The Change Agent in Preventing MRSA Spead - Research Paper Example

Leadership and Management Theory in Relation to Implementing Change in Preventing the Spread of MRSA Infection within the Surgical Ward Introduction Back in 1961, hospital-Acquired Methicillin-Resistant Staphylococcus aureus (HA-MRSA) is a predominant nosocomial pathogen or staph infection first discovered in the United States and United Kingdom (So and Farrington 2008). MRSA is commonly found in hospital settings and health care facilities such as surgical ward, nursing homes and dialysis centres. Since most of the patients who have been hospitalized for a long time are physically weak, failure to control the spreading of MRSA strains in clinical or hospital settings could cause the patients to become infected (Centres for Disease Control and Prevention 2008; Department of Health 2008a). It is crucial for each nurses to effectively control the spreading of HA-MRSA within the surgical ward. In order to enhance the quality care provided to patients within the surgical ward, this study will discuss the role of the senior sister as the agent who will make the change in preventing the spread of MRSA within her ward. As part of going through the main discussion, strategic ways on how the change will be implemented and measured will be tackled in details. As part of examining the effectiveness of the senior sister in terms of performing her role as the change agent in preventing MRSA spead within the surgical ward, auditing tools will be used in evaluating the senior sister’s ability to enhance the quality care within the surgical ward. As the assigned senior sister in the surgical ward, the advantages of using transformational leadership style over collaborative and transactional leadership style will be tackled when implementing organizational change. As part of going through the main discussion, significance of Lewin’s management theory of change, McGregor’s theory, and Lippitt’s phases of change theory will be examined in terms of its advantages and disadvantages when applied in surgical ward. Research Title / Topic “Leadership and Management Theory in Relation to Implementing Change in Preventing the Spread of MRSA Infection within the Surgical Ward” Significance of the Study Aside from enabling the nursing students to have a better understanding about the negative health impact of MRSA infection on patients, the study will also enable the student nurses to have sufficient knowledge and skills with regards to the importance of leadership and management theory in preventing the spread of HA-MRSA within the surgical ward. By preventing the spread of HA-MRSA within the surgical ward, nurses can effectively protect the patients from becoming infected with the antibiotic-resistant pathogens. Relevance of the Research Topic to Nursing Profession One of the main duty and responsibility of senior sister in the surgical ward is to ensure that each of the nurses will provide the patients with holistic caring. As part of rendering holistic caring services to the patients, the senior sister assigned in surgical ward should motivate each of the nurses to willingly and actively participate in the provision of nursing care that will hasten the healing process of each patient (Hunterdon Healthcare 2008). The spread of MRSA within the surgical ward can cause harmful health impact over the physical health of the patients. Therefore, nurses should keep the area from microorganisms. In line with this, it is the duty of the senior sister to remind the nurses about the importance of keeping the surgical ward free from MRSA by regularly disinfecting the area. Definition of Key Terms Decolonization – a method of eliminating MRSA such as the use of infection control measures and/or antibiotics. HA-MRSA – MRSA infection that are acquired within the hospital settings or had surgery within the past year (The University of Tennessee Medical Center 2008). Hand hygiene – hand washing with soap and water or use of an alcohol-based hand sanitizer before and after having a direct contact with each patient (CDC 2008). Holistic nursing – nursing practice with a goal of healing the patient as a whole person (Kozier et al. 2004, p. 1453). Isolation – the practice of isolating a patient for the purpose of preventing the spread of infection and communicable diseases. (Kozier et al. 2004, p. 1455) MRSA – a type of infection that is caused by a strain of Staphylococcus aureus bacteria which are highly resistant to antibiotics (The University of Tennessee Medical Center 2008). Reservoirs – “a non-human host that serves as a means of sustaining an infectious organism as a potential source of human infection” (Halcomb et al. 2008a). Screening examination – “a brief review of essential functioning of different body parts or systems” (Kozier et al. 2004, p. 1463). Standard precautions – “are set of infection control practices that health care professionals use to reduce the transmission of microorganism within the health care settings” (CDC 2008). Quality Health Service – provision of timely and accurate health care treatment to patients by recruiting more highly competitive health care staff to reduce the patients’ waiting period aside from improving other health care services related to cancer, heart diseases and mental health (NHS 2000). Literature Review Negative Impact of MRSA Infections in Surgical Ward Several studies explained that MRSA infection does not only