HLSC605 Module 1: Activity 1 by c4lth https://padlet.com/c4lth_fhs/osacboornwnv From the readings by Keyko (2014) and Pollard (2015), discuss key concepts that are, or should be, inherent in the relationship between leadership and relational ethics. en-us 2016-07-11 04:15:09 UTC 2025-11-28 20:10:58 UTC hello@padlet.com Leadership and Relational Ethics-Kayler Fox https://padlet.com/c4lth_fhs/osacboornwnv/wish/117287209 Relational ethics implies that ethical actions are made within the context of relationships (Pollard, 2015). Relational ethics build upon interdependent principles of mutual respect, engagement, embodied knowledge, environment and uncertainty (Pollard, 2015). Within the context of nursing not only the relationships between nurses and patients must be considered but that of the complexity of multiple relationships between nurses and leaders, colleagues, inter disciplinary team members, managers and organisation (Keyko, 2014). As Keyko (2014) states what happens at the bedside is not separate from the larger picture, and the implications of relationships are beyond individual levels. To maintain a moral relationship there must be mutual respect, and agreeance of some mutual standards and expectations within the relationship (Keyko, 2014).  If mutual standards and expectations are failed trust is broken, leading individuals to feel disempowered, devalued and moral distress may occur (Keyko, 2014). This is of particular importance within the leadership context, as staff who feel devalued or morally distressed may become disengaged with work and the organisation (Keyko, 2014). It is fundamental to nursing practice and nurse work engagement that there is trust between nurses and their practice workplace (Keyko, 2014). Authentic leaders build trust, respect and credibility through acting reliably in accordance with their personal values (Keyko, 2014). Through estabilishing trust in workplace leaders and management, nurses become engaged in their workplace, acting morally and feel confident to question or speak out (Keyko, 2014).
Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. dio: 10.1177/0969733014523167.
Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision making. International Journal of Caring Sciences, 8 (2), 362-368. Retrieved from http://search.proquest.com.ezproxy1.acu.edu.au/docview/1685874203?accountid=8194&rfr_id=info%3Axri%2Fsid%3Aprimo

]]> 2016-08-01 09:09:36 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117287209  Nurses must care with the patient (Pollard 2015) – I found this to be a profoundly stimulating statement and recommendation, for when the clinical nursing environment is examined as in (Keyko, 2014) it becomes apparent that the aspect of caring in the profession of nursing is not so straight forward. I found the article by Keyko (2014) so joyful to read because this authors opinions echo my own deep seated beliefs and ethical standpoint that I would consider innate within myself and most likely many healthcare professional s that are fortunate to work in supportive and ethically aware environments. This brings me to concepts that should be inherent in relationships between leadership and relational ethics. A concise view is expressed by Austin as cited in Keyko (2014) when suggesting there are 4 key concepts involved in leadership and relational ethics.   Relational engagement Mutual respect Embodiment Environment   Although these key concepts should be universal and inherent in our work places – the move to commercialise healthcare has resulted in an organizational health service approach which is task orientated and financially guided rather than being guided by the requirements of patients and their families.   Within the relational ethic framework mutual respect provides a means of interacting with others that are not equal, through recognition that “our differences complement rather than exclude one another” (Benhabib, 1987, 87).  I like the Canadian Nurses Association (CAN) value statements as these statements clearly explain  value statements to improves the knowledge of professional  nursing and offer weight to this subject. The following quote comes from the Illinois Institute of Technology (2011) and clearly displays the link between relational ethics and the role leadership and organisational perspectives play in the fostered environment. “The ability of nurses to engage in ethical practice in everyday work and to deal with ethical situations, problems and concerns can be the result of decisions made at a variety of levels - individual, organizational, regional, provincial, national and international. Differing responsibilities, capabilities and ways of working toward change also exist at these various levels.”             Austin W. The incommensurability of nursing as a practice and the customer service model: an evolutionary threat to the discipline. Nurs Philos 2011; 12: 158–166. Benhabib, S. (1987). The generalized and the concrete other: The Kohlberg-Gilligan controversy and feminist theory. In S. Benhabib & D. Cornell (Eds.), Feminism as critique: Essays on the politics of gender in latecapitalist societies (pp. 77-95). Cambridge: Polity Press Canadian Nurses Association (2002) Code of Ethics for Registered,Canadian Nurses Association, Ottawa   Code of ethics for registered nurses, Illinois Institute of Technology (2011) retrieved on 02/08/16 from http://ethics.iit.edu/ecodes/node/4679 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117338192
Priscilla Barclay 


]]> 2016-08-02 02:06:04 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117338192 Within the Keyko (2014) article I was interested by the comments surrounding the need for nurses to remain ethical within their practice they need to be ‘interested, open, and willing to engage in relationships and share the experience of those in their care, despite personal difficulty and organizational constraints.’ I believe this engagement is required to consistently deliver a high standard of patient’s centered care can take away from the nurses level of empowerment to focus of delivering good standards of care. Although I see myriad of issues that can set constraints around these practices thriving within the traditional health care system. I think it should be noted that Health care is strongly hierarchical in nature and can limit a nurse’s ability to ‘ethically flourish.’ Power dynamics between health professionals is commonly used to protect ones professional autonomy, there are also power dynamics between the private and public sector, even within different units at the local level. There can also attempts to reduce the dependency on other health professional disciplines- which can be led by power (McDonald, 2012). All of these ‘power battles’ can lead to ethically disabling  individual an individual clinician and leading to sub-optimal patient care. As mentioned in Keyko (2014) article mutual respect can be used to mitigate issues around power when the power is shared among the team, which may not be genuinely valued within the heath care setting. Mutual respect must be applied within the interdisciplinary: in which different skills, different knowledge bases, different access to and use of power is shared among all, with the focus on continually delivering patient-centered care. For this to occur I feel there must be a level of trust related to the acceptance of each professions’ roles at the individual, local and system level.   Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. dio: 10.1177/0969733014523167. McDonald J, et al. (2012). The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC Health Serv Res. 13;12:63. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117361705
Neil Gunn]]> 2016-08-02 09:22:46 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117361705 Four elements intrinsic to relational ethics exist: ·      relational engagement ·      mutual respect ·      embodiment ·      environment Keyko (2014) explores the concepts of relational ethics correlating the importance of each of these principles to the delivery of ethical nursing practice. Pollard (2015) expands on relational ethics further identifying it as a framework by which healthcare practice can be guided to facilitate ethical healthcare decision-making. Bamford, Wong and Laschinger (2013) suggest that managers who display authentic leadership skills will achieve greater work engagement of staff. They identify the importance of a leader enabling self-awareness, relational transparency, ethics and balanced processing to support staff engagement. With an ever increasing demand on healthcare organisations to be cost effective and productive, it would be possible to inadvertently inhibit relational ethics within nursing practice, risking the delivery of task orientated, goal focused care rather than one that is patient centred and ethical (Keyko, 2014).   Bamford, M., Wong, C. A. and Laschinger, H. (2013). The influence of authentic leadership and areas of worklife on work engagement of registered nurses. Journal of Nursing Management, 21: 529–540. doi:10.1111/j.1365-2834.2012.01399   Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. doi: 10.1177/0969733014523167. Retrieved from: http://nej.sagepub.com/content/21/8/879.abstract.   Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision-making. International Journal of Caring Sciences, 8(2), 362 – 368. Michele Burge https://padlet.com/c4lth_fhs/osacboornwnv/wish/117362562

