¶ … Change
Improving Hospice Urinary Infection Rates:
An Analysis of Foley Catheter Use in a Hospice Setting
Change is a necessary part of any organization. One critical area that demands change in hospice nursing is overzealous use of Foley catheters. Often these instruments are used when not medically necessary despite their leading to urinary tract infections and antibiotic resistance. In order to change the culture of nursing regarding Foley Catheters, an analysis of the key steps of organizational transformation are presented with a focus on Lewin's Force Field Model. Through an understanding of the mechanisms of change, nursing administrators can improve patient outcomes and improve antibiotic efficacy in any healthcare setting.
Introduction
The comedian Billy Crystal once quipped that, "Change. It's such hard work!" Nowhere is this remark more valid than in managing change in the healthcare setting. For effective change, expert planning is required, therefore this paper is going to discuss the strategy of change, organizational effect and the impact of using Foley catheters only when medically necessary in the hospice setting. This change will contribute to a lower frequency of urinary tract infections (UTI). The most appropriate theory of change to utilize Lewin's (1951) Force Field Model. This strategy of change is going to center on the problem identified, the key personnel involved, proposals for change, analysis of what actually might occur, and the evaluation tools. Through a thorough understanding of the strategy of chance, healthcare providers can more effectively address problems in their work and deliver superior healthcare to their patients. One such problem is the unnecessarily high rate of urinary tract infections in hospice care. Urinary tract infections can be understood as an infection of the ascending urine output infrastructure starting at the urethra and moving to the bladder and into the kidneys. In the hospice setting, when dealing with immobilized patients the rates are significantly higher. This rate is further compounded by the frequent use of Foley catheters in this setting. The Foley catheter is often inserted without medical necessity as it makes the life of the attending nurse significantly easier when caring for an incapacitated patient. In addition, they are utilized in settings when not absolutely medically necessary such as in the case of monitoring of fluids. This current culture of Foley catheter usage is dangerous as it predisposes to UTI which in turns leads to greater antibiotics use and resistance developing. This resistance endangers not only the patient's life but the other individuals in the nursing home who become colonized with resistant bacteria. Therefore the need to develop new management protocols for the use of Foley catheters is critical and an excellent avenue to examine the management of change in the healthcare setting.
The most appropriate and practical theory of change for a large scale adjustment is that of Lewin's theory. This theory operates on three key stages for the management of change: Unfreeze, Move and Refreeze (1951). To begin with the unfreeze stage, individual staff members must be selected to implement the change. It might be beneficial to schedule an orientation program on the new protocols for the staff in order to improve the quality of work performance and for better patients' outcomes. This will upgrade the hospice level of care as well as uphold the reputation of nurses. Furthermore, Gardner stated in Marquis and Huston (2006) that by keeping the same personnel when undergoing change is the way of conserving an organization. It is important to introduce changes to the way new staffs are being orientated, to enable them to work confidently and efficiently to meet the desired expectation.
In the process of implementing this change, there are two things to be considered, which is the driving forces and the restraining forces. Marquis and Huston (2006) defined the driving forces as the forces that propel the system toward the change, whereas the restraining force does the opposite, to divert the...
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