Answer :

TITLE OF THE ASSIGNMENT- NURSING AND HEALTHCARE

Executive Summary

The report based on the role of leadership in enhancing the nursing staff's performance is projected with a case study. The methodology of signifying the case study in alignment with the leadership theories is projected. The benefits and challenges of applying leadership theories are also discussed in the report. The findings highlight the literature review theme where the problems of the case study are discussed along with the strategies and recommendations to improve the performance of the nursing staff in the aged care setting. 

Introduction

The older age patients in their eighties and nineties have unique, nuanced, and multifaceted needs. The combined effects of the ageing process, illness, and environment, which challenge their sense of self and influence their perception of the quality of life, affect them in specific ways. Nursing care for the elderly is needed, and a nurse who is competent, professional, vigilant, compassionate, proactive, respectful, and enthusiastic about caring for the elderly should give it. The relationship between employee morale and efficiency or work quality can positively or negatively impact any organisation (Kang et al. 2020, p.7). Since professional standards directly impact patient health outcomes, this relationship is especially important in the healthcare environment. High employee turnover in the health care environment can confuse the implementation of patient care and experience enhancement activities. As a result, healthcare organisations should devote considerable resources to determining employee productivity and developing strategies to boost it. 

The stakeholders identified in this case study reflect the hospital or nursing home care provider, the nursing professionals, the patients and their families and the medical fraternity at large. The report highlights the improvement of service and care provisions by the nursing professionals in the elderly or aged care settings. The report envisages a case study on the Quality and Safety in Aged Care published in the Australasian Journal on Ageing (Wells et al. 2019, p.1). The case study focuses on the quality of care provided to elderly people, quality of leadership demonstrated by the nursing professionals, and discussion on improving the staff's knowledge, skills, and attitude. The report provides the strategies and recommendation to improve the nursing professionals' performance across the care facilities in the country. 

Literature Review 

Theme 1: Discussion on the importance of leadership and management in aged care settings

The case study encompasses the leadership theories that determine how nursing professionals' beliefs, goals, ideas, and values can be influenced in care settings. A nurse leader is in charge of a group of nurses and is responsible for making decisions and coordinating patient care programs. They have extensive clinical experience and are dedicated to improving the quality of healthcare. On the contrary, nurse managers are technically not interested in indirect patient care. Instead, they focus on daily activities and staff supervision. Nurse Managers are also in charge of budgeting, so they must have working experience in corporate management. Books and articles have identified leadership style as an important factor in healthcare efficiency. 

Strong leadership is considered one of the most vital factors in ensuring that a company achieves its goals. There have been significant positive correlations between successful leadership styles and high levels of patient satisfaction, as well as a reduction in adverse effects (Sfantou et al. 2017, p.2). Furthermore, numerous studies have emphasised the importance of leadership style in determining nursing home care standards. By inspiring, attracting, and helping seasoned staff, effective leadership indirectly influences lowering mortality rates. Although several studies have been published that show the value of leadership, few have attempted to link a specific leadership style to patient outcomes or healthcare quality measures. In Australia, the residential aged care sector has long been overlooked in management and leadership growth. Recent reforms in the elderly c sector aim to lower the cost of providing care, implement technology initiatives, and improve employee engagement and satisfaction (Naidu, 2019, p.75). Without effective management and leadership, these changes will be difficult to enforce, particularly in this era of consumer-centred care. 

Leadership theories in healthcare settings 

The nursing profession's leadership theories include transformational leadership, democratic leadership, autocratic leadership, and servant leadership. The anticipated leadership theories form the theme of different styles incorporated by the nursing professionals in their care of duty while considering the benefits and limitations of leadership styles. 

Methodology

Transformational leadership is a type of leadership practice in which followers have faith and confidence in the leader and are inspired to go beyond what has been anticipated to achieve organisational goals (Krepia et al. 2018, p. 190). There are four main dimensions of transformational leadership: Idealised influence (attributes and behaviour patterns) defines a manager who is an inspirational figure for followers, sets high expectations of conduct, and can articulate the organisation's vision to gain followers' confidence. The second dimension, inspirational motivation, represents a leader's ability to clearly articulate a convincing vision through expressions, images, and imagery (Boamah et al. 2018, p. 2). The third dimension, intellectual stimulation, represents how much a leader asks workers for their input on issues and weighs a range of viewpoints when making decisions. Finally, leaders who practice individualised concern, the fourth component of transformational leadership, give importance to their employees' individual needs and strive to coach or mentor them to achieve their full potential successfully. 

This leadership theory's benefits in the healthcare profession or specifically in the nursing profession are that transformational leaders are experienced in resolving conflicts. Transformational nursing leadership encourages and motivates workers to find new ways to achieve a target. They can coordinate people into workable groups, improving a group's well-being, morale, and encouragement through excellent rapport. However, it is argued that in the early stages of programs or ad-hoc settings, transformational nursing leadership can be unsuccessful (2). This form of leadership style necessitates an established system in order for further development and growth to occur, so it is not appropriate for the newly established care settings. 

