Introducing a self-monitoring process in a teenage and young adult cancer ward: impact and implications for team culture and practice change

Background: The project took place in a cancer service for teenagers and young adults (13-24 years) in the UK, as part of a large service change project. Chemotherapy that had traditionally been given in an inpatient setting was to be transformed into an ambulatory care model. Aim: The authors aimed to lead a change in practice whereby patients receiving chemotherapy would be taught to monitor and test their own urine output by the staff nurses. This meant challenging a matriarchal nursing culture within the team. Learning drawn from leading the project is discussed. Methods: Various approaches were used to initiate and embed change within the ward, including producing learning tools and resources, listening to the team and providing creative opportunities for feedback. Critical reflection was used to facilitate learning about change leadership and practice development. Findings: Initial resistance to change led to the development of leadership skills and a deeper understanding of team culture. Successful change leadership requires leaders to take the time to listen to stakeholders and provide real opportunities for feedback and collaboration. Critical reflection is essential. Conclusions: The workbased learning project was effective in the simultaneous development of leadership skills and implementation of change in practice. Implications for practice: • Team culture must be understood for practice development to be successful • Making time for critical reflection is essential for successful change leadership • Nurse leaders should actively seek feedback about change from stakeholders by providing a variety of approaches to communication • Workbased learning is an effective way of developing leadership skills