Abstract
This paper analyses the leadership change associated with the management of preoperative anxiety in a surgical patient. Apparently, the success of the surgical clinic depends on the collective coordination of the participants. Nurses, the core participant in any healthcare facility is the main target for change. Nurse leaders review the existing preoperative intervention to identify the point of source of the undesirable outcome. Training and remuneration of nurses is the key to implementing organizational change. This paper underscores the roles of nurses in change participation.
Introduction
Changing established performance of any kind is challenging. It is especially problematic in healthcare due to the complex relationships between a wide scope of organizations, experts, patients, and caregivers. Organizations often require a rigorous to implement change entirely and competently. Any leader must regard the level of change that staff can accomplish realistically. Definite factors may help to promote a favorable environment to initiate and propagate change.
An organization with strong leadership, and where each employee is focused on enhancing patient care, will nurture motivated staff with a zest for incessant improvement. Organizations need an explicit system in place to sustain the implementation of evidence-based guidance (National Institute for Health and Clinical Excellence [NICE], 2007). This research focuses on the change of management of preoperative anxiety in ambulatory surgical clinical practice. It identifies a change in postoperative pain management to improve healthcare.
Review of literature
Preoperative anxiety
Preoperative anxiety in surgery is an overriding concern in surgery for various reasons. Particularly, it is associated with key postoperative maladaptive behaviors, including sleep disturbances, apathy and withdrawal, feeding problems, and enuresis (McCann & Kain, 2001, p. 98). Knowing the risk factors for developing preoperative anxiety is crucial in the management of this problem so that more resources can be inclined towards vulnerable patients. General anesthesia is the principal factor responsible for preoperative anxiety (Mitchell, 2009, p. 1066) so leaders should focus change on anesthesia.
Preparing a patient for surgery is useful regarding this concern. Preparation of surgery patient has been ongoing since the conception of surgery. Such preparation programs have evolved throughout the previous decades. Thus, practitioners must familiarize themselves with the latest guidelines and research evidence on patient preoperative preparation. Again, they should engage themselves in continuing professional development (CPD) practice regarding this matter. Leaders should encourage these views.
Preoperative preparation interventions include the development of coping skills, modeling, play therapy, printed material and operating room (OR) tour. Currently, surgical professionals consider the development of coping skills to be the most useful intervention. Nevertheless, according to McCann and Kain, coping preparation does not have unique outcomes in the recovery room (2001, p. 99). This conviction indicates that a related reduction in preoperative anxiety may or may not justify the cost-effectiveness of surgery professionals. Nursing professionals should consider alternative interventions that will enhance postoperative outcomes of preoperative preparation interventions.
The range of premedication employed for preoperative anxiety is small. The most popular sedative medication is Midazolam, clonidine, and Ketamine. The outcomes of Midazolam use may vary with the route of administration (McCann & Kain, 2001, p. 101), such that leaders in surgery should advocate for the most economic route.
Budget process
The leaders of the surgery team will obviously base the budget process on implementing tools for measuring preoperative anxiety. The budget process may involve equipping the ambulatory facility with tools for detecting and measuring preoperative anxiety in patient preparation rooms. On top of that, professional nursing training on the use of the tool is another aspect of the process.
Surgery practitioners to assess patients’ conditions in preoperative and postoperative periods use various tools. The hospital Anxiety and Depression Scale (HADS) is the most appropriate tool for this purpose (Pritchard, 2011, p. 38). Therefore, the leader should consider the worth of implementing this tool in their facility.
Implementing HADS is cheap because it is in the form of a questionnaire sheet that patients complete. The tools cost roughly $150 per unit. The leader can purchase a one-month stock of about $150,000. On top of that, the cost of training professionals to interpret the results of the sheet will total roughly $10, 000 for 50 personnel.
The visual analog tool is also useful for assessing anxiety in surgery. This tool is essential for detecting preoperative anxiety (Pritchard, 2010, p.41). Surgical leaders should consider initiating this tool in surgical programs to cater to preoperative anxiety.
Plan of change
The trend in surgery of focusing most attention on the anesthetist so that preoperative anxiety goes unnoticed is the greatest concern for leaders. Pritchard attributes this trend to the introduction of managed care, technological sophistication, and reduction of costs (2011, p. 38). Thus because of the pressure on professionals, HADS are particularly relevant in this circumstance.
A leader may arrange two-hour training sessions twice daily. In an ambulatory facility consisting of 50 personnel, each leader may allocate 10 professions per session. This training may take a total of three days. This arrangement allows the facility to have staff attending to patients throughout.
Application to nursing practice
Resistance often follows change since it transforms the consistency of the team. Change interferes with established professional behaviors. The extent of the resistance is proportionate to the form of change proposed (Marquis & Huston, 2009, p. 176). Thus, leaders must brace themselves to meet this resistance and prepare strategies to overcome this challenge. Marquis and Huston (2009, p. 176) propose that leaders must motivate their subordinates to express their opinion concerning the change. This provides an opportunity for leaders to identify alternatives to circumvent objections.
Of course, this presumed change will influence the nurses in respect to the ANA nursing standards. The AACN nursing standards relevant to this situation include planning and implementation (American Association of Critics-care Nurses, 2008, p. 12). The introduction of HADS into the treatment program will disrupt a nurse’s autonomy to plan and implement an approach for the treatment of a patient under his or her care.
Certain legal issues usually arise from efforts to implement change within an organization. In this light, a healthcare organization is not exceptional. The law recognizes nursing as a self-governing profession having its own distinct body so that they are entitled to oppose any chance that they deem inconsistent with their nursing standards (Marquis & Huston, 2009, 97). The AACN nursing standards give nurses the autonomy of implementation (American Association of Critical-care Nurses, 2008, p. 13). The nurse attending for critically ill patient implement the plan coordinates care delivery and employs strategies to sustain health and a safe environment.
Reference list
American Association Critically-care Nurses. (2008). AACN scope and standards for acute and critical care nursing. AACN.
McCann, M. E., & Kain, Z. N. ( 2001). The Management of Preoperative Anxiety in Children: Anesth Analg, 93(9), 98–105.
Mitchell, M. (2009). General anaesthesia and day-case patient anxiety. Journal of Advanced Nursing, 66(5), 1059–1071.
National Institute for Health and Clinical Excellence (NICE). (2007). How to Change Practice: Understand, identify and overcome barriers to change. London: NICE.
Pritchard, M. (2010). Measuring anxiety in surgical patient using a visual analogue scale. Nursing Standards, 25(11), 40-44.
Pritchard, M. (2011). Using the Hospital Anxiety and Depression Scale in surgical patients. Nursing Standard, 25(34), 35-41.