DRIVING FORCES | RESTRAINING FORCES |
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• Critical incidents on the increase • Care given predominantly biomedical in orientation • Complaints from patients, doctors and relatives on the rise. • Increase in discharge against medical advice • Staff knowledgeable in change management • Ward manager's and peer lending support • Familiarity with ward culture | • Ritualism and tradition • Fear that this may lead to more work • Lack of confidence on the part of some nurses • Fear of increased accountability • Problems associated with arriving late at work • Problems associated with disclosure of confidential information |