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Running head: ASPIRATION PNEUMONIA 1
ASPIRATION PNEUMONIA 2
Organizational Change on How to Tackle Aspiration Pneumonia
Description of the Problem
Aspiration pneumonia refers to the infection of the lower respiratory tract that is caused
by the entry of secretions from the oropharynx or stomach contents into the lungs. In many cases
among the healthy adults, the normal defense mechanisms such as lung cilia and cough facilitate
the removal of the aspirated materials and, as a result, there are no ill effects. According to
Johnson & Hirsch (2003), patients or the elderly are often at a high risk of developing
pneumonia as a result of aspiration. Aspiration pneumonia complicates the process of treatment
for elderly patients. For instance, cancer patients often face the risk of aspiration pneumonia due
to the various cancer treatments and the disease’s progress (Guy & Smith, 2009). The condition
raises a lot of concern because it is a significant cause of mortality among patients from the
infections got from a hospital setting. The ailment has a 21-44 percent per 1000 incidence rate
for older adults (Janssens & Krause, 2004). Moreover, Janssens & Krause (2004) states that this
rate is four times that of younger people. Thus, it calls for more focus on the issue so as to curb
the deaths and complications that result from it such as bronchiectasis or lung abscess, and acute
respiratory distress. Therefore, it is vital and significant for the hospital to ensure patient safety
through the adoption of modern safety measures and relevant evidence based treatments for
aspiration pneumonia (DiBardino & Wunderink, 2015).
The hospital’s purpose is to ensure that the elderly and ill patients do not have
complications as a result of aspiration pneumonia. This will be achieved via the adoption of
preventive strategies, and specific treatment routines. Further, the hospital’s culture is based on
the tenet of good health care delivery to its patients or community. Thus, changing the clinical
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care processes by the use of modern and relevant strategies to manage aspiration pneumonia is in
line with the organization’s culture. To change these clinical care processes, the various
participants who make up the organizational structure have to be on board (hospital management,
health care professionals such as nurses, patients and their families). It is vital for the hospital’s
chief executive officer to agree to the change since he exerts control over the hospital staff. Also,
an informal leader such as a nurse who is knowledgeable about aspiration pneumonia will be
identified. A more knowledgeable health care provider will be viewed as being credible by other
health care providers. This will motivate the nurses in the hospital to easily agree to the clinical
The Risk Factors of Aspiration Pneumonia
Aspiration usually occurs as a result of impaired consciousness, reflux esophagitis, in
bulbar palsy if trachea-esophageal fistula (TOF) is absent. The risk factors include alteration of
the level of consciousness due to general anesthesia, seizures, sedation, drug or alcohol abuse,
head injury and acute stroke. They also include reduced mobility, increasing age, nil per oral
measures, male gender, Chronic Obstructive Pulmonary disease, and the increase in the number
of medications. Swallowing disorders such as dysphagia, esophageal stricture, neuromuscular
disorders, and pharyngeal disease also pose a risk. The others are nasogastric feeding tube,
ventilator-associated pneumonia, tracheostomy, post-gastrectomy, and gastro-esophageal-reflux
(Johnson & Hirsch, 2003).
Driving and restraining forces
The adoption of the clinical process change will encounter driving and restraining forces.
However, the manager and the informal nurse leader will provide information that will try to
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unfreeze the system via a reduction in restraining forces rather than increasing the driving forces
(Dawson, 2003). Some of the driving forces for the organizational change are; the new way is
more efficient. The adoption of evidence based and modern procedures for managing aspiration
pneumonia are more efficient than the traditional approaches used by the organization. This is
vital since the new procedures will reduce complications arising from the ailment. Also, the
hospital manager supports the new change. Support from management implies that the change is
acceptable. It’s also a go ahead sign from management. Managers in any organization determine
the changes that have to take place in the organization. Thus, support from management will
ensure that the change is implemented. Further, the adoption of the new change is not costly to
the organization. The organization will need little financial costs to implement the change. A
knowledgeable nurse in aspiration pneumonia will help other nurses comprehend the new
techniques and processes involved. An inexpensive undertaking is a driving force since it
improves the acceptability of the change by management. A hospital might lack the resources or
funds needed to support the change leading to its failure. On the other hand, there are restraining
forces to the change. First, the new change requires nurse training. Nurses will have to be trained
about the new processes and changes in how to manage aspiration pneumonia. Also, the new
change is time consuming since nurses will have to attend numerous training forums. Due to the
limited number of nurses in the hospital, the training will imply that some nurses who will not be
required to attend the training will be overburdened with work during the training period.
Goals and outcomes
The change process has three objectives or goals;
1. Better management of aspiration pneumonia
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2. All nurses to be educated about the new methods of managing aspiration pneumonia
3. The change process should be completed in a time frame of one month.
Process of Implementation of the Change
Change implementation in an organization often requires tools and interventions which
are specific to the problem and the required outcome. The organizational development theory
will guide the change process in the hospital. The theory states that for an organizational to
change successfully, the staff must accept the organizational goals or the goals for the change
(Rhydderch et al., 2004). Also, Lewin’s three step change model will be adopted. The model
specifies three steps which have to be followed during the change process; unfreezing, moving,
and refreezing (Kaminski, 2011). Unfreezing deals with discouraging and stopping old routines
or behaviours and habits while moving depicts the transition time. New behaviours and
procedures are adopted in this step (moving step). Refreezing on the other hand signifies the
establishment of the new procedures and routines or behaviours. A democratic type of leadership
will be adopted during the change process so as to inspire the hospital staff.
1. Communication from management about the proposed changes to the nurses. The
hospital manager will communicate to the nurses the need for change during the project’s
2. Selection of the informal nurse leader. The nurse who will lead the exercise will be
selected in the second week of the project
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3. Nurses undergo training (freezing, moving). Nurses will be educated about the efficiency
of the new approaches compared to the old approaches. They will also be trained on how
to perform the processes in a clinical setting. The training will take a week.
4. Nurses implement the new processes to practice (refreezing). After training, the nurses
will be required to implement the changes to their areas of practice after training.
During the change, nurses will be evaluated by the informal nurse leader and an outside
health professional if they have grasped the processes. After the change, the impact of the new
clinical changes will be evaluated to determine if the change had any significant impact on
managing aspiration pneumonia. Some of the elements that will be evaluated six months after the
change include: Do the nurses use the new methods in managing pneumonia? And how have the
new changes impacted patient outcomes?
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Dawson, P. (2003). Understanding organizational change: The contemporary experience of
people at work. Sage.
DiBardino, D. M., & Wunderink, R. G. (2015). Aspiration pneumonia: A review of modern
trends. Journal of critical care, 30(1), 40-48.
Guy, J. L., & Smith, L. H. (2009). Preventing aspiration: a common and dangerous problem for
patients with cancer. Clinical journal of oncology nursing, 13(1), 105.
Janssens, J. P., & Krause, K. H. (2004). Pneumonia in the very old. The Lancet infectious
diseases, 4(2), 112-124.
Johnson, J. L., & Hirsch, C. S. (2003). Aspiration Pneumonia: Recognizing and Managing a
Potentially Growing Disorder. Postgrad Med., 92-112.
Kaminski, J. (2011). Theory applied to informatics-Lewin’s change theory. Canadian Journal of
Rhydderch, M., Elwyn, G., Marshall, M., & Grol, R. P. T. M. (2004). Organisational change
theory and the use of indicators in general practice. Quality and safety in health Care,