Imagination & Innovation in Evidence Based Nursing Care

This article discusses the concept of imagination and innovation in evidence based nursing care, specifically focusing on the prevalence of dehydration among the elderly population. It proposes interventions such as patient education and reminder interventions to increase awareness and promote hydration. The article also includes a project proposal and management plan for implementing these interventions.

Imagination &
Innovation in
Evidence Based
Nursing care – Level
6.
PROJECT PROPOSAL & MANAGEMENT PLAN.
Name/Student Number:
Field of Nursing:

Introduction.
Dehydration is a severe health condition, which affects the water balance
mechanism of the human body and consequently affected individuals suffer from
severe healthcare complications. As per Frangeskou et al. (2015), the elderly
population is most affected by this lifestyle disorder and puts a considerable
clinical impact on their healthcare. The primary aim of this project proposal plan
is to highlight the prevalence of the dehydration condition among the elderly
population (65 and over) in the United Kingdom and analyse the age, gender,
lifestyle (living alone) and risk factors associated to it. Besides this, the paper
would highlight the primary contributing factors for the dehydration among the
elderly population with age 65 and above in the United Kingdom, who are living
alone in their community. The innovation that would be proposed to implement
for the specific community mentioned is talking alarm clock so that they could be
reminded with their hydration strategy and providing them with leaflets to
implement patient education in the healthcare process.
Project Proposal Briefing Paper (500 words)
Field of Nursing
(Adult, Child,
Learning Disability
or Mental Health).
providing patient education and reminder intervention among elderly population so that
effective awareness could be achieved
Proposed
Project/Innovation.
Contextualize the
choice & clearly
define the focus of
the project proposal
that has been
generated and
informed from your
area of practice?
(For example, what
is the proposed
project and where
are you proposing
the project could be
implemented)?
Include supporting
literature/evidence
in this section.
Dehydration is a health condition in which the amount of fluid or water reduced
and decreases the functioning of the body. This condition may vary from mild,
moderate to severe due to which affected people may suffer from various health
conditions (Shimizu et al., 2012). The elderly population is affected by
inadequate hydration condition majorly due to their physiological inabilities and
aging process (Miller, 2017). It has been observed through the research of
Konings et al. (2015) that aging decreases the sensation or urge to consume
water due to which the chance of older population to acquire several diseases
and disorders such as diabetes, thrombo-embolic complications, low blood
pressure, medicinal intoxication, urinary tract infections, kidney failure,
Alzheimer’s disease as well as delirium (mental/cognitive dysfunction) increases
(Fortes et al., 2015). It has been observed through the data provided by the
World Health Organisation (2014) that more than 75% of the elderly people
admitted to the healthcare facilities reported the signs and symptoms of
dehydration and associated complications and the fatality may rise up to 50% in
severe conditions. Therefore, a proper hydration strategy and the promotional
program should be proposed so that hydration could be reinforced in elderly
people (Shimizu et al., 2012). Including talking alarm clock and providing health
1

