Creating a Culture of Change

Creating a Culture of Change
Professor Zena Moore
Professor of Nursing, Head of the School of Nursing & Midwifery ,
RCSI. Director of the SWaT Research Centre, RCSI.
Adjunct Professor, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Melbourne, Australia,
Professor Department of Public Health, Faculty of Medicine and
Health Sciences, Ghent University,
Honorary Professor, Lida Institute, Shanghai, China,
Senior Tutor, University of Wales.
Outline
• Why change?
• Principles of change
• Culture – stalled or stuck?
• Attitude?
• Knowledge?
Why change?
• Pressure sores found in Egyptian mummies, some of which are more than 5,000 years old.
• Hippocrates (460-370 B.C) described sores developing in association with paraplegia with
bladder and bowel dysfunction
• During the renaissance, Ambrose Paré, wrote in his autobiography about a wounded French
aristocrat who had a sore great as the palm of a hand on the coccyx (for he has been too
much in the bed);
• 1866 Nightingale wrote: “another who cannot move may die of bed-sores…….”
• 1877 lecture notes of Jean-Martin Charcot described his study of decubitus ulcers, writing:
“decubitus ominosus, signifies not the patient in the bed, but the bed-sores supposed to
result from such positions”
Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India, 45(2), 244–
254. http://doi.org/10.4103/0970-0358.101287
Levine, JM. Historical Perspective: The Neurotrophic Theory of Skin Ulceration. Journal of the American Geriatrics Society (JAGS) 40: 1281-1283, 1992.
Levine, JM. Historical perspective on pressure ulcers: The Decubitus Ominosus of Jean-Martin Charcot. Journal of the American Geriatrics Society (JAGS) 53: 1248-1251, 2005.
Why change?
Pressure ulcers are not a modern phenomenon; Yet…………………
BAUER, K., ROCK, K., NAZZAL, M., JONES, O. & QU, W. 2016. Pressure Ulcers in the United States’ Inpatient
Population From 2008 to 2012: Results of a Retrospective Nationwide Study. Ostomy Wound Manage, 62, 30-38.
• Mean prevalence was 13.5% (SD 10%; Min 0.06%; Max 36%)
• Highest prevalence: Switzerland (27.70%; n=1); Lowest: Finland (0.51%; n=2).
Conaty L, Moore Z (2016) Pressure Ulcer Prevalence: What do the European Data Tell Us? MSc Thesis, RCSI
Why change?
Why change?
Principles of Change – Lewin’s Change Model
Lewin, Kurt (June 1947). “Frontiers in Group Dynamics: Concept, Method and Reality in Social Science; Social Equilibria and Social Change”. Human
Relations. 1: 5–41.
Lippitt, R., Watson, J. and Westley, B. The Dynamics of Planned Change. New York: Harcourt, Brace and World, 1958.
Principles of change – Lippitt Model of Change
2. Assess motivation & capacity for change
1. Diagnose the problem
3. Assess change agent’s motivation & resources
4. Select progressive objective
5. Choose appropriate role of change agent
6. Maintain change
7. Terminate the helping relationship
Principles of Change – Diffusion of Innovation
Rogers EM (1983) Diffusion of Innovations. 3rd Edition. Free Press, New York.
Kotter JP (1996) The eight-stage process. In Leading Change (Kotter JP ed.). Harvard Business School Press, Boston, pp. 22-158.
Principles of change – Kotter’s 8 Stage Process
So, we are all set to go, but………..
Example
• For wounds that were necrotic (7%, n=13), 38% (n=5) had a nonadherent (impregnated with soft paraffin) dressing applied;
• Of the highly exuding wounds, 31% (n=10) were dressed with a
low-adherent dressing;
• Of the low-exuding wounds, 31% (n=46) were dressed with an
absorptive dressing;
• Of those with non-infected wounds, an antimicrobial dressing was
used as the primary wound dressing in 42% (n=61) of cases.
SKERRITT, L. & MOORE, Z. 2014. The prevalence, aetiology and management of wounds in a community care area in Ireland. Br J Community Nurs, Suppl,
S11-7.
• Only 41% of those with a leg ulcer had a Doppler assessment
carried out.
