Modelling an environment in which the relationship between nurse and patient is expressed as trusting and supportive is an integral part of a nurse practitioner’s professional activities. The use of theoretical leadership concepts and care management models that constitute the importance of pre-designing the type of relationship plays an important role in such planning. Determining factors for the practical realisation of theoretical models regulating the choice of a particular model or the use of a particular concept are the patient’s current state, anamnesis, personal attitudes and behaviour patterns, and communication with family members (The GMC’s expectations, 2020). Thus, by collecting all the data and carrying out analytical work, a qualified nurse will build a type of relationship in which leadership and delegation of responsibilities are balanced to speed up a patient’s recovery.
In order to unite the knowledge gained from the academic course, as well as to systematise and structure their skills, students were asked to investigate a patient’s case study in detail. It should be noted that such a task makes it possible to transfer theoretical models to clinical practice to determine the completeness of the author’s knowledge and skills and gain the necessary medical experience for future work with patients. Thus, summarising what was said above, the purpose of this essay is to provide a professional assessment of the proposed case study and then determine the diagnosis, causes and nature of the treatment.
The construction method of this work consisted of a study of the individual phases required to create an overall holistic picture of the scenario. Thus, the proposed case study was first discussed in detail, and some of the constraints that a nurse practitioner cannot meet during her professional duties were identified. This is followed by establishing ethical standards that cover the problem of communication with patients who demonstrate destructive behaviour. The author of this paper then turns to some known theoretical models of care and offers a description of them so that the reader gets a full picture of the possibilities potentially used to solve the case’s problem. The next steps are to apply the concepts studied to the proposed scenario, discuss inter-professional cooperation and some of the consequences of negative attitudes on the part of patients.
Although theoretical models of care and the nature of relationships with problem patients are often more optimistic than their practical implementation, any qualified nurse must adhere to a professional code. Even when a patient demonstrates completely offensive and unacceptable behaviour, the clinical specialist must remain cool and steadfast (Yu et al., 2019). This idea was the basis for the scenario described in which a 62-year-old woman needed medical help from the London Clinic’s gastronomic department. Thus, there were two factors at once that argued that the patient would be problematic, namely verbal abuse of the host nurse and the words of colleagues that the woman, pretending to be sick, actually resided in the clinical wards for an indefinite period because she did not have her own home. Subsequently, during the clinical “treatment”, the homeless woman showed more outrageous behaviour episodes: according to the text of the script, some of her colleagues were unable to stand it. The main difficulty was making the older woman aware of the need to be transferred to an appropriate institution to provide her with real help and support. In other words, the woman would have a chance to have a free house, food and communication that would not be difficult for both parties (Barron and West, 2017). However, the patient stuck to her motives and refused to sign the papers. The conflict culminated when an injured employee openly disrespected the patient. On the other hand, the storyteller of the case was able to show the necessary tolerance and determination so that the patient was eventually transferred to a nursing home where she would be taken care of by highly specialised professionals.
There is no doubt that any health care worker will be offended and insulted after inappropriate behaviour towards them. Moreover, if these insults are justified by the ethnic or cultural characteristics of the individual, the wound from such aggression can be even deeper (Smith, 2018). However, the professionalism of an employee at a modern clinic calls for the absence of personal feelings and emotional worries and the ability to overcome such deviant behaviour (MacLean et al., 2017). However, it must be recognised that not all employees can tolerate this: and although episodes of intolerance and aggression are not acceptable for the healthcare institution, it is possible to understand the motives of medical workers. Personal grudges coming from a patient, combined with possible work stress or problems in relationships, can destroy person’s well-being (Stephenson, 2018). This, in turn, will have an impact on employee productivity.
Based on the preceding, it seems advisable to develop an organisational action plan that will be used as a protocol in the event of repeated cases of destructive treatment by the clinic’s patience. The core principles of benevolence and tolerance should be the basis for such a plan (NHS Wales, 2016; Ridgway, Mason-Whitehead and McIntosh-Scott, 2018). The use of some of the theoretical foundations of nursing care is also a necessary step (Watkins, 2020). Moreover, the relationships built should guarantee compliance with the code of ethics and rules of friendliness.