Democratic leadership, also recognised as participative leadership, is a governance style in which team members participate in decision-making. As a result, followers are more involved in the management process, more committed to the goals, and more driven to function efficiently (Xu, 2017, p. 156). Kurt Lewin, a behavioural scientist, researched the 1930s and discovered the significance of participative organisational leadership. In participative leadership, the leader advises team members to include followers in the decision-making process while retaining power. According to participatory leadership guidelines, the first stage is diagnosing decision situations, which involves determining the relevance of the decision, identifying people with relevant expertise, and determining whether a meeting is feasible. The second step is to encourage people to get involved, including encouraging people to voice their concerns, describing a plan as preliminary, searching for opportunities to expand on ideas and suggestions, and expressing gratitude for suggestions. While following this leadership theory involved in healthcare or nursing, in nursing and democratic leadership, the benefits realised will ensure that the team feels respected and comfortable speaking up. Transparency and feedback from team members with the most experience, not necessarily seniority or highest rank, are valued in high-reliability organisations, making this form of leader helpful in building a culture that encourages input from the entire team. It may be argued that when a team needs to react quickly, a democratic leadership style in nursing may be counterproductive (Georgescu, 2018, p. 43). Timing is crucial in an environment where unexpected events and emergencies occur, and democratic leaders who are unable to make swift decisions individually and without team input can struggle to succeed.

Autocratic leadership is another form of transactional leadership. Directives, commanding, power-oriented, and closed-minded leaders are all characteristics of autocratic leaders. The tasks "what, where, why, and how" is defined by the leader. He/she places a premium on discipline, integrity, and conformity to the laws (Durmus and Kirca, 2019, p. 4). Followers carry out the orders of the autocratic official. An autocratic leader may be considered preferable in an emergency because he or she makes all decisions, not consulting with the rest of the team. Sensitive information can be withheld from the team since information is seen as a source of control.

Furthermore, autocratic leaders can instil fear in their employees and often make decisions without consulting their teams. These leaders use "constitutional authority," "gratifying powers," and "oppressive forces" to empower their subordinates. Autocratic leaders may not be well-liked by their subordinates, but when positive outcomes arise due to their leadership, this can be turned into admiration and devotion (Lord et al. 2020, p.22). Although employees dislike autocratic figures, they often follow their orders. In nursing, autocratic leadership does not foster communication and commitment or information exchange; instead, it creates an atmosphere in which team members' valuable experiences and skills go untapped. This form of leader hinders an organisation's path to high reliability by suffocating collective decision-making and accountability. 

As proposed by Greenleaf, servant leadership suggested that there is a bond between followers and their leader, based on social exchange theory (Greenleaf, 2002). According to the social exchange theory, social activity is the product of a mechanism of exchange. The cost-benefit analysis of engaging in a human relationship is explained using this method. Employees in the workplace look for good aspects of their bosses' actions and react favourably as a result. When a leader's behaviour is conducive to developing a mutually beneficial and trusting partnership, followers are more inspired, and job satisfaction increases (Mitterer, 2017, p. 60). When combined, the team's mutual direction and feedback will help shift the balance, and a poor-performing team will continue to struggle under the servant leadership style. When top-down decisions must be taken to align the whole team rapidly, servant leadership in nursing is not recommended.

Role of leadership in the case study 

The studies have appeared in the Australasian Journal of Ageing (AJA) during the past ten years which has been included (from 2009 to 2018) to maintain the currency. A preliminary search of the AJA's EBSCO database of peer-reviewed papers is mentioned for reference of employees in the abstract. The investigation demonstrated 28 studies that were organised into themes (Wells et al. 2019, p. E2). Articles focused exclusively on residents (e.g. instruments to quantify resident functioning or analyses of the physical environment's effect on residents) were excluded, as were editorials. The Joanna Briggs Institute guidelines were used to determine the risk of bias in quality evaluations. Australian and International researches have shown that the quality of aged care nurses influences the quality of care provided to consumers. An important factor of the Quality of Care received is the framework of knowledge, attitudes, and skills used to evaluate staff capacity and satisfaction. More broadly, skilled staff and the quality of nursing leadership affect the quality of residential geriatric treatment. Consumers consistently acknowledge employee continuity, adequacy, and training as essential for service users to achieve good results.

Theme 2: The well-being of the staff and stability among the workforce

Findings

By 2047, the number of older Australians (main users of elderly care services) is estimated to be four times higher (Holland et al. 2018). This trend will lead to considerable growth in healthcare demand. Given these indicators, the efficient retention of qualified and experienced nursing staff is critical. The majority of the respondents interviewed reported extremely high workloads. Inadequate staff levels, excessive administrative tasks, and inadequate skill mixes were key determinants of the high reporting workload. Respondents also reported that problems with workload arose due to the lack of care quality in determining appropriate staffing levels. The respondents truly believed that the personnel's already high stresses were not only contributed to by high workload but also that workload pressure endangered patient care and safety. In an extensive study, the nursing personnel's capacity, age, and intention to leave were examined (Yu et al. 2019, p. 130). Compared to international figures, work capacity was high. The intention to leave among staff with low working skills was expected to be higher. Unfortunately, the working-age has not been predicted, and registered nurses demonstrated lower working capabilities than others. 

