RUNNING

HEAD: leadership project

Leadership Project Paper

Heather Hannon
Nur 4144 Professional Role and Development: Servant Leadership
March 30, 2015

RUNNING HEAD: leadership project

The quality improvement project (QI) that Ive decided to address is blood
administration. This idea comes from a quality improvement project that just finished at St.
Francis. A QI of this exact nature was done at St. Francis from October 2014 February 2015.
The aim of the quality improvement project at St. Francis was to decrease the risk for patient
harm related to blood transfusions, as demonstrated by a 20% increase in vital sign monitoring
during blood\blood product administration. (Blood Administration Rapid Cycle Testing of
Change, 2014, pg. 1) I felt like this is an important subject to look into because it occurs
frequently in the hospital and improvements could positively effect the population being served.
The four leadership domains that I need to utilize in my QI are: heart, head, hands and
habits. The heart helps us to ignite the same passion in others we have for our vision ( Beitsch
& Moran, 2009, pg. 3). First, I will incorporate the heart into by practicing several things. I will
be empathetic. As a manager, I will put myself in the position of my patients and co-workers. I
will try to understand each of their situations and take into consideration their thoughts and
feelings towards the project. As a patient, receiving a blood transfusion is scary and is most of
the time very unfamiliar. I will listen to my co-workers opinions about what it is going to take to
accomplish the changes being presented to them. When my co-workers have different opinions
on the matter than I do, I will be non-judgmental when talking to them about it.
Secondly, I will incorporate the head domain by exploring what is known about
decreasing harm related to blood administration and deciding what needs to be done to increase
positive results. By doing an investigation on what practices are the best for decreasing the
occurrence of harm related to blood transfusion, I will be able to figure out what needs to be
changed on the unit for positive results to occur in the QI. I will begin by looking up the policies
on blood transfusion. Policies are important because they give a hospital wide guideline for the

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way that a procedure should be done. In order decrease harm related to a blood transfusion,
early recognition of signs and symptoms is important. The Lippincott Procedures Blood and
blood product administration policy states, the nurse is suppose to stay with the patient for the
first 15 minutes monitoring for signs of a transfusion reaction because most life-threatening
reactions usually occur within the first 50 mL of the unit being transfused. (Lippincott
Procedures, 2014)
True leaders who have developed the change vision with their head and sold it with their
heart to the employees needs to take the next step and use their hands to model the behavior they
want to see in others (Beitsch & Moran, 2009, pg. 4). Thirdly, I will incorporate the hands
domain by modeling the behaviors I expect out of my employees. This includes training and
education. This will consist of team meetings and staff meetings to insure employee
understanding. My co-workers need to be educated about an important concept, the red flag
signs and symptoms when transfusing blood products. Assume that the presence of any of the
red flags signs and symptoms indicates a transfusion reaction. Do not assume that screening for
transfusion reactions is someone elses responsibility (Richards & Schub, 2013, pg. 7). Another
important piece is patient education. It is important to tell the patient and \ or patients family on
the purpose of blood transfusion, measures taken to reduce risk and any treatments that may
become necessary if a transfusion reaction were to occur (Richards & Schub, 2013)
Lastly, I will incorporate the habits domain by reflecting upon myself. I will determine
what changes I need to make within. We all have two selves. We have an external, taskoriented self that is use to getting jobs done, and we have an internal more reflective self that is
very thoughtful (Blanchard & Hodges, 2005, pg. 153). I will do this by practicing five habits,
mentioned in the book Lead like Jesus: solitude, prayer, study and application of Scripture,

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Accepting and responding to Gods unconditional love and involvement in supportive
relationships (Blanchard & Hodges, 2005). These habits are important because without a sound
mind I am unable to make decisions that are expected of me as a leader in a reasonable way.
While incorporating all of the Leadership Domains I will also need to utilize the Five
Exemplary Leadership Practices: Model the Way, Inspire a Shared Vision, Challenge the
Process, Enable Others to Act and Encourage the Heart. Model the Way, is a leadership practice
that allows for discovery of personal values and beliefs (Kouzes & Posner, 2013). I will utilize
this practice by educating myself and training my staff on the effective way to monitor for
adverse reactions during a blood transfusion. They will be educated on what signs and
symptoms to look for to identify the presence of an adverse reaction. The Lippincott Procedure
policy says to closely monitor the patient at the beginning of the transfusion. This is done
because that the first 15 minutes are when the severe reaction is likely to occur. The nurse is to
stay at the bedside for the first 15 minutes from the beginning of the transfusion. If after vitals
are taken and there is no indication of reaction the nurse is to continue to check on the patient
and obtain vital signs periodically, every 30 minutes, during transfusion. (Lippincott Procedures
Blood and blood product transfusion, 2014) The way I will provide this training is through elearning, similar Healthstream Modules that are done throughout Bon Secours hospitals. A study
in Scotland, found this to be the most effective method of learning over face-to-face and
workbook because of the flexibility and the ability to engage the learner in interaction and an end
assessment to check understanding. (Dalrymple & Watson, 2013)
The next leadership practice I will utilize is Inspire a Shared Vision. This entails getting
people on board by telling them the vision. Leaders offer their image of the future to others as
an invitation to join together and pursue a better place, taking into consideration others dreams

