With the continuous development of medical model, modern medicine has made higher demands on nursing work. How to effectively improve the patient's nursing effect and improve patient satisfaction, has become one of the key concerns of the nursing staff. Nursing leadership embodies the value of nursing as a professional value and autonomy of [1], is more and more applied to improve the effect of nursing care in the problem. In this article, we reviewed the current situation of the application of nursing leadership in patient care, and to provide the basis for promoting the development of nursing leadership in China.
1 overview of nursing leadership
Since 1960s, the study of leadership has been widely concerned by scholars. Leadership is the ability to lead, while still the leader's appeal and influence and the interaction between the leader and the force, leadership can determine the leadership behavior, to ensure the smooth operation of the leadership process, and ultimately to achieve organizational goals [2]. due to the purpose of research and environmental differences, leadership is also defined as a behavior [3-4], process [5-6] or method [7].
At present, the research of leadership has been widely used in the field of nursing. Foreign scholars have suggested that nursing leadership is a dialectical relationship among nursing staff's personal characteristics (personality traits, self cognition, career goals) and the creation of work environment (target promotion, trust, communication participation). The leadership is the ability to develop organizational members, that is, nursing managers should take care of patients in the first [9], the leadership of general nursing staff is the ability to promote professional development and self implementation of the [10], that is, the practice of routine care in the independent leadership behavior. In China, some scholars have defined nursing leadership as nursing staff (including nursing students, nurses and nursing managers) to use their leadership knowledge, skills and attitudes to influence other people in the organization (service object, colleagues or subordinates) attitude, emotion, belief, etc., to achieve organizational goals and behavior, to achieve organizational goals, and not only the care management or leadership needs to care leadership, nursing leadership should also be reflected in the routine nursing activities, but due to the work of the focus of the application will be different.
For the leadership of the measurement, measurement tool developed by foreign scholars has as many as a dozen. Among them, most commonly used measuring tool is bass and Avolio compiled by the multifactor Leadership Questionnaire (MLQ), and Kouzes and Posner prepared leadership practice questionnaire (LPI). American scholars laschinger compilation management practice scale (MAS) is a commonly used tool for evaluation of nursing management leadership, Yang Jinhua domestic scholars such as [12] will be finished form Chinese version of MAS, and measured its high reliability and validity, for evaluation of nursing management in China. At the same time, in the latest research, the scholars Wang Weili and other [13] prepared by the nursing management leadership questionnaire, including 29 projects, 7 factors: innovation ability, appeal, determination, affinity, coordination ability, control ability, and the ability to motivate, after testing found that it has better stability and reliability. Summary of current measurement tools found that leadership style, leadership style, leadership behavior, leadership skills and leadership practices, researchers can choose the appropriate measurement tools based on different research purposes.
2 the application of nursing leadership in patient care
The mechanism of the effect of nursing leadership on the patient care, has been at the exploratory stage. In 1960s, Donabedian[14] proposed the nursing leadership structure - process - effect (SPO) framework, the nursing leadership as a "structure" factor, through the work environment of innovation, employee motivation, team cooperation and nursing procedures, such as "process" factors, such as mortality, patient safety, comfort, complications, etc.. The process effect (SPO) framework is presented, which shows that the effect of nursing leadership can be changed by the influence of the intermediary variables.
2.1 the application of nursing leadership in reducing the mortality of patients
[15] and other Cummings to 90 emergency hospital care leadership is divided into 5 types: high harmony, moderate harmony, mixed type, moderate disharmony, and high degree of disharmony, for the detection of nursing leadership type and 21570 emergency patients within 30 days of hospital patients with low mortality, the reason may be harmonious nursing leadership can promote management skills, communication skills, resource sharing and evaluation index of efficient use; and in a harmonious leadership organization, nursing staff is difficult to meet the needs of nursing plan, health education, hospital discharge. In addition, Cummings and other [15] research results also show that the organization has a clear team goals can further reduce the mortality of patients. The nursing leader should be good at applying the harmonious nursing leadership, and the combination of the clear team goal, the greatest degree of reducing the mortality of patients.
In the relationship between the type of nursing leadership and the mortality of patients, Fagerstrom[16] should be considered as the external variables of organizational culture, environmental change and situational factors. Therefore, the premise of achieving harmonious nursing leadership is to create a harmonious organizational culture.