]]> 2016-08-02 09:51:40 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117362562 Good work, Kayler c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117437040 What do you think is one of the biggest challenges to relational ethics from a leadership perspective?]]> 2016-08-03 04:01:12 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117437040 Thought provoking comments, Priscilla. c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117437147 You have identified that organisational demands including the need for financial considerations can challenge the ethical relationship and/or caring relationship. These constraints lead on to how well the organisation supports the ethical relationship and the need for staff to have meaningful engagement in their work. I remember working in a PICU many years ago and it was a constant struggle to meet the tasks involved. It was a constant race against time and in some ways the babies did become 'objects of care' and I was the 'object of care delivery'. I left before becoming burnt out (maybe without realising it, that is why I did leave!) but you can see how this type of work environment can objectify both the patient and the staff by reducing the meaningfulness and emotional engagement in work. Sue G]]> 2016-08-03 04:04:31 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117437147 Good points raised here, Neil, in your broad perspective about interdisciplinary power imbalances and the need for collegial trust and respect. Sue G c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117438491 2016-08-03 04:29:31 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117438491 Good work, Michele. How easy would it be to apply a relational ethic framework in your own work environment or is there evidence of one, even implicit, in your work environment? Sue G c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117438625 2016-08-03 04:31:45 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117438625 Thanks Sue, we have a great manager who wor https://padlet.com/c4lth_fhs/osacboornwnv/wish/117450409 2016-08-03 09:47:03 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117450409 Thanks Sue, we have a great leader who despite the restraints of the private sector works hard to create an environment reflective of a relational ethic framework at a unit level.  She is a great mentor to have! Unfortunately the organisation has a little way to go. Michele https://padlet.com/c4lth_fhs/osacboornwnv/wish/117450410 2016-08-03 09:47:04 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117450410 Hello Everyone,  I really enjoyed both articles and also loved reading all the posts which helped me make more sense of the relationship between leadership and relational ethics. I found it interesting how Pollard (2015) pointed out that there a difference between past nursing where the nurse was a nurse "for the patient" instead of "with the patient". Also the examples used in this article with "Jamie" really helped to show the links between leadership and relational ethics. The key links between both concepts are mutual respect, engagement, embodied knowledge, uncertainty and environment, which both articles Pollard (2015) and Keyko (2014) discussed. These whole concepts remind me of a time where I wasn't particular happy in work due to ongoing constraints from higher management which now makes more sense to me.  Under engagement discussed by Keyko (2014) I found it interesting the argument between whether the opposite to engagement was to become burnt out. (which also was touched on a previous posting by Sue). I really believe in being engaged in work means I am positive, happy to be in work, dedicated and yet challenged in work with pride, while the opposite would cause me to burn out. I am sure there are occasional times in everyone's nursing career where they feel burn out. I remember feeling burnt out in work and feeling lack of mutual respect for my nursing role as nurse in charge of each shift from higher management, but once this was expressed and higher managers listened and accepted my frustrations, reviewed my role and responsibilities and made changes in our unit, I remember feeling very respected. Also, the environment appeared more supportive for better quality of nursing care hence I regained my pride in working for the unit. Looking back also the element of embodiment as Keyko (2014) describes as allowing nurses being fully present in the moment where constraints are lifted, became and still is evident in my workplace. this allows me to trust my new management team who are also authentic in their leadership. It feels great to finally make sense of it all through relational ethics which is a concept new to me. Thanks Una https://padlet.com/c4lth_fhs/osacboornwnv/wish/117450539 2016-08-03 09:53:04 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117450539 In this article Keyto discusses many concepts related to thenurse-person relationship. For example, Khan (in Keyto) discussed the concepts of personal engagement and personal disengagement and what this looks like in clinical practice processes. This aligns with another concept that describes how a nurse engages in the work environment being that of emotional work and emotional labour. In the context of emotional labour the person is expected to act and manage their feelings in accordance with the organisation which is associated with a higher rate of burnout (Wharton, 2009). This is in contrast to psychological safety where the person can feel safe to employ ones true self. This leads to a discussion on engagement and erosion which gives tangible context to the spectrum of burnout. In further exploring psychological safety, if the nurse feels safe to approach their person-engagement using their unique skill set, the ability to practice with meaning and purpose would translate to more functional and satisfying level of engagement. On the other hand, if the impacts of emotional labour see the nurse having to engage with the person under organisation constraints, which may conflict with ethical principles, the slide from meaningful engagement to burnout would become evident. Keyko introduces the concept of positive psychology that looks to develop strengths, values and goals in people rather than trying to repair that which is damaged. Positive psychologist such as Seligman and Hayes, also promote the nurturing and development of the persons own strengths to support their interactions with life stressors. This has been reflected in Schaufeli’s work that is discussed in this article. Schaufeli looks to develop and focus on the positive attributes of nurses and to nurture their personal resilience and thereby the work place resilience. This developing, nurturing and celebrating the positive is less demanding on time, energy and emotions then having to constantly battle against negative influences. This leads into the discussion on relational ethics and practice. I found this latter part of the article thought provoking and moved me to reflect on my own work practice and work place environment. The principles of relations ethics, mutual respect and embodiment also aligns with principles of cultural safety that proposes that in any engagement there are 2 sets of beliefs, experiences and ideas, and that for this relationship to provide both parties with a sense a value, mutual and unconditional respect (Happell, Cowin, Roper, Lakeman, & Cox, 2013) are present. A key take from this article for me is the continuing development of self through reflection and practice awareness.   Happell, B., Cowin, L., Roper, C., Lakeman, R., & Cox, L. (2013). Introducing mental health nursing: A service user-oriented approach, (2nd ed.). Sydney: Allen & Unwin. Wharton, S. (2009). The Sociology of Emotional Labor. Annual Review of Sociology. 35, 147-165. DOI: 10.1146/annurev-soc-070308-115944 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117495046 Amanda]]> 2016-08-04 00:03:38 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117495046 During reading the article by Pollard, I noticed a number of concepts that I found myself pausing and reflecting on. The first is that discovering what the right decision evolves during the dialogue with the person. A clinical scenario that was drawn to my attention is that of the use of a ‘crisis intervention plan’ that are used in my work place in mental health. The plan is formulated for use for consumers who have complex care needs and may come to the attention of the emergency department frequently. The philosophy of the plan is that there is a collaboration between staff, including at a senior level, (endorsed at an executive level) and the consumer, to create a plan that can be used by the mental health clinician who assess the person when they attend in crisis. While clinical judgement remains foremost, there are a set of actions already designated prior to the commencement of the relationship. In reading Pollards representation of relational ethics it would appear that this contradicts in some ways, the philosophy underpinning nurses practice of ethical decision making in the context of the relationship they are engaged in. I note the frustration portrayed in Pollards clinical exemplar, and in particular that no one presentation and situation is the same. Mutual respect and unconditional positive regard appear as ethical principles should guide decision making from the clinical parameter, but also from that of the nurse in leadership positions. In leadership roles it is as vitally important that relationship ethics is demonstrated in the relationship between the leader and the clinician. While there are more variable for the person in leadership roles, including wellbeing of the workforce, the consumer, but also the organisational requirements in determining decisions made in management level. This does generate further thought on the concept of the leader or manager making decisions that are, like clinical decision making, guided by 2 components of the relationship and ethics. Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision making. International Journal of Caring Sciences, 8 (2), 362-368. Retrieved from http://search.proquest.com.ezproxy1.acu.edu.au/docview/1685874203?accountid=8194&rfr_id=info%3Axri%2Fsid%3Aprimo https://padlet.com/c4lth_fhs/osacboornwnv/wish/117502770 Amanda Petrie]]> 2016-08-04 01:31:41 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117502770 The article defines work engagement as a key concept for improved organisational outcomes (Keyko, 2014). Working within a large organisation, a key issue is the amount of personal leave taken by nursing staff. When unpacking why this is occurring it has helped to read the citation by Kahn in Keyko, suggesting that engagement at work is driven by meaningfulness, that the individual is safe, and psychological availability which impacts directly from the environment in which you work. As Keyko (2014) explains so clearly, that a positive psychology is vital to human functioning, while building positive qualities it also repairs the phenomenon of burnout, which has been a common denominator in the nursing industry.  This demonstrates the link between for positive leadership and relational ethics. in the article by Pollard (2015), It is demonstrated that for nurses to create a healthy relationship with their patients they need to be supported in the workplace. The article clearly implies that the ethical context of nursing creates core elements to practice by. The nursing profession is fortunate to have  the code of ethics (Australian College of Nursing, 2008), to support the clinical decision making. leadership is exemplified in supporting staff to feel safe in the use of the ethical guidelines set down. This will always be a challenge when confronted by the financial limitations of an organisation as mentioned by Pricilla Barclay in her post. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117504754 Code of Ethics for Nurses in Australia. Australian College of Nursing. (2008). retrieved on 4/8/2016 from nursingmidwiferyboard.gov.au


