NUR302 Case Study: Registered Nurse Leadership in Healthcare Teams

This essay analyzes a case study focusing on Konstantina (Connie), a 79-year-old widow with multiple comorbidities including diabetes, hypertension, and renal failure, who underwent a lower leg amputation. The essay examines the critical role of registered nurses (RNs) as leaders within a collaborative healthcare team. It emphasizes the importance of clinical leadership in managing complex patient needs, including preoperative and postoperative care, pain management, wound care, and psychological distress. The analysis highlights the RN's responsibilities in prioritizing patient needs, adhering to NMBA standards, facilitating effective communication within multidisciplinary teams, and providing patient education. Furthermore, the essay underscores the significance of teamwork, delegation, and the implementation of holistic care to improve patient outcomes and overall healthcare quality. The essay explores the various roles of RNs in managing patient conditions and working with other healthcare professionals to improve patient care.

Running head: NURSING LEADERSHIP
NURSING LEADERSHIP
Name of the Student
Name of the university
Author’s note

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Case study 1 essay
With the complexity of the health care and the increasing demands of the health care
services, the roles of the nurses as care coordinators, leaders and advanced practitioners have
come to the forefront. They now go hand in hand with the doctors to provide the best care for the
patients. Clinical leadership is important due to the complexity, high rates of modifications,
safety and quality issues and workforce shortages occurring in the health care sector (Joseph and
Huber, 2015). This essay will focus on the case study of Konstantina (Connie) who is a 79 years
old widow living entirely on his limited pension. She had a 20 years medical history of diabetes
mellitus along with some other comorbidities like hypertension and renal failure. She also has
survived a hemi colectomy, which she had been managing independently, until two years before,
from when she will have to be entirely dependent on her children. Recently she had been
admitted to the orthopaedic ward for a lower leg amputation due to the occurrence of a large
infected ulcer with three gangrenous toes. It is evident from the case study that the patient is an
elderly person and is burdened with the several other comorbidities, which might be lethal for the
survival of this patient. Owing to this high risk patient, the registered nurses have to be more
vigilant and proactive to notice any deteriorating conditions. A body of evidence have
demonstrated the relationship between nursing leadership. Good clinical leaders have been found
to be associated with low patient, mortality, increased patient satisfaction, improved outcomes of
patient safety, less number of adverse outcomes, less number of complications and proper usage
of the health care resources (Wong, Cummings, and Ducharme, 2013).
The various elements of safety and quality has been discussed below along with the
clinical priorities of Mrs Connie. One of the main aspect of clinical leadership is to find out
nursing priorities of Connie. Shortage of heath care staffs in an organisation might impose

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excessive workload on the RNs. The only way to manage such burden and to avoid any clinical
errors and misses are to manage the tasks based on the priorities. While setting up the priorities
it is required to apply the knowledge of pathophysiology and then develop a plan for the patient
(Boivin et al. 2014).
One of the main clinical priority for Connie is to manage Connie’s distress in the
preoperative and the post-operative period. The post-operative management of Connie would be
to manage/ reduce his pain, prevention of infection by carrying out a proper wound
management plan. One of the most overlooked issue is the psychological distress that Connie
had been facing even after being assured by her daughter. It seems that she is distressed about
the pain that would follow after the amputation or might be distressed about how she would
cope up with this disability as she would have to remain totally dependent on somebody.
According to (Sahu, Sagar, Sarkar and Sagar, (2016) depression and anxiety are some of the
most common problems among the patients who have suffered from an amputation and the
irreversible process that the amputation can itself contribute to the occurrence of psychological
distress.
Some of the other clinical priorities would include diabetes management, hypertension
and renal diseases. The glycaemic level plays a huge role in wound management. Diabetes tends
to delay any wounds, increasing the chance of infection, posing a challenge to nursing care. this
due to the fact that people with high glycaemic level have poor blood circulation and with the
slowing down of the circulation, blood tends to move more slowly making it more difficult for
the body to transport nutrients to the wounds, due to which the wounds and injuries takes more
time to heal. Uncontrolled diabetes level can again cause to damage the nerves, numbing the
sensation of a particular area (Weledji and Fokam 2014).