(Suggested 200
words).
literacy to the elderly population are effective strategies to increase the water
uptake among the chosen population because as per Miller (2017), it could
increase their urge of drinking water to maintain a hydrated state as they would
be aware of the benefit it would exert on their health condition.
Project
Aim/Objectives.
The project aim
should be clear and
precise and inform
the marker about
the main intention of
the project.
The objectives
should be more
specific and provide
the marker with an
insight into what
your project sets out
to achieve. Try to
ensure the
objectives are,
Specific,
Manageable,
Achievable,
Realistic and Time
scaled (SMART
Objectives).
(Suggested 50
words).
While targeting the single elderly individuals living in a district nursing caseload it was
observed that majority of the elderly population over the age of 65 were housebound
and were completely depending on the nursing professionals for their health and
wellbeing. Hence, while proposing a hydration strategy for this community the aim of
the proposal would be providing awareness to the community in subject living alone in
their houses about the proposed strategy. This aim of adequate water consumption
level in the chosen community, three objectives would be achieved. These are:
1. Provide them with the education about adverse effects of inadequate
water level in human body and the severe complications it could lead to in
their health condition and implementation of this process would be
conducted for the first month of the proposed strategy implementation. This
would help them to increase their understanding of proper hydration routine
hence would benefit their health. This would be conducted for 3 months so
that with every educational session, their ideations could be improved.
However, it could also increase their stress by informing their health-related
risks. Further, it would be evaluated through an open-ended questionnaire
so that their knowledge regarding the process could be identified.
2. Providing them with the interventions such as pamphlets of patient
education and talking alarm clock as the reminder to increase their
consumption level and making them aware to use the process and conduct
this process for 3 months. This would also benefit them by informing the
benefits it could bring for their healthcare. However, in this aspect, their
forgetfulness could be the limitation as provided information might not be
understood by the patients. The intervention would last for 1 month and
evaluation of their knowledge would be done by questionnaire and their
previous knowledge of the process would be compared with the recent one.
3. The third objective would be assessing the health literacy of the chosen
population and then conduct a detailed analysis of the effectiveness of the
talking alarm clock in increasing the water consumption level. An
assessment would benefit the assessors to understand the lack and
loopholes in the process and they would be able to implement further
strategies for their benefit. However, with improper assessment, the
loopholes of the process would not be assessed properly and persistent
lack of knowledge would affect their understanding. This would be done by
conducting interviews with them and comparing their previous d current
knowledge after providing health literacy.
2

Rationale.
Create a sound and
coherent argument
for an appropriately
selected work-
based project.
The rationale
should provide an
explanation as to
why you have
chosen to focus
your project on a
particular area of
practice within your
own field of
nursing. For
example, what has
caused you to
identify this area of
practice? The
rationale provides
the opportunity to
put your argument
forward to support
the proposed
project.
Include supporting
literature/evidence
in this section.
(Suggested 200
words).
Dehydration is a health condition which is generally not considered or cared by the
sufferer or people around them as the majority of the people suffering from
dehydration are unable to understand the consequences of it (Miller, 2017). Further,
as previously mentioned by the World Health Organisation (2014) majority of the
elderly patients who admit to healthcare facilities, 30% of the people are older than 65
years. Hence, this population has been chosen as the target population for this project
proposal management plan. Frangeskou et al. (2015) mentioned that people generally
ignore their symptoms of dehydration because of prevailing unawareness due to
which, they become susceptible to several diseases and disorders affecting their
physical, mental and cognitive strength (Frangeskou et al., 2015). Therefore, it has
become an important aspect and awareness regarding dehydration should be spread
among the most susceptible age group so that they could be prevented from such an
adverse condition.
Potential /
Intended
Outcome.
How will your
project
proposal/innovation
meet the NHS
Outcomes
Framework?
Include supporting
literature/evidence
in this section.
(Suggested 50
words).
In this course, providing them with awareness program, promotional strategies and
interventions could increase their fluid uptake (Kinoshita et al., 2013). This project
helps to achieve the NHS outcome framework as through providing people with
proper environment and education helps them to protect themselves and avoid the
adverse consequences (NHS, 2018).
3

