Change Stimulation and Strategies in Clinical Pathways in Nursing Care - Term Paper Example

Type the company name] Nursing Case Study Change Stimulation and change strategies 8/25/2008 Would you like to change these things: 1. Empirical-Rational Strategy: the full paragraph. 2. the way that you write in text references, it should be directe quotation ( between backets ) 3. what is the full reference for ( Nickolas, 2003). Introduction to the problem A ward nurse wants to switch from traditional nursing methods to clinical pathways. The problem is choosing the right strategy for change so that she can implement the change and use clinical pathways for nursing. Clinical pathways could be defined as the structured approaches that are used to for achieving particular results for inpatient. The approach is responsible for defining the resources required and their amount and sequence for a particular case. Care pathways, critical pathways, integrated care pathways, and care maps, are the other names of Clinical Pathways. These are one of the main tools used for maintaining and managing the quality in healthcare with regards to the standardization of the whole process. A number of examples prove that the use of clinical pathways reduces the variation in clinical processes and also helps in improving outcomes. These methods encourage organized and efficient patient care relying on evidence based practice. These methods are responsible for the optimization of outcomes in acute care and home care settings. Timely changes are crucial for any department and the same theory is relevant for nursing and health care. However, a number of people are reluctant to change due to a number of reasons. As stated by NSW, (1997), we would be discussing change strategies and their selection criteria in order to introduce clinical pathways in nursing care. Power-Coercive Strategy This strategy for bringing about change relies on the legislations and litigation for influencing the individuals and system to change, where different forms of power remain the dominating factor. Power-coercive strategy focuses on political, economic, and moral boundaries using them as source of power or some type of forcing for obligating the individuals to adopt the change. One strategy used while using this strategy is staging demonstrations and non-violent protests states Bennis et Al. (1969). Another one relies on using institutions for achieving change. An example of this strategy could be using state-level litigations for changing educational policies. The third power-coercive strategy would be using powerful people. An example of this would be electing people to a particular position in order to support an intended change. There are two major reasons that account for the choice of this strategy. Those are: time and seriousness of the problem. This means that if the problem is such that it requires immediate change, then people must use this strategy. However, it is seldom the case that the identification of the gravity of a problem is possible without the problem maturing. It is difficult to understand the seriousness of a problem during its early stages. This happens especially in organizations where a threat is regarded as serious when it actually becomes serious. In terms of nursing or health care, this phenomenon of not identifying the gravity of a risk on time could prove to make the difference life and death for a problem. Very few people have this identification ability and even if they do identify it, convincing the powerful people to take action is mind-boggling. A number of theorists believe that change-minded leaders should fuel the seriousness of the threat earlier then waiting for it to occur actually. In this way, they would be able to take action earlier, however, this has a considerable amount of risk involved especially when we think about it in terms of nursing. Another driving force here is culture. Numerous factors depend on the culture. If the culture is one of benign bureaucracy and the threat is clearly visible, then it is likely that the members of the system would go along pragmatic and rational programs and would not care about their power or prestige. On the other hand, if the culture is autonomic and relies on entrepreneurship, and fat, dumb, and happy people are a part of it then they would resent it more and resist authoritarian changes. The second scenario would require replacements on key positions. Therefore, by the words of Nickols (2003), choosing power-coercive strategy would depend a lot on the culture and the intensity of the required change. Thus, this strategy is in use when leaders order change and people inferior in power comply to the orders. The use of this strategy requires the agent bringing about the change to have power and position so that he is able to obligate the change in an environment. This means that if the ward nurse uses this strategy then she must have the authority to bring the change and switch to clinical pathways . Empirical-Rational Strategy This strategy assumes that individuals are realistic and balanced; therefore, normally they follow their own rational thinking and perceptions. It essentially means that the changes are difficult to be accepted by rational people as well. This approach suggests, in order to stimulate change we need to bring innovative techniques. The primary technique that this model employs is that it uses the knowledge gained from research. An example of the application of this strategy is agriculture. Extensions in agriculture result from agencies and systems used from the development and diffusion of research results where country agents scatter the results of agricultural research. Similarly, it also finds application in education research and development, regional educational laboratories, state departments of education, colleges and universities, national diffusion networks, intermediate service agencies, and staff development personnel and other educational organs. The theorists of this strategy Ellis & Hartley (2003) also believe that the rational point of view neglects the fact that school systems already have passive thinkers who do not have time or the will to adopt or apply the change. The model relies on the principle that good innovations would not have to face rejection. However, a number of theorists believe that mixing political and cultural practices would enhance the effect of its success. The strategy for innovation in this case specifically focuses on incentives and managing risks. However, one approach makes the implementation of this strategy difficult. This approach develops when the outcomes of the change are just a little better than what they already have. The people required to make the changes believe that why they should risk what they already have for something that ‘might’ be a little better than their present approach. One strategy to counter such approach is to introduce doubt to the rationality and optimality of present processes and events. The person responsible for bringing the change could convince people to believe that the problem has arisen already or they can also try on convincing that the present state of affairs are not looking at the future of the issues. The