It is always crucial to alienate the services delivered from the personal attribute of the deliverer in order to attain uniformity. The process of ensuring that services are delivered in a professional way is the reason why various code of practice has been developed by and for the various professionals. A good example of this is the Hippocratic Oath that was developed by Hippocrates who up to date is considered the father of medicine. Similarly, other fields have developed the code of conduct which is considered as the agreed code of ethics of a given profession. This has also been developed for nurses. Classically, hospitals were considered as a place where the patient should get better physical and mental care than other places. However, in attaining physical and mental health, the social wellbeing of the client/patient needs to be considered first (Feller, 1996). This is crucial in improving the process of recovery.
It is critical to notice that most of communication that happens to a patient in a hospital occurs between the nurse and the patient. This communication occurs for various reasons and is absolutely important, as it assists nurses to know the progress of the patient. This is advantageous, since the above is achieved without necessarily running a test to make sure that the patient can communicate well. One should also note that the communication depends on the various factors, such as the moods of the parties involve, their personal attributes as well as the established code of conduct regarding communication in a hospital (SaunderS, 2011).
Instances of communication breakdown have been noted to have taken place in many hospitals. The management of some hospitals has held it for a long time that communication is one way, while the patients feel that the nurse should be a central part of the communication. In such instances, the patients’ feelings are not considered. This may affect the quality of the service that the patient receives. In Mauritius and other countries of the world, there has been a need for transition from the traditional forms of communication in the wards to the modern ones. Research has proved that communication is an important part of nurses’ work in today’s ward.
A nurse can not be in a position to take care of the patients’ needs if she cannot understand them. The process of understanding between nurses and patients can only take place in the presence of effective communication. There have been inefficiencies in this process of communication which is brought about by the use of unprofessional communication (American Nurses Association, 2010). The result of this has lead to dissatisfaction one the clients’ and patients’ side. There have also been some cases where the patients’ condition worsens to a point of threatening the life of the patient. This leads to intense research with the aim of correcting the issue and coming up with better ways of facilitating effective communication between various parties. Professional mode of communication can be an effective remedy to this, as the personal weakness of nurses, and the patients are not brought into the communication process. This reduces the noises in the communication channel, and hence effective communication (Bradshaw, 2007). This has lead to a need to fashion the communication process for better understanding of the patient by the nurse.
Management of the hospital has to step forward and ensure that nurses and other workers in the medical field use professional language when communicating with patients. This has been necessitated by the public outcry over the rude way some nurses treated their patients. The poor mode of communication has served to deteriorate the quality of health care services provided by some hospitals.
Some of them argue that the new system is likely to increase their responsibilities far more than it is necessary. Others see the transition as a show of lack of confidence in the services they offer to people. Despite all the above reasons, the community and various stakeholders agree that a change is needed. Some nurses are also in favour of the idea as they agree that the need for providing better services should be the overriding factor in the whole process. Furthermore, research shows that the implementation of the new method of professional communication will go a long the way in achieving better care for the patient, which is the ultimate goal of all nurses. This can be used as a possible motivator for dynamic nurses, as it will enable them to be proactive in selecting areas that the management should give preferential treatment to in effecting further changes. The ultimate goal of the changes will be to achieve better care for patients.
The recommendations that lead to the change are based on the findings of a recent research carried out in many hospitals. An example of change in the hospital is seen in a hospital in Mauritius where the bedside handover was undertaken. There is a similarity with a case at hand in which the traditional form of communication is being replaced with a new one. Since the two cases are similar, the cases at hand can borrow much from the earlier case study. In addition, the cases at hand require the use of Lewin’s procedure that was used in the first case (Odyssey Productions, 2007).
