Nursing Change: A Case Study

A study was done at a 1,300 bed urban facility over a 13-week period. The purpose of the study was to describe the causes of inpatient falls in hospitals (Hitcho, et al., 2004). All falls were reported except falls in the psychiatry service and during physical therapy sessions. During the 13-week period, a total of 183 patients at an average age of 63.4 years old fell. Of the total number of falls 79% were unassisted, 85% happened in the patient room, 59% occurred during the evening or overnight shift, 19% were while walking, and 50% were elimination related (p. 732). In this study it was identified that many patients did not use their call bell before getting up because they did not believe they needed assistance. It was stated that, “perhaps patients need to be better educated on the effects that a new environment, decreased activity, medications, tests, and treatments can have on patients’ energy and ability to ambulate safely” (p. 737). The findings of this study showed that falls not only happen in the elderly, but in the younger population as well. Patients that fall in hospitals are often unaided and are due to elimination needs. To prevent falls and decrease injury rates, more studies need to be done.

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).

These changes are then reinforced to employees by the Charge Nurses in Morning Huddles and in special called Safety Huddles throughout the week. While management is very open to change, implementation of the changes must be carried out by the actual hands-on personnel, and this often times leads to fear of the unknown. As Yoder-Wise (2015) states, “All changes, whether perceived as positive or negative, large-scale or simply, are scary and generate fear” (p. 307). In the short time I have worked in the ED, I have seen both support and resistance among co-workers regarding change processes. While some embrace change, others resist, and are set in their ways viewing change as inconvenient and an addition of time-consuming steps to an already stressful environment. Most whom I work with, when presented with the facts and evidence behind the change, view it positively and have no problem implementing it.

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

People generally like to stay in their comfort zone, they do not like changes. However, change is a necessary part of life, we see change in nature every day. Change can be positive or negative. We can choose to embrace the change or reject it, we also can choose to allow the change to have a negative or positive impact on our lives. Helmstetter lists six steps when dealing with change. First to recognize the change, then to decide if you are going to accept or reject the change. The next step is to choose your attitude toward the change, then choose how you are going to deal with it and what actions you are going to take. The last step is to evaluate your progress of accepting the change (Lamberton and Minor, 2012)

Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff and patients. According to Mclean (2011), “Every change begins with an ending” (p.79). How people respond to change can make the process easy or hard depending on how the change is presented.

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.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Implementing a change project is a challenging step of the Capstone Change Project. This paper focuses on steps that must be taken to implement a change, strategies to ensure the success, involved stakeholders and their roles, educational requirements, safety issues, ethical considerations, and external or internal regulations’ effects on the process. It also include the change theory, nursing theory, and evidence based practice influences on the implementation process.

In the healthcare facility there are many things that can benefit from change. Bedside rounding with the inclusion of the entire care team would be a beneficial change to any healthcare facility. By doing bedside rounding it promotes patient and family involvement in the exchange of information and planning of their care. This also allows for the interdisciplinary team to be completely involved rather than picking up bits and pieces of information throughout the day from multiple different people. This is also a great opportunity for the patient and their family to ask questions with the entire care team available for answers.

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 healthcare industry is an ever changing system in which there is constant pressure for it to provide quality care while maintaining rising cost. The pressure exerted on a healthcare system is exemplified by managed healthcare. This type of care involves integrating and comprehensive systems of health care providers, insurance, companies and government programs. University Hospital is a very large teaching hospital which scores well on accreditation tests and is known for its high quality level of care. Like all hospitals, they need to work on improving their financial situation. In order to alleviate financial stress, the hospital has taken on a “differentiated nursing practice” which has registered nurses as care

Every profession embraces change. Whether it is small, like a simple word addition to the important Patient Information document, or large, like a staff shift, the medical field is constantly changing. To fully understand the scope of what it means to change, I have been challenged to ask “Why?” The answers have helped me grow at Eastside Medical Center.

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.

While many health care practitioners are willing to change, the issue is that change is often mismanaged by leaders whom are either incompetent or lack the resources to follow through in the implementation of change. An example was documented in a study of a California hospital unit where patient satisfaction scores rose and immediately fell. At the time, the hospital was going through transition. The nurses in the unit saw this as an opportunity to improve patient satisfaction score. They initiated the process by recommending that the new chief executive officer (CEO) change the current procedure to one that could led to the improvement of patients’ satisfaction. The result, in a few months