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Leadership and Clinical Governance

Table of Contents

Significant risks.

Sources of research evidence.

Involving the patient in care impacting quality and safety.

Scope of practice.

Culture and leadership influencing the quality and safety of patients.

References.

Significant Risks

Nicole underwent the laparoscopic appendectomy that is much safer than the open surgery where major excision is done, but Nicole is not free from the risks of post-surgery. The risk of infection and complication is inevitable. Certain risks required to be focused on.

  1. wound infection
  2. Blocked bowels
  3. Nearby organ injury

Wound infection

Wound infection is quite common in the post-operative period. Wound infection in the surgical site is considered to be a risk in the postoperative period. The infection is a possibility in the post-surgery period as the excision may cause infection. It is found that pus or wound agglomerates in the part where the excision is done. It is a sign of infection in the body part where the excision has been done (Noorit, Siribumrungwong & Thakkinstian, 2018). Most of the doctors predicted the presence of the possibility of developing an infection in the post-operative period. The possibility of wound infection is higher in the patient with the presence of diabetic. Therefore, it is necessary to check regularly the level of blood sugar in the operated patient. The presence of infection is to be found early to manage it properly with care and consideration.

Blocked bowels

Blocked bowel is a common risk that occurs in the postoperative period. The blocked bowel has a certain characteristic, and clinically it requires to be managed early or it may cause severe damage to the body and infection (Castro et al., 2018). It is generally examined with the radiographical or physical examination. Bowel obstruction is found to have occurred in the immediate postoperative period. The pat5eint with the immediate post-operative bowel obstruction requires postoperative clinical intervention. Nicole needs to examine regularly to known if she feels any bowel obstruction. In most cases, the patients are managed in such a way, and very few patients are managed with open excision or open surgery.

Nearby organ injury

The risk of injuring the nearby organ is high in the laparoscopic appendectomy as the possibility of hurting the organ can happen as the use of a machine of surgical tools might affect the organs in a minor or substantial way. During the excision or in the post-operative prior, the impact of the operation may damage the nearby organ in a minor or substantial way. There is a possibility of nerve and muscle injury as the patient feels pain in the post-operative period. The muscle and nerve injury are a common injury that occurs to the patient during or during the postoperative period (Noorit, Siribumrungwong & Thakkinstian, 2018). The extreme form of organ injury is found to be the paralysis of the limbs. The paralysis of the limb after the laparoscopic appendectomy occurs in some exceptional patients. Even the magnetic resource imaging and electrodiagnosis could hardly indicate the cause of the injury in the patient or cause of the paralysis in the patient. The main cause of the paralysis is the damage to the nervous system. It might have affected the peripheral or central nervous system.

Sources of Research Evidence

The sources of evidence to be used to guide the care of Nicole in the post-operative period consists of

  • Nursing books
  • Peer-reviewed journals
  • Professional journals
  • Current research.

These are to be collected from the reliable sources. The reliable sources will provide reliable materials and reliable techniques to provide appropriate and necessary care to the patient in the post-operative period.

These will be employed to provide Nicole with enhanced care. The care that will be provided to the patient from the research evidence can be justified and appropriate.

Nicole underwent the laparoscopic appendectomy, it is necessary to provide her evidence-based care in the post-operative period, and the care is also to be provided to her from the modern concept of care and practice. Laparoscopic appendectomy is a safe surgery to manage appendicitis for effective treatment. Antibiotic therapy proved to be ineffective in treating the patient. In the postoperative period, she needs to be provided care that is essential to the patient in the post-operative period. 

The patient needs to be providing evidence practice. The patient is to be provided with initial care after the operation. It is to be ensured if the patient has gained conciseness completely. The blood pressure, pulse, heart rate, and body temperature are to be analyzed if these are functioning properly. Tradition, these are the best practice used in evidence-based care and it is a proven way of practice to manage the patient in the post-operative period (Chan, Shin, Pai & Jeffrey, 2011).

Nicole will be provided with all these initial cares so that it will be made sure if he is responding to the treatment in the post-operative period. The blood pressure, heart rate, pulse, and body temperature and saturation of Nicole's body are to be judged. The restoration of normalcy is good care. 

The patient then will be provided with the medicines that have been suggested by the surgeon or physician attending Nicole. Providing the patient with such a scientifically proved way of nursing care will help him come out of the wounds and complications in the postoperative period. The clinical intervention will support the patient with all the necessary treatments. The post-operative nursing care will cure the wound that is from the operation (Titler, 2008).

The expert opinion on the care is a scientifically proven guide to the care in the evidence-based nursing care practice that helps to provide the patient with necessary care and consideration. Pain management is considered to be the research evidence that helps to manage the post-operative patient. Pain management is a scientifically proven guidance to provide care to the patient. Sufficient pain control is a challenge to the nurses and nursing practice.