affect the health of the patients by increasing their mortality risks but also adds up the economic burden the patients’ family has to face since patients who were infected with MRSA on surgical site is more difficult to treat (Halcomb et al. 2008a; Tacconelli 2005; Engemann et al. 2003). In most cases, patients in surgical ward who has been infected with MRSA requires a prolonged hospital stay and expensive medicine to cure infection. In worst cases, patients infected with MRSA who are left untreated can develop severe necrotizing fasciitis which could either lead to loss of a limb or an estimated of 6 to 76% mortality rate (Headley 2003). Based on the study that was conducted by Engemann et al. (2003), the average hospital charges for in-patients is US$29,455 as compared to US$92,363 when the patient has been infected with MRSA on surgical site. On the other hand, the rate of MRSA infection cases in UK hospitals are as follows: England (8.2%), Scotland (9.5%), Wales (5.4%), and Northern Ireland (4.9%) (House of Commons Public Accounts Committee 2009). In line with this, the House of Commons revealed that estimated cost of annual healthcare associated MRSA infection in UK hospitals could reach up to £1 billion (ibid). As a contagious disease, different types of MRSA infection includes the skin and soft-tissue infections like necrotizing fasciitis, cellulitis, and abscesses which is composed of 69% up to 96% of the MRSA cases (So and Farrington 2008; Fridkin et al. 2005). In less frequent cases, serious infections like bacteremia (≤3%) and osteomyelitis (≤2%) as well as urinary tract infection and central nervous system infections may also occur (So and Farrington 2008; Gupta et al. 2007; Le and Lieberman 2006). In worst cases, tissue infection can lead to serious infections such as necrotizing pneumonia or fasciitis (Miller et al. 2005). MRSA occurs when a person is infected with bacteria that produces toxins known as Panton-Valentine leukocidin (PVL) and is characterized as staphylococcal chromosomal cassette which is highly susceptible to antibiotics (Gupta et al. 2007). Once infected with MRSA, the disease can easily be transmitted from one person to another through a close personal contact with a person who is infected with MRSA, poor personal or communal hygiene and having abrasion injuries (Millar, Prendergast and Moore 2008); one can easily acquire the disease. The Role of the Senior Sister as the Agent who will Implement Change in Preventing the Spread of MRSA within the Surgical Ward As the agent who will implement change in preventing the spread of MRSA within the surgical ward, the senior sister will act as a leader in terms of educating, inspiring and motivating the rest of the nursing team to actively participate in the control of MRSA pathogen in the ward area. Without the use of coercion or violence, the senior nurse should communicate, teach and lead the health care team concerning the importance of proper screening of patients prior to hospital admission, the practice contact isolation precautions, decolonize MRSA carriers, and disinfect air and medical equipments from MRSA contamination (Grossman and DeBartolomeo 2008; Fry and Burger 2008; Forsha et al. 2007; Walker 2007; Tacconelli 2005). Having in mind that patients can be infected with community-acquired MRSA (Romero et al. 2006), the senior sister should convince the rest of the health care professionals to support the implementation of proper screening of patients prior to hospital admission. Upon conducting a cohort study with 19-month control period, Wernitz et al. (2005) concluded that the use of proper microbiological screening of patients for possible MRSA infection prior to the admission to hospital is the best way to prevent the spread of MRSA infection in surgical ward. Likewise, Eveillard et al. (2002) revealed that 14.6% of newly admitted patients are infected with community-acquired MRSA. Since the admission of infected patients could trigger the increase in the number of MRSA infected patients within the surgical ward, Eveillard et al. (2002) suggested the need to implement systemic selective screening method on patients with high risk of MRSA carriage. This strategy will help reduce the risks of cross-transmission from one patient to another. It is equally important for the senior sister to require each of the nursing staff to implement timely isolation precaution as soon as a patient was detected to be a positive carrier of MRSA. Aside from providing immediate medical intervention to patients who are infected with MRSA pathogen, this strategy is effective in terms of preventing the spread of MRSA strains from infected to non-infected patients (Halcomb et al. 2008b; Tacconelli 2005). Before and after having direct contact with patients who are infected with MRSA, the senior sister should encourage the health care team to make it a habit to wear gloves, gowns, and masks and practice hand washing to avoid transmitting these bacteria from one patient to another (Halcomb et al. 2008b; Forsha et al. 2007; Wernitz et al. 2005). This guideline will also protect the health care team from becoming infected with MRSA. In case the isolated patients have visitors, the senior sister should ensure that nurses should instruct the visitors to follow the contact precaution guidelines like wearing gown and gloves and using hand sanitizer before and after visiting the patient (Fry and Burger 2008; Forsha et al. 2007). As