¶ … Confidence is a golden trait that can provide useful if not in all, than at least most situations any single person may experience. Confidence essentially includes having the ability to successfully negotiate any given task with grace, precision and tact. This acquired skill is therefore obviously extremely useful in the health care industry. Nurses are integral in the healing process and maybe more important than the physician in many instances of medical treatment. Nurses need not only technical skills but also social skills that will serve both their own career aspirations but also simultaneously assist in the practical application of their profession. The purpose of this proposal is to convince the reader that the problem of lack of confidence in nursing, and specifically their communication methods with patients, is significant and the ensuing plan will benefit the stakeholders involved.

This plan will first explain how raising confidence levels can contribute to the general efficacy of health care and provides of an outpost for future nurses to help guide them. This plan will use the Rosswurm and Larrabee model of empirical-based nursing practice (EBNP) as a framework to install this program. After synthesizing this model with the aforementioned problem, an evaluation plan will be presented and a guide to help maintain the positive changes that take place once the system has been in operation for enough time to mark the progress and build upon the foundation.

Contribution to the Future of Healthcare

Any application of a successful permutation of this model that increases the amount of confidence within the general pool of nurses will have an incredibly positive and dramatic effect on the healthcare industry as a whole. The profession of nursing is often overlooked within the entire healing practices of the mainstream and this change in attitude can help promote the profession to a new level of importance, prestige, and responsibility.

The healthcare industry can always be operated under more fiscally restrictive terms in order to maximize resources and get the most out of what is actually available. As a result of addressing this dearth of confidence in the nursing population's ability to communicate, the health care industry stands to benefit economically, politically and literally as new healing discoveries can be discussed and put into practice due to this new environmental shift of processes and understanding.

Change Model Overview

Rosswurm and Larrabee (1999) proposed a model for guiding nurses through a systematic process for the change to evidence-based practice. This model recognized that translation of research into practice requires a solid grounding in change theory, principles of research utilization, and use of standardized nomenclature. The model provides a pragmatic, theory-driven framework for empowering clinicians in the process of evidence-based practice.

The Rosswurm and Larrabee conceptual framework was used to adapt the existing medical evidence-based practice conferences to an approach that incorporated a focus on nursing phenomena with the goal of teaching nurses the EBNP model, while also evaluating the possibility of changing clinical practice.

Step1: Asses the Need for Change

Chapman (2009) suggested that "The current challenge in health care is to create an environment in which open and transparent communication is the norm, rather than the exception. One way to do this is by adopting strategies that have been successful in other industries, " (p.21). The rate at which miscommunication is happening throughout the health care industry suggests that more voices are needed that address the issues that have been ignored in the past. It is necessary for additional training for nurses to learn new communication skills.

Step 2: Link the problem, interventions and outcomes

This intervention training may cause some issues among nurses. A feeling of inferiority may soon take hold or the nurses themselves will resist any type of intervention. The balance of power may shift in unpredictable ways in the testing grounds for this new idea, but it appears the risk is worth taking. The desired outcome is that the nurses involved incorporate and master the communication skills being presented to them in an effort to influence their workplace within the health care industry.

Step 3: Synthesize the Best Evidence

Much evidence supports this approach and the best way to synthesize is to follow the lead of other research studies that have examined this problem. These studies include: Barrere (2007), Sheldon (2011), Robinson & Turner (2005), Bedorick and Bruce (2005). Heaven, Clegg & Maguire (2005) most closely represents this particular intervention and can be used heavily throughout to reference. This study ultimately concluded that "that whilst training enhances skills, without intervention, it may have little effect...

The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programme has been demonstrated. This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist, " (p.313).
Step 4: Design Practice Change

In order to design the desired practice change, it is important to hold roundtable discussions with the nurses in order to gain insights into their thoughts and opinions regarding necessary changes in their practice, especially those related to education and training. The outcome of these discussions will then be used to develop strategies to explore the original issue and develop tactics for achieving the desired change. Comment by Julie: ood

The education programs will need to be merged with mentoring programs in order to provide all round training for the nurses. This is because they will be able to develop their skills in practice through mentors and also to gain knowledge through the trainings. The head nurse and hospital management will need to be involved in all stages of the change. The nurses, who are the targets of this change, will also be involved in the change process. Other key stakeholders that will be involved are the nurses union which will help to provide essential training and mentorship strategies suitable for this change. Doctors will also be involved in the change since they are end users of information received from patients Comment by Julie: describe the intervention… what is involved with the class? How many classes? Is it part of orientation? Make it clear what the program is and what the current process is.

Step 5: Implement and Evaluate The Change In Practice

The change will be implemented by scheduling convenient weekly training sessions for the nurses. The nurses will be required to attend at least one training session every month. Change management is extremely necessary to prevent and reduce resistance It will thus be important to liaise with the head nurse and the hospital management in order to communicate the goals of the change to the nurses. Feedback channels will also be open to help the change managers to get feedback from nurses. This will help to identify sources of resistance easily and understand the progress being made. Comment by Julie: Period.

Step 6: Integrate and Maintain the Change in Practice

Integrating this change in practice is the most important step since it ensures the sustainability of this change. This will be done by ensuring the mentorship program is well developed and that it addresses the issues in the change and will be part of orientation. Regular refresher trainings and seminars will be held in order to help the nurses remember the importance of effective communication at all times. The change program will also be monitored and evaluated frequently using the feedback collected by questionnaires using a five point Likert scale, and other administrative data in order to find ways to improve it. Comment by Julie: Will it be part of orientation? Comment by Julie: Questionnaires or pt satisfaction survey results maybe?

Implement and Evaluation Plan

Weekly training sessions will be resourced and taught by the nurses themselves with appropriate guidance being offered by other doctors and staff. This training will include various topics including, grammar, logic and rhetoric as important classical subjects that deal with communications. Other modern approaches will also be incorporated as well. The questionnaire design, to measures the effectiveness of this plan will have 25 questions that measure their ability to communicate complicated issues amongst themselves and to doctors and other staff. This qualitative data can then be processed to find statistical relationships between the communication skills, professional proficiency and personal attitude.

Steps to Maintain Change

Using basic guidelines to maintain strategic output must be incorporated in this approach. To do so, five rules of thumb have been developed to ensure that this training and new approach will linger as long as it needs to.

1. Be flexible, times change, so should the organization

2. Treat others as you would like to be treated.

3. Update data only when it is necessary, let change dictate success.

4. ABC ..Always be learning..

5. Remember this is all about healing and helping our fellow humans...

Conclusion

Organizations should adapt when evidence suggests that the time is right. Any EBNP must incorporate some model of change and to ensure its effectiveness continually renew it by examining it with a new perspective. The aforementioned program accomplishes this by addressing the communication improvement needs that are present…