Kotter's Eight Step Model

The first step in the change process using Kotter’s eight step model is the “create a sense of urgency” (Kotter & Rathgeber, 2005, p. 130). Pain is a problem for patients with wound of many types, furthermore nurses often ignore patient reports or manage pain poorly (Bradbury & Price, 2011, p. 11). One way to recognize the urgency in a facility is to do a prevalence study of pre-treatment and post wound care for a predetermined amount of time. The 0-10 scale is an objective measurement tool for the subjective experience of pain (Bozimowski, 2012, p. 188), however it may not be the best tool to identify the impact of pain (p.188). “Because pain is a subjective experience, its relief can best be quantified through patients’ self-reports…”, furthermore,
130). For this example, a representative from various departments are desired for the team; suggested team members would include a/an: Physician, DNP, Wound Care Nurse (WCN), floor nurse, spiritual care provider, physical therapy, occupational therapy and Pharmacy representative. Each team member will provide valuable insight into the impact of pain on the patient and possible creative evidence based solutions. Bratta and Long (2004) found the nuances of the wound care management requires members from many disciplines to manage the factors associated with healing a wound (p.28). After, discussions with various stakeholders, a vision emerged to initiate a change at their facility (Bratta and Long, 2004, p.28). For our example, the next step is to “create a shared vision” (Kotter & Rathgeber, 2005, p. 130) relates to the patients experience during dressing change. For example, a shared vision might be for patients undergoing wound care at the facility will experience only, patient identified, tolerable level of pain with
Acknowledgement of the wins motivates people to continue the change process (p. 131). Following, “don’t let up” (Kotter & Rathgeber, 2005, p. 131) nudges team members to address barriers to the new process swiftly, so staff will not relapse to old behaviors. The perceived price of new treatments may be a barrier for facility administration, the question of cost for supplies, employee training and specialty services. Unfortunately, cost-benefit analyses are not easily found in pain literature (Bakerjian, Prevost, Herr, Swafford, & Ersek, 2012, p. 45). “Interventions that show cost savings should obviously be implemented; however, even if there is not a significant cost reduction, there may be other reasons for implementing the program” (Bakerjian, Prevost, Herr, Swafford, & Ersek, 2012, p. 45). Conversely, the cost benefit analysis may not include subjective quality measures such as quality of life (Bakerjian, Prevost, Herr, Swafford, & Ersek, 2012, p. 45), collecting the patient stories may be one way to address this quality of life