This paper will introduce the elements of our change project which encompassed, the development of a needs assessment, creating a presentation regarding pressure ulcer prevention for the employee, and the design of a poster and, pamphlet, as well as the rational of choosing this project. Moreover, the paper will present the main concepts that are relevant to the process of implementing change by using Lewin’s Change Theory. In addition, the paper will focus on strategies for developing a needs assessment, teaching sessions for the employee, pamphlets and a poster that address pressure ulcer prevention at the George Derby Care Centre. These components are going to be discussed according to the unfreezing phase of Lewin’s Change Theory. Furthermore, the driving and restraining forces in the change process and the role of nurses’ in the change project will be addressed.
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Nature of the Change Project and Its Rationale
Our group was delegated to carry out a change project that will implement positive change for the George Derby Centre. In the initial meeting, our mentors introduced and orientated our group to the facility; they also presented us with some of the barriers that the agency faces, such as lack of equipment, high ratio nurse patient, and lack of a policy addressing pressure ulcer prevention. After the initial meeting with our mentors it was established that the main focus will be on creating an attainable policy on pressure ulcer prevention and preparing a presentation of recommendations for pressure ulcer prevention to agency staff. However, subsequently, it was concluded that there are too many factors involved in policy making and therefore, we will not be developing a pressure ulcer prevention policy. Consequently the paper will focus only on developing a needs assessment, and teaching the front line stuff about pressure ulcer prevention.
In order to identify barriers and areas of benightedness in the basic steps and methods of pressure ulcer prevention among frontline staff, our group decided that a needs assessment is necessary. The rationale for this project is that, elucidating the barriers to minimizing the incidence of pressure ulcers within the facility, analysing the feedback to a needs assessment from the staff, and providing education in the areas where staff lacks the knowledge and skills will offer us an insight into where change needs to be attained. It was obvious from our meetings with our mentors that they are committed to change and willing to embark on a multifaceted approach to solving the problem of pressure ulcers that ultimately will alleviate residents suffering, enhancing their well being and reducing the cost of medical care.
In 1951, Kurt Lewin introduced the Change Theory which theorizes a three stage model of change that the change agent must undergo for planned change to occur as unfreezing, movement and refreezing (as cited in Marquis & Huston, 2008). Unfreezing is the first phase in which the change agent convinces group members and make them aware that a change needs to be implemented (Marquis & Huston). This stage focuses on gathering pertinent data, identifying the issue, determine whether change is needed and communicate the need for change to everybody involved. In the second stage, the movement, the change agent focuses on identifying, planning and implementing appropriate strategies ensuring that driving forces exceed restraining forces. The last phasee is refreezing (Marquis & Huston, p. 169). Two important elements of the change process are the change agent and the stakeholders. Moreover, Lewin’s Change Theory mentions about the concept of driving and restraining forces.
Plan of Purpose Change Project
This segment of the paper will focus on strategies that address the development of needs assessment and avenues in educating the front line staff focusing on the areas of knowledge gaps. The plan demonstrates the unfreezing stage of Lewis’s Change theory and consists on assessing the issue, reviewing the literature, and identifying eventual restraining and driving forces and the stakeholders.
Data collection: Literature review
After establishing the plan of action, it was agreed upon by our group that there is a need for laborious research on the main components of our project. Because our project encompasses a multitude of tasks, our group divided the work in order for a thorough research on the topic to be carried out. Relevant research topics focused on how to develop a needs assessment. The teaching process will be accomplished via three avenues: Power Point presentation, pamphlets and posters. For this part, the focus will be on how to create a pamphlet and design a poster, and the development of a Power-Point presentation. Moreover, for this topic, literature review on question development, survey distribution and collection, enhancing survey response rate, and literature review on adult learning (most effective way to teach to adult audience) as well as teaching to an ESL population will be pursued.
According to Rattray and Jones (2005) in order assure content validity of a project, data can be gathered “from a number of sources including consultation with experts in the field, proposed respondents and review of associated literature” (p. 237).
A needs assessment can be defined as a “formal, systematic attempt to determine and close the more important gaps between ‘what is’ and ‘what should be’ (Kaufman and English, 1979, p. 8). A mandatory condition for a survey result to be relevant is that the response rate is acceptable. To increase the response rate, the team that designs the survey should focus on knowing the respondents, requesting participation from respondents in advance, providing information about the purpose, giving the respondents time to complete the survey and, last but not least, offering an incentive for participating (The University of Texas at Austin, 2007).
According to Paul, Redman and Sanson-Fisher (2003), a review of the effectiveness of print materials found that pamphlets could be effective in changing knowledge, attitudes and behavior in relation to a wide range of health-related issues. Newel (1996) states that, in order to maximize the comprehensibility of the main message on a pamphlet, the use of short sentences, a low reading level, and use of illustrations is necessary. Up to this point, the remaining tasks had not yet been covered.
Identifying the Problem
Our project will influence positive change for the residents of George Derby Centre. This centre hosts 300 residents. The majority of residents are male and veterans of the Armed Forces. During the meetings with our mentors it was concluded that there is a need for educating front line staff about basic knowledge regarding pressure ulcer prevention. It was decided by our mentor and the group to focus on developing a needs assessment and, based on its results, to design tools to educate front line staff on pressure ulcer prevention. In our visit to the facility our group has made a series of observations. By talking to the care coordinator we learned that a full skin assessment is done once a week, on bath day, ratio care aide patient is 1: 14, there are only two part time PT and two part time OT, and there is insufficient transferring equipment and special mattresses. Also, Braden Scale tool assessments are found online but care aids have no access to computers. In many instances, care aides get caught up with time and task pressure that they easily miss the finer things like repositioning.
