-Reducing the incidences of malnutrition that often occurs during entrance to hospital has been a top priority within the nursing care profession for quite some time. There have been various explanations for this such as lack of staff, patients not able or are unwilling to say that they might need assistance, poor use of diagnosis tools and care pathways. A key factor in the prevalence of patients delivering with malnourishment is the disturbances patient's endure during mealtimes, such as ward rounds, non immediate medical interventions, housekeeping activities and tourists. This essay will explore the incidences of malnutrition, and those who are most vulnerable and the changes that contain been designed to reduce such incidences.
Change management should be regarded as an ongoing process, which requires good communication, planning, positive management and cooperation. This essay will endeavor to explore the change management procedures, management and team management skills found in the implementation of protected mealtimes. It will explore the negative aspects and problems came across when implementing a change and the ongoing management skills necessary to maintain such changes.
For many patients accepted to hospital, specifically the elderly, malnutrition is a common event. It is the nurse's fundamental responsibility of health care to provide patients with the highest of good care possible, a major requirement for any human being to endure and live a healthy life is the consumption of a healthy healthy diet, be that by typical methods or unnatural measures suited to the patient's state of health at that time (Royal College of Nursing 2007). Studies into hospital malnutrition show that as many as four out of ten elderly patients admitted to hospital already are malnourished and because of this of a hospital admission as much as six out of ten elderly patients, become malnourished, their situation worsens and their disorder frequently escalates (Time Concern 2006; BAPEN 2007). The NHS Improvement Plan (2004) place standards to deal with the increasing incidences of malnutrition within clinic settings; it has become apparent that these types of good practice suggestions havent been implemented in every hospital in the united states, as incidences of malnutrition persist. Davidson and Scholefield (2005) accounts that inadequate diet can result in longer hospital keeps, impairs the recovery of patients and increases financial costs; several private hospitals have indeed organized and executed changes to lessen such incidences but overall have had limited success. The authors discovered that constant interruptions from drug, rounds, scientific activities and insufficient nursing personnel being on the ward at mealtimes (credited to lunch break breaks coinciding with mealtimes) all accounted for patients being provided with very little or on occasion no nutritional intake at any given mealtime. Savage and Scott (2005) does indeed agree with this statement to some extent but argues that it is all to easy at fault nursing staff alone, it's the responsibility of every individual NHS trust to use managerial changes and guidelines and ensure they are monitored, examined and improved to supply the best care possible for each patient. Mamhidir et al (2007) argues that because the implementation of guarded mealtimes in a few hospitals there is substantial facts to claim that patients, specially the elderly benefit immensely; patients gained weight, restorative healing time reduced, were discharged before and mealtime experiences were a more pleasant experience for patients as well as nursing staff. Mooney (2008) argues that there is facts to suggest even after clinic trusts have been offered unarguable information that malnutrition is a major problem and a catalyst for longer clinic remains, only 43 percent of those trusts have not yet provided research they have implemented schemes in order to reduce appetite and malnutrition. A HEALTHCARE FACILITY Caterers Association (2004) further comment that mealtimes should not primarily concentrate on the provision of diet, it also makes method for social connection between patients and carers, they further comment that generally speaking the quality of the meals provided is not the issue, the inability of the individual to be able to give food to themselves is far more the worrying concern. Council of Europe (2003) comment that hospitals should be designed to be patient centred, making certain the delivery of nourishment is flexible and everything deliverance of good care is set inside a framework; all personnel should interact in collaboration to ensure that incidences of poor nutrition are dealt with. Repetitive accounts of malnourishment is information enough to claim that current tactics are no more working, change is a required power to ensure incidences are reduced. It's the responsibility of the first choice to ensure this is tackled (Era Concern 2006).
