¶ … 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...

Besides, Marquis and Huston (2006) also stressed in Lewin's model that the balance of driving and restraining forces must be changed in order for change to take place, where either to increase the driving forces or to decrease the restraining forces. The driving force involved in implementing change to the way hospice staff is their training to use Foley catheters. This transition will improve the hospice's reputation, improve patient outcomes and possibly promotion. Whereas the restraining force is be the attitude of conformity to the norm, which can lead to refusal to the change being adopted. Secondly, the unwillingness to take risk also might hinder the implementation of change, doubled with the fear of the unknown (Marquis & Huston, 2006).
After tackle all the driving forces and the restraining forces involved, the next task proposed by Marquis and Huston (2006) is to create an imbalance within the system by increasing the driving forces or decreasing the restraining forces. Hereby, the driving forces can be maximized and the restraining forces can be minimized by appoint a chairperson from the management of nursing, who has a say in authority to support in this change. The best person for this orientation program is the nursing manager of the hospice. This is important because as Marquis and Huston (2006) stated that one of the factor which affect successful implementation of planned change and resulted change never realized is because of lack of power. Another way driving forces can be enhanced while simultaneously suppressing the restraining forces is by allowing sufficient time for change. As this change involving the attitude attitudes of the staff, Marquis and Huston (2006) suggested adequate time is necessary to enable those involved to be fully embrace the change.

Movement is the second phase of planned change, according to Lewin's theory of change. Movement includes the identification, planning and implementation of appropriate strategies by the changer to ensure the driving forces exceeding the restraining forces (Marquis & Huston, 2006). The objective identified for this change is the new staffs will use Foley catheters only when medically indicated. Therefore, in order to include those who will be affected by the change in planning, a meeting among all the hospice nursing staff has to be held in order to discuss the issues of planned change.

The power of changer and the amount of resistance expected from the subordinates will determine the appropriate strategy for any situation. Resistance is perceived as a natural and expected response to change, efforts are undertaken by the changer to identify and implement strategy to minimize resistance to change instead of wasting time and energy to eliminate opposition (Marquis & Houston, 2006). As in this situation of new staffs orientation in Operating Room, there is only little anticipated resistance to the change and change is perceived as reasonable. However, the resistance to change will be encountered from those who involved and those who will be affected by this change. As for the senior staff nurses, the perception of extra workloads and the attitude of "who cares" might hinder them from participating, especially when this implementation of change interrupts into their busy working environment. Whereas for the new staffs, the unwillingness to change as conformity to their usual practice, lack of interest and initiative, might be the main obstacles in implementing the change. Nevertheless, with all these resistance, there are supports also which can be obtained from the management of nursing and the nursing manager of Operating Room into supporting this change. By encouraging the subordinates to communicate openly about their dissatisfaction about the changes can be one of the strategies to enable options to be identified as a way to overcome objections. Meanwhile, the staffs' perceptions of the forces driving the planned change are encouraged to be discussed it openly to ensure the changer can accurately assess change support and resources (Marquis & Huston, 2006). Apart from this, resistance also can be reduced by…