Home Exam: Nursing Leadership and Management - NUR567 Evaluation

This assignment is a home exam for the NUR567 course, focusing on nursing leadership and management. The exam explores a situation where an important decision had to be made, evaluating the decision-making process and its outcomes, particularly the application of critical thinking. The analysis details the use of different decision-making models, such as the rational decision-making model, and how these models were applied in evaluating staff performance. The second part of the exam discusses a patient care delivery system experienced during a clinical placement, specifically the case management integrated model of care, its effectiveness, and suggestions for improvement, advocating for a patient-centered model of care as a potential enhancement. The exam references key concepts from the course material, emphasizing the importance of adapting to societal changes, making informed decisions, and continually improving patient care delivery systems within healthcare organizations.

Running Head: EXAM ON NURSING LEADERSHIP & MANAGEMENT 1
NURSING LEADERSHIP AND MANAGEMENT
NUR567-Home Exam
Student Name:
Student ID:

EXAM ON NURSING LEADERSHIP & MANAGEMENT 2
Introduction
Healthcare organizations need to deliver a high quality of nursing care to their patients.
The role of nurses has emerged to be similar to managers and leaders. Nurses employed
across various domains of healthcare needs to collaborate with different types of personnel.
The nursing care delivery system has the responsibility to deliver appropriate nursing care to
the patient group. The nursing care delivery system is continuously transforming and has
undergone tremendous changes that can optimize the knowledge and skills of nurses. In this
rapidly transforming healthcare environment, demands are gradually changing and requiring
more management skills and excellent leadership skills. With the rapid transformation of
healthcare, there is needed more demand for self-care as technology impacts each aspect of
life and care. Nurses need to be ready to adapt quickly to societal changes such as gender,
cultural, and generational differences, increased violence, disasters, and pandemics. Nurses
while delivering care has to make various types of important decisions. Such decisions can
concern might have a tremendous impact on the team of nurses and healthcare professionals
as well as on patients. In the current analysis, a situation where an integral decision had to be
made is evaluated against its outcomes. Then in the second discussion, a patient care delivery
system during clinical placement has been discussed.
Analysis
1. A situation where an important decision was made and its outcome
Nursing managers are expected to make use of their knowledge from varied disciplines to
resolve challenges associated with patients, staffs as well as the organization. Nurses often
have to resolve challenges in their personal and professional lives. In the current situation, my
experience as a nursing quality coordinator has been evaluated. I was asked my decision to
put a written examination for my staff for yearly evaluation and undertaking an interview
apart from the head nurse's evaluation. To arrive at this decision, I had to implement critical
thinking skills and ascertain decision-making methods.
Nurses need to apply elements of crucial thinking to resolve such challenges. The process
of critical thinking includes analysis of underlying assumptions, interpreting, and evaluation
of arguments, exploration of choices for arriving at a justified choice. Critical thinking skill is
essential when nurses need to resolve complex problems. Zori, Nosek, and Muskil (2010)
applied the California Critical Thinking Disposition Inventory to ascertain critical thinking in
nurses. Their studies concluded that nurses with higher critical-thinking skills are to consider
their work environment more positively. When nurses make use of critical thinking skills,

