Posted: June 11th, 2024

NSG 4431 Guidelines for Change Project/Collegiality Paper

NSG 4431
Guidelines for Change Project/Collegiality Paper

1) The purpose of this paper is to review Evidence-Based Practice and its use to implement a change/collegiality process.
2) Identify a leadership/management problem or opportunity for improvement on a clinical nursing unit. Please do not use your workplace. The topic is to be related to nursing delivery, quality of care and/or patient safety. The problem must be a current problem, not one which has already been identified and remedied in the past.
3) The paper should describe why the ‘change process’ is necessary to address and potentially correct the problem and how collegiality among key personnel plays a part in solving the problem.
4) The paper is 5-6 pages, not including the title and reference page, and written in a scholarly form, using APA formatting.
5) The anti-plagiarism site, Turnitin, will be used for submission of the paper.
6) Do a search for the literature to find a minimum of 3 articles of studies published in peer-reviewed, scholarly journals and published within the last 5 years. The studies should be related to the chosen problem and change process. DO NOT use unpublished Master’s theses or unpublished doctoral dissertations, as these sources are not published in a journal but available from a repository. The published journal articles should be studies related to the topic and used as resources to support the information in the paper. Use these journal articles to write and give support to the information in the paper. One or more chapters from text can/should also be used as additional resources to support the information. However, the specific chapter author(s) must be cited and referenced correctly. See the document in the APA Notes section.

Parts of the Paper

1) Title page

2) Introduction: Introduce the topic. State/describe the problem or the need for a process change clearly.
3) Describe the Problem Requiring Change (Heading, centered and bold) given in the following: Describe how the problem may contribute to a deficiency in nursing delivery, quality of care and/or patient safety. Define the problem and describe how the problem causes a deficiency. Give support from the literature.
4) Describe the Change Theory (Heading, centered and bold) given in the following:
In general terms, describe in a paragraph change theory and how this can be used in nursing.
a. Choose a change theory. Give the actual name of theory in bold (Subheading, left margin, bold) Describe the chosen theory. Describe the steps or process of the theory. Cite all information. (See Marquis & Huston Ch. 8). Correctly cite the chapter in this section and correctly reference on Reference page. The journal articles also are to be used to giving supporting information.
b. Discussion of Change (Subheading, left margin, bold). Discuss how the chosen theory can be used as a framework for the problem. Give supporting citations. (See Marquis & Huston Ch. 8). Correctly cite the chapter in this section and correctly reference on Reference page. He journal articles may also be used to giving supporting information.

5) Leader and Team (Heading, centered and bold). Describe in general terms the persons in these roles and how these different roles are needed for change. The information should be at least one paragraph.
a. Key Players (Subheading, left margin, bold). Determine who (key players) would be needed to help solve the problem on the unit. List titles and job responsibilities. Determine who the leader should be for the Change. Describe what leadership style is used by this person. Describe why does this person uses this leadership style. DO NOT give name(s). (Marquis & Huston Ch. 8). Correctly cite the chapter in this section and correctly reference on Reference page. The journal articles also are to be used to giving supporting information.
b. Team Members (Subheading, left margin, bold). Describe the individuals in the group/team and list major characteristics, such as motivation, strengths, and weaknesses of the team. Describe the type of interaction & communication exhibited by this group. Describe the action/participation is needed from each member. Cite information. Correctly cite the chapter in this section and correctly reference on Reference page. The journal articles must also be used to giving supporting information.
c. Resources (Subheading, left margin, bold). Describe the resources needed for change. Describe how are/should the resources be obtained and utilized to rectify the identified problem. Cite information.

6) Review of the Literature (Heading, centered and bold). A review of literature is to be done on the problem or need for change. This review should include at least three (3) current, less than 5 years old, scholarly articles from peer-reviewed scholarly journals. DO NOT use a Master’s theses or doctoral dissertation found in a repository. Provide a summary of information for each source (purpose, data & conclusion) that would influence/support the solution to this problem and/or need for change. There should be at least 2 paragraphs per study. The text IS NOT included in the review of the literature. Cite all the information.

7) The Change Process/Plan (Heading, centered and bold). Outline a mechanism for implementing the change. Describe the plan thoroughly. Try to implement this plan or at least talk with the key personnel about the feasibility of such a plan. Identify which change agent strategy would be necessary/or identify one that you used. Describe outcome criteria. Cite information.
a. Reflection of Evidence Based Practice (Subheading, left margin, bold). Describe how the change mechanism and plan reflects evidence-based practice. Cite information.

8) Evaluation (Heading, centered and bold). Determine how you/the team did/would measurably evaluate the effectiveness of the change intervention or strategy. Discuss any resistance or reinforcing factors identified. Thoroughly discuss. This should be several paragraphs describing the evaluation process. Cite information.

9) Summary (Heading, centered and bold). Conclude the paper and summarize the information. This section need to be ½ to ¾ of a page in length.

10) Reference page

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 a 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. 4. Instruction: Humanize the given sentence.
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
● Union representatives
● 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. Union representatives advocate for the interests of their members.
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 against 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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