1 Reflection and Issues of Leadership Students Name Course Name Professors Name Institutional Name City and State Date 2 Reflection and Issues of Leadership Introduction Healthcare practitioners have a role as professionals to reflect on their practice and determine domains for improvement. Reflection includes reviewing a clinical experience by critically describing the elements, analyzing the experience and giving a professional evaluation to foster practice. Therefore, reflection is reasoning out an experience and thoughts to give a viable conclusion before giving an action plan (Delany and Watkin, 2008). Healthcare practitioners can assess themselves through reasoning and point out areas that need tailoring through change. Reflection offers a platform for a healthcare practitioner to self-evaluate and learn from the described and analyzed experience hence attaining competence (Mann, Gordon and MacLeod, 2007). From 2010 to the present, I have practised in different fields, which I will offer a critical reflection while assessing the events. Professional History In 2010, after completing my studies, I graduated and attained my degree as a midwife. After that, I applied for a job in three vacancies announced by three renowned healthcare organizations. I was fortunate enough not to have waited long since I secured the position a month after graduation. I was enrolled as a staff midwife and charge nurse in the labour and delivery department in a local maternity hospital in Saudi Arabia. Following that, I completed my training in the operations department and worked there for approximately one year. Then, I completed my bachelor's degree in nursing in 2018 and began working in a kidney and dialysis centre shortly after graduation. At work, I collaborated with health care professionals from various specialities, including paediatricians, dietitians, anaesthetists, nephrologists, and 3 students, in addition to other professionals. Additionally, I held leadership positions, which helped me exercise my skills and steer the team forward to accomplish tasks. Critical Reflection on Self Purpose and Characteristics of Reflective Practice Reflection happens when a healthcare practitioner undergoes an experience personally examines it critically and professionally to expose a gap that could have been filled through acting differently. Also, reflection gives a chance of evaluating what was done right throughout the experience so that it may be repeated in the future to yield satisfactory results. Past decisions offer a platform for demonstrating the strengths and weaknesses of actions, giving room to eliminate the negatives and foster the positives. Theorist John Dewey examined the concept of reflection and regarded it as being learning through experience by participation and relevant experimentation (Ferreira, Prado, Heimann and Oliveira, 2013). The person should experience a certain reflection scenario since it will form the foundation for observation. There is no reflection without experiencing an event or situation. Secondly, the person will have to observe the scenario he underwent and then reflect on it as it occurred, analyzing salient tenets to which it relates. Analyzing the situation's specifics helps understand its components and how they led to each other. Finally, knowledge develops after understanding the situation fully, which offers the person a chance to execute an action plan. Reflective practice has salient characteristics which make it an important and professional field for healthcare practitioners. Reflective practice needs a combination of skills to work effectively and produce constructive results. Critical thinking skills help a healthcare practitioner to identify and separate the strengths from the weaknesses that occurred in the 4 situation being reflected upon (Patel and Metersky, 2021). Without critical thinking skills and being open-minded, it will be problematic to evaluate the areas that will need to be eliminated and which ones to focus on (Bulman and Schutz, 2022). Additionally, reflective practice calls for a commitment since the practitioner will need to continuously monitor the event and practice to ensure that the changes made are accurate. Reflection on Self Having worked as a charge nurse in the labour and delivery department in a local maternity hospital, I had qualities and skills that were instrumental and critical in helping me accomplish my tasks and missions as a leader. The qualities which I have that have been beneficial to the organization include; good communication skills, the ability to make a solid and executable decision through decision making, the ability to resolve conflicts when they arise and motivation ability. These leadership traits relate to transformational leaders who prefer to transform current situations into better ones for future planning and orientation (Doody and Doody, 2012). Motivation, a key element in transformative leaders like me, helps the team work more efficiently with morale, hence yielding results beyond the scope of the organization's expectation (Renjith, George and Renu, 2015). I cultivated a positive environment within which the other midwives and patients thrived. My motivation ability inspires, raising spirit in the entire workforce of nurses and midwives to perform their duties and offer quality care. Through decision making, I have helped the organization escape barriers which could otherwise derail the significant operations (Nibbelink and Brewer, 2018). 