Nursing Leadership and Population Interventions

An Ethic of Care and Nursing Leadership

Ethics can be either obligation-based or responsibility-based. While obligation-based ethics derive from such theories as utilitarianism and deontology, “in which the decision-maker determines what obligations he or she has and responds consequently,” in responsibility-based ethics, “the relationship with others is the starting point” (Lachman, 2012, p. 112).

Considering that along with responsibility, and effective caring model should comprise such elements as attentiveness, competence, and responsiveness of a care receiver (Lachman, 2012), leaders must aim to motivate nurses to develop the habits of care that meet caring responsibilities best and focus on the establishment of beneficial relationships with patients. It is possible to suggest that a transformative leadership strategy is the most conducive towards the achievement of these goals as two of the primary objectives of transformational leaders are communicating particular values and visions to employees and inspiring them to implement those values in practice.

As stated by Stetler, Ritchie, Rycroft-Malone, and Charns (2014), transformational behaviors imply promotion of a vision, communication, and action upon that vision and related values, the focus of particular practical concerns (e.g., ethics of care), as well as intellectual stimulation, development of internal motivation, and empowerment of subordinates. By applying this leadership strategy, a nurse leader can enforce compliance with the ethics of care model by aligning personal and organizational visions and values and inspiring nurses to act responsibly.

However, based on my advanced nursing practice experience, it is possible to say that the provision of holistic care and the establishment of trustful and meaningful relationships with patients, which are the intrinsic aspects of ethical caring, can be challenged due to ineffective work structures, e.g., scheduling models and workloads. Thus, as part of the transformational leadership strategy, a leader should advocate for the creation of a supportive environment in which ethical and high-quality performance can be facilitated.

An Ethic of Care and the DNP-Prepared Nursing Leader

Transformational leadership is “a leadership approach that causes a change in individuals and social systems” (“Transformational leadership,” n.d., p. 1). The given strategy and style can be applied to resolve multiple types of issues of current concern, including the ethical ones. In clinical settings, ethical controversies are inevitable. According to Barkhordari-Sharifabad, Ashktorab, and Atashzadeh-Shoorideh (2017), ethical conflicts may arise when an individual (power and respect), professional (patient-oriented care), and organizational values (competition and efficiency) are in misbalance. A role of a transformational leader is thus to minimize the chance for the occurrence of conflicts between individual and organizational ethics by removing existing organizational constraints to ethical practice and motivating nurses to comply with high standards of care.

Based on the findings on the nature of ethical conflicts in hospitals, it is possible to suggest that a collaborative and holistic approach to change management is required to achieve positive results in eliminating ethical problems. A leader can work with his or her team directly and make them understand and implement ethical principles and standards, but favorable transformations of nursing practice at the hospital-wide level may be slowed down or halted without an appropriate environment.

During the DNP program, I have learned about the importance of advocacy and inter-professional collaboration. It seems apparent that these responsibilities of a DNP-prepared nurse can help foster the improvement of ethical performance in my hospital. After the completion of the program, I will aim to enhance the collaboration with professionals from different organizational levels to identify barriers to ethical care and develop an evidence-based approach to their elimination. Eventually, through this strategy, it will be possible to increase the nursing team’s ability to meet patient needs more efficiently.

Frameworks for Evaluating Outcomes

The Clinical Value Compass is a model aimed to direct the planning of various improvement initiatives. The four sides of the compass include the functional health status (health risks, physical functions, well-being, etc.), costs (direct and indirect healthcare costs), satisfaction (perceived benefits, etc.), and clinical outcomes (morbidity, complications, etc.) (“The Clinical Value Compass description,” n.d.). All four aspects must be included in the evaluation of the project outcomes because together, they help develop a holistic picture of a problem and a target population. If some of the factors are ignored, one can easily develop a plan that is “inconvenient, unpleasant, unfeasible and very costly to the patient” (“The Clinical Value Compass description,” n.d., p. 2).

The planned class project is the prevention of teenage obesity by using a multimedia educational program. The condition is associated with multiple adverse health issues, including cardiovascular disease, colon cancer, asthma, hypertension, and diabetes mellitus (Huh, Stice, Shaw, & Boutelle, 2012). Since over 30% of contemporary teenagers are either overweight or obese, and these rates tend to grow, the elimination of the problem can help significantly improve public health (Huh et al., 2012).

The identified health risks indicate that the project is associated with a high level of satisfaction because it can potentially produce many health benefits. As for the factor of clinical outcomes, it may lead to both short-term and long-term positive results. For instance, it may foster compliance with the principles of a healthy lifestyle (short-term outcomes), prevent the development of such adverse obesity-linked conditions as diabetes, and improve psychological state (long-term outcomes).

Lastly, the project will induce some time and financial costs as funds are needed to develop an appropriate program, involve specialists from various professional backgrounds, and integrate the program into the educational settings. However, in the long run, the program may help decrease the financial burden (on both hospitals and families) associated with teenage obesity because a lesser amount of medication and relevant clinical intervention services will be demanded.

Dissemination and Inter-professional Collaboration

DNP-prepared nurses can assist in the dissemination of findings, promotion of health, and effective health policies through patient education, research, and advocacy. By collaborating with various community stakeholders (e.g., educational settings, local authorities, and community-based organizations), nurses can raise awareness of multiple health issues and their solutions in public. It is important to remember that high-quality evidence can largely support health promotion initiatives. Thus, the administration of research on the selected topic, as well as advantages and disadvantages associated with the implementation of the project, is a primary requirement.

When speaking about adolescent obesity prevention and treatment, clinicians often refer patients with this condition to interventions outside hospitals, e.g., interactive nutrition and exercise sessions, in-group physical activities, cooking courses, etc. (Vine, Hargreaves, Briefel, & Orfield, 2013). Thus, to achieve better project outcomes, an inter-professional team can include social workers, childhood development specialists, nutritionists, and other professionals working in diverse clinical and educational settings. Together they can create a supportive network for those who need intervention and facilitate their referral to the developed educational program and other preventive activities.

Through collaboration, the inter-professional team members will be able to detect and address psychosocial and physiological factors defining teenage obesity, such as low incomes, genetic predisposition, etc., more efficiently. A multidisciplinary approach to patients will help target the origin of the problem at both individual and community levels and, in this way, will lead to better outcomes.

References

Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2017). Obstacles and problems of ethical leadership from the perspective of nursing leaders: A qualitative content analysis. Journal of Medical Ethics and History of Medicine, 10(1), 1-7.

Huh, D., Stice, E., Shaw, H., & Boutelle, K. (2012). Female overweight and obesity in adolescence: Developmental trends and ethnic differences in prevalence, incidence, and remission. Journal of Youth and Adolescence, 41(1), 76–85.

Lachman, V. D. (2012). Applying the ethics of care to your nursing practice. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 21(2), 112-116.

Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing, 11(4), 219-226.

The Clinical Value Compass description. (n.d.). Web.

Transformational leadership. (n.d.). Web.

Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the role of primary care in the prevention and treatment of childhood obesity: A review of clinic- and community-based recommendations and interventions. Journal of Obesity, 2013(172035), 1-17.