Catherine ]]> 2016-08-04 01:58:25 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117504754 I enjoyed your comments Neil. Some further comments on the train of thought around mutual trust in building strong relationships with clients/consumers - this is also reliant on the ability of health care staff, and the systems that are offered to support health care professionals in their care role. The challenge is to create/allow time, funds, policy and structure for reflective practice to support the vital human resource component of workplaces. The power imbalance of heirachies within health care systems can act as a constraint when we discuss partnership care, relational leadership and care models that imply equality. This is one of our challenges in leadership roles to build and develop systems that support genuine relational leadership. This also demonstrates use of leadership qualities - genuineness, reliability, resourcefulness and committment to people.  https://padlet.com/c4lth_fhs/osacboornwnv/wish/117528766 Bernie]]> 2016-08-04 08:41:23 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117528766 Ethical Relationships and Leadership https://padlet.com/c4lth_fhs/osacboornwnv/wish/117532345 Both these papers have a significant amount of wisdom to share. I enjoyed these papers, especially Pollard (2015) who introduces the statement  “with their patients”. I agree with this premise. I think being beside is another way of looking at this idea that brings with it a more empowering stance for the client but also a connection for the clinician deep in mutual respect.  Keyko (2014) presents four core elements that are essential to relational ethics: relational engagement, mutual respect, embodiment and environment. Pollard presents a variation of these also. I see these as core to leadership. Both papers present an aspect of relationship that is all about leadership. I see relationship especially in nursing as core and that to be able to have these qualities determines your leadership capabilities. Peter and Liaschenko (2013, cited in Keyko, 2014) propose that moral distress occurs when nurses expertise is devalued, cost effectiveness and efficiency is more important than engagement with clients. This lines up with Kahn who presents conditions that are important for engagement. Kahn (cited in Keyko, 2014) identified three psychological conditions for engagement at work: meaningfulness, safety and availability. Psychological meaningfulness refers to feeling worthwhile, useful, and valuable. Psychological safety is experienced when one can employ one’s true self without fear of negative consequences and can trust they will not suffer for being personally engaged. Psychological availability refers to the existence of the necessary physical, emotional, and psychological resources required for personal engagement, which speaks directly to the influence of the work environment. From these conditions I can see how easily staff could become disengaged with work and the organization. I have known work places that are not supportive and even still some staff have an ability rise above the politics and deliver safe quality care. This is leadership where relationships are more important than being involved in office politics. Relational ethics implies that ethical actions are made within the context of relationships which can explain why relationships are so important on many levels  (Pollard, 2015). Kerry M

Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. dio: 10.1177/0969733014523167. 
 
Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision making. International Journal of Caring Sciences, 8 (2), 362-368. 
]]> 2016-08-04 11:02:39 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117532345 I work in a highly stressful and busy Intensive Care Unit where burnout is rife. This has unfortunately led to many of the most senior and experienced nurses feeling disengaged and unhappy. In turn, this has had a devastating impact on our ability to employ and retain staff as these “disengaged” nurses have created a toxic and hierarchical environment making it very difficult for new and junior nurses to thrive. These nurses also develop “preferred” patient demographics rendering the rest of our patient population unfavourable to care for.    After a casual conversation with a few of these senior nurses, it became obvious that their underlying issues were anger directed to the organisation and its leadership team. They felt that they were “pushed” too hard in order to encourage patient throughput regardless of current bed status and adequate staffing. This supports a statement made in the article by Keyko, “multiple contextual factors, such as workload and staffing ratios, frequently make engaging in genuine relationships with patients difficult” pg 886, which demonstrates how an environment can negatively affect relational engagement. Along with many other points raised, the nurses also felt that their hard work went unnoticed and they were not rewarded for their efforts. The nurses in my workplace are disgruntled and feel undervalued by the organisation and their perceived lack of leadership. A direct causal relationship exists between these feelings and how they interact with the nursing and medical staff and more importantly the patients and families. This example demonstrates how a perceived lack of mutual respect by a nurse from their organisation can impact relational engagement as highlighted by Keyko. The keys points raised in this short conversation with just 2 of the nurses in my unit have been discussed in this article by Keyko. These nurses have highlighted that organisational issues impact heavily on nurse engagement and this can have drastic outcomes on the overall functioning of a workplace and can negatively influence patient care. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117533610   Isabelle L.]]> 2016-08-04 11:48:53 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117533610 Module 1 share board activity 1 Leadership and relational ethics learning from the article (Keyko, 2014) and (Pollard, 2015)   Leadership in nursing clinical practice linked greatly to how the nurse leaders able to apply their expert clinical knowledge and skills by creating meaningful active interactions between the patients, families, allied health team members, and the administrative members effectively (Keyko, 2014; Pollard, 2015). Few of the concepts described by Keyko (2014), for example, developing trustable nurse-patient therapeutic relationships is crucial to delivering a person-centered care. A person-centered care can be delivered safely when a nurse leader is ready to undertake the responsibility to connect every team member bedside nurses, allied health team and caring medical team along with the clients, the families, and the interpreter in case of patients coming from the diverse background (Keyko, 2014). According to Pollard (2015), nurses are expected to make the right clinical decision making for their patients. As highlighted in Keyko (2014), nurses are obliged to render safe evident based care for their patients by making daily care decisions by involving their clients as the center of their care. Nurses are required to engage actively in the work to deliver holistic nursing care ethically by making appropriate clinical care decisions promptly (Keyko, 2014).   Work engagement and nurse ethical practice in delivering safe and effective nursing care go hand in hand, a nurse who identified as disengaged may not be able to understand their patient’s needs holistically (Keyko, 2014). Nurse’s attitudes, nurse-patient, and nurse-organization relationships are very important to maintain the relational engagement (Doherty & Thompson, 2014; Keyko, 2014; Nursing and Midwifery Board of Australia, 2008).       The relational ethics includes three key steps relational engagement, mutual respect, and embodiment (Keyko, 2014). All the three steps are required to be applied while the basic and complex clinical renal nursing care decisions are made in the acute hemodialysis unit (Keyko, 2014; Nursing and Midwifery Board of Australia, 2006). Empowering the patients to choose the right option of renal replacement therapy, cease the dialysis treatment, and prepare advanced directive care plan are few of the complex clinical care decisions are commonly done in the acute hemodialysis units. A relational engagement process is when the nurses need to entirely think for their patients by placing themselves in their patient’s situation to empower them by giving them all required information through advocating informed decision-making process (Australian Commission on Safety and Quality in Health Care, 2016). A mutual respect is that providing adequate space for them to think and undertake right decision by giving respect to their views, health and illness beliefs, cultural values by not undermining their opinions (Australian Commission on Safety and Quality Care, 2008; Burton & Ariss, 2014). An embodiment principle is applied by structuring the renal nursing care plan pathway in accordance the chosen renal replacement therapy by being with them when they undertake specified treatment. According to Schmidt Bunkers (2010), nurses to be open, flexible, understand their faced problems, readiness to assist in their emotional care needs, and establish trustable relationships in considering to focus the principle of human flourishing. In summary, nurses to practice nursing profession in accordance to the key principles of adhering to the positive work engagement with relational ethics practice while the patient’s care is delivered. Nurse leader to undertake accountability to ensure that all teamwork nurses and allied health team members involved in the patient’s care is equipped to maintain and provide a safe holistic person-centered care. A nurse leader who ensures and practices nursing ethically by creating and maintaining healthy human interactions by being the authentic leader can be ethically responsible for their action.         Reference      Australian Commission on Safety and Quality Care. (2008). Australian Charter of Healthcare Rights. Australia: Australian Commission on Safety and Quality Care. Australian Commission on Safety and Quality in Health Care. (2016). Shared Decision Making.   Burton, N., & Ariss, R. (2014). Diversity in midwifery care: working toward social justice. Canadian Review Of Sociology = Revue Canadienne De Sociologie, 51(3), 262-287. Doherty, M., & Thompson, H. (2014). Enhancing person-centred care through the development of a therapeutic relationship. British Journal of Community Nursing, 19(10), 502-507. doi: 10.12968/bjcn.2014.19.10.502 Keyko, K. (2014). Work engagement in nursing practice: a relational ethics perspective. Nursing Ethics, 21(8), 879-889. doi: 10.1177/0969733014523167 Nursing and Midwifery Board of Australia. (2006). National competency standards for the Registered Nurse Retrieved 22/09/2014, 2014, from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx Nursing and Midwifery Board of Australia. (2008). Code of Professional Conduct for Nurses in Australia. from file:///C:/Users/USER/Downloads/6_New-Code-of-Professional-Conduct-for-Nurses-August-2008-1-.PDF Pollard, C. L. (2015). What is the Right Thing to Do: Use of a Relational Ethic Framework to Guide Clinical Decision-Making. International Journal of Caring Sciences, 8(2), 362. Schmidt Bunkers, S. (2010). A focus on human flourishing. Nursing Science Quarterly, 23(4), 290-295.   https://padlet.com/c4lth_fhs/osacboornwnv/wish/117637110
Gethsy Jayaseelan]]> 2016-08-06 11:56:02 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117637110 Relationship between leadership and relational ethics. dayolen999 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117639379 Pollard (2015) states that in order for nurses to be ‘ethically correct’ in their practice, there is the need to work ‘with’ the patient within the context of a relationship. This statement describes the need for relational ethics in the healthcare setting as essential for best practice. Pollard’s (2015) findings showed that there is a direct correlation between leadership in healthcare and relational ethics as the author describes the use of a relational ethic framework crucial to ethically reflective healthcare decision making. Pollard (2015) claims that in order to provide solutions to ethical issues that may arise in the complex healthcare environment, workers have to follow a designed framework. On the other hand, keyko (2014) emphasises on the fact that it is the meaningful relationships in nurses’ work that allows the delivery of ethical care. keyko (2014) argues that work engagement is the key towards ethical nursing practice while Pollard (2015) points out that the application of an ethical framework would provide an answer to any ethical questions. 

