Practical Application Of Lewins Force Field Analysis Change Model Nursing Essay

Practical Application Of Lewins Force Field Analysis Change Model Nursing Essay The aim of this paper is to to describe practical application of Lewins (1951) force field analysis change model in reducing Intensive Care Unit (ICU) patients length of stay (LOS) in a Tertiary Care University Hospital. Introduction: This paper reports on a change from 6.5 days to 4 days reduction in Intensive Care Unit (ICU) patients length of stay (LOS) in a Tertiary Care University Hospital. The change was embedded with systemic assessment, planning and implementing standardized strategies for all ICU long stay patients and finally evaluating the efficiency and effectiveness of ICU bed utilization with multidisciplinary team approach. Change is inevitable for the reason that it ingrained human lives, core processes and system reforms. Day by day many changes have been observed in health care; associated with disease processes explicitly from prevention to rehabilitation, health care norms and nomenclature, infra structures modifications, policy matters, reengineering and system transformation. Different components of health care depends on one another for assembling such changes in order to produce work like from providers to payers, hospitals to suppliers, education to regulatory bodies and research to professional associations; all these are interlinked to perform function. Many of the above stated happening are planned however at times nature takes its own turn to act as a catalyst for change for example natural occurrences like tsunami, some crucial system analysis like break through reports from Institute of Medicine (IOM) on patient safety and the quality of care provided to all the health care customers. Th ese were just simple examples of revolutions in health care taken place on an ongoing basis. Traditionally it is believed that changes are always for the betterment however at times it has been observed that this phenomenon is proven to be cynical and challenging especially when it is not made in a haphazard manner, without pursuing change management principles. Addressing the challenge of change Fetherston et.al (2009) stated that: Managing changing in the health care setting is always challenging, especially when it involves transforming entrenched habits grounded in professional expectations (p.2581). Despite change involves resources like human, material and cost and therefore whatever is proposed for change need to be evaluated for its effectiveness and efficiency, applicability, and consequences. It also depends on the team we are working with and there are times when the team building is so strong and the communication between the team is such that adopting to a new concept is very easy versus if the team members are not on same wavelength and have a lot of differences of opinions failure to reach to a simple consensus. Coch and French (1948) concluded that rate of recovery when learning a new task is directly proportional to the amount of participation. To improve understanding of change dynamics Armenakis and Harris (2011) recommends that readiness for change is distinguished from resistance to change and readiness is described in terms of the organizational members beliefs, attitudes, and intentions. Change agent is a very important contributor to make change happen constru ctively and productively. The personal and professional characteristics, interpersonal competency all these aspects are dependent to an outcome of change. Another factor involved in change process seems to be very crucial is the timeframe require for change. Is it a short term or a long run change which is going to measure and monitor, what about the sustainability of the proposed change etc. In order to have successful change Kotter and Schlesinger (2008) recommends and put idea in practice (Appendix) and suggested that analyze situational factors, determine the optimal speed of change, and consider methods for managing resistance (p1, 2). According to Lippincott-Raven Publishers 1986 Crucial to facilitating change is selecting a strategy that is likely to produce the desired change with minimal time and resistance. Background In todays health care setting, organizational change is essential for growth and development to keep up with the market competition Although health care continues to be enmeshed with ongoing challenges of cost, technologies, access to health care, human resources, quality inconsistent with an arena where error rates are too high there are multiple growing opportunities to improve client care management and service delivery components. Changes have been observed in clinical practice based on evidence based research resulting in application of new technology, diagnostics, drug regimes, treatment profile, care monitoring and finally the patient outcomes. All these are direct provision to a customer and perhaps if we look at the wider base it heavily involves all support functions available for patient care and employees of the organization. How all these are managed with patient flow and activities? Who is accountable? Change has both individual and institutional significance; and addre ssing its importance Watwood et al. (1997) shared that à ¢Ã¢â€š ¬Ã‚ ¦changes à ¢Ã¢â€š ¬Ã‚ ¦ bring opportunity for personal and institutional growth and development (p 162). When it comes to an institutional change; it has emphasized that it should complement