Identify a current nursing practice within your healthcare setting that requires change

Identify a current nursing practice within your healthcare setting that requires change

Identify a current nursing practice within your healthcare setting that requires change

Translational Research for Practice and Populations

Introduction

Constant and unrelenting change is the new norm in healthcare as a result of shifts in social, economic, and technological phenomena in the twenty-first century. Radical discoveries in biological sciences and medicine have altered the course of care and the practice of nursing. As a consequence, more change needs to take place in the nursing profession for a responsive and responsible healthcare system. This paper identifies the strict division of labor in our healthcare setting as a practice which needs to be changed in order to achieve inter-sectoral collaboration. Herein, it is argued that nurses have a special role in prevention and management of diseases, surveillance, and public education.

1. Current Nursing Practice Requiring Change

In our healthcare setting, nurses work in a division of labor model. According to Syed et al. (2013), division of labor is the allocation of tasks based on skills, qualification and classification of a job leading to a formalized and highly regulated work. Work division leads to task orientation which is focussed solely on completion of tasks without taking into account the outcome. For instance, in our hospital, nurses are assigned to specific duties which they must complete in posted time without reference to individual needs of the patients, or even the practitioners themselves.

It has been found that strict division of labor and task orientation affects the nursing profession by inducing stress in staff thereby impacting the safety and occupational health of workers. This nursing practice reduces efficiency and productivity of individual nurses by subjecting them to stressful working conditions detrimental to their health and safety. Syed et al. (2013) noted that stressful conditions of work can lead to increase in blood pressure, fatigue, and mental illness. Strict division of labor in conjunction with work hierarchies affect productivity in the healthcare setting through psychological factors such as social support, job demand, the pressure of time, monotony, autonomy, security, social reciprocity, and fairness.

Although the strict division of labor used to be effective in the past, it is no longer appropriate. Hence there is need to change the professional practice environment since contemporary nurses are vital professionals in healthcare delivery, with advanced skills and knowledge. In addition, they have the technical and scientific know-how, skills in critical thinking, and good decision making. As such, the traditional model of strict division of labor should be discarded for a new one which encourages autonomy and empowers them to use their creativity and skills. Nurses have the ability to adapt and adopt both in healthcare delivery and patient populations. Therefore, changes should be made so that nurses are encouraged to be creative and autonomous in the provision of care through collaborative practice.

1. Key Stakeholders who are part of the current practice

There are different key stakeholders in our healthcare setting who are part of the current practice; and will play a critical role in the proposed change. First, the registered nurses (RNs) who are the main target of the change since the strict labor division affects them most in the healthcare facility. Most nurses are allocated specific tasks within the organization with less control over their workload. The second group consists of the support staff such as the dieticians, recreation therapists, dietary aides, cleaners, and housekeepers. Thirdly, Nurse Leaders are key stakeholders since they are the main voice of staff and they serve as a link between the hospital management and the workers. They include the nurse manager, administrator, supervisor, director, and the chief nursing officer (CNO). Finally, the proposed changes will target the hospital administration and the board of management since influence policy and human resource management.

1. Evidence Critique Table

Click here Evidence Critique Table to download a pdf version of this table

Author and date	Title	Evidence type	Sample size	Study findings	Limitations	Evidence Hierarchy/Quality
Souza, Peduzzi, Silva, and Carvalho, (2016)	Teamwork in nursing: restricted to nursing professionals or an interprofessional collaboration?	A qualitative study	21 nursing professionals interviewed using a semi-structured interview	It was found that both accounts of teamwork (nursing professionals and interprofessional) were affected by interactive dimensions such as trust, communication, natural bonds, and respect.	Exclusive participation of nursing professionals without incorporating those from other areas.	III A (High Quality)
Silva, Peduzzi, Orchard, and Leonello (2015)	Interprofessional education and collaborative practice in Primary Health Care.	A qualitative study	Semi-structured interviews were used to collect data from 18 professors and 4 homogenous focus groups	The study found a need for change in the training of healthcare professionals. It was also found that stakeholders had problems in perceiving interprofessional education implementation.	Generalization of study findings	III A (high quality)
Wietholter et al. (2017)	Interprofessional collaborative practice through an adult medicine based simulation	Quasi-experimental study	RNs, pharmacists, and physicians completed a 24 item survey prior to a simulation experience.	It was noted that different professionals responded differently to different items in the survey, with most not comfortable to debate in a team with other professionals.	A single simulation exercise was carried out.	II B (good quality)
Barton (2014)	Preparing a collaborative, practice-ready workforce	Expert Opinion	Not applicable	Not applicable	Evidence has a weak scientific basis.	V B (good quality)
Brandt (2015)	Interprofessional education and collaborative practice: welcome to the “new” forty-year-old field.	Expert opinion	Not applicable	Not applicable	Conclusions are not clearly drawn	V B (good quality)

1. Evidence Summary

There is a need for a change in the professional practice environment from the strict division of labor to a collaborative approach. Various research studies and reviews have concluded that intersectoral collaboration is essential in all levels of healthcare from infection control to public awareness and education. According to Brandt (2015), interprofessional collaboration involves health workers from different professional fields in the provision of healthcare services by delivering high-quality care to patients and the community. For such collaboration to be effective, students from different fields need to learn together and from each other.

Souza et al. (2016) conducted a qualitative study using an interview to evaluate the conceptions of teamwork by nursing professionals. They noted that for effective collaboration, there is a need for respect, good communication, teamwork, and trust. They identified communication as a crucial bridge to other teamwork elements since it builds trust, respect, and appreciation of the other’s work. In a related study, Silva et al. (2015) sought to investigate the perception of healthcare providers, students, and professors about interprofessional education. They reported that there is a change in the complexity of health issues which demands collaborative work and education.