Involving the Patient in Care Impacting Quality and Safety

The involvement of Nicole in her care may affect the safety and quality of care provided to her in the post-operative period. Nicole's involvement in safety care will deeply affect the quality. There is a strict system of medication and check-up. Nicole's involvement may mar the routine and way of treatment. The quality care cannot be provided as there will be some mismanagement in the care, and the mismanaged may affect patient safety as the clinical mismanagement requires great consideration. The involvement of the patient in the clinical care practice is to affect the care deeply as there is a higher possibility of mismanagement. It also needs to be ensured if the patient is well aware of the fact that she has been provided with proper care and consideration. The awareness of the patient regarding the treatment will have a positive impact on the treatment too as the nurse will be able to manage the post-operative care in a better. The support of the patient is needed more urgently in the care. The positive response of the patient in the nursing care will allow the nurse to maintain quality and safety in post-operative care.

Nursing is a profession where it is necessary to provide the patient with quality care as a lack of quality care will keep the client unsatisfied and the patient could hardly be cured without the quality care. While providing care to the patient, it is necessary to consider safety as the patient will be deeply affected of the patient is not provided the care with safety (Haghighi, Shahdadi, Moghadam & Balouch, 2016). Lack of safety may not only affect the patient but also the caregivers. In nursing care, the patient hopes to receive quality care along with safety. The nursing care also aims to provide quality care with the utmost consideration of the safety of the patient. It is found that a lack of job satisfaction participation in the issues of the hospital and professional commitment leads to harming the nursing practice (Sillero-Sillero & Zabalegui, 2019). The lack of job satisfaction prevents the caregiver to act responsibly, and the expectation of quality care is deflated with the lack of job satisfaction. Lack of training and professional commitment among the nurses prevents them to act in a way to provide quality care to the patient along with restricting the nurses from providing enhanced quality of care to the patients. 

Quality and safety in nursing care practice are given utmost importance as the goal of the nursing care is to provide quality care and it also ensures to deliver quality care with safety. the involvement of the patient within the care is to affect the care quality and associated safety differently, and therefore, Nicole needs to be conscious regarding the way and type of treatment she is receiving, but the show needs to involve in the practice of care as it will cause some mismanagement and affect the quality and safety of the patient in a negative way.

Scope of Practice

Scope of practice determines the procedure used by a healthcare practitioner professional license. The particular aspects of healthcare limits the responsibility of a Health care practitioner using legal actions against specific education as well as experiences that are necessary for demonstrating specific competencies. Jurisdiction establishing laws along with license bodies for regulating the described requirements of education and training in the particular medicine and field determine the scope of practice (Weidner et al., 2018). Scope for practice focuses on the qualification of the healthcare professional who needs to be recognized qualified from an authentic educational institute along with having the requirements to be qualified as a registered practitioner within the jurisdiction. It is the responsibility of the healthcare professional with demonstrated competence in their work after understanding the scope of practice (Markowitz et al., 2017). Scope of practice for the registered nurse is dynamic which would be enhancing proportionately with the experience gained throughout the career of a nurse. Certain factors influence practice and motivate the nurse to reconsider their responsibility towards the patient. The factors involved competence practices of the nurse, practice setting, patient safety and needs along with the guidelines and policies implemented by the government.

Nicole was subjected to laparoscopic appendectomy which required medical intervention of the registered nurse to provide post-surgery care. The scope of practice motivates the nurse to forego the needs along with the rights and benefits of the patient along with maintaining the best quality of health service while providing post-surgery care to Nicole. It is necessary that the nurse follows the values and defines the nursing practices including respecting all patients without discriminating against age, race, religion, sexual orientation, family status and gender. Nicole is a 23-year-old woman who deserves equal respect from the nurse in the post-operative period. It is the responsibility of the lost venture that she is receiving all her rights while being in the post-surgery phase. Scope of practice in short that the nurses have developed a therapeutic relationship with the patient for enjoying open communication along with trust which would directly influence the empowering of the patient regarding the life choices.

According to the scope of practice, the nursing care recommendation of art and science focuses on the holistic approach based on socio-cultural and economical along with physical experiences of the patient. All the elements of nursing practices aligning with the scope of practice motivate the nurse to ensure that Nicole is receiving medicinal aid to recover after appendectomy (Kelly et al., 2016). The medicinal aid involves instructing Nicole to follow certain norms regarding the incision site. The nurses need to inform Nicole regarding the rights which would be necessary for delegating care appropriately. The nurse must inform Nicole that there are chances of using pain relievers minimize the discomfort however narcotic pain medications must be avoided after appendectomy because the particular composition of narcotic pain medicines might cause constipation. Certain activities such as folding a soft pillow over the stomach and exerting pressure before coughing helps in reducing the strain on the incision sites and avoid the possible discomfort.

Culture and Leadership Influencing the Quality and Safety of Patients

The culture within the nursing practice contributes to the planning of the activities that are necessary for providing care to the patient having different beliefs. The incorporation of culture nursing practices highly influence the quality and safety of the patients because the nurses can satisfy the cultural belief of the patient and receive their consent while providing post-surgery care. Understanding the cultural competencies in the nursing practice include enhancing the knowledge, modifying the attitude along with developing skills that align with the duties of a nurse (Strouse & Nickerson, 2016). Cultural injury in the nursing practice motivates the nurses to what is knowledge regarding the cultural base that can be considered while planning the activities regarding care provided to the patient in the postoperative phase. That patience responds to the treatment plan that includes the cultural belief of the patient in a better manner that directly influences the quality of care along with the safety of the patient.

