Running head: VOA PROJECT 1

VOA Project: Improving Clients Quality of Life

Amber Blankenship RN, Joem Evangelista RN, & Heather Somers RN

Western Washington University

Nurs 422: Organizational Readiness for Change

Bonnie Blachly MN, RN

05/29/2017
VOA PROJECT 2

VOA Project: Improving Clients Quality of Life

Volunteers of America (VOA) is a non-profit organization that serves vulnerable

individuals and families. One specific program the VOA operates helps individuals who have

experienced a traumatic brain injury (TBI) before the age of 18. The VOA is serving three

individuals living in one home suffering from TBIs. These clients are unable to care for

themselves because of their impaired cognitive and physical abilities.

A thorough assessment was completed of the home and community, which included

interviews of the staff and clients. After this initial assessment, concerns for safety and lack of

activity were identified. Clients expressed boredom and feelings of imprisonment. The backyard

was not wheelchair accessible, poorly built, and was unsafe for clients. To be specific, the back

yard had stairs, loose hand railings, and an uneven/unmaintained lawn. Two out of three of the

clients are wheelchair bound, and the third client has a very unsteady gait, making it unsafe for

them to access the backyard. Unfortunately, safety is a huge concern for clients with TBIs.

Environmental factors, such as loose railings, are a substantial contributing factor to many falls

in the home (Northridge, Nevitt, Kelsey, & Link 1995).

Building a new deck for the clients would foster opportunity for increased stimulation

through social and purposeful activities such as gardening (Soga, Gaston, & Yamaura 2017).

The clients would also then have enhanced opportunity to build relationships with housemates

and caretakers, thus gaining a sense of community within their own home. There is strong

evidence to support the psychological benefits of exposure to natural environments such as green

space and gardening (Lee & Maheswaran 2011). Strong evidence is identified relating nature

exposure to decreased levels of anxiety, stress, improved concentration, memory and mood
VOA PROJECT 3
(Bratman, Hamilton, & Daily 2012). Potential long-term outcomes are that the TBI clients will

gain a sense of partnership and accomplishment through common tasks, leading to self-efficacy

and decreased behavioral disturbances. According to Reavenall and Blake (2010), active

participants were more independent in activities of daily living, had greater self-efficacy for

exercise and were more educated than inactive participants (p. 360).

In order for a new deck to be built, the VOA needs to acquire funding through a federal or

state grants. The first step of this feat is to provide evidence that the funding would be used in a

way to increase the safety of the clients, as well as improve their quality of life. The VOA

requires research to support that renovating the backyard would increase the quality of life for

the clients.

Change Theory and Planning Phase

The best change theory for this project would be that of the seven phases in Lippitts

model. The Lippitt theory is similar to the nursing process where steps are broken down to

independent, adaptive stages. In this project, the needs of the clients have been assessed, key

stakeholders were identified as the senior director of Personal Support Services, the three clients

and their caregivers. The different perspectives and motivations of the key stakeholders have

been discussed and possible resources have been identified (phase 3 of 7). Once these factors are

established, the planning phase of the nursing process is next, which corresponds to Lippitts

phase 4 and 5. In this phase, the how to of the project is developed. This phase involves the

actual building of the new deck and landscaping of the yard once funds have been acquired. The

Lippitt theory of change can be compared with the Logic Model, where the input is similar to the

beginning stages of the Lippitts model and where the activity of the Logic Model is similar to

the how to phase of the Lippitts model.

VOA PROJECT 4
An analysis for the project using the Plan-Do-Check-Act (PDCA) model was done. The

project is currently in the planning stage of this cycle. In this stage, research is done and funding

is acquired to put the renovations into action. During the next phase of the cycle, the Do stage,

the senior director will find contractors to build the new deck and renovate the yard. From there,

the best way to decipher whether or not the yard has improved the clients quality of life is to re-

interview the clients and possibly check charting. The caregivers charting would show if there

were an increase or decrease in behavioral disturbances among the clients since the access to the

yard was improved. If the clients seem to have more behavioral disturbances, then in the next

phase, Act, the cycle would start over to assess for a new way to decrease the clients boredom.

If the project is successful, the Act phase would then look like new training for the caregivers,

to educate them on the importance of activity and stimulation for the clients, and to encourage

outdoor time.

Organizational Readiness for Change

The senior director of Personal Support Services, has been the main contact for this

project. With close communication, it appears that the VOA is more likely to adopt the project.

The senior director was already working on a proposal to help fund a backyard renovation and

the research provided to the VOA will help support the grant proposal.

That being said, Lewins Force Field Analysis can be used to determine the possible

challenges to implementing the change in the backyard. The main restraining force identified

was financial: will the grant proposal be approved? Will the amount of money the project is

approved for cover all of the expenses for the project? Will there be contractors available to do

the project with the budget allotted? Other restraining forces included the possible attitudes of

staff and the clients. There is no way to predict if the clients will enjoy the new yard once it is
VOA PROJECT 5
finished. The final restraining force was the possible lack of resources for the upkeep of the

lawn. When the backyard is finished, there will need to be some sort of service to provide lawn

maintenance long-term. The clients dont have extra money for these types of services, so some

sort of charitable resource would need to be identified.

