Advocacy and planned change exam 2

-Standard VII of ANA Scope & Standards of Practice (2010)

-Take appropriate action in illegal, unethical & inappropriate behavior, that threatens the consumer or situation. -Speak up to question health care practice. -Advocate for equitable health-care consumer care. -Differentiate between controlling & assisting patient choices

Nursing & the Media

-Take on the opportunity -Training programs -Be prepared -Manage 3-4 points -Stick to these points -Provide clear, concise information -Don't be afraid to say that you do not have the information or expertise to answer

Nonlinear Change Theory -Chaos Theory (Butterfly Effect)

-Determine the underlying order in the random information in a changing system -Hidden variables must be explored before change is considered -This chaos makes it difficult to determine the future -Ex: Organizations are open systems. Similar to a semi-permeable membrane. Periods of instability & transformation.

Patient rights (2)

(2) -Affordable Care Act -HIPAA, , GINA, & Mental H. Acts

Advocacy Situations

-End-of-life decisions -Technological advances -Health-care reimbursement -Access to health care -Provider-patient conflicts -Blatant lying or withholding of information -Insurance challenges -Medical errors

Strategies to minimize resistance to change

-Established trust & rapport. -Encourage subordinates to speak openly -Encourage workers to share their perceptions of the forces driving changes -Then, assess the need for support & resources -See & share the vision of what the future state will be after the change is implemented -Experienced change agent & project champion

Movement

-Identify, plans, and implement appropriate strategies -Ensures that driving forces exceeds restraining forces -Implement gradually and for good reason -Allow time for change to be fully assimilated

Whistleblowing as Advocacy

-Internal-occurs within org. Report up chain -External-reporting outside org.(media, elected officials) -Looked upon as disloyal—repercussions -Society has mixed views -LM must advocate for them -Nurses have responsibility to report acts -Takes courage, limited protection

Integrate Leadership & Management in Planned Change

-Know plan & implement. -Be aware of forces. -Provide tools/resources. -Be productive in a chaotic changing system. -Know the trends & changes . -Integrate vision, adapt to change & know when change is needed (Big picture) Model professional skills.

Resistance: Expected Response to Change

-Level of resistance is based on type of change -Technological changes involve less resistance --Changing IV pump -Perceived social changes that are contrary to customs or norms involve more resistance. lChange in who is able to administer certain types of IV therapy. lIt is easier to change knowledge levels than attitudes lValues, education, culture, experiences & social background affect level of resistance to change

Lewin Change Theory Components

-Lewin identified three phases -Unfreezing, Movement & Refreezing - -Change agent must be involved in the entire process

Level of resistance is based on type of change

-Technological changes involve less resistance --Changing IV pump -Perceived social changes that are contrary to customs or norms involve more resistance. lChange in who is able to administer certain types of IV therapy.

Necessary for Practice Changes to Occur

-Need for change (unfreezing) -A helping relationship between the change agent and agent (Movement) -Problem is identified and clarified -Alternatives for change are examined -Resources are assessed -Active modification -Movement is complete -Refreezing occurs; change is stabilized -The helping relationship ends

Integrating L&M in Advocacy

-Obligation to advocate for self, patients, subordinates & profession -Furthering the goals of the profession -Value autonomy & empowerment -Leadership: Risk taking & support varied choices, role model & political involvement -Manager: Create equitable and safe environment to meet needs & goals. Advocate public relations and demonstrate skills for working with the media

Continual Change in Health Care Organization

-Organizational Restructuring -Quality Improvement -Employee Retention

lRestraining forces (barriers)

-The forces that pull the system away from change - resistance, bad timing, lack of power

L & M Functions in Planned Change

-Organizational skills -Planning skills -Ongoing evaluation of organization goals -Changes implemented based on evaluation organization needs -Appropriate use fiscal & human resources -Be visionary & flexible in adapting to change

Change Theory

-Traditional Change Theory by Kurt Lewin (1951) -Good reason for change - Gradual -Planned -All individuals who would be affected by the change, should be involved in the planning.

Nurse Manager on 12 E is developing her legal role in nursing. Which of the below are elements of malpractice liability? Select all of the below that apply. 1. Injury 2. Inquiry 3. Standard of Care 4. Breach of Duty

1. Injury 3. Standard of Care 4. Breach of Duty

Organizational Aging: Change as a Means of Renewal

-Organizations progress through developmental phases. -As organizations age, they become more stable -Young organizations: High energy & fluid -Aged organizations: Established turf, control & change is limited. -Organizations must have balance -Without change; organizations stagnate/die

Change Agent Challenges

-Organizations tend to reject outside change agents. -Inside agents are influenced by personal bias. -Change agents must have sensitivity to needs of the organization

Areas for Nurse-Patient Advocacy

-Patient information disclosure -Patient grievance & appeals -Cultural sensitivity & diversity -Respect for patient dignity -Inadequate consents -Incompetent HCP's -Complex social problems -Aging Population

Planned Change Change Agent:

-Person skilled in theory and implementation of planned change.

Forces Driving Change in HCS

-Rising health care costs -Declining reimbursements -Workforce shortages -Increasing technology -Dynamic nature of knowledge -Growing elderly populations

Workplace Advocacy

-Safe work environment -Conducive for professional & personal growth -Workplace --OSHA --Protective workplace safety & standards --Information, training & assistance to employers/workers -- Workplace violence --Worker exposure --Injuries, accidents, hazardous materials, & stress -Human resources -Nursing shortages -Subordinate empowerment

Resistance Factors

-Because change disrupts the homeostasis or balance of the group, resistance should always be expected -It's a natural and expected response to change -Encourage subordinates to speak openly so that options can be identified to overcome objections -Change should be planned and implemented GRADUALLY!