the senior sister, it is important to teach the health care team about the importance of decolonizing MRSA carriers by regularly washing the infected parts of the body with undecylamidoprophyl-trimoniummethosuphate and phenoxyethanol-based antiseptic soap followed by applying intranasal mupirocin continuously for a short period of 5 days (Wernitz et al., 2005). Airborne MRSA can spread throughout the surgical ward. Aside from instructing the health care team to be careful when changing the cover sheets of the hospital beds since airborne MRSA particles can increase from 2 – 3 micron diameter before bedmaking up to more than 5 micron diameter during the process of bedmaking (Shiomori et al. 2002), the senior sister should encourage the nurses to regularly disinfect the air especially when used by patients with MRSA infection. Strategic Ways on How the Change will be Implemented and Measured Leadership is a special skill that the senior sister should possess when managing the surgical ward. In line with this, the senior sister should be aware that there are different leadership approaches that can be adopted when implementing change and that each type of leadership style has its own advantages and disadvantages. With regards to the different leadership approaches, several studies revealed that either the application of a transformational and/or transactional leadership style could be beneficial when managing health care professionals like nurses (Aarons 2006; Longenecker 2006; Gullo and Gerstle 2004). Basically, the use of these leadership styles does not only create a peaceful working environment but also increases the morale of GPs, nurses, and other health care professionals who are working in surgical ward. In general, leaders that are classified as transformational leaders are the ones who do not practice positional authority but are committed to train their subordinates to become a leader in their own way. Therefore, health care professionals under the leadership of transformational leaders are able to work effectively under less supervision and express themselves freely within the health organization. Transformational leaders and followers are equal in the sense that they work towards one organizational goal as a team. Aside from inspiring and motivating the team members to use their creative imagination to enable them to construct and develop the best solution that will enable the whole team to reach the organizational goal (Burns 1978, p. 4), transformational leaders are known for being capable of implementing a new idea or a solution to a problem (Johannsen, 2004). The only difference between a transformational leader and his/her subordinate is the fact that each of them has a different set of activities played within the organizational group (Kelly 1995). Contrary to transformational leadership style, transactional approach is based on reinforcement and exchanges (Aarons, 2006). Having self-efficient employee has gained importance in terms of making a health care organization increase its competitiveness in terms of delivering quality care to the patients. In line with this, the use of collaborative leaders is advantageous since this type of leadership style tends to mobilize employee towards a single organizational vision. The theory of McGregor suggests that theory X and theory Y employees exists wherein theory X employees are the ones who avoid work as much as possible and needs to be directed because of their lack of ambition and sense of responsibility to perform the assigned task whereas theory Y employees are the ones who are self-directed and enjoys working on their own without much supervision (Marquis and Huston 2009, p. 428; Basavanthappa 2000, pp. 18 – 19). For this reason, the senior nurse should use of transactional leadership style is more appropriate in managing theory X employees and transformational leadership style when working with theory Y employees. Implementing change can create driving forces that facilitate change or restraining forces that could hinder change. In line with this, Lewin introduced the three-step change model which includes the need to promote positive change behavior (unfreeze), reduce the restraining forces (movement), and to combine these two methods (refreeze) which is necessary to create balance when implementing organizational change (Kritsonis 2004 - 2005). When promoting positive change behavior, the senior sister should make use of transformational leadership style since this type of leadership style can effectively motivate the nurses in preparing them to accept and recognize the need for organizational change. Establishing trust between the senior sister and the rest of the health care team is important when implementing change since this strategy will make it easier on the part of the senior sister to convince the health care team that it is their duty to protect the patients from the health consequences of MRSA infection. Likewise, the senior sister should encourage the health care team to participate in brainstorming when deciding for the best preventive solution in controlling the spread of MRSA pathogens in surgical ward (Robbins 2003, pp. 564 – 565). This strategy will increase the health care team’s motivation and give them a sense of importance when protecting the patients in surgical ward. Lippitt’s phases of change theory is more extensive than Lewin’s change management theory in the sense that Lippitt’s phases of change