Reference List.
(Key literature /
evidence cited
within the Project
Proposal Briefing
paper only).
Please note: The
accompanying
reference list is not
included in the word
count for the Project
Proposal Briefing
paper.
Fortes, M. B., Owen, J. A., Raymond-Barker, P., Bishop, C., Elghenzai, S., Oliver, S.
J., & Walsh, N. P. (2015). Is this elderly patient dehydrated? Diagnostic accuracy
of hydration assessment using physical signs, urine, and saliva markers. Journal
of the American Medical Directors Association, 16(3), 221-228.
Frangeskou, M., Lopez-Valcarcel, B., & Serra-Majem, L. (2015). Dehydration in the
elderly: A review focused on economic burden. The journal of nutrition, health &
aging, 19(6), 619-627.
Kinoshita, K., Hattori, K., Ota, Y., Kanai, T., Shimizu, M., Kobayashi, H., &Tokuda, Y.
(2013). The measurement of axillary moisture for the assessment of dehydration
among older patients: a pilot study. Experimental gerontology, 48(2), 255-258.
NHS. (2018). NHS Outcomes Framework (NHS OF) - NHS Digital. Retrieved from
https://digital.nhs.uk/data-and-information/publications/ci-hub/nhs-outcomes-
framework
Shimizu, M., Kinoshita, K., Hattori, K., Ota, Y., Kanai, T., Kobayashi, H., &Tokuda, Y.
(2012). Physical signs of dehydration in the elderly. Internal Medicine, 51(10),
1207-1210.
World Health Organisation. (2014). World Health Organisation. Retrieved from
https://apps.who.int/iris/bitstream/handle/10665/104772/9789241506823_Module
-4_eng.pdf;jsessionid=E9DA09C5C480DAC10C99282895F59BC6?sequence=6
4

Literature Review
Dehydration-related health complications not only affect the physical abilities pf
elderly population but also disrupts the water maintenance structure of the body
and would affect the cognitive ability of the person (Konings et al., 2015). As the
primary aim of this proposal is to increase the level of awareness among the
elderly population living in a specific district nursing caseload, the literature
review would assess the prevalence of dehydration among the UK elderly
population and understanding the risk factors such as age and gender, ability to
communicate socially could be assessed (Frangeskou et al., 2015). Further,
through the identification of dehydration related harms, the contributing factors
for their dehydration conditions would be assessed.
Prevalence of dehydration: The first research article which should be discussed
under this theme would be from the researchers Hooper et al. (2015), the primary
aim of which is to assess the prevalence of dehydration among the elderly
population of United Kingdom. For this purpose, the researchers selected elderly
people over the age of 65 who were living in long term care centers. Researchers
collected the participants living in the long term, care centers with no history of
renal or cardiac conditions. For this research process, researchers conducted a
cross-sectional study so that through the process, chosen participant’s serum
osmolality, general health, a risk of dehydration and the symptoms of dehydration
could be assessed. Further, in the selected 118 participants 66% were women
and the mean age of the participants was 86 years. Data of the research study
were collected from the registered or community nursing professionals involved
in the study and then assessed their serum osmolality (the normal range is 275
to 295mOsm/kg) as well as conducted MSME process to assess their cognitive
behaviour. After completion of the research, the findings indicated the fact that
the majority of the participants suffering from dehydration were seen this
increased level of serum osmolality and hence, they were detected with diabetes
condition. Further, it was also seen through the research that majority of the
elderly adults who were diagnosed with dehydration, were observed with
cognitive impairment and hence, researchers indicated to the findings that due to
lack of cognitive abilities, elderly adults were unable to feel the urge of thirst
which leads them to develop severe dehydration condition. However, the primary
limitation of this research process was the selection of the participants was done
on the basis of the risk of dehydration but on the basis of the less complex
healthcare complication among the elderly population so that their resulting
dehydration condition could be assessed through proper observation.
5