5 Furthermore, conflict resolution has been among my best abilities as a leader who witnesses many cases of healthcare workers getting into conflict. Conflict causes job dissatisfaction for the parties involved and may necessitate turnover (Almost, 2006). Significantly, solving disputes has helped tailor a healthy and conducive environment for every worker hence higher productivity and reducing turnover (Lahana et al., 2017). Example for Reflection I was given a rare opportunity of being a nurse leader in the labour and delivery department after working as a staff midwife for a short period. One experience which I remember well happened in the second month after I was assigned the role of a charge nurse. A heavily pregnant lady whom I chose to call Esther for the sake of confidentiality arrived before 9 p.m., accompanied by her husband, and she seemed to be in so much pain. Confidentiality is a professional requirement for the nurse to safeguard a patient’s right’s (Abiola and Ataiyero, 2015). I was together with my assistant that night, and although many more patients were waiting to be attended to, we decided to give Esther more attention as she was about to give birth. Esther and her husband were Indians, barely understanding the English language. Gibbs Model of Reflection Gibbs Model of reflection comprises six phases collectively called the "Reflective cycle." The first phase is the description of the experience; the individual tries as much as possible to recall the scenario and get enough tenets for analyzing it critically (Wain, 2017). After describing the incident, the feelings phase begin. The individual takes time to evaluate and discuss the underlying emotions regarding what he thought and felt when the scene occurred. Next, the 6 individual explores the positives from that experience and the negatives, including events contrary to the expectations. After analysis, the person discovers the domains that will need improvement through skill interventions, hence offering time for learning. A conclusion follows the analysis, and the person is free to develop a judgement based on the information evaluated. The positives and negatives are used in the conclusion phase to tailor an action plan. The action plan sums up as the final phase of the Gibbs model of reflection. Gibbs model is straightforward, which makes its applicability and use feasible. Additionally, it offers a clear description of the feeling analysis, the scenario, and the experience's analysis to infer tangible conclusions. Also, it paves the way for the individual to develop a course of action to avoid the weaknesses from recurring while fostering the strengths. However, the model has a major drawback; it is not majorly and strictly introspective, a primary requirement of reflection. Using Gibbs Model to Present the Example Description of the Event My enrollment as a charge nurse necessitated my presence for the majority of the shifts in the organization. The goal was to ensure that things were going on as planned. On the material day when the event happened, I was together with my assistant ensuring that the nurses were performing their tasks as planned and we were ready to address any arising issue. While we were in the night shift before 9p.m a heavily expectant Esther dashed in with the help of her husband. They were Indians, and they did not master the English language well, which posed a problem in communication. Esther was in much pain, and because she could barely understand any of the Basic English words, we requested the husband, who knew few words, to allow us to call a 7 translator to help in the communication. They turned down our request, and I had to use sign language to request Esther's husband take a seat as we took care of the situation. Esther was in her late thirties, and this was the sixth pregnancy having had two miscarriages and three live births, of which were girls. The husband hoped that the baby she would give birth to was a boy, as we heard him praying in low tones. Esther insisted that she wanted to be attended by females only, citing her religious needs. Before taking her to the delivery room, my assistant explained the major details to Esther's husband. Even though he did not understand as fast as needed, the latter grasped the directions. After outlining the procedure, we brought papers for them to sign. Soon afterwards, the anaesthetist came and offered Esther the epidural. The husband refused to leave the room and let us continue with the procedure. He put his hand around Esther's head while touching his shoulder periodically, which was annoying for the staff. The epidural procedure is expected to be sterile to reduce the chances of infection. I had to intervene and struggled to tell him that bacteria could cause infection, which