Despite the fact that at the moment there is a low number of residents affected by pressure ulcers (only 12, which translate into 4% of total number of residents), the agency and our mentor insisted on creating education tools with a focus on the prevention aspect.
According to Canadian Association of Wound Care, the prevalence of pressure ulcers in Canada is 25% in acute care, and 22% in mixed health -care settings. Moreover, a month of treatment of pressure ulcers averages 9000 CAD. Therefore, with a simple algebraic formula the average monthly cost for George Derby can be estimated as following: % of prevalence (22% for a mixed health care setting)* number of residents (300)* monthly costs (9000 CAD) translates into 594000 Cad spend just for pressure ulcer treatment. Consequently it makes economical sense to focus on prevention rather than treatment. This saved money could be very well allocated in different direction such as acquiring new equipment, specialised devices, skin care products, easing the load of current staff by hiring additional staff and so on.
Steps in Project Plan
Under mentor guidance, the group has agreed on the time-line and on how the elements of our projects will be carried out. The needs assessment was already completed and approved. The next step is distribution of needs assessment to the staff which will be done with support of our mentor. It was agreed that, the mentors will send out a memo explaining the questionnaire topic and the importance of it. After that, memos and questionnaires will be passed down to care coordinators at every unit and will be discussed and distributed at report. A deadline will be given; the established date is October 20th.
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The second item of the project is a teaching session. To promote presentations, mentors usually send out emails and memos to care coordinators. The topic then gets discussed at report and staff members are assigned to attend to 15 -20 min presentation. We plan one full day of continuous presentations in the Rose Room at George Derby on November 23rd, 2012.
Stakeholders are defined as entities that “play a role in the organization’s health and performance or that are affected by the organization” (Marquis & Huston, p. 276). Our instructor and our Douglas College student group have a shared interest in implementing a positive change for the George Derby facility and therefore we are representing external stakeholders. In designing the needs assessment we have meetings with the mentor and the health care staff, who are part of the internal stakeholder group. Moreover, volunteers, residents and their families are also internal stakeholders.
Potential Driving & Restraining Forces
The project is due for success because of our group eagerness to practice research theory and learn new information and new skills in all aspects of the project. By going through the research phase, our group will have a chance to practice some of the most important roles of a nurse, research and teaching. Moreover, the group is motivated by the desire to improve residents’ well being and maintain an optimal quality of life. Another driving force are the change agents, our mentors, who strive to fulfill George Derby’s mission, to maintain residents’ “optimal level of personal health and well-being within a caring and supportive environment “. Furthermore they are determined to save funds by focusing on prevention. Also, one of their goals is to educate and enhance staff knowledge and skills. Possible restraining forces consist of staff reluctance to change their way of performing daily routine. The change agent will ensure the integration of our education tools in their daily tasks. Another restraining force could be a low response rate to our needs assessment. To combat that, our mentor established a dead line for formulary completion and posting the memos in visible places. Low attendance at the education session and failure to understand the message due to a high rate of ESL front line staff could potentially be barriers in the success of our project.
Nurse as researcher, educator and change agent
The nurse’s role as a researcher is paramount in promoting and executing change. We, as nurses, need to understand the process of research. As nurse researchers we must be capable of selecting the most relevant research data, and by critiquing, analysing and evaluating our findings we would are able to integrate them into our daily practice. This will help “anticipate and meet these constantly shifting challenges and maintain the profession’s societal relevance” ( LoBiondo-Wood, Haber, Cameroon and Singh, 2009, p. 5). By correlating evidence from research, clinical expertise and client preferences we can build upon a sound principle of evidence based nursing.
In the managing process of our project we have allocated important resources to conduct research pertaining to all element of the project. Not only have we improved our knowledge regarding pressure ulcer prevention, but, we were able to select the most relevant evidence based practice to support our project. With the knowledge acquired we developed a needs assessment and its analysis will lead us in determining where the gaps in knowledge need to be addressed through an education session complemented with pamphlets and posters.
Throughout this process we understood that the research findings and their application in practice is a major component of our job and by committing to this role we contribute to the “advancement of nursing science” ( LoBiondo-Wood, et all, 2009, p.6).
The next step of our project is to disseminate our findings and data to the audience. Based on the results of the needs assessment we will develop a teaching plan which will be used as a tool for the agency to improve and implement change in needed areas. The nurse’s role as researchers should be complemented by their roles as educators. We should be able to not only teach our patients, their families and our colleagues, but also “should act as facilitator, creating an environment conductive to learning “(Bastable, 2008, p.14).
Nurses may play the role of change agent, through their vital role in driving improvement for health factors at individual, family and community levels. A nurse can act as change agent in any health-related settings, such as hospital, community or family settings, and healthcare education institutions.
A nurse can became an effective change agent being motivated by making a difference in patients’ life, families, the work place and community. Nurses are natural change agent due to their unique position as the catalyst between patient and the other health care workers. In their leadership position, nurses have the power to promote change and transform the environments they are working on. Managing a range of responsibilities, advocating for their patients, fostering effective interaction, acting as a change agent are some of the tools that allow nurses to make a difference in the lives of their patients, colleagues, and the community.
This paper introduced a change project to be carried out at George Derby facility. To implement this change we focused on strategies related to unfreezing stage from Lewis’s Change theory. To pursue the change we needed to develop a needs assessment, the results of which will be used to develop an education session and additional tools. Promoting change and developing education tools is a time consuming process which requires steeping in a diversity of nurse’s roles as a researcher, an educator and a catalyst of change.
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