Chapter 13: Scenario
The medical practice council had just recently received the
new LEAD (lower extremity arterial disease) guidelines and had reviewed them as
a part of assessing how they informed changes in nursing practice. Elaine, RN,
BSN, was chair of the Practice Council and had noticed that these new LEAD
standards would affect clinical protocols for wound care and nursing practice
standards for patients with compromised arterial blood flow. During the
discussion held by the council, a number of conflicting issues arose with
regard to appropriate application of the standards of practice and their
implication for changing existing protocols and routines of the nursing staff.
Elaine knew that there were a number of challenges involved in the discussion
and decision-making around appropriate clinical standards for the management of
arterial wounds, as well as the need for staff management in practice changes.
In the initial dialogue in the Practice Council, she noticed widely differing
points of view on how the LEAD standards were to be translated and applied to
practice and how the protocols and procedures would be constructed to guide
effective practice. The Council was
eager to undertake its work in developing protocols and procedures but was challenged
by the diversity of insights, views, and recommendations from its members about
what those new practices might be and how they might be implemented on the
unit.
Questions
1.
Cleary, there is strong opportunity
for using negotiation and communication skills as Elaine facilitates dialogue and
decision-making around the adaptation and application of the new LEAD
practices. Assume Elaine’s role as Practice Council chair and, with your
learning team, plan out a strategy for negotiating the variety of views
regarding a standard and reaching a consensus on an acceptable standard.
2.
As Elaine leads this process and
moves it toward defining particular standards, there will be times when the
group members become entrenched in their positions. What are some of the
strategies That Elaine might consider to help move people off their positions
and into a place of acceptable agreement around a practice standard?
3.
Strong emotions often come to the
fore when people are attached to beliefs and practices. What are some
techniques or processes that can Elaine deal with these emotions and
attachments to positions by addressing them yet moving participants forward in
the decision-making process?
4.
Is there a role for testing and
experimentation of approaches when absolute agreement cannot be reached for a
single approach? How might that response be structured?
5.
When
a decision has been reached by the Practice Council for a particular protocol
or standard of practice. What are some of the characteristics and elements of a
valuation that need to be incorporated into its implementation as a way of
validating the usefulness and effectiveness of the protocol/standard?