NRSG377-Transition to Contemporary Nursing and Clinical Leadership Assessment

IDENTIFIED ISSUE: NON-COMPLIANT DRESSING CHANGE TECHNIQUE

The surgical ward's uneven and non-compliant dressing change procedures, which have increased the number of patients needing readmission owing to wound breakdown issues, are the practices I propose to improve. Adherence to established rules and evidence-based procedures is crucial to minimise wound infections and consequences, which is why dressing changes are significant. A breakdown in the standard of patient care is indicated by inconsistent practices and disregard for ward policies (Lin et al., 2019). As an illustration, a study by Wang et al. (2018) emphasises the significance of appropriate wound care approaches and the relationship between non-compliance and unfavourable patient outcomes. Inconsistent procedures may result in slower wound healing, higher infection rates, and more prolonged hospital admissions, all of which would raise the cost of healthcare (Unaegbu, 2021)

Additionally, wound complications can result in patient discomfort, extended hospital stays, higher healthcare costs, and, in serious situations, life-threatening infections. These problems also impact patient satisfaction and overall care quality (Woo et al., 2018). As a graduate registered nurse, it's imperative to advocate for change in this aspect of patient care to improve patient safety and outcomes. To address this issue, it is essential to implement a comprehensive wound care education program for the nursing and allied health staff on the surgical ward. This program would focus on evidence-based wound care techniques and emphasise the importance of adhering to the hospital's policies and protocols.

CHOSEN INTERVENTIONS

To address the issue of inconsistent and non-compliant dressing change techniques in the surgical ward, I propose two specific and achievable interventions that are well-supported by evidence from healthcare literature.

COMPREHENSIVE WOUND CARE TRAINING PROGRAM

Developing and implementing a structured wound care training program is fundamental to resolving the issue. Evidence from healthcare research consistently demonstrates that education and training are pivotal in improving wound care practices. For instance, a semi-systematic literature review by Welsh (2018) highlighted the efficacy of structured wound care education in significantly reducing wound complications in a hospital setting. This program would encompass theoretical components such as wound physiology, infection control, evidence-based practices, and practical, hands-on sessions to ensure staff competency, knowledge, and skills required for evidence-based wound care (Sartelli et al., 2020).

REGULAR SKILLS ASSESSMENTS AND AUDITS

Regular skills assessments and audits are another vital intervention, aligning with quality improvement principles. These evaluations are well-established as useful strategies for patient safety and quality improvement in the medical literature (Hut-Mossel et al., 2021). For instance, Kuhnke et al.'s (2019) qualitative analysis highlighted the significance of wound care audits in finding areas for improvement and reducing complications, eventually enhancing patient safety and the standard of care. By rigorously assessing staff adherence to the new wound care standards and reviewing wound care paperwork, we can identify areas that require more training or support. This data-driven strategy helps staff members improve their practices by pointing out areas for development and giving them unbiased criticism.

ENGAGING STAKEHOLDERS

STAFF ENGAGEMENT

It is crucial to involve the nursing and allied health workers in decision-making. The importance of including healthcare professionals in developing protocols and recommendations is highlighted by research by Nilsen et al. (2020), which leads to higher compliance and adoption. Regular meetings and open forums should be set up to allow personnel to voice their complaints and recommendations (Persson et al., 2021). According to a study by Lehane et al. (2018), it is crucial to involve healthcare professionals in the implementation of evidence-based practices and to ensure their active engagement since their input can provide important information about the difficulties they encounter when providing wound care and the best ways to address such difficulties.

CLEAR COMMUNICATION

The success of the recommended interventions depends on their clear and consistent communication. Numerous studies emphasise the value of good communication in enhancing healthcare (Sheehan et al., 2021). Informational posters, staff meetings, and email updates can all be used to spread the word successfully. These methods of communication should provide an explicit schedule for putting the wound care training program and skills evaluations into action while highlighting the justification for the change and any potential benefits for patients and staff (Hasanica et al., 2020).

BARRIERS TO CHANGE

INDIVIDUAL BARRIER: RESISTANCE TO CHANGE

Resistance to change within healthcare personnel is a substantial individual obstacle to adopting the suggested changes in wound care procedures in the surgical ward. Change can be unpleasant, and some employees may be reluctant to adopt new procedures or methods, especially if they have been using a specific method for a long time (Mareš,2018). Research and medical literature show that healthcare personnel are resistant to change. The disturbance of habits and dread of the unknown are two characteristics linked to individual resistance, according to a study by Khaw et al. (2022) on organisational reactions to change. For the anticipated improvements in wound care to go more smoothly, it is critical to acknowledge and address these worries. Clear justifications, including workers in decision-making, and giving assistance and resources for skill development are all tactics to reduce individual resistance to change.

