Nurses as Change Agents in the Community

The discussion assignment provides a forum for discussing relevant topics for this week on the basis of the course competencies covered.

For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course and text readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

In the chapter, “How Community-Based Organizations Are Addressing Nursing’s Role in Transforming Health Care,” the authors describe the community as the focus of advocacy action for change. They list a series of questions that help community teams develop organizing principles to guide their interventions, and the aim is to attack social determinants of health to make community change.

Suppose a community team identifies lack of access to exercise modalities as a public health issue. If the team were to determine that pedestrian walkways need to be constructed, discuss at least two factors that would facilitate the development of the walkways and two that would hinder the development. For the hindrances, discuss ways that the team might work to overcome those hindrances.

Continue to read daily from one of the policy briefs that are included in your weekly readings list. POLITICO Pulse is a daily briefing from POLITICO, and the Kaiser Health News Morning Briefing is a daily briefing from the Kaiser Family Foundation. Both focus on health care. Either one will keep you abreast of what is happening in health care policies and politics.

In addition, subscribe to the “HealthCetera” podcast and listen to the podcast weekly. This is a production of WBAI, free speech radio of Pacifica Foundation Radio in New York City. Diana Mason and Barbara Glickstein are founders and codirectors of the Center for Health Media Policy (CHMP). Both are recognized as experts in media, nursing, health, and health policy. They have a longstanding relationship as producers and moderators of HealthCetera, a live, award-winning radio program on public radio and iTunes. They are bloggers for Disruptive Women in Health Care and for the American Journal of Nursing (AJN). The CHMP is an interdisciplinary initiative for advancing the health of the public and healthy public policies through media, research, education, and public forums. Listen to the podcast throughout the course and think on the topics that are discussed, especially as they relate to how we advocate for issues of importance in this contemporary political environment.

Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages.

Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.

The potential diagnosis is UTI.

1.  What other assessment data would be helpful for the nurse practitioner to have?

2.  What are the organisms most likely to cause an UTI?

3.  What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

4.  What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

APA guideline 

Less than 15 % similarity

Choose two issues or challenges that the leaders of today’s health care organizations face. Select from among the following topics:

1. Staff Shortage (Physicians, Nurses, Allied Health Providers, Ancillary Services)
2. Reorganization in Response to Merger or Consolidation of Services
3. Layoffs as a Result of Declining Revenues
4. Influx of Registry, Part-Time, and Temporary Contract Staff
5. Poor Performance Outcomes Leading to a Reduction in Medicare Reimbursement Dollars
6. Poor Job Satisfaction Rates Resulting in Turnover

You are the manager of an ancillary service department at a large, 500+ bed hospital. Develop a proposal (750-1,200 words) that is directed toward your staff, in which you address the following:

1. Inform the staff of the two issues (from the topics provided) your organization is facing.
2. Describe the impact of these issues on your department.
3. Describe how improved communication, collaboration, and teamwork can improve conditions in your department.
4. Identify at least two examples from the required or recommended readings of techniques found to foster inclusion and improve communication and collaboration.
5. A minimum of three academic references from credible sources are required for this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

 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.