Posted: June 11th, 2024

Change Project Paper – Best Evidence on a PICO Question

Based off the Change Project Paper:
Identify a strategy for capturing best evidence on one PICO question related to the change you implement in the Change and Collegiality Paper.
Evaluate your Change Project. If a project was implemented, then describe how it was evaluated. If a project was not implemented, describe how/when it would/could be implemented and evaluated. Minimum of 300 words in length. Use of at least three (3) peer-reviewed, scholarly journal articles. If the textbook is used as an ADDITIONAL reference and multiple chapters are cited and referenced, correct chapter citations and references must be done. A separate reference page must be done at the end of the journal.

Strategy for Capturing Best Evidence on a PICO Question

 
Strategy for Capturing Best Evidence on a PICO Question
One PICO (Population, Intervention, Comparison, Outcome) question that could be addressed based on the Change and Collegiality Paper is P – Nurses experiencing disruptive behaviors and lack of collegiality in a hospital setting; I – Implementation of a multi-faceted intervention to promote a culture of collegiality and professional behaviors; C – Usual care or no intervention; and O – Improved nurse-to-nurse relationships, increased psychological safety, reduced incidence of disruptive behaviors, and improved patient outcomes. For the in-depth examination of this PICO question, an elaborate search through electronic databases, like CINAHL, PubMed, and Cochrane Library, should be carried out using desired keywords and MeSH terms, which are associated with the PICO elements. The number of references should be limited to the peer-reviewed, English-language studies published in the last 5-7 years to make sure the evidence is timely and appropriate. Research questions, including experimental, quasi-experimental, and observational designs that assess the efficacy of nursing teamwork enhancement and discouraging disruption should be incorporated.
The critical appraisal of the selected articles is done using the same standardized tool such as the JBI Critical Appraisal Checklist or Cochrane Risk of Bias tool to sound the methodological quality and risk of bias of the included studies. The appropriate data should be drawn from the studies which include study design, sample characteristics, intervention particulars, outcome measures, reported findings, etc. The results of the studies, which are part of the included studies, would be synthesized using a narrative synthesis approach, where the common themes, patterns, and key findings would be identified across the studies. Additionally, the overall quality and power of evidence should be assessed by utilization of a standardized framework such as grading of recommendations, assessment, development, and evaluation (GRADE) (Bezerra et al., 2022).
Evaluation of the Change Project
In the process of implementing the proposed change project, it is reasonable to carry out a pilot program within one or more nursing units within the hospital. Through this end, we can measure the intervention’s feasibility, acceptability, and initial performance (Bonetti et al., 2022). During the pilot and subsequent full implementation, the following outcome measures could be evaluated: nurse-reported perceptions of collegiality, psychological safety, and professional behaviors; incidence of disruptive behaviors; turnover rates, job satisfaction among nurses, and the patient’s satisfaction and incidence of adverse event related to the breakdown of the communication. It should also be done in addition to the outcome evaluation of implementation fidelity, the obstacles and the facilitators of implementation, and the engagement of the stakeholders. The oversight may encompass taking the attendance of the nurses and the extent of their devotion to the training sessions, witnessing and recording the new policies and procedures and their implementation, and doing the focus groups or interviewing with the nurses, nurse managers, and other stakeholders.
Statistical methods must be applied to the data of the pilot and full implementation to figure out the efficiency of the intervention and identify correlations and trends (Mishra et al., 2019). The results should be communicated to major stakeholders, including the hospital management group, nursing staff, and quality risk management teams. The evaluation results would help the project to be refined and adjusted, including the filling of identified gaps or solving of identified challenges. Then the monitoring and evaluation institution should be implemented to ensure the perpetual effectiveness of the intervention as well as its integration into the culture and practices of the organization.

 
References
Bezerra, C. T., Grande, A. J., Galvão, V. K., Santos, D. H., Atallah, Á. N., & Silva, V. (2022). Assessment of the strength of recommendation and quality of evidence: Grade checklist. A Descriptive Study. Sao Paulo Medical Journal. https://doi.org/10.1590/1516-3180.2022.0043.r1.07042022
Bonetti, L., Barello, S., Franzoso-Sartorio, C., Rinaldi, M. C., & Cattaneo, A. (2022). Protocol for a pilot and feasibility study evaluating a complex nurse-led patient education intervention to promote cancer patient engagement in a healthy lifestyle (O-PHE program). BMJ Open, 12(12). https://doi.org/10.1136/bmjopen-2022-066163
Mishra, P., Pandey, C., Singh, U., Keshri, A., & Sabaretnam, M. (2019). Selection of appropriate statistical methods for data analysis. Annals of Cardiac Anaesthesia, 22(3), 297. https://doi.org/10.4103/aca.aca_248_18

