Introduction
The focus of this project is on improving alarm response management in a clinical setting. This problem is becoming quite urgent because inadequate alarm response times may have adverse effects on patients’ health (Gazarian, 2014). This project will address three domains related to the issue. Patient outcomes will be improved as their health needs will be met more efficiently. Serious health hazards will be addressed in a timely manner. Effective time management will enable nursing practitioners to spend more time with patients addressing their physical, psychological, and emotional needs. More effective communication between the patient and the nurse will increase patient satisfaction. Nurses will benefit from the participation in the program as their alarm response fatigue will be reduced, and thus their overall job satisfaction will be enhanced. Finally, the administration of the facility will address issues related to nurses’ turnover and care quality. The new approach will help healthcare professionals to provide high-quality care without significant additional investment.
In order to implement change and improve the situation, it is necessary to employ Lewin’s Theory of Change. The theory is one of the most common theoretical frameworks utilized in the clinical setting due to its clarity (Sullivan, 2012). Although it was developed in the middle of the 20th century, it can be employed in modern health care settings. This model is easy to implement as it consists of just three major parts. Lewin also describes the most influential forces that tend to undermine positive changes and those that facilitate the implementation of change. These factors will aid in the development of an effective intervention to address the problem and implement change successfully.
SWOT Analysis
It is possible to conduct a SWOT analysis to evaluate the potential benefits and risks associated with the proposed project. As for the strengths of the intervention, the program will address several aspects of the issue, as improvement in the technological sphere and in nurses’ working environment and development will be attained. The project will not require excessive funding as it will be based on the use of the existing information systems. The opportunities associated with the intervention include the development of a method to implement change linked to nursing practice. Apart from achieving positive patient outcomes, nurses’ alarm fatigue will be reduced, while their satisfaction will be improved.
Nevertheless, the project can be characterized by certain weaknesses. Although the funds necessary for implementing the plan will not be excessive, some money needs to be allocated. The project requires strong leadership, which can be a problem for the facility in question and other healthcare units. Finally, some threats may undermine the effectiveness of the plan. The resistance of personnel may also be a threat, as some people may be unwilling to accept any change, especially when it is related to the investment of some effort (Sullivan, 2012). Since healthcare facilities tend to have limited budgets, the administration may be reluctant to provide funding. It is essential to consider the strengths and weaknesses of the intervention, as well as opportunities and threats associated with it, in order to ensure the successful implementation of the recommended plan.
Action Plan: Rationale for the Project Implementation
Modern healthcare professionals try to ensure the provision of high-quality patient-centered care using the latest technological advances and innovative approaches. Alarm response management is gaining momentum these days for several reasons. Clearly, one of the major concerns associated with unaddressed alarms is negative patient outcomes. A patient’s health may deteriorate abruptly, and it is vital to determine the cause of negative shifts in their health status and respond accordingly. Although the rate of lethal cases or incidents that involve serious issues is quite low, the problem is still urgent. Such cases should never occur, as they should be regarded as preventable hazards.
Various technological solutions have been developed to address problems such as inadequate alarm response. However, the use of technology tends to have a limited influence on the rate of false alarms. It has been estimated that the rate of unaddressed alarms can be as high as 99% in some cases (Gazarian, 2014). In addition, the layout of modern healthcare facilities and a lack of training can also have quite detrimental effects. Finally, the inability to prioritize and manage alarm response times results in ineffective time management. Nurses are unable to spend a sufficient amount of time with patients as they have to respond to alarms that often turn out to be false. Such situations have a negative influence on patient satisfaction, as well as their emotional and psychological states.
Apart from a significant adverse impact on patient outcomes, ineffective alarm response management affects nursing professionals’ performance and motivation. For instance, false alarms are some of the primary reasons for nurses’ alarm fatigue. Nurses feel overwhelmed with duties and tend to ignore some alarms as they believe that they are false (which is often the case) (Honan et al., 2015). The fact that only up to 48% of alarms are addressed (while the rate can be as low as 30%) has drawn healthcare professionals’ attention to the issue (Gazarian, 2014). It is noteworthy that nursing professionals acknowledge the importance of responding to alarms in a timely manner, but the response times and even response rate are still inappropriate. A lack of nursing practitioners and inadequate patient-nurse ratios also contribute to the problem (Honan et al., 2015). Understaffing has quite a direct influence on alarm response management, as nurses have to address the needs of many patients and these healthcare professionals often have to cover considerable distances.
