How To Improve Transitional Care By Implementing Transformational Leadership Qualities And SBAR Communication Tool As A Student Nurse?

Characteristics of transformational leadership in nursing

I am a registered nurse working in the emergency department. Our nursing challenges involve to improve patient satisfaction and quality of health care. A patient Julie has been admitted with injuries due to road traffic accident. She has developed infections at the injury site and received antibiotic administration after a gap of 8 hours post presentation. This resulted in serious consequences with manifestations of sepsis and cellulites due to lack of communication and team work coordination in transitional care. I have performed research on transitional care errors; I will discuss that evidence based practice can benefit health care professionals to increase patient outcomes by improving patient safety and reducing treatment accidents. Accurate nursing practice is brought about through transformational leadership skills in nursing profession, which can bring significant improvement in patient health quality (Beckett et al., 2013). I will provide a summary and analysis of evidences unfolded during my literature research. Finally, I will provide an implementation plan on new nursing practice with the help of transformational leadership qualities to minimize the transitional care errors.

In Julie’s case, she reported with injuries in face, legs and jaws in the emergency department where she underwent a delay in antibiotic administration and shifted to a medical ward. She was manifested with sepsis and cellulites. At the point of emergency admission, there was a delayed approach by the health care staffs. Adequate immediate supportive therapy to manage the accidental trauma was lacking; a generalised evaluation approach was performed by the emergency management team. The patient was thereafter shifted to the general ward and prescribed antibiotics to relieve associated fever and infections.

How ISBAR communication tool can improve communication between multidisciplinary nursing team ensuring patient safety and improved patient outcome in transitional care shifts as compared to generalized unstructured handover practice? This is the PICO question I have developed to address my research.

P	Population, Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Nursing professionals particularly shift nurses
I	Intervention	SBAR communication toola
C	Comparison	Generalized or unstructured handoff practice
O	Outcome	Improved nurse-physician communication and relation and improved patient outcome

I have searched Google Scholar to identify and support my research evidences. I have read through the associated references of my evidence based articles. I have considered Patient-centred care pyramid to advance through my research (Lusk & Fater, 2013). I have refined my research within the last 5 years and also included peer-reviewed articles. I will discuss the analysis of literature search that I have selected.

As evidenced by Storm et al. (2014), elderly patients during admissions and discharge in hospital settings face multiple problems in care offered by the health professionals. The involved healthcare personnels show an efficient caring approach during transfer of care services in different care levels. Lack of information exchange between care givers in care levels and also between patient family and involved personnels have resulted in serious consequences for elderly patients during discharge. This has led to rehospitalisation cases. Lack of familiarity among physicians and nursing professionals with the legal measures during discharge, reduced staffing in between clinical transfers, information gap between health personnels and patient family during admission and discharge facilities, difficulty in understanding among care personnels during multiple transfer care services have shown adversity among patient outcomes.

Effect of lack of communication and coordination in transitional care

Thomas et al. (2013) has shown that in his evidence based study selecting n=459 incidents from Australian Health service reporting system, significant proportion of errors in clinical handover services have been encountered in inadequate patient transfer in different care levels, the reported percentage being 28.8%. 26.9% error has been found in clinical mismatch while patient handover from one clinical personnel to another in care levels. Mismatch in clinical documentation is another significant error with 24% reported rate. 14.2% error has been reported due to omission of clinically important details from patient treatment care plan, which has led to adverse health conditions in patients generating patient dissatisfaction.

The systemic review performed by Roughead et al. (2016) showed that medication errors leading to adverse drug reactions among patients are concerned areas where proper interpretation and improved efficiency are necessary to reduce deterioration of patients’ health quality. Medical drug errors are due to inefficient knowledge and lack of communication among health care staffs operating at different health care levels. Lack of well documented approach on medication during discharge of patients has been significantly higher. Medication errors during a patient’s stay in hospital has therefore resulted in considerable increase in medication costs.

Considering the reviews of Allen et al. (2014), database search and literature reviews have shown that transitional care inefficiency has resulted in rehospitalisation of patients; patients have to stay for longer periods during rehospitalisation. There was lack of involvement of patients and their families during decision making regarding patient assistance. Lack of coordinated and collaborative efforts among nursing officials and involved multidisciplinary team have resulted in inefficient multiple transfer care facilities.

Evidence based nursing practice to improve patient care during transitional care shifts is to implement SBAR communication tool to enable a collaborative communication strategy among health care teams (DeMeester et al., 2013). Collaborative communication and efficient coordination among a multidisciplinary team are essential for successful treatment care and patient safety. Lack of communication among health care team members during shift transfers is a major cause for patients’ health adversity (Robinson & Dearmon, 2013). SBAR communication tool gives a description of the situation (S) with which the patient has been reported in hospitals. The background (B) section of the tool gives a description of medical details of the patient relating to current medical issue and the assessment (A) section determines the patient health status in current scenario and new assessment data. (R) section provides a recommendation in terms of treatment changes, consultation requirements or transfers (Martin & Ciurzynski, 2015). This communication handover tool bridges the communication gap between physician and nurse in a multidisciplinary assistance. The SBAR handoff tool maintains a continuous flow of information during multiple transfer activities (Cornell et al., 2014). The SBAR method of communication increases the confidence of the nurses in between shift transfer and enable them to have a detailed knowledge of individual patient. This eliminates adverse patient outcomes by reducing medication errors and improving timed management of patient care by shift nurses.

