Changes Within Healthcare : An Essential Component Of Quality And Improvement

According to Porter-O’Grady, 2016 et al p 324, our healthcare systems today are at the center of what is considered major change. Much of the change today is directly related to the foundational principles, concepts and associated with complexity in systems and relationships, and an understanding by nurse leader and follower; of what it takes to make meaningful change. Nurse Leaders, registered nurses, advance practice nurses, and other followers, at every level of our organizations must be increasingly aware of meaningful and sustainable changes that improves our healthcare systems (Porter-O’Grady, 2016 et al p 324).

Nursing theories have been a fundamental tool used to explain, guide and improve the practice of nursing. Theorists have contributed enormously to the growth of nursing as a profession. The four grand theorists I chose are Virginia Henderson, Peplau, Myra Levine and Jean Watson. These theorists have contributed tremendously in the field of nursing through their theories, and research. One thing the theorists have in common is that they are patient centered. They are all concerned on ways we can improve our responsibility to the patients, their families and the environment. They have different ideas but they are all aiming towards achieving the same goal, which is patient satisfaction and safety. Their differences are in their areas of

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

The Institute of Medicine (IOM) noted that nursing is the largest profession in healthcare in the United States, with more than three million members (2010). Thee IOM also noted that there are many barriers that prevent nurses from adapting to the ever-changing healthcare setting and system, and that these berries need to be addressed in order for nurses to advance health and lead in the change that is happening within the healthcare system (IOM, 2010). The four barriers the IOM focused on were: nurses should practice to the full extent of their education and training; nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States; and effective workforce planning and policy making require better data collection and an improved information

The Change Theory was developed by Kurt Lewin. He identified three stages in change: unfreezing, changing, and freezing. According to Lewin, in order to be successful in implementing a change, people must go through all three steps. The first step is understanding that a change is necessary. In the scenario, the staff may have been comfortable with their routine and disregarded the moderate sedation policy because no sentinel events had occurred previously. To unfreeze this behavior the staff must acknowledge their behavior and realize a change is needed. A thorough review of the findings that lead to the death of Mr. B will may assist the staff in recognizing the need for change. The second step is the “change”. In this stage the staff would update the moderate sedation policy and implement the recommended changes. Such as, one on one nursing monitoring, vital sign monitoring, and completing or updating required education. The third is “Freezing”. In this step the staff has implemented and performed the desired changes until they have become the standard practice. This will reduce the likelihood

Nursing-sensitive indicators are important in all aspects of patient care. A great deal of bedside care is given by nurses. Nursing-sensitive indicators are factors that rely directly on the nursing care of the patient. Quality nursing care improves patient care and therefore patient outcomes. Nursing-sensitive quality indicators promote patient safety and quality patient care. Since these quality indicators are reflective primarily on bedside care provided by nursing staff it is important that all nursing staff be aware of these indicators and their role in promoting quality patient care. There are specific indicators that could have been taken into account to promote patient

Preparing our nurses to assist in changing our healthcare system is a crucial step to provide more efficient, affordable and accessible care to all patients. Nursing is one of the fastest growing careers in the healthcare field, by utilizing the opportunities to improve education, undertaking leadership positions, and providing patient centered healthcare the undertaking of changing the healthcare system will be a positive change. Redefining the role and responsibilities of the nurse towards primary patient care in this remodeling process is crucial in implementing an effective and efficient health care system.

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

Being a registered nurse affords one the option of working in many diverse healthcare settings. In any practice setting the climate of health care change is evident. There are diverse entities involved in the implementation and recommendation of these practice changes. These are led by the Robert Wood Johnson Foundation (RWJF), the Institute of Medicine (IOM), nursing campaign for action initiatives, as well as individual state-based action coalitions. Nurses need to be prepared and cognizant of the transformations occurring in health care settings as well as the plans that put them at the forefront of the future.

Nursing care delivery is defined as the way task allocation, responsibility, and authority are organized to achieve patient care. Tiedeman and Lookinland (2004) suggested that systems of nursing care delivery are a reflection of social values, management ideology, and economic considerations. (Tiedeman&Lookinland, 2004) According to Fewer (2006), the quality of nursing care delivery systems affects continuity of care, the relationship between nurse and patient, morale, nurse job satisfaction and educational preparation.(Fewer, 2006) Nurses are essential human resources to provide medical services with professional knowledge and skills in the healthcare setting. However, the registered nurse turnover rate has increased in recent years resulting

According to the IOM report, the nursing profession is undergoing fundamental changes within the underlying operations of the field. A new regulatory environment coupled with increased scrutiny of the profession will dramatically impact the nursing profession. As the report indicates nurses, in the near future, will have job requirements that are business oriented. Nurses will need to have a better understanding of quality management methods in addition to overall concepts of management. As the health care system continues its rapid reform nurses must also be cognizant of the effects these changes will have on their overall roles and responsibilities. This involves a transformation of the roles and responsibilities of nurses as they enter the profession. As the health care landscape continues to change, so too must the nurses of the future. A dedication to continual learning is therefore needed to help diminish the influence of antiquated and obsolete knowledge regarding the profession.

for buy-in, enabling action, creating short-term wins, don’t let up, and making it stick). Bridges

Ongoing development and changes in healthcare delivery enable nurses to maintain standards of nursing and develop their competence and performance. Through this the patients well-being is maintained, respecting them through accessing up to date knowledge and skills that are essential in an ever changing environment.

Kurt Lewin developed a model of the change process that has stood the test of time and continues to influence the way organizations manage planned change. Lewin’s change model is a three-step process. The process begins with unfreezing, which is a critical first obstacle in the change process. Unfreezing involves encouraging individuals to shed old behaviors by changing the status quo. The second step in the change process is moving. In the moving stage, new attitudes, values, and behaviors are substituted for old ones. Organizations accomplish moving by initiating new options and explaining the rationale for the change, as well as by providing training to help employees develop the new skills they need. The last step in the change process is Refreezing. In this step, new attitudes, values, and behaviors are established as the new normal. The new ways of operating are concrete and reinforced. Managers should ensure