January 8, 2014 Leadership in Action To develop an understanding of leadership practices described by Kouzes and Posner (2003) Engage in self-reflection

on regarding learners own leadership practice Develop and integrate leadership competencies into their leadership plan Create a network of resources which provide guidance and support when addressing challenging issues

Cardin, S. & McNeese-Smith. (2005). A Model for Bridging the Gap: From Theory to Practice to Reality Nursing Administration Quarterly, 29(2), 154-161. Kouzes, JM. & Posner, BZ. (1993). The credibility factor. The Healthcare Forum Journal, 36(4), 16-24. Taylor, J. & Rutherford, P. (2010). The Pursuit of Genuine Partnerships with Patients and Family Members: The Challenge and Opportunity for Executive Leaders. Frontiers of Health Services Management, 26(4), 3-14.

As per my discussion with fellow cohorts I was able to understand the key concepts discussed in the above session. I began by understanding the concept put forward by Kouzes and Posner as they highlighted leadership practices of exemplary leaders. They discussed how such people challenge the process and seek out opportunities, share their own vision through effective communication, allow others to participate in by enabling them, create a model of success by defining a path and establishing tangible and achievable goals along the path and lastly, encouraging through recognition. As a scholar practitioner in educational setting I felt that such attributes are key to the streamlining of healthcare administration. Over the last 5 semesters I had the opportunity of observing two hospital CEOs in two major organizations. Although my interaction with them was quite brief but I was able to identify at least a few if not all of the above characteristics. A key aspect of their personalities was the recognition of the nursing staff and their efforts in improving wound care (in one case) and in the second case improving the duration of clients stay in a rehab unit. Secondly, both individuals were open to feedback from Nursing staff. They would go around the meeting room and acquire feedback from each individual which left a feeling of empowerment to me as an individual. My placements on various units has shown me a clear lack of nursing leadership in hospitals, since nurses are quite effectively trained in that department. The only leadership training seems to be experience. Although experience in many cases leads to decisions made by nurses who might not be update. This would lead to several conflicts such as distribution of responsibility and tasks on a given shift, how to deal with irate patients and families, lack of team work and essentially lack of proper care. Lack of leadership did vary from one to another organization and sometime from unit to unit, which also meant different energy in teamwork. At certain placements I felt I was just waiting for the day to end so I can get of this place; sometimes I would avoid lunch rooms and try to stand in the back during team huddles so to avoid part of a confrontation amongst the nurses. As per the study in the reading material by Taylor, J. & Rutherford one of the goals and challenges of leaders in healthcare is to empower patients and families to create partnerships in making decisions. For any leader to make it possible for clients to be part of their healthcare decisions families need to adhere to the leadership practices identified by Kouzes and Posner. For this particular semester our change gives us an opportunity to put such a vision into practice.

I intend to setup an information tool for clinical trial patients and families which could help them understand any clinical trial and its various stages. I often have patients who have no idea whats Phase 1 or 2 or3. Or sometimes they are so busy with following the protocols of the trial they dont realize what kind of facilities might be available to cancer patients. I intend to use the five steps of exemplary leadership to aid me in the process which are as follows Model the way: Hear a family or patient and tailor the improvement according to their need Inspire a shared vision: Discuss with the clinical nursing team Challenge the process and status quo Enable others to Act: Include staff, patients and family members in making suggestions Encourage the heart I intend to available online resources and possible research others as I implement my change project through semester 5 and 6. January 9, 2014
Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health,100(2), 254-263.

Upon active engagement in the sessions, co-learners /students will be able to: describe principles and skills typically brought to informed reading and interpretation of literary texts focused on health and nursing care in particular discuss select literary tools and their functions in relation to health- and nursing-based literary texts demonstrate basic skills in analysis and interpretation of health- and nursing-based literary texts explain the therapeutic benefits of the literary arts in relation to health offer and receive feedback on personal literary creations or selections exploring topics in nursing and health in a respectful and supportive setting discuss how the literary arts may be valuable in the nurses practice I start approached this session by looking to literature on the subject of literary arts and and its therapeutic benefits.
There are many more things, between heaven and earth, than are dreamt of in your philosophy, Horatio. Shakespeare, Hamlet

I came across a study by Stuckey and Nobel (2009) on the connection between art, healing and public health. They focused on creative arts or expressive activities that were being conducted primarily in North American and European countries and primarily with adults. They argued that throughout recorded history, people have used pictures, stories, dances, and chants as healing

rituals. They reviewed 4 different types of creative expressions namely music engagement, visual arts, movement-based creative expression, and expressive writing. In all 4 areas of creative artistic expression reviewed here, there were clear indications that artistic engagement has significantly positive effects on health. Overall the review indicated that creative engagement can decrease anxiety, stress, and mood disturbances. Nursing Practice and education can most certainly benefit from literary arts as depicted in the scholar practitioner program. During my placement at a Geriatric facility the hospital would constantly employ music and art to engage patients. Even if they did not enjoy the activity itself I found that they were delighted to come out of their hospital rooms and socialize with other patients. Some patients would bring along cards to play. During my placement on a general internal medicine floor I did not find any evidence of arts being used in nursing practice. I believe it was the nature of the health care setting but I found that patients very disinterested in the health care setting and wanted to leave as soon as possible. Although the setting had very apt and academically strong nurses but the patients seemed spend most of their time on the tTVor their mobile devices. There was possible idea of a change project but I did not investigate it any further.

January 24, 2014 By the end of this class learners will be able to: 1. Recall the five competency categories of entry to practice competency standards and the key competencies associated with each category a. Professional responsibility and accountability b. Knowledge based practice c. Ethical Practice d. Service to Public e. Self-regulation

2. Identify examples of violations of competency practice standards by reviewing actual CNO disciplinary decisions At certain during my practice I saw nurses violating the competencies of ethical practice and service to public especially when dealing with elderly. Nurses would force feed them, often criticize them and their mental state, physically struggle with them. Nurses also often tended to abuse time by taking breaks and often spending to watch TV or on their phones. 3. Identify the practice competencies and standards that were upheld in actual Ontario cases where care was exemplary. In one instant a nurse showed exemplary leadership when a patient who was slightly confused refused to change rooms. After he was moved he tried to force his way back to his old room. AS nursing we were unable to limit as he pushed his way out and cursing

us at the same time. At that instant one of the senior nurses walked and she held him by the hand and took him for a walk around the unit. After he was satisfied that he was receiving the same services in his new room and that someone else was no occupying his old room he calm down and returned to his rightful place. This incident demonstrated a sense of leadership and respect of patients condition, which as nursing students we had failed to consider. Maybe the patient just needed some extra reassurance.

4. Identify strategies for upholding practice standards, and minimizing the professional malpractice/misconduct. One possible way could be an anonymous system of reporting of malpractice and misconduct especially as students we are forced to keep ourselves from indulging in such practices because it might affect our passing the semester. 5. Actively reflect on and discuss issues or concerns related to current competencies and ideas for future revisions to entry to practice competency standards. After reviewing the different categories of competencies one issue I could particularly think of is creating a separate category for leadership. I believe that leadership does tie into all the above mentioned categories but still it would greatly benefit nursing practice to build competencies just under this category possibly using the model of Kouzes, JM. & Posner.