1. Strategic Change Presentation

2. The Issue: Artificial Hydration for Terminal Patients  Artificial hydration is a controversial topic and data remains insufficient to reach a final conclusion on the benefits or harm of dehydration in terminally ill patients (Schmidlin, 2008)  Each decision for or against hydration at the end of life needs to be on an individual basis (Schmidlin, 2008)

3. Kurt Lewin’s Change Theory Three Stage Model of Change: 1. Unfreezing 2. Change 3. Refreeze

4. Unfreezing: breaking down the existing status quo  Families/patients should have the option for artificial hydration! Current practice is that organization offers NO artificial hydration intravenously or subcutaneously.  Patients are refusing to sign on for care or are being turned away because they want the option.  Organization is not growing! Losing patients to other companies who are offering other options of care  Organization has no trained staff for IV fluid management or maintenance  Current studies suggest in some cases: artificial hydration may reduce drowsiness, somnolence and hallucination caused by dehydration and/or accumulation of medications in the body (Schmidlin, 2008).

5. Movement- the process of changing thought and behavior to a system that is more productive  Staff need to have proper training from trained professionals for IV fluid management skills.  This will take time and requires staff to feel comfortable and competent in their skills.  Benefits: Organization and staff will be better able to provide quality care to patients

6. Refreezing: establishing the change as a new habit  Staff will gradually feel more comfortable and competent  Patients and families will feel supported during a stressful time. Families will feel organization is doing everything they can to fulfill patient’s wishes within reason.  Nurse leaders will be readily accessible and available to help support staff  Nurse leaders will hold weekly meetings during change process to gather feedback from patients and staff to help address issues

7. Facilitators and Barriers to Change Facilitators  Nurse leaders will be at forefront of change  Trained professionals will teach staff new skills  Up to date supplies and equipment will be provided Barriers  Resistance of change from staff. Need to learn new skills.  Increased cost to organization: new equipment needed, new training sessions for staff, hiring of already trained staff to help facilitate the change

8. Possible Outcomes  A growing and expanding organization!  Organization will be seen as resilient and innovative in quality patient care instead of old and out dated  Organizational structures are continually evaluated and reshaped to better match the work to be done. Roles are added, modified, or eliminated to improve performance and outcomes. Each change is accompanied by anticipated but unknown outcomes (Porter-O’Grady & Malloch, 2011).

9. References  Mitchell, G. (2012). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.  Porter-O'Grady, T., & Malloch, K. (2011). Quantum leadership: Advancing innovation, transforming health care. Sudbury, MA: Jones & Bartlett Learning.  Schmidlin, E (2008). Artificial hydration: The role of the nurse in addressing patient and family needs. International Journal of Palliative Nursing, 14(10), 485-89.