Policy and Organizational Behavior

Running head: RESPONSE PLANS 1

RESPONSE PLANS 2

Response Plans

Samantha M. Tallarine

Capella University

Nursing Leadership & Management

Response Plan

March, 2019

Response Plan for Inpatient Nephrology Unit

Change Theory

Kurt Lewin had a change theory that involved three stages of change – unfreeze, change, refreeze. In this theory the basic idea is that in order to implement change you need to do away with current practices, implement the change, and then continue on with the new changes. In breaking down the system to see why patients are having an increased length of stay and implementing new guidelines and procedures to correct this problem, we are benefiting both our patients and our facility. The main focus is to optimize our patient’s health, and to also provide quality care to as many people in need as possible. If we have the same patient’s day after day with increased stays just for simple reasons such as recording intake and output and performing daily weights we are doing the community a disservice, and preventing new patients from receiving help.

Strategies and Rationales

In order to effectively care for the patients within the unit, doctor’s orders must be carried out dutifully. Nursing is a career that includes the continuity of care, which means that when it comes to patient care it is not specifically set to one shift or another. In truth, weights need to be taken during both shifts and intake and output records need to be continuous. The patient should be weighed before breakfast, before dialysis, and after dialysis. This means that the schedule of their care will revolve around their dialysis schedule and that both shifts will have to do their part.

In dealing with intake and output, it will be mandated to be in the chart at the end of each shift, therefore giving the oncoming shift a clean slate to deal with. This will need to be included, as part of the bedside shift report, and each nurse needs to hold the other accountable. Also, each patient’s space needs to be marked with a “Strict I&O” sign to act as a reminder for all healthcare workers. Leadership also needs to make the patients aware that they are part of their own healthcare team and that they need to make sure to communicate with their nurses what they drink, and how many times they use the bathroom.

As a manager, with the help of the supporting staff, they will need to scour the EMR (electronic medical record) and see who exactly needs to be spoken to about their charting habits. In speaking with staff individually it allows the opportunity to educate them on what they are doing wrong, and how they can fix their mistakes. It also opens up the communication line for them to be able to ask questions, and to let them know how serious upper management is about this issue. This would require an emotionally intelligent leader in order to keep the staff working together and efficiently. “Emotionally intelligent leaders are sensitive to their own and their followers’ well-being, feelings and emotional health, and they develop effective personal relationships while directing followers to common work goals.” (Cope & Murray, 2017)

Expected Outcome

After implementation of the new protocols, the hope is to see patients having decreased stays, as well as the opportunity to treat more people from the surrounding community. On top of providing quality care to the patients, I hope to also instill a sense of camaraderie between the different shifts of nurses. As stated earlier, nursing is a career that includes the continuity of care, therefore there needs to be teamwork not only among those on the same shift, but also those to follow the care after them. In promoting this positive attitude in the work place I believe only good things can come about, and the patients will benefit immensely.

Professional Standards

Professional standards need to be in prime function for the good of the patients. In order to ensure they are receiving optimal care the nurses need to make sure that each step of the nursing process is being implemented and that every staff member is doing their due diligence. The nursing process ensures that nurses stay within their scope of practice and operate under legal pretenses. If they stray from this process they can be operating outside of their scope of practice, which opens them up to legal action being taken against them.

Response Plan for School Nurse

Change Theory

Ronald Lippitt was a theorist who presented a change theory that was similar to the actual nursing process. I think this would be the best approach to handling this particular issue of educating adolescents on practicing safe sex, and having their parents on board with it. The theory is broken down into seven phases within four elements as follows:

Assessment:

Phase 1: Diagnose the problem

· 15% increase in students contracting sexually transmitted diseases and three girls in the junior class are pregnant

Phase 2: Assess motivation and capacity for change

· The community insists on only teaching abstinence, and the school board does not want to anger the parents. There is almost guarantee to receive resistance to new policies being put into place.

Phase 3: Assess change agent’s motivation and resources

· The problem is a growing community health issue, and needs to be corrected immediately. With proper knowledge, and providing adolescents with resources to practice safe sex the budding epidemic can be decreased greatly.

Planning:

Phase 4: Select progressive change objective

· Educate adolescents on the benefits of abstinence, but also prepare them for when they do start having sex.

Phase 5: Choose appropriate role of the change agent

· Sex education needs to be included in health class for the first year of high school in order to educate the students effectively.

Implementation:

Phase 6: Maintain change

· Let parents be active in classes, and offer resources to attend family counseling to help open communication between the parents and their children.

Evaluation:

Phase 7: Terminate the helping relationship

Strategies and Rationale

As stated above, the plan is to implement a sex education class and integrate it into the school curriculum. It would be most effective for incoming freshman to take as part of their health class. The class will first and foremost preach abstinence, and all the benefits of abstaining, but it will also educate the students about safe sex practices and the dangers of having unprotected sex. Most high school age kids fear pregnancy as the repercussions of having unsafe sex, but they are not even aware of all the different STD’s they can contract.

In order to not anger the parents, the school board needs to step in and explain the necessity of this new program. The parents need to be made aware of the growing problem, and they should also have the opportunity to see exactly what will be taught to their children. In giving the parents a say in the curriculum, maybe it will make them more open to educating their children properly. The school can also set up family counseling sessions to help initiate conversation within the home, and not make the subject of sex so taboo.