2.2 the application of nursing leadership in patient safety
In Maslow's theory of human needs, safety is the basic need to be the physiological needs. At present, patient safety is a common problem in the field of nursing. The British Royal Society of care, the nurses have the ability to carry out team leadership at all levels, but also called for the extension of the right to command, supervision, and to better care leadership applied to patients with [17]. many scholars in the safety of nursing leadership in the application of the effect were studied. Spence et al. [18] use the work environment, Maslach burnout inventory and adverse event reporting rate, the survey of 8597 nurses in Canada, the results show that nursing leadership in nursing work can play a role in decision-making, staffing, support nursing model and maintenance of health care, can create a good working environment for nursing staff, reduce the incidence of adverse events. Vogus et al conducted a cross-sectional study in 78 of the hospitals in 10 hospitals, and the results showed that the number of nursing organizations with leadership trust was less than the number of medication errors. [20] et al. 15 nurses and 82 nurses were investigated by using the hybrid method in 1 hospitals of England, and nurses were evaluated. In view of the nurses, the supervisor and recognition behavior can reduce the accident injury. In short, it is effective to monitor and identify, innovate, and trust behavior to ensure patient safety, and it is effective to apply nursing leadership.
2.3 nursing leadership in increasing patient comfort
The most severe form of patient comfort is pain. Because of the limitations of medicine, pain and can not be completely eliminated, but the nursing leadership can change the psychological perception of pain, change the living habits, improve comfort [21].Dysvik and other [22] with qualitative research methods analysis of nursing group leadership for 13 groups of chronic pain patients, compared to the ordinary nursing model, after 8 weeks of nursing group leadership, patients can obviously feel the degree of chronic pain, improve the quality of life. Choi et al. Findings from a [23] survey showed that nursing leadership combined with evidence-based nursing can significantly improve the compliance of patients with cancer: the use of pain assessment tools increased from 22% to 75%, receiving health education rate from 0 to 47%.
Farber[24] survey found that strict nursing leadership can lead to reduce the delay in information, timely response to the patient's needs, increase patient comfort. In addition, Wong et al [11] research indicates that most can enhance the comfort degree of patients with nursing leadership types is transformational leadership and leadership. Transformational leadership can stimulate or high levels of extension staff need [25], the relational leadership can for the nursing staff to provide psychological support [26] and promote the nursing staff to improve the patients' comfort degree as the value of nursing work reflected.
The research results show that nursing leadership can enhance the comfort degree of patients, of which type of optimal is transformational nursing leadership and relational nursing leadership. In addition, according to the evidence based on the implementation of nursing leadership, can effectively improve the patient's treatment compliance.
2.4 nursing leadership in the prevention of complications in patients
Nursing leadership in the prevention of complications in patients with the application of infection control. McCreery[27] believes that the organization's internal emphasis on infection control methods (such as hand washing, aseptic technology, etc.), depending on the organization's leader to treat infection control concept; in addition, nursing leadership is not only present in executive positions or management positions, but to show in the routine nursing care, if the nursing staff is not aware of their leadership role, to control the enthusiasm will be reduced. In the last 7 years, the most recent 1000 years, the most recent 7.7% years, catheter related bloodstream infection control effect: the most recent years, the most recent years, catheter related bloodstream infection control effect: the most recent 100 years, the catheter related bloodstream infection control effect, the average blood flow rate of 16 was reduced from 2.7% to 3, followed by 0. To sum up the experience of the research, to play the leading ability of nursing staff can effectively control the incidence of patients with infection, in addition, the concept of evidence-based and innovative ideas to improve the effectiveness of nursing leadership infection control.
2.5 the application of nursing leadership in self management of patients with chronic diseases
Long term care model of chronic disease has received attention from many countries in the [30], the study is a relatively wide range of chronic diseases, diabetes and cardiovascular disease. Among them, the nursing staff to play the form of nursing leadership mainly for the use of education conference, e-mail and remote calls, etc., to lead the long-term care of patients with chronic diseases.
Diabetes self-management program is a structured education program that is performed by trained nursing staff to lead the diabetes patients. The number of patients in each group was generally less than 10, and the education of nursing staff was varied from 6 months to several years. Nursing staff were mainly in the form of educational conference. The patients underwent [31] analysis. The results showed that, compared with common nursing model, the average increase of 0.342mg/dL in patients with high density lipoprotein (1.227mg/dL), and the risk of cerebral vascular disease in patients with diabetes mellitus ([31].Tshiananga). In addition, Shigaki and other [32] for 2 patients with type 13 diabetes, half structure interview, patients think that the leadership behavior of nursing staff participation in decision-making, self provided health information is consistent with expectations, nursing leadership can ensure that patients with diabetes adhere to healthy living habits, improve the compliance of treatment.
