Problem Identification
The rapid changes in the contemporary, highly industrialized, and digitalized world induce significant and continuous advancements in healthcare. The ability to lead change competently and effectively is one of the most valuable skills of a modern team leader at a health care organization. Nursing practice is characterized by a scope of responsibilities and areas for improvement as new research findings, and statistical data become available and emphasize the needs for change. One of the issues that require professional addressing in the medical inpatient setting is the development of pressure ulcers in patients with impaired mobility.
The majority of patients who are bedridden fall under the category of senior citizens. Being unable to move independently, older patients are exposed to spending most of their time in bed, which provokes pressure ulcers. Hospital-acquired pressure ulcers are skin or tissue injuries that occur due to pressure or friction (Hallaj, 2017). Pressure ulcers lead to significant comorbidities and often become a cause of death of American patients. The statistics demonstrate that almost 2.5 million patients acquire pressure ulcers each year in the United States. According to Hallaj (2017), “pressure ulcers hence have detrimental physical, social and functional consequences for older adults, health services and the community” (p. 58). Since many hospitals face the challenges of preventing pressure ulcers in elderly patients, there is an urgent need to implement a change that would facilitate nurse’s practice aimed at minimizing pressure ulcers occurrence and comorbidities associated with them
Change Model
Facilitating the Change
Advanced practice nurses’ (APN) change management competencies play a pivotal role in advancing health care practice toward time-appropriate requirements. A change model that might be applied to the implementation of a new protocol for preventing pressure ulcers in elderly patients should be based on a theory of organizational readiness to change (Nilsen, 2020). According to this approach, the investigation and evaluation of the team’s readiness for change implementation is a core element of successful improvement. Thus, APNs must diagnose the problem, assess the team’s preparedness, evaluate resources, ensure the team’s engagement in the change process, conduct the change according to the goals, and maintain the implemented improvement in practice.
For the particular case of pressure ulcer prevention in elderly patients, the new protocol for using smart medical beds is proposed. Multiple research studies demonstrate the positive outcomes of using smart beds and matrasses in pressure ulcer prevention (Ghersi et al., 2018; Stojmenovic et al., 2019). “Supplementing design features, customization of finishings, and materials” allow for achieving the best fitting surface for each patient’s bodily characteristics that minimize pressure and allow for equal distribution of body mass without causing tissue injuries (Ghersi et al., 2018). When implemented alongside traditional pressure ulcers prevention techniques, such as positioning change, nutrition, and skincare, smart beds have the potential to eliminate the burden of pressure ulcers for elderly patients (Hallaj, 2017). Thus, the specific roadmap for change implementation with the addressing of possible resistance is justified by the significant positive expected results.
Addressing Possible Resistance
Possible resistance to the proposed change might be rooted in the financial considerations due to the funding constraints and restricted budget. However, research shows that the launching of smart beds for pressure ulcer prevention might save significant sums from a long-term perspective. Indeed, as Stojmenovic et al. (2019) state, pressure ulcers-induced morbidity and mortality rates in the elderly become “a major economic burden to the healthcare system” (para. 3). Medical organizations spend approximately $19 billion for pressure ulcers and nonfatal falls in patients aged 65 and older (Stojmenovic et al., 2019). Thus, the validation of the proposed change with the help of economic concepts will allow for mitigating the resistance. Another source of resistance to change in the team might be the unpreparedness of some nurses to working with electronic devices, which might be more relevant to older nurses. This concern might be eliminated by a well-structured and informative training program.
Plan for Making Change
When planning the change implementation, multiple factors need to be considered. According to the research study conducted by Nilsen et al. (2020), the main concerns of teams undergoing change include an opportunity to influence the change, being prepared for the change, and valuing the change. Therefore, the preparation to change and the engagement of the team in the process by cultivating their concern about pressure ulcers and the benefits that are anticipated upon change-making is essential. Undoubtedly, the very implementation of change is crucial as well. The proposed roadmap provides the outline of the steps necessary to achieve the ultimate goal, which is the reduction of pressure ulcer cases in elderly patients.
Roadmap for the Team
Step 1: Problem Diagnosis
The prevalence rate of pressure ulcers in the facility will be diagnosed to obtain statistical data as the basis for further actions.
Step 2: Team Readiness Assessment
Questionnaires and tests will be used to assess the team’s knowledge about the identified problem, their perceived coping opportunities, and the readiness to implement change.
Step 3: Change Information Dissemination
The plan and objectives of the planned change related to the utilization of smart medical beds in the facility will be disseminated among the team members. It will contribute to the level of informing, knowledge, and readiness. Also, the feedback feature will allow for obtaining the team’s opinions and will address their ability to influence change.
Step 4: Establishing Financial and Organizational Support of the Management
Meetings with management with the presentation of the validation of change will be conducted. Financial and practice-related considerations will be presented as an argument for the change.
Step 5: Nurses’ Training for Smart Bed Maintenance and Use
Four-week in-practice training sessions will be initiated with the active participation of the smart bed manufacturer representatives to ensure competent utilization of the devices by the team members.
Step 6: Outcome Evaluation
Upon the training completion, the results will be evaluated by means of questionnaires and interviews with patients and nurses. The outcomes will be measure according to the experiences of the participants.
Step 7: Follow-up Interventions
Three months after the training completion, the tests will be conducted with the team to track the progress and evaluate the quality of change implementation. Also, the rates of pressure ulcers in patients will be compared to those before the change to assess the achievements.
The Importance of Effective Communication During the Change
The implementation of a change to practice involves multiple stakeholders and factors, which need to be addressed through effective communication. According to Nilsen et al. (2020), team engagement in the change process increases the potential of beneficial outcomes. Therefore, information exchange, opinion consideration, and feedback are crucial for functional team collaboration. The ability of APNs to establish result-oriented and competency-driven relationships in the team will determine the successful achievement of the set goals.
References
Ghersi, I., Mariño, M., & Miralles, M. T. (2018). Smart medical beds in patient-care environments of the twenty-first century: a state-of-art survey. BMC Medical Informatics and Decision Making, 18(1), 63.
Hallaj, F. (2017). Preventing pressure ulcers. Alexandria Scientific Nursing Journal, 19(2), 57-68.
Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20(1), 1-8.
Stojmenovic, M., Gedeon, T., Qi, H., & Buhari, S. M. (2019). Health informatics: Applications of mobile and wireless technologies. Wireless Communications and Mobile Computing, 2019. Web.