Patient Rights

-Bill of Rights - Help patients feel more confident in HCS - Stress importance of the relationship between patient & HCP. - Stress the role of patients in staying healthy -NLN & AHA: - Created documents for rights of patients - Not legally binding - Guide professional expectations in patient advocacy -Affordable Care Act -HIPAA, , GINA, & Mental H. Acts

Nonlinear Change Theory

-Complex Adaptive Systems (CAS) -The relationship between elements & agents within a system is nonlinear & are constantly in motion for change -Change agents must examine the focus of the relationships & interactions involved in change - -Ex: Nurses are independent agents, Participating in non-linear interactions

L& M Roles in Patient Advocacy

-Create a work environment that recognizes patients needs as paramount. -Managers must advocate for patients in regards to use of technology and distribution of resources. -Leaders must be risk takers when advocating for patients.

-NLN & AHA:

- Created documents for rights of patients - Not legally binding - Guide professional expectations in patient advocacy

Advocacy

-Definition: -Helping others to grow & self-actualize -Actions of an advocate: -To inform others of their rights and assure that they have adequate information to make a decision

Planned Change Definition:

-Deliberate application of knowledge & skills by a leader to bring about change -Well thought out effort to make something occur.

-Bill of Rights

- Help patients feel more confident in HCS - Stress importance of the relationship between patient & HCP. - Stress the role of patients in staying healthy

lDriving forces (facilitate)

- Push the system towards change - desire to please your boss, eliminate a problem, pay raises, and receiving recognition.

Needed Change to impact 21st Century Organization Dynamics

-21st Century organizations are contemporary -Change is unforeseeable & ever present -HCS's long term outcomes are unpredictable -This unpredictability can not be managed with traditional linear theories (Lewin) - -Nonlinear theories are needed to managed change in this unpredictable society

Leadership Role in Advocacy

-Advocacy & risk taking climate -Differentiate between controlling & assisting choices -Advocate fairness & justice -Strengthen support systems -Provide information & mediate -Membership in professional organization -Role model involvement in policy -Advocate the Patient Bill of Rights

Professional Advocacy

-Advocate for nursing profession -Culture for professional nsg. -Be a part of a system that is socially defined -Personal & public duty to serve -Commitment to the profession -Broaden the sociopolitical -Speaking out in legislation -Membership on policy making boards -Influence society concerns

Refreezing

-Assist in stabilizing the system to integrate into the status quo -Be supportive -Reinforce -Takes 3 - 6 months Be available until the change is complete -Refreezing does not eliminate the possibility of further improvements to the change

Management Role in Advocacy

-Assures information -Maintain a safe healthy workforce & environment. -Environment of empowerment. -Take action (illegal, unethical & inappropriate behavior). -Aware of legislative efforts -Demonstrate skills with media & legislators -Seeks consultation with advocacy conflict -Encourage subordinates to address concerns

Advocacy in Legislation & PP

-Attention on nurses & the profession -Participation in National Nsg. Organizations -Influence health policy & legislation -Lobby legislators in person/letter -Collective influence to impact HC policy -Political action committees -ANA reps attend official meetings -Group representation -Network groups -Speaking to groups, friends, neighbors

Nurse Manager for 8W is proactive in maintaining a legal & legislative role. Which of the below will support this role? Select all that apply. 1. Report substandard care 2. Update skills & certifications as needed 3. Avoid caring for patients who are legal minded 4. Foster honesty with patients

1. Report substandard care 2. Update skills & certifications as needed 4. Foster honesty with patients

Nurse Jones is informing her staff on the functions of the BON. Which of the below are actions of the BON? Select all that apply 1. Develop nursing laws and statutes 2. Provide licensure 3. Monitor educational standards 4. Disciplining Nurses

2. Provide licensure 3. Monitor educational standards 4. Disciplining Nurses

Nurse Jones is the Unit Director for 2 North Unit. She is emphasizing the use of the Nurse Practice Act. Which of the below laws is she maintaining? 1. Constitutional 2. Statutory 3. Administrative 4. Tort

2. Statutory

-Leadership:

Risk taking & support varied choices, role model & political involvement

AHA

American Hospital Association

Nursing Values Central to Advocacy

Caring Autonomy Respect Empowerment

Subordinate Advocacy ØStandard 16: ANA for Nsg. Adm. Environment:

Collaborative DM Know staff & listen to needs Know challenges & work them out Promote shared governance Empower staff & promote autonomy Provide a workable system Assist with ethical situations in DM

-Manager:

Create equitable and safe environment to meet needs & goals. Advocate public relations and demonstrate skills for working with the media

Lewin's

Driving and Restraining Forces

NLN

National League for Nursing

Planned Change

Time for change

Unfreezing Stage

Unfreeze the forces that maintain the status quo Awareness of need for change ¨Discontent, anxiety, guilt & feelings of anger. ¨ ¨Convince members of the need for change when feelings subside ¨ ¨Implement accurate assessment of the extent and interest of the change ¨ ¨Implement change for good reason ¨ ¨Coerce members of the group to change.

-Nonlinear theories

are needed to managed change in this unpredictable society

-Technological changes

involve less resistance --Changing IV pump

-Change should be

planned and implemented GRADUALLY!

-Perceived social changes

that are contrary to customs or norms involve more resistance. lChange in who is able to administer certain types of IV therapy.