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Another Safety priority for Connie would be to manage her hypertension and her renal
disease. Diabetes damages the arteries and hardens them causing atherosclerosis. This can
contribute to hypertension and if not monitored or treated properly might cause permanent
damage of the blood vessels giving rise to peripheral vascular diseases, heart attack and kidney
failure. It has been stated by Jensen et al., (2018), that there is an increases risk of developing
diabetes after undergoing a hemi colectomy. There are several long term and short term
complications after a hemocolectomy, which includes incontinence, vaginal fistula, or increases
the chance of Crohn’s disease, pelvic sepsis or formation of abscess. The complications increase
with a considerable deterioration of the quality of life. It is thus the duty of the nurses to assess
the condition of the patient and the raise red flags, in case further deterioration is found.
According the standards 4 of the registered standards of the Nursing and Midwifery board of
Australia, RNs should conduct the assessments accurately followed by an accurate analysis of
the information an data and then communicate the outcomes (NMBA, 2019). Hence, a strong
nurse leadership will be required to manage all these comorbidities simultaneously.
Again, as per the standard 4.3 of NMBA, nurse leaders work in partnership with the
patients and the other members of the families as well as other health care teams to provide a
comprehensive care to the patient (NMBA, 2019). An effective teamwork is an important tool
for the construction of a more effective and patient centred health care delivery system. Health
care services are provided to individuals, families by collaborating with them and providing with
the scope of participating in the decision making process. The incorporation of the shared goals
and responsibilities in a health care team will surely offer greater benefits for patients (Babiker et
al. 2014). It is the duty of the nurse leaders to manage the health teams as well as provided with
motivations, conflict resolutions, clinical decision making, innovation and managing the

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changes. It is the need that a team leaders understand the necessity of a team. If the leadership is
poor, it becomes challenging to bring together the disgruntled works pull together against and
effective management and a weak leadership. Nurse leaders should ensure good tem cohesion
where all the team members can work for pursuing the common goal of better health outcomes.
The standard 2.8 of the NMBA standard have clearly stated the role of the RN to be effective
communicators who are obligated to participate in collaborative practices (NMBA, 2019). Any
planning in nursing is not possible without effective partnership with the patient and the other
health care workers.
A multidisciplinary health care team is one where the team members are experts in their
own field. They communicate with each other, merging their observations, expertise and the
decision making responsibilities for optimizing the care of the patient. Poor communication
between the multidisciplinary team members can be stated as a common cause for most of the
medical errors. The multidisciplinary team members for Connie would involve a physician, a
registered nurses having ample experience in wound management, a diabetes educator and an
occupational therapist. The occupational therapist and the registered nurses will provide pre-
amputation services like helping in mobilizing the patients and providing psychological support
to the patients (Graham et al. (2019). Post amputation, an early rehabilitation would be required
for Mrs Connie. They might provide early advice about the use of wheel chair transfers or
exercises and the need for an extended for more period of early habitation, phantom pain
treatment and availability of amputee peer support. It is the role of nursing leader to understand
that all these needs of the patients are met. According to (Graham et al. (2019) in the early post-
operative period the nurses have to be more careful about the oedema management in the patient.
RNs should be mindful about wound infection and breakdown by proper interventions like the

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use of shrinker socks. The RNs should provide education to the novice nurses in care of the
patients about maintenance of the hand hygiene while cleaning and wound dressing, adherence to
the hospital guidelines of infection management. RNs should monitor the compliance behaviour
of the nurses. According to standards 6 of NMBA, RNs should appropriately delegate tasks to
the enrolled nurses and the other nursing staffs and are also accountable to provide effective as
well as timely supervision and direction for ensuring that the delegated practice is safe (NMBA,
2019).
In various acute care hospitals, nurses take leadership positions on the pain management
committees. Nurses can articulate better than any other healthcare professionals to assess the
pain and manage them. Effective pain management technique would include the application of
the analgesics. Pharmacological adjuvants such as Ibuprofen, neproxyn, gapapentin can be
provided to the patient to manage with the pain. Provision of effective analgesia in the early post
operative period have clinically important benefits, including long term recovery and reduced
incidence of pain (Glowacki 2015). The RNs should have proper knowledge about the regimens
of various multimodal therapies to reduce the pain (Glowacki 2015).
Leadership should also be displayed in the assessment of signs and symptoms of the
patients, which can be done by regular monitoring of the vital signs. According to the NMBA
standard 4, nurses should be able to accurately conduct nursing assessments and maintain an
accurate and timely documentation of the assessment reports (NMBA, 2019). Nurses needs to be
vigilant about the blood pressure as fluctuations in the blood pressure might delay the treatment
and especially to avoid any post-operative complications. Hypertension management of the
nurses would involve detection and follow up, management of medication, education to the
patients, skill building and counselling, care-coordination, office management and health