theory includes the need to diagnose the problem, assess motivation and need for change, assess resources and motivation of change agent, develop action plans, and maintain change through the use of communication and feedback before finally terminating assistance coming from the senior sister (Kritsonis 2004 - 2005). Using Lippitt’s phases of change as a guideline, it is clear that failure to protect patients in surgical ward from becoming infected with MRSA can lead to socio-economic problems on the part of the patient’s family members. Therefore, the senior sister should motivate the health care team to protect the health of each patient by encouraging the health care team to support the implementation of proper screening of patients prior to hospital admission, the practice contact isolation precautions, decolonize MRSA carriers, and disinfect air and medical equipments from MRSA contamination (Grossman and DeBartolomeo 2008; Fry and Burger 2008; Forsha et al. 2007; Walker 2007; Tacconelli 2005). MRSA infection in surgical ward can endanger the lives of the patients if not required for a prolonged hospital stay which can be very expensive on the part of the patients’ family. In motivating the nurses to accept the need for change, senior sister can explain that they can think about performing laboratory tests by taking samples from patients’ nose, throat, skin or soft tissue lesions, wounds, and other body parts wherein MRSA is most likely to develop prior to hospital admission. Basically, the use of screening method prior to hospital admission is cost-effective method since early detection of MRSA infection is less costly than treating patients for MRSA infection (Engemann et al. 2003). The senior sister should also explain to the health care team that other simple ways to protect the patients from MRSA infection includes the need to strictly require all staff to carefully observe the standard precautions and other infection control methods when handling body fluids like blood, sputum, and/or other forms of body secretions. Aside from wearing protective devices like gowns, gloves, and masks, the senior sister should remind the health care team about the importance of disinfecting their hands through proper hand washing using phenoxyethanol-based antiseptic soap, hand sanitizer, and/or alcohol rub/gel before and after having a one-on-one contact with the patient, decolonize MRSA carriers, and disinfect air and medical equipments (Grossman and DeBartolomeo 2008; Walker 2007; Forsha et al. 2007; Wernitz et al. 2005). When implementing organizational change, the senior sister should make use of transformational leadership style because this type of leaders tends to go beyond what is happening around his environment because of their ability to implement new ideas all the time (Johannsen 2004). Aside from being flexible when managing change, transformational leaders are able to adapt and inspire the health care team to implement a new strategic plan which aims to improve the patients’ safety. For this reason, there is a strong possibility that the members of the team will instinctively adopt with the organizational change (Burke 2002, p. 243). Basically, the senior sister should apply the use of transformational leadership style when implementing a discontinued change process and transactional leadership style when managing a continuous organizational change process (Burke 2002, pp. 201 – 203). As part of assessing the health care team’s motivation in supporting the need for change, the senior sister can gather the health care team to express their thoughts about the need to implement these changes. Hearing out the personal opinion and concerns of each of the health care team will enable the senior sister determine whether there is someone in the group who opposes the need for change. Likewise, it is possible to use of survey forms which aims to determine any suggestions and violent reactions coming from the health care team with regards to the implementation of proper screening of patients prior to hospital admission, the practice contact isolation precautions, decolonize MRSA carriers, and disinfect air and medical equipments from MRSA contamination (Grossman and DeBartolomeo 2008; Fry and Burger 2008; Forsha et al. 2007; Walker 2007; Tacconelli 2005). Having in mind the need to properly screening of patients prior to hospital admission, the practice contact isolation precautions, decolonize MRSA carriers, and disinfect air and medical equipments from MRSA contamination, the senior sister can start developing an action plan to make these changes possible. As soon as the senior sister is able to win the support of each of the health care team, the senior sister can maintain change through the use of communication and feedback form before terminating her assistance for change (Kritsonis 2004 - 2005) As defined by the NHS Management Executive (1991), nursing audit is “part of the cycle of quality assurance which normally incorporates the systematic and critical analysis of the nurses in conjunction wiht other staff when assessing the quality of planning, delivery and evaluation of nursing care and health improvement outcomes on the part of the patients” (Carey 2000, p. 48). As part of examining the effectiveness of the senior sister in terms of performing her role as the change agent in preventing MRSA spead within the surgical ward, a quantitative and qualitative research survey combined with