Nursing Management in Australia - Research Proposal Example

?Nursing Management Number: ial Time: This report aims to address the following objectives to outline your proposed change providing a clear rationale for the change; (2) to present a force-field analysis of the forces that are driving and restraining the proposed change; and (3) to suggest a strategy that might be used to help bring about the change Table of Contents Abstract 2 Proposed Change 4 A Force-Field Analysis of the Proposed Change 6 Strategy 7 Appendix 9 Reference List 10 Proposed Change Ward rounds has been a central activity of hospital life for hundreds of years and described as “a parade led by the senior doctor, with junior doctors, medical students, nursing staff and allied health staff in tow” (O'Hare, 2008, p. 309; Bradfield, 2010, p. 193). Evidences from the Garling Report and Bradfield’s evaluation in 2010 showed that records of ward rounds are often incomplete in terms of documentation of patient’s questions and that the use of a ward round checklist tool improves trainees' performance in communication and documentation during ward rounds (Bradfield 2010, p. 193). In line with this, the author proposed that representatives from the medical staff should also monitor, evaluate and approve the written records of the ward rounds, in addition to chief nurse or nurse managers. Reasons for changes include: incomplete records of ward rounds and documentation of patient questions when documentations are checked and monitored by chief nurse or nurse manager only; use of a ward round checklist tool improves trainees' performance in communication and documentation during ward rounds (Bradfield, 2010, p. 193); any needed intervention from other members of the multidisciplinary team could immediately be well accounted for and included within the scheduled patient care; closer clinical supervision of junior doctors results in better patient outcomes (Kennedy, et al. 2007, p. 1080); and double-checking reduces medication errors in a nursing context (Bomba and Prakash, 2005, p. 68). In addition to the inclusion of medical staff in monitoring, evaluating and approving written records of ward rounds, the author also mentioned the use of a ward round checklist tool. A ward round checklist is an important tool used to ensure and improve overall standards of care by reflecting on all the work and decisions that are of importance to patients (Herring, Desai and Caldwell, 2011, p. 21). In this paper, the author adopted Caldwell Checklist to use in ward rounds. Caldwell Checklist is grouped according to health team’s work pattern, preparation before going to the bedside, patient consultation, relevant bedside charts, ceiling of care, discharge planning, planning, documentation, summing up, and any conversation with relatives and in which yellow-colored areas represent essential check domains and while those white areas represent domains applicable only to some patients such as blood glucose chart (see Fig. 1) (Herring, Desai and Caldwell, 2011, p. 21). The use of Caldwell checklist in a ward round may improve the standards of care because of its simplicity that takes up only one side of the A4 paper, ease of adaption in clinical context, and recording of matter that has been considered and decided, if needed. Upon establishment of the proposed changes and the checklist that would be adapted, the next step is to integrate the proposed changes and the checklist into the institution’s operation. This could be done by creating a medical group for ward rounds that includes medical staff, chief nurse or nurse managers, consultant, and other professional observers. One of the members of the medical staff will act as a leader and each nurse will do their routines in assessing, monitoring, evaluating, and documenting client’s concerns and conditions. The leader will assign a checker (either the chief nurse or nurse manager) that will observe nurses’ documentation of ward rounds, ensure everything to be covered, and report and correct any omissions or errors. Yellow domains that are not covered may be marked with a circle while white domains can simply be left blank. Omissions or errors that are corrected can be tick off and be considered in the documentation process. The final review of the filled-up checklist will be on the hands of the medical staff and other professional observers but only the members of the medical staff are allowed to get all of the items on the list addressed. This is due to the fact that conducting ward rounds is an essential part of doctors’ hospital activities and only authorized persons in the care of the patients, such as doctors, are eligible to get all of the items on the list addressed (Norgaard, Ringsted and Dolmans, 2004, p. 700). In terms of enabling the patient/family to get to see the checklist and have input, we have a bedside communication sheet in our unit that we use on rounds and it has helped with our communication as we review the plan of care for the day/night and it stays at the bedside for all of the providers and parents to review. According to Cypress (2012), client and families’ involvement in ward rounds may