Lewins Force Field Analysis was also used to identify possible enabling forces. These

were identified as the senior directors motivation to complete the project as well as the

probability of increasing the clients overall quality of life. One large assessment finding in the

home was that the clients do not have much activity during the day and feel bored much of the

time. They also do not engage in many healthy hobbies throughout their week. Access to their

backyard could increase their healthy activity levels and decrease their boredom. Another

enabling force would be the increase in safe spaces within their property, and the fact that

reconstructing the deck would make the backyard less of a fall hazard. As it stands, the loose

railing on the deck and lack of wheelchair access increases the potential for falls, as well as the

lawn itself is uneven which also creates a risk.

Recommendations
Strong evidence supports the use of garden spaces for both mental and physical health

benefits. These elements support our recommendation to provide safe, wheelchair access to the

backyard by reconstructing the deck, providing a ramp, repairing the railings, and leveling the

yard. Encouraging use of garden and greenspace will provide stimulation and increase clients

daily activity. Once grant money has been secured, deck is reconstructed and yard landscaped,

education should be provided to caretakers to help in the promotion of daily activities for TBI

clients; as well, caretakers should be on the lookout for other safety concerns to help preserve the

safety of the environment.

VOA PROJECT 6

Conclusion
Many cultures use a holistic approach in healthcare treatments, using nature as a

therapeutic intervention. Strong evidence has been presented to support the claim that if safe

access to quality greenspace in the back court-yard is obtained, TBI clients will have improved

life satisfaction and a decrease in behavioral disturbances will be demonstrated. Providing

outdoor space will increase the likelihood of activity, providing stimulation, exercise and social

interactions.
VOA PROJECT 7
References

Bratman, G. N., Hamilton, J. P., & Daily, G. C. (2012). The impacts of nature experience on

human cognitive function and mental health. Annals of the New York Academy of

Sciences, 1249(1), 118136. https://doi.org/10.1111/j.1749-6632.2011.06400.x

Lee, A. C. K., & Maheswaran, R. (2011). The health benefits of urban green spaces: A review of

the evidence. Journal of Public Health, 33(2), 212222.

https://doi.org/10.1093/pubmed/fdq068

Northridge, M. E., Nevitt, M. C., Kelsey, J. L., & Link, B. (1995). Home hazards and falls in the

elderly: The role of health and functional status. American Journal of Public Health,

85(4), 509-515. doi:10.2105/ajph.85.4.509

Reavenall, S., & Blake, H. (2010). Determinants of physical activity participation following

traumatic brain injury...including commentary by Katz-Leurer M and Hassett L.

International Journal Of Therapy & Rehabilitation, 17(7), 360-369.

Soga, M., Gaston, K. J., & Yamaura, Y. (2017). Gardening is beneficial for health: A

meta-analysis. Preventive Medicine Reports, 5, 9299.

https://doi.org/10.1016/j.pmedr.2016.11.007
VOA PROJECT 8

Appendix A

Logic Model

INPUTS ACTIVITY OUTPUTS SHORT MEDIUM LONG

In order to In order to We expect We expect then 4-6 We expect
accomplish address our that once that if years: that if
our set of problem or accomplished accomplished accomplished
activities, we asset we will these these these
will need the accomplish activities will activities will activities will
following: the following produce the lead to the lead to the
activities: following following following
evidence or changes in 1- changes in 7-
service 3 years: 10years:
delivery:

Educate Provide a Caregivers Relationship Will have a Improve

caregivers on place for will building greater sense quality of
importance of caregivers to understand between of community life.
relationship engage with the benefits clients and within the
building. the clients. of engaging caregivers. home. Decreased
with the behavioral
clients. disturbances.

Increased
motivation

Gather The backyard Clients will Safe access to Decrease the Improve
funding to will be have be able backyard. clients desires quality of
hire wheelchair to access the to leave the life.
contractors to accessible. backyard and home without
safely build Deck will be spend time in assistance. Decreased
the built safely, the yard behavioral
deck/landsca with no loose during the disturbances.
pe the yard. railings. Deck day.
will have a Increased
ramp for motivation.
wheelchair
accessibility.

Gather Backyard will Caregivers Clients will Improve

funding for be safely will engage have a variety quality of
contractors to accessible and plan of activity life.
 VOA PROJECT 9
safely build and provide a activities for opportunities.
the deck. place for the clients Decreased
clients to outdoors. behavioral
engage with Disturbances.
each other as
well as the Increased
community. motivation

Educate The clients Clients will Clients will TBI patients Improve
caregivers on will be able feel more have a sense have a sense quality of
the to access their stimulated of purpose. of life.
importance of backyard as and accomplishm
activity in well as challenged. ent. Decreased
clients increase day- behavioral
experiencing to-day disturbances.
a TBI. activity.
Increased
motivation

ASSUMPTIONS CONTEXTUAL FACTORS

Senior Director will secure funding for
building the deck using our research
Senior Director will use the funding
appropriately to build deck
Caregivers will use the backyard, once safe
and accessible, to engage with the clients
The clients will enjoy their time in the
backyard
Able to obtain proper building permits
Caregivers will understand the importance of
the backyard
Backyard will be maintained to keep it clean
and safe
Weather may not warm enough to permit
outdoor activities
Competing activities (ie favorite TV shows)
Clients attitudes towards certain
caregivers/the outdoors
Lack of safety protocols for outdoor activities
Neighbors possible attitudes towards clients
Increased possibility for falls
VOA PROJECT 10

Appendix B

Lewins Model