the philosophy, mission and vision of the organization. Therefore Heller Arozullah (2001) identified four key factors for successful program development and achievement and those were: aligning the program with the strategic goals of the organization; obtaining active senior leadership commitment, including allocated resources; securing the appropriate infrastructure to facilitate integration of recommended actions into daily practice; and setting up systematic communications with all involved stakeholders (p551) Several challenges exists in system when it comes to a revolution however factors define by Heller Arozullah (2001) would help in embarking change in a more structured manner. ICU is a consolidated area of a hospital where patients with life-threatening illnesses or injuries receive round the clock specialized medical and nursing care. Intensive care is one of the hospitals most complex and expensive medical systems. As medical care has improved, the type of patients treated in critical care units has changed from those with acute illnesses to those suffering from complications of chronic diseases. While better technology and better ways of taking care of patients has improved longevity and general health, the patients in the intensive care units of hospitals are getting sicker and globally these beds have a high demand based on the critical needs of patients and it doubles the need in an arena where these resources are very scare and inadequate This would augment medical care required, cost of care and excess use of resources when they are not required. Long stays in the intensive care unit are associated with high costs and burdens on patients and patien ts families and in turn affect society at large. Williamss et.al (2010) states that: It has been estimated that between 2% and 11% of critically ill patients require a prolonged stay in ICU, accounting for 25-45% of total ICU days, and a significant proportion of resources(p 459) The cost of caring for patients in ICUs in the United States has been estimated to account for 1% to 2% of the gross national product shared by (Miller et al. 2000, Seeman David 2004) ) whereby Haugh (2003) stated that 15% to 20% of US hospital costs represents 38% of total US healthcare costs. According to Miller et al. (2003) the total number of hospitals, hospital beds, and inpatient days decreased during the years 1985 to 2000, the number of critical care beds and days in critical care increased dramatically during the same period Whereby Stricker et al (20037) found that only 11% of patients admitted to the ICU stayed for more than 7 days, these patients used more than 50% of ICU resources. Furthermore, in several studies (cited in Ryan et al 1997, Wong et al 1999) the mortality of patients with ICU admissions lasting 14 days or longer was estimated to be nearly 50%. Rosenberg et al. (2001) shared that Mortality rates are higher in ICU than in any other area of the hospital due to the complexity of patients medical condition. Fakhry et al (1996) found that 70% of patients with stay longer than 2 weeks reported less than 50% functional recovery. Esserman e t al (1995) found that 32% of ICU resources were spent caring for patients who survived less than 100 days after discharge from the hospital. In a tertiary care university hospital where I am presently working patients were found to be stuck in the ICU and have longer stays and in the month of January 2009 it was found to be 8.4 days and subsequently in the following quarter 1 it was 6.5 days (refer appendix 1). When explored, multiple factors aroused (refer appendix 2) and therefore to address this concern a multidisciplinary team was formed. It was proposed to undertake the work of reducing patients length of stay in ICU and therefore it the goal was to reduce patients length of stay from 6.5 days to 5.5 days in the second quarter for the year 2009. Rogers and Shoemaker (1971) framework was used to appraise the various component of the proposed change in order to identify its strengths and weaknesses.  Team assessed its relative advantages to current situation and felt that it is worth spending the time and effort for the given scenario, change seems to be appropriate and compatible with existing philosophy of the clinical area, easy to be understood and applicable by all bedside staff. Moreover the project was trialable to a pilot    before going the whole way and relevant to organizational goals. Discussion Changes will continue as an adaptation and at times mandatory in order to survive. Lot of literature is available when it comes to the change management in health care setting. There are models available to address organizational change, system revolution, and human transformations which address many other aspects of successful implementation of reforms. Change process follows the same course as of nursing process and problem solving approaches. According to Christensen a Christensen b (2007) Lewins (1951) theory of transitional change is the most used form of change implementation strategies. The change we were supposed to undertake; this theory appeared to address many aspects of it and therefore the mechanism for identifying the social system within organization for selecting, developing and implementing the strategies to serve as a solution was done by application of this model. According to course notes Lewins widely cited, classic model of the change process, the three changes are: Unfreezing, where