• Of those with venous leg ulcers, just 67% (n=36) were managed
with compression therapy (bandaging or hosiery).
• Of those with diabetic foot ulcers, just 39% (n=9) were receiving
offloading as a component of their management plan.
• Of those with non-infected wounds, 14% (n=64) were using silver
dressings and 78% (n=50) were using iodine-based dressings.
JORDAN O’BRIEN, J., MOORE, Z., CONNOLLY, B., CONCANNON, F., MCLAIN, N., STRAPP, H. & WILSON, P. 2016. Exploring the prevalence and
management of wounds in an urban area in Ireland. British Journal of Community Nursing, 21, S12-S19 8p.
Example
Culture – stalled or stuck?
Stuck: unable to change a situation Stalled: progress stopped
Culture – stalled or stuck?
https://www.hse.ie/eng/about/who/qid/nationalsafetyprogrammes/pressureulcerszero/ accessed 11th Jan 2019
http://www.rcsihospitals.ie/patient-care-and-treatment/, accessed 11th Jan 2019
N=1,83
1 beds
Target
0%
1. ASLAN, A. & YAVUZ VAN GIERSBERGEN, M. 2016. Nurses’ attitudes towards pressure ulcer prevention in Turkey. J Tissue Viability, 25, 66-73.
2. BEECKMAN, D., DEFLOOR, T., SCHOONHOVEN, L. & VANDERWEE, K. 2011. Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multicenter study in
Belgian hospitals. Worldviews Evid Based Nurs, 8, 166-76.
3. CHARALAMBOUS, C., KOULOURI, A., ROUPA, Z., VASILOPOULOS, A., KYRIAKOU, M. & VASILIOU, M. 2018. Knowledge and attitudes of nurses in a major public hospital in
Cyprus towards pressure ulcer prevention. J Tissue Viability.
4. Crowder-Klobofski AG, (2013) A descriptive correlation study regarding the effect of nurses’ attitudes toward pressure ulcer risk and care. MSc Thesis, Montana State University. CrowderKlobofskiA0513.pdf (974.4Kb)
5. DEMARRE, L., VANDERWEE, K., DEFLOOR, T., VERHAEGHE, S., SCHOONHOVEN, L. & BEECKMAN, D. 2012. Pressure ulcers: knowledge and attitude of nurses and nursing
assistants in Belgian nursing homes. J Clin Nurs, 21, 1425-34.
6. DILIE, A. & MENGISTU, D. 2015. Assessment of Nurses Knowledge, Attitude, and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government
Hospitals, Addis Ababa, Ethiopia, 2015. Advances in Nursing, 2015, 11.
7. ETAFA W, ARGAW Z, GEMECHU E, MELESE B 2018 Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing 17:14 https://doi.org/10.1186/s12912-018-0282-2
8. FLORIN, J., BAATH, C., GUNNINGBERG, L. & MARTENSSON, G. 2016. Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP
instrument. Int Wound J, 13, 655-62.
9. Habiballah L 2018 Attitudes of intensive care nurses towards pressure ulcer prevention. Clinical Nursing Studies 6(3):1-7
10. Hamdan AB, Javison S, Tamani J, Sashidharan S, Abu Yahya O, Hamoudi B (2018) Oncology Nurses’ Beliefs, Attitudes, Perceived Barriers towards Pressure Ulcer Prevention. J Health Educ
Res Dev 2018, 6:4 DOI: 10.4172/2380-5439.1000278
11. ISLAM S, SAE-SIA APDW, KHUPANTAVEE APDN. Knowledge attitude and practice on pressure ulcer prevention among nurses in Bangladesh. Poster presentation in the 2nd international
conference on humanities and. Soc Sci. 2010
12. KADDOURAH B, ABU-SHAHEEN AK, AL-TANNIR M. Knowledge and attitudes of health professionals towards pressure ulcers at a rehabilitation hospital: a cross-sectional study. BMC
Nurs. 2016;15:17.
13. KALLMAN, U. & SUSERUD, B. O. 2009. Knowledge, attitudes and practice among nursing staff concerning pressure ulcer prevention and treatment–a survey in a Swedish healthcare setting.
Scand J Caring Sci, 23, 334-41.
