Tuesday, January 28, 2020

Just Culture in Nursing

Just Culture in Nursing JUST CULTURE: An Approach that is Right and Just for the Philippine Nursing System Bernardo Oliber Alconis Arde Jr., RN, MAN Nursing has always been regarded as a â€Å"humanistic science† since it has evolved from experience to science. Anchored by altruistic motives, nurses perform nursing care to patients with tact and prudence; otherwise patients’ safety is jeopardized. Hence, it is safe to say that nursing should be a ‘perfect discipline’ – an arena where mistake is never an option. While there are great efforts by the nursing community to pursue perfection by its evidence-based approach, the fact still stand that humans are fallible. And by human nature, even if nurses make the best choices of care for their patients, other factors aside from these choices may still make them vulnerable to committing errors. If nurses’ infallibility can never be attained, how then can it be managed? Traditionally, healthcare’s culture has held individuals accountable for all errors or mishaps that befall patients under their care. When errors occur, the immediate solution is to blame an individual for the error. Blaming individuals creates a culture of fear, discourages open reporting and discussion of errors, and does little to prevent future errors or improve the safety of the health care system (NCBON, 2011). According to Leape (2000), as cited by American Nurses Association (2010) these approaches that focus on punishing individuals instead of changing systems provide strong incentives for people to report only those errors they cannot hide. Thus, a punitive approach shuts off the information that is needed to identify faulty systems and create safer ones. In a punitive system, no one learns from their mistakes. Many observers attribute underreporting to the punitive (‘‘name and blame’’) approach that many healthcare organizations have taken with regard to safety incidents. By inculcating a sense of fear, the punitive approach discourages reporting and, in doing so, prevents organizational learning and improvement (Barach Small, 2000; Blegen et al., 2004; Kadzielski Martin, 2002; Kingston, Evans, Smith, Berry, 2004; Manasse, Eturnbull, Diamond, 2002; Wakefield et al., 2001, 1999). As an alternative to this traditional system, application of a model which is widely used in aviation industry known as the Just Culture Model seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix the system issues (ANA, 2010). Just Culture, as defined in aviation industry, is a culture in which front line operators are not punished for actions, omissions or decisions taken by them that are commensurate with the experience and training, but where gross negligence, wilful violations and destructive acts are not tolerated (Eurocontrol, 2014). Reason (n.d), as quoted by Skybrary (n.d) claimed that it is an atmosphere of trust in which people are encouraged, even rewarded for proving essential safety-related information but in which they are also clear about where the line must be drawn between acceptable and unacceptable behaviour. In 1997, as mentioned by ANA (2010), John Reason wrote that a Just Culture creates an atmosphere of trust, encouraging and rewarding people for providing essential safety-related information. A Just Culture is also explicit about what constitutes acceptable and unacceptable behavior. Therefore a Just Culture is the middle component between patient safety and a safety culture (Reason, 1997). However, the term â€Å"Just Culture† was first used in a 2001 report by David Marx (Marx, 2001), a report which popularized the term in the patient safety lexicon (Agency for Healthcare Research and Quality, n.d.). Further he argues that discipline needs to be tied to the behavior of individuals and the potential risks their behavior presents more than the actual outcome of their actions (Marx, 2001). In the health care arena, Medscape (n.d) emphasized that Just Culture recognizes that human error and faulty systems can cause a mistake and encourages an investigation of what led to the error instead of an immediate rush to blame a person. A just culture, expert say, is a ‘‘non-punitive’’ environment in which individuals can report errors or close calls without fear of reprimand, rebuke, or reprisal (Blegen et al., 2004; Karadeniz Cakmakci, 2002; Kingston et al., 2004; Pizzi, Goldfarb, Nash, 2001; Wakefield et al., 1999; Wild Bradley, 2005). The concept of a fair and just culture refers to the way an organization handles safety issues. Humans are fallible; they make mistakes. In a just culture, hazardous human behavior such as staff errors, near-misses and risky actions are identified and discussed openly in hopes of finding ways to improve processes and systems — not to identify and punish the individual (Pepe Cataldo, 2011). In the Philippines, where nurses face a lot of workplace-related issues such as understaffing, undue remuneration, and hostile employers to name a few, they become more vulnerable to making mistakes. With so much pressure at hand due to how these errors are addressed currently plus the fact that nurses are more often unappreciated, they may burnout putting the delivery of care at stake. This existing practice is opposed by the concept of Just Culture, where according to Pepe and Cataldo (2011), is a model that distinguishes among human error, at-risk behavior, reckless behavior, malicious willful violations and the corresponding levels of accountability. Moreover, just culture is not a â€Å"blame-free† approach. It is a strategy that gets into the root of the problem, whether it is a worker wilfully contributing to the error or the system providing inadequate support to the worker’s need. Furthermore, it is a system of justice that involves both investigatory action and disciplinary action. Hence, a â€Å"just culture† stands between a ‘‘blaming’’ or punitive culture, on the one hand, and a ‘‘no-blame’’ or ‘‘anything-goes’’ culture, on the other. This view reflects the connotation of balance typically associated with the terms ‘‘just’’ or ‘‘fair.’ (Weiner, Hobgood Lewis, 2007). It balances the need to learn from mistakes and the need to take disciplinary action where appropriate. In a setting where just culture is implemented, encouragement of error disclosure is emphasized through open communication. As stated in Skybrary (2014) the personnel is clear, that in the interest of safety, the organisation wants to know, at all times, about unsafe events, unsafe situations that have presented themselves or could arise. They are keen to step forward and speak up when they perceive a situation as dangerous, think of a procedure as risky, or any other issue in their daily tasks that they judge as potentially harmful and are yet without good remedy. This system makes sure the staffs are motivated to report and the trend must be maintained. Moreover, whenever there are reports, the organization assures that they are acknowledged, discussed properly and provided with appropriate feedbacks. When errors occur, the person who committed the error is not blamed instantly. He or she is not punished outright but rather a safety investigation is initiated to determine the proper disciplinary action. The organisation investigates why this error was made and what can be done to avoid them or to mitigate the effects for future operations. The workforce is protected as best as possible from negative consequences resulting from human error or subsequent investigations and in principle the organisation will defend and support people should external prosecutions or litigations target them. The organisation attempts to repair the situation as best as possible and restore the operations to normal. The organisation provides compensation for those that have experienced personal loss or damage. The organisation tries hard to prevent that same event from happening again. A case is not closed by condemning or finding the guilty one, but by discovering the underlying problems in the system, by rectifying this and by repairing the damages done (Skybrary, 2014). When the problem is discovered, rectified and repaired, the organisation then communicates the situation with confidentiality to all the members of the group. This dissemination intends not to humiliate somebody but rather provides a learning platform for everyone. In just culture, the error that has happened was seen not as something to be fixed but rather an opportunity of learning and ironing the system. It creates an environment of introspection while errors are discussed and collectively outlines improved policies, protocols and/or guidelines. It also shapes a venue for the enrichment of managerial competencies. Hence, it is an implicit claim of just culture that it is inevitable for practitioners to commit mistakes that even the most experienced individual is capable of making mistakes. It is also implied in just culture that punishment is not an assurance that workers will not be making mistakes and that perfecting a performance is impossible and can never be sustained. ANA (2010), in their position paper about this concept officially endorse the Just Culture concept as a strategy to reduce errors and promote patient safety in health care. In their efforts to endorse this â€Å"non-punitive† approach, they promote and disseminate information about the Just Culture concept in ANA publications, through constituent member associations, and ANA affiliated organizations. Hence, the feasibility of incorporating this approach in the present system in the Philippines must also be taken into consideration. However, the adopting organization must develop its own strategies in implementing just culture. It is because no single method fits all in applying the just culture. This concept, when used as an approach in improving the quality of care, must be contextualized depending on the acceptance and capability of the institution to implement this model. Once this approach is incorporated in the system, ANA (2010) encourages continued research into the effectiveness of the Just Culture concept in improving patient safety and employee performance outcomes. To this end, Just Culture might just be the absolute answer to the faulty system not only of nursing but might as well the entire Philippine Healthcare system. References Erickson, A. K. (2012, November 1). Step forward: Hospital journey to Just Culture. pharmacist.com. Retrieved May 28, 2014, from http://www.pharmacist.com/step-forward-hospitals’-journey-‘just-culture’ ANA. (n.d.). Just Culture. http://nursingworld.org/. Retrieved May 29, 2014, from http://nursingworld.org/psjustculture Brewer, K. (n.d.). How a Just Culture Can Improve Safety in Health Care. Medscape Log In. Retrieved May 30, 2014, from http://www.medscape.com/viewarticle/746089_2 Building a Just Culture. (2014, January 8). SKYbrary . Retrieved May 30, 2014, from http://www.skybrary.aero/index.php/Building_a_Just_Culture Colorado Firecamp A Roadmap to a Just Culture. (n.d.). Colorado Firecamp A Roadmap to a Just Culture. Retrieved May 30, 2014, from http://coloradofirecamp.com/just-culture/index.htm Esarr Advisory Material/Guidance Document (EAM/GUI). (2006, March 31). Skybrary. Retrieved May 28, 2014, from . http://www.skybrary.aero/bookshelf/books/235.pdf Eurocontrol Driving excellence in ATM performance. (n.d.). Just culture. Retrieved May 30, 2014, from https://www.eurocontrol.int/articles/just-culture Harbour, T. (n.d.). Just Environment: Command Climate, Leadership, and Error Forest Service Fire and Aviation Management: Becoming a Learning Culture. http://high-reliability.org/. Retrieved May 29, 2014, from http://high-reliability.org/files/Harbour_HRO_Abstract_Just_Culture.pdf Just Culture. (n.d.). SKYbrary . Retrieved May 30, 2014, from http://www.skybrary.aero/index.php/Just_Culture Just Culture Policy. (n.d.). Eurocontrol. Retrieved May 28, 2014, from http://www.eurocontrol.int/sites/default/files/publication/files/201209-just-culture-policy.pdf Marx, D. (n.d.). Patient Safety and the Just Culture . health.ny.gov. Retrieved May 29, 2014, from http://www.health.ny.gov/professionals/patients/patient_safety/conference/2007/docs/patient_safety_and_the_just_culture.pdf NCBON. (n.d.). Just Culture In Nursing Regulation . ncbon.com. Retrieved May 29, 2014, from http://www.ncbon.com/myfiles/downloads/cet-booklet.pdf Pepe, J., Cataldo, P. J. (2011). Log in. Manage Risk, Build a Just Culture. Retrieved August 10, 2014, from https://www.chausa.org/publications/health-progress/article/july-august-2011/manage-risk-build-a-just-culture WISE, D. (n.d.). Getting To Know Just Culture | Outcome Engenuitys Just Culture Community. Outcome Engenuitys Just Culture Community. Retrieved May 30, 2014, from https://www.justculture.org/getting-to-know-just-culture/ Weiner, B. J., Hobgood, C., Lewis, M. A. (2008). The meaning of justice in safety incident reporting. Social Science Medicine, 66(2), 403-413.

