Leadership Practice: Outline of an Experience

Leadership Practice: Outline of an Experience
Various areas in practice always require periodical improvements. This can be easily identified through leadership experiences and evaluating all the leadership activities within a particular population of patients or practice settings. The paper aims to describe an area of practice concern for Parkinsonism patients and suggest practice approaches based on best practices.

Parkinson’s disease

Parkinson’s disease is a brain disorder that has various symptoms. The disease leads to stiffness, difficulty in maintaining balance, walking, or coordination. Most of these symptoms are gradual but becomes worse with time. Additionally, it leads to various mental changes and alterations in behavior and sleeps patterns. This immensely affects the quality of life of the patients (Bollu & Sahota, 2017). Therefore, there is a need to develop strategies to improve the quality of life of Parkinson’s patients.

I have worked with this population of patients for a very long time. However, through the experience and observations that I have made during my tenure, I have identified one particular area that needs improvement. Most healthcare workers always concentrate on the patients’ mental and most physical symptoms; however, less attention has been directed towards the sleep problems that the Parkinson patients always face. Hence, there is a need to develop approaches based on the best practice that will help improve the sleeping patterns as this tremendously affects the quality of life of these patients.

In the settings where I work, most of the patients are always reviewed, the physical examination are done, and medications are provided. Very few healthcare providers will conduct a sleep pattern assessment and determine the client’s best therapy to improve sleep hygiene. Lack of enough sleep leads to worsening symptoms in Parkinson’s, such as depression, among other emotional changes (Loddo et al., 2017).

The literature review provided a pathway that can be explored to improve sleeping hygiene among Parkinson patients. I believe that carrying out of sleep pattern assessment, health education, and recommendation of acceptable sleep hygiene practices with adjusting drug doses can reduce sleep disruptions among this population. There can be the utilization of the Parkinson’s Disease Sleep Scale (PDSS) by all the healthcare providers to assess the sleep patterns. Moreover, they can recommend practices like timed light therapy and proper management of the physical symptoms like nocturia, which are significant factors leading to sleep disruptions in the patients. Some medications can also be avoided or replaced with others if they affect the sleep pattern (Videnovic et al., 2017). These new approaches aim to improve the quality of life for all the patients by providing holistic care.

The implementation of the above strategies will ensure that each patient that comes into the facility is assessed. Recommendations of sleep behavior rules such as regular daytime physical activity, withdrawal of drugs affecting sleep, reducing dopaminergic load, and educating patients on adherence and application of sleep hygiene rules are provided to improve the non-motor symptom in Loddo et al. (2017).

In this essay, the best practices related to sleep management in Parkinsonism will be suggested and the additional resources needed to improve the quality of life of the affected people. To achieve these, the following will be handled;

  • Review the literature: between 250-350 words = approximately 1-1.5 page(s)
  • Determine best practice recommendations: approximately 250 words or 1 page
  • Stakeholders: between 200-250 words = approximately 1 page
  • Outline the tasks and resources: between 200-250 words = approximately 1 page
  • Expected outcomes: between 200-250 words = approximately 1 page
  • Creating awareness for change: between 200-250 words = approximately 1 page
  • Conclusion: approximately 150 words = approximately 1/2 page

Review of Literature

Parkinson’s disease affects around ten million people worldwide, with approximately 1 million being in the US. Precisely about 60 000 people are diagnosed with PD every year.  The incidence of PD increases with age, and about 4% being diagnosed before the age of 50. The numbers continue to grow in various healthcare settings; hence there is a need to develop multiple leadership strategies through experience to improve the quality of life for these patients precisely when it comes to sleep assessment and problems, as illustrated in Rossi et al. (2018).

According to Stefani & Högl (2020), sleep is one of the common symptoms in PD patients, increasing along with lifespan. Some of the sleep disorders among PD patients include insomnia, REM sleep behavior disorder, or increased sleep during the day, which can occur nocturnally or diurnally. Moreover, there are various causes of sleep disorders in this population. They include neurodegeneration and disruption of the sleep cycle through alteration in the brain amines that maintain the sleep cycle. Therefore, there is a need for nurse leaders to take note of these factors that are involved in sleep disorders in PD patients to work with this population effectively.

Nurse leaders and healthcare staff can apply various strategies to ensure that sleep problem in POD patients is effectively managed. Some of the strategy include sleep assessment, health education of sleep hygiene, and alteration of drugs that affect these patients’ sleep. All healthcare providers involved in the management of these patients must ensure that a sleep assessment is performed as this will help detect a sleep disorder. After that, the additional interventions can be brought forth. Therefore, the nurse leader must ensure that this is implemented (Chahine et al., 2017).

