Challenges and Barriers
Upon implementing positive change in a health care facility and evaluating the outcomes, it is necessary to ensure that the change is sustained, i.e. newly adopted policies or practices are not discontinued. Successful change projects incorporate how change can be sustained as a major consideration included in initial planning; the first step is identifying possible challenges and barriers that may impede sustaining change.
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Clarke and Marks-Maran (2014) suggest that a major challenge in this regard is an ever-changing environment; if practices to which health care providers are required to commit change constantly, procedures do not become well-established, and it is likely that positive change-related practices will be ultimately dismissed. This is why it is necessary to maintain an environment that is flexible, i.e. innovation is possible, but at the same time, the changes are not too frequent so that the work of health care providers is not disrupted.
Another major barrier is the nurses’ possible unwillingness to implement change. In a study conducted by Shifaza, Evans, and Bradley (2014), more than half of nurse practitioners referred to such unwillingness to try new ideas or practices as a barrier. This barrier is more likely to arise if nurses who will be proposed to commit to the new intervention of patient education and physical therapy are not properly explained the purposes of introducing the new intervention and the benefits of it compared to the currently implemented fall prevention efforts.
It can be expected that the barrier will be overcome because the health care providers who will be engaged in the implementation of change will be the people who participated in the research and thus have personal evidence of the way the proposed change project works in terms of reducing the fall rate and the negative effects of injuries related to it.
The stakeholders vital to sustaining change in the proposed project are health care providers, facility administrators, the researcher, and the nursing community. First of all, it will be the responsibility of intervention providers to ensure that the new fall-prevention practices become integrated into the working process. Macphee and Suryaprakash (2012) emphasize the role of leadership in this integration; nurse leaders should actively promote the new practice and address any challenges that other nurses may face; their feedback can help nurse leaders modify the practice as needed to ensure convenience and better compliance with nurses’ approaches to work.
Second, the administrators’ role is to incorporate the change into internal regulations, such as guidelines for the delivery of care, and enforce the regulations. Since they are leaders, too, the administrators should rely on feedback from implementers in case modifications are needed.
Third, the role of the researcher is to supply all the relevant research findings so that it is confirmed that the proposed change is effective. This will allow adopting the new fall-prevention practices in the evidence-based practice framework, which is crucial in approaching the issue of sustaining change (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). Therefore, the findings should be properly documented and supported by the theoretical framework developed as part of the change project. Finally, it can be argued that the nursing community in a general sense plays a role in sustaining the proposed change, too.
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The support that the community provides through professional communication and publications in relevant literature sources is an important factor in ensuring that positive change is sustained in a particular facility. If nurses are encouraged—during professional conferences or meetings—to sustain change, the success of sustaining it is more likely.
It is necessary to develop strategies that will help the stakeholders sustain the proposed change. A particular strategy can be derived from Lewin’s theory of planned change (Shirey, 2013). From this theory’s perspective, there are three stages of change, and the third one is refreezing, i.e. stabilizing the change and incorporating it into the current system. The strategy to be employed by nurse leaders in this regard is to organize the work of other nurses (i.e. in terms of scheduling or arranging meetings) in a way that allows the nurses to successfully adapt to the new fall-prevention practices and accepts them as part of their work.
Further, the strategy that the researcher should adopt is evidence-based; everything supplied to implementers and administrators should be supported by the proposed intervention’s findings as well as findings from other studies. The administrators’ strategy should be related to feedback from nursing care providers and patients; based on this feedback, the administrator can respond to challenges arising due to the implementation of the new practice and introduce necessary modifications.
The patient-centered strategy can be helpful, too, as patient satisfaction, along with fall rates, will be used for evaluation, and evaluation strengthens the efforts aimed at sustaining change. Finally, patients were not listed as stakeholders in the process of sustaining the proposed change; however, if patients actively engage in the new program and provide positive feedback, it will make a significant contribution to ensuring that the change is successfully sustained.
Clarke, U., & Marks-Maran, D. (2014). Nurse leadership in sustaining programmes of change. British Journal of Nursing, 23(4), 219-224.
Macphee, M., & Suryaprakash, N. (2012). First-line nurse leaders’ health-care change management initiatives. Journal of Nursing Management, 20(2), 249-259.
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5-15.
Shifaza, F., Evans, D., & Bradley, H. (2014). Nurses’ perceptions of barriers and facilitators to implement EBP in the Maldives. Advances in Nursing, 2014(1), 1-7.
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72.