one-on-one interviews with a couple of randomly selected health care professionals under the supervision of the senior sister will be requested to participate in the study. Basically, a primary research study will be conducted not only to evaluate the senior sister’s leadership skills in terms of convincing and managing possible resistance-to-change coming from the health care team during the process wherein the senior sister was convincing them to participate and support the need for change but also to test the senior sister’s ability in terms of enhancing the quality of care the patients within the surgical ward are receiving from the rest of the health care team. Likewise, the primary research study will also determine whether or not the health care team were strongly influenced and convinced by the senior sister in terms of supporting the implementation of proper screening of patients prior to hospital admission, the practice contact isolation precautions, decolonize MRSA carriers, and disinfect air and medical equipments from MRSA contamination (Grossman and DeBartolomeo 2008; Fry and Burger 2008; Forsha et al. 2007; Walker 2007; Tacconelli 2005). With the use of Likert scale type of questionning as explained by Neeraja (2003), the researcher will make use of numbers 1 to 5. In line with this, the score of 1 would indicates that the research respondents ‘strongly agree’ with the statement whereas the score of 5 indicates that the research respondents ‘strongly disagree’ with the statement. The score of 3 means that the research respondents are ‘undecided’ (ibid). As compared to the use of ‘yes’ or ‘no’ type o of research questions, Neeraja (2003, p. 433) revealed that the use of likert scale questions and research method is more advantageous in terms of providing the researcher a more accurate and definite response to each of the research questions. Since the use of quantitative type of research questions does not provide the researcher with a more descriptive answer with regards to how well the senior sister was able to accomplish her goal in terms of convincing the rest of the health care team to support the need for change, part of the primary research study will make use of one-on-one interview with a couple of randomly selected interviewees who were under the supervision of the senior sister during the implementation process. As a way of evaluating the senior sister’s success in handling organizational change within the surgical ward, the interview report will be analyzed together with the quantitative research results. Conclusion Leaders are individuals who do not only influence, select, equip, and train the followers with different abilities and skills but also persuades them to willingly participate with the leader in terms of achieving a common goal (Winston and Patterson 2006, p. 7). In general, there is no right or wrong when it comes to the proper way of choosing how to strengthen the leadership skill of each nurse. Since different people have their own way of developing their own leadership style based on their own strength and weaknesses, personality, and beliefs, nurses should be able to combine the use of the available leadership approach depending on what the situation calls for. Resistance-to-change is one of the major causes of organizational change failure. Other than coming up with an effective and more efficient solution in preventing the spread of MRSA in surgical ward, senior sister nurse should convince the rest of the health care team members to actively participate and support strategies that will protect the patients from becoming infected with MRSA through the use of a good leadership approach and understanding the change management theories of Lewin’s, McGregor’s, and Lippitt’s. MRSA bacteria can be easily transferred by having a close physical contact with infected individuals. It is also possible to spread MRSA within the hospital environment caused by continuous movement or the in and out of the people. To avoid having the MRSA pathogen spread throughout the hospital environment, nurses should observe the standard precautions or the set of infection control practices which are effective in fighting against the colonization of MRSA, the importance of hand hygiene using alcohol-based hand rubs and personal protective equipments (PPE) like gowns, gloves, masks and eye protection when handling contaminated blood, body fluids, body excretions or secretions like touching the patients’ mucous membranes or sputum. Educating the nurses about these precautionary measures will remind the nurses that they can easily control the spread of MRSA in surgical ward by requiring the hospital admission nurses to develop and implement a proper screening procedure prior to patients’ admission to the hospital, isolate the MRSA infected patients, observe the national infection control standards, and decontaminate medical equipments and hospital environment using air disinfectant and EPA registered detergents or disinfectant 1:100 bleach / water. As a result, improvement in terms of minimizing the incidence of HA-MRSA is possible (Grossman and DeBartolomeo 2008; Walker 2007). *** End *** References Aarons, G. A., 2006. Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice. Psychiatric Services , 57(8), pp. 1162 - 1169. Basavanthappa, B., 2000. Nursing Administration. Jaypee Brothers Medical Publishers Ltd. Burke, W., 2002. 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