Monday, January 20, 2020

Appearance vs. Reality in Henry IV :: Henry IV Henry V Essays

Appearance vs. Reality in Henry IV      Ã‚  Ã‚   Shakespeare's play Henry IV begins with a king (King Henry) beginning a pilgrimage after killing King Richard II.   Henry believes that by gaining the throne of England he has done an honourable deed, yet he admits that the fighting and bloodshed could continue, A. . .  Ã‚   ill sheathed knife . . . @ (I.1.17).   He, also, admits   that his own son, Prince Hal,   is not honourable enough to occupy the throne, Asee riot and dishonour stain the brow of my young Harry"   (I.1.17).      Ã‚  Ã‚  Ã‚   Shakespeare continues the topos of honour and redemption into Act three, scene two, where he uses elements such as anaphora, topos, imagery and rhetoric in a meeting between King Henry and Prince Hal that is both   crucial and climatic to the overall structure of the theme of honour.      Ã‚  Ã‚  Ã‚   At the beginning of Act III   sc. ii,   Shakespeare clears all other characters from the stage to allow King Henry=s first meeting, face to face with Prince Hal, to be focused and intense.   King Henry is the first to speak and sets a sombre tone as he begins to unmask himself to his son A. . .   some displeasing service I have done @   (3.2.5).  Ã‚   As well Shakespeare allows King Henry to bring Prince Hal=s mask to attention by using anaphora:      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Could such inordinate and low desires,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Such poor, such bare, such lewd, such   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   mean attempt, such barren pleasures,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   rude society as there art matched withal . . . (3.2.12-15).    The word such is used to emphasise his [Henry]   displeasure of Hal=s friends and the image they   portray around him causing Hal in the eyes of Henry to lose his princely image.      Ã‚  Ã‚  Ã‚   Shakespeare, then allows Prince Hal to defend himself to his father's interpretations of his (Hal) character.   Again, there is a contrast between what King Henry perceives and what is reality.   The king is obviously distressed over Hal=s choice of friends   and how they affect this   'Princely image'.  Ã‚   Hal   on the other hand asks for Apardon on my true submission @ (3.2.27), claiming that such people (friends) tell stories that may not always be true Aaft the ear of greatness must hear @ (3.