In the first cases where the old bedside procedure was being replaced, the hospital had a bed capacity of 28 beds and had specialized in offering gynecological treatment and other forms of assistance to women. This facility catered for women who were above 16 years of age. In the ward, there were 21 nurses 14 of which were professionally trained, while the others were untrained assistants. The work experience of this group of nurses ranged from 18 months to 33 years. The handover of these nurses was done far away from the patients, as no one knew the nurse that would proceed to give her care after the current shift expired. The handover was done in a process they referred to as ‘ritual inheritance’. Another common characteristic that was seen in the handover was that it was done in the manager rooms or offices. The nurse in control gave the relevant information to the coming nurse. Another common feature in this hospital was its lack of centralized information, which would form central platform on which information on each patient would be recorded for a centralized healthcare planning (Webb, 2011). The information was sometimes written on the office board and a nurse taking the next shift was required to read it. Nurses would be assigned to one of the patient using the information relating to the medical diagnosis and required treatment.
This method ignored the psychosocial factors of healing that are important for the full recovery of a patient. In this hospital, a repeated cycle of shifting only gave the biomedical healing the central significance. The updates of the information in the office board often went inundated, and the issue of the patient progress was not taken into consideration. This made the progress of the patient be of secondary or even tertiary importance in the process of handover. The inefficiencies that came from this process were often blamed on the nurses, and that further eroded their productivity. This did not better the health of the patients, as the level of discontent arose from clients and the patients’ relatives.
As there were problems and inefficiencies in the handover process, using non-professional communication can make the process of provision of improved healthcare a mirage. This can also reduce the efficiencies of the process in many ways. The review of the mode of communication is to be effected in a systematic way to get a conclusive outcome. When the main cause of the problem has been identified as faulty and inefficient communication, the process of rectification can commence. The process of reform and change should start with a research, which can act as a yardstick to determine the depth of the problem. The conclusion that the psychosocial wellbeing of the patient is crucial is forming the bases for the review of communication. Scientific research has shown that effective communication is crucial for recovery, as it deals with the psychology of an individual. This helps the patient acquire attitude necessary for quick recovery.
It is very crucial for the effective communication to take place between doctors and nurses and patients in the wards. This can only be achieved through fostering professional communication between various people. In this case, patients gain access to information that is believed to contribute positively to their recovery. Patients are able to discuss their issues and their concerns, thus enabling nurses to deal with them. This was found to have had an effect of improving the steadiness and the stability of patient’s healthcare. It was described as being revealing, accurate, as well as all-inclusive. In light of the above discovery, professional communication can go a long way in assisting patients to receive better care and recover easily.
Methodology
Theories Reinforcing the Change Process
There are some theories that reinforce the need for change. The Lewin’s three steps are useful in implementing change in communication in the hospital to make it professional for effective provision of healthcare. The initial step is referred to as unfreezing. Unfreezing involves encouraging people to ponder the situation at hand with a view to assisting them to understand the need for change of the existing system. The transformation to be started needs to enclose an intellect of bearing, enough power, as well as good leadership. Transformational leaders need to be people committed to excellence. The motive of change and transformation needs to be based ostensibly on provision of quality services, which can be achieved throughout the use of professional communication.
The proponents of change should take the first step, which involves raising awareness through communicating to the parties involved. This should concern all people involved in order to effect the necessary change. People that should be consulted first include nurses, patients and ward managers to enable them to work out a common course toward achieving improved conditions for patients. The goal that is being sought by this series of action is well-articulated before the whole course begins. There is research-based information that is utilized to illustrate the practicality of the proposed system and the level of success it can achieve. The research materials to be utilized in this process should come from a successful case study. Success in these cases is evaluated in terms of effectiveness in the transformation from one system to another.
The next step should involve proposing new changes well before the commencement of the procedure. This can be done through the application of various channels of communication. The major communication channels that can be utilized involve personal contacts that can be used by various individuals. Individual employees and nurses may engage each other in a personal conversation. This can be done with a view to deliberating and comparing two systems. The new method is adopted if it is superior to the existing one in terms of performance. Staff information notice boards can also be very crucial in communicating to various parties. The relaxed conversation plays a major role in generating a cognitive disagreement, which will aggravate the quest for knowledge about the improvement in communication. This discussion will permit the nurses to talk about various scenarios in their clinical environment and the existing form of communication in the wards. The overall aim should be to examine the pitfalls, as well as benefits of the new proposal in their localized environment.