Transformational leadership development in nursing provides an organisational approach to improve the nursing performance and improve patient outcomes. Transformational leadership skills are integral to the nursing management to enable the nursing officials to arrange a workforce and identify the required change in practice. Transformational leadership style enables the nurses to work effectively and guide a vision to improve nursing practice to increase patient safety and outcomes. Transformational leadership is rooted to four components: idealized influence, inspirational motivation, intellectual stimulation and individual consideration (Zhu et al., 2013). The transformational leader possessing idealized influence characteristic provide themselves as a role model to other team members and encourage them to meet the patient needs overcoming all obstacles. The component of inspirational motivation enables optimistic approach to a change adaptation in nursing practice and guides through a compelling vision. It gives a confidence to all the nurses to accept challenges with enthusiasm and instills a high team spirit (Giltinane, 2013). Intellectual stimulation factor of transformational leadership allows the nurses to seek different perspectives in critical analysis and solving problems. Non-traditional thinking approaches are also allowed in changed practice. The final component of transformational leadership is individualized consideration where the transformational leader provides education to the team members and followers and promote self-development. This allows consideration of individual concerns and help team members to develop strengths in promoting changed nursing practice (Wong, Cummings & Bucharme, 2013). All these components of transformational leadership are integrated to develop patient centred care approach.

Literature review on transitional care errors

Transformational leadership in new nursing practice is possible in supportive and optimistic environments, where every team member engage with each other to allow for blending of their creative imagination and vision to develop organisational capacity (Wang & Liu., 2015).

Transformational leadership is obtained with accuracy through application of Registered nurse standards to incorporate new nursing practice in hospital settings (Ross et al., 2013). Standard 1, 2, 4, 5 and 7 are critical for implementing a new nursing practice and achieve improved patient outcomes.

In clinical settings under my supervision, I would implement SBAR communication tool to promote patient centred care through maintaining streamline flow of information exchange. I would initially discuss with the healthcare team about the use of SBAR communication tool as a handoff approach during multiple shift transfers. A formatted standard protocol would be designed on how to use SBAR tool during shift transfers. I would ensure that short term training sessions are arranged to develop and improve the communication style between shift clinicians. I would allocate specific roles to shift nurses as a part of SBAR implementation program. A checklist criteria would be maintained as a part of SBAR tool use. The nursing management team would be responsible for initial monitoring to check whether the shift nurses are performing efficiently and accurately according to the checklist criteria (Hutchinson & Jackson, 2013). Frequent training on communication style development would be arranged for bridging the communication gap among different shift nurses (Curtis et al., 2013). A team of nurses would be appointed to take regular follow ups immediately after patient transfers to check whether accurate diagnostic assessment of patients are followed according to (S) and (B) sections of SBAR communication tool. A web based transfer of patients’ medical details would be allowed between multiple shift rooms to minimise documentation mismatch, thereby promoting greater screening and assessing time to individual patients.