There is no doubt that the roles of the modern nurse for advanced clinical practice have expanded noticeably. Although a modern nurse’s tasks still include technical duties, their importance has significantly increased (Leary and MacLaine, 2019; Thomas, 2016). For instance, a nurse can independently monitor and treat certain groups of patients and use a doctor’s services for accompanying consultations. While this work’s prestige is gradually growing, organisations are being established around the world to provide support for employees in this sector (Marangozov, Williams and Buchan, 2016). This is justified by the idea that nurses with the latest knowledge can do their work better and more efficiently, which will affect not only the well-being of patients but also nurses’ satisfaction with their work.
The high professionalism of a nurse is the most important moral factor in the partnership, collegial relationship between a nurse and a doctor, and a nurse-patient system. The family name, the non-official nature of relationships in the performance of professional duties, deliberate insults and disrespect for the interlocutor’s opinion are condemned by medical ethics (Bijani et al., 2017). Therefore, for example, if a nurse has doubts about the appropriateness of the patient’s wishes, she must tactfully discuss the situation first with the patient and, if there is still doubt, consult higher-level workers.
Another important problem concerning the nurse-patient relationship is the apparent ageing of the population. There is no doubt that modern medical advances are much more skilled at coping with painful conditions, which means that the patient’s overall age is legitimately increasing. Thus, the obvious pattern is that ageing patients leads to an increasing proportion of chronically ill patients. In turn, this effect can cause a raise in irritability, aggression, and hatred among older patients (Vernon, 2016). This is true for the scenario under discussion, in which the 62-year-old woman cannot adequately maintain a professional dialogue and exhibits acts of hostility toward the clinic staff. Especially in these circumstances, a nurse must strive to establish a trusting relationship with the patient that promotes psychological peace of mind and physical healing (Mathieson, Grande and Luker, 2019). So, it is important to note that managing a conflict situation is a nurse’s job, and therefore, in-depth research of leadership mechanisms is prioritised.
Regardless of the specifics, the leader in an organisation is traditionally defined as a team member who is recognised as having the authority and right to make important decisions in critical situations. This is especially true when the workforce is divided and not constructive: the probability of a unified opinion or all employees’ involvement is greatly reduced (Mesthri, 2018). In this case, the leader’s importance lies in the performance of the regulatory role in the team, including the clinical organisation (Ellis, 2018). It is fair for any group to say that the leader forms a team whose efficiency and productivity largely depend on its personal qualities and character traits. Peculiarities of subordinates, style of relations, microclimate, the psychological atmosphere in the group: all this is largely determined by the leader’s personality (Asghar and Oino, 2017). It follows that it is the leader’s qualities — whether it is the head nurse, practitioner or trainee — that determine the effectiveness of management activities and the regulation of team relationships.
However, it is fair to recognise that a working team for a clinical worker can also be a nurse-patient system where there is regular interaction between the two parties. In this regard, a nurse who has taken over the responsibility of leading the patient recovery process is characterised by several roles, which can also be used together (Mimeo, 2016). The most obvious role for a leader nurse seems to be that of a coordinator of the joint activities of the persons involved. The essence of the administrative function is not so much the independent performance of the work as the delegation of responsibilities and instructions to other group members. For example, a nurse is not obliged to feed a patient or perform hygiene procedures, but it is in their power and competence to create an environment in which patients will perform these procedures independently (Phillips and Norman, 2020). In this sense, it is worth acknowledging that the administrator may be uncomfortable with delegating professional responsibilities in some cases. The reason for that, as a rule, are the personality characteristics of the individual, the inability to work in a team and excessive leadership (Magnusson et al., 2017). As a result of this relationship model, the leader deprives the patient of a sense of responsibility and prevents them from being involved in the work.
For this reason, in the scenario under discussion, some of the colleagues have experienced an emotional crisis that seems to be provoked by differences between working expectations and a practical case. The desire to show high leadership qualities becomes a decisive factor for employees. However, the unprofessional initiative can cause pressure on the patient. This, in turn, triggers a defensive response, expressed, as in this case, through insults and then an open conflict between the parties. On the other hand, the storyteller did not seek to become an active leader but illustrated a true leader’s hidden qualities. By listening to the patient’s requests and seeking to provide her with the necessary level of comfort, the author created a favourable environment of trust, in which the patient made her own decision to transfer to a nursing home.