To come up with healthy and constructive discussions, various sources of information can be utilized. These sources are both primary and secondary. As various research articles were utilized in an attempt to strengthen the beliefs held by the members of the staff working in the wards in the cases study described above, the same can be useful in establishing communication. These articles were and can also be used to analyze how the existing shortcomings can be overcome or improved.
If there has been a common agreement among all the parties that the current system is inadequate, this becomes crucial in ending the status quo. The resistance from various quarters can be overcome easily through negotiating a common agreement. Senior nurses may think that the change will throw them off balance, and this is a concern that should be dealt with. When their fears are dispelled, they can even volunteer freely to mentor younger nurses in the hospital. This is a process that should be done out of good will with a view to the junior colleagues. The support should be maintained until such a time when they feel confident enough to handle all the challenges adequately. This can be applied effectively in the case at hand.
This is a process that is meant to get people to discuss a matter at hand with the view of assisting them to realize the need for a change or an improvement. The process of unfreezing people should be allowed to take place unhindered. People should be provided with the freedom to express the issues at hand and any change that is necessary. This can help in ensuring that no individual is left behind during the transformation process. Additionally, this will give the process a head start as every one will own it, thus making it a success. The next step involves selection of the most appropriate action to take. When it is clear that something new is to be done the next step is taken.
A lot of new steps could have been undertaken, hence a need to decide on the best option. This process was followed by intensive search in the literature to identify the most viable option for current communication (Gerald, 1987). Extensive consultation and debate should be enhanced. A SMART criterion should be utilized to seek a new direction regarding the selection of communication. Only the best method should be adopted. while the ones that are outweighed by their disadvantages are discarded. As far the selection of a mode of communication is concerned, only the best professional mode should be selected. Professional communication is the best, as it is universal in almost all the places of the world and the most suitable for application.
Due to the existing need to transform the mode of communication in a hospital, intensive weighing out of possible options capable of replacing the existing method is to be undertaken. As in the Lewin’s model, the process of unfreezing the various parties should be undertaken first. This process should be followed closely by weighing out possible replacements. In the case of the replacement of the use of the unprofessional method of communication, a possible replacement could be achieved through the use of professional language. This language is well described in the nurses’ code of conduct, and hence reduced need to seek many options for consideration. Due to the local situation, professional language between nurses and patients in the wards should be implemented to ensure that nurses are not rude towards patients. Professional language should also be encouraged to foster a healthy dialogue between nurses and the patients, thus leading to patients receiving quality services. The issue of cost may not feature prominently regarding the adoption of professional communication in the wards, since no capital installation may be necessary in this process.
The Lewin’s procedure requires force field analysis to be conducted with the view of determining the force behind and against the change. The force behind the change usually will support the best practice. In the case of replacing unprofessional communication in the wards, some nurses will continue to be rude to patients without caring for their feelings. These would be the outright opponents of change. They would desire that the status quo be maintained (McLaughlin, 2002). The force behind the change would be nurses that promote ethical practices, patients and other parties. Due to the lack of necessary information, other parties would oppose the change. Provision of proper information can make them review their stand, as truth is availed to them. There should be awareness process to ensure that everybody accesses information with a view to promoting the good course.
Lewin’s assessment requires the change to be implemented in a planned way. This was the case in the hospital in Mauritius, where implementation of the new nurse handover process was planned and undertaken in steps to ensure smooth running of events. In the medical profession, abrupt changes can lead to trauma for the patient, which is undesirable. In the cases of introducing professional mode of communication between nurses and patients, the plan should be executed in steps. The first step should be the abolishment of unprofessional communication toward the patient (Hill, 1966). This would ensure that space is created to be occupied by the professional form of communication. The next steps would be to encourage old nurses, doctors and ward managers to nurture the inexperienced nurses, as well as other medical assistants in the wards to adopt acceptable mode of communication.
