The healthcare sector is one of the most vital institutions today. People require access to healthcare services in order to maintain a good health. An effective change design is needed in order to offer quality services to people. Change is essential in any institution because it enables people to have quality access to services in a more convenient way (Fawcett & Garity, 2009). The following paper focuses on change in the health sector through the introduction of compulsory two months palliative care course to all nurses. Implementation of the following program will be achieved using the Rosswurm and Larrabee six step model (Rosswurm and Larrabee, 1999). These steps include:
Contribution of the palliative care course to the future of healthcare
Presently, palliative care is practiced and learned by few professionals who form the palliative care team. The limited number of experts in the palliative care sector leads to a situation whereby the demand for palliative care services exceeds the number of experts. For instance, the Association of Palliative Medicine indicates that of its 271 non-consultant career grade (NCCG) doctors, only 30% have palliative care knowledge (The Royal College of Physicians, 2007).
With the introduction of a compulsory palliative care for all nurses countrywide, the following situations will minimize and people will get access to these services whenever required. The following change will contribute to the improvement of healthcare services and people will become less worried of their health. In addition, other stakeholders in the healthcare sector will benefit from the program since they will have a chance to learn more about palliative care for people with terminal illnesses. Examples of stakeholders include those taking care of the sick at homes, hospitals whose nurses attend such courses and learning institutions.
Change model overview
According to Rosswurm and Larrabee (1999), the six-step change model provides an outline of six steps that change agents should follow while planning and implementing changes. Every organization needs change but many fail to implement it because they lack the necessary tools to promote change. The six steps outlined in the model are as follows: “(1) assess the need for change; (2) link problem interventions and outcomes; (3) synthesize best evidence; (4) design practice change; (5) implement and evaluate change in practice; and (6) integrate and maintain change in practice”.
The main benefit of using this model in the nursing practice is its ability to facilitate provision of professional care to patients. Using this model, a researcher is able to compare data from the already excising practices with the newly introduced practice and determine which practice is more effective. In addition, by using this model nurses will get a chance to evaluate their performances and determine the best action to take in the absence of a doctor. This model will facilitate change in the healthcare sector through introduction of an effective delivery of patient care.
Rosswurm and Larrabee suggested that before the commencement of the project, the researcher should come up with research questions based on the inadequate nature of the present practice (Rosswurm and Larrabee, 1999). The research will make use of PICOT formula in generating research questions. The questions take the format of Patient-Intervention-Comparison-Outcome-Time (PICOT).
P: Do patients with terminal illnesses undergoing treatment in a health care center have better palliative care when a nurse has undertaken a palliative course versus when a nurse has no special training?
I: In patients with terminal illnesses how effective is the hospital based-care treatment and home-based treatment when attended by professionals compared to normal doctors?
C: What is the total duration of recovery for patients who receive treatment from nurses with palliative care course as opposed to those attended by regular nurses?
O: Are patients with terminal illnesses who receive medical attention from hospitals with no professionals in palliative care at increased risks of suffering more compared to patients from hospitals with palliative care experts?
T: In patients aged 10 to 35 years undergoing palliative care program, what are the differences in the recovery process found in the two instances at the end of the palliative care?
Step two: Link the problem, intervention and outcomes
The above design for change involves an introduction of a compulsory two months palliative care course for all nurses practicing in the healthcare sector. The following program aims at improving the general palliative care practices to patients suffering from terminal illnesses in hospitals or at home based care. It has been discovered that most patients endure a lot of pains while undergoing treatments from various illnesses and, the lack of knowledge from caring nurses leads to increased problems to these patients.
Nurses lack the necessary skills required to relieve pains through palliative care approach. With this in mind, the introduction of palliative care courses will result in improved healthcare practices leading to improved pain relief and decreased stress in terminally ill patients. Moreover, the implementation of a compulsory palliative care training program in all hospitals will enable nurses to deal with patients with terminal illnesses without the intervention of a physician (Leadbeater & Garber, 2011).
Step three: synthesize the best evidence
Palliative care knowledge has been found to improve nurses’ effectiveness, especially those with palliative care skills (World Health Organization [WHO], 2003). In a study to determine the impact of palliative care knowledge on palliative care effectiveness and efficiency, it was found out that a short palliative care course taking two hours is enough to significantly improve palliative care knowledge and, hence effectiveness (Callahand, Breakwell and Suhayda, 2011). In this research, a two weeks course is hereby proposed. This will be a more adequate time compared to the above not only provide nurses with the basics of palliative care, but enable them to have a clear understanding of palliative care. In addition, the humble time in training will equip them with more experiences compared to the ones achieved in Callahand, Breakwell and Suhayda’s study.
On the other hand, palliative care courses have worked well in some hospitals in other countries by producing best doctors overall. A study of a Makerere University Palliative Care Unit shows that students who undergo the program end up being the best doctors in the country. The institution provides such courses in order to improve health care services at hospital and home level (Leng, 2011). The implementation of compulsory palliative care for all nurses will ensure people have access to quality health care. Nurses who have not undergone a palliative care course find difficulties in attending to patients with terminal illnesses in the absence of a doctor (Fiona, 2013). The proposed change is intended to eliminate such instances by ensuring every nurse who secures herself a place in a government hospital undergoes this course. This has been evidenced by the results observed from the above studies.
