Bedside Shift Reporting

Change Theory

Ayva Rodriguez

Felician College

Change Theory

The complex system of health care are always changing to find a better way of serving and providing the best practice, safe, quality, cost-effective patient care (Mitchell, 2013, p. 32). A good communication is essential for the patient safety and decrease errors caused by miscommunication (Sitki, Weitzel, & Glisson, 2013, p. 25). And to improve the communication between nurses or caregivers and with the patient, a plan of changing the way that the nursing staff performs shift-to-shift reporting will be implemented. But the implementation of change can be challenging and choosing the right approach is vital for the success of the bedside shift reporting planned change

(Mitchell, 2013, p. 32). The success of the planned change depends on the leadership style and the framework used by the manager (Mitchell, 2013, p. 34). There are different leadership styles and change theory that can be used and each will affect the outcome of the intended change (Mitchell, 2013, p. 34).
One of the leadership styles that can be used for the implementation of the bedside shift reporting is the democratic leadership style.

The leaders believe that the staff will do well, motivated, and would like to be independent (Giltinane, 2013, p. 37). Additionally, leaders share their responsibility by involving the staff in the decision making as well as being considerate to them (Giltinane, 2013, p. 37). These traits help the staff members improve their own leadership skills and develop autonomy (Giltinane, 2013, p. 37). And with the leaders’ guidance, open communication with the staff, and involvement in the decision making, this can lead to an increase motivation, cooperation and good working relationship or teamwork (Giltinane, 2013, p. 37). And the coordination and cooperation of the staff members are needed for the implementation of change (Mitchell, 2013, p.

35).
Lewin’s change theory was used and tested in a clinical study of bedside shift reporting that improve patient satisfaction (Radtke, 2013, p. 20). Therefore, it is best to use this theory for the planned change. Lewin’s theory used three steps such as unfreezing, movement, and refreezing (Sitki et al., 2013, p. 26). The unfreezing stage focused on motivating the staff in preparation for the change, recognizing that the change is needed, building the trust from the staff and encouragement of staff’s involvement in brainstorming solutions (Sitki et al., 2013, p. 26). The movement stage happened when the staff started incorporating the planned change (Sitki et al., 2013, p. 26). And the last stage refreezing occurs after the implementation of change (Sitki et al., 2013, p. 26). And because Lewin’s change was studied in a clinical setting, critical errors was discovered such as the lack of urgency in establishing the change in the unfreezing stage and the lack of clear vision in both unfreezing and movement stages and lastly, not making sure that the staff are not reverting back to old behaviors (Sitki et al., 2013, p. 26).
In the unfreezing stage, leaders will discuss the proposed change to all individuals who are going to be affected such as the nurses and the patients (Sitki et al., 2013, p.

26). All nurses were held accountable for the new practice expectations and a clear expectation that the bedside shift reporting was not an option and that all shifts are expected to use this (Sitki et al., 2013, p. 26). A clear written bedside shift report policy about the expectation will be distributed to all involve individuals and letting them know that this is one of the nursing division goals for the fiscal year (Sitki et al., 2013, p. 26). Discussions in meetings will be facilitated that includes the advantages of bedside shift report to patients and staff, citing an example of the hospital’s successful implementation and asking for any suggestions of bedside shift report would look like and what content will be included and concerns will be discussed and addressed (Sitki et al., 2013, p. 27). A bedside shift report demonstration video and competency checklist will be presented (Sitki et al., 2013, p. 27). And the shared competency validation would be between the nursing facilitators, unit manager and the identified unit champions (Sitki et al., 2013, p. 27). When the manager is not around, the unit champions will play a role in holding the staff accountable and encouraging the new practice behavior (Sitki et al., 2013, p.

27).
In the moving stage, paper handouts that included frequently ask questions, competency checklist were distributed to become familiar of the expectations (Sitki et al., 2013, p. 27). The unit manager will ensure that the staff watched the video 2 weeks before the implementation date (Sitki et al., 2013, p. 28). Each involve staff were validated as they gave report to the oncoming shift (Sitki et al., 2013, p. 28).
Lastly, in the refreezing stage the positive effect of bedside shift report scores and patient satisfaction were shared routinely with the staff (Sitki et al., 2013, p. 28). Patients and families were routinely asked about the report process (Sitki et al., 2013, p. 28). Managers made sure that the bedside shift report was used every day, every shift and with every patient (Sitki et al., 2013, p. 28). Additionally, at least 6 months of monthly spot check in the evening and night shift should be done and a routine progress update to the director of nursing and a routine rounds during change of shift reporting for all shift and staff were held accountable for doing the report and beginning on time (Sitki et al., 2013, p. 28).
In conclusion, coordination and cooperation from the staff are needed to implement a change and that democratic leadership style is appropriate. Lewin’s change theory was tested and implemented in clinical settings and errors were identified during implementation and a plan was developed to address the issues. Therefore both democratic leadership style and Lewin’s change theory are useful in the bedside shift reporting change.

References
Giltinane, C. L. (2013, June 12). Leadership styles and theories. Nursing Standard, 27(41), 35-39. Retrieved from http://ezproxy.felician.edu/login?url=http://search.proquest.com/docview/1368907593?accountid=10819
Mitchell, G. (2013, April). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37. Retrieved from http://www.academia.edu/3112551/Mitchell_G._2013_Selecting_the_best_theory_to_implement_planned_change_Nursing_Management_20_1_pp._32-37
Radtke, K. (2013, Jan/Feb). Improving patient satisfaction with nursing communication using bedside shift report. Clinical Nurse Specialist, 27(1), 19-25. http://dx.doi.org/10.1097/NUR.0b013e3182777011
Sitki, K. O., Weitzel, T., & Glisson, D. (2013, July). Freezing the process: Implementing bedside report. Nursing Management, 44(7), 25-28. http://dx.doi.org/10.1097/01.NUMA.0000431431.39008.af