As seen in the cases study discussed earlier, the process of carefully planning was found strategically essential to break the status quo by giving room for improvement. After the introduction of professional language, the next step should involve the evaluation to see the extent to which the application is successful. If the feedback is positive, the steps taken should be continued. In case of negative feedback, the application methods can be reviewed (Kakabadse, 2004). For instance, if a simple and friendly way of implementation is not successful; other methods have been shown to act as viable alternatives. Other viable approaches involve empowering of experienced nurses, as well as other people who can be of help. In such a situation, rewarding any positive way can also inspire those who are yet to change. The above alternative has shown positive feedback in many instances.
After the change has been broken down into a sequence of steps that are arranged strategically, a strategy for the implementation of such a change is required. Selection of a suitable strategy for the course of change is dependent on various factors. The interpersonal relationship of the various stakeholders is very crucial. For the implementation strategy to work, the management should devise steps that ensure that a cordial relationship between the patients, nurses, ward managers and the doctors exist. This will make all the parties accept the change and hence reduce the resistance. In the case when nurses are required to revert to using professional language toward their patients in the ward, it would do more harm than good to leave nurses out of this process as they would feel victimized (Luis, 2010). All inclusive strategy should concentrate on making nurses realize the great potential they have to make the lives of the patients better. This can make them highly motivated to realize the dream in the process of exploiting their potential.
The above process of making a change should be driven by the insiders. It can be described as the empowerment of the staff. If the process of change is done forcefully, the results can be anger and resentment and hence act as a hindrance to the whole process. There should be meetings and discussions between all the groups involved, so as to clarify the motives behind every move, as well as the expected outcome. Additionally, the process of reducing the multilayered structure of implementation through reduced oversight makes everyone feel responsible and motivated to achieve the common goal at each personal level. The changing that comes from within is the best for every participant (McAllister, 2011). There is empirical data that has proven the success of the above observation in several organizations. This reinforces the fact that nurses should be entrusted with the responsibility of ensuring that the communication between them and patients is professional. Therefore, such methods as instruction or oversight are detrimental and do not achieve much in terms of the results, as they fail in changing the attitude of the various of the nurses.
Empowering nurses themselves will definitely change their attitude and trigger a personal action from everyone. This is done with a view to bettering of the current situation (Sullivan, 2010). Due to this, there will be a higher collaboration with other members of the staff, thus accelerating further the process of change. Moreover, the management raises the pace of the achievement of the goals through positively underpinning the action of all other staff members. The management can achieve this by effectively encouraging and appreciating the achievements of the workers. Compliments and positive appreciation should be aimed at encouraging any members who have played a crucial role in boosting their morale. This will be important for nurses in terms of assisting them to adopt professional communication fully.
The actions that follow the pilot project involve implementation of the rest of the project. The pilot project in the case of shifting from unprofessional to professional communication would involve the use of the experienced nurses to start using professional language in some selected wards. Researchers conduct statistical research to evaluate the success in the selected wards against the others. After the researchers have given the green light for continued application, implementation of the whole process follows. This can only follow when the selected wards show improved performance in terms of patients’ satisfaction and other parameters. As the implementation of the bedside handover process required a pilot project, the case at hand also needs a well-executed pilot project. The success of the pilot project, the rest of the project can be rolled out.
It is a good practice to use empirical data in the evaluation of the success. Qualitative data may not provide as much information as the quantitative data. For this reason, there is a need to get the results obtained after the change has been effected. The evaluation of the success level of the implementation may be done in various phases. This can involve an interview in which questionnaire are filled in by the various respondent. The information obtained from the various sources, such as patients and clients, can be very crucial in drawing the conclusion. Written records in the hospital can also be utilized. The hospital management can evaluate the effects the new method has on the recovery period of the patients. If the patients are able to take shorter periods to recover due to the implementation of change, the change can also be regarded as a success (Powell, 1991).