Discussion 

The strategies that were embedded to counter the issue of quality and safety in aged care can be elaborated in the following segment: 

Emotions Intelligence is a readiness that focuses on the intuitive depiction and expression of emotions. Emotional intelligence is an understanding of emotional knowledge, the use of feelings to enhance thinking. The nursing performance comprises more than just the effective utilisation of resources; it includes competent standardised care in compliance with the Nursing Code of Ethics, effective interpersonal communication and technology use and an adequate Nursing-Patient Ratio (Staffing) (Khomami and Nasreen, 2019, p.1). Top-notch, extensive, systematic reviews are required to improve everyone's understanding of the factors that influence employees' capacity to provide care and interventions to increase the ability of their employees to ensure the safety of caregivers.

The nursing leaders adopt the strategies through their expertise in combining quality improvement, healthcare management and managing the policies and procedures to ensure the better patient outcome in aged care (Kelly et al. 2021, p. 99). The nursing leaders are responsible for assessing the nursing professionals' performance and helping the management in designing and executing the training programs. The nurse leaders are efficient in soliciting and collecting the feedback of the colleagues, patients, families and members from the community to ensure that the service or performance of the nursing personnel engaged in aged care is provided at their best capacity. The nursing personnel are trained to demonstrate empathy and self-motivation while dealing with elderly people (Holden, 2017, p. 6). The improvement is evident when the nurses can display their critical thinking and problem-solving capacities to provide relief to the patients in the care settings. 

Nursing is rapidly shifting, but technological progress is even speedier sometimes. Although new nurses may lack years of direct patient experience, they are often familiar with the technology. Technology is considered an integral part of modern nursing with applications that allow healthcare providers to determine dosages and interactions for medications and websites, allowing patients access to electronic health records (Bagherian et al. 2017. p. 4). Technology also enhances standards and the therapeutic relationship through evidence-based practices and clinical decision-making support. Many health providers today have adopted technologies that support evidence-based nursing practices and provide data-enabling clinical decision-making. This helps healthcare providers standardise care delivery in and outside of their organisations, resulting in improvements in the quality of care for the entire healthcare cycle. These solutions also contribute to reducing clinical mistakes and administrative delays that can affect overall care quality.

Recommendations

The future recommendations in improving nursing personnel's performance in the aged care setting comprise the following methods. Lecture or coaching method by the senior nursing leader or manager can be taken up to improve the nursing staff's performance. Although teaching is sometimes considered passive or boring, it is thought that it is a time-efficient, cost-effective, and efficient way to give groups of students much new information. The ability to use presentation methods, like videos, can allow students to find a way to learn fun. High-fidelity simulation is the current trend in healthcare settings (Singh and Thembekile, 2020). Incredible interventional study scenarios help nurses develop skills, teamwork, trust and critical thinking at the lowest potential for risks to the aged patients. 

Concept mapping is a new technique adopted by healthcare providers. The whole teaching method helps students to see how differing views interconnect. Concept maps can help students to recognise their understanding today and to develop new ideas (Khrais and Ali, 2017, p. 1336). Meta-cognitive strategies help students to organise or process their knowledge logically. It is proposed to encourage critical thinking, implementation, and interpretation by this visual training technique. Students also gain a sense of their knowledge gaps and future learning requirements. The flexibility, effectiveness, and cost of online learning help nurses. Online study can be preferred to on-campus modes for student nurses on the job or the job. Role-playing is not like simulation because it is not preplanned. Role-plays in nursing education is vital because they expedite communication and conflict management. It is essential to communicate support, reflection, and further learning after playing the role.

Case studies are rational and multifaceted narratives and usually involve a conflict or dilemma that the learner must resolve. The focus is to reduce the gap between practice and theory and increase the plan for action and critical thinking (Bristol et al. 2019, p. 95).  After the learners themselves can work on the case, the instructor must inform the students of contextualised suggestions to solve the case study. Case studies help the nursing personnel adapt to the hospitals' real-time situations, which provide them insight into how the critical cases may come up. Based on case studies, the nursing staff may get the scope on outlining the intervention framework or guidelines that may assist them in the ineffective quality of care. The debates approach provides the opportunity for rational reflection, alternative perspectives and verbal communication and learning. This approach can help students develop their research skills and present their thoughts or arguments. Discussions or briefings after the debate may help support, feedback, cooperation and critical thinking and assessment for learners. 

Conclusion

In the concluding statement, it may be suggested that the report presented the leadership theories in the context of healthcare and aged care setting deciphering the active roles played by the nursing personnel in leading the organisations. The benefits and challenges of the leadership theories have been discussed in the case study that reflects the quality and safety offered to elderly patients. However, the case study has not directly dealt with any particular event or situation of any patient but has mentioned several studies undertaken to ensure quality and safety to the elderly people through the nursing services. The report also highlights the strategies adopted to improve the performance of the nursing personnel. The recommendation also derives several possible solutions for future implications.