TRIBHUVAN UNIVERSITY

INSTITUTE OF MEDICINE
LALITPUR NURSING CAMPUS
SANEPA, LALITPUR
Post-Basic Bachelor Nursing Program
Leadership and Management
Hospital Major Practicum
A report on change process
Definition of change:
Change means substituting one thing for another, experiencing a shift in circumstances
that cause differences, or becoming different than before. Therefore the term change can
be as any significant departure from the present status. Change as a process viewed as a
means of transition to different end or the process of moving from one state to another.
Change Agent:
A change agent is the person responsible for moving others who are affected by the
change through its stages. In planned change, in an organization, the manager is often the
change agent. The change agent could either be external or internal to the client system.
More specifically the change agent generates ideas, introduces the innovation, develops a
climate for planed change by overcoming resistant and marshalling forces for acceptance
and implements and evaluates the change.
We were posted to surgical Ward, Patan hospital for eight weeks for our Leadership and
Management Practicum for Partial Fulfillment of Post Basic Bachelor Degree of Nursing
Second Year Curriculum. At that period, we have to do one change process. So in order to
bring the positive change in the Surgical Ward, we have adapted the following steps:
1) Assessment of need for change
2) Interest and Motivation
3) Support of other for initiating change
4) Reasons for resisting change among group

5) Identification of source of power

6) Planning goals of change
7) Plan the appropriate techniques for dealing with resistance to change
8) Channels of communication
9) Implementation of change, recognizing and valuing the efforts of the group
10) Evaluation of the changed action and planning for further changes
1) Assessment of need for change:
This is the initial or first phase of change process, During this phase we assessed the
needs and problems of Surgical Ward, which were essential to change within our effort,
and could be done by using local available resources.
For the awareness of group toward need for change. We discussed needs with the Ward
Incharge and other staffs of Surgical Ward. We approached them in kind manner and
made them aware of need or problem by stating problems with solving methods or action
plan. We explained them about differences between what is happening and what should
be done or change. We discussed them about root of causes the problems. We enlisted
problems what we assessed through observation, questionnaires, data collection etc.
By taking suggestions from them, we planned to bring the following changes:
Arranging the emergency drugs, cannulas, syringes, needles, I/V fluids,
equipments in a systematic order in individual shelves of emergency trolley.
Making the metacards of NPO for pre-operative and USG patients.
Planning labels of buckets with pictures for different hospital wastage.
Labeling of toilets with pictures according to the gender.
Update the notice board regarding Self Breast Examination technique, prevention
and treatment of cancer.
Making thick paper boxes for putting plan card, rough paper, OT list & I/V sets at
nursing station room.
Putting different kinds of information for patients and visitors in each door of the
ward.

2) Interest and Motivation:

We identified interest and motivation of groups for change. We identified the forces that
may be either driving force or restraining forces. That may be resist change as well as
those forces that might facilitate change through careful observation and analysis of the
situation. We convinced staff to believe that their beliefs, attitudes, and behaviors need
modification or alternation for effective organizational development by:
Restating problems with root causes.
Briefing the problems by various view point.
Explaining our thinking towards change process.
Restating the positive outcome of change process.
While we proposed the above mentioned activities, we asked for their opinion. At that
time, they expressed the importance of systematic arrangement of drugs, equipment and
other goods in emergency trolley, as it will help them to easy to remember and take out
needed items at emergency situation. They were also happy to have thick paper boxes
in nursing station to keep the plan card, OT list, rough paper and I/V sets making
nursing station clean and tidy. They appreciate the metacards of NPO for preoperative
and USG patient as it help them to identify the NPO patient easily. They felt the
informations regarding visitor control, labeling of waste disposable bucket and toilet
doors useful. We updated the notice board by discarding the old notices and only kept
the current and important notices with pictures chart of self breast examination
technique, prevention and treatment of cancer. We also changed the old thumbpins. The
board looked attractive. So they were really motivated and interested by our change
process.
3) Support of other for initiating change:
Support is almost necessary in order to initiate and to sustain change process. So
different personnel supported us for this change process. They are as follows:
- Concerned Teacher
-Ward In charge

-Nursing Staffs of Surgical Ward

-Our Colleagues

The continuous support and commitment by governing body i.e. ward In-charge was
driving force of our change process.

4) Reasons for resisting change among group:

We identified some reasons for resisting changes mainly on putting metacards of NPO
in surgical ward are: There was change in routine works
Time consuming
Lack of proper number of staffs caused more work overload and shortage of time
5) Identification of source of power:
Our source of power for initiating formal change was ward In-charge. Her strong
encouragement and guidance made other nursing personnel of Surgical Ward became
internal source of power. Ward In charge has legitimate power for the change process. So,
we are very grateful to her.
6) Planning goals of change:
This phase is crucial phase in management. Awareness of people to change must be
translated into desire to change, readiness to change and capacity to change. We started
change process by discussing with groups what should be changed in the situation to
solve the problems.
The goal of change was especially focused on patients beneficence as well as help to
nursing staffs for effective management. The main goal of this change is to provide
comfort to staff during work.
7) Plan the appropriate techniques for dealing with resistance to change:
After identification of various resistances to change, we had planned the following
activities to overcome those resistances.
Communication with ward incharge, staffs and colleagues as well as taking

valuable suggestions from concerned teacher

Participation and Involvement of staffs to be encouraged
Inform to all friends, staffs and ward incharge
Facilitation and support
Negotiation
Manipulation and Co-operation

The above techniques significantly made us comfortable for dealing with resistance to
change process.
8) Channels of communication:
Openness of person is the crucial in effective communication not only for the change
process but also important for all managerial activities. So, we kept open channel of
communication with all level of staffs, our Concerned Teacher and Colleagues in all
phases of change process such as assessment, planning, implementation and evaluation.
9) Implementation of change, recognizing and valuing the efforts of the group:
Implementation is the action phase of change process. So, in order to implement,
recognize and valuing the effort of the group of, we have performed the followings
things:
Good rapport was built up with all level of staffs in Surgical Ward.
Valuable suggestion and opinion were gathered from ward Incharge, Concerned
Teacher, Ward Staffs, Colleagues and PCL students.
All the staffs had used it and feel comfortable with this change.
Support and co-operation was achieved from all staffs and colleagues.
We used all those measures to overcome the resistance to change as we identified in
planning phase and opened communication channel in all phases in order to implement
the change successfully
10) Evaluation of the changed action and planning for further changes:
Our goal was achieved as they agreed change process and their commitment in
implementing continuous within Leadership and Management Practicum period of 8
weeks.
Regarding plan for future changes keeping continuity of above change among nursing
staffs of surgical ward and will have revised according to needed.

TRIBHUVAN UNIVERSITY
INSTITUTE OF MEDICINE
LALITPUR NURSING CAMPUS
SANEPA, LALITPUR

Post Basic Bachelor of Nursing 2nd year

Leadership and Management Practicum
Hospital Major

REPORT OF CHANGE PROCESS

Submitted To:
Madam Khagi Maya Pun

Submitted By:
Srijana Bhomi
Merina Khadka Chhetri
Seema Adhikari
Susma Devkota
Nirmala Pant