The effects of lack of sleep or enough sleep among PD patients has a significant impact on their prognosis. Sleep increases with age in PD patients; hence there is a need to tackle the issue in the early stages. Some of the impacts include worsening the condition, depression, and some lifestyle disorders like diabetes or hypertension. Thus, sleep disorder should be managed efficiently through best practices to prevent sleep disorders’ side effects.   As a person who has worked with this population for a long time, my main aim will be to manage them effectively and promote their health through evidence-based practices.

Best Practice Recommendations

The nurse leader should pick the best recommendation to handle the problem identified in the practice settings.  A multidisciplinary approach is an essential practice in the management of PD patients. The nurse leader must collaborate with all the departments to ensure that the identified problem is effectively addressed.  Sleep assessment is essential in the management of sleep problems among this population. Nurse and physicians must ensure that sleep assessment is conducted at any therapeutic interaction with this population. Parkinson’s disease sleep scale (PDSS) is a useful tool that can be applied to assess for sleep disorders. Additionally, the utilization of the diagnostic criteria for insomnia can also be utilized for sleep assessment, as in Zhang et al. (2020).

Moreover, Lysen et al. (2019) stated that health education on sleep hygiene would be essential. It is critical to provide health education on physical activity, day time sleep, bedroom practices. This will ensure that the patients engage in productive sleep practices that will increase the sleep cycle and help prevent most sleep disorders because they improve with age. The nurse leader will ensure that all relevant staff provide health education in each hospital visit and reorganize home visits and community health services . Rossi et al. (2018) stated that health education promotes the adoption of positive health behavior and promotes health services utilization. The nurse leader can also implement strategies that will ensure that drugs that affect the sleep cycle in these patients are withdrawn, or their frequency minimized. The nurse leader should ensure that these recommendations are implemented in practice settings to help manage the PD patient’s sleep disorders.


The stakeholders that are involved in this strategy are also essential to ensure that it is successful. Each stakeholder has a specific role in carrying out throughout the process to ensure that the patients’ quality of life is improved. Some of the stakeholders are the community health workers, nurse educators, doctors, physicians, physiotherapists. Other stakeholders include community support groups and nursing homes. These stakeholders will play an essential role in ensuring that the task and resources outlined will be implemented and followed at all levels. The stakeholders will also be involved in the implementation and evaluation of the outcomes of the whole initiative. These stakeholders have been selected because they play an essential role in dealing with PD patients.

The leadership initiative will include all the stakeholders in the decision-making table. This will ensure there is a seamless flow of information and decisions among the strategic stakeholders. The stakeholders will also provide essential resources that are needed to complete the whole initiative. The outcomes of this experience are also necessary for the stakeholders as an improvement in PD patients’ quality of life will also positively impact the results and experiences of the stakeholders.  The organization’s administration, management, and board is also an essential aspect of the whole initiative. The recommendations must have a sportive impact on the health of the patients, be feasible and also have benefits on the side of the stakeholders. The most important outcome

Tasks and Resources

Various tasks and resources will be utilized in the whole initiative. I will undertake the following tasks; identification of the stakeholders and being informed about the leadership experience. The next step will outline the importance and significance of the identified issue to the patient outcomes and the whole organization. Additionally, a multidisciplinary team will be recognized and a collaboration strategy developed through transformational leadership. After developing the team, the next step is to outline the vital task. The crucial central part will be the identification of the sleep assessment tool. The tool is to be harmonized to be used by all multidisciplinary team members and the stakeholders. The relevant consumers are given a short educational session to teach them how to assess sleep in PD patients.

Additionally, I will outline health education strategies to the whole team, and expected outcomes will also be outlined and strategies for evaluation. The central tenet will be implementing the sleep assessment practice, provision of health education, and minimizing drugs that affect the sleep patterns in PD patients. Most drug prescribers will also be informed about the currently needed change and their role in ensuring that they minimize the drugs.

Various resources will be needed to implement and carry out the task effectively. Human resource is essential, as the multidisciplinary team members and the stakeholders must be involved in carrying out the task. The additional aid will be the sleep assessment tool that is very critical in the whole process. Health education resources and tools will also be available, as this will help educate the patients on sleep hygiene. I will avail all these resources in collaboration with the organization to ensure that the whole plan is an absolute success, and all tasks are implemented as needed.