faced with a dilemma or disconfirmation the individual becomes aware of the need to change; changing where the situation is diagnosed and new models of behaviour are explored and tested and finally, refreezing where the application of new behaviour is evaluated and adopted. (p53) Huber (2006) states that: The basic concept of the change process was outlined by Lewin A successful change involves three elements: unfreezing, moving and refreezing. (p810) Fetherston et.al (2009) emphasized the importance of major change like this and endorsed that: Where a major change is implemented, models such as Lewins (1951) model of unfreezing, changing and refreezing can be a useful guide Baulcomb (2003) states that This theory places emphasis on the driving and resisting forces associated with any change, and to achieve success the importance lies with ensuring that driving forces outweigh resisting forces. Driving forces tend to initiate change or keep it going whereas restraining forces act to restrain or decrease the driving forces. The intention to reach a state of equilibrium (p277). Unfreezing Lewins change approach fall within three steps and this is the first one where the process of thawing out the system to create motivation for change. Its like getting the team warming up to play their cards; getting everybody on the same wavelength and organizing. Huber (2006) shared that the first stage is cognitive exposure to the change idea, diagnosis of the problem, and work to generate alternative solutions. (p811). Though it was a great challenge for the team however the process of systemic assessment and unfreeze stabilizing the team readiness was initiated for the said change. Different strategies were brain stormed in a multidisciplinary team.ICU patients length of stay was gathered prospectively. Potential predictors were analyzed for possible association with prolonged ICU stay. Driving and restraining forces were studied (Appendix ) Moving Then we proceeded with the second stage of Lewins theory i.e., moving and changing. It involves moving a target system to a new level maintaining equilibrium; viewing the problem from a new perspective, situation is diagnosed and new models of behaviour. This stage was determine through formation of ICU long stay committee with terms of reference, notification of long stay patients stayed in ICU for more than 7days or earlier if deemed necessary to all concerned, holding meeting with primary team everyday to discuss next course of action, identification of patients difficult to wean, patient requiring early tracheotomy to maximize discharge process, initiating daily rounds by multidisciplinary team with primary team. Furthermore, introducing expected admission discharge time (EADT) to facilitate bed identification. According to Hoda (2008) length of stay (LOS) may be influenced by the availability of appropriate high dependency units to discharge patients. Review on daily basis the n eed for bed for inpatients and emergency. Admission /discharge policy was reinforced through multidisciplinary approach. Alternate accommodation in other units like CICU and CCU which has same bed accessories and uniform care provision were identified. Early tentative beds are booked in wards before rounds in order to facilitate early bed arrangement and patient transfer. Refreezing The final stage is refreezing. In this stage new developments are incorporated and improvements are made to stabilize the selected strategies to ensure the sustainability of the project. Daily check at unit and divisional level by bed management coordinator and ICU team. Monitoring on shift bases by charge nurses and nursing supervisors. Interventions involving palliative care, ethics consultations, and early decision about patient transfer and orders writing, family willingness and readiness and other methods to increase communication between healthcare personnel, patients, and patients families were helpful in decreasing length of stay in the intensive care unit. Thus, interdisciplinary communication played a vital role in improving ICU patients LOS whereby its importance is being defined by Pronovost et al (2003) and point out that communication failures lead to increased patient harm, length of stay (LOS), and resource use (p71). Hence to a major extent the daily communication st rategy worked out very well and the team was successful to bring about this change. ICU length of stay was 6.5 days in quarter one and it was reduce to 5.6 days in the second quarter for the year 2009 and consequently to 4.8 and 4 day in third and fourth quarter of 2009. Fetherston et.al (2009) stated that: When change is managed in systematic steps with adequate evaluation and communication throughout the process, it is more likely to result in successful outcomes. (p 2582) Evaluating the Change Project s took place and was received very positively. Following are the most important attributes I have experienced for this successful change like it was logical, efficient, and planned not haphazard then it was based on explanation of reason for a change so that individuals understand it. After that it was very informative and staff supported change when they were involved in assessment and planning. Change agent interpersonal competency and expertise (knowledgeable) of the given task was outstanding and hence the monitoring feedback on timely basis -to ensure that all team members is on same wave length wa carried out in a very sposticated manner.