Step four: Design Practice Change
In order to implement the above proposed change, the following plan will be followed. Firstly, a research will be conducted in all healthcare centers in the country aiming at determining the number of nurses who have not undergone a palliative care course. The researcher will conduct a study with an aim of discovering the quality of health services offered by these nurses. Secondly, all healthcare centers will be required to take their nurses on a compulsory two week training course on palliative care.
Nurses who will undergo this course and pass will be presented by certificates. No healthcare center will admit a nurse without this certificate. On the other hand, newly hired nurses will be required to undertake this course before reporting to their respective centers. In addition, nursing schools will be required to incorporate this course in their institutions as a compulsory unit for every student. The main stakeholders involved in this program are the government, hospitals management, nursing institutions and physicians.
Step five: Implement and Evaluate the Change in Practice
In implementing and evaluating changes in practice the following will be done. Firstly, the core planning team will be assembled. The team will select researchers to data collected before the program is implanted will be compared with data collected after the implementation. Secondly, mission alignment will be done to determine the suitability of implementing this change in terms of benefits, acceptability by the stakeholders, challenges, and financing. Thirdly, a system assessment and need evaluation will be conducted. Finally, a program evaluation process will be conducted to determine the acceptability of the program to stakeholders.
Step six: Integrate and Maintain the Change in Practice
If adopted, all nurses seeking registration with nursing boards and hence be given the go ahead to practice nursing will be required to undertake and pass the palliative care course. Accordingly, various nursing registration boards will be required to amend their constitution and nursing requirements to include a section requiring all applicants to have passed this compulsory course
Implementation & Evaluation Plan
The following implementation and evaluation plan will be adopted.
1: Assembling the core planning team
A planning team will be formed who will represent the hospital and its environment. The implementation of this plan will ensure the all the program needs are met. The work of this team will include assessing the needs of patients, evaluating the excising resources and practices and their gaps. In addition, the team will define the type and scope of the palliative care program proposed and develops appropriate administrative structure. The team will be made up of the hospital management, nursing leaders, pain management specialists, administrators and government representatives.
2: Mission alignment and assessing stakeholders’ priorities
The following plan forms the key to getting support for the palliative care program. This plan will aim at connecting the palliative care course to achieving healthcare goals. Proponents in the effective palliative care must understand what hospital management requires hence, the planned change must bring benefits to the organization (Dowel, 2002). With this in mind, the assessment will involve the following: identifying the healthcare priorities, determining the work of the hospital administration and management, identifying the source of finances to support the program, identifies the possible sources of challenges, and gaining the opinion of other stakeholders involved.
3: System and needs evaluation
In this planning section, two aspects will be evaluated: system assessment and needs evaluation. In system assessment, the excising strengths within the healthcare system will be identified that have positive impact on the palliative care program. These assessments include the desire for hospital to implement change, the hospital chaplaincy program, disease management and discharge programs, and community interests in support of the program.
On the other hand, needs evaluation will assist in identifying areas of need within the healthcare sector. These areas include pain and symptom management, patient and family fulfillment, nurse capability, length of stay and costs associated.
4: Program evaluation
Nursing professionals and pain management consultants will be required to draft the course and come up with tests that will be required to evaluate students or registration applicants. To evaluate the impact of the proposed change, a pre-test and post-test measure will be conducted to evaluate students’ knowledge before and after the course. If positive results are achieved, the stakeholders will be required to promote the program.
Steps to Maintain Change
The following steps will be followed to ensure the proposed changes are maintained in years to come. Firstly, the Board of nurses should change their constitution and include an act stating that all nurses must undergo a palliative care program before practicing the profession. In addition, they should state that any healthcare facility/ hospital that hire a nurse who has not passed the course are liable for a huge fine. This step will ensure all nurses working in healthcare centers, whether public or private; have undergone the palliative care course.
Secondly, campaigns and rallies will be organized in all major towns across the country to promote the program. These campaigns will aim at ensuring the information reaches everyone, even people at the village level. The campaign will call for everyone to report any practicing nurse without the palliative care training certificate.
There is a need to improve palliative care by ensuring that all nurses have palliative care knowledge. In doing so, there will be an increase in palliative care consultants and this will improve palliative care practice and, improve pain relief and decrease stress in terminally ill patients. The current shortage of physicians with palliative care knowledge has two negative impacts on the nursing field. Firstly, there is insufficient number of palliative care providers and secondly, nurses are negatively affected by the death of patients under their care due to lack of palliative care knowledge (Vadivelu, 2013). The proposed change will help address these two problems by ensuring all nurses have the capacity to take good care of patients with terminal illnesses on their own. In addition, the change will promote the healthcare sector and attract people from other areas.
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