A resonant leader would thrive in this scenario because they would be able to connect with their employees, as well as their patients. Resonant leaders are able to draw on their emotions, which would be perfect in this scenario in dealing with parents. They are especially effective when it comes to conflict resolution, which there is sure to be a lot of when you’re dealing with angry parents.

Expected Outcome

A hopeful outcome would be that sexual education is implemented into the school curriculum, and there is a decrease in overall instances of sexually transmitted diseases. Initially, the school board may experience some push back from the parents who are so adamant about abstinence, but the goal is to ultimately have the parents on board with the new curriculum. In involving parents in the classes, and offering counseling sessions the school can open up communication within families, and also educate these students to make the best possible choices. In educating them on both abstinence and safe sex practices, it can be ensured they have all of the information needed to make good choices.

Professional Standards

Professional standards are extremely important in this particular case because they are dealing with both children and their parents. It is also a massive health concern to allow the current practice to stay in place; therefore it is significant to make sure these kids are practicing either abstinence or safe sex. In the process of educating both the students and their parents it is of the utmost importance to remain professional, and be aware of the sensitive material in which they are teaching.

Response Plan for Pediatric Vaccinations

Change Theory

Lewin’s change theory would fit best in rectifying the problem of pediatric vaccinations for this scenario. The three step process – unfreeze, change, refreeze – allows you the time to examine the whole situation, keep what is working, and change what needs to be changed. If parents continue on the path of not vaccinating their children then the chance of herd immunity greatly decreases, and those who are not eligible for vaccination are at an even greater risk. As the manager of the pediatric unit it is their responsibility to make sure the staff can educate the parents in a respectful manner, and be non biased in their assessments.

Strategies and Rationale

In order to go about this without stepping on too many toes, the healthcare providers in the practice need to come together and brainstorm on what is the best way to deliver information to the parents. They also need to be trained to decipher on who can actually be exempt from the vaccinations due to medical or religious issues, and who is just afraid of the information they’ve been given. The first step would be to educate all the staff in order to allow them to the opportunity to teach the parents of the patients about facts vs. fiction. In today’s age of social media and constant Internet access, many people are accessing websites that are not factual, and are meant to spread lies. For every parent that wants an exemption, there should be a process put into place in order for both parties to get the information they need.

The first step should be a counseling session between the healthcare provider and the parents. They should explore what their main reason is in asking for exemption; if it were a medical or religious belief then we would start them in the process of applying for those specific exemptions. If it is solely based on philosophical reason then they need to explore further into what exactly they are under the impression of, and how they can make sure they are given all the facts. The practice can also set up an information session for parents to come speak to different healthcare providers, and maybe some representatives from the companies who manufacture the vaccines.

In order to handle this situation, a transformational leader would be most effective in dealing with angry and scared parents. “These leaders are motivational and empowering and they inspire others to identify with and pursue a long-term vision.” (Cope & Murray, 2017) In trying to convince scared parents to vaccinate their children, the staff and leader included are facing an uphill battle. In having a leader who can help parents understand the benefits vs. the risks, and do it in a way that will be sensitive and effective, is extremely important.

Expected Outcome

The expected outcome would of course to have all children who are not medically or religiously exempt from the vaccines, receive them. There are many children for whom vaccines are medically contraindicated, but they can be protected by what is none as herd immunity if the others around them are vaccinated. If majority of parents start receiving exemption, this threatens the herd immunity, and makes the whole community susceptible for these preventable diseases. It is their job to ensure that the community remains safe, and in order to do that, they need to ensure the children are vaccinated.

Professional Standards

In dealing with both parents and children we need to be extremely cautious in how we proceed with parents who are against vaccinations. An effective nurse leader knows how to manage their staff and give them the tools for success. In ensuring the staff is fully educated on vaccines, you give them the resources needed to effectively deal with parents, and continue to educate those around them. A good leader also knows that no task is easily completed, and that this will most likely be an ongoing issue that can take years to rectify. In knowing that this will be an uphill battle, the manager can make sure that your resources are ongoing throughout the year, and that they are allowing a safe space for parents to come and voice their opinions and get educated as needed.

Resources

Adolescent and School Health. (2018, June 14). Retrieved from https://www.cdc.gov/healthyyouth/sexualbehaviors/

Clinical practice guidelines for chronic kidney disease: Evaluation, classification and stratification. (2002). Retrieved from https://www.kidney.org/sites/default/files/docs/ckd_evaluation_classification_stratification.pdf

Cope, V., & Murray, M. (2017). Leadership styles in nursing. Nursing Standard (2014+), 31(43), 61. doi:http://dx.doi.org.library.capella.edu/10.7748/ns.2017.e10836

Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). (2013, June 14). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

Tiffany, C. R. (1994). Analysis of planned change theories. Nursing Management, 25(2), 60. Retrieved from http://library.capella.edu/login?url=https://search-proquest-com.library.capella.edu/docview/231415471?accountid=27965

Vaccine Recommendations and Guidelines of the ACIP. (2018, January 11). Retrieved from https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/mmr.html