7HSK0280 – LEADING & MANAGING NURSING CARE FOR

ADULTS:

SUMMATIVE ASSESSMENT – MAY 2023

 TABLE OF CONTENTS

1.0 Introduction....................................................................................................................................1
2.0 Reflective Essay 1.............................................................................................................................1
2.1 Description..................................................................................................................................1
2.2 Thoughts and Feelings................................................................................................................2
2.3 Evaluation...................................................................................................................................2
2.4 Analysis.......................................................................................................................................3
2.5 Conclusion..................................................................................................................................3
2.6 Action Plan..................................................................................................................................3
3.0 Reflective Essay 2.............................................................................................................................4
3.1 Description..................................................................................................................................4
3.2 Thoughts and Feelings................................................................................................................4
3.3 Evaluation...................................................................................................................................5
3.4 Analysis........................................................................................................................................5
3.5 Conclusion...................................................................................................................................6
3.6 Action Plan...................................................................................................................................6
4.0 Reflective Essay 3.............................................................................................................................6
4.1 Experience..................................................................................................................................6
4.2 Reflection....................................................................................................................................7
4.3 Action..........................................................................................................................................8
5.0 Conclusion......................................................................................................................................9
REFERENCES........................................................................................................................................15

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1.0 Introduction
This paper consists of three reflective narratives concerning experiences which occurred
during my professional placement. Two reflective models twill be employed for the
narratives under consideration; namely, the Gibbs Reflective Cycle by Gibbs (1988) and the
ERA Cycle by Jasper (2013). The Gibbs Reflective Cycle has been selected due to the fact
that it enables nurses to analyze their experiences in an in-depth manner and also to
determine how to improve their practice in the future (Bolton & Delderfield, 2018). In
addition, the ERA Cycle was selected due to the fact that it seemed to the most suitable for
the third reflective narrative based on the requirements and the information that the model
generates. In other words, it focuses directly on the experience and the actions that one will
take to better themselves and / or others (Tanguay, Hanratty & Martin, 2020).
This cycle has been known to involve six steps or stages; namely, (1) a description of the
experience under consideration; (2) relevant feelings and thoughts about the experience; (3)
an evaluation of both the good and bad aspects of the experience; (4) an analysis of the
overall meaning of the situation; (5) a conclusion about what was learned and what could
have been done differently; and (6) an action plan pertaining to how I would deal with similar
situations in the future (Gibbs, 1988).
In line with the ethical consideration of respect for confidentiality, the names of patients,
staff, either of their relatives, and organizations will be withheld from this paper. This is in
accordance with the Nursery and Midwifery Council (NMC) Code of Conduct
(https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf).
2.0 Reflective Essay 1
2.1 Description
The concept of emotional intelligence refers to the ability of an individual to perceive, control
and evaluation one’s emotions as well as the emotions of others. Someone who is
emotionally intelligence can think rationally and objectively about their emotions instead of
just acting out on them (Coon, Mitterer & Martini, 2021). Raghubir (2018) indicated that
emotional intelligence allows for those involved in the nursing profession to make better
decisions, more effectively manage their patients, improve their relationships, and positively
impact the quality of care provided to patients and families.
The incident in question involved a personal application of emotional intelligence during an
experience with a particular patient. The patient was a 39-year-old patient mother who was
coming in for a surgery (an ovarian cyst removal) that day, but was distraught due to having
had a hostile domestic issue with her husband the previous day which I had heard through my
colleagues. Understanding the difficulty in disconnecting oneself from two emotional
situations, I made an attempt to at least address what I had perceived to be the most
distressing one to her without crossing the boundaries of respect for patient privacy.
With this in mind, I started by rather innocently mentioning how my parents would be
celebrating their 35th anniversary the following month. I even went as far as to show her
some personal family pictures with them. As she become more and more engaged with the
conversation and began to ask questions, I interjected and even exaggerated by briefly
mentioning some of the serious challenges that I had witnessed them go through and even