could be problematic. After stepping out, the baby was delivered but floppy, and he didn't seem alive. Esther got more worried when she saw meconium gushing and started crying. I explained that we could do our best to offer extra attention until things were okay. After one hour, the doctors managed to extract the meconium while rubbing him, after which he cried, relieving our worries. After some hours, we transferred Esther to the postnatal ward. Feelings I was empathic each time I saw how worried Esther was during the delivery procedure. Empathy is an emotional connection to the state of another person (Terezam, Reis-Queiroz and Hoga, 2017). She wanted the baby boy to survive, together with the husband. Additionally, I 8 empathized with them for losing two pregnancies to miscarriage, which triggered more worry during this procedure. Being Indians and unable to properly comprehend instructions given out in English, it was irritating for the majority of the healthcare practitioners present. However, being in charge and a leader, I tried to mend this bridge of misunderstanding to tailor a good relationship. When I saw Esther in pain, I used hand gestures and expressions which she could understand to ease her pain, and after smiling, I felt she was getting better (Gultekin et al., 2016). Body gestures are non-verbal communication skills that can facilitate communication (Akoja, Abolarin and Ogunlalu, 2019). After the procedure, I kept eye contact with Esther to showcase my interest in helping if she needed some more interventions. Evaluation I feel it was right to engage with Esther and her husband when they visited the centre. My approach was good when I tried to understand their worries and what they wished to be done regarding giving Esther quality care as she sired. Explaining to them the benefits of having to be attended by male practitioners instead of being exclusive was understanding the patient's needs and ensuring they are satisfied with the best options available. Cultural diversity requires that healthcare practitioners exercise professionalism to be culturally sensitive for patients with diverse beliefs (Ekman and Emami, 2007). Fostering cultural awareness improves understanding and confidence, a recipe for holistic care for individuals with diverse cultural backgrounds (Prosen and Bošković, 2020). Analysis My good communication skills were instrumental and beneficial in providing quality care to Esther. The clients being Indian, my non-verbal communication skills rescued the situation, 9 and even though the husband knew a few English words, it was problematic to respond hence hindering communication. In the Indian sphere, which exercise Hinduism and the majority are Hindus, it is fundamental and almost undisputed that a patient should be attended by a healthcare practitioner bearing the same sex. Additionally, it is required that minimum exposure of the patient's body is tolerated. Miscommunication is a problem that should not be a basis for unnecessary rifts, and interventions should be done to help the situation. Conclusion Exploring this reflection has opened my thoughts on how important it is to accommodate patients with language uncertainties and diverse cultural backgrounds. The reflection has helped to pinpoint the effectiveness of my approach to this category of clients. Esther needed support and personalized attention, and quality care. Religious stands of different populations impact how people perceive healthcare approaches and strategies. Hindu patients have a different view of how healthcare should be undertaken compared to other religions in the case mentioned. Some healthcare providers may find this absurd and get irritated with these individuals' demands. Intercultural misunderstandings have detrimental effects in the long run. Therefore, healthcare providers must be sufficiently equipped to satisfy patient needs, including an interpreter. Action Plan As a healthcare practitioner and not just a practising midwife, having worked in other departments such as kidney and dialysis sections, I plan to evaluate the best ways to deal with diverse clients. When engaging with a patient from another cultural background, I would strive 10 to master basic words and research the culture to help grasp the expectations. I will continue employing my communication skills to help understand the patient's needs and give them the instructions I will deem necessary. Communication is an essential tool in giving quality care and attaining positive clinical outcomes. Furthermore, I will never prejudge my patient based on first impressions, but I will engage with them to understand their stand and make possible changes if I feel something is wrong. Having learned the importance of listening, I will continue to listen and set my eyes on the client's gestures to create trust and showcase commitment (Jahromi, Tabatabaee, Esmaeili Abdar and Rajabi, 2016). Additionally, I should respect people's fundamental beliefs and principles as I attend to their needs. Leadership Key Characteristics of an Effective Leader Leading a nursing team is not an easy task if a leader lacks “emotional