DQ Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP intervention
NRS 493 Topic 4 DQ 2
Understanding how a nursing theory relates to nursing practice helps to understand the models of health care. In the 1950s, a biomedical model was the primary health care model. According to this model, good health is the freedom from pain, disease, or defect. The model analyzes every malady as physical, focusing on objective data from tests, excluding psychological, environmental, and social influence. A working example is that a disability is purely a biomedical issue: to be cured and to return the patient to normal. This presented controversy regarding what is normal and the thought that a disability is negative. Many were upset at the tenets of the biomedical model (Gruman et al., 2021).
Between 1960 and 1980, George Engel authored many papers criticizing the single focus of the biomedical model, postulating that the belief that every illness results from organic dysfunction were limiting. Engel felt that behavioral, social, and environmental factors cause-and-effect diseases. He coined this theory the biopsychosocial model and included human and psychological data. The biopsychosocial model was criticized because it could not empirically deliver research data, so it did not conform to the structure of a model. This model did not overshadow the biomedical model. They still use biomedical in western medicine and exclusively in European medicine (Farre & Rapley, 2017). The biopsychosocial model is more representative of the art and science of nursing and is vital for consideration in developing nursing practice.
Change is often met with resistance. To discern the most effective way to go about a change, I looked at the research. Chauhan and colleagues (2017) completed a systematic review of effective strategies and change models. The conclusion was that behavior changes that included education, training, and collaborative team-based approaches effectively change practice. That became a priority for a change model.
After considering that the two years of survival mode has made nursing into a task-oriented job and the belief that all care and interventions should be patient-centered. I investigated the model our system uses: The Theory of Human Caring. Watson’s theory is mentioned in readings with change theories such as Lewin, Stage Model of Change Unfreezing Changing Refreezing: piquing my curiosity.
Lewin’s model is three steps: unfreezing, change, and refreezing. The unfreezing step is to get rid of “that is the way we have always done it” so that change can occur. Changing or moving phase is three-fold; Convincing others that the change is beneficial and the status quo is not, working with others to find added information and connecting with leaders to garner support (Udod & Wagner, 2018). The phase of refreezing is to implement the change and ensure its sustainability. In my opinion, this model does not address interpersonal relationships, the role of the change agent that is important in nursing and that I would like to be a cornerstone of a nursing practice change. The intrinsic inspiration of who we are and why we do what we do.
Watson’s Human Caring Theory uses the nursing process to guide practice change using the nursing process: assessment, plan, intervention, and evaluation. The tenets of the theory are that the person is not an object but the summation of all their experiences, deserving respect and dignity. The change agent, the nurse, has a crucial role in addressing the personhood complexities of each unique person. Using Watson’s theory allows all components to return to the patient and the nurse’s role to care (Pajnkihar et al., 2017). Incontinence brings with it stigma and decreased QOL for the patient. Caregivers can find disgust in caring for the patient after incontinence and nonverbally express that to the patient. It is important to consider the patient’s perspective to embrace the importance of timely and kind incontinence care.
Our organization bases its operation and interventions on Watson’s theory. My preceptor explained how it is used in infection control interventions and is the core of practice. She reports that when patients are at the center of our care it is quality and effective care.
Farre, A., & Rapley, T. (2017). The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness. Healthcare (Basel, Switzerland), 5 (4), 88. https://doi.org/10.3390/healthcare5040088
Gruman, J., Schneider, F., & Coutts, L. (2021, February 16). Biomedical model | Applied social psychology (ASP). Sites at Penn State | powered by CampusPress. https://sites.psu.edu/aspsy/2021/02/16/biomedical-model/
Pajnkihar, M., McKenna, H. P., Stiglic, G., & Vrbnjak, D. (2017). Fit for practice: Analysis and evaluation of Watson’s Theory of Human Caring. NURSING SCIENCE QUARTERLY, 30(3), 243–252. https://doi-org.lopes.idm.oclc.org/10.1177/0894318417708409
Udod, S., & Wagner, J. (2018, June 30). Common change theories and application to different nursing situations – Leadership and influencing change in nursing. Leadership and Influencing Change in Nursing – Simple Book Publishing. https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-9-common-change-theories-and-application-to-different-nursing-situations/
One change theory, very widely used in nursing, is Lewin’s Change Theory. Lewin developed the change model to illustrate how people react when facing changes in their lives. The three stages of this process include unfreezing (the person has an existing state), moving or changing towards new ways of being, and then refreezing into a new state. The theory has barriers and facilitators, referred to as driving and resistant forces. Driving forces facilitate change because they push the person in the desired direction. For this theory to be successful the facilitating factors must overcome barriers and resistance (Current Nursing, 2020).