Change Project/Collegiality Paper

Change Project/Collegiality Paper
Introduction
Cooperation and communication among the nurses are critical for assuring superior and safe patient care. Nevertheless, in practice, nurses have to cooperate more to work seamlessly as a team in a hospital setting. One of the major problems can be the hierarchical bullying of experienced nurses and hostile behaviors, mainly directed toward the novices and least experienced nurses. Such behavior uncertainty constitutes a danger to the workplace. It erodes psychological safety, prevents nurses from airing their concerns, and messes with nurse teams in terms of communication and work-togetherness, all of which can result in medical errors, low-quality care, and unsuccessful patient health outcomes. Additionally, it makes nurses feel overwhelmed and insists on the retention of a competent workforce.
Problem Requiring Change
Lack of collegiality among nurses and disruptive behaviors definitely positively affect the quality and safety of nursing care delivery. The inefficiency of communication among healthcare professionals is the most well-known main source of severe adverse reactions and medical mistakes (Alder, 2023). When nurses feel psychologically unsafe, they won’t likely share key details with others. Disruptive behaviors such as condescending attitudes also undermine newcomers’ confidence and inhibit them from seeking assistance, contributing to errors. This problem is defined by recurrent instances of hostile conduct and unresolved interpersonal conflicts that disrupt collegiality and collaboration among nursing staff.
Change Theory
Lewin’s Change Theory
One of the most widely utilized and foundational change theories is Kurt Lewin’s Three-Step Change Model. The first step in Lewin’s model is creating motivation and readiness for change by highlighting why the current state is inadequate and destabilizing the status quo. Second is taking action and implementing the desired change, with active participation from those impacted. The last step is stabilizing and integrating the change into established processes, policies, and norms so it becomes the new status quo (Marquis & Huston, 2023).
Discussion of Change
As Marquis and Huston (2023) state, “Communication is critical during the first step so that those who will be most affected by the proposed change can examine it, provide input, and discover what, if any, benefits the change might have for them” (p. 228). Activities like presenting data on adverse events linked to disruptive conduct can underscore the need for change. The movement/change stage involves actively implementing new policies, training, and processes to promote positive collegial interactions and address underlying tensions. This requires engaging all nurses, role-modeling desired behaviors, coaching, and championing the changes at all levels (Marquis & Huston, 2023).
Leader and Team
Effectively leading organizational change requires collaborative efforts between a designated change leader and a committed team comprising key stakeholders. The change leader provides vision, direction, and accountability, while the team offers diverse perspectives, shares ownership of the process, and reinforces change across the organization.
Key Players
● Nurse Manager: As the formal leader of the unit, the nurse manager should spearhead and actively champion the change efforts. An effective nurse manager leading change exhibits a transformational leadership style that inspires motivation and commitment to the change vision through individualized consideration, intellectual stimulation, and idealized influence (Marquis & Huston, 2023).
● Staff Nurse Champions: Engaging trusted staff nurse opinion leaders from both day and night shifts is key for enhancing buy-in and modeling new norms across all teams. These nurses should be selected based on their respected presence and ability to influence their colleagues.
Team Members
● Staff nurses from all shifts
● Nurse educators
● Quality/risk management personnel
● Organizational development/employee assistance experts
The success of this team hinges on its ability to collaborate despite different motivations, communication styles, and areas of emphasis. Clear team norms around respectful dialogue, candid information sharing, and conflict resolution must be established (Marquis & Huston, 2023). Each team member’s unique strength contributes to the overall effort. For example, staff nurses closest to the issues provide invaluable frontline perspectives, while risk managers ensure alignment with safety priorities.
Resources
Key resources required to support the successful planning and execution of a collegiality improvement initiative include executive leadership endorsement and funding support, labor relations guidance to ensure policy/contract compliance, workload evaluations, and potential staffing adjustments. Obtaining sufficient funding will likely require a formal budget proposal and business case substantiating how an investment in promoting positive nurse relationships links to better care quality, patient safety, nurse retention, and reduced costs from preventable adverse events.
Review of the Literature
Kangasniemi, M., Rannikko, S., & Leino-Kilpi, H. (2023). Nurses’ collegiality: An evolutionary concept analysis. Nursing Ethics, 0(0), 1–16. https://doi.org/10.1177/09697330231221197
This study aimed to clarify the concept of collegiality in the nursing profession using Rodger’s evolutionary concept analysis. The authors identified the attributes, antecedents, and consequences of the concept of nurses’ collegiality. The attributes included achieving mutual goals, equality, reciprocity, trusted advocacy, powerful self-regulation, and engaged belongingness. Antecedents included an existing professional group, connections between professionals, shared professional ethics, and professional self-esteem. The authors concluded that nurses’ collegiality is a value-based concept with a unique character based on professional connections, bringing together ethical and pragmatic strategies to achieve the best results for the nursing profession.