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management of the population (Himmelfarb, Commodore-Mensah and Hill 2016). Renal failure
in Connie can be managed by monitoring electrolyte and fluid balance in the patient, as these
levels as these are some of the potential indicators during all the phases of disorder (Thomas
2019).
Another important aspect of nursing leadership is to provide patient education, for
building the knowledge of the patients, for developing preparedness for the self-management of
the conditions. The RN should educate Connie both in the preoperative as well as in the post-
operative period. In the preoperative period, the RN should provide psychological support to the
patient revealing about the procedures that needs to be conducted. The postoperative education
prior of after the rehabilitation would include necessity of a continuous follow up , adhering to
the medication regimen, educating about mandate reporting in case of any deterioration (Bergh et
al. 2017). Connie can be referred to a dietician in order to plan a diet chart for Connie
considering her the diabetes and hypertension. A dietician hence can be incorporated in the
multidisciplinary team.
It is evident from the case study, that Connie had already been affected by both the
physical and the psychological burden of diseases. She needs a holistic care of support, which is
believed to be the heart of the science of nursing. As stated by Zamanzadeh et al. (2015), holistic
care can be described as a behaviour which can recognize the person as a whole , including the
biological, social, psychological as well as the spiritual aspects. It includes a wide range of
approaches like medications, education, self-help, communication and complementary treatment.
Hence, Connie should be assured that she will be provided with full support and that there is
nothing to be scared off. During or after the rehabilitation, Connie or her family can be

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recommended to any community based organisation supporting patients like Connie in a number
of sectors like assistive aids, provision of home care packages.
In conclusion, it can be stated that clinical leadership uses the skills of the RN and adds
the general leadership skills. The clinical leadership attributes that are required for the
management of this case study in communication, managing a multidisciplinary team,
management of pain, renal function, hypertension and diabetes. After the amputation, the
primary role would be to manage pain, prevention of infection, provision of psychological
support to the patient. Moreover, a holistic care of approach is required for Connie.

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References
Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri, A.,
Al Saadi, M., Shaikh, F., and Al Zamil, F. 2014. Health care professional development:
Working as a team to improve patient care. Sudanese journal of paediatrics, 14(2), 9–16.
Bergh, A. L., Friberg, F., Persson, E., and Dahlborg-Lyckhage, E. 2015. Registered Nurses'
Patient Education in Everyday Primary Care Practice: Managers' Discourses. Global
qualitative nursing research, 2, 2333393615599168.
Boivin, A., Lehoux, P., Lacombe, R., Burgers, J. and Grol, R., 2014. Involving patients in setting
priorities for healthcare improvement: a cluster randomized trial. Implementation
Science, 9(1), p.24.
Glowacki, D., 2015. Effective pain management and improvements in patients’ outcomes and
satisfaction. Critical Care Nurse, 35(3), pp.33-41.
Graham, L., Doherty, M., Wilson, C., Wilson, C. and Currie, M., 2019. The multidisciplinary
rehabilitation of patients after lower-limb amputation. Diabetic Foot Journal, 22(3).
Himmelfarb, C.R.D., Commodore-Mensah, Y. and Hill, M.N., 2016. Expanding the role of
nurses to improve hypertension care and control globally. Annals of Global health, 82(2),
pp.243-253.
Jensen, A.B., Sørensen, T.I., Pedersen, O., Jess, T., Brunak, S. and Allin, K.H., 2018. Increase in
clinically recorded type 2 diabetes after colectomy. Elife, 7, p.e37420.

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Joseph, M. L., and Huber, D. L. 2015. Clinical leadership development and education for nurses:
prospects and opportunities. Journal of healthcare leadership, 7, 55–64.
https://doi.org/10.2147/JHL.S68071
NMBA, (2019). Registered nurse standards for practice. Access date`: 13.4 2020. Retrieved
from:https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards/registered-nurse-standards-for-practice.aspx
Sahu, A., Sagar, R., Sarkar, S., and Sagar, S. 2016. Psychological effects of amputation: A
review of studies from India. Industrial psychiatry journal, 25(1), 4–10.
Thomas, N. ed., 2019. Renal Nursing: Care and Management of People with Kidney Disease.
John Wiley & Sons.
Weledji, E. P., and Fokam, P. 2014. Treatment of the diabetic foot - to amputate or not?. BMC
surgery, 14, 83.
Wong, C.A., Cummings, G.G. and Ducharme, L., 2013. The relationship between nursing
leadership and patient outcomes: a systematic review update. Journal of nursing
management, 21(5), pp.709-724.
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., and Taleghani, F. 2015. Effective
factors in providing holistic care: a qualitative study. Indian journal of palliative care,
21(2), 214–224.

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