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mentioned that despite the fact that I was sometimes even scared about what would happen
while observing them, they ultimately managed to pull through. As I narrated this, I began to
sense some sort of positive, “light at the end of the tunnel” look on her face. Following this, I
saw a drastic positive change in her level of relaxation which even made it easier to sedate
her.
2.2 Thoughts and Feelings
At first, when I came to an understanding of what was taking place, I was overcome with a
sense of worry for the woman. This was because I was able to connect with her feelings and
knew in my heart how distressing it would be to undergo a surgery with such emotional
baggage if I were in her position. Furthermore, based upon the knowledge that I already had
about surgery, I knew by all means that the woman was already under a considerable amount
of stress based on the observations of researchers such as Hawn (2022) that it is normal for
people who are to undergo surgery to feel anxious even if the operation can restore their
health or save their life. The next logical thought in my head was that it would be both
beneficial to her and to my development of empathy as part of my “toolbox” of nursing skills
if I was able to connect with her emotionally and help her to resolve her issue; even if only
temporarily. In fact, Perry et al. (2021) highlighted empathy as a skill that leads to better
patient outcomes and that if without, it can negatively affect patient care and treatment,
potentially leaving a patient feeling frustrated, neglected and / or confused.
On the other hand, after the experience was over, I experienced an overwhelming sense of
relief being glad I had taken the risk of talking to a patient about personal issues which could
have easily been taken offensively if it had not been implemented properly. With that, I also
began to think that I would have to upgrade my skills regarding empathy and emotional
intelligence to be able to distinguish myself in my profession.
2.3 Evaluation
Critically evaluating the situation under consideration, it can be said that being passive
initially did not have any positive effect on the patient’s situation. At first, this was my plan
of action based on the observation that was affirmed by Rosdahl (2021) that the majority of
people approve of the “nice nurse” because she does not threaten people’s aggression system
by confronting them. However, as I continued to study the body language, facial expressions,
and the energy that was being exuded by the patient, I could clearly see that she was agitated
and that there was therefore a need to execute some sort of intervention.
Taylor, Lynn and Bartlett (2022) posited that being assertive is more effective in such
situations as it can be used to establish a trusting interpersonal relationship with patients
which enables nurses to make suggestions, communicate openly with patients, and be
assertive in their care. Likewise, in this particular situation, it appears as if being assertive
enabled me and the patient to form a temporary bond which, in turn, allowed me to make
subtle suggestions to the patient and for her to imbibe those suggestions in a positive manner.
However, the manner in which I was assertive was an indirect approach in which I did not go
straight to the point to inquire about the patient’s problems, but rather assumed to know the
problem and, as such, addressed it in an indirect manner. I firmly believe that having
addressed the matter in any other way would have caused some form of confrontation which
would have exacerbated the situation and caused some sort of patient-nurse conflict.

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2.4 Analysis
In the final analysis, I do firmly believe that the attempt that I had made at talking to the
woman turned out being successful due to her degree of vulnerability at the time. This is in
harmony with Aguinis’ (2023) school of thought that many successful efforts in life come as
a result of good timing. From my own personal experience, I have been able to realize that
most often, the majority of people experience of feeling of wanting to talk to someone during
a tough phase in their lives. However, many people do not have a person that is willing to
listen or who is unobstructed enough to hear their thoughts and troubles in an effort to assist
in being part of the solution. There are even cases in which people might profess love and
loyalty for a person, but yet are not ready to make time for them when they want to be heard.
My guess is that up to that point, the woman did not have anybody who was willing to
demonstrate a sincere interest in what she was going through, and thus this was what made
her be willing to readily accept my emotional gesture or “olive branch.” With this in mind, it
opened up the possibility that if it had been under any other circumstance, things could have
gone bad.
2.5 Conclusion
In light of aforementioned, I think it would be worthwhile to both my personal life and my
career to develop my emotional intelligence skills and, with that, my faculty of intuition. In
fact, I have realized that emotional intelligence often relies, in part, on intuition even though
intuition is a more general tool (Craemer, 2020).
Nevertheless, I believe that the development of these skills or assets should not only be
within the realm of nursing, but also during the course of everyday life. The reason for this
focus on emotional intelligence and intuition is because although the faculty of ‘reason’ is
indeed beneficial, I have been able to observed that it does in fact have its limitations when it
comes to interacting with people one-on=one; more specifically, when communicating with
them. This is even supported by research which has uncovered that emotions compel
decisions more so than logic does, and therefore, it is better to use emotions when trying to
change people’s minds (Acker, 2021; Craemer, 2020; Goleman, 2019). However, it should
not be misinterpreted that logic is of no significance since, after all, it provides the foundation
for making ideas stock together in the person’s mind after the emotional “high” has
“evaporated.”
Notwithstanding, during the process of learning, I feel that it would be to my own benefit to
not only learn from my own experiences, but also the experiences of others. This would
involve reading many books as well as listening to the personal testimonies of others who
have been able to master the application of intuition and emotional intelligence.
2.6 Action Plan
In order to adequately prepare for a similar situation in the future, I plan on reading at least
one book a week and 5 online articles where it pertains to how to properly carry out
emotional intelligence. Likewise, every week, at least 5 different testimonies (whether it be
online or offline) of individuals’ positive experiences with carrying out emotional