Change Management can be described as the procedure of developing a planned method of change in a organisation. The objective should be to maximise the collective benefits for many stakeholders mixed up in change and minimise the chance of failure applying the change. Change entails diagnosis, planning and analysis; changes where people are nursed should always be centered on the benefits patients will receive if change is integrated (Country wide Institute of Health insurance and Clinical Superiority, 2007). Welford (2006) writes that there are many ideas which explore the necessity for change; the target ought to be the provision of the best quality of treatment, each individual involved in the delivery of such treatment should work together, be determined and supportive of one another during times of change. Change in just a team which contributes to new procedures and ideas impacts each individual differently; it can be a very daunting task for some as well as for others it is embraced to permit for personal development and the sharing of knowledge (Murphy 2006). There are various ideas which uses steps or phases that can evaluate when a change is needed and when the changes that are applied work. For the purpose of this essay the writer refers to a popular theory developed by Lewin in the 1950's which requires three periods to execute effective change the popularity and participation of all those involved in the area necessitating change. The first stage, commonly referred to as the 'unfreezing' level of this theory requires the participants to acknowledge the need for change; evidence should be provided to encourage new thinking and beliefs about current practices. Hallpike (2008) writes that there surely is evidence to suggest that clubs can be split into groups who have their own specific judgment on certain regimes, practices and care deliverance. This can be said for the provision of nourishment to patients. In this specific study the writer reviews that some team members did not think there is an issue with the current provision, some were not convinced that changes would be made and others didn't have faith in a holistic approach across the team. In this example it's the responsibility of the team head to persuade all the associates that the necessity for change is essential to be able to supply the best service possible, that the whole team work at the goal. Welford (2006) discusses the second stage of Lewin's theory; describing this stage as the moving stage, allowing individuals to voice their own ideas, experiment with different regimes, it allows time for representation, to discuss positive or negative conclusions. Past routines may have seen some team market leaders adopt the belief that employees were seen to are better when the first choice provided demanding job explanations and a plan of that which was expected of them; their thoughts and ideas weren't of value to the entire success of a team. Major (2002) argues that for a innovator to adopt such thinking is only going to lead to flaws and a feeling of negativity within a team; the first choice should adopt good communication skills and openness to permit for effective team building, positive group dynamics, all working efficiently and productively. Dennis and Morgan (2008) suggests that although change is the duty of the company, type from the service end user is unquestionably a valuable tool in examining in case a change is doing work for the greater good. Feedback, irrespective of being positive or negative ascertains if the change is a positive one. If the new change has a negative affect to the service customer then the change has been a negative one, this involves a go back to the freezing stage to allow the team to make further changes to increase the advantages to the service customer. The writers' further comment that managers should be observed as advocates for the service individual; it should be the duty of the supervisor to challenge team members over poor practice, poor attitudes and resistance to change for the better. Turmoil within a team causes unrest, a disbelief that change is for the higher good resulting in a dysfunctional team. The third period of Lewin's theory can be commonly known as the 'refreezing' stage, where new ideas and behaviours turn into a new or common practice. Pearce (2007) argues that to mention this phase as a result denotes that the change remains static, market leaders should continuously strive to make changes for the better, communication over the whole team allows for individual's points of view to be subjected and discussed; feedback on how a fresh change is working is necessary in order to achieve the highest levels of quality health care.
Leadership styles become a key concern when developing, utilizing and upholding change. Determination of staff also plays an integral role in the approval of change; leaders should demonstrate they are a good role model, adopt a friendly attitude towards team members, recognizing of criticism and become happy to provide positive responses, when the team endeavour to believe in and put into action the change (Darlington 2006). Corkindale (2009) argues that market leaders need balance their role within the team to ensure that they do not become too over acquainted with individual associates, as this might lead to team members relying too greatly on the leader to make all the decisions and expert may be affected.
Murphy (2006) creates that market leaders need to adopt a method of control that suits the workforce; a laissez-faire strategy can be seen as the leader not taking into account specific team member's ideas, work ethics and determination seriously, it can lead to a team sense devalued and unorganised. The National Institute for Mental Health (2007) further suggests that leaders who show their determination, by working alongside their acquaintances, adopting and retaining the changes themselves shows a leader who's at the forefront in the deliverance of quality care. They further claim that each leader provides their own set of ethics, life experience and education to a team, will often choose their own style of leadership that could be a mixture of several styles moulded to suit the team and the area of practice they are employed to control. Opportunities for team members to tone of voice their opinions and concerns are important; they are after all the main implementers of the change and can have be the first ever to recognise if the change has gained positive or negative results. The change can only work if leaders allow for representation, discussion and adaptation of the change to suit each individual involved in the change process. An alteration that is difficult to put into action or maintain will end in failing, this leads a team adopting negative emotions and a level of resistance to change in the future.
Goleman (2000) suggests that to adopt an authoritarian procedure, can sometimes be considered a positive method of leadership especially if some team members resist change or there's a need to create quick results. Goffee and Jones (2000) disagree with this affirmation and claim that a good innovator is somebody who other folks want to follow without bullying, dangers or the fear of reprisals; they lead by conversing effectively and take up a method of leadership that allows the team to comprehend what is expected of them.
RCN (2007) writes that the only way malnourishment can be determined and monitored effectively is with effective use of recognized testing tools. Perry (2009) argues that in many cases nursing staff are given the means and tools to determine an individual, but most are inadequately trained to comprehend the conclusions of the assessment or are unwilling to require other medical researchers in the care and attention of the patient. A multidisciplinary method of deal with such problems should be used. Secured mealtimes have shown to be useful to not only the patient but to the whole attention team, it allows for analysis in areas such as speech and words, mental medical issues and other physical problems which make a difference the nutritional absorption of individuals. South Staffordshire Key Health care Trust (2009) records that covered mealtimes impacts and will involve all personnel within in the organisation from physiotherapists, local staff, maintenance staff through to outside the house specialists such as sociable workers. It will involve every area of professional medical practice where patients require nutritional intake, not limited to patients who are unable to feed themselves but also for those patients who require and have earned a silent, interruption free period to eat, drink and relax.
To maintain and keep an eye on the change process and could require several tries before the focus on is reached. takes time and might not exactly continually be successful first time. National Patient Basic safety Agency (2008) declares that many professional medical staff referred to the execution of shielded mealtimes as a hindrance to their day to day routine, but once the benefits for patients as well as the staff members were explained they became more compliant and understanding for the necessity to change.
