Leading And Managing A Change In Clinical Practice Nursing Essay

I had seen many patients’ complains of complex wounds that need long time to cure. Complex wounds are considered as a real challenge to the health care providers especially when it is accompanied with factors that can play role in impaired and complicate wound healing such as Surgery, infection, the presence of diabetes, Trauma, Radiation, Autoimmune diseases and arteriosclerosis. As stated by Ferreira. M, 2006: The most commonly seen complex wounds that require special care and attention are Wounds in the lower extremity of diabetic patients, Pressure ulcers, Chronic venous ulcers, Wounds following extensive necrotic processes caused by infections and Chronic wounds related to vasculitis and immunosuppressive therapy that have not healed using simple care.

There is no specialized and responsible team who can determine the best type of management for the patients with complex wounds. The health care provider in the hospital is providing the same care and management to the patients who complaining of simple or complex wounds. They need to know that There are striking differences between simple wounds, for example surgical wounds or skin scratches, and those chronic wounds that do not heal primarily and demand specialized care, mostly in hospitals (Ferreira. M, 2006) .This will harm the patient (physically and emotionally), decrease the quality of care that provides to the patients, delay wound healing and increase the period of hospitalization.

The care provided for patients with wounds can be described in one single word which it’s DRESSING. While the treatment of the complex wound is much complicated. Determining that the majority of these complex wounds should be considered surgical cases and not just cases for dressings as stated by Ferreira. M. 2006. The treatment of complex wounds should be by using surgical procedures instead of the clinical measures. In addition to debridements, skin grafting, and flap coverage.

Health care providers (doctors, nurses, etc) need to increase their awareness about the important of the presence of wound management team in each hospital to decide the best type of management, decrease the complexity of the treatment and choose the best surgical approaches that will increase the quality of life to the patient.

Step 2

A complicated wound needs more than just a bandage to recover and heal. It needs special attention; compassion of a wound care team who are specializes in non-healing and slow to heal wounds. As stated by Tjandra. J, 2001Wound healing is the replacement of destroyed tissue by living tissue, and is fundamental to survival.

My vision is to form a team of professionals who work together to assess patient’s wound and provide input regarding their treatment. This team consists of physicians, physical therapists, dietitians and nurses “wound therapy nurses and nurses specialized in complex wounds”. These specialized wound nurses may visit patients in their home in order to provide an effective plan to heal their wounds.

They have to work on providing appropriate wound care to the patients that will help the complex wound to heal faster. As well as they should know that “Wound healing may be impaired by general factors such as malnutrition, corticosteroids, diabetes mellitus and anaemia, which affect the patient as a whole. And local factors such as infection, ischaemia and hematoma which affect the site of the wound (Tjandra. J, 2001)”.

In addition to cleansing, control bacterial growth and prevent infection. This team will also provides education to patients and their families to help prevent any future complications, increase there awareness regard complex wounds and their demands to heal, encourage them to collaborate with the team and participate in the treatment. This change will enhance the quality of care patients received; improve the quality of life, decrease the period of hospitalization and promote the process of healing.

“It is important that all practitioners are aware of the pathophysiology and aetiology of pressure ulcers and mechanisms to prevent pressure ulcer development (Ousey, K, 2005) because Patients with complex wounds need to spend long period in the hospital so they will be at high risk of develop bed sore. Team members should coordinate program to prevent pressure ulcer that will protect the patient from getting this series skin problem.

This change will build up a very strong team who are able to put the patient on the right way of cure and make them able to treat the complex wounds in time less than the expected. It is a real chance for all the health care provider specially nurses toward increasing their knowledge and improving there skills. Wound care team consider as a good step towards improving the health care services in the hospital.

Step 3 & 4

Leadership is a very important concept in nursing professional that helps to develop the skills of nurses and the other health care professionals. I will be able to achieve my vision by using one of the most important models in leaderships and management. It is John Adair’s Leadership model. Adair has developed what he calls a functional approach to leadership based on three overlapping circles of needs which are achieving the task, managing the team or group and managing individuals (Cipd 2010).

By adopting this model of leadership, my responsibilities as a leader to achieve the task are as follows: sharing my vision, goals, and objectives with the team members. Then, create an action plan to achieve the task, considering timescales and strategies. It is important to share my action plan with the members and ask them for feedback or suggestions. After that I will distribute responsibilities by agreement and delegation, monitor and maintain overall performance against plan and report the progress toward the team aim continuously. Finally review, reassess, adjust plan, methods as necessary.

In addition to that I will encourage and motivate the members to be involved in making decisions and giving suggestions, to make the task a success and meet our goals. The leader should try to resolve any groups’ conflicts and look for ways to develop a cooperative team working. However, to develop each nurse and improve her skills, we will recognize the team member as individuals, and get to know their strengths and needs, we have to help them and encourage them to challenge the complex cases of wounds. It is very important to give awards and recognitions to the individual’s hard efforts and work.

