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  1. Elopement in a skill nursing nursing




    Discuss what is meant by Elopement in a skill nursing nursing  



Subject Nursing Pages 5 Style APA


Theoretical Framework for Implementation of Elopement Prevention in a Skill Nursing Facility

Nursing homes have been facing a persistent problem when it comes to elopement since a majority of their residents are demented, so they tend to engage in dangerous activities if not monitored closely. As highlighted in the preceding assignment, the solution to this problem lies in the establishment of effective patient monitoring systems and security measures. Such a realization led to the belief that wander alarm bracelets and coded electric doors would be instrumental in mitigating these incidences in the skill nursing facility. For such an intervention to demonstrate efficacy, it must be implemented systematically. Theoretical frameworks such as Plan-Do-Study-Act (PDSA), Kotter’s 8-Step Model, and Lewin’s 3-Stages of Change are instrumental in facilitating success throughout the process (Cameron & Green, 2018). The present paper provides in-depth discussion on how these models can be applied in the implementation of the highlighted intervention (employment of wander alarm bracelets and coded electric doors).



            PDSA is a four-stage framework that is commonly used by problem-solvers to implement change. These phases include planning (P), doing (implementing) (D), studying (evaluation) (S), and acting (improvisation) (A). When applying this strategy, it is important to consider three fundamental drivers including the end-goal, anticipated change, and actions needed to facilitate the transformation. The first stage is planning, and it necessitates a plethora of activities including recruiting a team, developing an aim statement, describing the process, describing the problem, and identifying solutions and alternatives (Morelli, 2016). It appears wise to point out the facts that this is the most comprehensive phase which in line with the three strategies mentioned earlier. Once a clear blueprint is designed for the implementation, the team can proceed to the implementation phase. At this point, the team should be vigilant in the documentation of problems and outcomes based on observation (Morelli, 2016). Each milestone should be scrutinized carefully to ensure that the intervention offers a sustainable solution. Some of the issues to consider include outcomes vs. expectations, trends, and side effects (Morelli, 2016). Analytical findings developed from this observation should guide the organization in case of needed improvements: noteworthy is the fact that the final stage involves reflection, and strategic improvisation.

Application in the Proposed Intervention


As far as the proposed intervention is concerned, the change agent (nurse leader) will recruit a team of technology experts to collaborate with the organization’s nursing team in ensuring that all residents are logged into the system. This process is highly likely to demand some training for nurses to learn basic technical skills to manage the system as soon as the technology experts are dismissed. The leadership will then share the plan, during brainstorming sessions, to bring all relevant stakeholders (mainly the practitioners) on board for the sake of commitment and seamlessness.


The technology team will install a software in the hospitals information system, then distribute logged wearables to the patients, who will then become traceable through a graphical user interface. Four electric doors will replace the old manual ones to ensure that only people with a passcode can open them. Also, the system will be alerting the nurse on duty whether the door is tampered with, or when a resident is close to it. Such a proactive approach will allow the team to keep tabs on risky movements. As long as the plan is detailed and clear, this implementation phase will be seamless.


            It suffices to argue that the implementation phase should be segmented to ensure that each milestone is measured separately to guide further steps. The process will be divided into three sub-phases including software installation and training, resident registration, and electric door installation. The outcomes of these stages will be measured at this point: emphasis shall be placed on the results vs. the anticipated outcomes.


            This stage will capitalize on the findings recorded after evaluation (the preceding phase). Any failures or need for improvement will be resolved through the formulation, and implementation of a new plan.

Kotter’s 8-Step Model


            Kotter’s change management theory is among the most popular models in the world, and it is grounded on the idea that change is often implemented in eight phases. According to the theorist, the first stage involves creating an urgency. The change agent executes this phase by identifying and highlighting inevitable inefficiencies bound to plague the organization if change is not implemented (Galli, 2018). With this knowledge, the change agent proceeds to the second stage which mandates the formation of coalitions with guiding teams (key stakeholders). Once the team understands the stakes, they collaborate in fine tuning the change agent’s vision to the organizational purpose (Galli, 2018). This vision is then conveyed to other team members who will partake in the execution. Kotter believes that the best move is empowerment, so that the team players can enact the vision (Galli, 2018). This phase usually necessitates the provision of essential resources and rewards. The sixth stage is usually implemented through the generation of short-term wins to foster improvements and maintain high motivation levels. The penultimate phase calls for the consolidation of goals (based on observation) to accelerate sustainable change (Galli, 2018). Once the transformation is deemed sustainable, it is then anchored in the organizational system and culture.

Application in the Proposed Intervention

Creating an Urgency

            Like the PDSA concept, Kotter’s 8-step technique can also be applied to promote success in the proposed initiative. The nurse leader will first create an urgency by researching and highlighting the obvious threat elopement poses on the runaway resident’s lives as well as the institution’s reputation.