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intelligence will be read. In so doing, I will take note of what was done properly and what
was done improperly, while trying to arrive at a set of critical success factors for emotional
intelligence.
Lastly, I plan on having at least three encounters with people in which I utilize emotional
intelligence tactics. During these incidents, I will take notes on what went well and what
didn’t go well as well as the perceived reasons why.
3.0 Reflective Essay 2
3.1 Description
A critical incident was defined by Faggiano, McNall and Gillespie (2011) as “a threat to the
operation, safety or reputation of an organization with an element of surprise and
unpredictability, necessitating rapid and effective decision-making.” Through the placement,
I was able to observe how the management of critical incidents requires effective
communication, tactical response, mutual aid, training and rules of engagement in line with
the views of Blokdyk (2018).
The critical incident which took place involved a doctor not listening to me (the nurse) when
I had indicated to him directly through my own intuition that the patient was in a critical
condition. The patient had been brought into the hospital after having experienced a seizure
at home. I then proceeded to assess the patient and listen to his lungs. Based on the results, I
felt the need to conduct a lab report, a chest X-ray and a D-dimer test. Since everything had
to be ordered by the physician, I had to present this case to him before anything could be
done. Unfortunately, he did not feel as if there was a need for any of the above measures.
After having worked on the seizure, the physician was ready to discharge the patient when I
had realized that the patient’s O 2 requirement had increased and he had developed
haemoptysis in which he was coughing up blood. The physician finally realized that there
was a need for a D-dimer test and therefore he ordered one to be done. The test revealed that
the level of D-dimer was excessively high. The physician then ordered a contrasted CT scan
of the patient’s chest. Following this, there was an emergency call from the resident
radiologist in which there was a confusion about the patient’s health status.
I raced the patient back to the ER Department, pulled up the images on the screen in the
DocBox, and showed the physician. It was then that we realized that the patient was suffering
from fungal pneumonia. The patient then fell back into a seizure. It was then that the patient
was given medications in order for a breathing tube to be successfully inserted. However, the
patients stats begin to plummet despite the use of Ativan, anti-seizure medications, and a non-
breather oxygen mask. After much trial and error, I begin to panic and yell at the secretary to
call the anesthesiologist. When she arrives, she gets the patient intubated and his sats are
coming back up with the forced high concentration again, and everyone breathes a sigh of
relief. The physician was then able to transfer the patient to a higher acuity hospital.
3.2 Thoughts and Feelings
During the earlier part of the experience, I could not comprehend exactly why the physician
chose to outright ignore my observations and requests. With that I can honestly say that
being ignored was a very embarrassing and frustrating experience. In fact, initially, I was