The involvement of culture within the nursing practice motivates the registered nurses to listen to the perception of the patient and understand their concern regarding their medical issue. The process of listening to the perception of the patient ensures that the nurses can identify the lack of knowledge within the patient from the perspective of medical rights as well as explaining the patient regarding the benefits of accepting the particular plan for treatment (Arthurs et al., 2018). Nicole is a young patient who needs to be back on track to lead a healthy life for which it is necessary to explain to her the importance of the planned treatment along with aligning it with her cultural belief to increase her safety and the quality of care provided to her.

The leadership of the units providing care to Nicole influences the quality of care provided to her along with maintaining her safety while being under the registered nurse. The leadership fitting the nursing practices involved emotional intelligence that is necessary for processing with the routine challenges that needs to be processed for avoiding any form of infection around the incision site. The leadership qualities within the registered nurse ensure that the nurse processes with critical thinking while making decisions for the maintenance of safety of the patient (Backman et al., 2017). The leadership style includes having a stable communication within the nurses along with the patients. The proper communication helps the nurses to identify the factors which influence the safety within the patients. The registered nurse needs to ensure safety within the patients focusing on providing the best quality of care in the postoperative phase (de Moura et al., 2017). In the case of Nicole, incorporation of leadership along with the culture in the treatment plan would ensure that the care provided to her is of the upgraded quality as well as safety is considered as important. The nurses would be able to understand her concern regarding her health status and inform the other nurses who are appointed in providing care to her to ensure that she stays positive after the surgery and respond to the medication that is prescribed for healing the incision site.

References for Leadership and Clinical Governance

Arthurs, K., Bell-Gordon, C., Chalupa, B., Rose, A. L., Martinez, D., Watson, J. A., & Bernard, D. P. (2018). A culture of nursing excellence: A community hospital’s journey from Pathway to Excellence RG to Magnet RG recognition. Journal of Nursing Education and Practice, 8(5), 26-37.

Backman, A., Sjögren, K., Lindkvist, M., Lövheim, H., & Edvardsson, D. (2017). Characteristics of highly rated leadership in nursing homes using item response theory. Journal of advanced nursing, 73(12), 2903-2913.

Castro, B. A., Novillo, I. C., Vázquez, A. G., García, P. Y., Herrero, E. F., & Fraile, A. G. (2018). Small Bowel Obstruction after Laparoscopic Appendectomy in Children. World Journal of Surgery and Surgical Research1(1).

Chan, L., Shin, L. K., Pai, R. K., & Jeffrey, R. B. (2011). Pathologic continuum of acute appendicitis: sonographic findings and clinical management implications. Ultrasound quarterly27(2), 71-79.

de Moura, A. A., Bernardes, A., Balsanelli, A. P., Zanetti, A. C. B., & Gabriel, C. S. (2017). Leadership and nursing work satisfaction: an integrative review. Acta Paulista de Enfermagem, 30(4), 442-450.

Haghighi, M. J., Shahdadi, H., Moghadam, M. P., & Balouchi, A. (2016). The impact of evidence-based practices on postoperative pain in patients undergoing gastrointestinal surgery in Amiralmomenin hospital in Zabol during 2014-2015. Journal of clinical and diagnostic research: JCDR10(7), IC01. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020264/

Kelly, M. A., Berragan, E., Husebø, S. E., & Orr, F. (2016). Simulation in nursing education—International perspectives and contemporary scope of practice. Journal of Nursing Scholarship, 48(3), 312-321.

Markowitz, S., Adams, E. K., Lewitt, M. J., & Dunlop, A. L. (2017). Competitive effects of scope of practice restrictions: Public health or public harm?. Journal of health economics, 55, 201-218.

Noorit, P., Siribumrungwong, B., & Thakkinstian, A. (2018). Clinical prediction score for superficial surgical site infection after appendectomy in adults with complicated appendicitis. World Journal of Emergency Surgery13(1), 23.

Ryu, G., Song, S. H., & Lee, K. H. (2014). Monolimb paralysis after laparoscopic appendectomy due to conversion disorder. Korean Journal of family medicine35(6), 321.

Sillero-Sillero, A., & Zabalegui, A. (2019). Safety and satisfaction of patients with nurse's care in the perioperative. Revista latino-americana de enfermagem27.

Strouse, S. M., & Nickerson, C. J. (2016). Professional culture brokers: Nursing faculty perceptions of nursing culture and their role in student formation. Nurse education in practice, 18, 10-15.

Titler, M. G. (2008). The evidence for evidence-based practice implementation. In-Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality (US).

Weidner, A. K., Phillips, R. L., Fang, B., & Peterson, L. E. (2018). Burnout and scope of practice in new family physicians. The Annals of Family Medicine, 16(3), 200-205.

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