intelligence, integrity, critical thinking, good communication and skills.”Emotional intelligence in the clinical setting is an essential feature that effective leaders possess. As a team leader who has been in a team where the leader had emotional intelligence, it was established that help develop emotional intelligence to the team members helps them cope with stress when challenges knock in their routine (Regis College, 2021). Emotional intelligence helps the effective nurse to train the team members of possible interventions and strategies that can be employed to counter negative influences. Secondly, integrity is a key characteristic for nursing team leaders. My leaders in the teams I have been in and my personal experience integrity was instrumental in making the right 11 choices by evaluating moral principles and ethical codes (Regis College, 2021). Clinical practice is met with difficult situations that need a leader to tailor acceptable and right choices to eliminate the problem and address difficult junctures in the treatment plans. Ethically viable practices help in making safe and effective healthcare decisions. Furthermore, critical thinking makes effective leaders make polished decisions concerning a complex array of influencing elements in practice. Effective leaders should be able to think critically, weigh on the options available and choose those which have a beneficial influence on the team (Cherian and Karkada, 2017). Multidisciplinary collaboration calls for critical thinking leaders to solve puzzles and attain better outcomes. Also, an effective team leader should have good communication skills as they deal with a collaborative set of individuals. Collaboration only materializes through the correct laying of information and specifics to the other team members. The Dynamics of Teams and Building teams. Team members often have distinct roles they play, which can be influenced by behaviours that impact other group members. Building and developing teams involves four major phases; forming, storming, norming and performing. The leader offers a high degree of guidance in the forming phase since the individual roles are not defined. This phase is less established. Next in storming, there is the development of an understanding regarding how team decisions are tailored. Additionally, the purpose is clear during storming, but the relationships are not salient nor clear but blurry. During norming, the team understand the relationships and commits to achieving team goals. Lastly, there is a “high-level commitment” for good 12 performance in the performing phase of building the team. The workers focus on being strategic together with the leader, helping in the smooth running of the team without much oversight. There are five dynamics of teams: “psychological safety, dependability, structure and clarity, meaning, and impact.” In psychological safety, the team members should feel safe in engaging in risky ventures, making them seem vulnerable to others. Dependability dictates that all the team members should perform the tasks promptly, meeting the objectives collectively. Furthermore, structure and clarity need that team members to have defined and clear roles and plans to accomplish tasks. Having clear roles helps create clarity, and hence everyone is accountable for their portions. Meaning as a dynamic asserts that work is individually critical to the entire team hence should be performed based on importance. Lastly, impact forced team members to reflect on how and why their work matters, put more effort, and tailors change. The Position of My Team My team sits in the kidney and dialysis department and centre in the organization. Additionally, we are contacted to offer training sessions to new employees and offer educative services. Furthermore, the team liaises with the physicians in other departments to ensure goals are achieved. My team strategizes on plans that will help train new nurses and get them absorbed quickly in the system. Common Leadership Problems The common leadership problems which nursing leaders face include; staffing, budgeting, burnout problems, and retaining nurses. Staffing problem is common for nursing leaders as they have to create additional time as it eats much of the available time. Creating extra time is to solve staffing problems that ensure that ratios are maintained to provide quality care to 13 the clients (Ofei, Paarima, Barnes and Kwashie, 2021). Scheduling shifts without compromising safe staffing can be problematic as the nurse leader should account for costly overtime. Secondly, budgeting is a major problem that nurse leaders face. There are bulk nursing budgets as influenced by the payroll and purchasing of supplies to ensure quality and efficient care (Prempeh et al., 2021). These components eat up on the budget allocated, and the nursing leader is left to battle financial constraints should the expenses exceed the budgeted amount. During scheduling, the ratio of the nurses to patients may be beyond the required, and workable scope required causing burnout. Burnout is a problem for leaders since it has detrimental effects on workers' morale (Western Governors University, 2019). Low morale leads to poor quality patient care being offered and may lead to good workers resigning. Furthermore, retaining the nursing staff is a problem that the nursing leaders face. High demands for care against staffing limitations long shifts causing burnout all affect the stands of nurses; hence may opt to leave the job (Dall’Ora, Ball, Reinius and Griffiths, 2020). Interventions to Leadership Problems Increasing the number of nurses through recruitment helps attain the required ratio of patients to physicians hence eliminating burnout. Additionally, nurse leaders should liaise with nursing financial analysts to evaluate possible unsuitability in the proposed allotments. Financial analysts will help examine monetary information and tailor strategic budget recommendations, which helps draft finite budgets. Also, nurse leaders should boost team morale through forging healthy relationships acknowledging concerns and rewards each time the nurses succeeds (Stapleton et al., 2007). Rewarding helps the nurses to feel appreciated hence boosting morale and avoiding burnout. 14 Issue of Concern An issue of concern is workplace violence. Workplace violence may not be physical, and it takes the form of verbal assault and abuse (American Nurses Association, 2021). I had encountered one issue of workplace violence when a nurse came and reported to me that she was subjected to physical violence by a patient and incivility by a team member. A coworker was constantly being rude to her and gossiping lies about her to other members. Two days before this escalated, she was punched by a patient while requesting him to take medication, and she did not report to me immediately but chose to keep quiet. I called the perpetrator, warned her about the said behaviour, and asked her to verbally apologize to the nurse and write a formal apology letter to management. Addressing Workplace Violence To address this workplace issue, I have developed and enforced a "zero-tolerance policy" for the perpetrators of violence of any form of incivility. There are hefty fines imposed on those who will be found guilty of such uncouth behaviour. A zero-tolerance policy helps the staff members to fear losing their jobs or facing even serious cases in court if they perform actions that may harm their coworkers. Secondly, I have tailored training programs that will help nurses counter violent incidents in the workplace. Educating nurses on violence management policies helps to know the right channel to follow when such incidents happen (Al‐Qadi, 2021). Selfdefence programs initiated helps the nurses to be mentally and physically prepared for physical violence. What to Change in Future 15 Suppose such an incident of workplace violence occurs again. In that case, I will call the perpetrator to a crisis meeting and request the executives to suspend him or her to be a lesson for such uncouth behaviour. The zero-tolerance rule will apply, and the nurse will pay a hefty penalty after the four-month unpaid suspension is over. Suspending a violent worker will act as a warning to others of similar behaviour. Conclusion The paper has critically addressed my reflection of key experiences as a practising nurse. Using the Gibbs cycle model, I have reflected on my experience case while working as a midwife. Reflection happens when a healthcare practitioner undergoes an experience personally examines it critically and professionally to expose a gap that could have been filled through acting differently. Theorist John Dewey examined the concept of reflection and regarded it as being learning through experience by participation and relevant experimentation. Reflective practice needs a combination of skills to work effectively and produce constructive results. Gibbs Model of reflection comprises six phases collectively called the "Reflective cycle." These phases include; "description, feelings, evaluation, analysis, conclusion and action plan". Gibbs model is straightforward, offers a platform for making a course of action, and is clear. However, the model is not majorly introspective. Reflection gives a chance of evaluating what was done right throughout the experience so that it may be repeated in the future to yield satisfactory results while eliminating the bad. Reflection on Module This module was not only interesting, but it was thought-provoking, having given me a platform to reflect on my experience as a practising nurse. This has been a good experience to 16 open my mind and demonstrate my ability to outline my experience using the Gibbs cycle model. I never cherished nursing experiences as a trendsetter until I encountered this module. Through critical thinking, which is among the secretive tenets of this reflective module, I have learnt of my past weaknesses, which I will eliminate in my practice as I work on bettering my strengths. This module is constructive and educating at the same time through the elements it teaches about critically examining scenarios that have happened in the past and how they influence a nurse's future practice. 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