Change Agents include nurses who identify problems of all sorts and try to fix them. Fixing a problem might involve making a change. To effect changes, one of the components that is essential for a successful change is communicating the reason for the need to make a change. This will avoid the resistance to change but rather aid the acceptance of the change. In this Blog, a clinical issue is identified and related to each component of the model of Professional Practice Regulation from the base to the peak of the pyramid.
The above diagram shows the components of the model of Professional Nursing Practice Regulation.
I worked in a wound care clinic where I took care of patients with wounds. Wound dressings were changed and topical medications were applied in line with the doctor’s order. I followed the standard of practice and worked within my scope of practice while caring for patients. I also performed wound assessments as trained. Sometimes, I had to attend seminars and training on wound care and the different kinds of dressings for different wounds. My manager was wound care certified and she cared for patients following the standard of practice. (Nursing’s Professional Scope of Practice Standards of Practice, Code of Ethics, and Specialty Certification).
During patient care, confidentiality is paramount and information can only be disclosed to only individuals involved in the patient care or health decisions. I had a challenging experience where a wound was draining excessively. I knew the current dressing was not the best as it was soaking the good skin causing more harm to the wound and surrounding skin. Following the Nurse Practice Act, I am not supposed to change orders or practice medicine without a license but I can advocate for the patient. (Nurse Practice Act & Rules and Regulation).
In order to advocate for my patient and make the required change, I had to inform the nurse manager first. This was the protocol that existed. Also, there was a policy that existed on assessing a wound both old and new wounds with each dressing change. The wound had to be assessed by the nurse directly involved in the care and evaluated by a certified wound care nurse which was my manager. Although I knew a change had to be made after my assessment, complying with the protocol was important. The nurse manager after her assessment reached out to the doctor and informed the doctor of it. She also gave me the phone to explain the issue at hand in detail since I was involved directly with patient care. (Institutional policies and Procedures).
I explained the need to change the dressing twice a day and as needed (PRN) as against daily which was the order. This was to protect the skin surrounding the wound thereby maintaining skin integrity. I knew that this change will further prevent infection and worsening of the wound. My advocacy and determination led the doctor to give me a new order for more quality patient care. I was determined to make a positive change for a better patient outcome. (Self Determination).
Med, W. R. A. 150-. (1970, January 1). Prompt #2: Defining Ethics (Nursing)- Bradley Robinson. http://wramed.blogspot.com/2016/02/prompt-2-defining-ethics-nursing.html.
American Nurses Association. (2015). Nursing : Scope and Standards of Practice: Vol. 3rd edition. American Nurses Association.