Nursing Report: Implementation of Change in Clinical Practice, Nursing

This report, structured in two sections, delves into the critical area of partnering with consumers in nursing practice. Section 1 provides a literature review, focusing on the barriers and facilitators to implementing change in clinical practice, particularly in the context of shared decision-making. The review highlights the impact of these factors on comprehensive change implementation, referencing key studies and standards. Section 2 outlines a clinical project, focusing on a power-point presentation aimed at nursing professionals. It details the project's planning, including the target audience, information to be conveyed, format, and evaluation methods. The project centers on improving communication and consumer partnership in line with NSQHS standards, emphasizing the importance of effective communication and patient engagement for better health outcomes. The report provides a thorough analysis of relevant literature and practical project planning for nursing professionals.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Section 1: Literature Review
Introduction
According to the National Safety and Quality Health Service Standards [NSQHS]
(standard: 2), it is the duty of the leaders of a healthcare organisation to implement systems in
order to support partnering with the patents and their carers. Australian commission on Safety
and Quality in Healthcare (2012) are of the opinion that partnering with the patients and their
carers help in the improvement of the safety and quality of care. In the case study of Ysabel
Green, standard 2 of NSHQHS has been bridged. Thus the following review of literature
focuses on implementation of change in clinical practice in the domain of partnering with the
consumers. The review of literature will initiate with a barriers towards implementing change
in clinical practice followed by the facilitators in implementation of practice. While analysing
the barriers and the facilitators, the review will highlight how these barriers and the
facilitators impacts the comprehensive implementation of change in clinical practice
(partnering with consumers or the patients).
Discussion
The study conducted by Légaré and Witteman (2013) are of the opinion that
partnering with the patients or their care givers under the clinical practice helps in the
improvement of the overall health outcome of the patients. Howrey et al. (2015) are of the
opinion that partnering with the patients and their family members promotes informed or
shared decision making and this in turn increases the patient engagement in the therapy
leading to improved health-related outcome. However, partnering with the patients and their
care givers in the clinical decision making process has certain limitations or barriers. Carman
et al. (2013) are of the opinion that first barrier is time. Perceived time constraint is frequently
highlighted barrier to change in clinical practice. Involving patients and their family of carers
in the shared decision making process demands significant amount of time as majority of the

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time is devoted in explaining the medical consequences to them and resolving their anxious
queries. This time, energy and patience creates barriers coming from the side of the
healthcare professionals in implementing the change in clinical practice (Howrey et al.,
2015). Another barrier in the change in clinical practice is the characteristics of the patients.
According to Laurance et al. (2014) vulnerable group of population like the older adults,
immigrants with lack of proper education and those with poor literacy rate report less interest
in comparison to the general population towards involving shared decision making process.
However, Cliff (2012) highlighted that this vulnerable population stand to benefit from
indulging in shared decision making process. Clinical situation is also highlighted as another
perceived barrier towards implementing shared decision making process and partnering with
the consumers. Under shared decision making process, it is the duty of the healthcare
professionals to provide a comprehensive report of the interventions used and its projected
impact on the health care process along with intended patient outcome (Cliff, 2012).
However, the study undertaken by Kitson, Marshall, Bassett and Zeitz (2013) highlighted that
detailed description of the therapy process, its projected outcomes along with unintended
effects under clinical situations like knee replacement or hip surgery, caused lower rates of
surgical procedure adherence.
According to Barry and Edgman-Levitan (2012) the main facilitators of change in
clinical practice in the domain of partnership with the patients and involved of shared
decision making with the patients and their family members is the urge or the concerns of the
patients and their family to know clearly about the therapy plan and its projected outcomes
along with unavoidable side-effects. This eagerness in knowing about the therapy plan and
concern about the patients help in the promotion of effective implementation of the change in
clinical practice towards shared decision making. Trustworthy relationship is another
facilitator towards the implementation of the change in the clinical practice. Having a

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trustworthy relationship of the patients and their family members with the healthcare
professionals help them to understand the importance of shared decision making and at the
same time enable them to freely discuss their concerns with the healthcare professionals
while spontaneously accepting the change in practice (Peek et al., 2013).
Joseph-Williams, Elwyn and Edwards (2014) are of the opinion that shared decision
making is the principal component of patient and their family member engagement in the
therapy plan of the patients. In order to implement this change in the clinical practice it is the
duty of the healthcare professionals to indulge into effective communication with the patients
and their family of cares. However, use of effective communication towards implementing
change in the clinical practice in shared decision making can only be done under the proper
training of the healthcare professionals. According to Shay and Lafata (2015) training of the
healthcare professionals in the domain of interprofessional approach to shared decision
making is effective in promoting change in clinical practice. This kind of training helps the
healthcare professionals to learn how to engage their patients in shared decision making. It
also helps the healthcare professionals to effectively balance the time between accomplishing
the professional work along managing time to respond to the queries and concerns of the
patients and their anxious family members. Shay and Lafata (2015) highlighted the
importance of patient-mediated interventions towards effective implementation of the change
in clinical practice (shared decision making). Patient-mediated interventions are defined as
efforts undertaken in order to increase their knowledge about their health-related quality of
life and process how the medical process operates. Patient mediated interventions mainly
involved clarifying four basic questions to the patients by the care givers. These four basic
questions include “what are the options?”, “what are the benefits and harms associated with
these options?”, “How likely are these?” and “What will happen if I fail to adhere or refuse to
adhere the therapy?”. These four basic question help to overcome the barriers like lack of

