Have you been wondering what change theories in nursing entail? Change is an essential aspect of nursing practice. Leading change in the complexities and challenges of evolving health care environments to provide quality patient care is a challenge for nurse leaders. This chapter is intended to guide different change theories in nursing and frameworks to support the change process in creating healthy work environments effectively. You will also learn about change resistance and how to respond to change constructively. This chapter provides nurse leaders guidelines for encouraging and facilitating change theories in nursing leadership.
Types of Change Theories in Nursing
Two forms of change that can be observed in organizations and throughout a person’s life are planned change and change by drift. Before the mid-nineteenth century, people frequently debated whether they should intervene in a situation or let nature take its. Before this point, the thinking was more in line with the change by drift method, in which there is no regulator over change or effort put into change. It is regarded as unintentional change, whereas planned change is intentional or purposeful.
During planned change, the leader’s skills and knowledge influence and implement change within the organization. By the 1950s, there had been a shift in how people viewed change and how it should be handled. People begin to wonder how and when to plan for change, rather than whether intervening was necessary to effect change. “Progress took on a meaning that authorized the use of science in the service of humans and said that experts should meet people’s needs according to how the experts interpreted those needs.”
During this time, healthcare organizations expanded, technology advanced, and patient population needs grew and changed. These organizations needed to recognize the need for change and plan interventions to implement and sustain change.
Change Theories in Nursing Practice
Three policies can be used to facilitate change, according to the classic model developed by different scholars. Which of the following initiatives should be used depends on the characteristics of the change agent and the amount of resistance encountered.
1. Power-coercive
Strategies are based on the use of legitimate authority to wield power. The nurse leader makes little effort to enforce change, and the staff cannot alter the course of the change procedure. Power-coercive approaches can be used when change is critical, time is limited, resistance is high, and there is little or no chance of reaching organizational consensus.
2. Empirical-rational
Strategies assume that the most potent requirement for change is the provision of knowledge. This strategy assumes that people are rational and will act in their self-interest when they realize that change will benefit them. It may be effective if the change is perceived to be reasonable or beneficial to individuals.
3. Normative-reeducative
Strategies assume that people act according to social norms and values, influencing their willingness to accept change. To effectively implement change in the health care environment, the nurse leader focuses on individual behavioral motivators such as roles, attitudes, feelings, and interpersonal relationships.
Kurt Lewin’s Nursing Model of Change Theories in Nursing,
Kurt Lewin was a German-American psychologist widely regarded as the father of modern social psychology. He conducted research in group dynamics, experimental learning, and action research. Lewin’s three-phase change model from the 1950s still guides how planned change is implemented today. This model explains the competing forces that strive to maintain the status quo while pushing for change. In this model, Lewin’s three phases of change are unfreezing, movement, and refreezing.
1. Unfreezing
According to Lewin and his research, it must be planned for an organization to successfully implement change theories in nursing, necessitating the system’s unfreezing. When the change agent illustrations the need for change theories in nursing and convinces group members that change is necessary, the process of unfreezing begins. This is often referred to as the discontent phase because the change agent elicits like response in others, tolerating them to see that change is required.
This dissatisfaction, which is required to promote change, can be either internal or external. To ensure the success of this change effort, the change agent must be able to clear competing significances and emphasize the need for change to occur. The change agent must also be able to overcome opposition from those who are fearful of change. People who resist change frequently experience increased stress and require comfort, putting additional strain on the change agent. When this happens, motivation suffers. Instead of consoling such people, Rockwell suggests that the change leader should ask, “What would you like to do about that?”
2. Movement
The movement phase is the next stage of Lewin’s theory. The change agent develops, plans, and executes appropriate strategies. They also ensure that driving forces outnumber restraining forces. As change is a complex process, it necessitates careful planning, precise timing, and, if possible, gradual implementation. The importance of the change agent’s leadership skills becomes apparent during this phase when handling and appropriately replying to the increased stress felt by all those affected by the change. During the movement phase, the change agent is responsible for providing inspiration, setting goals, building trust, and prioritizing change.
3. Refreezing
Refreezing is the final stage of Lewin’s theory. Because the goal of this phase is for the change to be integrated into the status quo, the change agent must assist in system stabilization. The change will be ineffective if this phase is not completed, and pre-change behaviors will resume. “Many researchers demonstrated that the important variable in terms of the success of change is people, as without the support of people, no matter how good the change program was developed, the change cannot be achieved successfully.”
Kurt Lewin’s change model can be applied to various scenarios involving implementing change in the healthcare setting. Lewin’s Theory of Change can be used to change a surgical technique to reduce the risk of post-operative infection or to assist a patient in making a lifestyle change to lose weight. This model has aided in driving change in the healthcare setting since the 1950s.
The Change Theories in Nursing of Driving and Restraining Forces by Kurt Lewin
Kurt Lewin’s change theories in nursing were expanded by including “force field analysis.” He proposed that people keep the status quo by using driving and restraining forces. The driving forces are referred to as facilitators, while the restraining forces are referred to as barriers. According to this section of Lewin’s theory change theories in nursing, human behavior is influenced by forces such as beliefs, values, expectations, cultural norms, and life experiences.
Supervisory pressure, incentives, and competitive and social demands can all be positive or driving factors. Restraining factors, on the other hand, frequently affect the ability to move forward with change. This could be due to apprehension about change, an inability to afford it, or a lack of time or energy. Forces that drive some people may be restraining forces for others, so when considering driving and restraining forces, the change theories in nursing agents must consider several factors.