Both journals agree that the factors that affect relational ethics include mutual respect, engagement, embodied knowledge and environment. However, Pollard (2015) also emphasises on uncertainty which may arise due to the multidimensional nature of the profession such as cultural values. Pollard (2015) further expands on uncertainty as being an important aspect that encourages clinician to be self-reflective and more conscious of the ethical issues. 

Dayolen

]]> 2016-08-06 14:31:33 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117639379 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117649679 Healthcare now is driven like a corporate business with expectations placed upon staff to achieve certain outcomes which are ultimately measured from a financial perspective. These demands and expectations can affect staff when they are unable to deliver care in accordance with their own ethical framework. These two articles about delivery of nursing care, highlight the need for engagement, in particular relational engagement.
 Keyko (2014) describes relational engagement as the idea that ethical action must begin with an attempt to understand another person’s situation, perspective and vulnerability. Pollard (2015) states professionals not imagine themselves in the place of their patients; they must identify the unique needs, talents and capabilities of their patients. Relational ethics (Pollard 2015) encompasses mutual respect, engagement, embodied knowledge, environment and uncertainty. Meaningful engagement takes time and thus can affect the bottom-line negatively, which is often more valued than a patient connection. (Keyko 2014). Yet a meta analysis of over 7500 business units indicated positive outcomes from customer satisfaction, productivity profit, employee turnover and accident rates, when there was employee engagement. (Keyko 2014). More specifically in the hospital setting a recent Gallup poll found nurses work engagement was a significant factor on mortality and complication rates across hospital in the United States (Keyko 2014). Even more recently I know of one hospital group where three significant Medical errors occurred within weeks of each other and all had a common denominator-haste. The throughput of patients in this busy theatre complex was indeed far more valued than meaningfully engaging with each patient. 
Thankfully from these unfortunate errors a new protocol has been instituted which requires both Doctors and nurses to stop and formally engage with the patient. Responsibility for nurses’s engagement does not rely within the individual nurses but also in the context of practice environments, the organization, and the healthcare system (Keyko 2014).
I concur with the Canadian Nurses Association statement that “nurses value the provision of “safe, compassionate, competent and, ethical care” (Keyko 2014). 
Engagement has a need for understanding the complexity of every situation, each individuals perspective, and each person’s vulnerabilities (Pollard 2015). 
Trust and understanding both from a nurse –patient perspective and from an organisation-nurse level will enable the engagement of the nurse both on a direct nursing care level but also as an employee. Emphasis on these engagements are needed to maintain and increase positive outcomes in Healthcare.
 
Simone
 
Keyko, K (2014) Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics 21 (8), 878-889 doi:10.1177/0969733014523167

Pollard, C (2015) What is the Right Thing to Do: Use of a Relational Ethic Framework to Guide Clinical Decision-Making.International Jounral of Caring Sciences 8  (2) (362-368
 
]]> 2016-08-07 04:03:29 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117649679 It was very interesting reading Pollard and Keyko,  and relating them to our current nursing practice. The department that I currently work in has a number of factors that limit the ability to practice relational ethics. We have a new-ish "batch"of younger nurses who appear to believe that the patients should feel lucky to be provided care by them. The idea of engagement appears to be unconsidered.  It is interesting to see this attitude as a common theme among quite a number of nurses. I wonder how this has happened? Is this a reflection of the lacking in leadership? Or is it a reflection of the current state of the department? We are nearly always bedblocked, and the rate of burnout over the last couple of months is alarming. Although we have patients staying in the emergency department longer than the standarised four hours, this should seemingly give us time to develop our relationships with the patients, and should allow us time to engage more. It doesnt though! Maybe it's our history of a quick turnover, that we have forgotten how?? Did we never learn to consider this? Is it something that we learned briefly as undergraduates that was lost in the learning of other more concrete skill? Is this what happens to emergency nurses because of the nature of the department? Is it that we are usually so busy trying to treat the health condition (rather than the patient holistically) so we can get the next patient treated also, that we cant engage fully? The patients easily become " objects to be cared for in standardised ways to optimise efficiency". We are caught in the difficult position of attempting to assist as many patients as we can, at risk of providing suboptimal care from a relational ethics view. It is easy to understand then why burnout is so prevalent.  Keyko writes that trust in the manager directly affects work engagement. Leadership in this department is difficult. Managers tend to spend their time fighting for the department while all around them are trying to stay afloat. They don't have time to promote, educate and assist  the nurses in providing relational ethical care.  The leadership of the organisation has been to apply the "corporate structure" and nursing in the emergency department has indeed "become a mechanical process of fulfilling a certain number of predetermined tasks". The 'leadership' of the organisation has seemingly ignored the relationship between leadership and relational ethics. It is interesting to ponder how relational ethics can be kept alive in the current climate of our over burdened healthcare system. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117650803 Naomi White]]> 2016-08-07 05:40:50 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117650803 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117651415 The concepts that link leadership and relational ethics are essential to ensure human flourishing between patients and colleagues alike.  Pollard (2015), identifies mutual respect, engagement and responsibility as the most vital aspects of the relational ethical framework in healthcare.  The ideal that communication and understanding exists, regardless of inequality or perceived power, is inherent to ensuring that differences 'complement rather than exclude each other'. (Pollard, 2015).  I believe the key concept that links leadership to relational ethics is trust in nursing managements which directly impacts on work engagement and therefore ethical nursing practice. (Keyko, 2014). 

Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. dio: 10.1177/0969733014523167. 
 Yvette
Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision making. International Journal of Caring Sciences, 8 (2), 362-368. 
]]> 2016-08-07 06:41:43 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117651415 Key concepts from the two publications on the relationship between leadership and relational ethics. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117653847
The two publications were important in asking a lot of questions to the Nurse Practictioner of today on relational ethics, and I think generated more questions than answers. Pollard (2015) notation that there has existed a time of authoritarian rule where nurses used opposition relationship where only they knew what patient wants is still very true today. To improve on this, it is true that nurses need to work with their patients to truly be able to offer best ethical care.

The use of an examplar of Jamie by Pollard (2015) raised a lot of questions that nurses should ask themselves if they are to understand and practice relational ethics. The fact that Jamie agrees to only having medication whilst lying in a position mimicking Jesus on the cross should help nurses as they try to understand what Jamie might be thinking. As I was reading this and thinking of how I have always tried to "put myself in their shoes' when trying to get to what is right or wrong, Pollard (2015) confronts that as a no-go for nurses but instead encourages nurses to remove the divide between nurse and patient by "identifying their unique needs, talents and capacities."

The main concept echoed in there was Mutual Respect which Pollard (2015) described as a means of mitigating power differentials as automatically, there is an imbalance as the Nurse is the one holding an injection in the hand and probably also with the power to say that Jamie is at risk to self and others, that she needs to be sanctioned under the Mental Health Act against her consent. I have been looking at the values of hospitals around me, five of them to be exact. I realised that the notion of respect is evident on all five of these hospitals' values, and began questioning myself as to why then, do we as nurses get to be questioned as to our failure to have mutual respect. It was then when I read Keyko (2014) work on work engagement that I realised that we have a long way to go.

Keyko (2014) argues that there are ethical importance to work engagement as an engaged worker according to Kahn (1990) is one that is "physically involved, cognitively vigilant and emotionally connected." When these three are available, maybe the nurse will be able to see through their eyes, hear through their ears as the emotionally touching video by Cleveland Clinic seems to portray.

One of the key concept that arose from Pollard (2015) is embodied knowledge. This has been described as integrated consciousness, which is knowledge that we get from past learning and experience. I however liked Jamie's nurse in that he/she was raw, new to the job and the team, questioned self against dealing with an "experienced' patient who has been admitted 25 times. There is probably a dependence on nurses sometimes, as with other professionals it has to be said, that sometimes we feel like we have seen it all, heard it all and hence can make a judgement within a split second. Jamie's nurse had to leave what others were saying, and start to see Jamie as a person, a human being and not through the various tags of mental health conditions she has been diagnosed with. It is this fresh start that has enabled all these valid ethical questions to be asked.

Keyko (2014) rightly summarises that work engagement comes in from need to improve nurse retention, performance, patient outcomes and financial profitability amongst others according to Simpson (2009) and Bargagliotti (2012). It is therefore not far-fetched to conclude that relational ethics and work engagement can work hand in hand. An engaged worker has all the attributes present to then go and do what is ethically best with the patient they are employed to look after.

References:

Cleveland Clinic Empathy: The Human Connection to Patient Care. Available at https://www.youtube.com/watch?v=cDDWvj_q-o8. Accessed 7 August 2016.

Keyko K (2014) Work engagement in nursing
practice: A relational ethics perspective. Nursing Ethics

2014, Vol. 21(8) 879–889

Simpson MR. Engagement at work: a review of the literature. Int J Nursing Studies 2009; 46: 1012–1024.


Kahn WA. Psychological conditions of personal engagement and disengagement at work. Acad Manage J 1990;

33: 692–724.

Bargagliotti AL. Work engagement in nursing: a concept analysis. J Adv Nurs 2012; 68: 1414–1428

Pollard CL (2015) What is the Right Thing to Do: Use of a Relational Ethic Framework to Guide

Clinical Decision-Making. International Journal of Caring Sciences 2015, 8 (2), 362-368

Allington Gono


]]> 2016-08-07 10:13:53 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117653847 The articles by Keyko (2014) and Pollard (2015) identify the main principles of relational ethics which are mutual respect, engagement, embodiment and environment. These principles are essential for practising effective leadership in the healthcare setting. The relational ethics framework plays an important role in today’s current healthcare setting where nurse leaders have to influence surbodinates to make risky choices through creating positive attitudes and influencing colleagues by requiring them to alter their innate values and beliefs. Leadership can be defined as a multifaceted process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve mutually negotiated goals (Porter-0’-Grady, 2003). Leadership in nursing requires good role-models. Nurse leaders are supportive and caring to both subordinates and patients and within this relationship is an ethical code. Keyko (2015) describes the principles of relational ethics as “core elements essential to the ethic.” Mutual respect allows each member of the healthcare team to make a positive contribution to care of patients and values contributions made. Keyko (2014) further explains that this power sharing continuum “simplifies decision making and makes interactions significant.” Pollard (2015) provides a different perspective to mutual respect and further explains that nurses and patients exert unequal and different powers which are alleviated by mutual respect. Engagement refers to the act of putting oneself in another person’s situation. Pollard (2015) explains that “the decision to engage is not an option when used within a relational ethic framework.” According to Pollard (2015) embodiment is a core principle which allows nurses to use emotional and physical cues to make decisions. The environment plays a major role in influencing decision-making amongst nurses and more importantly influences ethical behaviour. This is best described by Keyko (2014) who identifies that “nurses’ work environment has an important effect on nurses’work engagement and ethical practice.” l Tapfumanei Masendu References: Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. doi: 10.1177/0969733014523167. Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision-making. International Journal of Caring Sciences, 8(2), 362 – 368. Porter-O’Grady T (2003) A different age for leadership, part 1. Journal of Nursing Administration; 33: 10, 105-110. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117660386 2016-08-07 16:57:17 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117660386 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117682737 Both the articles for this activity highlighted the ethical under pinning of the complex and diverse relationships formed by nurses throughout their careers. Nurses are often faced with ethical dilemmas and challenging decisions. The concept of relational ethics aids nurses answer questions what linger after making a tough decision such as “did I do the right thing?”  The central views of relational ethics include mutual respect, engagement, embodied knowledge, environment and uncertainty. These ethical views have vastly changed the nature of nursing relationships, especially those between nurses and patients. Pollard (2015) sums this change up succinctly by illustrating the transition from nurses being “for the patients” to nurses working “with the patient”. This transition also highlights the cultural shift amongst nurses to a more holistic approach to care, with the patients’ needs being the central focus of care. Both articles resonated with me and made me reflect on my own practices and evaluate the foundations of the relationships I have made throughout my careers. -uxanu���

]]> 2016-08-08 02:25:57 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117682737 Leadership and relational ethics https://padlet.com/c4lth_fhs/osacboornwnv/wish/117752626 Pollard (2015) explains that relational ethics are the “ethical decisions/actions are made within the context of a relationship”. Keyko (2014) and Pollard (2015) believe that the core elements that encompass relational ethics include: relational engagement, mutual respect, embodiment, environment and – Pollard (2014) adds – uncertainty. Both articles highlight the importance of quality of relationships between work colleagues and between members of the multidisciplinary team and carers, family members and patients. These authors also stress that all persons involved be recognised as valued members of the decision-making process. I found myself agreeing with this because the foundation of quality mental health nursing is rooted in quality relationships between all parties. Keyko (2014) states that the six areas of work life include: workload, control, rewards, community, fairness and values. Work engagement and burnout are impacted upon when one or more of the six work areas are compromised. This can lead to increased stress on nurses, worsen work environments and diminish patient outcomes. I can see this within my workplace after recent budgetary cutbacks and policy changes that have impacted upon the level of nursing care able to be provided that inevitably will impact upon the quality of patient care and patient safety. When it comes to autonomy and mutuality, Pollard (2015) highlights the daily struggle that mental health nurses have to face when having to work with involuntary patients who have impaired insight and judgment, as well as the nurses working within a recovery-focused model without “knowing what's best” for a patient who is too unwell to make informed decisions. In a leadership role, nurses need to understand the complexity and multidimensional aspects of the relationships between everyone involved in the work environment, including patients, as well as what impacts on them. Keyko (2014) stresses the correlation between “authentic leadership and nurses’ work engagement”. Authentic leaders empower through their ability to win the respect and trust of followers, build credibility and act in accordance to their values and convictions (Keyko, 2014). Personally, I have found the nurses who make the best leaders in mental health support their staff in all aspects of their work, fostering trust and respect, encourage learning and positivity, and challenge beliefs and work practices in a positive way in all situations. 