The advantage of nursing leadership in long-term care is also reflected in the care of cardiovascular disease. Cicolini et al. A randomized controlled trial of 198 patients with high blood pressure ([33]) received routine cardiovascular prevention and education programs, and 100 patients in the experimental group received a reminder program (NRP-e). The contents of the message by the nursing staff, mainly include:
The test results showed that the risk behaviors and habits of the experimental group were significantly better than those in control group. The risk behaviors and habits of the experimental group were significantly better than those in the control group. The risk behaviors and habits of the experimental group were significantly better than those in the control group. The average body weight decreased by 16%, the total cholesterol was decreased by 56%, the total cholesterol was decreased by 40%. The blood pressure decreased by 61%..
With the development of science and technology, the application form of nursing leadership is becoming more and more diverse. For patients who are far away from the hospital, a remote training program is also available. The remote training program (Hartcoach-programme) [34] is a two level preventive plan for the care of patients with cardiovascular disease by telephone. The plan is to lead the implementation of the nursing staff. Call content is mainly about the patient's treatment compliance, the related behavior change and the long-term condition improvement; after that, the patient can receive a hand written letter, recorded the important suggestion and the content summary. The remote training program for each 4~ 6 weeks, until the completion of the risk factor control objectives, generally 6 months.
Leemrijse [34] to 400 cardiovascular disease patients were randomized controlled trials, 200 cases in each group; experimental group except received the routine nursing care, also accepted nursing personnel organization and leadership of remote training program; the results of the present study has not been reported, but the researchers predict, in remote training plan, nursing staff can for discharged patients self management of family education and professional support and application of nursing leadership to the concrete measures of family nursing, bridge the gap between theory and practice.
In short, the application of nursing leadership in the long-term care of patients with diabetes and cardiovascular disease, reflecting the diversity of application form and obvious improvement effect. The combination of nursing leadership and new technology can be applied to other chronic diseases, and to improve the long-term nursing level.
3 inspiration
3.1 clear the role of nursing leadership mechanism, improve the application effect of nursing leadership
Nursing leadership as independent variable can affect the patient's nursing effect by many kinds of intermediary variables (patient mortality, patient safety, comfort, complications, etc.). Among them, the factors that may play a mediating variable are environmental innovation, employee motivation, team cooperation, nursing model [14], management skills, resource sharing [18] and personnel allocation [15], etc., the psychological cognition of patients, living habits [21], etc.. In addition, [16], organizational culture and situational factors [15] can also be used as an external factor to influence the application effect of nursing leadership, so the specific application of nursing leadership should also pay attention to the guiding role of external variables. In short, the effect of nursing leadership on the role of nursing care for patients, can provide a theoretical basis for the rational application of nursing care.
3.2 strengthening the application of nursing leadership
Foreign research has been more in-depth to clarify the application effect of nursing leadership, influence factors and scientific performance form, and achieved remarkable results in promoting the effect of patients with care. However, there are many kinds of clinical diseases, the difference of nursing measures in different diseases is different, which also provides the development space for the application of nursing leadership in different wards. At present, the domestic research mainly focused on the training or improvement of nursing leadership, and the research on the application of nursing leadership is less. Jiang Chaomei et al. [35] to explore the establishment of the leading group of ICU care can reduce the incidence of adverse events and complications (P<0.01 or P<0.05). However, the effect of the application of nursing leadership in the specific disease care is not innovative. According to the status quo of the application of foreign nursing leadership, nursing care in China should explore the nursing leadership style and the performance form, improve the nursing effect of patients.
3.3 to improve the nursing work environment, to ensure the implementation of nursing leadership
Nursing leadership can promote the patient's nursing effect, improve patient satisfaction. Especially the creativity of transformational leadership and follow the concept of philosophy proposed, the application of nursing leadership have more scientific and reasonable direction. However, the application of domestic nursing leadership does not highlight the professional value of nursing staff. The main reason is that the workload of nursing staff, lack of awareness and lack of external support. In order to better improve the prognosis of patients, improve the nurse patient relationship, the nursing industry should increase the external support, expand the number of nurses, reduce the pressure of work environment and more in-depth show the nature of nursing, nursing staff can have time and interest to show their leadership. In addition, in the new nurse recruitment, the recruitment department should pay attention to the leadership of the potential candidates, as a future leader in nursing staff.
Reference test
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