ORGANISATIONAL BARRIER: RESOURCE CONSTRAINTS

Resource limitations are an organisational barrier that may prevent changes in wound care procedures (Gillespie et al., 2020). Providing more staff time and financial resources to implement a thorough wound care training program and routine skill audits and evaluations could be necessary. This can involve allocating funds for instructional materials, allocating time for staff to attend training programs, and allocating personnel to carry out skill audits and assessments. Allocating the resources required for change efforts can be difficult in the healthcare industry since resources are frequently stretched thin, and budgets are frequently constrained. To overcome this obstacle, hospital administration must see the value of funding patient safety and quality improvement initiatives (Nilsen et al., 2020). They could need to repurpose funds or look for outside financing to support the suggested interventions. The effectiveness of the change activities must be ensured by careful planning and resource allocation in the face of organisational limitations.

LEADERSHIP STYLE

I would adopt a transformational leadership style for innovation in change management to improve wound care practices in the surgical ward. Transformational leadership is widely recognised for its effectiveness in inspiring and motivating teams to achieve significant improvements and innovations (Steinmann et al., 2018). Two key attributes of this leadership style, inspirational motivation and individualised consideration play a crucial role in guiding the success of this change management proposal.

INSPIRATIONAL MOTIVATION

The attribute of inspirational motivation involves the leader's ability to inspire and motivate team members by creating a compelling vision and communicating it in a way that resonates with the entire team (Steinmann et al., 2018). In the context of enhancing wound care practices, inspirational motivation is indispensable. A study by Belrhiti et al. (2020) revealed the role of inspirational leadership in motivating healthcare professionals in Moroccan settings to embrace change initiatives. I would employ this attribute by clearly articulating a vision of excellence in wound care. I would underscore the positive impact of these changes on patient outcomes, staff satisfaction, and the overall quality of care. By doing so, I can create a shared sense of purpose and enthusiasm among the staff, which is crucial in overcoming resistance to change. This inspirational motivation will instil a deep commitment to the proposed changes and a strong desire to make the envisioned improvements a reality.

INDIVIDUALISED CONSIDERATION

Transformational leaders excel at recognising each team member's unique needs and potential. This attribute is invaluable in implementing change in healthcare (Steinmann et al., 2018). Wound care practices may affect different staff members differently. Some may have concerns about an additional workload, while others may be eager to learn and implement new techniques (Arsenault Knudsen et al., 2021). Research in healthcare leadership, such as the work of Khaw et al. (2022), underscores the importance of individualised consideration in addressing staff concerns and needs during change implementation. By demonstrating individualised consideration, I can address these concerns and tailor support and guidance to each team member. This individualised consideration ensures that staff members feel valued and heard, which is essential for overcoming resistance to change and promoting a culture of collaboration and continuous improvement (Amarantou et al., 2018).

CONCLUSION

In conclusion, addressing inconsistent dressing change practices in the surgical ward is critical to improving patient outcomes and safety. Implementing a comprehensive wound care training program, regular skills assessments, and engaging stakeholders through clear communication are vital steps. Overcoming individual and organisational barriers and a transformational leadership style can drive successful change and enhance wound care practices.

REFERENCES

Amarantou, V., Kazakopoulou, S., Chatzoudes, D., & Chatzoglou, P. (2018). Resistance to change: an empirical investigation of its antecedents. Journal of Organizational Change Management, 31(2), 426-450. https://doi.org/10.1108/JOCM-05-2017-0196

Arsenault Knudsen, É. N., King, B. J., & Steege, L. M. (2021). The realities of practice change: Nurses' perceptions. Journal of Clinical Nursing, 30(9-10), 1417-1428. https://doi.org/10.1111/jocn.15693

Belrhiti, Z., Damme, W. V., Belalia, A., & Marchal, B. (2020). Original research: Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: A realist evaluation. BMJ Open, 10(1). https://doi.org/10.1136/bmjopen-2019-031160

Gillespie, B. M., Walker, R., Lin, F., Roberts, S., Eskes, A., Perry, J., Birgan, S., Nieuwenhoven, P., Garrahy, E., Probert, R., & Chaboyer, W. (2020). Wound care practices across two acute care settings: A comparative study. Journal of Clinical Nursing, 29(5-6), 831-839. https://doi.org/10.1111/jocn.15135