Nicola Bull]]> 2016-08-09 00:46:54 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117752626 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117780307 Leadership and Relational Ethics.
Nursing engagement not only includes the daily nursing practice but includes the nurses attitudes to their work and their patients Keyko(2014).
Relational engagement involves nurses needing to have empathy."The human connection to patient care"Keyko (2014). This includes having the ability to see, hear and feel what the patient is able to see, hear and feel, and to base our care on treating our patients as we would like ourselves and loved ones to be cared for.
Mutual respect for patients and their families by including them as valid members of the team, allows the power to be shared. This is seen today at work by having bedside handovers involving the patients and relatives as necessary to share and voice concerns about their care.Keyho (2014) describes that mutual respect promotes equality and values all people.
The enviroment also determines nurses engagement. Factors including workload, staffing ratios, rewards, sense of community,fairness and values. As well as trusting the manager and work collegues.When workloads are too high and annual leave is not able to be taken burnout occurs and increases sick leave.
I have also worked in very unhappy wards and their was no respect for staff by the NUM. Sick leave was through the roof because staff were so unhappy.
Even if the workload is high, if you are treated well and the working environment is positive you enjoy work and are less likely to take leave unless really necessary.
Pollard, (2015) also discusses the need for both nurse and patient to be present for each other shifting the domination of power from the nurse. Also mutual respect which also mitigates power differentials. Mutual respect provides a way to interact with others, that are not equal, by recognizing that "our differences compliment rather than exclude one another(Pollard. 2015).
In all my relationships at work I need to have mutual respect so that everyone I come into contact with feels valued.Nurses must care with the patient not for the patient (Pollard, 2015)

]]> 2016-08-09 10:30:23 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117780307 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117782698 I just put my post up at 830pm on 9/8/16 but didnt put my name which is Patricia Mair]]> 2016-08-09 11:11:50 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117782698 How often nowadays do we hear nurses talking about being burnt out and their lack of work fulfilment? Time constraints and inadequate meaningful interaction with patients leave us feeling that we are not delivering our best nursing care. Keyko (2014) believes that as healthcare focuses increasingly on corporate values and improving efficiency, patients are consequently being treated as objects, while we as healthcare professionals are also losing our individuality. To practice relevantly and ethically, we must trust that our beliefs and objectives align with those of our healthcare system and that we are engaged in our work (Keyko, 2014). Peter and Liaschenko in Keyko (2014) propose that if we perceive that our beliefs and objectives are incompatible with those of our organization, moral distress occurs and we suffer burn out. However, healthcare organisations now seem largely focused on cost-effectiveness and efficiency, and we seem to have little control over decision-making (Keyko, 2014). Can we hope to make ethical decisions and determine what is “the right thing” (Pollard, 2015) if we are currently working with different objectives and there is an 'erosion of engagement' (Maslach and Leiter, in Keyko, 2014)? Relational ethics is based on interaction through relationships, whether that is the relationship between a nurse and their patient (Pollard, 2015) or between the nurse and their work (Keyko, 2014). A successful relationship is based on mutual respect, trust and engagement and understanding the other's situation, perspective and vulnerability (Keyko 2014, Pollard 2015). How we act can affect our workplace, for better or for worse (Keyko, 2015). As ethical leaders and individuals, perhaps we can cultivate ethical practice within our environment and re-engaged with our work and patients to make our workplaces 'moral communities' (Pollard, 2015).    Dallas F https://padlet.com/c4lth_fhs/osacboornwnv/wish/117782856 2016-08-09 11:16:52 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117782856 Key Concepts-relational Ethics... https://padlet.com/c4lth_fhs/osacboornwnv/wish/117785113 I have found it interesting to read through all the responses on this share board. I like most contributors read both of these articles with interest. I do admit to a certain amount of trepidation too!
I found the article by Pollard ( 2015) particularly relevant to my workplace. Nurses and midwives are often debating the "right way to do"... we defiantly consider ethics in our decision making whether we do this consciously or not is a question to ponder.
I believe in a certain amount of creativity in my decision making whilst at work. Decisions to be made can sometimes be annoying and disruptive to our work flow i.e a challenging client with particular strong views on vaccination at our community health clinic. This however does often allow me to reflect and develop skills to further aid these decisions. 
Empathy as discussed by Pollard is strong part of relational ethics. I will always remember the wise words of my first midwifery tutor "put yourself in the mum's shoes and most times you will make the right decision"... .
I am now in a senior nurse leadership role and I believe in the values of mutual respect and trust as discussed in Keyko..

Thanks for reading
Kylie Rayner]]> 2016-08-09 12:14:13 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117785113 How often nowadays do we hear nurses talking about being burnt out and their lack of work fulfilment? Time constraints and inadequate meaningful interaction with patients leave us feeling that we are not delivering our best nursing care. Keyko (2014) believes that as healthcare focuses increasingly on corporate values and improving efficiency, patients are consequently being treated as objects, while we as healthcare professionals are also losing our individuality. To practice relevantly and ethically, we must trust that our beliefs and objectives align with those of our healthcare system and that we are engaged in our work (Keyko, 2014). However, the inherent values of organizations now seem largely focused on cost-effectiveness and efficiency (Keyko, 2014). Peter and Liaschenko in Keyko (2014) propose that if we perceive that our beliefs and objectives are incompatible with those of our organization, moral distress occurs and we suffer burn out. So how can we hope to make ethical decisions and determine what is the right thing to do (Pollard, 2015) if we feel that we are working with different objectives and there is an 'erosion of engagement' (Maslach and Leiter, in Keyko, 2014). According to Pollard (2015), employing relational ethics requires that relationships are formed and that the unique needs, talents, and capacities of each individual be identified. As ethical leaders we need to try to understand the other person's situation, perspective and vulnerability and that there must be engagement within the relationship. It is essential that the engagement is relevant for ethical nursing practice and that it extends to the broader context of practice environments, the organization, and the healthcare system.  Leiter and Maslach (in Keyko, 2014) identify that an individual's engagement with work can significantly be enhanced if a person is well matched with the six areas of work life (workload, control, reward, community, fairness, and shared values). If there is a mismatch then they become emotionally exhausted and become disengaged or burnout. As all the six areas are interrelated, if one area is improved, then at least some of the others will also improve. The study found that staff nurses felt more empowered when leaders’ behaviours promoted autonomy, encouraged participative decision-making and displayed confidence in employees (Greco, et al, 2007). This research gives me hope that by using leader empowering behaviours and cultivating ethical practice, I can change my work environment and improve work engagement. However, I believe that until the current healthcare system changes its focus to allow for enhanced work engagement for its employees, nurses will continue to burnout.   Dallas F                   Greco P, Laschinger HKS and Wong C. Leader empowering behaviours, staff nurse empowerment and work engagement/burnout. Nursing Leadership 2006; 19: 41–56. https://padlet.com/c4lth_fhs/osacboornwnv/wish/117798043

]]> 2016-08-09 14:35:09 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117798043 https://padlet.com/c4lth_fhs/osacboornwnv/wish/117849076 I found both of these papers to be very thought provoking and lead me to reflect upon my past and current practice]]> 2016-08-10 01:46:16 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117849076 Share board 1- Leadership and relational ethics.  https://padlet.com/c4lth_fhs/osacboornwnv/wish/117850186 ** I started typing before and accidentally clicked out and cannot edit so have started again**

I found both of the articles to be very through provoking and relevant to past and present practice. Like some of my peers have mentioned the concept of relational ethics is a new concept to me, however throughout the readings I realised that the "name" relational ethics was new however the concept is something that I have been exposed to throughout my nursing career. Keyko (2014) highlights the link between leadership and the relationships between nurses and their patients, families, colleagues and the organisation. The Key concepts of relational ethics, environment, mutual respect and embodiment are all essential to leadership and ethics. These concepts allowed me to reflect back to past practice when I entered the nursing workforce as a new grad with high expectations and hopes to be met with a lack of trust, mutual respect and an environment that was not supportive.

