Nursing Literature Review: Clinical Knowledge

Discuss about the Nursing Literature Review.

Introduction

Nursing means to foster or cherish; to treat or handle with care; to train and to preserve. The root of the word research is to quest again or to examine critically. The research builds a body of clinical knowledge which validates improvement in nursing. Researching is important for a leading healthcare professional to improve leadership strategies, improve nursing care, for the health care delivery system, for the patient outcomes and to make health care efficient as well as cost-effective. The understanding spawned through research is crucial to provide a scientific basis for depiction, clarification, estimation and planning. Incorporation of research data into clinical practice is vital for the delivery of superior-quality nursing care. Leadership behaviours of a clinical or nurse manager and administrator have been recognised as essential to support the use of research and evidence-based practice. A leading nurse must use research to provide correct directions, to raise consciousness and knowledge of the team. However, marginal evidence exists that indicate what kinds of interventions aid leaders to positively stimulate research-based care and how research enhances nursing leadership. The aim of this literature review is to describe the use of research evidence that influences the leadership activities of leading clinicians.

Clinical Leadership Theories

Clear ideas about different types of leadership theories of this century is essential to understand how research practice influences the leadership strategies. Some of the most important clinical leadership theories are described below.

• The great man theory: Concepts of leadership started with the great man theory. According to this theory, leaders are born, not made (Northouse, 2015). But in clinical sector effective leaderships is only acquired through discipline, passion, management skills, experience and research practice.
• Behavioural theory: Behavioural theory states that leaders are made but not born. In nursing context, this theory is quite true. This theory analyses what characters and actions make effective leaders. Analysing the behaviour of effective clinical leaders can provide useful information (Northouse, 2015).
• Transformational theory: Transformational leadership is a vital style of leadership where the leaders work together with staff members to diagnose the indispensable modifications, supervision, and stimulation. It also upsurges inspiration, self-reliance, and job role of staffs through an array of systems (Hutchinson & Jackson, 2013). How a clinical leader transforms is also determined by the proportion of research incorporated in the practice course. Research backs up this model. The principles of transformational theory are:
• Joining the intellect of followers and contribution in an assignment and the collective uniqueness of the association
• Becoming a role model for employees in order to embolden them and proliferate their attentiveness in the duty
• Influence the followers to take larger challenges for amplified work competence
• Understanding and accepting the positive talents and limitations of team associates
• Trait theory: Somewhat same as the great man theory, trait theory assumes that leaders are born with specific traits particularly suitable for leadership. Good leaders possess sufficient amounts of these traits. There may be some traits which can make leaders successful.
• Admitting mistakes and errors instead of covering them up
• Staying calm under pressure
• Becoming expert in wide range of sections
• Persuading followers without resorting to forced tactics
• Quitting narrow minded approach

All of these traits can be gained through hard working and integrating research in practice method. Huber (2013), believes that leadership can be taught. To develop risk-management behaviours, self-determination, critical thinking and reflection a leader must adapt evidence-based clinical practice.

• Role theory: Role theory describes how expectations shape behaviour. In an organisation, information about leadership values, training, culture and theories frames expectation and behaviour. Often expectations do not match the behavior and give rise to role conflicts. When a leading nurse struggles to cope with expectations, conflicts can occur until new behavioural patterns are learnt (Huber, 2013 and Northouse, 2015). Integrating research for evidence-based practice can help to modify conflicts and fulfil the expectations.
• Situational leadership theory: According to this leadership principles, a leader should motivate and encourage the followers according to the particular situation. In the ever-changing environment of the healthcare sector, situational leadership can be very effective (Northouse, 2015). A leading nurse must take vital decisions based on what situation demands and available support, evidence and resources.
• Collective leadership: This emerging view of leadership provides a new way of thinking about what leadership is. In this model leadership influences and influenced by several factors like researching, resources, cultural values, health care workforce, patient-staff relationship, organisational objectives, insight and wisdom (Northouse, 2015).

Significance of Research in Clinical Leadership

Clinical research is researches that deliver evidence used to support practising methods. Nursing is an evidence-based practice area which has been evolving since the period of Florence Nightingale to the present time. Modern day nurses also work as researchers in many health care settings (Grove, 2014). According to Goode et al. (2013), some clinical leaders possess the idea that biological and biomedical researches are only piloted by researchers with biology, microbiology, chemistry, biochemistry and genetic qualifications. But involvement in clinical researches can change the perception of those leaders.