Hence, in this situation, to determine the prevalence of dehydration another
research article by Picetti et al. (2017), should be included in the paper where the
primary aim was to assess the awareness level among the elderly population,
who were suffering from dehydration. This was an important research process as
it targeted the most crucial aspect of healthcare improvement programs that is
patient literacy (Paulis et al., 2018). This paper included more than 170 elderly
populations in the healthcare facilities of UK so that the gap in the hydration
strategies among elderly patients suffering from dehydration could be assessed
and then implemented on them as a healthcare literacy intervention to achieve
maximum hydration. Majority of the participants (56%) mentioned that consuming
6 glass of water would be helpful in maintaining their hydration condition,
however, only 6% were having misconceptions and more than 61% were
unaware of the amount of water which is important for their adequate hydration.
Hence, through the research, researchers indicated a crucial aspect of
dehydration among elderly adults. Higher percentages of dehydration were
observed in participants who were aware of the hydration level and others who
were not aware of the importance of it for their healthcare. Hence, lack of
knowledge and ignorance towards the knowledge was the two primary concerns
of the elderly population affected with dehydration in the UK, as per this research
process.
Risk factors of dehydration and harms: To understand the risk factors and
associated harmful events among the elderly population of United Kingdom, the
governmental websites and foundations should be assessed so that through
statistical data, the risk factors and associated harmful conditions could be
provided. As per the British Nutrition Foundation (2019), the primary risk factor
of dehydrating condition among elderly population is their age and associated
physiological changes, due to which physical mental and cognitive frailty
increases and risk of severe health complication increases (Miller, 2017). Further
as per Lin, Chen and Wang (2015), reduction of thirst due to the lack of urge due
to a cognitive impairment such as schizophrenia or dementia could lead such
elder patients to suffer from dehydration. Moreover, as the elderly population
consumes laxatives, diuretics due to their physiological health consumptions,
water retention capacity of the body reduces and the patient starts excreting all
the water from the body, leading to dehydration condition. ‘
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The harmful conditions, which could arise from such dehydration condition could
result in several hospitalizations that affects the mental strength, self-esteem,
and confidence of the elderly population. Further, it increases their episodes of
numbness, fatigue, lack of energy and increases laziness. Further common
disorders such as constipation, lack of concentration and delirium and dizziness
could increase among the elderly population.
Contributing factors of dehydration: This is a crucial step for this proposed project
to assess the type of contributing factors that adds the risk factors for the
dehydration condition of the elderly population. In this aspect a worldwide
assessment would be conducted as the contributing factor of dehydration is
similar worldwide. The first article which has been selected for this assessment is
by Wolff, Stuckler, and McKee (2015), in which the researchers had the aim of
calculating the number of patients who admitted to hospitals of London from care
homes or facilities after suffering from severe dehydration that lead to increased
mortality among these patients. In this Retrospective observational study, total
21,610 patients were selected who were above the age of 65 and suffering from
dehydration between 2011 January to 2013 December. The patients who were
suffering from dehydration were suffering from mental health conditions and they
were transferred from their care homes to healthcare facilities because of severe
dehydration condition. Further, 12% of the patients who were assessed in this
research were found to have severe chances of mortality due to the lack of
awareness, proper medication. Therefore, the primary lack that emerged from
this research process of Wolff, Stuckler, and McKee (2015) was the lack of
awareness and lack of infrastructure in the care homes of community care
facilities due to which more than 21000 elderly adults were admitted to the
healthcare facilities of London between 2011 and 2013. However, the
participants who were assessed in this research were not screen for their prior
history of dehydration or hospital admission that affected the findings of the
research process. However, the research of Hooper et al. (2014), all the
participants were selected on the basis of their adequate hydration level and all
the patients who had a previous history of dehydration and hospital admission for
dehydration condition were excluded from the process. The primary aim of this
research process was to assess the contributing factors of dehydration process
and for this, they conducted a cross-sectional study so that the elder population
and associated dehydration condition could be assessed. After completion of the
research, it was observed that more than 30% of the older adults were unable to
remember their fluid intake and hydration strategy provided by the clinical nursing
professionals. Hence, forgetfulness emerged as the primary reason for the lack
of hydration among the older adults of a chosen research study.
7

Further, another research study assessed the primary reason for dehydration
and inability of the nursing professionals to comply with the hydration strategy in
the community care homes of the United States (Fortes et al., 2015). The
researchers conducted a prospective diagnostic accuracy study so that through
the process the level of hydration among the elder population admitted in the
care homes could be assessed and if dehydration occurs, the primary reason
behind it could be assessed (Fortes et al., 2015). After completion of the study,
the researchers found that the care home professionals working in the care
process for the elderly people suffering from dehydration were unaware of their
dehydration condition and hence, they lacked the ability to assess and implement
strategies so that effective care could be included for patients suffering from
depression (Fortes et al., 2015).
8

