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Nursing Change Theories

Innovation in repositioning of patients guarantees comfort and improvement in healthcare delivery. According to Institute for Health Improvement (n.d), the science of improvement using Plan-Do-Study-Act strategy aids in improving measures through observing outcomes of evidence based practices during the implementation of changes. On the other hand, Twenty-One Nursing Problems theory put together by Abdellah requires nurses to observe patient care practices within a given period of time to identify how the magnitude of the problems affects the patient. The science of improvement provides better evidence based practice than Twenty-One Nursing Problems theory.

Slide sheets refer to a two-part system that consists of a slider draw sheet and fitted slider bottom that reduces friction and centers the patient in the middle of a jersey sheet. Slide sheets ensure protection of both the patients and the nurses during performance of handling and moving tasks. Slide sheets improve patient’s care during repositioning through minimizing shear and friction when the sheets become placed under all bony prominences of the patient. However, there exist problems with the use of slide sheets connected to the gap between practice and training (Gorecki et al., 2009). Using slide sheets in repositioning may result in errors because nurses chose wrong slide sheet numbers and sizes, which leads to incorrect repositioning. It should be noted that Twenty-One Nursing Problems theory is only aimed at checking patient behaviors but not errors that occur due to nursing practices. Consequently, the fact that there are no slide sheets of one size, which fit all repositioning tasks leads to staff repositioning errors. The difficulty in implementing slide sheets evidence-based practices makes the use of the technology hard for nurses. Therefore, there exist a need to look for a more suitable patient care technology for repositioning patients.

The science of improvement led to the development of Versal slides, which is an improved version of slide sheets. Versal slide reduces repositioning errors that result from the use of slide sheets, aids in complying to evidence-based practice and simplifies repositioning tasks handled by the nurses. Moreover, Versal slide uses a single slide sheet and guarantees simplified and improved repositioning regardless of the task complexity. Versal slide facilitates lateral turning and transfers while its bed-sized corners have splits that ensure freedom of movement. Compared to simple slide sheets, Versal slide minimizes delays in processing tasks, reduces embarrassments the patients may experience due to the need of a second slide sheet and guarantees more comfortable repositioning processes due to better handling experience. Moreover, with Versal slide, nurses do not need to make decisions regarding slide sheet sizes or numbers for every task, thereby, saving time and ensuring no confusion. Additionally, slide sheets reduce the gap between training and real practice because nurses require only one procedure to master for all repositioning tasks.

However, despite the fact that Versal slide is an innovative product compared to regular slide sheets, my mentor prefers using repositioning sheets. The science of improvement led to the innovation of repositioning sheets. As a result, they result in better evidence-based practices in comparison with slider repositioning, as they guarantee better quality patient care, especially in regard to skin integrity. According to Gorecki, et.al. (2009), slider prepositioning worsens the quality of skin due to prolonged exposure to acidic excretion, moisture and urine (p. 1175). Additionally, Hopper and Morgan (2014) state that old patients with skin sensitive to pressure or sores experience more pain when they slide (p.179). Heavy old patients need mechanical lifting on sliders that cause discomfort. Moreover, using one slider sheet for more than one patient may cause transmission of infections, which increases patients morbidity, treatment time and hospital stay (Nelson, Collins, Siddharthan, Matz & Waters, 2008). According to Moore, Conroy and Cowman (2011), moving repositioning sheets with patients reduce skin shear, lower friction, reduce the time needed to reposition overweight patients and chances of infection transfer in case one slide is used more than once (p. 2633). Therefore, repositioning sheets offer better evidence-based practice than slider sheets.

 

Both slider repositioning and repositioning with sheets serve to reduce friction and pain during patient repositioning. However, repositioning with sheets guarantees skin integrity and prevents shear in addition to reducing time required to reposition overweight patients. While comparing slider repositioning and repositioning with sheets, the latter provide better evidence based practice that should be adopted in moving immobile older patients. The use of repositioning with sheets ensures that nursing activities align with the Manual Handling Operation Regulations that demand that nurses pose minimal identified risk to patients. Repositioning with sheets provide improved innovation version of both Versal slide and regular slide sheets. Therefore, Science Improvement theory should be implemented in nursing practice to work with immobile old patients rather than Twenty-One Nursing Problems theory.

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