4
blaming myself for what had occurred which could most likely be equated with a form of
insecurity.
However, after the experience had transpired, I began to realize that the problem in question
had not come from me, but rather from the physician in terms of his inadequacy as a superior.
In fact, according to Mathis et al. (2016), a good boss always keeps an open mind regardless
of the demeanor of the employee. This is exactly what he did not do which now
demonstrates to me his limitations in being able to work with others in a very complicated
and fast-paced environment. Valentine et al. (2019) even went as far as to assert that any
boss who avoids his or her employee is either a narcissist or is not performing a main priority
of his or her job.
3.3 Evaluation
As in the first reflection, with this reflection, it is also relevant to make a distinction between
the state of being passive and being assertive in the nursing profession. With that being said,
I was able to realize during the incident that being passive and submissive failed to get my
superior to take my suggestions seriously. It was rather the case that I was ignored and my
input was discounted. In the final analysis, I now feel that the physician took my being
passive as being timid and, as such, as a form of weakness. Moreover, that even though this
is not the case with all people, he was in fact one of those individuals who perceived
submission as a form of weakness. Northouse (2021), on the other hand, clarified the matter
by stating that some people misinterpret submission as a form of weakness, even though it is
rather a form of peaceful acceptance.
In light of the aforementioned, I now believe that the physician would have taken me more
seriously if I had been assertive in a respectful manner; in other words, being assertive
without being overly aggressive. To support this, I recall having observed him respect the
opinions of certain employees in our department and other adjoining departments who were
rather aggressive in their approach. According to Ohno (1988), respect from others within a
workplace or other environment comes from one standing up for themselves instead of being
walked on.
Nevertheless, unfortunately, what eventually worked in this situation was leaving the
physician to come to his own conclusion about what was the proper procedure to undertake.
The unfortunate aspect, however, was the fact that it could have potentially cost the patient
his life.
3.4 Analysis
Making sense of the situation, this incident sheds light on the necessity in acknowledging that
those in the clinical profession are not infallible and they do in fact make mistakes. Based
on my experience, people are generally in the habit of putting a great amount of trust in
doctors and are highly disappointed when they fail. However, this should not be the case.
People should rather anticipate their occasional failure mainly due to the unavoidable
existence of human error. In other words, people should embrace the simple fact that not all
error arises from careless mistakes, but that it can also arise from the lack of knowledge or
lack of attention to detail—the root of which can be caused by the lack of training or
education, fatigue, stress and / or distractions, among other things (Emanuel et al., 2011).

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Nonetheless, since there is nothing that can be done to totally eradicate the risk of making
mistakes, it also appears that an important thing is for those in the profession to humbly and
openly admit their mistakes and to not repeat them again. In this particular instance, it
appeared that the physician had lacked humility in both being able to admit his error as well
as in being able to remain open-minded to receive suggestions from his subordinates.

3.5 Conclusion
After having analyzed the situation in its entirety, it can be concluded that the lines of
communication between a superior and his or her subordinate should be strengthened before
such a critical incident (as aforementioned) occurs. This is in order to ensure that when it
does occur, the mutual exchange of information and ideas can lead to the preservation of the
patient’s life. As a matter of fact, according to Faggiano and Gillespie (2005), effective
communication is crucial during critical incident management as it helps to ensure that all
relevant parties are both fully informed and aware of the incident, its status, and the actions
that are being taken and should be taken to resolve the incident.
Another conclusion that is being made is that managers and all superiors must humble
themselves and not feel insecure about receiving suggestions or being corrected as it is
possible for God or a higher power to pass the needed information during any situation
through any person or object. With that being said, it is my opinion that those in the clinical
profession in the U.K. should adopt the management style of the Japanese in the sense that
rather than a strict authoritarian approach to leadership, they employ a much more
collaborative approach (Azar, 2016).
3.6 Action Plan
In the future, when faced with a similar situation in the form of a group setting, before a
critical incident occurs, I will be sure to establish good lines of communication as well as
good rapport between me and the rest of my team members; especially my superiors. This
will be in order to establish a foundation of trust, mutual respect, and good communication
that will be needed during such an event if it happens that fast decisions must be made in a
high-pressure environment. Furthermore, when a critical incident does occur, rather than
being passive, my plan of action is to exude much more assertiveness and self-confidence
based on the observation of researchers that these are the leadership qualities that many
people tend to be receptive to and therefore respect (Johnson & Hackman, 2018; Northouse,
2021). Aside from this, I also plan on reading at least three books every month henceforth on
how to gain influence with other people; especially those within the same workplace.
4.0 Reflective Essay 3
4.1 Experience
Whereas leadership denotes the ability of an individual to influence, motivate and enable
other individuals to contribute toward the success of an organization, management involves
the controlling of a group or a set of entities to achieve a concrete goal (Northouse, 2021).
Essentially, while managers rely on power and control, leaders rely on their ability to
influence and inspire others. Therefore, without the bestowed power and control, managers