I reflect now to my current place of practice where Keyko's concepts of trust, mutual respect, and a supportive environment are present through productive management, healthy working relationships, diverse teams, appreciation for staff input and a transparency from higher management. I see first hand the importance of these concepts in allowing nurses to be fully engaged in their work. I am able to feel a worthwhile and valued member of a very diverse team. I value my autonomy which in turn motivates me to give 100% to my job.

Pollard (2015) highlights the importance of negotiating care "with" the patient, shifting away from making decisions for the patient, which forms some of the basis of the recovery model. Pollard argues that nurses can use a relational ethical framework to determine clinical decision making. The case study within Pollard's article and the questions arising from these are things that nurses face regularly within mental health nursing. It is important to recognise that there are times that nurses make clinical decision that the patient may not agree with for example involuntary treatment orders, however as Pollard highlights the importance to the nurse that the the decision is made within an engaged relationship rather than making decisions based on "technical knowledge".

I still feel that we have a long way to go, to continue to shape healthcare to be patient centred and to fully embody relational ethics and leadership. Despite many paradigm shifts there are still a large component of organisation constraints be that staffing levels, budget cuts etc that hinder the development of relational ethics. Keyko (2014) writes that "to be ethical, nurses myst be interested, open and willing to engage in relationship and share the experience of those in their care, despite personal difficulty and organisation constraints" I think that this can be applied also to the organisation, to be interested, open and willing to engage in relationships with nurses building again on the key concepts of mutual respect, trust, promoting positive environments.

Jessica Moussa

Thank you to my peers for your valueable and insightful postings also.

Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics, 21(8). 879-889.

Pollard, C. (2015). What is the right thing to do: use of a relational ethic framework to guide clinical decision making. International Journal of caring sciences, 8 (2). 362-368]]> 2016-08-10 01:58:28 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117850186 That is often the way, Michele, but having leadership where there is role modelling of care giving within a relational ethic is an excellent c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117967142 2016-08-11 04:25:55 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117967142 Excellent commentary, Kerry c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117968224 2016-08-11 04:39:11 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117968224 Excellent Isabelle c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117968409 Your reflection is not dissimilar to my own past experience of working in ICU (long before I was aware of concepts such as staff engagement and relational ethics) where there was often a preference by some staff for patients who were ventilated so that engagement was minimalised. I am hopeful though, that this situation is not the norm.
Sue G]]> 2016-08-11 04:41:22 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117968409 Developing trust is certainly an important aspect of leadership. What other characteristics do you think are reflective of exemplary leadership? What qualities would you look for in an ideal leader, Yvette? More importantly, what qualities do you have, or would you like to further develop, to be considered an exemplary leadership by your colleagues? c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117968878 Sue G]]> 2016-08-11 04:47:21 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117968878 Thank you for your commentary, Gethsy. Would you consider that Pollard argues against placing oneself in the place of the patient and rather, advocates a stronger role in understanding the patients' perspective and in supporting the patient in decision-making? Pollard also takes very much, a phenomenological viewpoint in asking, "what is this experience like for Jamie"? c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117969278 Sue G]]> 2016-08-11 04:52:48 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117969278 Great comparison of the two articles, Tapfumanei.  Perhaps as well as supporting staff with risky choices, a good leader also demonstrates managing competing demands or supporting staff in this way. ometimes the ethical obligation between two or more competing demands can be equal which makes decision-making more poignant for the care giver. c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117969663 2016-08-11 05:00:22 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117969663 Excellent reflection of your own positive engagement and professional flourishing that is enabled by your work environment to a degree notwithstanding your comment that the organisation has a "way to go". c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117969990 Sue G]]> 2016-08-11 05:06:09 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117969990 Excellent reflection on the link between relational ethics and leadership, Nicola c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117970128 Sue G]]> 2016-08-11 05:09:38 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117970128 Yes, the situation that you describe is common, Dallas - the tension between cost efficiencies and quality care that can certainly impact on the relational ethic of care-giving. However, as more leaders become aware of the importance of concepts like work engagement and relational ethics and are able to role model, authentic leadership and advocacy for both staff and their patients, there will be more overt recognition of the influence of leadership as an essential factor in balancing cost with quality. This is becoming more evident with the increase in health care organisations moving towards achieving  Magnet status, or at least being aware of the importance of staff retention and the effect of a positive patient relationship on wellbeing. Sue G c4lth_fhs https://padlet.com/c4lth_fhs/osacboornwnv/wish/117970248 2016-08-11 05:12:50 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117970248 Jessica,  https://padlet.com/c4lth_fhs/osacboornwnv/wish/117999254 If you want to edit, double click on your post, and in the top right hand corner is a pen and bin. Click on the pen to edit or bin to delete whole post. I did the same thing and spent ages working this out!
Dallas ]]> 2016-08-11 12:47:09 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/117999254 https://padlet.com/c4lth_fhs/osacboornwnv/wish/118070012 I found the Pollard (2015) article interesting and relevant to my current area of practice particularly the emphasis on including the consumer in their care and moving away from the nurse being an authority figure, to nurses working alongside their consumers. There are times however where this is not always easy or ethical in the mental health setting, especially where consumers are acutely unwell and being treated under an Involuntary Treatment Order (ITO). While we are guided by the Mental Health Act, there are still some decisions made for consumers that leave room for ethical dilemmas and at times can put the nurse in a tricky position.

In saying this, the Keyko (2014) article also highlighted some important factors in leadership, and made connections between the relationships of consumers, nurses, families and the organisation as a whole. In a leadership role in a mental health setting, it would be within a recovery-orientated framework to continue to build the therapeutic relationship between nurse and consumer, and therefore working together to make ethical decisions together as a team (Pollard, 2015).

Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective.Nursing Ethics, 21(8). 879-889.

Pollard, C. (2015). What is the right thing to do: use of a relational ethic framework to guide clinical decision making. International Journal of caring sciences, 8 (2). 362-368

Emily Rayner
]]> 2016-08-12 00:41:17 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/118070012 https://padlet.com/c4lth_fhs/osacboornwnv/wish/118073587 When considering what the right thing to do in a clinical context especially as a nurse in charge of a shift, Pollard's quote resonated with me: " To determine what is "the right thing" nurses must negotiate the requirements of care and responsibility with their patients within the context of a relationship". While a simple statement the implementation of the complex power struggle that can exist between nurse and patient can change when leadership decisions are made inclusively and individually to include what's best for the patient. Especially at times when ethical patient care can be subjective. When collaborating with the patient the right thing to do for that patient may differ to another or to the ethics of the health professional. Respectful collaboration is therefore a key concept in the relationship of leadership and ethics.