Therefore, to achieve my vision and reveal the benefits of this change I will apply Lewin’s three- stage model of change. It is a holistic model that helps people to think about the change and gradually adopt it as pointed out by martin (2003). Lewin proposed 3 stages for any changes to occur, including: the unfreezing stage is when people start to believe that there is a need for change, the moving stage, when it is possible to make changes, and the refreezing stage is when the change is strengthened and becomes the new normal state (martin 2003).

In the unfreezing stage team members must realize that they will be able to treat any type of complex wounds and promote wound healing if they work on improve their knowledge and skills. They will see the importance of act as one collaborative group to enhance the quality of care and promote wound healing.

As stated by Reinelt (2010) Evidence-based practice (EBP) is commonly used to inform practice decisions in the fields of medicine, nursing, social work, child welfare, and criminal justice. So it is important to provide the team with some evidence based research that will guide decision-making about what treatments and protocols to use with individual patients, and offenders to ensure the highest possible accountability for producing good results. Reinelt (2010). In addition to that, I will invite nurses and doctors from other countries that are already implemented this idea in their hospitals and ask them to give presentation to our health care providers about their experience and discuses how this change can improve the quality of care and increase the benefits to the patients.

Throughout this stage, I will be expecting initial resistance to the change by some people but I will listen carefully to their opinions and issues, I will try to convince them of the important and the benefits of implementing this change. I will also encourage them to give suggestions that would help in achieving my vision.

In the moving stage, we will see the possibility of forming complex wound team in the hospital and improve member’s skills and knowledge. In this stage I will arrange for different teaching sessions and workshops that will help in increase members knowing, improve their therapeutic and communication skills, and enhance their confidence. One of the most important nursing leadership qualities is supporting your team, If the members of the team wish to develop new skills, or apply their theoretical knowledge in a practical environment, it is important that the leader provide a supportive environment for them to try out these skills. This will provide them with the true method of learning, and develop their skills in a competent manner (Lalwani, P. 2010). In addition, there will be a team supervisor who will distribute and organize the work between the members and promote team collaboration.

In the refreezing stage, the change is carried out and implemented, the team is working together to treat and promote healing of any difficult wounds. Leader should keep in mind that not every member can deal with stress and other such aspects of the profession very well. So, as a leader, I will need to support them, and understand and help them in a way that proves useful for them (Lalwani, P. 2010). The Leader is responsible of solving problems, encourage and motivate the members and introduce feedbacks, as stated by Lalwani, P. 2010, Feedback can, and should also be positive, as this will further encourage your team members to perform better and keep introducing innovative yet efficient ways of becoming independent. Therefore, there will be monitoring committee to observe team achievements, evaluate their understanding, knowledge and skills and recognize the benefits of this change for patients, families, and the healthcare providers. The findings will determine if we will carry on this change, stop it or create another action plan to overcome the difficulties and improve the outcomes.


As stated by Lalwani, P. 2010, my goal is ensure the betterment of the organization I am work for, by improving the quality of patient care, which I can do with the application of various creative leadership qualities and management strategies, and the different leadership styles in nursing. My action plan included many steps and events which will aid to achieve my vision and create wound management team consist of physicians and nurses specialize in the complex wounds. This will help to achieve my goals such as enhance the quality of care patients received, improve patient’s quality of life, and promote healing of the difficult wounds. In addition to improve health care provider’s knowledge and skills regarding the difficult wounds and the most important thing is create nurses specialize in wound therapy and make them able to treat any complicated wounds. So I think my action plan is fit well with my previous explanation and rational for change.


By the end of this assignment I discover that there are at least 8 qualities that successful leaders have: Responsibility, Integrity, Decision takers, Deal with facts, Vision and inspiration, Optimism, Resilient, and Excellence (Brodie, D. 2008). The Successful leaders are not just working to put themselves in good senior position but to use their skills, knowledge and all the leadership qualities for the growth of the organization that they are working for, provide high quality of care to the patients that will lead to patient satisfaction and play role in the progress of their health and well being. I can understand now that the leaders are those who are willing to follow. They must be perfect in whatever they do, because by doing their best; they will discover that only the best is expected from their team members.

– http://www.scielo.br/scielo.php?pid=S1807-59322006000600014&script=sci_arttext

– Tjandra, J. Clunie, G. Thomas, R (2001). Text Book of Surgery/ Wound Healing and Wound Management. USA, Canada, Australia. 2nd ed., Pp 20, 23, 24, 25.

– Ousey. K, (2005) Pressure Area Care, UK.1st ed., Pp 13

– http://www.cipd.co.uk/subjects/maneco/leadership/leadshipovw.htm?IsSrchRes=1

– Martin, V. 2003 Leading change in health and social care, 1st ed., Routledge: London and New York, Pp. 104-06.

– http://leadershiplearning.org/blog/claire-reinelt/2010-06-29/use-evidence-based-practice-field-leadership-development

– http://www.buzzle.com/articles/nursing-leadership-qualities.html (Lalwani, P. 2010)

– http://ezinearticles.com/?The-8-Qualities-of-Successful-Leaders&id=760414