Sunday, January 12, 2020

Concept Analysis: Mentoring Nurse Managers

Mentoring is a multidimensional relationship that energizes personal and professional growth (Wagner and Seymour, 2007). The purpose of this paper is to explore the concept of mentoring and the key role it plays in the development of nurse managers. Introduction Over the past 20 years the concept of mentoring has grown more popular in our workplaces. Many public service organizations, as well as, corporations have developed formal mentoring programs for both management and staff for the purpose of improving overall operations, productivity and overall commitment to the organizations goals. Mentoring is now being recognized in nursing and other healthcare fields. This concept analysis will attempt to clearly define the concept mentoring while differentiating it from precepting and clinical supervision. Finally, this article will discuss the importance of a mentoring program designed for developing managers. Definition While searching the literature, many articles regarding mentoring can be found in business and management journals but few are found in nursing and medical journals. In the nursing and medical journals the concept of mentoring appears murky. In some cases the terms mentoring, precepting and clinical supervision are used interchangeably. This leads to confusion and inaccuracy. The word mentor dates back to Greek Mythology. Mentor was a friend of Odysseus entrusted with the education of Odysseus’ son Telemachus. The Webster dictionary defines mentor as a trusted and wise counselor or guide, a tutor or coach (Give, 1966). Other definitions include, â€Å"a learning relationship†, â€Å"a critical companionship† and a process in which two or more people create a connection in a safe environment that allows healing truth and wisdom to be discovered (Wagner and Seymour, 2007). For the purposes of this paper we will use the following definition: Mentoring occurs when a senior person in terms of experience not necessarily age provides information, advice and emotional support for the mentee or protà ©gà © in a relationship lasting over an extended period of time and marked by emotional commitment by both parties. If the opportunity presents itself the mentor uses both formal and informal forms of influence to further the career path of the protà ©gà ©. (Bowen, 1985) The mentoring process consists of four steps: initiation, cultivation, separation and redefinition (Kram, 1983). The first stage involves the mentor and the mentee becoming acquainted and setting goals. During the cultivation stage, information is shared, problem solving, decisions and exploration of alternatives occur. During the separation stage, the mentee is empowered to move towards their goal and enhance their career path. In the final stage of redefinition, the mentor/mentee relationship evolves to a mutual friendship or the relationship is terminated. (Wagner and Seymour, 2007) As stated earlier mentoring should not be confused with the terms preceptor and clinical supervision. Clinical supervision is defined as the process whereby a practitioner reviews with another person his ongoing clinical work and relevant aspects of his own reactions to that work. It is also defines as a practice focused professional relationship involving a practitioner reflecting on practice while guided by a supervisor. (Lyth, 2000) Clinical supervision focuses on an individual situation. Once the goal is reached the process is complete. Precepting is defined as teaching job responsibilities and related tasks (Grossman, 2009). The precepting relationship is similar to that of a teacher and student. Once the task is learned sufficiently, the relationship ends. The precepting relationship is time limited in that the task must be learned within a certain timeframe. Attributes of Mentoring Walker and Avant define this step of concept analysis as showing the cluster of attributes most frequently associated with the concept (Walker and Avant, 2005). Some of the common attributes involved in mentoring are caring, self reflection, confidence and knowledge. In the literature search caring is addressed in every mentoring article I read. Every successful mentor/mentee relationship has a caring base. Consider Watson’s Theory of Human Caring, in the caring moment the caregiver and the cared – for share on a personal level and create a mutual opportunity for learning from each other (Watson, 1999). This statement mirrors the definition of mentoring. Self reflection is the process in which someone stops to re evaluate a situation or action after the occurrence of an event. This is done for the purposes of learning, self growth and self improvement. A good mentor realizes that during the process they too will learn a great deal. Confidence is believing in yourself and your abilities even in the face of adversity. A good mentor does not fear teaching or sharing information. Succession planning is not a threat, but rather, the opportunity to continue their work and legacy in the organization after retirement (Tagnes, Dumont, Rawlinson and Byrd, 2009) Finally, the mentor must possess mastery of knowledge in their area of expertise. If the mentor has no knowledge or information to share, the process cannot start. Antecedents Antecedents are those events or incidents that must occur prior to the occurrence of the concept (Walker and Avant, 2005). Two crucial antecedents to mentoring are the mentor and the mentee or protà ©gà ©. Without either party, the concept will not exist. The other critical antecedent is the mentor must possess knowledge and skills to be shared. Effective communication skills and interpersonal skills are also necessary. If adequate communication cannot occur, the mentoring relationship cannot develop. The mentor and mentee must also be committed to devoting time to the process. If there is no available time, the mentoring process cannot begin. Consequences Consequences are those events that result from the occurrence of the concept (Walker and Avant, 2005). Successful mentoring programs benefit an organization by: increasing retention, reducing turnover costs, improving productivity and enhancing professional development. Creating a mentoring culture continuously promotes individual and employee growth and development (Foster, 2008). Model Case Example Sally is a new nurse manager. During her orientation process, Paulette is her assigned preceptor. Paulette has been with the organization many years and has over 15 year’s management experience. She voluntarily offers her services as a mentor to many new managers. After meeting and discussing goals, they decide Sally needs assistance understanding the various roles of people in the organization and how their roles interact with one another. Paulette takes Sally with her to meet the various employees. She schedules luncheons and meetings with various departments so Sally can better understand their roles. She also brings Sally to the administrative meetings as well as the administrative picnic to learn how decisions are made. Sally is encouraged to voice ideas and concerns in these various sessions. Her input is well received. After approximately 6 months Sally now has a sense of confidence and feels comfortable handling many of the day to day situations presented to her. Although the formal mentoring program is complete, Sally still meets with Paulette every few weeks to discuss life and feels comfortable calling her for advice. Paulette also calls Sally from time to time for her opinion regarding situations. This example sites all of the necessary qualities for a positive mentor/mentee relationship. Illegitimate Case Model As Kim started her role as a manager, the administrator assigned her worthwhile and appropriate assignments and tasks to perform. She had the opportunity to attend a multitude of meeting and had some contact with the major staff. However, she was never invited to listen to informal conference calls or side meetings where all of the major decisions were made. She was not involved in the development of changes. She was however, told what need to be done by her administrator. She was not informed of any history behind decision making strategies. The administrator in this situation served as a preceptor not a mentor. She only took the time to teach tasks and failed to elicit input or encourage professional growth. Conclusion Mentoring is a multidimensional process that can be learned over time. It requires reflection, knowledge of self and profession, knowledge of mentoring process and skills, communication and social skills, practice and support (Vance, 2002). Qualities of a good mentor include: commitment, honesty, compassion, personal/professional ethics, expertise, energy, creativity, effective interpersonal and communication skills (Kappel, 2008). A good mentor is passionate about her work and is committed to helping the mentee successfully meet their goals. Communication between the mentor and mentee is open and honest in a positive caring environment for success to occur. A good mentor creates opportunities and opens doors. Mentors know your strengths and abilities. They do not set you up for failure. Mentors set an example through both their words and actions. Mentors want you to succeed and help you learn from your mistakes. Mentors want you to become independent. Mentoring nurse managers is crucial to the success and survival of nurses. The nursing profession is continually working to recruit more people into the field. Nurse retention can improve under the supervision of visionary nurse leaders because the environment created by their leadership is directly related to the success in retaining nurses (Colonghi, 2009). Nurse Managers need seasoned mentors to guide and nurture them to their full potential which promotes a supportive environment and give them the endurance to survive in difficult times. The mood, attitudes and examples set by the nurse manager set the tone and attitudes of the staff.