Reference	Author validity	Method & where it fits on the evidence pyramid	Aim/Question	Setting	Results	Limitations	Implication
Storm, M., Siemsen, I. M., Laugaland, K., Dyrstad, D., & Aase, K. (2014). Quality in transitional care of the elderly: Key challenges and relevant improvement measures. International Journal of Integrated Care, 14(2).	The authors are competent and skilled to carry out the research. They work with reputable research institutes and their qualifications are valid. They have no conflict of interest.	Case study reports of elderly people above 75 years of age are considered. Patient admission and discharge reports, open-ended conversation with patients and patient families and involved health care professionals are performed. Thematic observational approach is considered.	The aim of the paper is to establish that knowledge based skills by health care professionals are important in improving transitional care of elderly patients during transfer of patient services. It provides a suggestion of implementation measures considering the issues affecting transitional care of elderly patients.	Hospital settings in the emergency care.	Lack of exchange of information between health care personnels, involvement of patient and patient families in decision making, difficulties in professional skills and lack of competence have been identified as challenges affecting quality of care in transitional settings during transfer of patient services in different health care levels. Gap in knowledge skills among health care professionals have been identified as major challenge in transitional care inefficiency.	The data are collected from two hospital regions in city area. Data from rural areas are not considered.	Observation and evidence based structural care plan would improve the patient care during patient transfer services in different care levels.
Thomas, M. J., Schultz, T. J., Hannaford, N., & Runciman, W. B. (2013). Failures in transition: learning from incidents relating to clinical handover in acute care. Journal for Healthcare Quality, 35(3), 49-56.		Incident based observation and data collection has been performed.	The aim of the paper is to highlight the inefficiency of clinical handover care due to errors during patient handover of patient details between health care personnels in acute care settings to provide the basis of strategic implementation of improved clinical practice.	Acute care settings in hospitals.	The findings involve inadequate handover of patients in clinical settings, exchange of patients’ clinical documented reports with other patients, omission of clinical information of patients’ clinical health care plan as the major challenges in clinical handover of patients among different health personnels.		Omission of clinical information and clinical information mismatch can be prevented through a structured approach of standardised information set to ensure that clinical details of patients are not mismatched or omitted.
Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. International journal of evidence-based healthcare, 14(3-4), 113-122.		Online search strategy through various databases and online resources are employed to estimate the medical drug errors. Previous data on medication errors have been taken through literature search.	The paper aims to provide an estimation of medical errors particularly prescription errors and adverse drug response errors that are encountered by a patient during his hospital stay in Australia.	Acute care settings in Australia.	The previous and current findings suggest that high proportion of medication errors have been found among patients in admission times. Prescription errors have been found to be the most prevalent with 2 errors per patient. Errors in medication documentation have also been found significantly higher during patient discharge from hospitals.	The research data are based on online resources and prior and current literature review. No quantitative or qualitative study have been performed to confirm the online resource data.	Medication safety is related to ensuring improved care among patients; this has been a significant problem in complex health care facilities. This requires proper recorded documentation of medical drugs and strategic management to minimize considerable error rates.
Allen, J., Hutchinson, A. M., Brown, R., & Livingston, P. M. (2014). Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC health services research, 14(1), 346.		Search strategy involved searching through eight databases and screening of those results to select peer reviewed articles. Randomised control trial designs have been utilized for comparative study approach.	The paper aims to compare the transitional care interventions with the standardized hospital care settings and provide recommendation on improving transitional care quality.	Older people in hospital settings during discharge.	The findings suggest that transitional care interventions have shown improvement as compared to standard hospital care strategy. Lack of patient centered care and effective bonding between patient and care giver are still observed reducing patient outcomes.	The research study has been generalised independent of study characteristics. Study is restricted to older people above 60 years and did not include patients of different ages to make a conclusion. Gaps of evidences are present due to short timeline considered for study.	The research concludes that there is an evidence based gap in knowledge and understanding among health care professionals. There is an increased need for designing efficient transitional care interventions to reduce the gap in knowledge and understanding and improve patient outcomes with high satisfaction between patients and care givers.

References:

Allen, J., Hutchinson, A. M., Brown, R., & Livingston, P. M. (2014). Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC health services research, 14(1), 346.

Beckett, P., Field, J., Molloy, L., Yu, N., Holmes, D., & Pile, E. (2013). Practice what you preach: developing person-centred culture in inpatient mental health settings through strengths-based, transformational leadership. Issues in mental health nursing, 34(8), 595-601.

Cornell, P., Gervis, M. T., Yates, L., & Vardaman, J. M. (2014). Impact of SBAR on nurse shift reports and staff rounding. Medsurg nursing, 23(5), 334.

Curtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., … & Arnold, R. W. (2013). Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. Jama, 310(21), 2271-2281.

De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse–physician communication and reduces unexpected death: A pre and post intervention study. Resuscitation, 84(9), 1192-1196.

Giltinane, C. L. (2013). Leadership styles and theories. Nursing Standard, 27(41).

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), 11-22.

Lusk, J. M., & Fater, K. (2013). A concept analysis of patient?centered care. In Nursing Forum (Vol. 48, No. 2, pp. 89-98).

Martin, H. A., & Ciurzynski, S. M. (2015). Situation, background, assessment, and recommendation–Guided huddles improve communication and teamwork in the emergency department. Journal of Emergency Nursing, 41(6), 484-488.

Robinson, B. K., & Dearmon, V. (2013). Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students. Journal of Professional Nursing, 29(4), 203-209.

Ross, E. J., Fitzpatrick, J. J., Click, E. R., Krouse, H. J., & Clavelle, J. T. (2014). Transformational leadership practices of nurse leaders in professional nursing associations. Journal of Nursing Administration, 44(4), 201-206.

Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. International journal of evidence-based healthcare, 14(3-4), 113-122.

Storm, M., Siemsen, I. M., Laugaland, K., Dyrstad, D., & Aase, K. (2014). Quality in transitional care of the elderly: Key challenges and relevant improvement measures. International Journal of Integrated Care, 14(2).

Thomas, M. J., Schultz, T. J., Hannaford, N., & Runciman, W. B. (2013). Failures in transition: learning from incidents relating to clinical handover in acute care. Journal for Healthcare Quality, 35(3), 49-56.

Wang, S., & Liu, Y. (2015). Impact of professional nursing practice environment and psychological empowerment on nurses’ work engagement: test of structural equation modelling. Journal of Nursing Management, 23(3), 287-296.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.

Zhu, W., Newman, A., Miao, Q., & Hooke, A. (2013). Revisiting the mediating role of trust in transformational leadership effects: Do different types of trust make a difference?. The Leadership Quarterly, 24(1), 94-105.