EXAM ON NURSING LEADERSHIP & MANAGEMENT 3
they need to question their underlying assumptions which include the various beliefs that
affect an individual's reasoning. The interpretation of evidence or information is crucial such
that the facts can be substantiated. This enables evaluating whether the evidence is
undertaken using emotional or biased information, it also allows evaluating errors associated
with reasoning. Objects evidence for the support of arguments needs to be determined to
evaluate alternative perspectives.
Nurses make use of varied types of critical thinking skills to make decisions. They need to
determine the problem-solving or decision-making methods they use. Nurses are known to
face various types of problem-solving challenges and decision-making methods. Common
problems can be solved using routine decisions, which make use of policy and report form.
Adaptive decisions are applied in case of problems and alternative solutions when they are
unusual and less understood. This is a situation where nurses need to undertake innovative
decision making, to create novel solutions. There are various decision-making models that a
nurse can select from, they are the rational decision-making model, the descriptive rationality
model, satisficing and the political decision-making model. The rational decision-making
model undertakes rational selections for the maximization of objectives. The descriptive
rationality model focuses on the limitations of the rationality of the decision-maker as well as
the situation. In satisficing, individuals select an alternative that can meet the existing
condition or is the first acceptable alternative. In the political decision-making model, the
objectives and interests of the powerful stakeholders are evaluated for decision making.
There are various decision-making techniques available as per the nature of the problem, for
example, an artificial intelligence expert system. The problem-solving method is applied in
case there is a gap between the present state and the desired state. Problem-solving has
various methods that can be applied which include the trial-and-error method. Nurses can
make use of such techniques to creatively resolve problems and effectively resolve problems.
Applying all the above knowledge related to critical thinking, it can be said that critical
thinking was applied when I had to give a written examination for my staff for their yearly
evaluation. For every question that I was setting, I undertook a practical evaluation of
whether the staff could attempt them or not. I selected each question in a rational manner that
was relevant to their practical experience and the knowledge of which they are likely to
possess. I selected most questions from the internet and nursing guide books available online
on relevant topics of patient care and the healthcare environment. I phrased each question in a
manner such that they are easily understood by the staffs and they can comprehend the
meaning of the questions. I considered alternatives for every question such that the

EXAM ON NURSING LEADERSHIP & MANAGEMENT 4
knowledge and skills of staff can easily be understood from the same. While phrasing
interview questions for my staff also I undertook critical thinking skills. As critical thinking
is central to effective decision making, creativity and problem solving, I made use of
effective critical thinking. Deciding regarding all the questions for my staff, I undertook the
adaptive decision method. This enabled me to undertake an innovative decision-making
attitude while forming questions. The decision-making process that I adopted was the
rationality decision-making model. As I undertook a series of logical and well-grounded
choices based on rationality to maximize the attainment of objectives. I evaluated the
outcomes of all possible questions post which I considered the question for the written paper
as well as for the interview for my staff.
Content related to critical thinking and decision making from chapter 9 was applied in this
situation. The content from chapter 9 guided me regarding ways such that I could apply
critical thinking skills, also it enabled me to select the correct decision-making style. It acted
as a guide for my decision making and also enabled me to undertake a more rational
approach. With guidance from the chapter, it was possible to adopt an appropriate decision-
making technique in the healthcare situation.
2. Patient care delivery system at the clinical placement site. Its effectiveness and
suggestion for a better system
Nurses are focussed on the delivery of patient care across varied healthcare organizations.
The nursing care delivery system provides a structure to deliver nursing care to a specified
patient group. There are tremendous and significant changes brought about in nursing
delivery systems to deliver quality care and contain costs. Patient care delivery systems aim
at the best utilization of nurses and a group of nurses such that their skills and knowledge can
deliver appropriate care to patients. With patient-focused nursing care, there can be a better
hospital environment with lower rates of morality as per Aiken et al (2008) and nurse
satisfaction as per Spencer-Laschinger (2008). Models of Care are devised according to the
needs and demands of nurses and patients to meet population and facility care needs. Some of
the traditional models of care are total patient care, a functional nursing model of care, a team
nursing model of care, and primary nursing. Some of the integrated Models of Care includes
Practice Partnership, Case Management, and Critical Pathways of care. Some of the evolving
models of care are Patient-centered Care, Synergy Model of Care, and Patient-centered
Medical Home.