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possess very little in terms of influence (Johnson & Hackman, 2018). Nonetheless, both
concepts are very important as leadership is needed to set a company’s vision, goals and
direction and managers are important for actually implementing the tactics as well as
organizing the activities for achieving these (Griffin, 2016; Huber, 2017).
My experience involved my participation in a placement at a hospital whose name will be
withheld for confidentiality purposes. My responsibilities included: (i) treating and taking
care of patients’ needs under the supervision of a clinical nurse; (ii) administering medication
under the supervision of a staff nurse; and (iii) charting and documenting patients’ conditions
and progress. I also engaged in all duties that were provided to parents by a nurse, but under
their supervision. This reflective piece explores my chosen approach to leadership and
management based on my experiences during the placement which did in fact include a
limited number of leadership tasks.
4.2 Reflection
An acceptable descriptive definition of transformational leadership can be provided as a style
of leadership in which a leader works with his or her subordinates to identify a needed
change, create a vision to guide that change through inspiration, and to execute the change in
tandem with committed members of a group thus enhancing the motivation, morale and job
performance of followers (Ebener & Jalsenjak, 2021; Pittino, 2022). The experience under
consideration allowed me to personally observe the manner in which effective
transformational leadership within a healthcare organization has the ability to improve both
the experiences and performances of healthcare workers; and that this, in turn, could benefit
patient’s health outcomes.
As far as experiences are concerned, this includes the inspiration, motivation and morale
components. With respect to inspiration, during the placement, I was able to observe
firsthand the act of healthcare administrators and leaders communicating their organizational
vision to their subordinates so articulately that their subordinates were also able to internalize
it as their own vision and convert that vision their own personal vision. In so doing, I had
also observed that this had given the them a strong sense of purpose as well as high standards
and expectations for achievement.
Regarding motivation, another observation that was made was of employees being stimulated
intellectually through presenting them with the idea of achieving ambitious goals, therefore
encouraging them to be more creative. I has also observed employees being stimulated
emotionally by their leaders appealing to their higher ideals and values. Interestingly enough,
the above observations are in line with Huber’s (2017) assertion that transformational leaders
are able to both inspire and motivate their team members by way of communication.
Concerning morale, I also realized how apart from inspiration and motivation, the
transformational leadership style was able to significantly boost employee morale within the
organization. Unfortunately, I was not able to observe the mechanics with which this had
occurred. Western (2019) indicated that there are four elements of leadership that boost team
morale; namely, (1) idealized influence in which managers act as exemplary role models who
can be trusted and respect, (2) intellectual stimulation which enables employees to propose
different, innovative, or even remarkable ideas, (3) inspirational motivation, and
(4) individualized consideration which enables organizations to create diverse and supportive