Patient education as an intervention to prevent dehydration among elders: There
are several research articles which mention the application of patient education
in increasing the chances of reorienting the dehydration condition of the patients
so that through the restoration of the process effective intervention could be
achieved. To determine this aspect the research of Konings et al. (2015) should
be included in the research process so that the effectiveness of the educational
sessions could be achieved. This research process included two interventions to
make patients aware of the dehydration and its adverse condition and then make
them able to achieve the level of awareness so that they could take care of their
hydration level. Further, the second intervention included in the study was a
reminder device, similar to which was included in my research proposal so that
patients could be provided with reminders of including these devices in their
hydration intervention (Konings et al., 2015). This study was termed as a two-
armed parallel study as two interventions and their effectiveness was
simultaneously assessed. in this process, two groups were formed where one
group included patients with 65 years age and another group included patients
with 80 years age. Further, both of these groups have an intervention and a
control group and inclusion of participants of such groups were randomized. The
inclusion of participants included patients consent and their prevailing
dehydration condition, so that after the interventions, detailed evaluation of the
effectiveness of the interventions could be achieved (Konings et al., 2015) These
interventions were applied to the group of patients for 6 weeks and after the
completion of the interventions, they were provided with a questionnaire so that
their ability to comply with the hydration strategy due to the inclusion of patient
education and reminder alarm could be assessed. The findings of the study
indicated to the fact that more than 60% of the elderly population, despite their
prevailing aging and associated health complications were able to take part in the
educational sessions and comply with the hydration strategy as a reminder
device helped them to consume water (Konings et al., 2015). Further, it was also
mentioned through the research process that majority of the patients who were
affected with dehydration took effective participation in the patient education
sessions and hence, it helped them to increase their healthcare literacy, which
would help them in their future healthcare complication associated situation.
However, this research process was unable to determine the patient’s ability to
manage dehydration-related complications as the primary focus of the research
process was centralized on the ability of patients to consume water after
provided with reminder and education (Konings et al., 2015). Therefore, the
research of Strachan and Morris (2017) should be assessed to overcome the
loopholes of the study conducted by Konings et al. (2015). This research was
focused on the ability of patients to manage their severe dehydration condition
and understand the strategies that helped them to achieve the mentioned target.
9

For this research process, researchers selected a 68-year-old Caucasian man
who was included due to his severe dehydration risk and associated kidney
failure risk factors. It was found after the complete case study analysis that with
the help of proper patient education, and assistance of nursing professionals
included in the care process, they were able to manage their condition and
regulate his water intake abilities.
Besides elderly patients and their inability to comply with the hydration strategy, it
is seen that nursing professionals and their lack of knowledge and inability to
maintain proper hydration in patients could also lead to severe dehydration
episodes (Bhatti et al., 2017). Hence to understand the risk factors, reasons and
loopholes for the hydration of elderly patients, this aspect should also be
assessed so that holistic review of the dehydration and associated complication
could be conducted. After completion of this assessment in the Chelsea &
Westminster Hospital NHS Trust, UK, it was found that the healthcare
professionals did not encourage the patients suffering from mental disease and
was found to be affected with stroke and due to the prevailing healthcare
complications of dehydration process (Bhatti et al., 2017). To overcome this
situation, they applied hydration stickers around the patient wards so that nursing
professionals and the family members of the staff could read them and then
implement them to encourage the patients so that through their influence and
encouragement, effective care could be reinforced in the healthcare process
(Bhatti et al., 2017).
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The literature review conducted in this project proposal indicated towards some
crucial and important aspect of patient dehydration and associated complications
and in the process was able to find out the risk factors, loopholes and gaps that
were present in the care process of elderly patients suffering from dehydration in
the United Kingdom (Konings et al., 2015). The primary reason for dehydration
among elderly patients was found to be a lack of awareness and ignorance
towards water consumption because of the limited or decreased urge for water
consumption. As mentioned by Wolff, Stuckler, and McKee (2015), majority of
the elderly patients living in care homes were completely dependent on the care
professionals for their health and wellbeing and hence, if the nursing
professionals are unable to provide the patient health literacy for water
consumption, they were unable to include water in their lifestyle. Further, it was
also seen that the majority of the elderly adults used to live alone and they were
dependent on the care professionals or family members for their food, diet, and
activities of daily life, and hence, without reminder, they were prone to forget the
water consumption routine provided to them for their improved health and
wellbeing (Bhatti et al., 2017). Therefore, this proposal provides interventions for
patient education by providing them with educational pamphlets and then
provides a talking alarm clock which would remind them of their water
consumption timings.
Project Management Plan.
Introduction of change management
As per Ginter, Duncan and Swayne (2018), while undergoing substantial change
in the process, human resources or the strategy using which the complete
organisation performs their work, it is important for the leadership, supervisor and
the management of the organisation to control the change and accelerate the
change through controllable pace. This control over the process of change helps
the employees or professionals working in the care process to acquire the
change through repeated attempts and them after the completion of the change
implementation, complete compliance is achieved (Van Rossum et al., 2016).
Therefore, while leading change in the healthcare organisations of UK so that
implementation of awareness and intervention for elderly population regarding
their hydration process, change management process should be implemented.
As per Nica (2015), proper change management plan and theory is an important
aspect because choosing proper change management strategy helps the
management to gain the support of the employees and they help the organisation
by delivering their best performance. However, if the management does not
apply an employee friendly change management process and strictly imposes
11

