Design for change in practice - Research Paper Example

Design for change in practice is largely based on the framework proposed by Rossuwurm and Larrabee (1999). According to Rossuwurm and Larrabee (1999), design for change in practice is manifested through protocols, procedures, or standards. In the case with communicating terminal diagnosis to patients in order to improve their quality of life design relies on the mechanism of protocols distributed to medical personnel. Since the overall complexity of design determines the likelihood of change acceptance (Rossuwurm and Larrabee, 1999, p.320), protocols contain only well-structured and detailed information regarding terminal diagnosis disclosure practice and follow up procedures aimed to improve patients' quality of life.

Because feedback from patients (stakeholders) is essential when designing a change in practice (Rossuwurm and Larrabee, 1999), design also includes a questionnaire produced to measure changes in patients' quality of life. (1) Practice of terminal diagnosis full disclosure. . As explained by Fitch (1994) once a word like "cancer" or "terminal" is heard, a mental retreat is often enacted and thus true communication may not take place until the stark essence of the initial message has been absorbed.

Similarly, when news of terminality are communicated rapidly, the patient may remember very little of what has been said. Therefore, in order to implement this change in practice some patients should have information about their terminal diagnosis divided into manageable stages so that self-perceptions gradually shift from well, to ill, to dying over a period of days or weeks. The fundamental premise of this change in practice is that physicians should exclusively opt the strategy of full disclosure of terminal diagnosis for their patients. (2) Eliminating avoidance practices.

The issue of death and dying like any topic or situation that creates anxiety tends to trigger avoidance responses. In medical practice, two types of avoidance may be seen: physical avoidance, in which an individual makes an effort to avoid being in the presence of persons, places or objects that cause anxiety; and topical avoidance, in which a clinician avoids thinking or talking about an anxiety-producing issue. Physicians and nurses tend to avoid patient feelings (i.e., depression, anger, or anxiety) by focusing on the explicit content of the patients' message (Dilbeck, 1996).

Related to this response in medical personnel is the finding that patients report that technological interventions and procedures cause them to feel that their need for support through compassion and caring is being denied (Super & Plutko, 1996). Patients cannot