Activity as a process planner can become an alternative role model typical for a nurse leader. Such a leader often takes on developing the methods and means by which the group achieves its goals (Ellis, 2016). This function can include both immediate identifying steps and developing long-term action plans. Although this scenario did not explicitly mention the manifestations of the planning leader, the collective idea of the need to transfer the woman defined the goal of nursing care. One of the most important functions of a modern nurse leader is to set goals and the basic behaviour of a group (Steinmann et al., 2018). Group goals and methods of achieving them can be realised through the guidance of superiors, through subordinate participants’ needs or as the leader’s expression of will. It has been repeatedly mentioned in the scenario that an elderly patient had individual needs and wanted to be treated with respect, although she was not prepared to show courtesy and friendliness towards the clinic staff. An effective leadership strategy executed by the storyteller had full respect for the homeless woman and an episode of listening to her complaints (Abdelrahman and Abdelmageed, 2017). The author then revised the material and proposed a ready-made solution, which proved to be acceptable to the patient despite previous acts of disagreement.
It is important to recognise that the definition of personal qualities that establishes a nurse’s role as a leader is very important in the context of the discussion on this issue. In other words, by carefully considering how a leader should act, the employee has a better chance of effectively fulfilling this role. Thus, the research direction in leadership studies from a trait-based leadership perspective was influenced by the English psychologist and anthropologist Francis Galton, who put forward the idea of heredity in the nature of leadership (Trait-based leadership, 2016). This approach’s basic idea was to believe that if a leader has qualities that are hereditary and that differ him from others, then these qualities can be distinguished. Leaders tended to be distinguished by their intelligence, desire for knowledge, reliability, responsibility and activity (Weberg and Davidson, 2019). However, effective leaders found to show different personalities in different situations. A modern leader in medicine must have a spectrum of several personal traits that can be used depending on the specific situation (Carragher and Gormley, 2017). First and foremost, this concerns enthusiasm: having this trait meets the demands for optimism and hope. A homeless patient began to trust an employee that showed proper initiative towards her. Reliability is the second quality of a leader: a person who is honest and open in all affairs and relationships. So, despite the initial insults, the storyteller continued to perform his professional duties. Any leader must be disciplined: the nurse can lead others because she knows how to behave herself. In this regard, the intermediate position of a nurse seems to be a very suitable role for demonstrating leadership skills. Other generalised leadership traits may include confidence, calmness, determination, humour, loyalty and an analytical set of mind.
The leadership theories applicable to clinical practice are no different from those that apply to organisational management, the financial sector and large enterprises. In part, this is justified by the similarity of the procedures being performed and the objective’s identity: to achieve maximum optimisation of internal processes. Therefore, theories of the great man or situational leadership can be discussed in the context of medical leadership (Stanley, 2016; Heatley, 2018). In addition, the theory of personality traits, which has already been discussed above, can also be included.
According to the great human theory, great leaders who can advance processes and fundamentally change existing ecosystems are born out of nature, not influenced by the environment or education. The core of this theory is that all people are born with certain traits, and the set of natural features of true leaders is very different from those of all other people. It is these specific traits that enable them to lead the masses and write history. In the context of the case study under discussion, this seems to be a theory that is too broad for the London Clinic staff, but the fact that only one nurse was able to show proper leadership may indirectly indicate that the theory of the great man can be applied.
Situational leadership is based on the idea that managing people in different styles and the level of development of employees concerning a task positively affects the team. These styles are based on the principles of mentoring, guidelines, support and delegation. The direction is achieved by setting clear orders with a high level of nurse control. Mentoring leadership styles are task-oriented and people-oriented (Cabral, Oram and Allum, 2019). In this case, the manager explains the decisions, sells the idea, listens to the patient’s opinion, but the control and setting of tasks are done continuously. In a supportive mode, a nurse is even more focused on people than on the task. Thus, they try to help the subordinate in every way possible, with almost no intermediate control. During the delegation leadership, all authority, rights and responsibilities for the task are delegated to the subordinate: the manager does not interfere in the workflow.
