NURS3003 Inquiry for Evidence based Nursing Practice

Introduction

Change is a process of regularly altering nursing practices. The change proposed in this study is done to reduce the suicidal ideation of patients in the mental health wards. According to the WHO guidelines, recognising the people with suicidal ideation is important for taking preventive measures and prevent suicides. Communication of motivational messages on the mobile phones of the patients can be implemented to make the patients feel motivated and manage their suicidal ideation (Grupp-Phelan et al., 2019). According to Dithole et al., (2017) communication by nurse is important for effective motivation of patient. Without proper communication there can be adverse events, delayed progression of health. Further, in a study conducted by Schnieder et al., (2018), use of pictorial messages along with texts can also enhance the cognitive functions of the brain. Therefore, this innovation can be useful as the nurse will recognise such patients in the mental health care unit and the innovation can be implemented. The author of the study will be the enacting as the leader with subjective knowledge on the change process and leadership skills for the implementation of the change. Further this study will also discus the innovation, leadership skills and the change theory with evidence from Google scholar website and databases like Pubmed. Other online journals and databases would also be used for collecting relevant evidence for supporting the proposal.

Innovation in healthcare

Healthcare organisations are growing rapidly throughout the world and continuously facing challenges in the development (Agbo, Mahmoud & Eklund, 2019). Nurses and other healthcare professionals are vital in bringing a change for the betterment of the patient care process. This can be done by introducing innovative changes. The process of innovation in the clinical environment is the generation of new idea, solutions or products using the knowledge and skills that the healthcare professionals possess. The innovation developed is for the enhancement of patient safety and improvement in the care quality that is delivered. Hence, innovation is a very important step for making the health care system better (Kelly & Young, 2017).

The PDSA cycle of the tool of Plan, Do, Study and Act can be used to identify the changes in the healthcare system on a small scale. It is a tool that provides a framework for the development process, testing proposed change and implementing the change. With this tool healthcare professionals can study the changes brought in a much more effective and structured pattern and provide an agent who is responsible for bringing the change to understand the effectiveness of the change. In this manner, the process of change implementation would be safe for the patient and the healthcare system (Crowfoot & Prasad, 2017).

This tool is used quite often for the improvements projects and studies and is used to provide the best results and for sustaining the changes. The author of this study would have to initially brainstorm why the change is required that is for understanding the objectives of the changes and then with selected subordinates in the mental health ward, ward nurses would be trained for understanding the change that is to implemented (Pérez-Cuevas, 2018). The subordinates or the other members of the project will further train the ground nurses. This will be followed by undertaking a pilot study 1 month before actually implementing the change to understand the current problems in the mental health ward regarding the suicidal ideation of patients. After this another round of data collection would be done to understand the effectiveness of the change that would be implemented. The data would be audited and the recommendations from the nurses would be collected though the process feedback collection (Alzeban, 2019). The author upon thorough understanding would make the required amendments in the change process based on the collected information and the PDSA cycle would be repeated until the proposed change can be finally rolled out.

Further the possible implications of the changes would be that the patients would be motivated much more towards the reduction of suicidal ideation tendency. It can impact the safety of the patient. Improved delivery of messages will further promote the nurses to understand the importance of communication in patient care. The patient care would be conducted as planned but the nurses would have to identify how the patient visualises life and make use of relevant tools for making pictorial messages to be delivered to the patient (Carey, 2016). This improved the confidence of the nurses to engage into proper communication and reduction in the suicidal ideation of the patient. This will further enhance the care quality that is provided to the patients.

Use of Evidence to support the change

It is important that nurses practice the use of evidences while making clinical decisions. This is also known as Evidence Based Practice. The Singapore Nursing Board promotes the nurses to practice EBP regularly for improving the services delivered and patient outcome. This allows the nurses to identify the best evidence that is suited as per the patient requirements. Therefore, a number of evidences were identified for the use of pictorial messages delivery in the form of SMS to patients to reduce the suicidal ideation in the recognised patients.

According to Klansky, May & Saffer (2016), Suicidal behaviour is one of the leading causes of death in the world and the early identification of the patients is necessary. This includes people who have suicidal thoughts and ideas of self-harm. In the study conducted by Spoelstra et al., (2016) it has been that the use of text messages to promote the adherence of patients to medications has high been highly effective. The patients said to be highly satisfied and improved after the implementation. The study conducted by Brittom et al., (2020) motivational interview is a method of communicating with patient and motivate them to reduce their thoughts of suicidal ideation was successful and reduced the ambivalence of patients and that a more intense Motivational interview with frequent follow ups can increase the effectiveness of the intervention. Further Cyz et al., (2020) reports that providing support and motivation in texts continues to be an acceptable form in the care continuity of patients and also reduce the risk of suicide in the identified patients.

