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Neonatal intensive care units (NICUs) are developing ways to improve their practice. Many NICU patients include preterm neonates. Simple practices, such as skin to skin contact, have shown to have outstanding effects on neonate outcomes (Cardin, et al., 2015). The neonatal integrative developmental care model (IDC) includes 7 neuroprotective core measures (Cardin, et al., 2015).
The seven core measures include a healing environment, partnering with families, positioning and handling, safeguard sleep, minimizing stress and pain, protecting skin, and optimizing nutrition (Cardin, et al., 2015). Through these core measures, NICUs can provide quality care for neonates. Without these core measures, neonates may experience undesirable outcomes; such as increased hospital stays, delayed development, distress, and nutritional deficits.
The Nurse as a Change Agent
A change agent is one who motivates and/or facilitates change, questions the current situation, and encourages others in accepting change (Kennedy, 2014). A nurse would be a good change agent for this project because this is a change in nursing care. The best way to get nurses to accept the change is to have the nurses facilitate the change. Change theories evaluate the change processes. Lewin’s Change Theory uses a three-step system used for planned change. The first step is unfreeze, the second is changing/moving, and the third step is refreezing (Wojciechowski, Pearsall, Murphy, & French, 2016).
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The neonatal IDC model focuses on seven core measures including the healing environment, partnering with families, positioning and handling, safeguarding sleep, minimizing stress and pain, protecting skin, and optimizing nutrition (Cardin, et al., 2015). These seven core measures are evidence-based strategies to support neurological development and family processes (Cardin, et al., 2015). This intervention should be implemented in the University of Vermont Medical Center (UVM) NICU to improve patient outcomes and the experience of the families.
Of course, in order to implement this intervention there must be strong support. Areas to draw support from include the stakeholders, managers, and informal leads within the unit. The stakeholders are people or groups with direct interest within the work of the organization (Sullivan, 2018). The stakeholders are anyone who has a lot of time or money invested in the organization. At UVM one stakeholder could be the CEO, John R. Brumsted, MD. You can easily concur that the CEO of UVM is considerably invested in the outcomes of the organization. The advantage of John Brumsted is that he is both a board certified physician and tenured professor in obstetrics and gynecology (University of Vermont Medical Center, 2018). Appeal to his knowledge in obstetrics and make the case that implementing the neonatal IDC model will lead to better patient outcomes and higher patient satisfaction.
Another group of individuals that need to be on board with this change are the managers. The managers of the NICU at UVM will be the ones implementing the change and disseminating the knowledge. The nurse manager can use the normative-reeducative strategy of change. This strategy assumes that people act according to the social norms and values within an organization (Sullivan, 2018). The change already lines up with the values of the organization. According to the University of Vermont Health Network, their mission is “to improve the health of the people in the communities we serve by integrating patient care, education, and research in a caring environment” (University of Vermont Health Network, Slide 5, 2017). Next, you must make this change the norm. Get staff nurses involved. Particularly, find an informal leader. An informal leader is someone who’s knowledge and personal skills substantially influence other people’s actions even without the formal title of a leader (Sullivan, 2018). Use informal leaders to influence the rest of the team by advocating for the implementation of the neonatal IDC model.
As with any change their will be driving and restraining forces. Driving forces are things that facilitate change by pushing people in the right direction (Sullivan, 2018). Restraining forces are factors that prevent change and push people in the wrong direction (Sullivan, 2018). In this case, the driving factors are that nurses generally want what’s best for their patients and their families. They want their patients to have the best possible outcomes. Administrative leadership, such as the CEO would likely be supportive in the change as well because he knows that its safer for the patients and will likely draw more patients to their facility. However, as with any change, there may be some push back as well. The restraining forces might include nurses who are tempted to say “well this is how we’ve always done it and it’s never been an issue.” You may have other people that find the seven core measures of the neonatal IDC model too complicated or feel that they’re too busy to learn something new. Administrative leadership may not want to spend the money. However, even with all these restraining forces, it is still possible to successfully implement this change. Begin highlighting your compelling message.