Action Plan: Change Theory Model
Lewin’s framework is still commonly applied since it ensures the successful implementation of change. The theorist proposed his change model in the 1950s, and it became the basis for many change theories that have since appeared (Sullivan, 2012). This tool consists of three basic stages to focus on when implementing change. During the first phase, which is referred to as unfreezing, it is essential to make sure that the established status quo is upset and people understand the need for change. The second stage is change, and it involves the use of new instruments and approaches to address the existing issues. The final step is called refreezing, and it is associated with making the new methods a norm and a part of the organizational culture through the development of guidelines and standards.
Lewin also described the primary forces affecting the success of the new plan. Driving forces are people who are willing to change the status quo and try new ways to achieve this aim. The restraining forces are the stakeholders who do not understand that changes are necessary and are resistant to any new methods and strategies. The theory under analysis is linked to the following concepts: leadership, communication, and empowerment. Effective communication and staff empowerment are the pillars of effective application of the model. Strong leadership is another factor contributing to the effectual use of the theoretical paradigm. A leader should make sure that driving forces remain active while restraining forces change their attitude and become less resistant.
Action Plan: Project Details
The unfreezing phase will include such steps as data collection and discussion. Nurses’ alarm response times will be calculated using the available information system. Furthermore, nurses’ attitudes towards alarm management will be collected with the help of surveys that will be distributed through the existing information system and will be available online for the convenience of the staff. The results will be discussed with nurses as well as with the facility’s administration. The change stage will start with an upgrade of the alarm system and staff training. Nurses will be taught to use the new system, which will be aimed at prioritization and staff matching.
The most experienced nursing practitioners will receive certain signals in the most serious cases. Cvach, Frank, Doyle, and Stevens (2014) note that the peculiarities of healthcare facilities’ layout and acoustic environments prevent nursing professionals from hearing announcements or alarms. Therefore, the researchers propose the use of pagers. Since the use of this kind of technology may require quite substantial funds, it is possible to utilize nurses’ smartphones. Clearly, all precautions related to data security and safety must be undertaken. Other nurses will respond to cases of moderate and low severity. After the termination of the project, it will be critical to evaluate its outcomes. The focus must be on alarm response time, patient health outcomes, patient satisfaction, nurses’ attitudes, and the cost-effectiveness of the plan. Such data collection methods as surveys will be mainly employed.
Action Plan: Communication
The primary communication channel utilized to announce the change will be discussions. As mentioned above, discussions will be preceded by surveys that will set the agenda. Regular meetings can be used as the major platform for announcements and exchange of opinions. The leader will provide the results of the surveys and will announce the start of the new project. The need for change will become one of the central topics to discuss. Work groups can be created to assist the personnel in identifying the most urgent issues and acknowledging the benefits of the plan.
Apart from regular meetings, it may be necessary to arrange a meeting for all the nursing staff where the most important aspects related to the program will be discussed. Work groups will be a preferred method to announce the start of the intervention, as sending e-mails is unlikely to motivate people to embrace the change. However, it is necessary to add that e-mail can be utilized to announce specific dates or measures to be undertaken. In simple terms, updates can be disseminated via electronic means (Sullivan, 2012). It is also important to note that both formal and informal communication channels will be employed in order to facilitate the effective implementation of the project. In addition to the formal channels mentioned above, such informal channels as instant messaging and conversations during breaks can be employed. The leader can initiate this kind of communication, and it will likely continue as the staff will be more willing to share their views on the matter outside of a formal setting.
Action Plan: Leadership Styles
In nursing practice, leaders sometimes use autocratic leadership styles, which often involve rewarding and punishing. However, this kind of leadership is associated with high turnover and employees’ inability to delegate or even interact properly (Sullivan, 2012). Transformational leadership is the most appropriate framework to implement change as it entails a high degree of engagement from the personnel. Transformational leaders do not force action, but instead inspire people to perform well. Significantly, employees are empowered to innovate and use new methods and strategies (Sullivan, 2012). Communication and creativity are central to this type of leadership. The leader uses various communication channels to facilitate effective collaboration among employees.
