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Essay: Attending a suspected stabbing – leadership (reflective)

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This essay is a reflection of practice on an incident that I attended where I will critically evaluate and reflect on the application of leadership, coaching and mentoring styles that have been used. Hpc-uk.org. (2018) “Standard of conduct, performance and ethics” states that a paramedic should be able to designate, instruct and monitor task to other to help them expand their knowledge and understand, as well as to increase their skills to help others. I will be using the reflective cycle by Gibbs to understand and explain my understanding (Gibbs, 1988)
I attended a suspected stabbing (see appendix 1) and was the attendant where I used an authoritative leadership style towards the patient (Feldman et al., 2011). I was crewed with a paramedic who took on a laissez-faire leadership style (Bass, B.M., & Riggio, R.E. 2006). Further resources attending shortly after consisted of the Operational Manager (OM) who took on a laissez-faire approach allowing the crew to deal with the patient and for the paramedic to turn to a more coaching role (Whitmore and McFarlane, 2017). The Medical Emergency Response Incident Team (MERIT) arrived shortly at the same time as the OM adopted an autocratic approach (Blaber and Harris, 2014).
I was very nervous as this was the first stabbing I had attended but felt reassured as I had experienced staff around me if I required help.
Evaluation and analysis
Zenger, Folkman & Stinnett (2010) suggest that a leader in a situation doesn’t actively choose what style of leadership they are adopting, but instead draw on their past experiences as to how best choose a style and how to adapt it if required. Goleman, Boyatzis and McKee (2013) state that a good leader knows the different leadership styles and what style is best to use for what situation. The authors go on to state that a good leader is able to change their leadership style if they feel that their style is not working and to choose a more appropriate style to get the best out of those around them. In the situation I was faced with, the patient was intoxicated, standing in a bus stop talking to those around him. Arriving on scene we were not aware of the full extent to the emergency, as I needed to keep the patient calm and required him to cooperate with us, I took on an authoritative leadership role. Feldman et al (2011) states that an authoritative style helps to inspire others into doing what is required and often uses the phrase “come with me” when you want someone to do something. This worked well at first with the patient to gain their trust in me as a clinician so that I was able speak to them to gather more information as to why we were called. The patient was refusing to come with the crew to the ambulance and proceeded to explain what had happened to him. Whilst explaining he had informed us he had been stabbed in the chest and this was when my role changed. I needed a more assertive role, Sfantou, et al. (2017) states that autocratic leadership works better in time critical situations as a single person takes charge and tells each person what to do. Blaber and Harris (2014) suggest this is also the best method of asking direct questions to get the information as quickly as possible. Blaber (2012) goes on to state this is good for inexperienced staff such as the student, as it provides clear instructions on what they need to do. The author does go on to state that this can have a negative effect as team members don’t develop their own problem-solving skills as they are just told what to do. The paramedic, who was the highest ranked clinician on scene had opted to take a laissez-faire leadership, which Yang (2015) states is good for encouraging personal development but still being kept in the loop of information. By adopting this style, the paramedic was able to let me use my skills to treat the patient whilst still being there in case I needed further interventions, this allowed me to develop my trauma skills. Looking back I realised that the paramedic had also adopted a coaching style to assist me as this was my first trauma job. the paramedic being the senior clinician, took on a coaching role, as this would be able to develop my skills further by questioning what it was that I needed and wanted from the situation (Phillips, 1996). I realise the paramedic had used the GROW model (Whitmore and McFarlane, 2017) as they helped me to realise what it was that I wanted, what stage was I at in the process, what can I do and what am I going to do. The paramedic then helped to assist me to achieve these goals. Whitmore and McFarlane (2017) designed the model that can provide the structure that has the potential to increase the persons potential by increasing confidence and motivation, with both long term and short-term benefits. I realised that the paramedic used a coaching style as it is designed for individual situations and provides short term education, whereas mentoring is more useful for longer periods (Alred, Garvey and Hailstone, 2011).