The empirical data should be recorded, analyzed and a conclusion drawn. This can be used as bases for evaluation of the process for efficacy, possibility of replicating it elsewhere, as well as improvements. This was also done in the case study in Mauritius, in which a bedside handover procedure was being reviewed with a view to replacing it. The best practice in terms of delivering the best result is used as a benchmark. For instance, if it is established that events run the smoothest when nurses are polite and show empathy for patients, this will be an indicator that nurses should improve their attitude to avoid stooping lower than that.
The third step of implementation of change is refreezing. According to Lewin, there was a stage of implementation that is referred to as unfreezing. This involves getting people to talk about the current system with a view to realizing its shortfalls. The discussion triggered at this stage is meant to make various groups see the need for change. They can achieve this by critically analyzing the current system for its achievements based on what a change may introduce.
The current stage is referred to as refreezing and is the opposite for unfreezing. This involves triggering a discussion aimed at evaluation the new system with the view to identify where changes should be applied to make it run smoothly (Dart, 2011). These steps involve triggering a discussion that is at assisting the management to assess the level at which the new system is identified. In the cases study regarding the bedside handover, it was realized that a small group of nurses were unwilling to fully use the new system, as they thought of it as inadequate to facilitate the provision of good care. The above reason made ward managers implement the change further by mentoring the unwilling nurses to adopt it.
In the case of replacing unprofessional methods of nurses’ communication with patients, it is still possible to find a group of nurses trying to stick to the old procedure. This may happen even after a rigorous unlearning process. This situation can be solved by providing accurate information regarding the success of the new system. This is done with a view to convincing this group to join them and be a part of the success story. The other process that can be used to solve this would involve receiving the support of other members who have changed in terms of being able to use professional language toward patients. The group that is unable to do it is encouraged to observe others who have been successful. This approach is able to produce positive results.
At this stage, Lewin’s procedure is implemented fully. The next step involves critical analysis by the local people, so as various lessons can be learned. The success, failures and shortfalls of the Lewin’s method are analyzed. Problems that the management may encounter involve difficulty in rallying all the people behind the change and making them accept it (Keller, 1991). The process of unfreezing, for instances, will involve getting nurses to see the ills of unprofessional and impolite communication with patients. This would not be an easy thing to do, as they are the people who use unprofessional language. The first resistance is generated from the fact that people and in this case nurses will always resist change.
Other nurses become rude to the patient as a way of showing their seniority over patients. The attempt to make them polite toward patients would make some feel as they are relinquishing their powers. For this reason, the hospital management should come up with a way to review this mentality or replace it. In the above case, nurses should be assisted to value the emotional wellbeing of patients first and work to foster it through professional communication.
One hospital-based procedure that is done at this level involves evaluating current as well as future shortfalls of this procedure. Nurses should be motivated further and be a help to realize the crucial role they play in the recovery of patients. They should be assisted to understand that any problem arising in the future will still require their hard work and goodwill to succeed.
One example in which new approach may bring problems involves patients taking much of nurses’ time which may affect their productivity positively (Caring for the Emerging Majority, 1993). To deal with this, patients are advised to understand that a nurse has many patients to care for. A nurse needs to use empathy in communicating this so that patients are not hurt. Another thing that may limit the success of the newly adopted system may involve the victimization and stigmatization of nurses who are not able to apply the new system effectively. The group mentioned above should be treated with utmost respect and their dignity should be upheld. In addition, they should be natured and empowered further. Lastly, performance can be enhanced further by rewarding positive behavior among nurses.
Conclusion
The process of managing change in a hospital is not easy. This is not only a physically draining task, but also one that requires heavy engagement. It may also demand a change of attitude and behavior of the nurses. The environment in which this is expected to happen is complex and involves many factors that need effective collaboration. In the implementation of the Lewin’s three stage model, everybody’s deep involvement in the process is required to achieve the overall success. This is seen in the cases study in which the handover process was being reviewed. In reviewing unprofessional communication, various challenges and shortcomings can be overcome by fostering and encouraging effective communication through the whole process. Moreover, empathy should be applied in communication between doctors, nurses and ward managers to promote an atmosphere of mutual understanding. This would be very crucial in making the whole process a success.