Strategies to Communicate and Educate Stakeholders in Change

Family Nurse Practitioner: Promoting Change

Strategies to communicate and educate stakeholders

I am currently employed as family nurse practitioner and am doing my DNP at a clinic under the supervision of a medical doctor. Communicating with patients is an essential component of treatment and care. If patients cannot engage in effective self-care at home, the treatment dispensed by the clinic will be of little value. The nurse must communicate clearly and seriously the full weight of the patient's condition and need for treatment. For example, if a patient is pre-diabetic, the nurse must make the patient understand what this means: that weight loss, diet and exercise modifications may be able to prevent full-blown diabetes from occurring. The fact that diabetes is not a disease that can easily be managed with drug treatments, although many new drugs and forms of glucose monitoring are available, should also be conveyed to the patient: pre-diabetes is still a serious condition. The nurse must work with the patient's schedule, budget, and knowledge when suggesting a feasible meal plan and exercise routine. Communication is much more than merely saying information: it means responding to the patient's unique needs.

As well as communicating with patients, another important stakeholder is that of the other healthcare providers existing within the organization. The nurse must be in contact with all elements of the patient's treatment team. The nurse's primary role is that of the patient's advocate who balances the patient's social, psychological, environmental, as well as physiological needs. Rather than simply treating the patient as a constellation of symptoms, the good nurse views the patient in a holistic fashion. This perspective is a necessary counterweight to a purely empirical and medical model. For example, a nurse might be aware that a doctor has a different paradigmatic analysis of a patient that needs surgery, as the doctor may primarily focus on the technical aspects of the surgery. The nurse may be equally concerned with the patient's psychological state, pain management, and concerns about postoperative follow-up with the family. Neither the nurse's nor another healthcare paradigm is perfectly 'correct:' what is fruitful is acknowledging these differences and engaging in dialogue. Ideally, the organization will support the concept of what has been called a 'learning organization:' "built on five practices…systems thinking, personal mastery, mental models, team learning, and building shared vision" (Small & Small 2011). Holistic integration of perspectives and a commitment to shared values is vital.

Engaging the support of those with power and authority

Nurses must know how to speak the language of persons with power and authority to be persuasive. This can be very difficult for nurses who are primarily versed in the language of patient-centric healthcare. Those in power, however, are also concerned with financial issues and a cost-benefit analysis is likely to be more compelling than arguing from anecdotes or an ethos of compassion -- the nurse must have data-driven analysis to back up his or her claims. The nurse must understand the mindset of those who are the final arbiters over the programs she or he supports. It is also essential to use concepts such as team-based learning that are important to the discourse of the organization's mission and vision. The nurse must be aware that he or she is not merely articulating a personal vision, but a vision for the entire organization.

People with power and authority in the organization will want to know why specific changes are needed now and justify the opportunity costs of time as well as money required; they will demand specificity in terms of the detailed plan that is submitted. Real change is only possible when outlined in a step-by-step process with concrete objectives.

Successful implementation of your proposed evidence-based change

Overcoming the challenge of change resistance is vital. "The demands of healthcare mean nurses work in constantly changing environments; they must continually adapt to different demands, new technologies, government policies and other innovations" (Bowers 2011). However, nurses are often resistant to change because they feel the change is being imposed upon them by tone-deaf management. The most common change model is that of the 'unfreeze,' 'move,' and 'refreeze' model. This underlines the fact that it is essential that nurse leaders convey the need for change to generate a sense of urgency for the change to be effective and also once the change is implemented, standard operating procedures are instituted to ensure that the change 'sticks.' "When managing change it is important to identify with people and reduce the possible resistances they will have in accepting new ways of practicing…leading change means helping people to embrace the challenges to the point where they positively accept and psychologically own new ways of practicing" (Bowers 2011). Even if a change is clearly necessary in the eyes of the leadership, this does not mean that all nurses will automatically agree this is the case.

What are potential challenges for knowledge integration?