Building Coalitions

Such a clear outlook will allow the change agent to form alliances with other organizational leaders in the finance, technology, and nursing departments. These stakeholders are instrumental in the success of the intervention since they have the authority to implement such initiatives.

Developing and Inspiring Vision

            Of course, the change agent often has a vision from the word go; however, the highlighted stakeholders must have a role in fine-tuning, or at least, affirming the vision so that it is in line with the organization’s values, vision, and mission. This vision will focus on explaining how the wearable monitoring bracelets and the coded electric doors will promote resident safety and the organization’s prestige.

Conveying the New Vision

            Once the key stakeholders are confident in the vision, they will then share it with other team members including nurses, technology experts, and other vested parties including patients’ families.

Empowering the Team to Implement the Vision

            Empowerment is a crucial ingredient in any change process, since people tend to resist the same. For this reason, the leadership will ensure that all the necessary financial, human, and technological resources are available to safeguard the project. It would also be fair to offer rewards for top performers during the process.

Short Term Wins

            Short term-wins can only be attained through the division of the project into goals. As highlighted in the PDSA model, process will be divided into three sub-phases including software installation and training, resident registration, and electric door installation. These goals will give the team an opportunity to experience short-term wins.

Sustaining Acceleration

            This phase is usually important since it marks the point where the team reflects on outcomes and develops further plans to accelerate the change process. As far as the proposed intervention is concerned, the leaders will evaluate data recorded during the previous stage to determine the types of improvements needed.

Instituting Change

            If the outcomes of process will be satisfactory, the intervention will then transition to this phase. This point will be marked by the integration of the new developments into day-to-day organizational activities and rules.

Kurt Lewin’s 3-Step Change Model


            Unlike Kotter’s multi-thronged strategy, this one defines the change process as a simple three phase activity which involves unfreezing, changing, and refreezing normative practice. The first step involves challenging the status quo (Hussain, et al., 2018). Here, the change agent is expected to prove why the current practices are detrimental to the organization. The tension created at this point inspires the entire organization to implement the change (Doppelet, 2017). Lewin urges leaders to maintain keen observation and analysis during this stage since it determines whether the organization will move forward or backwards. Once the change is implemented, it is established as the new status quo (Hussain, et al., 2018).



            As highlighted in the previous techniques, the first stage will involve exploring and exposing the current errors facing the facility with regards to elopement. The team will be taken through insightful brainstorming sessions to convince them that the current state is not beneficial for the residents, and the organization at large. When the majority are convinced that change is necessary, the leaders will then share the desired vision and purpose (Hussain, et al., 2018).


            This implementation phase will rely on effective observation and analysis skills; therefore, the process will be divided into three parts including software installation and training, resident registration, and electric door installation respectively. Each phase will be closely monitored and analyzed before proceeding to the next phase.



            Once the change is made, the organization’s leadership will convene meetings whereby new rules shall be formulate to ensure that this intervention is normalized as a sustainable organizational practice. The clinical practitioners will have to learn how to manage the systems without overreliance on contract-based technology experts.


            Clearly, implementing change is a process that demands systematic thinking and acting. A thorough exploration of the PDSA, 8-Step, and 3-Stage models of problem-solving has showed the usefulness of each of them. As a matter of fact, they all tend to apply a somehow standard approach: emphasis on challenging the system, planning an intervention, implementing the change, and evaluating the outcomes. One of these techniques can be utilized in the intervention proposed earlier.



Cameron, E., & Green, M. (2019). Making sense of change management: A complete guide to the models, tools and techniques of organizational change. NY, USA: Kogan Page Publishers. Retrieved from http://www.uop.edu.pk/ocontents/Change%20Management%20Book.pdf

Doppelt, B. (2017). Leading change toward sustainability: A change-management guide for business, government and civil society. London, UK: Routledge. Retrieved from https://books.google.com/books/about/Leading_Change_Toward_Sustainability.html?id=2bHjQwAACAAJ

Galli, B. J. (2018). Change management models: A comparative analysis and concerns. IEEE Engineering Management Review, 46(3), 124-132. Retrieved from https://ieeexplore.ieee.org/abstract/document/8486843/

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. Retrieved from https://www.sciencedirect.com/science/article/pii/S2444569X16300087

Morelli, M. S. (2016). Using the plan, do, study, act model to implement a quality improvement program in your practice. American Journal of Gastroenterology, 111(9), 1220-1222. Retrieved from https://journals.lww.com/ajg/Fulltext/2016/09000/Using_the_Plan,_Do,_Study,_Act_Model_to_Implement.2.aspx


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