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IMPLEMENTING A CHANGE IN PARACTICE The principle of change theory are beyond the scope of this chapter, but factors

to be considered include communication, involvement and commitment. staff development and continued monitoring of the process. The process communication about the proposed researchbased change in practice requires thoughtful planning with nursing administrator, staff educator, and staff nurse. Just as the involvement of nurse at all levels enhances the testing of findings describe above, it is essential for an effective change process. The first step may to be help administrator understand the rationale for the change without feeling inadequate in their knowledge of research. A face-to-face e planation with the opportunity to have questions answered is likely to gain the stronger support. !or e planations to staff nurses, a nurse who was involved in the evaluation trial may be the best person to e plain the problem and the purpose change. A researcher clinician with research preparation may be helpful to e plain the research base. "any change involve or affect other health care workers, as well as nurse, and e planations need to be appropriately delivered to these groups. #rofesional with a knowledge of research will appreciate the reports of the original research. The strength of the research will have a significant effects on the willingness to support a change. The same factors as those that must be considered in e amining clinical merit and designing a trial to test findings, such as comple ity of the innovation, measurability of result, cost, and the political reality of the institution, relate to the likelihood of adoption of change in practice. innovations with tangible benefits and low costs of effort are likely to be the most readily adopted, but many worthwhile innovations require considerable work to learn and adopt the practice. $esistance to change is a common phenomenon that may be overcome when nurse perceive the problems as relevant to their practice, have an increased understanding of benefits, and belive they are being supported. Time and an opportunity to learn a new approach are needed . %nterference with change may result if nurse are e pected to make a change for which they are not adequately prepared. A program of gradual or phases change may be most effective.

&nce a change has been implemented the innovation and its outcomes need ongoing monitoring. This may be incorporated into an e isting quality improvement program, or it may be specifically planned in the change process. An innovation that was appropriate at one time or with one groups of client may not be useful in different circumstances.