Innovation and Change in Nursing - Essay Example

Innovations in Nursing I have gained a new appreciation for the Biphasic Positive Airway Pressure ventilation system; specifically the Evita Ventilator. Its a step up from conventional ventilation machines since it doesnt use separate modes for assisted ventilation and spontaneous breathing, but it has a wide range of therapies. One of the medical sales reps that stopped by described it as a universal ventilation mode. But theres a lot of flexibility, patients on my ward have freedom to breath, but under controlled pressure. (Baum, et al., 1989) It was a big aggravation for respiratory patients before we put in BIPAP; it just felt natural to try to resist the forced ventilation fro older machines. Patients were bothered by the interruption of their natural breathing when the machine kicked in with enforced respiration. BIPAP matches the patients normal breathing, but maintains the extra pressure they may need, if theyre on my ward. Under the older respirators, sometimes the elderly surgical patients had troubled getting weaned off the machine, since it was going all their breathing for them. With BIPAP, they are actually working their own diaphragm, but with a system that works with their lungs, instead of forcing the job. The level of assistance the system provides is adjustable, it can take over respiration for an unresponsive patient, one of four stages that support breathing at lower or higher pressure levels. (Hörmann et al., 1994) BIPAP systems can be set for constant tidal volumes, and to limit or control pressure. In fairness, Ive seen the volume control can still make some patients want to resist the effects, and the effect may not fully cover both lungs equally. But since it is so adjustable, airway pressure can be kept in check, the different settings can reduce the long-term changes in lung function that might make weaning off the system harder. That consideration is always a factor; ventilation for respiratory diseases should be used sparingly, when most needed. (Lawin, et al., 1994; Baum and Benzer, 1993) But with Pressure-limit settings, the Evita allows for assisted breathing for the patient. The airflow can adapt constantly, as needed by the specific conditions of the lungs. The desired tidal volume is established as quickly as possible. The Ventilator is mainly recommended to treat oxygenation and ventilation challenges. You can treat oxygenation problems mainly by ensuring that patient has sufficient residual capacity available for gas exchange, by adjusting the average airway pressure. If residual capacity drops too low, alveoli can be damaged by endexpiratory collapse, (Bahns, 2011) which I saw a year before we got the Evita Ventilators. The main points in using the Evita BIPAP system are to not use controlled volume modes too long, and to keep an eye towards weaning the patient off the respirator when they can be reasonably expected to breathe on their own. It could be used to do all the work by itself, if the patient is completely comatose; but it also has a lot of range and sensitivity to support spontaneous breathing at lower, and higher pressures. And among its settings is the option to hold those pressure levels in check. Its a versatile system that makes resistance, and non-compliance less likely, which Ive gotten in the past from live people who just needed a little help breathing on their own. Theories of Change The issue of change within the individual, in terms of patterns of belief to the extent that they are psychologically ingrained is a complex field of study. Resistance to novel ideas is a reality in many professional disciplines, including the medical fields. To encourage innovation when necessary, there are researchers that investigate the patterns of by which an individual is resistant to change, and the stages in the psychological process of transformations in belief. Other researchers, Lewin in particular are interested in outward behavioral cues. When and in what context are demonstrable behavioral changes most likely to occur? Bridges believes that there is a disconnect between policy changes made by an organization and behavioral changes made by those individuals comprising that organization. If a corporation institutes a new policy, changing the ways its employees interact with one another, this is a consequence of our rational decision-making process. A corporate structure can make a determination as to what behaviors or practices will yield the most efficiency given a current economic climate; yet there is still the potential for friction should these practices interject with the personal beliefs of the actual employees. Many nurses have well-founded ideas concerning the needs of their ward, based on realistic, practical experiences that may not always be factored into the hospitals bottom line. And Doctors can often overrule nurses, rightly or wrongly. Dress codes, or sexual harassment regulations may be adopted by a corporation out of entirely logical reasons, yet the individuals who might not oppose such changes in an abstract sense may still resist such measures privately. Cultural sensitivity can also be a factor in larger hospitals. Families from certain Latin American countries may believe in The Evil Eye, for instance; or certain maternity patients from Asian countries may have customs requiring them to take the used placenta and bury it under the floor of their home. While the hospital might publicly state support for the beliefs of all cultures; on a practical level hostility to customs like these may be expressed by staff, despite official tolerance policies. Bridges identifies a psychological re-patterning by which the beliefs of an individual are broken down, moving into a neutral state before a new beginning is revealed to the transitioning a person. Resistance and denial are transformed into an awareness of new possibilities, as the individual undergoes a psychological shift. Kurt Lewin on the other hand, was more focused upon outward signs of behavior as an indicator of psychological change. Lewin’s chief observation can essentially be expressed as a comparison between the effectiveness of a lecture as opposed to peer pressure. A crowd of individuals can listen to an informative lecture exhorting them to change their lives for the better. The reasons given may be grounded in logic. Yes it has been found that a single speaker preaching at people is far less effective than the influence of peers. When individuals are placed within a group, and expected to perform a function it is pressure of that group which is most effective at yielding behavioral change. If the members of a group uniformly insist upon a behavioral change those changes became more likely by a difference of 2 to 10 times greater effectiveness than any moral uplift derived from a lecture. (Cartwright, 1951; Lewin 1951) Findings such as these could be important in the encouragement of older medical professionals to accept novel techniques when traditionalist inertia might make them skeptical. Bennis and colleagues provide a definition on the factors that compel change. When personal change in terms of psychological behaviors does occur, it can be the result of pure empiricism, the accumulation of evidence – when a mind is already receptive to this evidence, this method can be considered top – down. But the Lewin studies make it clear that emotional investment can alter the premise by which facts are evaluated. The individual must be made to adopt to the worldview of the lecturer/empiricist. A bottom-up approach has also been classified by Bennis. In which the individual himself realizes the need for change, and begins the search for a new ideology. The other way individuals can change is through the coercion of someone who has power over them. (Such as the leading doctors of the Hospital,) But coercion is most likely to yield seeming compliance and covert resistance. Bridges identifies the process of change, Bennis identifies the sources of change, and Lewin clarifies what circumstances make changes more likely. REFERENCES Bahns, Ernst. 2011. Two Steps Forward in Intensive-Care Ventilation. An introductory guide to Evita ventilation. Dräger Medical GmbH. Drägerwerk AG & Co. KGaA Baum M., Benzer H., Putensen Ch., Koller W., Putz G.(1989) Biphasic Positive Airway Pressure (BIPAP) - a new form of assisted ventilation. Anaesthesist 38: 452 – 458. Baum M., Benzer H. (1993) Einsatz von Atemhilfen. In: Benzer H., Burchardi H., Larsen R., Suter P.M. (eds.) Lehrbuch der Anaesthesiologie und Intensivmedizin. 405 - 437. Bennis, W , Benne, K , Chin, R and Corey, K (1976). The Planning of Change. New York: Holt, Rinehart and Winston. Brennan, D Wildflower, L. 2011. The Handbook of Knowledge-Based Coaching: From Theory to Practice. John Wiley and Sons, May 18, 2011 Cartwright, D (1951) achieving change in people: some applications of group dynamics theory. Human relations. Copyright 1951 by Sage publications. 4(1). Hörmann Ch., Baum M., Putensen Ch., Mutz N. J., Benzer H. (1994) Biphasic Positive Airway Pressure (BIPAP) - a new mode of ventilatory support. European Journal of Anaesthesiology 11: 37 - 42. Lawin P., Scherer R. und Hachelberg Th. (1994) Beatmung In: Lawin P. (eds.) Praxis der Intensivbehandlung. 357 - 394 7. Appendix Read More