outcome of these stories would be obviously people who would share the same belief as you. These people could be helpful depending on their importance in the whole process. In this regard, another important strategy could be targeting people who have position and are influential; convincing them would mean that the whole process of stimulating change would become easier. Nursing or health care is a slow process, but the outcomes are crucial and could make the difference of life and death for a patient. This strategy of brining change in health system seems suitable considering the fact that the person trying to change the environment of the ward is a nurse and in order to stimulate change, she would have to talk to the authorities and convince them about the advantages of clinical pathways. Normative-Reeducative Strategy The normative-reeducative strategy visualizes the individual as consistently in search of satisfaction and comfort. He wants to fulfill his desires and needs. The individual does not just go about accepting whatever comes in his way and takes actions towards his goals. Moreover, the theory believes that changes occur at the most personal level and they are not just mere response to new events, rather they occur as a result of changing values and habits. In addition to this, the social and institutional norms of a place or environment guide an individual and his actions. Therefore, the writers of Open learning world, (2007) are of the opinion that the basic principle that this theory puts forwards is that in order to stimulate change, an individual must work towards his/her re-education for the change to occur. The model involves the intervention of change agents who focus on client-approaches and work with them to solve their problems. This strategy basically formulates the point that people are social beings and they try to comply with social norms and value. Change depends on the redefinitions and reinterpretation of existing norms in such a way that people feel committed to the new norms and values. Normative-reeducative strategy focuses on culture, i.e. the beliefs that people have about their world, their perceptions about work, and personal behaviors are consistent with the belief that this strategy builds itself upon. Usually, the change in culture does not happen overnight. Therefore, we can say that this strategy is not optimal for circumstances that require immediate changes or in those threats that are about to become real in little time. All innovation efforts have short as well as long-term goals. The long-term strategy or thinking would be using normative-reeducative strategy for the stimulation of change says Nickols (2003). In case of health care processes and bringing change in them seems a daunting task. This is so because in case of health care, the matter is not of materialistic things that a company might lose in case the change is not successful. It is the scenario where people could lose their lives; therefore, convincing people to leave a working method to one which may or may not work is difficult. However, convincing them to shift from the norms through a slow consistent procedure might be easier. Similarly, changes in health care do not happen overnight and if we try to analyze the changes that took place in the past, we would see that all of them were a result of slow consistent procedures. This strategy is useful for stimulating change; however, the time it involves is an issue here. Participants of Change If we discuss the participants of change considering the three change strategies, we would see that the key players or the change stimulators are the people from administration. They would be the ones responsible for the actual implementation of the change. The first strategy, i.e. the power-coercive strategy for change relies completely on the upper management people and therefore, it cannot be used in the current scenario. Therefore, the key players of this strategy are the admin people since the strategy believes on imposing changes on inferiors. Moreover, the strategy also points out that it is best for immediate changes because, since the administration people are making the changes, therefore, they can make them right away. Besides the people imposing the changes, all the other people of the company are the ones affected by the changes and they are not participants. If we consider empirical-rational strategy, then there are a number of participators in this one. This strategy theorizes that individuals are rational and they would understand a rational change. It involves convincing people and then using the convinced people to convince more people for the stimulation of change. This strategy involves a number of participators, and is time consuming. The third strategy as is described by Ellis & Hartley, (2003), that is the normative-reeducative is an even more time-consuming change-stimulation strategy. It believes that changes happen from within and for a change to occur; an individual must act towards his reeducation. The strategy believes in the redefinition and reformulation of social norms and values. The key players or participants of this strategy are the people themselves and it does not involve any particular players except the ones convincing them about the requirements of change. All of the three change strategies rely on different participants for change stimulation. Each on of them involves participants according to its own theories and principles. For example, power-coercive requires people with authority to impose innovations on people while the inferiors would just comply to the innovations. Empirical-rational participators are the individuals trying to convince others about the rationale of the change and there is not particular requirement about those individuals. The final strategy involves all individuals and it requires them to change internally for external change to happen. Conclusion Our case-study involves a ward nurse wanting to switch from traditional nursing to using clinical pathways. The method is advanced and extremely effective, therefore, the best method would be using empirical-rational, which would require the nurse to try and convince the people from administration and all the others about the optimality and rationality of the method. Using power-coercive would not be good here as in our case the change-stimulator is a nurse and secondly, imposition of changes is not always the best strategy stated by Ellis & Hartley, (2003). The normative-reeducative strategy is not good, since the current scenario does not require individual changes, it requires system change. References NSW (1997). NSW Health Annual Report, Glossary of terms. Retrieved on August 25, 2008 from Warren G. Bennis, Kenneth D. Benne, and Robert Chin (Eds.). Holt, Rinehart and Winston (1969). The Planning of Change. (2nd Edition) New York: 1969.  Janice Rider Ellis, Celia Love Hartley (2003). Nursing in Today’s World. Retrieved on August 25, 2008 from Martha Nickols, (2003), Principles and basis of hospital management philosophies. Harvard University Press Publications, USA Open learning world.com (2007). Change Management – Four basic strategies. Retrieved on August 25, 2008 from Read More