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and aspirations as well (Kouzes & Posner, 2013 pg. 54). This is important because it allows
everyone to find a common goal and talk about the vision of the future. Fewer cases of
significant harm done by blood transfusion reactions is the vision that I want to share to my coworkers about this QI project.
Challenge the Process entails looking at policies, actions being taken and then asking
what needs to change for this to be a safer and more effective procedure. I will incorporate this
leadership practice into my QI project by looking at my hospitals policies and procedures on
blood administration. Ask myself, what can I do to better this policy? During my QI projects I
will continue to follow policy and make changes that conveys the best results.
Leaders know that they cannot achieve great success alone (Kouzes & Posner, 2013,
pg. 98). Enable others to act is the fourth leadership practice that I will incorporate into the QI
project. This is important because it involves getting people to work together, allows them to
establish trust and agree on common goal. I will do this by giving my co-workers the tools to
learn about proper blood and blood product transfusions. I will implement the formation of a
committee on blood transfusions and weekly staff meetings regarding the findings and updates
on how the QI project is going. As a leader and nurse manager I want to empower people to do
their best and give them the power to turn into leaders themselves.
The last and I believe, most important leadership practice I will utilize is Encourage the
Heart. Leaders have high expectations of both themselves and of their constituents. They
provide others with clear direction, substantial encouragement, personal attention, and
meaningful feedback. They make people feel like winners, and winners like to continue raising
the stakes (Kouzes & Posner, 2013 pg. 120). I will incorporate this into the QI project by
encouraging my co-workers. I will constantly let them know how much I appreciate them for all

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of their hard work. Encouragement plays a key role in getting things accomplished thoroughly.
If you make people feel appreciated they want to do what they can to help you out and the results
will be more meaningful for everyone.
This QI will have an affect professional nursing practice. It will find ways to decrease the
adverse effects to the clients receiving blood transfusions therefore decreasing stressful events
caused by harmful reactions to blood transfusions. Also, it could would create a new standard
for a safer, more effective blood \ blood product administration. Blood and blood product
administration is a beneficial procedure but it also could be harmful if not done correctly by
following all of the necessary steps. Policy updates may be put into practice regarding blood \
blood products. This will affect professional nursing practice because the usual way of
administrated blood and blood products may change.
In conclusion, the improvement of outcomes of this project will affect the population
being served by recognizing signs of a blood transfusion reaction and decreasing the severity of
harmful reactions during procedure. Efficient patient teaching it also will allow for an increase in
knowledge of blood\blood product administration by the client prior to infusion. This is
important because the more information the client is given prior to procedure the more likely the
patient will be able to recognize severe sign and symptoms along with the nurse. The population
being served will greatly benefit from this QI project. Safer outcomes and less risk for harmful
adverse reactions will occur.

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References:
Beitsch, L., & Moran, J. (2014). Become A Complete Change Leader By Using Your Head,
Heart, and Hands. The Quality Management Forum, 30(1), 1-23.
Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.
Blood Administration - Rapid Cycle Test of Change. (2014). 1-3.
Blood and blood product transfusion. (2014, January 1). Retrieved January 1, 2015, from
http://procedures.lww.com/lnp/view.do?pId=654038&hits=transfuse,blood,transfusion,tr
ansfused,transfusing,transfusions&a=false&ad=false
Dalrymple, K., & Watson, D. (2014). Ten Years of transfusion practitioners and better blood
transfusion in Scotland. Nurse Management, 20(10), 27-30.
Kouzes, J. M., & Posner, B. Z. (2013). The Student Leadership Challenge: Student Workbook
and Personal Leadership Journal. San Francisco: Jossey-Bass.
Richards, S., & Schub, E. (2013). Transfusion Reactions: Monitoring - an Overview. Nursing
Practice and Skill, 1-6.