Expected outcomes

There are three main outcomes that is expected from the whole plan.   The first outcome is an increase in the sleep assessment practice in PD patients using various approved tools in the organization. The second outcome is an increase in provision of health education to all PD patients regarding health hygiene. Additionally, drugs that affects sleep will be minimized in all prescriptions for these patients. The health education is expected to increase the level of knowledge and attitude. The change in the knowledge and attitude will make the patients adopt healthy strategies like physical activity and avoiding daytime sleep and this will be essential towards minimizing the effects of sleep disorders.  The central or primary outcome will be increase in the identification, prevention and management of the sleep disorders in all PD patients. The main aim of this is to improve the quality of life by increasing the number of sleep hours. To evaluate these outcomes, the number of sleep disorder screening records will be evaluated at the end of the month. Additionally, the level of knowledge on sleep hygiene among the patients will be assessed and then finally, the impact of this in the quality of life will be evaluated (Stefani & Högl, 2020).

Creating Awareness for Change

Creating awareness of the change is also vital and essential in ensuring effective implementation. I will utilize Kurt Lewin’s change theory to guide the whole change process. Kurt Lewin’s change theory identifies a current state of organization and guides change to achieve the desired process. For the change to be appreciated and adopted, the organization must be aware of the change (Hussain et al., 2018).

To create awareness of the change, the following will be outlined to the stakeholders and the team; the nature of the change and how it aligns with the organization’s vision, the reason why the change is needed, and the impacts of not having the change. Additionally, the benefits of the change will be outlined to all the relevant stakeholders. Moreover, how this change will affect each stakeholder will be outlined. Continues medical education sessions will be used for the avenues of delivering such information. Other avenues will be meetings with other administrative members and managers of the organization. They will be updated accordingly on the essential aspects of the change. I will also involve the managers of the various units and departments that manage PD patients in spreading the message about the proposed change. The awareness will be created among all the relevant stakeholders who will additionally have a role to create awareness in other platforms.


Describing the practice issue in managing sleep disorders in PD disorders will improve the quality of life. The nurse leader identified this practice issues from experience and thorough evaluation in the area of practice. The leader then devised additional strategies to be used in handling the identified problem. I have worked with this population for a long time. The best recommendation that I developed is to have a multidisciplinary approach to improve the management of sleep disorders in patients. The best recommendations designed include creating and implementing the sleep assessment strategy, health education on sleep hygiene, and minimizing drugs that affect sleep. The expected outcomes include increase in sleep disorder screening, provision of health education and improvement in the quality of life and slep among all the patients.  Therefore, handling the practice issue through leadership experience is essential and useful since it provides evidence-based rationales and activities. Additionally, all PD patients need to have quality and healthy sleep patterns to prevent worsening symptoms and improve their overall health status with progression. 


Bollu, P. C., & Sahota, P. (2017). Sleep and Parkinson Disease. Missouri medicine114(5), 381–386.

Chahine, L. M., Amara, A. W., & Videnovic, A. (2017). A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015. Sleep medicine reviews35, 33–50. https://doi.org/10.1016/j.smrv.2016.08.001

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Loddo, G., Calandra-Buonaura, G., Sambati, L., Giannini, G., Cecere, A., Cortelli, P., & Provini, F. (2017). The Treatment of Sleep Disorders in Parkinson’s Disease: From Research to Clinical Practice. Frontiers in neurology8, 42. https://doi.org/10.3389/fneur.2017.00042

Lysen, T. S., Darweesh, S., Ikram, M. K., Luik, A. I., & Ikram, M. A. (2019). Sleep and risk of parkinsonism and Parkinson’s disease: a population-based study. Brain : a journal of neurology142(7), 2013–2022. https://doi.org/10.1093/brain/awz113

Rossi, A., Berger, K., Chen, H., Leslie, D., Mailman, R. B., & Huang, X. (2018). Projection of the prevalence of Parkinson’s disease in the coming decades: Revisited. Movement disorders : official journal of the Movement Disorder Society33(1), 156–159. https://doi.org/10.1002/mds.27063

Stefani, A., & Högl, B. (2020). Sleep in Parkinson’s disease. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology45(1), 121–128. https://doi.org/10.1038/s41386-019-0448-y

Videnovic, A., Klerman, E. B., Wang, W., Marconi, A., Kuhta, T., & Zee, P. C. (2017). Timed Light Therapy for Sleep and Daytime Sleepiness Associated With Parkinson Disease: A Randomized Clinical Trial. JAMA neurology74(4), 411–418. https://doi.org/10.1001/jamaneurol.2016.5192

Zhang, Y., Zhao, J. H., Huang, D. Y., Chen, W., Yuan, C. X., Jin, L. R., Wang, Y. H., Jin, L. J., Lu, L., Wang, X. P., de Wang, C., Zhao, X. H., Zhang, X., Li, W. T., & Liu, Z. G. (2020). Multiple comorbid sleep disorders adversely affect quality of life in Parkinson’s disease patients. NPJ Parkinson’s disease6, 25. https://doi.org/10.1038/s41531-020-00126-x

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