
each other. This will ensure that they both communicate in a friendlier and understanding way. A
simpler way of improving communication in health care practice is by engaging all health care
workers and students to communication skills lecture at an early contact. This helps cultivate the
culture of good communication skills through practice. An assessment should also be done
regularly by engaging the patients and health workers in a survey to look at the strengths and
weaknesses in the health care system in the communication sector.
Application of leadership principles to clinical roles and the provision of services
Effective leaders are needed in the health care system and their inadequacy or lack can
lead to a compromised quality of health care (McSherry and Pearce 2016). Clinical leadership is
significant in health care quality improvement. How can this be done? Clinical leaders are able to
internalize the expertise the gain from their clinical settings and transform it a comprehensive
relationship within a team. By doing this, they facilitate revolution and change through their
expertise. Such a success is achievable through recognizing, influencing and empowering
different people through effective communication. With efficient and well-structured
communication strategy, the individuals are able to learn from each other. McSherry and Pearce,
(2016) further suggest that the success of this model is realized by pointing out where and how
the duty of honesty can be brought into line within the existing governance framework in clinical
practice. Creating an organizational culture where a duty of openness exists is a major challenge
for health care organizations. A strict focus on the clinical leader’s duty and responsibilities will

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play a pivotal role in facilitating, supporting, influencing and evaluating that candor related
duties happen in practice.
Clinical leaders have special characteristics. In his study on clinical leadership
characteristics, Stanley, (2014) describes the qualities of a clinical leader as being approachable,
competent, supportive, mentoring others, being seen in practice, of great help to people,
enhancing confidence, being a good communicator and above all putting on integrity. More
attributes are being looked for in a clinical leader and according to the study they include
knowledge, reliability, enthusiasm and non-judgmental state of an individual.
The exercise has taught me on the gaps of communication that exist in the health care
system. Communication is important in relationship building, preventing conflict for instance
between the mentor nurse and the student, enhancing good team relationship for better patient
care and also enhancing creativity in how to approach technical issues. Feedback is also
important since it helps eliminate anxiety and provide support to the person being communicate
to (Gardiner and Sheen 2017). Implementation of a new learning experiences ensures that
continuity is preserved whenever someone learns a new thing. I would do the following to
implement whatever I have learnt: critically analyze the importance of communication and
feedback in health care, assess the level of communication and feedback in a health care system
by conducting a survey to answer the question, do data analysis and find out the strengths and
gaps in the system. After this I will use my findings to draw meaningful conclusions and
recommend to the facility the way forward towards realizing efficient communication among
their health care providers and between the health personnel and the patient. I would then follow
up on the report and help in implementing the findings so that the gap can be filled. A
monitoring and evaluation will then follow as I assess how the system has improved and look out

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for any other gaps to be filled. By doing this, a cycle of interventions is established. This will be
an overall victory for better health care.

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References
American Psychological Association, 2015. Guidelines for clinical supervision in health service
psychology. The American Psychologist, 70(1), p.33.
Anderson, J, Malone, L, Shanahan, K and Manning, J, 2015 Nursing bedside clinical handover–
an integrated review of issues and tools. Journal of clinical nursing, 24(5-6), 662-671.
Barnlund, D C 2017 A transactional model of communication. In Communication theory (pp. 47-
57). Routledge.
Bernard, J. M, 2014 Tracing the development of clinical supervision. In Supervision in
Counseling (pp. 11-30). Routledge.
Boden, A, 2015. Handling Complaints Pocketbook. Management Pocketbooks.
Butterworth, T and Faugier, J, 2013 Clinical supervision and mentorship in nursing. Springer.
Gardiner, I and Sheen, J, 2017 Graduate nurses' experience of feedback, support and anxiety: a
pilot study. Australian Journal of Advanced Nursing (Online), 35(1), 6-15.
Gausvik, C, Lautar, A, Miller, L, Pallerla, H and Schlaudecker, J, 2015 Structured nursing
communication on interdisciplinary acute care teams improves perceptions of safety, efficiency,
understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary
healthcare, 8, 33.
Keshavarzi, S, Azar, E. F, Mirnasab, M and Gargari, R B, 2016 Effects of a Transactional
Analysis Program on Adolescents’ Emotion Regulation. International Journal of Psychological
Studies, 8(4), 51.

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Kiesler, D J, 2017 The process of psychotherapy: Empirical foundations and systems of analysis.
Routledge.
Kourkouta, L and Papathanasiou, I V, 2014 Communication in nursing practice. Materia socio-
medica, 26(1), 65.
Martin, P and Milne, D L, 2018 Reciprocal leadership in clinical supervision comes of age.
Journal of advanced nursing.
McSherry, R and Pearce, P, 2016 What are the effective ways to translate clinical leadership into
health care quality improvement? Journal of Healthcare Leadership, 8, 11.
Nowell, L, White, D E, Mrklas, K, and Norris, J M., 2015. Mentorship in nursing academia: a
systematic review protocol. Systematic reviews, 4(1), 16.
Stanley, D, 2014 Clinical leadership characteristics confirmed Journal of Research in Nursing,
19(2), 118-128.
Wong, M C, Yee, K C and Turner, P, 2017 Complex clinical communication practices: how do
information receivers assimilate and act upon information for patient care?. In ITCH (pp. 376-
381).

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