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Planned change is an essential component of medical practice for a great number of reasons. However, implementing change in a particular environment can present a challenge. A manager has to possess the knowledge and understanding of change theory frameworks to succeed in this effort. One of the major obstacles in the way of change is conflicts between the employees and the patients. The best way to deal with such conflicts is through negotiation. This article is dedicated to the matters of change and negotiation regarding complications prevention of Foley Catheter use in surgical patients. It identifies the target audience, various stakeholders, and describes the change and negotiation strategies that could be implemented in this situation and offer a proposed communication plan for the change.
Foley catheters are often used in patients that are being prepared for surgery or any other kind of medical care, and could not empty their bladder on their own, for various reasons. The catheter is a thin tube made out of plastic, rubber, or latex, which is inserted through the urinal tract and into the bladder. It automatically drains the bladder, and the urine is stored in a special container. While this procedure is widespread and common, conflicts often arise between the patients and the nurses who wish to insert the catheter. The information presented in this paper would be useful to nurses, doctors, and managers that have to deal with these situations. A change in the current negotiation strategies might be required to lessen the number of patients that refuse the treatment via an internal catheter.
First, let us address the root causes of this conflict. Many patients dislike the Foley Catheter, as it is a very uncomfortable procedure. More often than not, it is painful and leaves a feeling of great discomfort for many hours afterward. There is a chance of causing bleeding or infection if the catheter is inserted carelessly or improperly (Wilson, 2008). These are the reasons why so many patients often request the catheter to be changed for the external one. While remarkably more comfortable, the condom catheter is also less effective and could not be implemented in certain scenarios. A patient associates the nurse or the doctor charged with the insertion of the undesired catheter with pain, which causes stress and conflict situations. The nurses and doctors are also stressed because the patient is uncooperative. Frequently, they dismiss the grievances of the patient as immature. They are upset that the patient refuses to accept the prescribed treatment for his good. Since the insertion of the catheter requires informed consent, the nurses and doctors have to go through a long and grueling process of convincing the patient to accept the catheter.
Lippitts change model should prove itself adequate in promoting positive change. The suggested alterations would help improve the relationship between the nurses and the patients that require administration of the Foley Catheter. It is a very efficient model that has been used in hospitals for quite some time. Lippitts model is based on the Levin model of change management. It is comprised out of four elements, which are split into seven phases. These elements are:
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Assessment
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Planning
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Implementation
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Evaluation
The assessment part is split into three phases. First, it is required to identify the problem. Then, the agent of change must assess the motivations of all the sides involved and the capacity for change. Lastly, the agent must assess his or her motivation and resources at hand. The planning part is comprised out of two phases. These phases include the selection of the objective for progressive change and the appropriate role that the agent is going to take in the process. The last two parts are self-explanatory the implementation part is preoccupied with maintaining change until a satisfactory outcome has been achieved. The change is concluded with the conservation of the obtained standards and results and termination of the process (Mitchell, 2013).
The stakeholders involved in the process of change would be the patients, the nurses, and the medical managers tasked with implementing the change. The patients health is the end goal of the change process, as the applied changes are supposed to enhance their understanding of the procedure and compliance with the administration of the Foley Catheter. The nurses are the secondary agents of change. It would be their responsibility to convince the patients that the internal catheters are not to be feared. The health managers are the primary agents of change since their tasks would involve properly instructing the nurses and adjust their behavioral patterns according to the new strategy.
The changes proposed in this article address the issues between the patients and the nurses. Since a patient is the centerpiece of every medical effort, the proposed strategy would primarily rely on instructing the nurses to resolve the conflict situations with the patients on their own. The primary strategy of solving conflicts would be that of negotiation between the two parties, to ensure compromise and compliance. Solving conflicts between patients and nurses through a position of power would be unadvised, as the medical manager has no authority over the patient (Kerridge, 2012). Exerting authority over a nurse or a doctor would only provide a short-term solution and cause lingering negative aftereffects (Lachman, 2010). It is important to make sure that medical personnel understands the importance of conflict-solving this understanding is going to reinforce their patience, which is often required when the patient is being difficult and refuses to cooperate.
