Answered Planned change assignment NR534

13 August 2024

Planned Change in Healthcare: Implementing Bedside Shift Reports

Melody Conley Chamberlain College of Nursing NR534: Healthcare Systems Management Spring 2015

Introduction

In the dynamic field of healthcare, the ability to adapt and implement change is crucial for ensuring high-quality patient care. With the ongoing advancements in evidence-based practice and new research models, it becomes necessary for healthcare organizations to continuously evaluate and improve their clinical practices. One area where change is often needed is in the methods used for nurse shift reporting. This paper discusses the need for implementing a bedside shift report on an Intermediate Cardiac Care Unit, drawing on Lewin’s Change Theory as a framework for facilitating this change. The objective is to enhance patient safety, improve nursing staff satisfaction, and ensure a seamless transition of care between shifts.

Identification of Change

The need for change was identified on the Intermediate Cardiac Care Unit after multiple complaints from nurses who felt that the current “silent report” system was insufficient. In this system, nurses receive reports without direct interaction with the outgoing nurse or the patient, leading to a lack of familiarity with the patients and a diminished capacity to ask pertinent questions. This lack of communication has been linked to a decrease in the quality of care and patient safety, as nurses are not adequately prepared for their shifts.

To address this issue, the proposed solution is to implement a bedside shift report. The goal of this change is to enhance the handoff process by involving the patient and their family, thereby improving communication, patient safety, and the overall quality of care. Bedside shift reporting allows for a more comprehensive exchange of information, reduces the likelihood of errors, and fosters a sense of accountability among nurses. Furthermore, this approach aligns with the principles of patient-centered care by actively involving the patient in their care process.

Benefits of Bedside Shift Reporting

Implementing bedside shift reports can bring several benefits to both patients and nursing staff:

  1. Improved Patient Safety: By conducting shift reports at the bedside, nurses can verify information directly with the patient, reducing the risk of miscommunication and errors. This method ensures that the incoming nurse is fully informed about the patient’s condition, treatment plan, and any immediate concerns.
  2. Enhanced Quality of Care: Bedside shift reports allow for real-time updates on patient status, ensuring that the care plan is current and accurate. This leads to more effective and personalized care, as nurses can address any changes in the patient’s condition promptly.
  3. Increased Patient and Family Involvement: Involving the patient and their family in the shift report process fosters transparency and builds trust. Patients are given the opportunity to ask questions, clarify their understanding of the care plan, and provide input, which can lead to higher levels of satisfaction.
  4. Higher Nursing Staff Satisfaction: Bedside shift reporting can improve job satisfaction among nurses by promoting a collaborative work environment. Nurses feel more confident in their ability to provide quality care when they have direct access to accurate and up-to-date information. Additionally, this method of reporting can strengthen teamwork and communication among nursing staff.
  5. Accountability and Professionalism: Conducting shift reports at the bedside reinforces accountability among nurses. The outgoing nurse is responsible for accurately conveying all relevant information, while the incoming nurse can immediately verify and clarify any details. This process also allows for a more professional transition of care, where the patient can witness the collaboration between nurses.

Utilizing Lewin’s Change Theory

Lewin’s Change Theory provides a structured approach to implementing change within an organization, making it an ideal framework for introducing bedside shift reports. The theory is divided into three stages: Unfreezing, Changing (or Moving), and Refreezing.

1. Unfreezing

The first stage involves preparing the organization and its staff for change. This stage is crucial as it addresses resistance and helps to create a sense of urgency for the proposed change. In the context of implementing bedside shift reports, the unfreezing stage would involve communicating the shortcomings of the current silent report system and the potential benefits of bedside reporting. This could be achieved through meetings, presentations, and discussions with the nursing staff and management. The goal is to build consensus and obtain buy-in from the staff by highlighting how bedside shift reports can improve patient safety and care quality.

2. Changing (or Moving)

Once the staff is prepared for the change, the next step is to implement the new process. This stage involves the actual transition from the silent report system to bedside shift reporting. A committee should be formed, including staff nurses, the unit manager, and other key stakeholders, to oversee the implementation process. The committee’s responsibilities would include planning the details of the shift report process, providing education and training to the staff, and addressing any logistical challenges that may arise.

To ensure a smooth transition, the change could be introduced gradually, starting with a pilot program in one unit before expanding to the entire Intermediate Cardiac Care Unit. Regular feedback sessions should be held to monitor the progress of the implementation, address any concerns, and make necessary adjustments to the process.

3. Refreezing

The final stage of Lewin’s Change Theory involves solidifying the new practice as the standard procedure. This stage is critical to ensuring that the change is sustainable and becomes an integral part of the unit’s operations. To refreeze the change, it is essential to provide ongoing support and reinforcement. This could include continuous education, regular evaluations of the bedside shift report process, and recognition of staff members who excel in implementing the new system.

Policies and procedures should be updated to reflect the new reporting method, and any barriers to the continued use of bedside shift reports should be addressed promptly. By embedding the new process into the unit’s culture, the organization can ensure that the benefits of the change are realized in the long term.

Conclusion

The implementation of bedside shift reports on the Intermediate Cardiac Care Unit represents a significant opportunity to improve patient safety, enhance the quality of care, and increase nursing staff satisfaction. By applying Lewin’s Change Theory, healthcare organizations can effectively manage the transition from the current silent report system to a more interactive and patient-centered approach. This planned change not only addresses the concerns raised by the nursing staff but also aligns with the broader goals of delivering high-quality, evidence-based care. Through careful planning, engagement with staff, and ongoing support, the change can be successfully integrated into the unit’s operations, leading to better outcomes for both patients and healthcare providers.

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References

Finkler, S. A., Jones, C. B., & Kovner, C. T. (2013). Financial management for nurse managers and executives. Elsevier Health Sciences.

Lewin, K. (1951). Field Theory in Social Science: Selected Theoretical Papers. Harper & Row.

Schub, T., & Karakashian, A. (2017). Implementing Change in Healthcare: Using Lewin’s Change Theory. Nursing Management, 48(1), 32-38.