The purpose of this concept analysis is to explore the concept of resistance and provide an operational definition for nurse leaders. While resistance has been deemed a major barrier to the implementation of successful practice change in popular literature, specific evidence as to how it is a barrier within health care organizations is lacking. The Walker and Avant model of concept analysis was used to analyze the concept of resistance. Literature searches utilized the Cumulative Index for Nursing and Allied Health Literature (CINAHL), PsychARTICLES, and Google scholar. Resistance is defined as an individual's behavior in response to perceived or actual threat in an attempt to maintain baseline status. It may be preceded by and amplified through mistrust, fear, and communication barriers, ultimately influencing the implementation, quality, and sustainability of the change. Historically resistance has been viewed with negative conations due to its potential impact on organizational success. However, resistance is a normal response to a threat to baseline status. Nurse leaders prepared with knowledge of resistance, including the antecedents and attributes, can minimize the potential negative consequences of resistance and capitalize on a powerful impact of change adaptation.
Background: It is challenging to quantify the soft elements of care, that often make the most difference in the long-term success of the patients’ recovery such as stroke knowledge, readiness for discharge, family involvement and patient support resources. The interdisciplinary team members document their specialty notes, however they are saved individually and in different sections of the EMR. The stroke team was challenged to create a process that pulls this data together. Hypothesis: We hypothesized that combining interdisciplinary team documentation into a Stroke Care Coordination Note in the EMR, would empower the care team to modify the acute care plan and simultaneously communicate post-hospital needs in order to maximize patients’ transition and outcomes. Methods: Through the engagement of Lean Six Sigma resources, the multidisciplinary team evaluated current processes and documentation to identify gaps. Tools utilized in facilitated meetings include; scope and critical success factors, SIPOC, process mapping, PARMI analysis, and brainstorming. Additionally, sensing sessions and GEMBA observations provided key insights into current state and engaged stakeholders. Results: The team created a Stroke Care Coordination Note in the EMR that consolidates interdisciplinary notes, demonstrates the stroke patients’ individualized plan of care and communicates post hospital needs. Post implementation, additional benefits have been realized such as: ease of use (one touch click), improved nursing communication during transitions of care, and improved communication with ancillary teams such as therapy and discharge planners. Conclusion: A thorough assessment of the current state and gaps, Joint Commission requirements and engagement of interdisciplinary team members, led to the development of a Stroke Care Coordination Note. At any given time, this note can be activated, convey the patients individualized stroke plan of care in the EMR, and be accessed by the interdisciplinary team. The care team stated improved overall patient care and communication during transitions of care. The ease of the use of the note and additional realized benefits support future systemic implementation among additional disease processes and entities.
Approximately 3.4% of Americans have a mental health condition and suicide is the 10th leading cause of death. While the rate of mental health conditions has slightly increased for adult populations, America’s youth has experienced a significant rise in depression. From 2008 to 2017, occurrence of depression in the adolescent population increased from 8.3% to 13.3%. As adolescents mature into adults; it is likely the rate of mental health conditions for the adult population will rise as well as it is the common thread that binds the diseases of despair: drug abuse, alcoholism, and suicide. Arising out of the deinstitutionalization movement of the 1960s, the Medicaid Institutions for Mental Disease (IMD) Exclusion Rule (§1905(a)(B) of the Social Security Act) prohibits reimbursement for Medicaid recipients ages 21 to 64 years receiving inpatient care at a psychiatric hospital with 16 or more beds. Consequently, the rule limits payment for psychiatric treatment to general hospitals and smaller, nonspecialized centers, which blocks patients from receiving inpatient care and transfers the financial burden of care onto psychiatric hospitals. The IMD Rule is approaching its 55th anniversary. It requires reevaluation. Although a state waiver process is available, use of this option has the potential to increase the incidence of racial and ethnic disparities across states. Full repeal of the IMD Exclusion Rule could help provide immediate access to inpatient care that is consistent nationwide and be a vital step toward creating financial, treatment and ethical parity for mental health services.
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