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interest in knowing in details about the therapy process generation of pessimistic attitude
towards undergoing the therapy plan (Shay & Lafata, 2015).
Conclusion
Thus from the above discussion, it can be concluded that implementation of the
change in the clinical practice program towards shared decision making process has sudden
barriers like time constrain, lack of interest of the people from poor socio-economic
background to indulge in shared decision making and generation of fear in the therapy plan.
However, change in practice has various facilitators like improvement in the overall outcome
of care. So in order to implement change in the clinical practice the healthcare professionals
must be trained under the effective communication skills and intra-professionals
communication skills and approach.

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References
Australian commission on Safety and Quality in Health Care. (2012). National Safety and
Quality Health Service Standards. Access date: 4th October 2018. Retrieved from:
https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-
Standards-Sept-2012.pdf
Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of
patient-centered care. New England Journal of Medicine, 366(9), 780-781. Retrieved
from: https://www.nejm.org/doi/full/10.1056/NEJMp1109283
Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J.
(2013). Patient and family engagement: a framework for understanding the elements
and developing interventions and policies. Health Affairs, 32(2), 223-231.
https://doi.org/10.1377/hlthaff.2012.1133
Cliff, B. (2012). The evolution of patient-centered care. Journal of Healthcare
Management, 57(2), 86-88.Retrieved from:
https://journals.lww.com/jhmonline/Citation/2012/03000/The_Evolution_of_Patient_
Centered_Care.3.aspx
Howrey, B. T., Thompson, B. L., Borkan, J., Kennedy, L. B., Hughes, L. S., Johnson, B.
H., ... & Degruy, F. (2015). Partnering with patients, families, and communities. Fam
Med, 47(8), 604-11. Retrieved from:
https://www.researchgate.net/profile/Jeffrey_Borkan/publication/282043161_Partneri
ng_With_Patients_Families_and_Communities/links/567c465908ae19758384dd8f/
Partnering-With-Patients-Families-and-Communities.pdf

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Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for patients:
a systematic review and thematic synthesis of patient-reported barriers and facilitators
to shared decision making. Patient education and counseling, 94(3), 291-309.
https://doi.org/10.1016/j.pec.2013.10.031
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of
patient‐centred care? A narrative review and synthesis of the literature from health
policy, medicine and nursing. Journal of advanced nursing, 69(1), 4-15.
https://doi.org/10.1111/j.1365-2648.2012.06064.x
Laurance, J., Henderson, S., Howitt, P. J., Matar, M., Al Kuwari, H., Edgman-Levitan, S., &
Darzi, A. (2014). Patient engagement: four case studies that highlight the potential for
improved health outcomes and reduced costs. Health Affairs, 33(9), 1627-1634.
https://doi.org/10.1377/hlthaff.2014.0375
Légaré, F., & Witteman, H. O. (2013). Shared decision making: examining key elements and
barriers to adoption into routine clinical practice. Health affairs, 32(2), 276-284. doi:
10.1377/hlthaff.2012.1078
Peek, M. E., Gorawara-Bhat, R., Quinn, M. T., Odoms-Young, A., Wilson, S. C., & Chin, M.
H. (2013). Patient trust in physicians and shared decision-making among African-
Americans with diabetes. Health communication, 28(6), 616-623.
https://doi.org/10.1080/10410236.2012.710873
Shay, L. A., & Lafata, J. E. (2015). Where is the evidence? A systematic review of shared
decision making and patient outcomes. Medical Decision Making, 35(1), 114-131.
https://doi.org/10.1177/0272989X14551638