any new rule or process, it could increase friction in the organisation and
increase resistance among employees (Pirozzi & Ferulano, 2015). Therefore, in
this application of proposed project plan, prior to implementing the educational
and talking alarm related intervention in the care profess of elderly patients and
their dehydration concern, change management should be implemented in the
care facilities of the chosen community (Ginter, Duncan & Swayne, 2018).
As per Booth (2015), while implementing change in the care processes, it is
important to gain the support of healthcare professionals as without their support
it would be difficult to implemented change in the process. Georgalis et al. (2015)
mentioned that while application of chance in the care process, employees
generally unwilling to shift their flow of work as they think that due to the new
process, they would lose their ability as an efficient worker. However, with proper
guidance and leadership, it could be eliminated from the organisation that is
prepared to undergo change management. Further, Matos Marques Simoes and
Esposito (2014) also mentioned that if the employees are not aware of the
process and the purpose of the change and are asked to implement the change
without any prior intimating or informing, then it could affect the acceptability of
the employees regarding the new process, implemented on the organisation.
The change model developed by Kurt Lewin is one of the most effective and
applicable change management theory that with the help of its three steps of
unfreezing, change and freeze, it helps to implement effective and employee
friendly change in the organisations. The change model by Kurt Lewin is one of
the simplest models of change management as the application of this, as per
Cummings, Bridgman and Brown (2016), could implement a crucial process or
organisational change in the organisation, with the support of employees. The
acceptability of this change management model determines that due to the ability
of this model to develop a perception of change, the majority of the employees
are able to support the changed model. Thereby, the increased efficiency of this
process is observed. Further, the primary aim of this paper is to implement two
process and intervention-related changes in the care process so that NHS
outdone related to domain 2 and 3, application of interventions to provide
effective care and helping people to overcome their ailments respectively.
Therefore, in this aspect, application of Lewin’s change management model
would help the healthcare facilities of UK undergoing the change to inform their
employees regarding change and they would be able to support their facilities
through participation effective training and educational sessions.
Who would drive the change process?
In this healthcare change management process, nursing professionals
conducting care process with elderly patients’ in the care homes would be the
12