One of the top challenges for complex healthcare organizations is how to deal with change effectively. Rising healthcare costs, declining reimbursement, workforce shortages, new technology, and the growing elderly population are critical factors driving the force for change, whether in a clinical or hospital setting. “Contemporary healthcare agencies must continually institute change to upgrade their structure, promote greater quality, and keep their workers” (Marquis & Huston, 2017). Healthcare organizations must continually make changes to organizational restructuring, patient satisfaction, and employee satisfaction leading to retention. However, it is essential to realize that not every organizational change program is a success. They are implementing the use of change theories such as Kurt Lewin’s models of change, Burrowes and Need’s Contemporary Adaption of Lewin’s model, complexity science and adaptive systems, and Edward Lorenz’s Chaos Theory. Healthcare organizations can implement effective change to meet the demands of the ever-changing healthcare system. They understand when change is necessary to increase patient satisfaction and employee satisfaction and maintain a successful, thriving organization.
Kotter’s Eight-Step Change Model, created in 1995, includes the following change management steps: create a sense of urgency for change, form a guiding change team, create a vision and plan for change, communicate the change vision and plan with stakeholders, remove change barriers, provide short-term wins, build on the change, and make the change stick in the culture. According to Kotter change happens when at least 75% of employees are convinced that change is necessary. This sense of urgency is developed among employees by “change leaders” with a focus on what are new realities, what are threats and new opportunities. In this theory, the vision for change needs to be agreed upon Barrow, Annamaraju &Toney-Butler, 2021).
Lewin and Kotter’s theories both must overcome resistance for change to occur. Lewin’s theory, more generalized, is described in three steps as opposed to Knotter’s whose theory put emphasis on organizations, highlighting teamwork and coalition formation.
References
Barrow, J. M., Annamaraju, P., & Toney-Butler, T. J. (2021). Change Management. StatPearls StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459380
Current Nursing. (2020). Change Theory – Kurt Lewin. https://www.currentnursing.com/nursing_theory/change_theory.html
Kurt Lewin not only has a nursing theory, he is considered the father of social psychology and the designer of the nursing model known as Change Theory and it his original theory which others have used as a foundation. (Petiprin, 2020). Lewin’s Change Theory is known as the “unfreeze-change-refreeze model” with 3-concepts or steps which are the “driving forces, restraining forces and equilibrium” per Petiprin (2020). The key points of Lewin’s change model is compelling forces, “restraining forces and equilibrium” (Petiprin, 2020).
Step 1 = “Unfreeze”: to put aside old ways of doing things. Helping people to do away with old patters or habits, increasing the key need to readdress away from the something has always been done.
Step 2 – “Change” in ways of thinking, acting and/or feeling that is a more productive manner.
Step 3 = “Refreeze” establishing solid actions, ways of doing things or habits in such (firm/solid/established) way that the actions, thoughts or feeling replace the prior. If this is not fully established the olde ways shall become new again ~ not actually replaced per Petiprin, 2020. (side thought: if no fresh trays and water for the “icecubes of life”…trays of ice just left on the counter and melted, but not really dealt with ~ using the same olde water, not a fresh source for fresh cubes to be created)
Lippitt has a Seven-Step Change Theory that has the foundation of Levin’s change theory [er .
Step 1: Acknowledge (Diagnosis) the problem: come to grips as to the issue or problem by looking at information, data or the big picture to assess what needs to be and that whoever shall be affected by the change is committed to the outcome needed.
Step 2: “Assess the change agent’s motivation and capability for change”: assess what shall be needed to in the process of achieving the change.
Step 3: “Assess the change agent’s motivation, resources, experiences, stamina and dedication”
Step 4: “Select progressive change objectives”: assess what needs to be done, what is needed to achieve accomplish it and how to go about it to get it done.
Step 5: “Explain the role of the change agent to all employees” to assure everyone fully comprehends what is needed and expected of them.
Step 6: “Maintain change”: encourage and welcome interaction from employees
Step 7: “Gradually terminate the helping relationship of the change agent”: due to a full understanding and utilization of change incorporated, the change agent shall not be needed, as the employees shall fully realize the importance of the changes made and shall “take ownership” going forward and sharing the information/new ways/procedures/interventions with others. (per Wisconsin Technical Manner, n.d.)