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environments for their employees. However, since I was not able to observe this happen
directly, I can therefore not attest to the truth of any of this.
Regarding performance on the other hand, I had the privilege of personally observing how
the transformational leadership style was able to motivate and inspire employees to achieve
the organizational goals within the healthcare organization that I was having my placement.
This was achieved by way of establishing a clear vision of the future state of the organization
and defining the steps that were required to achieve this thereof. Interestingly enough, the
findings of studies that were conducted by Choudhary, Akhtar and Zaheer (2012) and James
and Lahti (2011) demonstrated that an increase in employees inspiration and intrinsic
motivation made them more effective and efficient towards their work performances.
Another important observation that I was able to make was that selflessness of one of the
managers was able to inspire trust and confidence among his department members due to
their belief that they would be supported and protected thereof. In fact, this led to a feeling of
loyalty and gratitude among these same employees. This is in sharp contrast to the
observation that was made by Pynes (2023) that selfishness drives the absence of power-
sharing, benefit-sharing, risk sharing, team inclusivity, profits sharing which eventually leads
to the general outcome of unfulfilled teams, employee attrition, and a dying organization.
4.3 Action
After my exposure to the significant benefits that can be derived through the use of both the
transformational and servant styles of leadership, my preferred style of leadership is a hybrid
of both leadership styles. However, the manner in which I desire to integrate them to
influence and to inspire others is peculiar and will be explained below.
Regarding the transformational style of leadership, the application will involve myself:
(i) engaging in visionary thinking which will involve possessing a clear and compelling
vision for the future and communicating this effectively to others within the organization;
(ii) empowering others by providing them with the autonomy and resources that they need in
order to achieve their goals; (iii) strategic thinking as well as making decisions that align with
the organization’s goals; (iv) utilizing emotional intelligence in order to understand and
manage my emotions and the emotions of others and get the best out of employees;
(v) resilience or being able to handle stress and adapt to change; and (vi) leading by example
which will involve constantly learning and growing and being willing to take on new
challenges. Unfortunately, however, it has been anticipated that there may be a significant
degree of resistance to change among employees with the implementation of such a
revolutionary leadership style that requires one to have the courage to take on the status quo
and to make it better (Northouse, 2021). In fact, based on observations, people have a
tendency to continue to do things the way they have always been done. There are also others
that fear that such a change will expose them in the sense that a greater emphasis on
efficiency and productivity will expose their errors and laziness (Pynes, 2023).
Therefore, aside from carrying out the above transformational leadership tactics, it appears
that it is as equally important to communicate with all of the employees that my goal is to
seek more effective and efficient ways of getting the job done and that no one is being
targeted as new policies and procedures are being implemented. In other words, it must be
presented as an overall improvement to the workplace and success of the organization.

8
Regarding the servant leadership style, I will apply this approach by not expecting to be
served, but rather serving others. In so doing, I will make sure that I serve on many different
levels; give strength empowerment and energy to my subordinates; provide support,
inspiration, coaching, mentoring, and training to my subordinates; give my subordinates the
space to grow; cultivate rather than dictate; know as much as I can about my work, sharing
my knowledge with others and encouraging them to do the same; and loving what I do as
well as the people that I work and interact with. The above principles are in line with those
that were asserted by Western (2019).
Another aspect of my leadership will approach will involve how I will cope with the demands
of leading in busy healthcare environments. Firstly, this will entail embracing uncertainty in
such an environment rather than being overwhelmed by it; changing my mindset from
complexity being a detractor of success to being a contributor of success; locate informal
leaders, network with them, and learn as much as I can about team dynamics and their
leadership styles; and identifying those within the organization who can serve as my
advocates.
5.0 Conclusion
After having critically reflected on the experiences that I had during my placement, I have
only now realized that I failed to take full advantage of the opportunities for improvement
and advancement that were made available to me. However, this should not be interpreted as
an act of self-blame. I was rather ignorant of these opportunities at the time.
Notwithstanding, in the final analysis, it is strongly felt that, among other things, I need to
conduct much more research on emotional intelligence in order to be able to maximize my
skills in this regard and, with that, be able to connect with patients emotionally and also
empathize with them. This will involve consulting literature such as books, online articles,
and online testimonies of individuals. It will also involve tracking my progress achieved in
emotional intelligence.
As a result of the reflections, I also came to the realization that it is necessary for me in the
future to cultivate the habit of developing good relationships, good rapport, and mutual
respect between me and my superiors at work. In addition, to exude more assertiveness and
self-confidence with my superiors without coming off as being disrespectful in order to
possibly be better heard and appreciated by them.
Lastly, the reflections enabled me to arrive at the conclusion that any future leadership role in
the nursing profession that I undertake should be approached with a combination of the
transformational leadership style and the servant leadership style. It is believed that this will
enable me to inspire, motivate and nurture others, boost their morale, serve as an example to
them that they can emulate, and above all, achieve the optimal results that are necessary for
both personal and organizational growth and development.

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