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reply to the following discussions with 100-150 words each. thank you!
DQ 1 (1 below)
Understanding the health care system at the local level is important when it comes to helping patients to provide them with the best effective care to improve overall patient outcome. Multihospital healthcare system leaders and individual nurses are challenged to integrate standardized evidence-based practices that support continuous performance improvement in their systems. Locally, transformational nurse leaders within each hospital can share the vision for implementing EBP; at the system level, transformational nurse leaders can collectively allocate resources to create a system-wide online EBP education plan with EBP competencies and tool kit to increase RN exposure to EBP and standardize practice (Warren et al., 2016). Using evidence based practice to take care of our patients is within the best standard and being able to connect and incorporate patients’ cultural beliefs or values help them understand their care better. They may feel motivated to be more cooperative and want to be proactive in their plan of treatment.
After speaking with my mentor about preventing catheter-associated urinary tract infections (CAUTIs) and the different ways to manage patients with indwelling catheters, we both agree that the staff member taking care of the patient must use aseptic techniques and be aware of preventing any infection. Close monitoring and constant communication with the physician to remove the catheter when the patient no longer needs one is very important because physicians may sometimes forget that a patient has one or forget to put in the discontinuation order. Patients need to be educated as well on speaking up about their plan of care and notifying their nurse or physician about any new signs and symptoms of infection. Many facilities do not have a nurse driven protocol where nurses have the autonomy to remove the catheter however this protocol can increase staff’s awareness of indwelling catheters and allow for independent nursing clinical decision making and judgment.
Warren et al. (2016). The Strengths and Challenges of Implementing EBP in Healthcare Systems. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26873372
DQ 2 (3 below)
One change theory is Lewin’s 3 stage change model that includes, unfreezing, moving and refreezing. Saying that unfreezing is when you recognize change is needed, moving is when a change occurs, refreezing is when equilibrium is established, and you’re satisfied with the results. The cycle may eventually repeat itself.
Another theory is the Lippets seven phase theory. Starting with phase one diagnosing the problem, assess motivation and capacity for change, evaluate change agent’s motivation and resources, choose the appropriate role of the change agent, maintain difference, terminate the helping relationship.
Lippet’s seven-phase theory may be more comparable to the nursing process, there’s not a significant difference between them, but with Lewin’s there are three fundamental steps. Quite often nursing is much more complicated than three levels. Looking back through situations as a critical care nurse, some conditions not so involved, but most were complex on multiple levels. These patients are in critical condition therefor so are the problems that need addressing. Three steps seem like it would be easy just to get stuck in the Moving phase.
My mentor has tried hard to instill change on the site, but it’s challenging if you’re middle management. You have to have a committee to make the difference. Quite often you have to be the tough guy and hold people accountable for their actions. Holding co-workers responsible for their actions is difficult when your peers take it personally and don’t respond as trained professionals.
Mitchell, G. (2013) Selecting the best theory to implement planned change. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=1&sid=45445661-2fc1-450c-a7cd-2a9fd2199e02%40sessionmgr4
There are several different “change theories” in nursing and “The Change Theory of Nursing” is credited to Kurt Lewin, known as the father of social psychology. He described a three-stage model of behavior change that is “dynamic balance of forces working in an opposite direction”. These are the following 3 stages: unfreezing, change, and refreezing. Unfreezing requires finding a way of making it possible to help people recognize an unproductive pattern of behavior and stop it. It requires overcoming individual resistance and group conformity. Change, aka “moving to a new level”, requires a change in either thoughts, feelings, behaviors, or all three. Refreezing involves the “change” as the new “habit” and becomes ingrained so the individual doesn’t revert back to previous habits. Another change theory is from Rogers which is a five-step theory. It is called the Innovation Diffusion theory which desribes how “an individual proceeds from having a knowledge of innovation to confirming or rejecting the decision to adapt or reject the idea.” One interesting component of this second theory is that even if the “change agent” is initially unsuccessful in implementing the desired EBP, it can be tried later at a more appropriate time or in a modified form. This theory also acknowledges the importance of including key “players” such as policy makers, recognizing group strengths, and mitigating factors that impede the overall process. Both of these theories are similar in that both acknowledge that behavior change is complex and multi-dimensional and involves many “social” dynamics as we are basically socially-oriented individuals. The theory from Rogers seems to be a more comprehensive theory, in my opinion. My mentor has not specifically used either of these theories intentionally, but overall has used elements and strategies from both in her clinical practice. For my EBP of skin-to-skin contact (SSC) to promote breastfeeding and newborn/family bonding, I believe Roger’s theory would be most applicable. It allows for the education of patients about the SSC intervention which is ideally used to facilitate breastfeeding. It acknowledges patient preference to decline the intervention even after the education is given. Even if a particular parent rejects the intervention, the overall potential impact on other newborns and their families is considerable. It recognizes the “group strength” of motivated individuals, both nurses and patients, in the maternity setting to improve the health outcomes of newborns and their families.
Nursing Theory/Lewin’s Change Theory. Retrieved from www.nursing-theory.org/theories-and-models/Lewin-Change-Theory
Wagner, Joan and Udod, Sonia. Leadership and Influencing Changes in Nursing (2018). Common Change Theories and Applications to Different Nursing Situations. Chapter 9.
Kurt Lewin (1951) introduced the three-step change model and this change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage and refreezing stage. Lewin’s theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change. The resistant forces are employees or nurses who do not want the proposed change. For this theory to be successful, the driving force must dominate the resistant force.
Another theory is the Everette Rogers five-stage theory. Everette Rogers modified Lewin’s change theory and created a five-stage theory of his own. The five stages are awareness, interest, evaluation, implementation and adoption. This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially.
My mentor used the Lewin theory in implementing the bar-coded Medication administration. Bar-coded medication administration is one type of technology that uses a scanning device to compare bar codes on patient identification bands with bar codes on prescribed medications, electronically verifying the medications against the medication records, thereby reducing medication errors significantly. My mentor choose Lewin’s theory because it can lead to a better understanding of how change affects the organization, identify barriers for successful implementation and is useful for identifying opposing forces that act on human behavior during change, and with the result of overcoming resistance and leading to acceptance of new technologies by nurses.
Oguejiofo, N. (2018). Change theories in nursing. Retrieved from https://bizfluent.com/about-5544426-change-theories-nursing.html