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Section 2: Planning your Project
Brief outline of the topic
Planning of the project will centre on the standard two of NSQHS that is partnering
with the consumers. As per the case study of Mrs X, when her husband was inquiring about
the condition of wife while she is scheduled to go for a gall bladder surgery, he was provided
with limited information or misleading information. Furthermore, the assistant unit manager
though assured Tom that he will be informed about Mrs X’s health condition after surgery,
the same did not happened.
Who is you audience?
My main audience in the project planning is the nursing professionals. According to
Blair and Smith (2012) the nursing professionals are the one who spent majority of the time
with the patients when they are admitted to the hospitals such that, there is a greater tendency
of development an attachment and trustworthy relationship with the patients. Moreover, Blair
and Smith (2012) are of the opinion that nurses are the main point of contact for both the
patients and the doctors. It is the duty of the nursing professionals to undertaken an active
approach under two-way communication in order to extract valuable information of the
patients in relation to his or her health and covey and useful and significant data to the
doctors. It is also the duty of the nursing professional to respond to the patient’s query in with
less medical terms and more in lay-man language. So targeting nursing professionals will
help in effective promotion of the partnering with the consumers.
The information to be conveyed
The maim information that is be conveyed towards partnering with the consumers
include proper communication with the family members on regular basis and providing them

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brief about the upcoming therapy plans and current health condition of the patient. Under
partnering with the consumers, it will be the role of the nursing professionals to inform the
any change in the therapy plan and its intended and unintended outcome (Mattila, Kaunonen,
Aalto & Åstedt‐Kurki, 2014). Moreover, proper information must be given in the domain of
maintaining privacy and confidentiality of the patient and this will help to establish the pillar
of trustworthy relationship and thereby promoting effective partnership (Riley, White,
Graham & Alexandrov, 2014).
Format
The format that I am planning to choose for my presentation is power-point.
According to Hessler and Henderson (2013) power-point presentation provides an audio-
visual platform for learning. It provides an interactive approach, which promotes effective
learning and development of skills among the nursing professionals.
Evaluation
The evaluation of the effectiveness of the power-point presentation will be done on
the basis of the interview with the focus group. This interview will be based on open-ended
questionnaire. According to Mitchell (2015), interview with the focus group with open-ended
questionnaire is an important evaluation tool that can be used to understand participant’s
experience through their own words and perspectives. This help in the overall evaluation of
the education plan. The main question that will used for evaluation include
1. Tell me your understanding of partnering with patients
2. How will indulge in shared-decision making?
3. What is the role of effective communication in shared decision making?

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References
Blair, W., & Smith, B. (2012). Nursing documentation: frameworks and
barriers. Contemporary nurse, 41(2), 160-168.
https://doi.org/10.5172/conu.2012.41.2.160
Hessler, K. L., & Henderson, A. M. (2013). Interactive learning research: Application of
cognitive load theory to nursing education. International journal of nursing education
scholarship, 10(1), 133-141.
Mattila, E., Kaunonen, M., Aalto, P., & Åstedt‐Kurki, P. (2014). The method of nursing
support in hospital and patients' and family members' experiences of the effectiveness
of the support. Scandinavian journal of caring sciences, 28(2), 305-314. DOI:
https://doi.org/10.1111/scs.12060
Mitchell, G. (2015). Use of interviews in nursing research. Nursing Standard, 29(43), 44.
DOI: 10.7748/ns.29.43.44.e8905
Riley, B. H., White, J., Graham, S., & Alexandrov, A. (2014). Traditional/restrictive vs
patient-centred intensive care unit visitation: perceptions of patients’ family members,
physicians, and nurses. American journal of critical care, 23(4), 316-324. DOI:
10.4037/ajcc2014980

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Section 3: Presenting your research
Provided separately in the power-point presentation

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Section 4: Seeking Feedback
The evaluation tool, that will used to evaluate your session include an interview to the
focus group. According to Mitchell (2015) interview with open-ended questionnaire are most
frequently used as an effective means to elicit the lived experiences of a group of people
under sudden situation. The rationale behind using focus group interview as a method to
evaluate the process and seeking feedback is, such interview helps to generate empirical data
or evidences that assist the healthcare practitioner to generate optimal healthcare practices
(Green & Thorogood, 2013).
According to Parahoo (2014) the focus group interview with open-ended questions
must be undertaken under complete privacy where none of the names of the participants will
be disclosed and none of the participants will be forced to participate in the interview as per
the interview ethics. Interview will only be conducted under the informed consent of the
participants. Interview questions will not contain any personal questions or questions that
might hurt the sentiments of others.
The questions that will be used for interview for seeking feedback include
1. Kindly inform whether this interactive power-point session is helpful for you to understand
the importance of partnering with customers in healthcare?
2. How this power-point session has helped to change your perspective about shared decision
making and its importance in partnering in care?
3. Do you think that the important barriers of implementing change in clinical practice were
comprehensive? Do you want to more point?

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4. Do you think this power-point presentation must be modified in certain way or do you feel
that this approach was proper?
5. What are you opinion about effective communications and intra-personal skills?

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References
Green, J., & Thorogood, N. (2018). Qualitative methods for health research. Sage.
Mitchell, G. (2015). Use of interviews in nursing research. Nursing Standard, 29(43), 44.
DOI: 10.7748/ns.29.43.44.e8905
Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan
International Higher Education.