Read a finished NUR 400 Module 3 Milestone Two applying transformational leadership and Lewin's change model to a device-related pressure injury initiative in an ICU, with stage-by-stage actions, resistance analysis and references. Searches like "nur 400 module 3 assignment", "nur400 module 3 milestone two" and "nur 400 module 3 example" land here.
The NUR 400 Module 3 example, in full
Milestone Two: Leading Change to Prevent Medical Device-Related Pressure Injuries in a Medical Intensive Care Unit
[Student Name]
Southern New Hampshire University
NUR 400: Systems Leadership for Continuous Quality
Final Project Milestone Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone Two: Leading Change to Prevent Medical Device-Related Pressure Injuries in a Medical Intensive Care Unit
The Problem and Initiative in Brief
Milestone One described a rise in pressure injuries caused by medical devices on a composite 16-bed medical intensive care unit. Over the previous six months, 9 of the unit's 21 hospital-acquired pressure injuries were related to devices, most often endotracheal tube holders, oxygen tubing over the ears, noninvasive ventilation masks on the bridge of the nose and nasogastric tubes against the nostril. These injuries are common across hospitals. In a study of hospitalized patients, those with medical devices were more likely to develop pressure injuries, and device-related injuries made up about a third of hospital-acquired pressure injuries (Black et al., 2010), and a large international prevalence survey found that such injuries occur across care settings and are often associated with respiratory devices (Kayser et al., 2018).
The proposed initiative is a device bundle: protective foam dressings under high-risk devices, repositioning or checking under each device at least every four hours, documentation of skin under devices in a dedicated flowsheet row, and weekly device skin rounds by two nurses. This milestone explains the leadership approach and change model that will guide the initiative.
Why Transformational Leadership
Transformational leadership describes leaders who inspire followers to go beyond self-interest for a shared goal, and its four commonly named elements are a leader whose conduct others want to copy, a vision that motivates, encouragement to think problems through, and attention to each person's needs (Bass & Riggio, 2006). In the literature these are called idealized influence, individualized consideration, intellectual stimulation and inspirational motivation. This style fits the device bundle for a specific reason. Preventing device-related injuries depends on thousands of small checks made by individual nurses at the bedside, often at night and without anyone watching, so compliance cannot be secured by rules and audits alone; it depends on nurses caring about the outcome.
Each element translates into leader behavior. Idealized influence means the nurse manager and unit educator model the practice themselves, lifting a mask to check the nose during rounds rather than asking others to do it. Inspirational motivation means connecting the bundle to patients the staff remember, such as a young man left with a scar on his nose after weeks on noninvasive ventilation. Intellectual stimulation means inviting staff to solve problems, for example how to check under an endotracheal tube holder without risking dislodgement. Individualized consideration means coaching nurses who find the checks hard to fit into heavy assignments rather than simply citing them for missed documentation.
A transactional approach, rewarding compliance and correcting lapses, still has a role in audits and feedback. Used alone, however, it tends to produce documentation of checks rather than the checks themselves, which would not solve this problem.
Applying Lewin's Change Model
Lewin described change as a process of unfreezing existing patterns, moving to new ones and refreezing them so that they last (Lewin, 1947). The model suits a unit-level practice change because it emphasizes preparing people before asking them to act differently and securing the change afterward.
Unfreezing. The first stage is building a sense that change is needed. The manager will share the unit's device injury data at staff meetings, with photographs of injuries used with permission and without identifying details, and compare the unit's results with others in the hospital. Staff will be invited to identify which devices cause the most trouble. Nurses who express concern will be recruited as unit champions.
Changing. The second stage introduces the bundle. Champions will help select foam dressings and test the new flowsheet row for one month on half of the unit before full rollout. Education will take place at the bedside, in short sessions during each shift, using real devices. Respiratory therapists, who manage many of the devices, will be trained with nurses so that both groups share responsibility for checking under masks and tubes.
Refreezing. The final stage makes the change part of normal work. The device skin check will be built into the electronic flowsheet so that it appears with every four-hour assessment. Weekly device skin rounds and monthly posting of results will continue after the project ends, and new nurses will learn the bundle during orientation. Champions will be recognized at unit meetings.