Clinical research has remarkable influences on present and future of professional clinical leadership. Research is valuable to the clinical profession and is obligatory for continuing advancement that promotes ideal health care. When nursing and research is combined, optimal clinical care can be provided depending on the newest research discoveries. The evidence found by the research of clinical leader can be circulated to nurses who work directly with the patients to whom the study evidence relates (Mannix, 2013). Trials that has presented to be effective through research, permits leaders to advocate for patients and offer the greatest promising care. The mainstream of nurses and health care staffs who deliver patient care are the consumers of nursing research. Thus, disseminating evidence of gained by the leader's effort and implementing evidence-based nursing practice is important to deliver advanced nursing care (Grove, 2014). Information availed from clinical research experiments has the potential to directly influence the care delivered to patients in every health care scenarios. Clinical research is an emerging and up-surging field in which leaders can apply their clinical knowledge to discover different progressions that encourage evidence-based care. 

Research Sectors that can Facilitate Clinical Leadership

The prime research field is genetics and genomics that can contribute towards effective clinical leadership. Research in this field can make health professional understand health problems caused by genetic elements as well as evaluate the risks of a specific disease in a patient. Genetic testing is a very reliable process for confirming diseases caused by gene elements. When a clinical leader becomes proficient in genetic testing of disorders, it not only enhances leadership techniques, but also the leader can provide advanced care and also direct the followers for better caregiving. Integrating genetic research in clinical leadership also provides enhancement of treatment procedures of health problems caused by genetic aberrations and mutations, either by genetic alteration or medications. Maximum genetic diseases cannot be cured, yet, several patients have regained their health and escaped potentially life-threatening disease, thanks to genetic research. The objective of clinical research in genomics and genetics is to advance the quality of health care for the patients and their families.

Calzone et al. (2011), showed how nurses are transforming health care with the help of genomics and genetics.  In order to benefit the patients, clinical leaders are becoming competent in obtaining information about risks of developing inherited diseases in people, gene influenced drug reactions, the genetic background of cancer, diabetes and cardiovascular diseases (Ley et al., 2016). When leaders share their knowledge of genetics with the followers, they can make informed decisions about patients and diagnose the outcomes of genetic experiments and treatments. The assimilation of genomics and genetics data into all parts of health care offers clinical leaders a tool to treat patients as unique entities and implement novel diagnostic screening and therapeutic interventions all directed at improving population health (Calzone et al., 2013). The gap between the nursing community and genetic research in clinical care can only be reduced by the involvement of clinical leaders in evidence-based research practice. Understanding the associations of genetic changes linked with disorders have the potential to increase the identification of health complications, risk decreasing interventions, improve present screening techniques, enhance treatment choices, grow individualised remedy, an assortment of treatment established on genetic variants that stimulate drug responses and determine regimen of medicines.

Many clinical leaders have very little or no knowledge of biomedical advancements. Involvement in biomedical researches can help clinical leaders to enhance the diagnosis characteristics of the team followers and themselves. Improved diagnostics also mean that various disorders can be identified earlier, and with this upgraded verdict derives a superior prognosis for treatment and cure. Hence, for numerous diseases, the number of incidences are not falling but the viewpoints for the nurses have intensely enhanced. The different approaches of biomedical research provide insight to the leaders (Tappen, 2015). Clinical trials by the leaders can offer significant evidence about the effectiveness and antagonistic properties of medicinal interventions by regulating the variables that could affect the outcomes of the trial. Feedback from everyday clinical practice is also essential for linking and refining the use of vaccines, drugs, antibiotics, clinical devices and diagnostics. As an example, FDA approval of a medicine for a specific symptom is constructed on a chain of measured clinical experiments, generally with hundred to thousand individuals. After approval, the drug may be consumed by millions of patients in numerous diverse circumstances. Thus, following experience of patients with the medicine is imperative for finding comparatively sporadic effects and for shaping the efficacy of the drug in different populations or in different environments (Holloway & Wheeler, 2013). It can only be done by clinical leaders. They can take initiatives for biomedical research to improve their leadership. It is essential to document and evaluate drug use experience in clinical leadership so that guidelines can be developed for utmost practices and to confirm high-grade patient care.