Thus, there is every reason to believe that situational leadership applied to a homeless woman. If you examine the text of the scenario in more detail, you can understand that the narrator demonstrated a combination of supportive and delegated leadership styles that resulted in the goal being achieved. Specifically, during the initial appointment, a nurse did not interfere with the conflict or respond to public insults in her direction. This can be seen as a delegation of delegated management authority at a given time and not create a negative communication experience. When the leader nurse brought dinner to the woman and listened to all the complaints, it was an example of a supportive situational leadership style. After assessing current problems, the author proposed the solution that was also justified by the real threat to the health and safety of the patient, the COVID-19 pandemic.
These same statements are also true for relational leadership, which is based on relationships. The nurse who told this story, unlike her colleagues, did not seek to hurt the patient’s feelings or humiliate her in return. On the contrary, guided by the laws of relational leadership, the nurse invested her energy, strength and time in building a relationship of trust with a problematic client (Cardiff, McCormack and McCance, 2018). Indeed, there were risks involved, as such investments may not have the right effect, but it worked in this case. The nurse allowed the patient to get involved in her recovery and was actively interested in the woman’s opinion. By expanding her rights in the patient-nurse system, the employee allowed the woman to manage the care process and demand that certain needs be met. At the same time, the author only displayed ethical behaviour and never argued with a homeless woman. In the end, this determination led to a positive result, and the patient was discharged from the hospital on her own will.
It is wrong to believe that such a leadership style can only be justified by the narrator’s personal desire to help the patient. On the contrary, previous work to create a favourable environment, conducted by the clinic management, the attending physician and the participating nurses, could have led to an unacceptable outcome. It must be recognised that an act of intolerance on the part of one of the nurses could have been an exception, which means that this behaviour was programmed unacceptable in that department of the clinic. In addition, as an intermediate link in the healthcare system, the nurse went to consult with the head of the clinic, who instructed them to obtain the client’s signature by all means possible. Finally, nurses received support from the nursing home colleagues, who proposed a final solution to the problem. Thus, achieving the goal was only possible thanks to the active engagement of the parties involved. Summarising the above, it should be noted that interprofessional intervention has positive results for any organisational process. In addition, having diverse colleagues promotes competition, which is important for the motivation of employees.
The discussion of the applicability of the cited knowledge to personal medical practice deserves special attention. As a nurse practitioner, I am sure that I will encounter many dissimilar patients. Indeed, while some may be loyal and polite, others may be intolerant and conflicting. So, the role of skilled nursing requires me to provide equal care to any patient, regardless of their behaviour. Nevertheless, using my knowledge of different leadership approaches will greatly facilitate my work practice. For example, for quiet patients, an excellent one is the democratic or partnership style. This statement is justified by assuming that calm and responsible patients listen to the health care provider and do not engage in conflict. On the other hand, for aggressive and intolerant patients, the best choice is situational or transformational leadership, involving some hierarchy.
It is also fair to acknowledge that working practice will not initially fully meet theoretical expectations. In turn, this can cause emotional imbalance and stress, affecting performance (Hunter et al., 2019). A professional needs to manage these states and identify possible negative factors promptly. In particular, the lack of extensive experience and the newcomer’s role in the team as a professional can be causes of stress. Learned leadership styles and acquired knowledge of soft skills would allow inhibiting the development of undesirable consequences. Thus, it must be concluded that a future medical practice is guaranteed to confront me with work problems and mistakes, but responding to them in a competent and timely manner will allow me to develop professionalism.
In conclusion, it should be said that a modern nurse’s role has significantly expanded, and therefore leadership is a major advantage for medical workers. In this paper, a training scenario was discussed in detail, in which good strategic leadership inhibited deviant behaviour. It was shown that the theoretical leader model is based on the idea of forming a social role that inspires the rest of the team and plans organisational tasks. In addition, delegation plays an important role, without which it is impossible to form trusting relationships. The work identified the basic style used by the storyteller in the proposed scenario, situational leadership, and found that relational management was also characteristic of this case.
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