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Chapter 6 Phase Two
important element in implementing change is a smooth transition from an old
system to a new one. Adequate time and planning need to be allocated for this
transition period, especially for identifying key people to help implement change,
and for identifying possible areas of conflict (Coghlan and McAuliffe, 2003).
We then drafted the care plan templates and when we were all in agreement with
their content, the templates were printed into a complete care plan (Appendix
24). The five main domains from the New Zealand guidelines were used as the
main care plan templates and were to be used alongside assessment tools e.g.
falls risk assessment informed the “safety” domain (Table 6.3).
Table 6.3: Assessment tools which informed the care planning
Assessment Tool Domain of Care
Waterlow pressure ulcer risk
assessment
Personal care and Safety
Falls risk (FRASE) Safety
Mini nutritional assessment (MNA) Food
Barthel dependency Personal care
Continence assessment Personal care
Activities/Interests past, present,
future
Social participation
It was decided to phase the new care plan in ward by ward (each ward had
between 5 and 6 residents each). Each nurse was paired with a health care
assistant so that they too could be part of the care planning process. This phased
introduction enabled all staff and residents to be part of the care plan
development and to identify strengths and/or weaknesses in the design at an early
stage. Following introduction of the care plan in the first ward we decided to
distribute a simple questionnaire (Appendix 24) the purpose of this questionnaire
was to solicit the views of the new approach to care planning from all co-
researchers. This questionnaire was returned anonymously. Seventy per-cent of
the co-researchers agreed that they wanted to continue with the new care
planning approach and thus we commenced a second action cycle and extended
the introduction of the care plans to the rest of the site. While there was full buy-
in and support from the staff to implement this change, there were many barriers