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Advance directives are essential for patients of various ethnicities, beliefs, and religions. In the modern world, humans should be provided with the possibility to choose the way of treatment and the person responsible for their healthcare decisions on special occasions. Advance directives, including a living will, healthcare proxy, and durable power of attorney, allow individuals to pick up medical tactic that is most comfortable for them. These preferences may change within time and should be reassessed to meet patients expectations (Sean Morrison, 2020). Moreover, according to the research by Jang et al. (2017), the lower implementation of advance directives was estimated among Asian Americans than the general population of the US (26%-36%). In the way of decision-making, nurses play a central role in informing the patients and helping them make the right choice according to their wishes.
Scope and Purpose of the Project
This Capstone Project aims to evaluate how Washington University School of Medicine implements advanced directives to the patients through Nurse Case Management Department. Nurse Case leadership involves a variety of tasks such as structure performance, achievement of healthcare policy, system integrity, timely care delivery, and efficiency. The project will disclose various ways how the Nurse Case Management Department provides the patients with advanced directives and evaluate the feedback of the system from both patients and the staff.
Outline of the Action Plan
The first step of implementing the project is data gathering. The major purpose is to estimate the patients awareness about advance directives and their satisfaction with the system. If the nurses informed them about all the possible variants and their rights; if nurses answered the patients questions; if the patients were satisfied with the system if they happened to experience it. Data gathering from the patients will include filling application forms with one open section allowing to express some ideas for possible improvement of the system.
Gathering data from staff will present an in-depth interview of nurses and their leaders about advance directives and their work with them. The staff will answer the questions if they think patients are aware of the system; how often do they think patients use it; have they faced the complications in the system or they think it is developed properly. If the staff emphasizes various shortcomings in the system, they should be asked how it can be avoided.
The second step of the action plan is analyzing the data: if the patients age is distributed unequally and if the patients were diagnosed with disorders limiting them to use the system (for instance, dementia, schizophrenia, Alzheimers disease, etc.). On these occasions, advance directives can be an issue especially for gerontological nurses (Miller, 2017). Elderly individuals with a lower level of attention and patience might give less precise and detailed feedback than young people. However, some elderly adults have spent a substantial amount of time at the hospitals and might have more experience in using advance directives than young generations. That means additional human resources might be needed to gather data from older generations if the application forms are not informative enough. Moreover, the percentage of satisfaction will be estimated to make judgments on the perception of the system by patients and staff. An open section in the patients application form and answers from staff can help identify the major disadvantages the system has and possible ways of correcting them.
The last step of the action plan is highlighting recommendations for the system that can be corrected according to the data analysis. For instance, if the patients are not aware of their rights or do not understand the choice they should make, the supplementary education of nurses should be implemented. Nurses might lack knowledge about advance directives, the skills to inform the patients and discuss the possible choices they can make. The other recommendations might include correcting the major dissatisfactions from the patients or changing the system specialties of work.
Unique Organizational Factors, Including Resources and Barriers
The medical system does not always have statisticians in its organization, and before implementing the project, a data analyst should be invited to make proper calculations. Therefore, the extra costs from the budget should be spent on the additional professional. The resources needed for the project are mostly human resources that involve staff and patients, their activity in surveys and application forms. Furthermore, nurse leaders will be used as the ones implementing the project action plan and organizing the recommendation changes.
Leadership Theories Crucial for the Project Implementation
For the implementations of the Capstone Project, there are a few organizational leadership theories that are important to keep in mind. The first relevant theory to discuss is the theory X and Y which was first described by McGregor in his book The Human Side of Mind . The theory describes two different leadership theories, where one (theory X) is controlling the employees by rewards and sanctions. The mindset of an employer with this leadership style thinks that his employees are lazy and lack the desire to work. The other leadership style, theory Y, provides his employees with trust, autonomy, and freedom. This leader gives her employees the benefit of the doubt and believes people enjoy working towards a common goal.
In the Nurse Management Case Department, most of the employees have taken a long education and thus it is reasonable to assume that the nurses and doctors have internal motivation to work towards the common project of treating patients. In addition, there is empirical evidence that shows that leaders that adopt theory Y in a medical setting increase employees psychological safety and organizational citizens ship behavior (Prottas & Nummelin, 2018). Consequently, for the implementation of the capstone project, we should utilize the theory Y leadership style.
There is also another highly relevant contingency theory to consider. The situational leadership theory from Hersey and Blanchard covers four different leadership styles, namely delegating, supporting, coaching, and directing. The optimal leadership style depends on the situation, meaning that there is no optimal leadership style. Why this theory is relevant in a contemporary medical context is because the staff is a continuous turnover of staff and thus it becomes increasingly hard to pool the staffs knowledge (Alsaqqa, 2020).
When implementing the Capstone Project, it is important for leaders not to have too high leader directive behavior, since it might hinder nurses and doctors innovation for possible improvements to the project. However, the leader should not just be delegating the task either since a hospital requires active leadership for implementation. Thus, the optimal situational leadership style for the Nurse Management Case Department is either a supportive or coaching leadership style.
References
Alsaqqa, Hatem. (2020). The Situational Leadership for the Three Realities of Healthcare Organizations (A Perspective View). Journal of Health System and Policies, 2(2), 230-247.
Jang, Y., Park, N. S., Chiriboga, D. A., Radhakrishnan, K., & Kim, M. T. (2017). The knowingdoing gap in advance directives in Asian Americans: the role of education and acculturation. American Journal of Hospice and Palliative Medicine, 34(9), 874-879.
Miller, B. (2017). Nurses in the know: The history and future of advance directives. OJIN: The Online Journal of Issues in Nursing, 22(3), 1-7.
Prottas, D., & Nummelin, M. (2018). Theory X/Y in the health care setting: Employee perceptions, attitudes, and behaviors. The Health Care Manager, 37(2), 1-4.
Sean Morrison, R. (2020). Advance directives/care planning: clear, simple, and wrong. Journal of Palliative Medicine, 23(7), 878-879.
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