Leadership

The process of nursing leadership can be defined as the influencing other individuals for improving the quality of care delivered to patients along with the participation of the leader in the process of care. This can be practiced in an environment with clear vision and where the staff can be motivated and empowered. The nursing leadership is important for improving the outcomes of a patient, reduce chances of errors and improvement in the retention of staff (Lotfi et al., 2018). These aspects as a whole would benefit the healthcare system and workplace. The two leadership techniques that can be implemented in study by the leader are the transformational and transactional leadership styles.

The focus of the transformational leadership is towards the sharing of goals and vision between the leaders and the followers. This will enable the professional to show high commitments and motivation in the conduction of the nursing practice along with acknowledgment of the individual opinion and needs (Musinguzi et al., 2018). The style of transformational leadership can be valuable in settings where a new practice or change is implemented or adopted. A transformational leader considers the opinion of other before taking a decision. The leader will influence others by affective communication which is engage the subordinates emotionally. The leader will motivate the subordinates by presenting idealised influences and stimulate them intellectually. The inspiration is in such a manner that the followers of the subordinates will truly understand the collective vision towards the benefit of the organisation. There is a positive relationship between the leader and the follower by the development of the follower’s ownership which in turns increase the moral values of the follower (Boamah et al., 2018). This helps in the development of a mutual respect and trust between the two individuals that contributes effectively to the goal of the organisation and also indicating effective leadership. Moreover, the leader would use the technique of idealised influences to promote the behaviour and attributes of the subordinates. To stimulate the subordinates intellectually a transformational leader would empower the followers and encourage them to present new ideas for the development of the organisation and nursing practice. These leaders therefore, guide the followers in a democratic way. The leader also focuses on the problems individually and addresses them accordingly. Therefore, a transformational leader is found to be working in a much more effective manner for work engagement and create environments that are pleasant for the nurses and allowing them to grow and produce better outcomes in terms of patient safety. Additionally, the transformational leader also develops a positive environment and treat the staff respectfully. Therefore, the transformational leadership suits the nursing environment and is useful in improving the quality of service that is provided by the nurses but again, the same is not effective in a situation of emergency.

The two strengths of a transformational leader include, keeping the ego in check and adapting to the given situation and entertainment of new ideas. Communication with subordinates is an important aspect of a transformational leader. Therefore, keeping the ego in check is really important as it prevents the leader from practicing a defensive behaviour. This helps the leader to accept a situation and adapt to it affectively despite of not liking certain things about it. The transformational leader also encourages to subordinates to introduce new ideas to the table. This will make the team members feel that they are important and they will feel a part of the whole team. The weaknesses of this leadership style includes that the subordinates are heavily dependent on the leader. If the leader does not evaluate the values in a proper manner, then the leadership efforts might be ineffective. With this style of leadership there is not much flexibility of the rules permitted and there can be pressure generated on the basis of the goals and opportunities set. In this case the transformational leadership can be used in taking the feedback of the nurses about how the innovation can be useful upon implementation. Steve Jobs is one of the persons who implements this leadership style

Another leadership style that can be used in implementing this change is the transactional leadership. This is the style that focuses mostly on the supervision and the organisation of the work which will further affect the performance of the subordinates. This style promotes the performance of the followers by rewarding them or punishing them if ends are not met. In this manner the followers are kept motivated for meeting the short-term goals which ultimately help in the progression of the organisational goals. Unlike the style of transformational leadership, in this style the leaders do not necessarily focus on changing the future goals and hence this leadership approach is effective when it comes to emergency situations or any crisis. There are two factors that come into play in this leadership style. First is the provision of conditional rewards which can help in development of both a constructive and efficient relationship between the leader and the followers. The followers receive reward bonuses or recognition when completion of a work. The rewards are solely based on agreements between the follower and the leader. The second factor of this leadership style is to manage by exception. In this the transactional leader can bend the rules as per requirement and use the best recommended practices. This can be either active or passive. The leaders who are active keep a watch on the followers to evaluate the performances while the passive leaders would only assess the performance of the followers after completion of their task and will put forwards their feedback (Sims et al., 2021).