coincide with the principle of privacy and may put medical staff at risk for litigations; however, the greater benefit of improving the line of communication between families and health care team outweighed the risks involved (p. 53). A Force-Field Analysis of the Proposed Change Force field analysis was developed by Kurt Lewin, a technique in which the basis and nature of change depends on the balance of driving and restraining forces in relation to a particular target situation or something that you want to change (Buchanan and Huczynski, 2004, n.p.). A force field analysis is used in structuring discussions around change and in identifying forces that work for and against change. In this paper, the author will explore the driving and restraining forces surrounding the proposed change or target situation of having representatives from the medical staff (in addition to chief nurse or nurse managers) to monitor, evaluate and approve the written records of ward rounds and of adapting a ward round checklist to improve standards of care. Traditionally, only chief nurses or nurse managers checked and monitored documentation of ward rounds that are often incomplete and inaccurate. Aside from the reasons stated earlier for the proposed change, literatures from the study of Kassean and Jagoo (2005) listed additional driving forces for the proposed change which include increased of critical incidents in health care settings, biomedical-oriented care, rise of complaints from patients, doctors, and relatives, increase in discharge against medical advice, knowledgeable staff in change management, support from ward managers and peers, and familiarity with ward culture; whereof, restraining forces ranged from ritualism and tradition, fear that the change will lead to bulk of work and increased accountability, lack of confidence of some nurses, and problems associated with punctuality and confidentiality of information. After the assessment and identification of the driving and restraining forces, each factor is weighted based on a score, decision maker, and greater degree of accuracy. If the driving forces are much stronger than the restraining forces or if both forces are fairly balanced, change is likely to go ahead without trouble. Since there are more driving than restraining forces in the proposed change of including medical staff in ward rounds and in adaption of ward round checklist, therefore, this change will work smoothly and likely to become successful. However, if the restraining forces are overwhelming, then the change may need to be postponed until conditions are more favorable for change. Strategy The strategy for the proposed change is grounded upon Lewin’s 3-step model of unfreezing, moving, and refreezing and on empirical-rational strategy. Using the empirical-rational strategy, the change agent enabled the prospective users of change through appreciation of research findings or evidences that indicates need for change (Gopee, 2008, p. 124). This strategy assumes that people are essentially rational thus, are more likely to adopt change if given the reasons and processes of the proposed change. The same processes are employed in Lewin’s 3-step model where change agent create awareness and motivation for change (unfreeze), identify, communicate and adopt new behavior, norms or culture (change), and reinforce new behavior through reward system, communication, structures, etc. (Kassean and Jagoo, 2005, n.p.). Appendix Figure 1: Caldwell Checklist Reference List Bomba, D.T. and Prakash, R. 2005. A description of handover processes in an Australian public hospital. Australian Health Review, 29(1), pp. 68-79. Bradfield, O.M. 2010. Ward rounds: the next focus for quality improvement? Australian Health Review, 34(2), pp. 193-196. [Online]. Available from http://readperiodicals.com/201005/2055989061.html (Accessed March 23, 2012). Buchanan D. and Huckzynski, A. 2004. Organizational Behaviour: An Introductory Text. Canada: Pearson education Ltd., n.p. Cypress, B.S. 2012. Family presence on rounds: a systematic review of literature. Dimensions of Critical Care Nursing, 31(1), pp. 53-64. DOI: 10.1097/DCC.0b013e31824246dd Gopee, N. 2008. Effective Practice and Clinical Practice Development. Mentoring and Supervision in Healthcare, 1st ed. California: SAGE Publications, Inc., pp. 104-126. Herring, R., Desai, T. and Caldwell, G. 2011. Quality and safety at the point of care: how long should a ward round take? Clinical Medicine, 11(1), pp. 20-22. Kassean, H.K. and Jagoo, C.B. 2005. Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius. BioMed Central Nursing, 4(1), n.p. DOI: 10.1186/1472-6955-4-1 Kennedy, T. J., Lingard, L., Baker, G.R., Kitchen, L. and Regehr, G. 2007. Clinical oversight: conceptualizing the relationship between supervision and safety. Journal of General Internal Medicine, 22, pp. 1080-1085. Norgaard, K., Ringsted, C. and Dolmans, D. 2004. Validation of a checklist to assess ward round performance in internal medicine. Medical Education, 38, pp. 700-707. DOI: 10.1111/j.1365-2929.2004.01840.x O'Hare, J. A. 2008. Anatomy of the ward round. European Journal of Internal Medicine, 19, pp. 309-313. Read More