PLEASE RESPOND TO THIS PEER DISCUSSION POST BELOW 

A successful change requires a person who is well developed in leadership and planning as well a functioning as a change agent (Angel-Sveda, 2012). A change agent is skilled in theory and implementing change. I witnessed this with an educational leader. This educational leader is in charge of most of the department’s education but mostly involved with the orientation portion of education, when candidates are first hired and during their probation period. I was part of a change process, including going into the field (patient home) during orientation observing patient care, documenting, time spent in home, and then coming back to report and review the charting. The change model was implemented to help familiarize ne employees to the work environment as well as reinforce policies for existing employees.

Using one of the change theories in the book or one that you have researched, analyze the change effort that you presented.

The Lewin’s Change Theory: This model describes the change process in three steps; described as “Unfreeze-Change-Refreeze”.

The Unfreeze stage is when the change is anticipated to happen or initialing began; involves supporting staff, feedback, empowerment, and freedom for independent thinking (Coghlan & Brannick, 2003)..  In the case for me the unfreeze stage was when the new employees shadowed the existing employees on their home visits. The existing employees were very apprehensive about this training but reluctantly participated.

The Change stage is when  all the employees are expected to adapt the change and adhere to rules (Coghlan & Brannick, 2003). During this stage many employees reverted back to their old ways, not charting in the home or tracking their miles at the time of the visit; leaving room for error in documentation.

The Refreeze stage is when the change is expected to be followed and evaluation of adherence is need to ensure change is effective (Coghlan & Brannick, 2003). After a few weeks the employees did comply with the change the educator presented but some employees did not and were retrained by having to attend a class reiterating the company policies.  

What went well?

The new employees got hands on experience during orientation, which included, real-time charting, on point questions, and engaging with clients. They also had the opportunity to navigate through the portable computer system before diving into the field alone. Another good outcome was the employees were able to get to know one another during this time and a mentor relationship is usually developed. 

What didn’t go well?

Some existing employees thought the change model was a way to ‘spy’ on them or track their amount of time spent in the home. There was a lot of resistance from employees or many of them declined to participate in the new orientation/training process. 

What would you have done differently if you had been in a leadership position?

I would have explained the need for the change model in the first place.  The educator introduced the change model but did not explain its need or rationale thoroughly. I also would have included high positional workers into the conversation and implementation so other employees knew this was important and required for compliance.

Describe the key concepts underlying community activism and  2) give examples of how each of these concepts applies to a specific context. 3) Examine how advanced practice nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.

Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.

Patient Advocacy and in the Community and Legislative Arena: http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print

 

Sampling methods and sizes are different for quantitative and qualitative research. In quantitative research, sampling methods include simple random sampling, stratified random sampling which occurs when the researcher knows some variables in the population that are critical for the study, cluster sampling uses natural groups that have similar characteristics, systematic sampling which can only happen when an ordered list of all members of a population is available, convenience sampling when people are in the right place at the right time, and quota sampling when the groups are preidentified by the researchers. Sample sizes tend to be bigger in quantitative research. Quantitative research is seen as more vigorous if there is a large sample size. Researchers with good understanding of parameters into sample size such as significance level, power, effect size, standard deviation and event rate, are able to calculate an informed sample size estimation and to report more clearly the rationale for applying any particular parameter value in sample size determination (Malone, 2016). 

Qualtitative research sample sizes are usually smaller. Evidence indicates that sample size is matter of contention and practical guide to issues demanding consideration (Pepin 2018). Methods include purposive sampling where the researcher selects certain participants for a reason, network sampling locates samples that would otherwise be difficult to locate, and theoretical sampling where the researcher gathers relevant data for theory generation. 

My quantitative research question is: Among Registered Nurses, is job retention lower when workplace incivility is present in the workplace as opposed to when it is now present over the course of one year? I would try to use a large sample size in this case. Maybe I would choose a hospital and send surverys to nurses who quit in less than a year of working to find out if their reason for quitting was due to bullying. This is probably cluster sampling. 

My qualitative question is: Among registered nurses, is patient satisfaction lower when bullying and incivility is present in the workplace as opposed to when it is not present? I would use a smaller sample size in this situation. I would probably choose one unit that is known to have bullying, and interview patients over a set period of time. This would be purposeful sampling. 

References

Malone, H. E., Nicholl, H. (2016). Fundamentals of estimating sample size. Nurse researcher, 23(5), 21-25. 

Pepin, G. (2018). Reporting rigorous qualitative results: moving beyong small sample sizes. Australian Occupational Therapy Journal, 65(2), 77-78. 

The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.

Objective Data

1. Height: 68 inches; Weight 134.5 kg
2. BP: 172/96, HR 88, RR 26
3. Fasting Blood Glucose: 146/mg/dL
4. Total Cholesterol: 250mg/dL
5. Triglycerides: 312 mg/dL
6. HDL: 30 mg/dL

Critical Thinking Questions

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

1. Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.
2. Ranitidine (Zantac) 300 mg PO at bedtime.
3. Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

1. Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)
2. What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.