EXAM ON NURSING LEADERSHIP & MANAGEMENT 5
Acknowledging and learning regarding the various models of care, I was able to diagnose
the care system prevalent and practiced in my hospital. My hospital applies Case
Management Integrated Model of Care. This model of care enables the identification,
coordinating and monitoring of service implementation to arrive at patient care outcomes for
some time. Nursing care in this model of care is focused on diagnosing patient groups and
then providing predetermined outcomes for the patient within a specific period.
In this model of care in the hospital, there are patients selected who are high-risk cases,
high-volume and high-costs. The patient population once selected is analyzed such that
effective case management can be rendered. Post selection of the patient population, a
collaborative team is built from varied disciplines such as nursing, physical therapy, medicine
and so on for deciding upon intervention method. This allows the determination of specific
and measurable outcomes within a specific period. The collaborative practice team agrees
upon the final critical pathway to attain patient outcomes.
This method of patient care model works well for the hospital. As the hospital handles
varied numbers of complicated cases and a large influx of patients, this model of care works
pretty well. The case manager decides upon the patient caseload and then assigns it to
different caregivers. I have witnessed many health care systems and patient care models
facing significant pressures from an increasing number of patients with complicated cases
and with long-term conditions. They face pressures to reduce healthcare budgets and to
provide current resources more effectively. The case management model successfully enables
managing costs and also allocate resources more appropriately. Case management undertakes
clinical judgment of an expert's opinion. Case management theoretically can increase
efficiency by reducing unnecessary contacts with the health system encompassing fragmented
routine and emergency contact. The focus is to deliver coordinated care to provide
individually-tailored contacts and care planning.
Case management was appropriate for the organization and it was functional. Due to the
acute shortage of staff at the hospital, each case at the hospital had to be evaluated and then
time-bound action had to be taken. Due to the shortage of nurses, nursing care had to be
provided to patient cases that needed the most attention. Critical patient care had to be
prioritized and resources had to be evaluated such that care could be rendered to the patients
and reduced rates of morbidity and mortality can be attained. Moreover, the increased
numbers of old aged patients and patients with long-term conditions, it was almost impossible
to provide support and assistance to all in a similar manner. So, cases had to be prioritized
and then designated care needed to be devised by the case manager. In the health sector,

EXAM ON NURSING LEADERSHIP & MANAGEMENT 6
coordination of case management and care is positive for hospital conditions or based on
mobility and society. In this area, only community management is taken into account.
Community case management is more mobile than office health service. Community case
management is the most complete and human-oriented approach (model) of the method
(model) because it corresponds to the customer intersection. Through its holistic and
comprehensive approach, community-based case management can include most components
of other highly specialized case management models.
Though the appropriateness of this model has been seen in the current healthcare system,
and it functions effectively, yet there is a more emergent and consistent care model that can
provide better patient outcomes. The patient-centered model of care is a new model to deliver
care for ensuring adequate and appropriate care can be provided to the patient population at
the healthcare system. Though this model of care requires adequacy of staff to be present yet
this can deliver appropriate care for the patient of the hospital.
Patient-centered care is a model for patient care, and the role of nurses is expanding to
coordinate the multifunctional care unit. Patient-centered hospitals have all patient care units,
including reception and discharge services, diagnostic and medical services, environmental
and nutritional services and medical records. Patient-centered care focuses on
decentralization, efficiency, quality and cost control. The use of this care model reduces the
number of nurses assigned to patients, but their responsibility increases to reduce service time
and waiting times. Team support assistants provide environmental services and help health
and selection of needs. Administrative support staff shall continue to monitor patient records,
transcription orders, coordination of reception and discharge procedures and assist in the
performance of general office tasks. Patient-centered reported. Also, mortality can be lowered
in patients with acute heart conditions. People with chronic conditions are the right people to
access hospital care, including the use of complementary and alternative treatments. The role
of nursing managers in inpatient care takes a long time. The manager is no longer responsible
for patient care and care. Instead, to be responsible for a more diverse workforce and fewer
professional RN employees are assigned roles. The allocation of support staff between
organizations also increases the need for coordination and cooperation with other managers.
Findings
1. The outcome regarding an important decision