The comparison is that Lippitt’s change theory made use of the foundation of Levin’s change theory which was concise and to the point and branched it out to expound upon it, creating a more detailed set of steps (WTCS, n.d.). Although it seems too many steps, Lippitt’s 7-Step Change Theory seems to make most sense, especially in the light of out-patient care regarding Covid-19 at the site of my preceptorship and capstone. The site I am at does not utilize either theory, yet verbalized Lippitt’s theory would work well in most medical settings.
Resources
Petiprin, A. (2020). Kurt Lewin – Nursing theorist. Nursing Theory. https://nursing-theory.org/nursing-theorists/Kurt-Lewin.php
Wisconsin Technical College System (WTCS) . (n.d.). https://wtcs.pressbooks.pub/nursingmpc/chapter/4-3-implementing-change/#footnote-993-1
The three stages that make up the Lewin theory of change are known as “unfreezing,” “moving,” and “refreezing.” It argues that the cycle will ultimately repeat itself because unfreezing occurs when there is a requirement for change, movement occurs while change is occurring, and refreezing occurs when change is stabilized, and equilibrium has been achieved. Because of this, forces are set in motion that either encourage or discourage change (Petiprin, 2020).
- Unfreezing (when change is needed).
- Moving (when change is initiated).
- Refreezing (when equilibrium is established).
The approach proposed by Lewin is highly logical, goal- and plan-oriented. It does not take into consideration personal circumstances, which are a potential driving force for change. On the other hand, the change hypothesis developed by Prochaska and DiClemente It outlines a change process that is more generic, and as a result, it is less particular. It suggests that rather than going around the problem, people should learn from their past mistakes by reflecting on such experiences. My preceptor claims that she frequently makes use of Lewin’s and Lippet’s change theories when she wants to launch a change since these theories are highly persuasive and drive people to change. Additionally, the theories assist her in recognizing any and all types of resistance that may impede the process of change implementation.
Reference:
Petiprin, A. (2020). Kurt Lewin – Nursing theorist. Nursing Theory. https://nursing-theory.org/nursing-theorists/Kurt-Lewin.php
Change theories are important in the context of this course and can be applied to support the Evidence Based Practice intervention. Two examples of change theories are Lewin’s Change Theory and Roger’s Diffusion of Innovation Theory. The Change theory was created by someone known as the father of social psychology who is Kurt Lewin and this theory is said to be the most influential of them all. This theory is separated into 3 stages of the model which is referred to as the unfreezing-change-refreeze model which enunciates the need for rejecting and replacing old ideas that have since become outdated (Lewin’s change theory, 2020). The three main ideas of the theory are driving forces, restraining forces, and equilibrium. Driving forces cause change to occur. The restraining forces counter driving forces by hindering any change and equilibrium is when driving forces and restraining forces reach a balance (Lewin’s change theory, 2020).
The three stages of nursing theory are unfreezing, change, and freezing. Unfreezing allows individuals to let go of old patterns and the method to this is increasing driving forces or decreasing restraining forces (Lewin’s change theory, 2020). The change stage allows for the creation and production of changes in thoughts and behavior and refreezing establishes change as a new habit so that patients don’t fall back into their old counterproductive habits (Lewin’s change theory, 2020). The Diffusion of Innovation Theory was introduced by Gabriel Tarde in 1903. This specific change theory is regarded with the modification and presentation of technological innovation so that all types of needs are met (Kaminski, 2017). This theory enunciates the significance of networking between peers and communication. Innovation diffusion is the adoption of new ideas, perspectives, practices etc. and this process is mapped out within this theory eluding to the fact that there a few initially who are open to the new ideas and adopt it to put into practice (Kaminski, 2017).
These adopters start spreading the word so that more people are influenced to do the same. The new idea or practice is circulated until everyone has adopted it or the popularity of it spreading has died out which is called saturation point (Kaminski, 2017). The five categories of adopters are innovators, early adopters, early majority, late majority, and laggards, and sometimes non-adopters (Kaminski, 2017). Innovators appreciate technology, gatekeep for the next group, recruit peer educators etc. Early majority are seen as opinion leaders and tend to be trend setters and role models within their social system and society. The late majority respond best to peer pressure and are very cautious about change and implementing new practices and policies but they are motivated to keep up with competitors and very cost sensitive (Kaminski, 2017). Finally, the laggards are isolated from opinion leaders and suspicious of innovations and almost completely opposed to technology. I think the Lewis Change Theory makes the most sense for implementing my EBP because it allows for the freezing of old theories and practices, change of treatment plans and intervention, and freezing of new practices that are included in the solution to the problem.