kerrie ]]> 2016-08-12 01:36:31 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/118073587 What thought provoking articles. Like others on this shareboard, I was not familiar with the term “relational ethics”, however the definition and the concepts are definitely important to me, and my nursing practice. Keyko (2014) and Pollard (2015) discuss the concepts of mutual respect, embodiment, environment and engagement as being the central concepts to relational ethics. Pollard (2015) also mentions uncertainty. These concepts are essential to both leadership and ethics.   Having worked for many years in a busy public emergency department, I found myself really focussed on the phrase working “with” not “for” the patient, as mentioned in both articles, predominantly in Pollard (2015). In a fast paced, hectic environment, it becomes easy to believe that what you know, the test book treatment answer, is the best treatment option for the patient. Pollard (2105) describes this as “nurses want to do what is best for their patients. This is characterized by an attitude that nurses know what is “best” for their patients”.   Pollard (2015) discusses the shift from technical decision making, to negotiating care through an engaged relationship, as being a key factor of decision making. I have noticed this occurs more frequently, since moving to a private hospital, however I am also finding myself more away of the negative notion of dehumanisation, as there is a focus on minimising costs in the private sector that I was not aware of in the public sector.   These concepts are crucial for leadership in healthcare. The framework of relational ethics allows leaders to support and motivate colleagues to question their practice, and hopefully to implement the concepts addressed in the articles to their own practice.                  Lily Turner                                                                            Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics, 21(8). 879-889.                                                                                        Pollard, C. (2015). What is the right thing to do: use of a relational ethic framework to guide clinical decision making. International Journal of caring sciences, 8 (2). 362-368 https://padlet.com/c4lth_fhs/osacboornwnv/wish/118170977

]]> 2016-08-13 03:12:36 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/118170977 Relational ethics and leadership https://padlet.com/c4lth_fhs/osacboornwnv/wish/118257960
Caeli

Key concepts that are, or should be, inherent in the relationship between leadership and relational ethics:

Relational ethics describes the ethical considerations existing within the interactions between people (Pollard, 2015).  It resonates strongly with shared mutual respect and knowledge sharing. When employed in the healthcare setting relational ethics can become quite complex between the organization, healthcare workers, patients and extended networks (Keyko, 2014). Promoting relational ethics in interactions within an organization between all members promotes an environment of respect, shared knowledge, understanding, and improved outcomes for workers including reduced risk for burnout for healthcare workers.  

When considering leadership relational ethics becomes very important.  Poor employment of these ethics can result in feelings of disempowerment in other staff members that can flow down through the organization to impact patient outcomes and engagement (Keyko, 2014). Through promoting positive interactions between those in leadership roles and their co-workers staff-members are encouraged to engage fully in their work, and discuss concerns, ideas and outcomes (Keyko, 2014). 

Personal Reflection:

Relational ethics and leadership is particularly relevant to nursing practice. Poor relational ethics can impact negatively on both the mental health of the nursing staff, the patients and their extended networks. For this reason members in leadership positions such as Unit Managers need to be aware of how the interact with their team and their ideas and experiences. Promoting a workplace of mutual respect and understanding reduces risk for burnout and can increase productivity. 

      Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. dio: 10.1177/0969733014523167. 

Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision making. International Journal of Caring Sciences, 8 (2), 362-368. Retrieved from http://search.proquest.com.ezproxy1.acu.edu.au/docview/1685874203?accountid=8194&rfr_id=info%3Axri%2Fsid%3Aprimo p��I�7]

]]> 2016-08-15 09:05:42 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/118257960 Leadership and Relational Ethics https://padlet.com/c4lth_fhs/osacboornwnv/wish/118258002 Caeli McCance

Key concepts that are, or should be, inherent in the relationship between leadership and relational ethics:

Relational ethics describes the ethical considerations existing within the interactions between people (Pollard, 2015).  It resonates strongly with shared mutual respect and knowledge sharing. When employed in the healthcare setting relational ethics can become quite complex between the organization, healthcare workers, patients and extended networks (Keyko, 2014). Promoting relational ethics in interactions within an organization between all members promotes an environment of respect, shared knowledge, understanding, and improved outcomes for workers including reduced risk for burnout for healthcare workers.  

When considering leadership relational ethics becomes very important.  Poor employment of these ethics can result in feelings of dis-empowerment in other staff members that can flow down through the organization to impact patient outcomes and engagement (Keyko, 2014). Through promoting positive interactions between those in leadership roles and their co-workers staff-members are encouraged to engage fully in their work, and discuss concerns, ideas and outcomes (Keyko, 2014). 

Personal Reflection:

Relational ethics and leadership is particularly relevant to nursing practice. Poor relational ethics can impact negatively on both the mental health of the nursing staff, the patients and their extended networks. For this reason members in leadership positions such as Unit Managers need to be aware of how the interact with their team and their ideas and experiences. Promoting a workplace of mutual respect and understanding reduces risk for burnout and can increase productivity. 

      Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics. dio: 10.1177/0969733014523167. 

Pollard, C. (2015). What is the right thing to do? Use of a relational ethic framework to guide clinical decision making. International Journal of Caring Sciences, 8 (2), 362-368. 


]]> 2016-08-15 09:06:32 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/118258002 Good afternoon everyone, I believe that the key concepts that should be inherent in the relationship between leadership and clinical ethics, should embrace everyday clinical EBP, as a foundation for creating culture change within the organisation. This attitude in my clinical are is often conflicted with a culture of ‘this is how we do it here’ type response, unfortunately. I am of an understanding that utilising the good/valuable/improving attributes which individual nurses may bring to their role from their previous life/work experience, helps create a very unique experience for each nurse within their particular domain (Keyko, 2014). I found the disharmony between clinical ethics and the directives as set by the particular organisation an interesting commentary within the Keyko article. I was interested to learn about the factors which lead to burnout which seemed to revolve around a conflict of values between nurses and those of the organisation which lead me to question whether the same would occur between negative feedback from co-workers and or patients (in the case of putting yourself in the place of being personally engaged in the outcomes of a patient) (Keyko, 2014 p.10). I feel that developing a culture of nursing within an organisation which promotes insight into one’s own nursing practice, would be highly beneficial, unfortunately to a degree I think reflective practice doesn’t work as well for everyone, but incorporating this into training could help improve its effectiveness. Keyko, K. (2014). Work engagement in nursing practice: A relational ethics perspective. Nursing Ethics, 21(8), 879-889. mr_morgz https://padlet.com/c4lth_fhs/osacboornwnv/wish/118381688 2016-08-16 06:06:58 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/118381688 https://padlet.com/c4lth_fhs/osacboornwnv/wish/119042361 Shareboard Activity One
Patricia Mair
After reading both readings my feelings are that Leadership and relational ethics are directly linked.
The key concepts identified by Keyko (2014) are Relational engagement, mutual respect, embodiment and environment. Work engagement is rooted in the idea to improve organizational outcomes such as productivity and efficiency (Keyko. 2014). Work engagement is the relationship between the person and the organization, and is in proportion to staff feeling valued. worthwhile and useful as stated by Keyko (2014). Burnout can occur in areas where staff feel they are not valued.
Leadership therefore has a direct influence on work satisfaction and work engagement. The six areas that are included in worklife  morale are workload, control, rewards,community fairness and values.
I have worked in a ward where the Nurse Unit Manger was negative, gossiped about her staff to other staff members, was dissrepectful and humiliated staff in front of patients and other staff. Of course sick leave was high and morale very low. I have also worked in a ward where the workload was very high but the Nurse Unit Manager was respectful, kind, rewarded staff for their efforts and cared about her staff and the sense of community was high. In this situation sick leave was much lower and staff engagement was much higher. When staff are treated with respect it fosters a culture of high output where staff want to come to work and give 100% each day. and be responsible caregivers and care for people the way they would like their loved ones to be cared
 for Keyko (2014).
Pollard (2015) discusses the need for nurses to negotiate the care of their patients with the patient and that the responsibility of the care shifting from "nurse knows best" to a share in the care with patient involvement. Of course the situation needs to be evaluated on the underpinnings for this to occur (Pollard.2015).
Following what you believe to do the right thing ,can open you up to criticism from staff. As evident in the story about Jamie. Through mutual respect , acknowledges the need for our attention and also changes the power between nurse and patient, where our differences compliment each other and encourages bonding and sharing.. 
We can all be leaders at work by demonstrating mutual respect and treating our patients the way we would like to be treated ourselves]]> 2016-08-21 10:15:41 UTC https://padlet.com/c4lth_fhs/osacboornwnv/wish/119042361