The two strengths of this leadership style are working of the area where one individual can be motivated and creating the reward on the basis of the motivation points. This can motivate the follower in the right direction as they would ultimately want to receive the reward. These leaders are also practical in nature and believe more in the concept of reality instead of idealism and therefore, the order and the goal are very clear for the leader. There are certain disadvantages too. These leaders do not respond to the creative individuals. They do not follow the concept of collaborative ideas. For these leaders, performance of the subordinate is the main thing and hence the followers do not have the freedom to present creative solutions (Ma & Jiang, 2018). The followers keep on becoming more demanding in terms of motivation. Upon receiving security and physiological needs as rewards the followers tend to want more (Diebig, Bormann,  & Rowold, 2016). An example of this leadership style is Bill Gates.

Change theory and change management

Change is an importance process towards the development of an organisation. It is required in the healthcare to enhance the outcomes for the patient by especially bringing in improvement in the nursing care services. The management of change is a crucial step in managing the implemented change for achieving progress. The use of change models can be done as these are guides of how the change should be introduced and implemented in the system (Atkins et al., 2017).

The Rodgers model of change (1983) is one of the most common models of change that can be implemented in the nursing system for implementing a change. The basic concept of this model is that the process of implementing an innovation in the system involves the individual (leader) to pass from the first stage of the innovation knowledge to forming a point of view towards the innovation, to a decision which is to be adopted or rejected, to implementation and to confirmation of this decision. The benefits of this model are that the developer, Rodgers, has identified the various characteristics of the innovation which would influence the decision of adopting or rejecting the change. The model identifies whether the process of change would be compatible or not (Miller & Moyers, 2017).

The first stage of this change model is Knowledge. In this stage the author realised the innovation which can be use of motivational messages for reducing suicidal ideation but lacks the required knowledge. During this change the author lacks the motivation to find more data about the innovation (Wang & Wang, 2016). In the next stage of persuasion, the author seems to be more interested in the innovation and understand that it can be beneficial in reducing the suicidal tendencies and finds the details about the same and identifies the patients admitted in the mental health ward by proper communication. The third stage is about making a decision after weighing the advantage and the disadvantages of the change. The barriers of the change are considered which can be network issues, fear of nurses to implement the change, lack of interest of the patient.  The author decides whether to adopt or reject the change. The next stage involves implementation of the change. Further, the individual will gain more knowledge on the innovation and determine the effectiveness (Afuah, 2020). This can be done by taking the feedback of the nurses about the change.

Another theory that can be utilised is the Lewin’s change theory. In this theory, the leader or a nurse can be the change agent. There are three steps for implementing the innovation into the system (Barrow, Annamarju & Toney-Butler, 2017). The nurse leader as a change agent would behave as a driving force for the subordinates and guide them towards the direction of sustaining the introduced change. The first stage of this model is unfreezing step. In this stage the nurse leader would understand the need for this change and raise awareness amongst the followers which will prevent the barriers from restraining the process of change. The second stage involves the moving stage in which the change is implemented. In this stage, the nurse leader executes the plan of action towards the implementation of the innovation. This stage is guided by strong communication among the team members in terms of the progress, training and guiding are the key strategies towards sustaining the change. The last stage is known as the freezing stage. In this stage the changes are made permanent by the nurse leader which is done rewarding the outcomes. The changes made are now accepted as the new norm. This model is easier to understand and hence it should be implemented. This model also helps in encouraging the participants to stick to the changes and make it last. The gradual approach towards the change implementation builds a momentum or a flow which is why it becomes easy to implement (Grant, 2016).

A change agent is someone who drives the process of change in other terms they are also thought to be the catalyst in the process of change. This person is important as he or she implements the process of change by influencing, motivating and inspiring other members to drive the change process (Alagoz et al., 2018). In global healthcare environment today change is driving force towards betterment and nurses are thought to be the change agent and that they are responsible for introducing innovations in the healthcare that improve the patient outcomes and the care delivery. The change agent for implementing and sustaining the changes should be a critical thinker for identifying and addressing the problem by recognising the need for the change (Rafferty, 2018). This is done by planning the change, implementing it, evaluating the effectiveness of the change by analysing the outcomes and stabilising the change.

Conclusion

In conclusion, effective leadership is important to facilitate an innovation or a process of change which is important in terms of prospering the healthcare system and improving it. The nurses are represented as change agents that initiate the process of change. This is followed by effective planning which is required for successful implementation. In this study, leadership styles have been studied which are suitable for the change implementation and are necessary skills of the leader followed by change theories. The Lewin’s theory has been identified as an appropriate model of change to be implemented. This theory would be recommended for further application when implementing further innovations for the prevention of suicidal ideation.

References

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