Lee, S. E., Kim, E., Lee, J. Y., & Morse, B. L. (2023). Assertiveness educational interventions for nursing students and nurses: A systematic review. Nurse Education Today, 121, 105655. https://doi.org/10.1016/j.nedt.2022.105655
The purpose of this systematic review was to synthesize evidence on educational interventions for developing assertiveness in nursing students and nurses, examine the interventions, identify effective components, and recommend considerations for future research in this area. The review included 14 articles, mostly from Asian countries. Four types of interventions were identified: simulation-based learning, classroom-based learning, classroom-based learning with peer support, and hybrid learning. Most studies measured self-reported speaking-up behaviors, with mixed results on intervention effectiveness. The authors concluded that educational interventions can strengthen the skills, confidence, and capacity of current and future nurses to employ assertive communication.
Arsat, N., Chua, B. S., Wider, W., & Dasan, N. (2021). The Impact of Working Environment on Nurses’ Caring Behavior in Sabah, Malaysia. Journal of Nursing Management, 29(5), 1220–1231. https://doi.org/10.1111/jonm.13272
This study aimed to investigate the impact of five types of work environment on nurses’ caring behavior: (i) participation in hospital affairs, (ii) foundations for quality of care, (iii) manager ability, leadership, and support of nurses, (iv) staffing and resource adequacy, and (v) nurse-physician relations. Data were collected from 3,532 nurses working in public hospitals and health clinics in Sabah, Malaysia, in 2015 using a cross-sectional survey design. The hypothesized model was evaluated using the partial least squares method. The findings revealed that participation in hospital affairs, foundations for quality of care, manager ability/leadership/support, and nurse-physician relations had a positive effect on nurses’ caring behavior. The study contributes to the theoretical understanding of how work environments influence nurses’ caring behavior and has practical implications for nursing practice and management.
The Change Process/Plan
The unfreezing process will be the first to destabilize the unhealthy situation quo through data-motivated information-enrichment initiatives. Staff surveys will be considered to get nurses direct feedback about the present conditions and their rating of team relations and professionalism. This point shifts the focus of the nurse supervisor to the expression of such data in her staff meetings and thus makes a very strong case for why the hostility directed towards the colleagues and lack of mutual respect should be stopped and changed. Lastly, training on how to review facts, as per studies that show that an abrasive personality puts patients at risk, will ensure that a rationale for teamwork from an academic perspective is provided. The process then moves forward to this stage with staff being conscious about the importance of change and then getting involved in the movement stage.
Reflection of Evidence-Based Practice
This thorough collegial process reflects the integrated utilization of current clinical research from current literature. The application of educational training, which furnishes nurses with critical competence in communication skills, assertiveness, conflict management, and crucial conversation, speaks to suggestions by Lee et al. (2023). The writers stress the importance of training in which the horizontal hostility issue and the interpersonal issues that are threatening the growth of feeling-based care environments are highlighted.
Evaluation
A balanced database showing various aspects of “progress” is vital for tracking the implementation success and deciding where the amendments or extra reinforcements are needed. Through quarterly monitoring of process metrics, such as the attendance rates that are noted for the obligatory educational training modules, participation rates of the structured nurse-to-nurse feedback sessions, and the number of disruptive conduct reports that are received, we will be closely monitoring these metrics. The indicators that are characteristic of nursing will be analyzed bi-annually (for example, staff turnover rates, patient contentment scores, and the occurrence of adverse events that are usually caused by communication breakdowns (like medication errors, patient falls, delays in treatment, etc.)).
Summary
The stirring of nurses in the facility, such as bullying, hostile attitudes, and interpersonal conflicts, is a contributing factor to the formation of a toxic work environment that is unhealthy and unsafe for employees. This hides nurses from communicating openly, asking for help when needed, and working together toward a common goal, yet that increased risk of medical errors and poor patient outcomes can be prevented. Apart from being stressful, the abrasive conditions in the workplace also adversely affect job morale, well-being, and retention of the accomplished staff. Solving these problems needs a multifaceted effort by using core change management strategies. The efforts of changing the culture from a hostile to a supportive one include a thorough explanation of the reason for the change, nurse nurses at all levels implementing the new policies and training, the development of norms of professionalism, mutual respect, and consistent leadership that models and enforces desired collegial behaviors.
 
References
Alder, S. (2023). Effects of poor communication in Healthcare. The HIPAA Journal. https://www.hipaajournal.com/effects-of-poor-communication-in-healthcare/
Arsat, N., Chua, B. S., Wider, W., & Dasan, N. (2022). The impact of working environment on nurses’ caring behavior in Sabah, Malaysia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.858144
Kangasniemi, M., Rannikko, S., & Leino-Kilpi, H. (2023). Nurses’ collegiality: An evolutionary concept analysis. Nursing Ethics. https://doi.org/10.1177/09697330231221197
Lee, S. E., Kim, E., Lee, J. Y., & Morse, B. L. (2023). Assertiveness educational interventions for nursing students and nurses: A systematic review. Nurse Education Today, 120, 105655. https://doi.org/10.1016/j.nedt.2022.105655

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