Part B: Lewin’s change theory
According to Wojciechowskihe et al. (2016), the Lewin’s change theory takes three significant concepts; driving forces, restraining forces and equilibrium. The process of change is approached in three major stages;
stage 1; unfreezing, which involves researching on the way to facilitate people letting go of unwanted, counterproductive and ineffective ways. It allows the teams or individuals to overcome strains towards change. It involves strategies such as open up communication channels, education, creating guidelines, and demonstration. It the case scenario to may involve asking the primary ED team to voice work-related challenges, challenges with current guidelines, training and demonstration of procedure in case of several concurrent emergencies
Stage 2: change; decrease the restraining forces through strategies as brainstorming, coaching, mentoring, stakeholders engages and implementing proposed changes. In this case, it may involve the increasing of personnel in ED, further training of the LPN nurse on conscious sedation protocols, establishing the threshold for the support team call. Implement the new model for multiple concurrent ED cases
Stage 3 setting equilibrium, re-freezing and sustaining the established changes. Evaluate to show improvement from the previous model. It may involve strategies such as retraining, drills, reward and keeping records of key performance indicators. In this case, evaluate adherence to the conscious sedation protocols, where all patients go through all stages of escalation as provided in the protocol; no record of diversion from the protocol. The support team is called on time after the emergency threshold is reached for multiple cases. No patient on conscious sedation is left alone
Part C: Failure mode and effects analysis (FHEA)
The FHEA is a systematic, proactive tool that is used to assess processes in which may result to harm. It includes members from all section of the process under inquiry to predict possible pitfalls of the process. The team establishes where, how, and the extent to which the process may fail, causing harm to the patient or staff. It then allows providing recommendation and implementation of the measures to minimize or eliminate the risk of an event (Institute for Healthcare and Improvement, n.d)
TABLE
Part E: Nurse leadership
Promoting quality care
Nurses are principle personnel in healthcare delivery. They play a critical role in the direct patient care, coordination of care, prevention of adverse events, support patient and their families to optimize provided care. However, the promotion of quality care goes beyond the patient and extends to the participation of organizational and system quality structure to consistently promotes and maintain quality of care. Nurses can take up the obligation to monitor, report the appropriateness of existing organizational structure and recommends area of improvement. They can also engage in research and provide evidence for safety and quality care (Oldland, Botti, Hutchinson, & Redley, 2019)
Promoting patient outcomes
The complexity of healthcare provision cannot be understated, and nurses are an indispensable resource to ensure positive patient outcomes. Nurse work in multidisciplinary teams and enhance collaboration to improve and sustain safe, and quality care and patient satisfaction. Patient outcomes do not necessarily reflect professional experience and professionals need to adjust their own practice to reflect visible contribution to patient outcome. As indicated by Keift et al. (2014), to improve patient outcomes nurses should (1) promote patient involvement in decision making (2) provide clear, understandable information and self-care (3) provide emotional support, demonstrate empathy and respect (4) provide physical and environmental needs of the patient (5) involve the support of family and friends (6) facilitate a smooth transition of care.
Influencing quality improvement activities
Without the implementation of quality promoting and patient outcomes strategies, patients continue receiving poor quality care experience poor patient outcomes. Nurses are thus required to take up advocacy responsibility to ensure evidence-based practices are implemented, and issues affecting patient outcomes are resolved effectively. Nurses are involved in advocacy to improve the quality of care at institutional and policy formulation levels. As healthcare most trusted professional, nurses are strategically placed to take leadership roles and help to move past perceived risks in the adoption of new policies (Sensmeier et al., 2019).
In the case study provided, the nurses are involved in the RCA and FHEA to provide essential information regarding the provision of care at the facility. In RCA, the nurses are involved in the retrospective process to investigate and provide insights into the causes of the event and provide recommendations to prevent future recurrence in the conscious sedation policy. In FHEA the nurses are involved in the proactive process to review and identify the possible areas that may result to failure in providing safe and quality care, how it may happen and the extent it might hurt the patient. The nurse also had an opportunity to provide recommendation for the rectification of the process to prevent the occurrence of the postulated events