These change theories in nursing have numerous applications in the medical field. When providing patient care and setting treatment goals, the health care team and the patient should be aware of the driving and restraining forces influencing their outcome. If a patient requires ongoing monitoring for a condition but lacks transportation, insurance, or the ability to miss work, the change that may be required for their condition is unlikely to occur. If, on the other hand, the clinic or hospital assisted in arranging transportation and offered income-based payments, this patient may seek assistance and make the necessary changes.
A Modern Adaptation of Lewin’s Model
Nina Burrowes and Adrian Needs published a more modern adaptation of Lewin’s model in 2009. Their discussion was organized into a five-step change model (SCM). They reasoned that it would be easier to assess readiness for change by breaking down the change process into steps. When there is no intention to change behavior, contemplation or Stage 1 occurs. It is followed by the contemplation stage, in which the individual or organization considers making a change. At this point, the change theories in nursing agents may consider additional motivational techniques.
Stage 3 is considered preparation, and during this stage, the individual intends to make a change. In stage 4, the individual takes action and actively modifies their behavior. The fifth and final stage of maintenance follows. The change agent ensures that the change is maintained and that relapse is avoided in the final stage. Burrowes and Needs imply that individuals following this change model may spiral around several times before successful change occurs by depicting the stages of change in a cycle.
This SCM model is frequently used in healthcare rehabilitation settings. “This could lead to improved selection procedures for rehabilitation programs, a reduced dropout from programs, more effective use of resources, and development of interventions to improve readiness to change,” according to one researcher.
Change theories used in nursing by Bennis, Benne, and Chinn
Bennis, Benne, and Chinn identified three strategies for effective change concerning behavioral strategies in 1969. The change agent must be familiar with the stages of change and the use of behavioral strategies to encourage change. The change agent can select the most suitable strategy and increase the success rate by being conscious of the person or group affected by the change.
The first type of behavioral strategy is rational-empirical, in which the change agent recognizes that resistance results from others’ lack of knowledge. Recognizing this allows the change agent to provide factual information outlining the need for change. This strategy could assist a patient with weight loss by providing information on the health problems associated with being overweight and resources to assist with dieting.
Peer pressure is used in normative-reeducative strategies to effect change. In terms of power, this strategy differs from the power-coercive strategy. In the normative-reeducative strategy, the change agent has no legitimate power over others. The change agent encourages the patient’s spouse and family members’ support during this phase. The change agent uses authority to force power in the power-coercive strategy. In the power-coercive technique, the change agent may deliver every meal for the patient attempting to lose weight by controlling their menu options and forcing them to eat healthy foods.
Change Theories in Nursing of Complex Adaptive Systems Change and Complexity
Complexity science has emerged due to ever-changing technology and the discovery of the subatomic world and quantum physics. According to this theory, the world is as complex as its inhabitants. Complexity science theory examines individual and body system behaviors, healthcare practices, and thinking, all of which must be considered when caring for a patient. These factors are not only dynamic and complex but also patient-specific, allowing for a more comprehensive approach to medical care.
The Complex Adaptive Systems (CAS) theory is based on complexity science and states that internal system components are unstable, and adaptations result from this instability. CAS allows for the adaptation of uncertainty during change rather than attempting to predict change through stages of development. These adaptations are nonlinear, which means they are unpredictable and uncontrollable. When applying this to healthcare organizational change, the focus should be on the micro-level rather than the macro-level. With this change, the change agent must be able to focus on the relationships of each element.
As treatments and goals are based on many factors that are individualized, and patient outcomes are not always predictable, both complexity science and complex adaptive systems change theory can be beneficial in healthcare. It can be challenging for healthcare professionals to predict what will happen with different treatments for a patient with several chronic illnesses. Still, by examining the specific symptoms of that patient and looking at the big picture, a better outcome should be achieved. It would be counterproductive to treat each of that patient’s diagnoses separately.
The Chaos Change Theories in Nursing
In the 1960s, meteorologist Edward Lorenz set out to improve weather forecasting techniques, which later became the foundation for chaos theory. He concluded that even minor changes in situations could have dramatic effects. He also mentioned that these changes often appear chaotic and uncontrollable, but they are not.
Chaos theory aims to discover the underlying order in what appears to be random data. Chaos theory is more in line with how change occurs over a person’s lifetime. There are cycles of unpredictability and chaos, but there can also be periods of stability. In the emergency department, chaos theory is frequently beneficial. It frequently appears disorganized and chaotic, but stabilization can occur if one person, such as a change agent, steps in. Although the emergency department appears to be in complete chaos, there is some order.
Conclusion
The healthcare system is constantly changing to meet the needs of patients to provide better outcomes, better services at a lower cost, and increase employee retention in the healthcare system. Individuals and organizations must consider many factors for effective change, such as culture, population knowledge, and whether there is a genuine need for change theories in nursing. Whether the timing is appropriate, and what change theory should be used to provide the most beneficial outcome.
The change agent’s skills, knowledge, and leadership will also significantly impact the outcome of implementing change. Lewin’s Models of change theories in nursing and the Theory of Driving and Restraining Forces laid the groundwork for change theories in nursing, which influenced Bennis, Benne, and Chinn’s Contemporary Adaptation, Complexity Science, CAS, and Chaos Theory. Healthcare professionals must understand the significance of the change, the examples of change theories in nursing that underpin change, the role of the change agent, and why this is necessary for the healthcare setting.
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