Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.
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This chapter explores how three successful nursing leaders, using different leadership approaches, demonstrate traditional leadership attributes such as strategic vision; risk-taking and creativity; interpersonal and communication effectiveness; and inspiring and leading change. It discusses the opportunities and implications for nursing leaders and those external to the profession to develop collaborative and transformative partnerships to advance quality health care. Pragmatic leaders demonstrate leadership excellence by effectively translating their nursing care assessment skills into the ability to approach organizational problem solving and decision making in a systematic, logical manner. In contrast to the present-needs focus of pragmatic leaders, charismatic leaders are vision-based leaders who predicate their leadership agenda on attaining future goals. Each of the three nursing leaders profiled understands the importance of being politically astute and effectively leveraging power and influence to make value-added contributions. To varying degrees, the various constituents of the nursing leaders profiled view them as socialized leaders.
In order to function effectively, clinicians need to have both confidence in their professional judgment and belief in their clinical competence. The overconfident clinician who ignores opposing evidence or overlooks additional information runs considerable risk of not only making mistakes but alienating patients and families. Hubris is a major source of mistakes within health care. It is this hubris that also accounts for much of the downstream impact of medical mistakes. Patient-provider relationships are especially harmed when clinician hubris inevitably proves unwarranted, the diagnostic conclusions are erroneous, and/or mistakes occur. Mindfulness allows for self-correction, a recalibrating of one’s compassion capacity and an energy re-orientation away from ineffective self-enhancement and a refocus on patient treatment. However, when mistakes do happen, apologies are necessary. Apologies are best when they are sincere and delivered with humility and understanding.
The author, Arthur G. Cosby speaks about his mother, Lillie Mae Mclntire Cosby; a nurse who led him to understand what constitutes leadership, his responsibilities to others, and the role of women in the modern world. In his mother’s mind, discipline was a critical aspect of good health care. As head nurse, she supervised large number of junior nurses, aids and orderlies, many of whom had limited formal health care training. It was very important to him that he had a mother who could do so many things and do them well. Not only was she a mother and nurturer, she was also a woman who was the breadwinner, who could successfully carry out most any job even the most difficult. Over the course of her career, she actively carried out the health care responsibilities of head nurse, hospital administrator, emergency room nurse, obstetrics nurse, public health nurse and nurse practitioner.
Nurse leaders should be poised for change. One of the common themes across entries was that nurses are central to the changes occurring in health care and that they should seize the opportunities to be in charge of the redesign of the U.S. health care system. There was another strong theme that permeated the entries: that of the knowledge necessary for nurse leaders in health care delivery. To assume leadership roles in a new delivery system, nurse leaders are advised to understand policy and finance and the roles of all team members. Furthermore, leadership must be about the organizational goals, not one’s individual goals. Self-knowledge is essential, including the understanding of how you are reflected in the eyes of others. A high level of self-confidence is essential for leadership. Other important developmental needs for nurse leaders include quantitative skills and technological expertise, including electronic and digital forms of communication.
Steven A. Wartman, the author, provides key advice for potential and aspiring nurse leaders. He advises to let go of the guild mentality, particularly important for nurses who aspire to leadership positions that transcend nursing. Nurse’s perspectives are invaluable in bridging the gap between the technical experience of health care and its meaning in the lives of patients and their families. Nurse leaders are advised to become transformational rather than transactional leaders, and to move beyond the rewards and punishments inherent in transactional leadership styles. Transformational leadership is especially challenging, given the traditional hierarchies in the medical fields and academia. To provide the most effective and “transformational” leadership, potential nurse leaders should focus their efforts on four areas: eliminate the “guild mentality”; change restrictive policies and regulations that weaken the role of nursing; seek to become a “transformational” leader; and learn to take the ego out of the job.
Disgust may seem like an odd topic to highlight in a book dedicated to enhancing patient-provider relationships, but it bears special consideration given that it is rarely openly discussed even though it is a common phenomenon. In the course of the authors’ work, clinicians are exposed to patients’ most basic human products: urine, feces, pus, blood, and vomit, to name a few. The authors encounter smells, see anatomical parts, hear bodily sounds, and touch things that people outside of health care can only imagine. Some of these things are very difficult to experience, and yet doing so is not only part of the job, but doing so graciously, with acceptance and sensitivity, is a gesture of compassion. Being in a state of mind to make that compassion happen is aided by mindfulness. This chapter provides an example of a forty five year-old woman with end-stage pancreatic cancer.
This chapter focuses on partnerships between low- and middle-income countries (LMICs) and higher income countries (HICs). It presents information about three types of international partnerships. The first type is partnerships that focus on academic education, prelicensure as well as advanced degree programs. The second type is partnerships that focus on advances in professional nursing, which provide professional development for nurse leaders and clinicians in specific settings and capacity-building measures for the profession in the host country. The third type is partnerships that provide direct clinical care or improve a specific aspect of health care in a developing country. The chapter addresses the host partner factors and presents a case study that reports on the educational partnership between the Alice Ramez Chagoury School of Nursing (ARCSON), the Lebanese American University (LAU), and the University of New Mexico College of Nursing (UNMCON).
This chapter addresses several common ethical–communication–related scenarios: provider autonomy, truth telling, confidentiality, informed consent, health care economics, and quality of life/death. From an ethical perspective providers must decide how much information to share with patients, what role the provider intends to play in the decision making, and how or how much to include the patient in his or her illness/injury/wellness care plan. Providers need to remember that although their education and expertise clearly offers them unique insights into patient’s health care/wellness issues–providers are not the sole arbiters of health care decision making. It is impossible to expect patients to make empowered, collaborative decisions if they are not given complete and unbiased information with which to make their judgments. The role of ethical communication in clinical practice is critical to informed and collaborative decision making, but also to enhancing provider–patient interpersonal relationships and trust.
This chapter presents an interaction between the provider and the patient’s employer. Health Insurance Portability and Accountability Act (HIPAA) laws prevent the provider from discussing the patient’s condition with the employer. The interpersonal communication in this interaction impacts the relationship between the occupational medicine clinic and the employer. Government regulations for worker’s compensation cases impact the provider-patient relationship. Providers must know the rules and regulations related to their roles and the care of their patients. Worker’s compensation and occupational medicine are different co-cultures from traditional provider-patient relationships. In worker’s compensation cases, providers must communicate with the patient, the employer, and the worker’s compensation insurance company. Providers in this co-culture must recognize the differing values and goals from other areas of health care. Unique goal of this co-culture is to meet the employer’s expectations in order to maintain their business affiliation.