Barton (2014), recommended for creation of a collaborative workforce in healthcare for the provision of safe, efficient, timely, and equitable services to the patients and the community. Collaborative practice is preceded by collaborative education which utilizes knowledge mobilization and critical reasoning for patient care. Collaboration should be based on shared vision and common values so that the whole community can respond to challenges in a proper manner. These recommendations are supported by the World Health Organization (2010) through a model known as the Framework for Action on Interprofessional Education and Collaborative Practice.

A study by Wietholter et al, (2017) investigated the effect of interprofessional collaborative practice on medical practitioners. They conducted a simulation in which nurses conducted patient assessment followed by clinical rounds in conjunction with a pharmacist and a physician. The simulation exercise was found to positively change the perceptions of nurses about collaborative care.

1. Best Practice Based on Evidence

The evidence discussed above suggests that collaborative practice should replace the strict division of labor in the healthcare setting. It is only through integrated teams that patient-centered and effective care can be achieved. It is, therefore, proposed that the hospital administration and nursing leaders evaluate systems, cultures, and infrastructures within the organization to ensure the vision are achieved. According to Elsevier (2013) collaborations means that organizations commit to a new operational framework in which their workforce is integrated and there is support for innovation and technology.

To achieve effective collaboration, it is proposed that a climate of mutual respect is maintained by all professionals. Secondly, the mutual roles of the professionals should be used to address the needs of patients and the population. Thirdly, it is important to communicate to patients and the community in a responsible way using a team approach. Finally, it is proposed that different teams should utilize their dynamics and relationship-building values to deliver safe and efficient care. For such to happen, interprofessional communication is key to the exchange of information among the various stakeholders (Elsevier, 2013).

1. Practice Change Model

According to Wyant (2017), an organization adopts a model which aligns with goals, fits their context of care, and guides to a collaborative practice change. In this regard, the Iowa Model is proposed since it is patient-centered. The model uses research findings to facilitate change for better decision making and evidence-based practice (University of Iowa Hospitals and Clinics, 2018). The model is chosen because it ensures that evidence-based practice is sustainable and that clinicians at all levels are involved. To use the model, a clinical problem is first identified, which in the current case is the strict division of labor. The model progresses in phases beginning with the formation of interprofessional teams, to review of the evidence, critique, and synthesis. Change is then implemented in three stages: piloting, ongoing evaluation, and results dissemination (Wyant, 2017).

1. Barriers to Successful Implementation

The proposed practice may face many barriers in its implementation. First, there may be organizational barriers such as regulatory and financial constraints, legal issues, hierarchical administration and lack of knowledge of the roles of team members from different professions. The second form of barriers relates to the team including leadership ambiguity, orientation challenges, conflicts, professional cultures, and apathy among members. Thirdly, there could be barriers based on individual members such as competition, prejudice, lack of trust, and split loyalties. The barriers can be overcome if the team commits to a common goal and agrees on a unifying philosophy which advocates for respect of others’ knowledge and skills.

1. Ethical Implications

Interprofessional collaboration is critical to improving the care of patients and in giving practitioners a more holistic understanding of service delivery. However, inadequate training on the same can lead to adverse outcomes such as lower patient satisfaction and increased medical errors. Ethical considerations of any collaborative approach should include patient-centered care and respect for unique values, skills, roles, and expertise of other professionals. Interprofessional culture has been shown to flatten hierarchies thereby threatening the normal order of administration in the organization. In conclusion, it can be noted that true interprofessionalism is founded on shared values and ethics to create a vision of an inclusive clinical culture with more communication and collaboration.

References

Barton, A. J. (2014). Preparing a Collaborative, Practice-Ready Workforce. Journal of Nursing Education, 53(7), 367-368.

Brandt, B. (2015). Interprofessional education and collaborative practice: welcome to the “new” forty-year-old field. The Advisor, 9-17.

Elsevier. (2013, December). Interprofessional collaborative practice in healthcare. Elsevier. Retrieved from: www.elsevier.com/__data/assets/pdf_file/0018/184050/Elsevier-Collaborative-Care-White-Paper-Final_June-2016.pdf

Silva, J. d., Peduzzi, M., Orchard, C., & Leonello, V. (2015). Interprofessional education and collaborative practice in Primary Health Care. Journal of School of Nursing, 49(2), 15-23.

Souza, G., Peduzzi, M., Silva, J., & Carvalho, B. (2016). Teamwork in nursing: restricted to nursing professionals. Journal of School of Nursing, 50(4), 640-647.

Syed, I., Daly, T., Armstrong, P., Chadoin, M., & Naidoo, V. (2013). How do work hierarchies and strict divisions of labor impact care workers’ experiences of health and safety? case studies of long-term care in Toronto. The Journal of Nursing Home Research, 29(1), 835-841.

University of Iowa Hospitals and Clinics. (2018). The Iowa Model revised: evidence-based practice to promote excellence in healthcare. University of Iowa Hospitals and Clinics,  Retrieved from uihc.org/iowa-model-revised-evidence-based-practice-promote-excellence-health-care%C2%A9

Wietholter, J., Grey, C., Howard, C., Johnson, B., Sween, R., & Rowlands, A. (2017). Interprofessional collaborative practice through an adult medicine based simulation. Journal of Interprofessional Education and Practice, 9(1), 21-26.

World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. WHO, Retrieved from: apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf;jsessionid=BCAC83EC92905D0CF8079E6225CE4AF4?sequence=1

Wyant, T. (2017, November 21). Adopt an evidence-based practice model to facilitate practice change. Voice, Retrieved from voice.ons.org/news-and-views/adopt-an-evidence-based-practice-model-to-facilitate-practice-change

Identify a current nursing practice within your healthcare setting that requires change