By Leppitts change model, here is the plan for this particular change process:
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Assessment
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The problem: conflict situations between the patients and the nurses in regards to the administration of the Foley Catheter.
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Motivations for both sides: The patients are feeling uncomfortable about the catheter and find the procedure extremely unpleasant. They wish to avoid it at all costs. The nurses want the patients to be compliant with the procedure and are upset when they are not. This leads to conflict. The capacity for change is deemed medium to high. The nurses are likely to respond positively to the proposed changes, while the reaction of the patients can vary from one person to another.
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Change agents resources: using their higher positions within the hierarchy, the medical managers have the authority to implement changes and make the nurses comply with them.
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Planning
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The objective: decreasing the number of conflicts between the patients and the nurses regarding the application of the Foley Catheter. This is going to be the progressive goal for the duration of the entire change process.
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The nurses are going to play a pivotal role in the process (Kowal, 2013). They are going to be instructed on how to interact with the patient to lessen the degree of anxiety prior, during, and after the insertion of the catheter. They are going to be made aware of the patients fears and grievances. To enable them to relate to their patients better, the nurses have to be able to perceive the procedure through their eyes. Additional medical training and practice might be required to minimize the painful effects of the procedure.
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Implementation
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Once the instruction period is completed, the nurses would be required to interact with the patients according to the guidelines outlined in the planning section. While maintaining the newly applied changes, supervision under medical management may be required.
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Evaluation
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Once the patients and nurses adjust to the new program and the results are evaluated as positive, the change becomes the norm. The supervision of the change agents is no longer required.
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The primary method of interaction between a nurse and an uncooperative patient is going to be through negotiation. Several negotiation strategies could prove effective when addressing these kinds of conflict situations. The standard communication plan for the nurse must be written by the medical manager in charge of the change process and explained to all the secondary agents involved. A clear understanding of all tactics and strategies mentioned in it has to be achieved to ensure the best results. The plan itself has to involve an explanation of the process, statement of clear benefits of the procedure, and positive reinforcement (Marcuis & Huston, 2009).
Practice shows that many patients fear the insertion of a Foley Catheter due to a lack of knowledge. Instead, their reluctance is driven by rumors, hearsay, and untrustworthy sources. The nurses primary task in the negotiation process would be to ensure that the patient has a clear understanding of the procedure. The second step in earning the patients compliance is convincing them that the implementation of the internal catheter is necessary for their health. Nurses have to apply their medical knowledge to have the patients understand that while the procedure may be uncomfortable, it is necessary to avoid further complications.
Lastly, an atmosphere of positive reinforcement has to be maintained both during and after negotiation. The nurses have to construct her verbal patterns in a way that does not create division between them and the patients. A common way to do this is to use words like we, us, together instead of I and you. Flattery is a common negotiation strategy (Marcuis & Huston, 2009). A nurse should reward the patient with words of gratitude, encouragement, and appraisal for their compliance.
Conflicts are unavoidable in healthcare, as it is a very stressful environment. However, the costs of mistakes generated from built-up stress are even higher, since the patients health is on the line. The strategy of mitigating conflicts through negotiation between the nurse and the patient should help decrease the levels of stress for all parties involved and improve the quality and safety of the provided medical services.
References
Kerridge, J. (2012). Leading change: 2 Planning. Nursing Times, 108(5), 23-25.
Kowal, C. (2013). Implementing changes for better patient care. Web.
Lachman, V.D. (2010) Strategies necessary for moral courage. OJIN: The Online Journal of Issues in Nursing, 15(3), Manuscript 3. Web.
Marcuis, B.L., & Huston, C.J. (2009). Leadership roles and management functions in nursing: theory and application. Philadelphia, PA: Wolters Kluwer Health.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management UK, 20(1), 32-37.
Wilson, M. (2008). Causes and management of indwelling urinary catheter-related pain. British Journal of Nursing, 17(4), 232-239.
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