Nrega Scheme a Success Essay

Is NREGA(National Rural Employment Guarantee Act) a success or a failure? The NREGA is an Indian Job Guarantee scheme, enacted by the legislation on Aug 25,2005. The scheme provides a legal guarantee for one hundred days of employment in every financial year to adult members of any rural household at a wage of Rs 120 per day. So almost after five years of its commencement can NREGA be considered a success ? This essay will consider a number of explanations for concluding the impact of NREGA. My argument would be that definitely NREGA has been a success. First of all we need to remember that NREGA is a programme without precedent. No other employment programme has even come close to being implemented on such a large scale. So the output can’t be compared to that of any other programmes. Taking into account the success story of the Pandurni village in the Nanded district of Maharastra which won the award for the best performance in implementing the Rural Employment Guarantee Scheme for 2009-2010, we can see that around 1500 people from the village are registered under this scheme from which around 800 have been benifited from it. Pandurni has completed over 100 irrigation projects. Of these projects one that has been remarkable is the rocky bund built by around 200 villagers, to prevent soil erosion. Officials claim that implementation of the scheme on such a large scale here has prevented the migration of labourers to other districts. Similar success stories have also been reported from various villages of Rajasthan. NREGA has created more work for rural people than any other programme since independence. If we look at the coverage of the scheduled caste and scheduled tribe, if we look at the participation of women, if we look at the financial inclusion that we have achieved about more than 10 crore bank accounts and post office accounts that have been opened for NREGA workers then a lot can be said in terms of its achievements. It can be agreed to a fact that nothing in this world is an unmixed blessing. I agree if the NREGA has good side, it has a bad side also. But the ill effects have been largely due to corruption in our country. Its because of that only the ‘aam admi’(ordinary people) are not able to avail the proper benifits of the scheme. NREGA is a scheme which if implemented properly can benefit the labour class of our country.

Get the Scoop on C1 Esl Compare Contrast Essay Topics Before Youre Too Late

Get the Scoop on C1 Esl Compare Contrast Essay Topics Before You're Too Late Students write much better papers when they have some great examples in front of those. They can typically understand the structure with just a short amount of instruction. They will find some good points and ideas necessary for the development of a good school or college comparative essay. They learn to analyze information about two different subjects. Before you begin any paper, you will need to get an understanding of the way to write it. While preparing the text, you will need to recognize that you have to separate these 2 topics from one another. The procedure will appear pretty similar. The next thing to do is to begin writing. The 5-Minute Rule for C1 Esl Compare Contrast Essay Topics Again, compare and contrast essays can cover just about any topic and can pop up in an assortment of subject areas. Citations and extracts from assorted sources have to be formatted properly. Take a look a t our compare and contrast essay samples to observe how to compose essays of this sort all on your own. In both instances, the outcome is a finished essay. There are good techniques to begin a compare and contrast essay in this informative article. Ultimately, references need to be done in the style that is suitable for the essay's subjects for the ease of distinct folks in various fields. There are several factors that have to be considered if you would like to opt for a workable and intriguing essay topic. Moreover, an essay writer must also have the ability to supply valid references on the arguments which he would want to include in the paragraph. On this phase of the writing process you need to have a good idea of the objective of this essay. A strong essay is going to have an opening paragraph that comes with a thesis statement and a concluding paragraph. The reply to the disturbing question like how to compose a compare and contrast essay starts with the structure of this kind of academic writing. If you are searching for an essay topic to receive your assignment off the ground, the above mentioned choices can prove to be useful. A conclusion shouldn't be too long. It is the easiest part. Always keep