Describing need for change
Theatre nurses are charged with the duty of evaluating pain in patients and administering pain relievers. However, their efforts to lessen pain are highly dependent on their relationship with the doctors and patients. That is because they are not autonomous experts in the field, but rather operate in accordance with the prescriptions given by the doctors and assessments offered by the patients (Pope & Deer 2017). It is vital to enhance the quality of pain control since constant pain has serious consequences and it is a way of being compassionate about the patients. Nurses in their day-in day-out routine, encounter a number of constraints that prevent them from practicing effective pain management interventions. Overall, pain management is a source of concern among surgery patients thus compromising their recovery (Cherry & Jacob, 2013). The ideal situation would involve the surgery patients not suffering unnecessary pain. The ideal is, however, not always the case as theatre nurses are sometimes unable to correctly evaluate and manage the patients’ pain. The result is lower satisfaction levels among the patients who feel that the nurses and other medical personnel are not doing all that they can to manage their pain (Mottram & Chester, 2015).Change model Nursing Research Paper
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The issue to be addressed is ensuring that surgery patients do not suffer unnecessary pain, with theatre nurses playing a critical role in assessing and managing the patients’ pain. One way of addressing this concern is through developing and applying non-pharmaceutical pain management strategies that are not subject to dosage monitoring. It is correct to suggest that surgery patients’ pain can effectively be managed during the post-surgery period. In addition, it is reasonable to suggest that non-pharmaceutical approaches present theatre nurses with an effective pain management tool (Feldman, 2012). According to Mottram and Chester (2015) and for this study, it is correct to suggest that non-pharmacological approaches offer a chance for improving pain management for surgery patients with minimal risk, therefore, it is rational to propose that it is possible to improve pain management for surgery patients.Change model Nursing Research Paper
Although the proposed change is intended to improve pain management outcomes for surgical patients, perhaps the stakeholders most affected by the change are nursing personnel. Nurses’ knowledge is a basis for poor pain management among surgery patients. Studies show that nurses give first precedence to some of their other roles such as the technical feature of care, communication and collaboration, along with management while pain control is given a last precedence. Furthermore, majority of nurses suppose that experiencing pain is an obvious occurrence for patients in hospital. With such a mentality, nurses are then so reluctant in carrying out pain relieving activities in patients. Also, if pain management is given the last priority, it means that it is either shoddily done or not done at all hence patients continue to suffer (Hamric et al., 2014).
In addition, decision-making approaches by nurses form another constraint. Most nurses use backward way of thinking whereby they operate rearward from a proposition to assess varied alternatives or to find a way out. Also, they use analogous kinds and amounts of data prior to making a resolution regarding the most suitable nursing care. Surprisingly, aspects like academic level, age and extent of work experience do not seem to influence their decisions on their management of pain among patients. All these are characteristics of non-professional way of thinking and decision- making that indicate the reasons for ineffective pain management intercession by nurses and hence forms a limitation (Hamric et al., 2014).
Poor time management during evaluation and control of pain has been a big challenge in the provision of effective pain relief by nurses. Research indicates that, disruptions such as attending to phone calls, taking part in doctor’s rounds, backing up other nurses as well as departing the ward to search for stuff like drugs and bandages are key obstacles to effectual pain management since they cause hindrances between pain evaluation and control. Also, it has been observed that nurses mainly focus on things that have to be done prior to the end of their shift along with exchanges with other medical personnel and end up forgetting undertakings that directly contribute to their patients’ relief. The pain relief procedure that runs from assessment to control should be consistent, which in turn forms the only way of ensuring effective pain management (Hamric et al., 2014).
The third group of stakeholders affected by the change is the facility management. Organizational formation impacts the nurses’ capacity to offer successful pain relief to patients. Some surgical facilities do not have proper treatment strategies, have indistinguishable allocation of duties and are short of stability in care. Moreover, nurses in certain facilities experience inadequate access to doctors which result into anxiety while the unskilled doctors who are normally available rarely give a way out. Most of nurses have complained that some doctors are hesitant to commence analgesic care which is crucial for adequate pain relief and instead stress on cure. Under such circumstances, the nurses usually do not have a say but have to go by the doctors’ orders. Also, time limits that are present in most medical facilities make accurate pain assessment. This is because patients in critical condition get more attention to the detriment of other patients. In other words, the structure adopted by surgical facilities hinder the provision of effective pain control services (Mason et al., 2016). In this respect, the stakeholder analysis reveals that the proposed change affects patients, nursing personnel and facility management as stakeholders.
