Leadership Exemplar
This story begins on a calm Thursday evening at around six o’clock. This evening I was given a full patient assignment. Generally, most of my hospital tasks before included taking care of obstetrical patients, surgical, or medical patients. On this particular evening, I was given an opportunity to attend to one of the young ladies I had taken care of the previous day. Her name was Brenda. She delivered a baby the day before through Caesarean because of the absence of the labor process (Blumenfeld-Kosinski, 2019). The child she had delivered was her first baby. I had established a rapport with Brenda the previous day I took care of her. Upon getting into her room, I found many friends and family members who had visited her. Therefore, I introduced myself to the family and friends and asked Brenda if she would be ok if I completed her assessment at that time. She replied that that was the best time to do it. I requested her company to step out of the room for some time to allow me to do the assessment. I commenced by inquiring how Brenda and her child were doing and then proceeded to assess her vital signs. I found that she had stable vital signs. After the vital signs, I started the assessment of head-to-toe. I established that she had a firm fundus located in her midline and umbilicus. Brenda’s vaginal bleeding (lochia) was negligible, red in color, had no foul odor, and no clots were observed. The assessment also revealed a normal urinary output. During the check, I found no bladder distention signs such as a bulge or frequent voiding bladder, bladder discomfort, and excessive lochia (Berhe et al. 2017). Also, there were no signs of fundus displacement. I proceeded to the examination of the lower extremities to check symptoms or signs of thrombophlebitis. Her breasts were symmetrical, ‘non-tender,’ and soft. She denied having any discomfort in the rear of her knees upon dorsiflexion of her foot. She had affirmative bowel sounds. Brenda’s dressing at the abdomen was also intact and dry. As I was carrying out all these assessments, I informed Brenda step by step what I was doing and the significance of doing those assessments. I initiated the standard cesarean care plan before, which I constantly followed as I took care of Brenda. The assessment went on well, and I never sported any severe health problem with the patient.
On finishing the assessment, I realized that Brenda was not as happy and energetic as she was the previous evening I was with her. I inquired from her to know how her recovery session was going; unfortunately, she started weeping. I asked Brenda if she was experiencing any pain in the body; she replied that she had no pain but instead ‘soreness’ in the area of her incision. I was not satisfied with the answer she gave me and inquired to know more. I, therefore, requested her to be free and talk about what she was feeling. She stopped weeping, collected herself, and gave me the story of the issue tormenting her.
Brenda began: ‘My day has been so horrible.’ I sat on her bedside when I realized her tears were starting to roll down her cheeks once again. ‘Everyone who visited me today took a photo with my child, but no one, not even one bothered to have a picture with me. None was willing to take a snapshot with me because of the bad condition I was in and how dreadful my body appearance looked. You know I am a specialized dancer. I suppose not to have such body shape and appearance.’
I offered emotional support to my patient by actively listening to her sentiments, employing silence where needed, and asking open-ended questions where necessary. I demystified to Brenda that her concern and feeling were indeed real, and it happens in real-life situations. I told her that the first step to relieve herself of such stress is to talk about how and what she feels. I enlightened her that during the period of postpartum hormonal response can always instigate and increase particular feelings (Sundström et al. 2017). I reminded her that she must also be concerned about reverting to her normal situation. I also informed her that the continued concern and endurance she will put into practice would see her weight go down hence regaining her prowess and abilities in dancing.
She also said, ‘I don’t believe it was rational for me to undergo Caesarean because this was nowhere in my mind.’ I gave her time to express her concerns by being patient and by means of open body language. I supported her concern by authenticating the feelings she voiced. I then elucidated to her the reason why C-section was performed on her and its importance. I also let her know the fantastic task she had achieved since she got her surgical procedure. The outstanding jobs I put to her attention included putting into practice all the educational opportunities we offered her, undertaking the set of breathing exercises, and taking early ambulation. I commended her for being physically inclined to enhance her recovery process. Furthermore, I requested her obstetrician to have a discourse with her about her capability of returning to her previous routine, which she admires.
I notified her that since she had begun breastfeeding, she would heal faster and get back to her normal weight because that is one of the best things to do in her cases like hers (Sundström et al. 2017). She also raised concerns regarding her companion not finding her sexually striking. I weighed on this concern by encouraging her to find time in the evening and discuss with his husband to let him know she is feeling.
The following evening Brenda reserved for me the following statement, ‘Let me take this opportunity to thank you for the advice you voiced to me yesterday. Doctor Alejo talked to me and made me feel better about my condition. Most importantly, last night I had a lengthy talk with my partner. I clarified to my husband I had a nervous breakdown on him. I felt so much better after you enlightened me and gave me the courage to go set time and talk to my husband. Thank you once again.’ I week later, I received a letter from Brenda and her husband with an attachment of the picture of their lovely baby. In the letter, they thanked and appreciated my co-workers and me for the fantastic service and stay.
Looking back over this experience, I had to balance my role as a charge nurse. Even though there were also many events that I needed to attend during the shift, the leadership abilities I harbor helped me accomplish the needs of Brenda, a patient who was noticeably in distraught.
I held the standard of ANA Code of Ethics with Interpretive Statements in the nursing practice leadership exemplar in the following ways. In the scenario when the patient’s interest conflicted with the healthcare professional’s actions, I used provision 2 sub section 2.1 of ANA codes of ethics dealing with conflict of interest (Winland-Brown, Lachman & Swanson, 2015). The provision states that nurses need to solve the conflict to ensure patient safety and interests when disputes arise. For example, when the patient complained about C-section, I validated her feelings to meet her interest and informed her why she needed C-section and its importance. This put sense in her making her accept the decision taken by the health professional. I also employed provision 6, sub-section 6.1 about the environment and moral virtue and value of the ANA Code of Ethics (American Nurses Association, 2014). For example, when the patient felt neglected by the people who visited her, she thought it was her shape and changed appearance that made them not take pictures with her. I used moral value and virtue attributes such as patience, honesty, wisdom, and compassion to convince the patient. I used these attributes to clarify to her that it might be the postpartum hormonal response driving her feelings and thoughts because it was out of love that her friends saw it prudent to come and visit her in the hospital. I also observed the standards of the ANA Code of Ethics by using provision 2 of the standards, which advocates for primary commitment are to the patient (Winland-Brown, Lachman & Swanson, 2015). For example, I dedicated most of my time to this Brenda to help her alongside other duties I had during the shift. One of the projected variations in my future practice is the involvement of couples during postpartum patient counseling. The implication is to make the husband understand the situation of the wife. The action and changes I might make in my future practice as a nurse leader pertaining to the analysis are that I would invite the husband to the patient who has just delivered for joint counseling. I would let the patient and his husband understand what postpartum feelings are and how they should handle each other in case they arise.