14. MOORE, Z. & PRICE, P. 2004. Nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention. J Clin Nurs, 13, 942-51.
15. OSENI OG, OJEWUYI OO, OTENE CI, OLAITAN PB 2018 Knowledge, attitude and practice of pressure ulcers prevention among nurses in a teaching hospital. International Journal of
Scientific Research. 7(4):37-9
16. TALLIER, P. C., REINEKE, P. R., ASADOORIAN, K., CHOONOO, J. G., CAMPO, M. & MALMGREEN-WALLEN, C. 2017. Perioperative registered nurses knowledge, attitudes,
behaviors, and barriers regarding pressure ulcer prevention in perioperative patients. Appl Nurs Res, 36, 106-110.
17. TOLULOPE ESAN, D., AKINWANDE FASORO, A., FUNMILAYO OJO, E. & OBIALOR, B. 2018. A Descriptive, Cross-sectional Study to Assess Pressure Ulcer Knowledge and Pressure
Ulcer Prevention Attitudes of Nurses in a Tertiary Health Institution in Nigeria. Ostomy Wound Manage, 64, 24-28.
18. TUBAISHAT, A., ALJEZAWI, M. & AL QADIRE, M. 2013. Nurses’ attitudes and perceived barriers to pressure ulcer prevention in Jordan. J Wound Care, 22, 490-7.
19. UBA, M. N., ALIH, F. I., KEVER, R .T. & LOLA, N. (2015). Knowledge, attitude and practice of nurses toward pressure ulcer prevention in University of Maiduguri Teaching Hospital, Borno
State, North-Eastern, Nigeria. International Journal of Nursing and Midwifery, 7(4), 54-60.
20. UNVER, S., FINDIK, U. Y., OZKAN, Z. K. & SURUCU, C. 2017. Attitudes of surgical nurses towards pressure ulcer prevention. J Tissue Viability, 26, 277-281.
21. YILMAZER T, TÜZER Ha, ERCİYAS A Knowledge and Attitudes Towards Prevention of Pressure Ulcer: Intensive Care Units Sample in Turkey Turkiye Klinikleri Journal of Nursing Sciences in press
10.5336/nurses.2018-63157
Attitude?
Attitudes: Results

AssignmentTutorOnline

Attitude
• Two independent influences determining an individual’s intention to perform a
behaviour.
• Personal (the attitude towards the behaviour)
• Social (the social pressure to perform the behaviour).
• Perceived control is also an important variable in the prediction of behavioural
intention and is influenced by factors such as:
• Knowledge
• Skill
• Time
• Opportunity
• Autonomy
• Resources
But what about opportunity?
Knowledge
DALVAND, S., EBADI, A. & GHESHLAGH, R. G. 2018. Nurses’ knowledge on pressure injury prevention: a systematic review and metaanalysis based on the Pressure Ulcer Knowledge Assessment Tool. Clin Cosmet Investig Dermatol, 11, 613-620.
Knowledge
• One of the stages of change
• self-liberation, the individual’s ability to choose.
• Choice occurs when there is more that one alternative
• if there is only one choice then there is no freedom
• Choice can create anxiety felt in taking responsibility for that choice
• Choosing is made significantly more difficult when there is an
insufficient amount of information gained regarding a situation
• Therefore, a tendency to cling to ritualistic practice may stem for a fear of
change due to lack of knowledge rather than an unwillingness to change.
So……stalled or stuck?
Prochaska J. O., Di Clemente C. C. (1984). The process of change in: The Transtheoretical Approach. Pp 33-44. Dow Jones-Irwin.
In conclusion
After the 41st Phase the
final Score:
Ireland 15; France 13
Why?
Everyone knew exactly
what they had to do, they
knew they needed each
other to do it and everyone
was dependent on each
other to achieve the goal
Creating a Culture of Change
Professor Zena Moore
Professor of Nursing, Head of the School of Nursing & Midwifery ,
RCSI. Director of the SWaT Research Centre, RCSI.
Adjunct Professor, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Melbourne, Australia,
Professor Department of Public Health, Faculty of Medicine and
Health Sciences, Ghent University,
Honorary Professor, Lida Institute, Shanghai, China,
Senior Tutor, University of Wales.