This paper examines a nurse manager's proposal to add a certified wound care nurse to an orthopedic and post-trauma hospital floor. It begins by defining the specialized role of wound care nurses and identifying gaps in current patient care. The paper then outlines the interests of three key stakeholder groups — hospital administration, floor nurses, and patients — before applying Lippitt's seven phases of change theory as the implementation framework. Each phase is mapped to concrete actions, from diagnosing the problem and assessing resources to maintaining the change through feedback and gradually withdrawing managerial oversight. The analysis draws on evidence-based practice literature to support the case for specialization in wound management.
The paper demonstrates structured application of a named theoretical framework. Rather than simply describing Lippitt's phases in the abstract, the author maps each phase explicitly onto the specific change being proposed — hiring a wound care nurse — producing a step-by-step implementation roadmap. This technique shows readers how to use theory as a practical planning tool, not merely as a citation.
The paper opens with a definition of wound care nursing and a rationale for specialization, then provides clinical context through a floor description. A stakeholder analysis section examines competing interests before a change theory section compares Lewin and Lippitt, justifying the choice of Lippitt's model. The longest section walks through all seven implementation phases in sequence. A brief conclusion synthesizes the benefits and acknowledges implementation challenges. This introduction-context-theory-application-conclusion structure is well-suited to nursing management proposals.
Wound care nurses play a special role in the hospital environment, and hospitals without these specialized nurses may not be able to offer the same level of care as those that employ them. Wound care nurses, sometimes referred to as wound, ostomy, and continence (WOC) nurses, specialize in wound management — the monitoring and treatment of wounds due to injury, disease, or medical treatments. Their work promotes the safe and rapid healing of a wide variety of wounds, from chronic bed sores or ulcers to abscesses, feeding tube sites, and recent surgical openings (Nursing Schools, 2012).
While it may seem as if any nurse should be qualified to perform these functions, it is critical to recognize that wound care is a specialized field. Their main objectives are to assess wounds, develop a treatment plan, clean wounds, and monitor for signs of infection. If wounds worsen, these nurses must be able to recognize symptoms that could require surgical debridement or surgical drains. Wound care nurses also work with patients and other caregivers to educate them on wound prevention (Nursing Schools, 2012).
While it may be possible for other types of nurses to provide comparable care, it is unlikely that they can consistently match the level of care that wound care specialists deliver. Best practices therefore suggest that a hospital with a high number of wound patients should employ a dedicated wound care nurse to manage these injuries and engage in patient education. Because the floor where I work sees a high volume of serious wound patients, the hospital would benefit significantly from the addition of a wound care nurse. This paper uses Lippitt's phases of change theory to describe how to tackle the challenges of securing a certified wound care nurse for this hospital floor.
At this time, I work in a hospital with no dedicated wound care nurse. I work on the orthopedic and post-trauma floor as a staff nurse, and part of my duties include wound care. However, some of the wounds seen on that floor are very serious and require specialized knowledge to treat properly. While the nurses on the floor are adequate at caring for wounds, providing appropriate care for the most serious cases sometimes requires additional research time, which delays services for all patients — not simply those with the serious wounds.
I believe that the addition of a wound care nurse would provide significant benefits to the hospital. Most importantly, a dedicated wound care nurse would increase the quality of patient care, which is the most critical consideration when evaluating additions to a hospital's nursing staff. Beyond patient benefits, a dedicated wound care nurse would reduce staffing concerns for nurse managers, decrease the burden on floor shift nurses, and more properly align nursing duties with industry standards for job performance.
Several stakeholders are involved in the implementation of any change in the hospital. The first group includes the hospital's board of directors, who must manage the hospital's budgetary concerns. The second group includes the nursing staff. The third group includes the patients. While it may appear that all three groups share the same interests, that is an oversimplification of the personal stakes in this scenario. All three groups share the same overarching goal — the provision of affordable, high-quality health care in a supportive environment — but each is driven by a distinct set of primary concerns.
The board of directors, for example, must not only budget for an additional staff member but also consider the legal consequences of hiring a wound care specialist. If a specialist is on staff but another nurse manages a patient's wound care and the outcome results in infection or other complications, does the existence of an unused specialist raise liability issues? Conversely, does the hospital's failure to employ a specialist in the first place create its own liability exposure? These are the questions the directors must weigh when evaluating this proposal.
The nursing staff might theoretically offer unanimous support for the addition of a wound care specialist, since it would free them for their other duties. However, a wound care specialist could also be perceived as undermining the apparent authority of the floor nurses. Research suggests that individuals often claim to access knowledge through formal channels such as journals while in reality consulting colleagues from their own and other professions. Like nurses, doctors also have vested interests in claiming to use research information as the basis for practice (Thompson et al., 2001). This indicates that patients may currently not be receiving state-of-the-art wound care, and the arrival of a specialist might reveal those gaps in service. Additionally, assuming a fixed nursing budget, the addition of a specialist who does not perform general floor duties would likely produce no significant reduction in workload for other nurses and could reduce the likelihood of raises.
Patients would generally have an interest in receiving the best-quality care, and the added cost of a wound care nurse, distributed across the floor's patient population, would not significantly increase any individual's financial burden. However, patients often grow attached to their floor nurses. It is worth considering whether a dedicated wound care nurse might undermine their confidence in their regular nurse, or whether patients would resist having a nurse specifically assigned to wound management. All of these questions reflect the genuine concerns of patient stakeholders.
There are two primary change theories commonly applied when implementing change in a nursing environment: Lewin's change theory and Lippitt's change theory. Lewin's model proposes a three-stage process known as the unfreezing-change-refreeze model (Kritsonis, 2004–2005). In this framework, driving forces cause change to occur, restraining forces counter those driving forces, and equilibrium is the state in which driving and restraining forces are equal and no change takes place. The first stage, unfreezing, involves finding a way to let go of old, counterproductive patterns. The second stage, change, involves a shift in thoughts, feelings, or behavior. The third stage, refreezing, involves establishing the change as a new norm (Kritsonis, 2004–2005).
Lippitt's phases of change theory extends Lewin's three-step model by focusing on the roles and responsibilities of the change agent, rather than simply tracking the evolution of change itself. For this reason, I find it a more appropriate framework for tackling the challenges of instituting this particular change. The seven steps of Lippitt's theory are: (1) diagnose the problem; (2) assess the motivation and capacity for change; (3) assess the resources and motivation of the change agent; (4) choose a progressive change objective, including developing action plans and strategies; (5) select the roles of change agents; (6) maintain the change through communication, feedback, and group coordination; and (7) have the change agent gradually withdraw from the role over time (Kritsonis, 2004–2005).
"The successful implementation of an evidence-based wound management program can be a complex process, as there are many factors that inform the effective delivery of quality patient wound care" (McIsaac, 2007). Moreover, the success of implementing such a program is not based solely on the quality of care given to patients with severe wounds. Success can be achieved through the simultaneous implementation of multiple clinical, educational, and operational strategies, including a focus on patient-centered care, a multidisciplinary approach to implementation, ongoing education for all stakeholders, a clearly articulated process for knowledge transfer, the creation of a comprehensive strategic plan, and a method for outcome measurement to evaluate and assess program effectiveness (McIsaac, 2007). Keeping all of these factors in mind helps guide each step of the change process.
Rycroft-Malone, J. (2004). The PARIHS framework — A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304.
Thompson, C., McCaughan, D., Cullum, N., Sheldon, T., Mulhall, A., & Thompson, D. (2001). The accessibility of research-based knowledge for nurses in United Kingdom acute care settings. Journal of Advanced Nursing, 36(1), 11–22.
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