change agents. This is because, the intervention related to patient education
would be provided to the patients’ through the application of nursing educators
and community care professionals (Renedo et al., 2015). This is because as per
Birken et al. (2015), community educators would be able to provide complete
educational knowledge to the patients and due to culturally competent care, the
effectiveness of care would be increased. Further, as per Hancock (2016), a
majority of the elderly patients are dependent on the nursing professionals in the
care facilities for their diet and fluid consumption because they lack tracking
abilities of their diet and medication. Therefore, the change in water intake
routine would be transferred to their lifestyle through the application of accurate
change agents that are able to drive the change effectively among the target
population (Altin & Stock, 2015). Besides this as per Renedo et al. (2015),
change agents of any change management process are the lower tier workers or
employees who are at direct contact with the consumers of the organisation. As
these employees are at direct contact with the populations, they are able to
conduct the changed process with their complete efficiency. Therefore, nursing
professionals taking care of elderly patients around the UK would be the change
agents of this project proposal plan (Birken et al., 2015).
Implementation of change management plan
While implementing change management process it is important to understand
the theories mentioned by Lewin, regarding the application of change
management process. Lewin said that “it is important for the organisations to
understand the importance of motivation prior to implement any change so that
through their motivation, employees could understand the importance of it”.
Hence, as per Al-Haddad and Kotnour (2015), the application of transformational
change is the key to implementing a change management plan in healthcare
facilities of the UK. It is evident that the majority of the employees working in old
age care profess are suffering from burnout and are unable to take proper care of
their patient because of their own mental state. Hence, as per Hornstein (2015),
the chances that they would resist the change management process is higher.
Hence, transactional leadership would help them to overcome their mental
burnout state and they would be provided with the benefits the new and changed
process would bring. Therefore, it would help to achieve maximum support from
healthcare professionals through the application of the transactional leadership
process.
The second step of change management would include the application of change
management proposed plan so that healthcare professionals could effectively
apply this proposed intervention in the care process for optimal hydration of older
adults in healthcare facilities of UK (Hornstein, 2015). While conducting a
13

changed management process, it is expected that the management would follow
a structured process so that while implementing the changed process, it could
lead to less friction and increased support from the employees (Blok et al., 2015).
There are several methods using which increased efficiency of the changed
process the employees could be achieved (Yu & Sun, 2018). This change
management process in healthcare facilities should discuss the transition
process instead of change, as transition provides the employees to learn from
their mistakes, whereas change forces them to change their process without any
mishap (Yu & Sun, 2018). Further, transition helps them to change internally and
once their transit from one state to another, complete compliance with the
process is achieved. However, the application of the proposed intervention
should be analysed in this step so that if any threat of opportunity of improvement
was present, it could be easily implemented. Therefore, the analysis of SWOT
would be conducted to understand the effectiveness of the applied interventions
and processes in the care of older adults.
To implement the reminder alarm cloak and patient education regarding the
harmful effects of dehydration among the elderly population of the UK, three
steps of Kurt Lewin’s change management model would be used. The first step
of unfreezing would provide the information of the changed project to the
healthcare professionals, ward manager, staff nurse and other healthcare
professionals who work directly with older adults and could implement the
changed or proposed interventions for their healthcare improvement (Yu & Sun,
2018). However, without any prior training and education regarding the process,
the chances of their compliance with the care would decrease hence, the
leadership would help them by influencing and motivating them to implement the
new and proposed project. While applying the proposed interventions and
associated change model the nursing professionals would be provided with the
interventions and the management would inform each of them through a group
discussion so that each of them could be informed of the change or transition,
the management is planning (Haddad & Kotnour, 2015). SWOT of the change
management
Strengths  The internal strength of
the proposed project
would be improved
hydration of the elderly
individual
 they would be protected
from critical health
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conditions.
Weaknesses  As the patients are
cognitively weak providing
them with patient
education would not be
helpful as their chance of
forgetting the provided
education is higher.
 Hence, application of
patient education for
dehydration would not be
able to achieve complete
success.
Opportunities  Providing education and
implementing reminder
related intervention helps
the nursing professionals
to learn
 research about the care
aspects to provide
complete care to such
patients
 hence, acquiring this
knowledge would help
them to achieve added
skill for their future growth
as a nursing professionals
Threats  Patients could become
anxious or stressed after
learning about the risk
factors if dehydration, due
to which their healthcare
complication could
increase.
15