The change model utilized can shape the use of transformational leadership tools in various settings. For example, during the first stage of the change process (unfreezing), the leader informs people about the outcomes of the existing problems and tries to inspire them to discuss and develop new approaches. Setting goals with each nurse will also take place during this phase. The change stage will be characterized by mentoring and guiding. The leader will help the personnel to attain the established goals. The leader motivates employees and creates a favorable working atmosphere during this phase, which has a positive effect on change implementation. It is noteworthy that performance measurement, rewards, and punishment will not be used, or will be utilized in a particular form and in a limited number of cases. Such instruments as appreciation and empowerment are central to transformational leadership. Finally, the stage of refreezing is associated with the development of a new or updated organizational culture in which employees are committed to the new approach.
Action Plan: Management Functions
In order to implement change successfully, the nurse leader should fulfill certain management functions. Henri Fayol described four primary management functions in 1916, but this framework is still relevant in the healthcare setting (Sullivan, 2012). The four functions described by Fayol include planning, organizing, directing, and controlling. One of the first planning functions to perform is data collection, which will become the basis of the future project. The use of an evidence-based approach will ensure the effectiveness of the transformations. An assessment of the current alarm response times and an analysis of patients’ views and nurses’ attitudes will be instrumental in evaluating the present situation and setting clear and attainable goals. It is also possible to measure nurse’s alarm fatigue with the help of the modified Oldenburg Burnout Inventory. At this stage, it is also important to craft a clear planning and action statement that will guide the further planning process and the implementation of the project.
The leader will develop a comprehensive plan, and this process will include such areas as organizational structure, human resources, other resources, and delivery systems (Sullivan, 2012). The program will involve the collaboration of the nursing staff, IT professionals, and the facility’s administration. The leader will highlight the exact roles and responsibilities of the stakeholders involved. For instance, the administration will allocate funds, the IT professionals will upgrade the information systems or monitor the process, and the nursing staff will provide care in terms of the new alarm response management approach. The leader will calculate the necessary funds and highlight the required materials. The plan will include a description of the communication and delivery channels linked to the responsibilities of the stakeholders.
The change stage will start with the dissemination of the plan that has been developed and a description of responsibilities within it. The plan will be discussed, and the training provided to the nurses can be shaped in accordance with any feedback received. The training will address such areas as the use of technology, effective communication, time management, and task delegation. Nursing practitioners will be trained to use the new features of the information system. During this phase, the program will be implemented, and nurses will employ the upgraded system. The leader will coordinate the process and will provide mentoring if necessary.
The final stage (refreezing) is associated with program evaluation and making conclusions as to its efficiency. A similar methodology will be employed in order to identify alarm response times, patient satisfaction, and nursing professionals’ views of the effectiveness of the program. Alarm fatigue will be measured with the help of the modified Oldenburg Burnout Inventory three months after the start of the program. Equipped with the results of the research, the leader will initiate a discussion of the program with the nursing personnel. Based on the data obtained and opinions collected, the corresponding changes will be introduced. The leader will also create a set of guidelines and policies that will make sure the new program is incorporated into the organizational culture and daily nursing practice.
Action Plan: Budget Requirements/Implications
As mentioned above, no extreme amounts of funding will be needed to implement the proposed project, but a certain level of funding will be needed. The development and further maintenance of the software will take up to $5,000. The administration may choose to utilize an outside developer specializing in the needed software. The developer will provide the product and the corresponding training to ensure the proper functioning of the software in the future. It is also possible to make use of in-house services, but it is important to make sure that IT professionals will handle the project. When inside resources are utilized, the costs may be lower, but it is still necessary to consider IT professionals’ salaries or rewards related to the plan.
Staff training may require the investment of $3,500, as the discussions and training sessions will be conducted during nurses’ working hours. This approach will motivate nurses to be more engaged and motivated to really explore the program. Finally, certain materials may be needed to ensure the implementation of the intervention. Some hardware, as well as printed forms, will be necessary for software development and staff training.
Implementing and evaluating the program will take approximately four months. The first two weeks will be for collecting and analyzing data, and another two weeks will be needed to disseminate the information and develop a stable plan. Training will be provided over four to six weeks. Project implementation will start one month after the start of the program. Nurses will use the new system over a duration of 9-12 weeks (approximately three months). Four months after the start of the project (weeks 12-16), the leader will collect data, evaluate the intervention, and develop policies and guidelines.