Once on the ambulance I was able to adopt a more charismatic leadership role, whereby I was able to allow the student to get on with the tasks assigned to them whilst I was able to get the patient to do what was required of them so that everyone was working to the same goal (Bass and Riggio, 2006). St. Thomas University Online (2018) states that both autocratic and charismatic styles are very similar, with differences being that a charismatic style inspires people to do what is wanted, whereas autocratic demands, with both styles producing similar results in the short term. Shortly after getting on the ambulance, both MERIT and the OM arrived on scene to assist, with the OM taking a laissez-faire leadership style. Marriner Tomey (2009) states that a person can allow the experience of the members of staff around them can be left to perform their duties whilst still receiving feedback from the team, which worked well for the OM as the MERIT team has a doctor who has a higher clinical skill set. Bass and Riggio (2006) do suggest that a laissez-faire approach can lead to ineffective decision making, whereas Lewin (1939) goes further to state that a group without leadership can become non-productive over time. Einarsen (1999) states that a lassa-faire leadership can create friction within the groups due to the lack of leadership. Although this maybe the case, due to the small group of the crew. The MERIT team used a very autocratic leaderships due to the possible seriousness of the wounds, as this method provided clear instructions on what needed to be done without having to worry about why (Stanley, 2016). A democratic leadership style may have worked well due to it allowing the delegation of the work to varying crew members to do the tasks required (Gastil, 1994) However due to the nature of injuries to the patient, they would not have benefitted from a democratic leadership style, as Frandsen (2014) states this style takes time to collect on the information and is slow. Frandsen (2014) states a more relaxed style, such as democratic, would have been good to put the patient at ease and be able gather the opinions of everyone who was there, which can lead to better staff satisfaction as their opinions are seen as of value. Frandsen (2014) does go on to explain that this process takes a long time to process the opinions and can lead to anxiety in experienced staff. This style of leadership would not have been effective as the situation required a rapid decision process.
After the patient had been transferred to the major trauma centre for further assessment, I was able to reflect on the job with the senior paramedic and the MERIT team doctor about how the incident went. Pegg (2003) described the 5C’s of the mentoring model that works Discussing the challenges that we faced when dealing with the patient, the choices that we had, the consequences of our actions, what solutions that we could create and finally what was the conclusion of all our efforts. The author goes on to name this theory as the “pulling and pushing” methods between the mentor and the mentee. This type of method is a long term ongoing development style and was helpful after the situation to be able to look at how I had performed in my first trauma situation.
Zenger, Folkman & Stinnett (2010) suggest that the best leaders are often those who are able to inspire people to do the best work are leaders who are able to connect on an emotional level. Goleman (2011) states that the best leaders, no matter what style they use or what skills they have, are able to connect on an emotional level with those around them by having “emotional intelligence”. I initially chose the authoritative role as stated by Feldman et al (2011) for this situation as I felt it would give me the best chance at connecting with the patient and being better able to assess the situation and the needs of the patient. Once I had learnt the nature of the patients injuries, by changing to a more autocratic style I was able to command the situation better, impressing on the dangers of the situation to the patient and thereby getting the patient to do what was needed from a more time critical situation (Blaber and Harris, 2014). This situation proved to me that whatever leadership style I took on, you have to be adaptable and be prepared to change your style as the situation demands.
The laissez-faire approach from the paramedic allowed me to develop my skills and give me the experience of controlling a situation. Although I was inexperienced in trauma, the laissez-faire style of the paramedic worked well to help me expand my skills and as we were working in close proximity, they were getting instant feedback from the situation and were able to help if they were needed. I felt this helped me to be more comfortable with the situation as they were there as backup if required. As the paramedic had taken on a coaching role this helped me to focus on what it was that was required and what I needed, which I feel worked well in this situation as it was my first trauma incident. The coaching method enabled me to ask the questions to see what it was that I needed and how to do it, in a situation I was unfamiliar with.
Once the MERIT team had taken charge of the situation using an autocratic style, I was in less of a leadership role and more of an assisting role. I believe this was the better style of leadership to use for the situation as we did not know the full extent of the injuries to the patient but the history suggested that it could be time critical. Using a more relaxed approach such as a democratic style, would not have been effective in this scenario as it would have taken valuable time away from getting the patient the best possible treatment
Due to the increased experience of the staff on scene, the OMs laissez-faire style was good as they allowed all levels of expertise of the dealing crew and MERIT team to deal with the patient whilst keeping a distance. The OM was still available in case the dealing team required further resources but remained at a distance so as not to overcrowd the situation.
Although the situation was my first trauma situation I believe it went very well, especially after talking with the MERIT team once the patient was at hospital. I do believe due to the nature of the job, especially if the trauma had been more significant, and that a debrief would have proven beneficial. Zenger, Folkman and Stinnett (2010) designed the “FUEL” coaching model that can be used for more long term goals, allowing the mentor and mentee to discuss what had happened and be able discuss an approach to developing their skills and their confidence when dealing with similar situations. I feel this type of mentoring would have been beneficial to help me in case further situations were to occur.
Action plan
By creating an action plan using the SMART format I realise some future development can be made to help develop my skills and leadership style (Gibbs, 1988).
Specific – Research further management procedures including leadership styles best used for trauma cases, especially those caused by stabbing.
Motivation – To better prepare myself for future situations where a patient has suffered a major trauma.
Achievable – Speaking to my mentor, using local policies and procedures, and further research into best leadership styles for traumatic situations
Results – Better knowledge and understanding of how to manage situations and patients in similar situations
Timely – continued development and research with further understanding before next period of time working.
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