Friday, January 3, 2020

Above The Bare Article - Free Essay Example

Sample details Pages: 1 Words: 288 Downloads: 8 Date added: 2019/05/07 Category Law Essay Level High school Topics: Minimum Wage Essay Did you like this example? According to the layout of the information relayed on Above The Bare article, it is probable that the intent of the author could have been enlightening entrepreneurs and corporate managers on key parameters constituting to the growth of organizations. Besides, the author has not neglected the human resource but rather opts to offer an insight into wages evaluation as compared to living standards. In other words, the article aims at presenting the mutual co-existence between management and employees and its importance in improving production. Don’t waste time! Our writers will create an original "Above The Bare Article" essay for you Create order The article Above The Bare has provided varied aspects involved in effective managerial skills deemed to motivate employees in order to achieve set targets. Marina Krakovsky has exemplified the mandate of corporate organizations towards workers in regards to wages distribution. In addition, the article has further articulated the possible repercussions speculated to affect an organization either positively or negatively. On the other hand, the human resource has also been put into the limelight as to how organizations perceive and act upon their welfare (Krakovsky, 30-36). The commentary in the article could be of great assistance to upcoming managers in a number of ways. First and foremost, the article has clarified on the challenges employees endure during their service periods struggling with rising living standards and unsustainable wages. In addition, managers could learn to build strong relationships with employees by considering their opinions while trying to comply with minimum-wage laws. The impacts accrued from implementing such practices have also been highlighted and definitely, managers would greatly want to exercise. To sum up, the issues emphasized in the article have proved important to upcoming business entities. However, the mode of analysis has not been verified as to whether the statistics represent ideal situations by the employees.