Kaminski, J. (2017). Diffusion of innovation theory. Diffusion of Innovation Theory | Canadian Journal of Nursing Informatics. Retrieved May 14, 2022, from https://cjni.net/journal/?p=1444
Lewin’s change theory. Nursing Theory. (2020, July 19). Retrieved May 14, 2022, from https://nursing-theory.org/theories-and-models/lewin-change-theory.php
Nurses hold significant roles in healthcare and in society in general by ensuring that various changes have been implemented that can help in impacting healthcare positively. To ensure that they act in a manner that enhances improved outcomes, nurses make use of evidence-based practices to inform their course of action. The use of evidence-based practices in healthcare has been advocated for and it is the route to improved outcomes. in order to develop and implement evidence-based interventions, nurses and other healthcare providers use theories to identify evidence in research that informs healthcare practices. Theories, therefore, are one of the best tools in healthcare that enhances the development, adoption, and implementation of change. One important change theory in nursing is Lewin’s Change Theory which has three main components. The Lewin change theory has three aspects; unfreezing, changing, and refreezing. The first concept, unfreezing is the action of perceiving the need for change. The second concept, change is the act of introducing the newly proposed change or behavior that suits the previous gap. The third concept refreezing entails the act of embracing the newly implemented change and taking it as a norm (Udod & Wagner, 2018).
Another important theory of change in healthcare is the person-centered theory of change by Carl Rogers. The theory has been widely used in the change process especially in enhancing therapy. The theory has been used in psychotherapy by emphasizing on the role of external forces in enhancing change. The theory postulates that external forces are responsible for initiating and implementing change. In psychotherapy, the theory aligns the counselor in initiating change for their clients by offering unconditional positive regard, empathy, and congruence (Florkowski, 2017).
My preceptor made emphasis on using the Lewin change theory to implement the Q2 turns for paralyzed patients and Q3 for patients who can make little movement by themself when she use to work in the ICU and this has been made part of the policy for turns on the unit.
Of the two theories discussed, Lewin’s change theory makes the most sense in the implementation of evidence-based practice which explores the three main concepts of change. My receptor has made use of Lewin’s change theory to reduce alarm fatigue in critical care units. Change theories are effective vessels in enhancing change in healthcare.
References
Florkowski, R. (2017). Person-centered approach and rehabilitation. Teaching Crossroads: 12th IPB Erasmus Week, 81.
Udod, S., & Wagner, J. (2018). Common change theories and application to different nursing situations. Leadership and influencing change in nursing.
A theory of change is a purposeful model of how an initiative such as a policy, strategy, program, or project contributes through a chain of early and intermediate outcomes to the intended result. Theories of change help navigate the complexity of social change (Serrat, 2017).
Kurt Lewin’s change theory is widely used in nursing and involves the unfreezing stage, moving stage, and refreezing stage. Lewin’s theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change. The resistant forces are employees or nurses who do not want the proposed change. For this theory to succeed, the driving force must dominate the resistant force.
On the other hand, Everette Rogers modified Lewin’s change theory and created a five-stage theory. The five stages are awareness, interest, evaluation, implementation, and adoption. This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially (Oguejiofo, 2018).
Lewin’s change theory will help implement EBP intervention in the nursing field because the stage of unfreezing makes it possible for people to let go of an old pattern that was somehow counterproductive. It is necessary to overcome the strains of individual resistance and group conformity. Three methods can lead to the achievement of unfreezing. The first is to increase the driving forces that direct behavior away from the existing situation or status quo. Second, decrease the restraining parties that negatively affect the movement from the current equilibrium. Thirdly, finding a combination of the first two methods. The change stage with Lewin’s change theory helps the process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive. In addition, the refreezing stage involves establishing the change as a new habit so that it now becomes the standard operating procedure. This last stage makes it possible for patients or staff not to return to old habits.
The clinic I am doing my capstone project is found using Lewin’s change theory to initiate change in the patient-staff communication system to help better serve their patient. The clinic leadership made it known to their staff the importance of this change and implemented this change among staff. They also continuously monitor staff compliance with this newly implemented policy.
References
Oguejiofo, N. (November 21, 2018). Change Theories in Nursing
https://bizfluent.com/about-5544426-change-theories-nursing.html
Serrat, O. (2017). Theories of Change. In: Knowledge Solutions. Springer, Singapore. https://doi.org/10.1007/978-981-10-0983-9_24