EXAM ON NURSING LEADERSHIP & MANAGEMENT 7
Findings regarding the situation where I had to make an important decision, the outcome
was extremely successful. I was successfully able to apply the learned skills and knowledge
of critical thinking and decision-making. I was able to learn successfully and apply those
skills in making decisions in the selection of questions and for interviews. As a nursing
quality coordinator, I am expected to diagnose the gaps in existing knowledge and skills of
staff and then devise questions according to such that such skills can be bridged. Step-by-step
problem-solving techniques can assist in resolving such gasp in perceived knowledge and
skills amongst staff levels. I have tried to diagnose the questions in a manner that can resolve
the problem of knowledge and skill gaps. Hence, I was able to effectively diagnose the
problem and attain the desired outcome for my decision making.
2. Patient care delivery system at the clinical placement site. Its effectiveness and
suggestion for a better system
Findings from the several models of care that was available allowed me to evaluate the
model of care. The patient-centered model is a better model to be applied in this case as
compared to the case management model of care. Case management, also known as health
care coordination, is a comprehensive and integrated medical and social intervention that
makes a unique contribution to health, social care and the participation of people with
complex health problems. In the 1960s, case management developed when large numbers of
people with severe mental illnesses were referred to outpatient treatment and other public
services for deinstitutionalization. In the 1970s and 1980s, spending on decentralized health
and health had an impact on the role of directors. Since the 1990s, case management has been
present in several conditions, including acute and acute post-hospital, rehabilitation, long-
term care, and the community environment. Administrative tasks are now carried out by
people from different disciplines, people from different backgrounds and communities who
have different problems. These many interactions between relationships and corporate
management create variability in the description of case management. Quality, policy, and
planning analyses are limited by significant differences in terminology, misunderstandings
and joint case management and care coordination. There is an urgent need for a common
international language, but first, it is necessary to understand the terminology used in
literature to describe business history. Several parameters affect case management. Corporate
management is carried out in very different service sectors (high and low resource
parameters). Its presence in various contexts highlights the importance of doing business in

EXAM ON NURSING LEADERSHIP & MANAGEMENT 8
the horizontal integration of health care into health, social services, and other sectors, as well
as in the vertical integration of health care for primary, social, hospital and higher education.
Health leaders are leaders from different disciplines such as nursing, occupational therapy,
physical therapy, psychology, rehabilitation management, social work, speech therapy and
various practical areas (such as social welfare, primary care) are evaluating models of care.
Also, there are many case management models and practical reference methods, partly due to
the different case management departments, the age of the clients and their health. Patient
care requires a dignified and respectful treatment by nurses and their participation in all
decisions relating to their health. This concern is also referred to as "human-oriented care".
The patient-centered model of care treats patients with dignity, respect, and compassion.
Over time, it communicates and coordinates the relationship between sessions and various
services. In such care, patient care is delivered between healthcare professionals and hospitals
to adopt the approach to patient needs and what they want to achieve. It helps find ways to
improve, take care of oneself and stay independent. Patient-centered care is more than the
way the healthcare professional treats an individual. It is also about how health care and
government develop and support policies that bring health care users, not health workers, to a
health center. The main objective of patient-centered care is to improve individual health
outcomes, not just public health, although the results of the population can also be improved.
Patients have not only the advantages but also the patients and their families are happier. A
better reputation for consumers in the health sector is ensured. Improved morale and
productivity of doctors and new employees. Improve resource allocation and most
importantly reduce costs and increase the continuity of financial surpluses for all benefits.
Conclusion
In conclusion, learning regarding critical thinking and decision making enabled me to
make appropriate decisions for selecting questions for my staff for the written examination as
well as for the interview. In the absence of the knowledge and skills that I developed from the
learning of theories, it would nearly have been impossible to devise an appropriate and
balanced question paper or questions for the interview. Similarly learning of the several
models of care enabled me to evaluate the current model being practiced at my hospital. A
better reputation for consumers in the health sector is ensured. Improved morale and

EXAM ON NURSING LEADERSHIP & MANAGEMENT 9
productivity of doctors and new employees. Improve resource allocation and most
importantly reduce costs and increase the continuity of financial surpluses for all benefits.
Also, I could decide upon a suitable model of care that will be appropriate and suitable in
the context of my clinical setting.

EXAM ON NURSING LEADERSHIP & MANAGEMENT 10
References
Sullivan, E.J. (2018). Effective Leadership and Management in Nursing. Pearson. 9th Edition.