Clinical leaders who involved themselves in the field of microbiology and medical biotechnology directs their followers in a much-organized way for handling infectious diseases, regenerative medicines, vaccines and diagnostics. Become competent in handling of microbial cultures and identification of pathogenic organisms under the microscope is considered as an essential quality of a nurse leader (Liu et al., 2014 and Bowen et al., 2016). A clinical leader with broad knowledge of biotechnology and advanced medical instruments can help other staffs with proper handling of medical instruments and decrease the frequency of errors (Davis et al., 2014).

Barriers to Promote Clinical Research Practice

As stated by Lilienfeld et al. (2013), there are few barriers to clinical research practice that can hamper effective leadership. The primary barriers are funding problems, poor time management, challenging environment and workload stress that hinder research and improved leadership. Next obstacle is the establishment of recent methods for improving treatments or health of patients (Melnyk et al. 2012). Another major barrier for integration of research into clinical leadership practice is a deficiency of workshops to encourage the nurse leaders to acquire new skills. Valuable treatment techniques may never be recognised in some health care settings as a result of these barriers. Not only will the patients endure but also the leaders will not have the opportunity to discover innovative skills (Lilienfeld et al. 2013).

Conclusion

Research-based clinical practice is fundamental for application of critical diagnosis and evaluation of medical test results. The research-based clinical practice uses current and strong experimental evidence in serious decision-making about patient’s health. It teaches the values of innovation in every phase of health care. The research-based clinical practice also satisfies the individual requirement of each patient and offers chances for treatment to be more individualised, efficient, dynamic, streamlined, and effective. Research increases the quality of clinical judgment in leaders. When evidence are used to explain practice approaches rather than to embrace previously standing practices, health care sustains rapidity with the most recent technologies and gets benefits of novel discoveries. The research-based practice has a huge impact on clinical leadership. It transforms a leader into an effective leader by clarifying many health related issues, gives insight about the pathogenesis of different diseases and provides the opportunity to innovate new drugs and treatment methods. When leaders stay up-to-date, other staff members get benefited from them and ultimately contribute towards enhanced patient care.

References

Bowen, C. M., Coleman, T., & Cunningham, D. (2016). Reducing Blood Culture Contaminations in the Emergency Department: It Takes a Team. Journal of Emergency Nursing.

Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. F. (2010). Nurses transforming health care using genetics and genomics. Nursing outlook, 58(1), 26.

Calzone, K. A., Jenkins, J., Bakos, A. D., Cashion, A. K., Donaldson, N., Feero, W. G., & Robinson, N. (2013). A blueprint for genomic nursing science. Journal of Nursing Scholarship, 45(1), 96-104.

Davis, M. M., Freeman, M., Kaye, J., Vuckovic, N., & Buckley, D. I. (2014). A systematic review of clinician and staff views on the acceptability of incorporating remote monitoring technology into primary care. Telemedicine and e-Health, 20(5), 428-438.

Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration, 43(2), 73-79.

Grove, S. K., Burns, N., & Gray, J. R. (2014). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.

Holloway, I., & Wheeler, S. (2013). Qualitative research in nursing and healthcare. John Wiley & Sons.

Huber, D. (2013). Leadership and nursing care management. Elsevier Health Sciences.

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing Inquiry, 20(1), 11-22.

Ley, S. H., Ardisson Korat, A. V., Sun, Q., Tobias, D. K., Zhang, C., Qi, L., & Hu, F. B. (2016). Contribution of the Nurses’ Health Studies to Uncovering Risk Factors for Type 2 Diabetes: Diet, Lifestyle, Biomarkers, and Genetics. American Journal of Public Health, (0), e1-e7.

Lilienfeld, S.O., Ritschel, L.A., Lynn, S.J., Cautin, R.L. and Latzman, R.D., 2013. Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33(7), pp.883-900.

Liu, L. M., Curtis, J., & Crookes, P. A. (2014). Identifying essential infection control competencies for newly graduated nurses: a three-phase study in Australia and Taiwan. Journal of Hospital Infection, 86(2), 100-109.

Mannix, J., Wilkes, L., & Daly, J. (2013). Attributes of clinical leadership in contemporary nursing: an integrative review. Contemporary nurse, 45(1), 10-21

Melnyk, B.M., Fineout-Overholt, E., Gallagher-Ford, L. and Kaplan, L., 2012. The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), pp.410-417.

Northouse, P. G. (2015). Leadership: Theory and practice. Sage publications.

Tappen, R. M. (2015). Advanced nursing research. Jones & Bartlett Publishers.

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