Anticipating Resistance
Resistance is likely from three directions. Some nurses will see the bundle as more documentation on an already heavy workload; the leader can respond by removing an older, redundant skin documentation field so that the net burden does not grow. Some staff may fear that lifting devices will cause harm, such as dislodging an endotracheal tube; the educator can address this with hands-on practice and a clear two-person technique. Physicians and respiratory therapists may assume that device injuries are unavoidable in critically ill patients; sharing data showing that most injuries appeared on stable patients, and inviting them to device skin rounds, can shift that view. Treating resistance as information about barriers, rather than as defiance, is itself part of transformational leadership.
Measuring Whether the Change Is Taking Hold
Lewin's model also implies that a leader must know when each stage is complete. Readiness for change will be gauged before rollout by a short staff survey asking whether nurses believe device injuries are preventable and whether they know how to check under each device; the manager will not begin the changing stage until most respondents agree the problem is worth solving. During the changing stage, weekly device skin rounds will measure the share of devices with a protective dressing and a documented check in the previous four hours. Refreezing will be judged complete when those process measures stay above 90 percent for three consecutive months without special reminders, and when the number of device-related injuries falls from the baseline of nine in six months. Sharing these results openly keeps the unit engaged and gives the leader evidence to sustain resources after the project period ends.
Conclusion
Preventing device-related pressure injuries depends on consistent bedside vigilance that no policy can guarantee alone. Transformational leadership provides the motivation, modeling and support that such vigilance requires, while Lewin's model provides a clear sequence: build awareness with local data, introduce the bundle with staff involvement, and make it permanent through the electronic record, rounds and orientation. Milestone Three will turn this approach into a detailed plan with a timeline, resources and responsibilities.
References
Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Lawrence Erlbaum Associates.
Black, J. M., Cuddigan, J. E., Walko, M. A., Didier, L. A., Lander, M. J., & Kelpe, M. R. (2010). Medical device related pressure ulcers in hospitalized patients. International Wound Journal, 7(5), 358-365. https://doi.org/10.1111/j.1742-481X.2010.00699.x
Kayser, S. A., VanGilder, C. A., Ayello, E. A., & Lachenbruch, C. (2018). Prevalence and analysis of medical device-related pressure injuries: Results from the International Pressure Ulcer Prevalence Survey. Advances in Skin & Wound Care, 31(6), 276-285. https://doi.org/10.1097/01.ASW.0000532475.11971.aa
Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103
How this NUR 400 Module 3 example is structured
The milestone connects theory to a specific initiative, so every theoretical section ends with what the leader will actually do. It starts with a short recap of the problem and the initiative from Milestone One. The leadership section describes the four elements of transformational leadership and explains why this style fits a problem that depends on bedside vigilance rather than a single policy. Lewin's model is then applied in three stages, unfreezing, changing and refreezing, each with concrete actions. A section on resistance identifies likely sources and responses, and the conclusion shows how the chosen theories shape the planning in Milestone Three.
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Send the NUR 400 Milestone Two guidelines and rubric and your Milestone One initiative. A leadership and change theory section written for your initiative arrives in 24 to 48 hours; the first sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
NUR 400 Module 3 questions, answered
What does NUR 400 Module 3 Milestone Two usually cover?
The second milestone of the NUR 400 project generally examines leadership styles and a change theory or model that would guide the quality initiative proposed in Milestone One. Students are asked to justify the choices and show how they would be applied. Your guidelines list the exact elements.
Which change theory works best for a nursing quality project?
Lewin's three-stage model is common because it is simple and fits unit-level change, but Kotter's eight steps, Rogers's diffusion of innovations and the Plan-Do-Study-Act cycle are also used. Choose the one that matches your initiative, and explain how each stage becomes a specific action rather than describing the theory in general.
Should I discuss more than one leadership style?
It often helps to compare briefly, for example why transformational leadership suits a practice change better than a purely transactional approach. The key is to justify the style you choose using the features of your initiative and your unit, and to show what the leader will do differently because of it.