The change process will be guided by transformational leadership theory. The theory places emphases on leaders to be charismatic while applying effective management elements (Marquis & Huston, 2017). In this case, the major concern is to ensure that the objectives, standards, ethics, values and emotions around management are observes while satisfying existing needs. For that matter, the leader is respect and trusted to act as a role model who makes good decisions that are based on knowledge and experience. Through applying transformational leadership in the present change project, the change manager will influence the project participants to want to change, improve and be led by creating a vision that inspires them to exceed expectations (Northouse, 2016). Change model Nursing Research Paper
The project will recruit nursing personnel as change agents. They will be expected to promote and enable the change to proceed. In their capacity as change agents, nursing personnel will clarify the vision for the change, patiently and persistently implement the change, ask constructive questions about the change, lead by example through their extensive knowledge and experience, and rely on their strong relationships to build public trust in the change.
The change model adopted for the program is the John Hopkins Nursing model (JHNM). Developed by the Institute for John Hopkins Nursing (IJHN), the model has been deemed appropriate since it is specifically targeted at nursing and ensuring evidence-based practice (EBP) is adopted in institutions where nurses practice. In the present case, the problem was addressing unaddressed pain among surgical patients. With regards to the model, its choice is based on the fact that the problem has been assessed and the model has managed to produce a strategic implementation plan (Fulton, Lyon & Goudreau, 2014; John Hopkins Medicine, 2015). To ensure that the JHNM synthesizes and translates the evidence into practice, three principal nursing tools will be applied. This will be research, education and practice. In this case, research has been conducted to determine the best strategy for addressing pain in surgical units as well as collecting tangible peer reviewed evidence to support the project’s implementation. The collected evidence suggests that non-pharmacological approaches could provide opportunities for improving pain management results for surgical patients. Finally, the results of the project will be used to influence standard nursing practice in the institution by recommending the best strategy to address the problem based on whether the treatment group had better results than the control group (Buchko & Robinson, 2012).
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Two barriers are likely to have a negative impact on the project is left unaddressed. Firstly, medical personnel are likely to resist the change since it address to their workload. This barrier will be addressed by engaging medical personnel in discussion where they are informed that the change merits outweigh the demerits. Secondly, funding the project could be a challenger. This will be addressed by identifying and seeking funds from independent funding sources.
The project results will be comparing pain management outcomes at the beginning and end of the project. This would help in determining if the project had an effect since it would be assumed that any reported changes for pain management would be attributed to the implemented change.
Anchoring and supporting continuous change
Once it has been determined that the change produces favorable outcomes, the next step would entail anchoring and supporting continuous change. This will entail including the change in operating procedures and protocols applied in the surgical unit. This will ensure the change is formalized and turned into routine nursing practice. Change model Nursing Research Paper
Buchko, B. & Robinson, L. (2012). An evidence-based approach to decrease early post-operative urinary retention following urogynecologic surgery. Urologic Nursing, 32(5), 260-264.
Cherry, B. & Jacob, S. (2013). Contemporary nursing, issues, trends, & management (6th ed.). Amsterdam: Elsevier Health Sciences.
Feldman, A. (2012). Understanding health care reform: bridging the gap between myth and reality. Boca Raton, FL: CRC Press.
Fulton, J., Lyon, B. & Goudreau, K. (2014). Foundations of clinical nurse specialist practice (2nd ed.). New York: Springer Publishing Company, LLC.
Hamric, A., Hanson, C., Tracy, M. & O’Grady, E. (2014). Advanced practice nursing: an integrative approach (5th ed.). St. Louis, MO: Elsevier Saunders.
John Hopkins Medicine (2015). Evidence-based practice. Retrieved from http://www.hopkinsmedicine.org/institute_nursing/continuing_education/evidence_based_practice.html
Marquis, B. L. & Huston, C. J. (2017). Leadership roles and management functions in nursing: theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Mason, D., Gardner, D., Outlaw, F. & O’Grady, E. (2016). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier Saunders.
Mottram, D. & Chester, N. (2015). Drugs in sports. New York, NY: Routledge.
Northouse, P. G. (2016). Leadership: theory and practice (7th ed.). Thousand Oaks, CA: Sage Publications.
Pope, J. & Deer, T. (2017). Treatment of chronic pain conditions: a comprehensive handbook. New York, NY: Springer.
Stephens, R. & Umland, C. (2011). Swearing as a response to pain – effect of daily swearing frequency. The Journal of Pain, 12(12), 1274-1281. Change model Nursing Research Paper
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