Action Plan: Assuring Staff Compliance
Resistance is an inevitable part of change implementation, and the leader should be prepared to address it. Sullivan (2012) describes groups such as supporters, the early and late majority, laggards, and rejecters. Supporters and the early majority can be the driving force of change, and the nurse leader can rely on these groups. The late majority include those who resist change until the majority of the staff accepts the new approach. Laggards do not support changes and express their opinion openly. Rejecters are active opponents of the change process and can even sabotage it.
As far as strategies to ensure the personnel’s compliance are concerned, these are mainly associated with such concepts as transparency, trust, and collaboration. The leader should provide the most relevant data concerning the project and its implementation. The focus should be on the positive outcomes of the project as well as the negative consequences of continuing to use old strategies (Sullivan, 2012). One of the most effective instruments is the development of work groups or ensuring the involvement of both supporters and rejecters (or laggards and the late majority). The enthusiasm of supporters is an effective motivational factor for those who resist change. Finally, the focus on external threats can also become a unifying factor. These threats can be regulations, limited budgets, or many other issues.
Action Plan: Evaluation
The proposal promises to be effective as it is detailed, comprehensive, and evidence-based, and it relies on a strong methodology. The proposal describes the primary stages of the project and certain responsibilities of the stakeholders. Ways to address possible obstacles to implementing the intervention are also included. Significantly, the plan contains guidelines that can be used to address the type of resistance that is most likely to occur. The proposal is based on research concerning alarm response management. The modified plan proposed by Cvach et al. (2014) is the foundation of the proposed plan. The researchers report on the effectiveness of the method, which provided the present project with its primary solution to the existing problem. This proposal highlights all the principal aspects of the intervention and can be a guide for the development of a detailed plan.
Nevertheless, this proposal is characterized by a limitation associated with the need to modify the plan during the process of implementing the intervention. It can be difficult to foresee all possible factors that may influence the project. For instance, it is difficult to estimate the budget, as the costs associated with software development often fluctuate. Furthermore, the costs may depend on the complexity of the project, as software developers will have to integrate the new features into the existing information system, which can be associated with certain difficulties. The facility may face serious financial constraints due to unforeseen issues in the economic and political spheres of the country, so no projects may receive funding.
Decision-Making Process
The development of the present proposal involved making various decisions. One of the strengths of the decision-making process was that it was evidence-based. I conducted research to collect data on the problem and existing solutions. I also chose some of the most relevant methods that have been utilized and proved to be effective in other settings. The choice of the theory of change was not the easiest part of the project, as many relevant models exist. However, the analysis of the current literature was instrumental in making this decision. Another effective strategy I employed was focusing on leadership and communication. I have used transformational leadership when implementing several projects, so I understand its benefits and areas that should be considered in certain cases. Communication is the key to success of any program through coordinating the efforts of all stakeholders and helping people remain motivated.
Clearly, certain areas still need some improvement, and this brief analysis of the imperfections will equip me with the necessary knowledge and skills to implement change more effectively. Although I believe Lewin’s model is effective and the most appropriate choice in the present case, I am committed to trying other change theories in the future. I want to use different frameworks and identify their strengths and weaknesses and ways to apply them in different situations. I understand that the clarity and cohesion of the presentation are critical for the success of the project, as a presentation may or may not lead the administration to approve a project. For me, it is sometimes difficult to choose the right words to create presentations. However, assignments like this and further practice help me improve my skills.
References
Cvach, M. M., Frank, R. J., Doyle, P., & Stevens, Z. K. (2014). Use of pagers with an alarm escalation system to reduce cardiac monitor alarm signals. Journal of Nursing Care Quality, 29(1), 9-18. doi:10.1097/ncq.0b013e3182a61887
Gazarian, P. K. (2014). Nurses’ response to frequency and types of electrocardiography alarms in a non-critical care setting: A descriptive study. International Journal of Nursing Studies, 51(2), 190-197. doi:10.1016/j.ijnurstu.2013.05.014
Honan, L., Funk, M., Maynard, M., Fahs, D., Clark, J. T., & David, Y. (2015). Nurses’ perspectives on clinical alarms. American Journal of Critical Care, 24(5), 387-395. doi:10.4037/ajcc2015552
Sullivan, E. J. (2012). Effective leadership and management in nursing (8th ed.). New Jersey, NJ: Pearson Prentice-Hall.