Hasanica, N., Ramic-Catak, A., Mujezinovic, A., Begagic, S., Galijasevic, K., & Oruc, M. (2020). The effectiveness of leaflets and posters as a health education method. Materia Socio-Medica, 32(2), 135-139. https://doi.org/10.5455/msm.2020.32.135-139

Howell, R. S., Kohan, L. S., Woods, J. S., Criscitelli, T., Gillette, B. M., Donovan, V., & Gorenstein, S. (2018). Wound Care Center of Excellence: a process for continuous monitoring and improvement of wound care quality. Advances in Skin & Wound Care, 31(5), 204-213. https://doi.org/10.1097/01.ASW.0000531354.39232.70

Hut-Mossel, L., Ahaus, K., Welker, G., & Gans, R. (2021). Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS ONE, 16(3). https://doi.org/10.1371/journal.pone.0248677

Khaw, K. W., Alnoor, A., Al-Abrrow, H., Tiberius, V., Ganesan, Y., & Atshan, N. A. (2022). Reactions towards organizational change: A systematic literature review. Current Psychology, 1-24. https://doi.org/10.1007/s12144-022-03070-6

Kuhnke, J. L., Keast, D., Rosenthal, S., & Evans, R. J. (2019). Health professionals' perspectives on delivering patient-focused wound management: A qualitative study. Journal of Wound Care, 28(Sup7), S4-S13. https://doi.org/10.12968/jowc.2019.28.Sup7.S4

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., & Hegarty, J. (2018). Evidence-based practice education for healthcare professions: An expert view. Bmj Evidence-Based Medicine. http://dx.doi.org/10.1136/bmjebm-2018-111019

Lin, F., Gillespie, B. M., Chaboyer, W., Li, Y., Whitelock, K., Morley, N., Morrissey, S., & Marshall, A. P. (2019). Preventing surgical site infections: Facilitators and barriers to nurses’ adherence to clinical practice guidelines—A qualitative study. Journal of Clinical Nursing, 28(9-10), 1643-1652. https://doi.org/10.1111/jocn.14766

Mareš, J. (2018). Resistance of health personnel to changes in healthcare. Kontakt, 20(3), e262-e272. https://doi.org/10.1016/j.kontakt.2018.04.002

Nilsen, P., Seing, I., Ericsson, C., Birken, S. A., & Schildmeijer, K. (2020). Characteristics of successful changes in health care organizations: an interview study with physicians, registered nurses and assistant nurses. BMC Health Services Research, 20, 1-8. https://doi.org/10.1186/s12913-020-4999-8

Persson, S. S., Blomqvist, K., & Lindström, P. N. (2021). Meetings are an important prerequisite for flourishing workplace relationships. International Journal of Environmental Research and Public Health, 18(15). https://doi.org/10.3390/ijerph18158092

Sartelli, M., Pagani, L., Iannazzo, S., Moro, M. L., Viale, P., Pan, A., & Catena, F. (2020). A proposal for a comprehensive approach to infections across the surgical pathway. World Journal of Emergency Surgery, 15(1), 1-26. https://doi.org/10.1186/s13017-020-00295-3

Sheehan, J., Laver, K., Bhopti, A., Rahja, M., Usherwood, T., Clemson, L., & Lannin, N. A. (2021). Methods and effectiveness of communication between hospital allied health and primary care practitioners: A systematic narrative review. Journal of Multidisciplinary Healthcare, 14, 493-511. https://doi.org/10.2147/JMDH.S295549

Steinmann, B., P. Klug, H. J., & Maier, G. W. (2018). The path is the goal: how transformational leaders enhance followers’ job attitudes and proactive behavior. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02338

Unaegbu, T. (2021). Wound Care Management and Documentation Non-Compliance in Prevention and Care of Wounds. [Doctoral project, University of St Augustine for Health Sciences]. https://doi.org/10.46409/sr.XPUU8046

Wang, Y., Beekman, J., Hew, J., Jackson, S., Issler-Fisher, A. C., Parungao, R., & Maitz, P. K. (2018). Burn injury: challenges and advances in burn wound healing, infection, pain and scarring. Advanced Drug Delivery Reviews, 123, 3-17. https://doi.org/10.1016/j.addr.2017.09.018

Welsh, L. (2018). Wound care evidence, knowledge and education amongst nurses: A semi‐systematic literature review. International Wound Journal, 15(1), 53-61. https://doi.org/10.1111/iwj.12822

Woo, K., Santos, V. D. G., & Alam, T. (2018). Optimising quality of life for people with non-healing wounds. Wounds Int, 9(3), 6-14. https://www.biosanas.com.br/uploads/outros/artigos.pdf

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