The NICU at UVM is the only level III NICU in the entire state (The University of Vermont Children’s Hospital, 2017). That means that for most Vermont residents, and a large group of New York, this is their only option for care. The stakeholders, managers, and care team all need to understand that as the only level III NICU in Vermont, they have an obligation to provide the absolute best care possible. Don’t they owe that to their patients? Especially because these neuroprotective measures in the neonatal IDC model have been proven to improve patient outcomes and patient satisfaction (Altimier, Kenner, & Damus, 2015).
Prior to trying to implement this change, you must have a plan in how to manage doubts and concerns that arise. If administrative leadership is concerned with the cost of implementing the program, reframe it as a way to boost reimbursement through patient satisfaction. If nurses are concerned with the amount of time that it takes to learn and implement the program, provide incentives for those that participate. Perhaps you could award extra vacation time to those who help facilitate the change. If nurses don’t see the necessity in changing and want to keep things the same, educate them in the latest evidence based practice and remind them that this is what is best for the patients and the families. When conflicts arise, confront the issues and attempt to resolve the problem through communication and reason (Sullivan, 2018).
Change
While attempting to implement a change, communication is key. Communication in a professional setting is not the same as an average conversation. When having a professional conversation about change there are certain guidelines for this type of communication. It must be the right person at the right time and right place (Sullivan, 2018). Change can be scary and cause conflict so communicating the right way is very important. In this situation the nurses in the NICU must be on board, so communicating to them is the most important since they will be implementing the change.
One of the challenges of communication is rumors. When people talk, sometimes the information gets mixed up and that can lead to things that are not true being spread around. In this situation the plan for making this change will be written up in a pamphlet and placed around the NICU. If someone hears something they do not know to be true or that upsets them they can refer to the pamphlet or speak directly to the manager heading up the implementation of these measures.
To push for acceptance of this change, reward and praise will be offered to empower action. The people who start to implement this change will be rewarded with a weekly staff lunch, where their actions will be acknowledged and praised. This will encourage people to start implementing change and not hold on to the ways they have provided care in the past. Nurse do so much and many times it feels like a thankless jobs. This encouragement will facilitate a new, positive environment in the NICU. The praise will be used as positive reinforcement to encourage the continuation of change.
The nursing staff must be fully involved in order for this change to be successful. The involvement will start with a mandatory staff meeting on the neonatal IDC model’s neuroprotective core measures. They will be taught what they are, how to implement them, and how this will differ from the ways things are done currently. Then the nursing staff will be observed using these neuroprotective core measures and be signed of on competency. This is to ensure that they understood the teaching and know how to implement it correctly.
Referens
The changes will be implemented by the unit managers overseeing the NICU at UVM. Nursing leaders and educators will train the staff using evidence-based practice in order to ensure that the change will be effective and the nurses understand the importance of the neonatal IDC model. Once the official change has been made and the policy is put into place, through repetition, overtime it will become routine and standard practice for the staff. As this change becomes a part of the NICU’s culture, those who are using this new practice may discover possible problems with the method or set up of the intervention. This will lead to developing new ways to provide support and maintain the change.
Supporters of this change will be responsible for updating the stakeholders with the progress of the implementation and ensuring that the change will not be abandoned if met with restraining forces. Nurse educators and clinical managers will be accountable for supporting staff throughout the change and continuing to educate incoming nurses to the units and updating current staff of any new research findings that could influence their care. It is important that the clinical managers celebrate the success of the change and to reward those who were proactive with the new implementation. Perhaps offering an incentive for those who are willing to be trained to be preceptors or advocates for the change. Encouraging the nurses who are directly affected to be driving forces for the change will be instrumental as progress moves forward.
In conclusion, we have identified the need for more quality neonatal IDC models in NICUs, especially at UVM, and how the nurses will be the change against. We have developed a plan that confronts possible restraining forces, stakeholders, involvement of driving forces, communication among staff, and how to support and sustain the success of this change into the culture of the unit. After the change has been fully implemented there will be evidence to confirm that infant care has improved and the core measures have been met with their desired outcomes.