in mind that your conclusion should only restate facts you've already analyzed. When making comparisons or contrasts, it's essential to be clear what criteria you're using. Depending on the sort of work you're citing, you might have to include extra details. To begin with, both issues for comparison have to supply considerable material for the research. To begin with, list all information on the very first topic of comparison. C1 Esl Compare Contrast Essay Topics Features There are additionally some lessons that you will have to always keep in mind before you get started writing your essay. Before you start to compare the 2 subjects, research to acquire more knowledge on the topics you're writing about. It's possible to use any as the subject of your essay particularly whenever you're not assigned any specific theme. The topic for a compare and contrast essay will probably be set by the topic or course a student is enrolled. When the writer has the information that will enter the essay, they should just begin writing! Nonetheless, the top-notch writers who are a part of the Elite Essay Writers team have an increased potential of supplying you with a high-quality paper. When it can be less difficult to write on a well-known topic, with a little research and organization, a writer can make an essay on an assortment of subject areas if assigned. You might also be assigned with writing about many other diverse topics. If you compose an essay with no external aid, you might wind up stressed, and you may eliminate plenty of time. The sources you use has to be authentic to your topic, also referred to as authoritative, and have to be logical to the message you're trying to get across, or pertinent. Per APA style, you must offer equal attention to every side. Go over the complicated relationship between the united states and Russia. The cost of an essay depends upon the total amount of effort the writer has to exert. After you have read our helpful on-line article, we'd love to provide something you couldn't even imagine. It's a fact that the on-line journalist may write blogs along with their personal reported stories and then for some media companies, they might even be asked to compose a blog. The movie is a combination of interviews, archive footage. By taking into account both your objectives and your own personal taste, it'll be easy that you figure out which sort of school is best for you. By observing the differences between the two sorts of bags, you are going to be able to find that using paper is better than using plastic. In a way, you may be proper. Go at your own pace, and work through the outline one section at one time if you want to.

Essay On How To Get Ready For Birth - 1254 Words

Preparing for your first born It might appear like your pregnancy will go on perpetually, however youll get the opportunity to meet your new infant before you know it. Meanwhile, exploit the long hold up to plan as well as can be expected for the progressions ahead. A little propel arrangement now will make it less demanding to unwind and make the most of your pregnancy as your due date nears. Here are some useful approaches to get ready for your childs entry: Find out about the birth procedure: The possibility of conceiving an offspring can be overwhelming, and you might be enticed to put everything crazy until it happens. Consider taking a birth class to find out about the phases of work, choices for labor administration,†¦show more content†¦Similarly as its vital discuss how your partner can enable you amid work, to make certain to talk about what youll require from each other amid the infant time frame. Varying desires can make enormous clashes, so attempt to work this out early decently well. Try not to accept that your partner knows how much your new child will flip around your lives. Discuss how youll separate infant and family unit obligations. Whats more, instruct your partner about more subtle things, similar to how to boost you in breastfeeding. You can likewise make life less demanding by hashing out some significant choices now, similar to what to name your child, how youll sustain your infant, and whether to have a religious function, (for example, a submersion or infant naming). Converse with mothers There are a wide range of things about new parenthood that, for reasons unknown, once in a while stay forbidden subjects – spilling pee, postnatal depression, and lessened sex drive, just to give some examples. You wont have an indistinguishable ordeal from your companions, yet getting some answers concerning certain things early can decrease the stun consider. 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