The third step of the change management process would refreeze the process
and changes. As per Matos Marques Simoes and Esposito (2014), after the
nursing professionals become aware of the process, and they do not have any
inquiry or could conduct the process without any difficulties, the leadership
should implement refreeze step of change management so that no further
change could be implemented. However, to increase the efficiencies of
healthcare professionals implementing the change, the leadership should
implement punishment and reward-related aspect so that with the help of these
aspects, they could easily implement the care intervention on the adult
population of UK. The change or transition-related process would be transferred
to the change agents or the nursing professionals conducting the care process
through the application of group meeting, team hurdles, and educational
sessions. This is an important process as Konings et al. (2015) mentions that
team meeting and hurdles are effective communication process through which
important information is provided to a larger section of employees and through a
collection of their feedback effective strategies and policies could be
implemented in the organisation. In this aspect of change management as well, a
group meeting with all the healthcare professionals working in the geriatric units
for the hydration of the patients would be conducted so that important messages
and information could be provided to them. Further, the key stakeholders for the
changed process would be the nursing professionals conducting the change,
elderly patients who are living in the district caseloads, the families and
supporting acre professionals would be the primary stakeholders involved in the
change management process.
Time frame of the change management
Month 1 Month 2 Month 3
preparatory
(week 1 or
2)
implementin
g (week 2, 3
and 4)
preparatory
(week 1 or
2)
implementing
(week 2, 3
and 4)
preparatory
(week 1 or
2)
implementing
(week 2, 3
and 4)
patient
assessment
dehydration
among
patients
16

providing
patient
education
implementin
g patient
reminder
strategy
assessing
patients
learning
evaluation of
reminder
strategy
correction
and again
implemented
Evaluation process
To assess the patient’s leaning and the effectiveness of the intervention in determining
the restoration of hydration among patients, survey and questionnaire would be used so
that through the application of the process, their learning and effectiveness of the
process could be achieved. The evaluation would help the organisation management to
understand the degree of success their intervention has achieved in increasing the water
consumption of the elderly adults in the UK and then if any correction required in the
process that would be achieved. Besides these, healthcare professionals would be able
to understand their own strength and weaknesses in maintaining the reminder and
patient education process and hence, the evaluation would help them to assess their
progress (Blok et al., 2015). Further, the application questionnaire and open-ended
survey would help the leadership of the organisation to understand the extent of
healthcare professionals to acquire the knowledge of proposed interventions. Moreover,
the clinical audit prior to and after the implementation of change would help to
understand the effectiveness of the process (Yu & Sun, 2018).
Conclusion.
Dehydration is a critical healthcare condition in which a patient loses all the water
stored in their body and hence, loses the water maintenance balance that helps
17

to reflux all the impurities and toxins out of the body (Hancock, 2016). Therefore,
due to the dehydration, patients’ starts acquiring complications sever for their
health and wellbeing. As per the world health organisation, a majority of the
elderly adults around the world is suffering from dehydration condition because of
their lack of urge for water consumption, cognitive impairment, that make their
forget their water routine and dependence on nursing professionals without
whom, they are unable to take care of themselves. Therefore, the primary aim of
this healthcare proposal plan was to include such interventions through which
elderly patients could become aware of their health complication and then
provide them with another intervention through which they could be reminded of
their water uptake routine (v et al., 2015). This proposal hence implemented
patient education and talking alarm clock related intervention to support the
elderly population and their dehydration condition. Further, it also provided a
detailed change management plan, in which the Lewin’s model was used to
provide a smooth transition of the change process so that nursing professionals
could easily change to their new roles (Georgalis et al., 2015). Finally, through a
detailed evaluation process, the strategies of evaluation were in this proposed
management plan assignment.
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