The Change Theory Of Nursing Model

There are numerous change theories that nurse leaders can use to help make a change. According to our textbook, one of the most useful theories is Lewin’s change theory. This theory of change is described in three stages, (a) Unfreezing, (b) Moving, and (c) Refreezing (Grossman & Valiga, 2012). First, in the unfreezing stage, a problem is identified, analyzed and the start for change begins. Second, in the moving stage, this is where you make the change, new policies are developed and implemented. Last, in the refreezing stage, the change has been made and this is the new way of doing things now. Lewin’s change theory also mentions the driving forces, restraining forces and equilibrium, in order for organizations to remain in balance.

These changes are then reinforced to employees by the Charge Nurses in Morning Huddles and in special called Safety Huddles throughout the week. While management is very open to change, implementation of the changes must be carried out by the actual hands-on personnel, and this often times leads to fear of the unknown. As Yoder-Wise (2015) states, “All changes, whether perceived as positive or negative, large-scale or simply, are scary and generate fear” (p. 307). In the short time I have worked in the ED, I have seen both support and resistance among co-workers regarding change processes. While some embrace change, others resist, and are set in their ways viewing change as inconvenient and an addition of time-consuming steps to an already stressful environment. Most whom I work with, when presented with the facts and evidence behind the change, view it positively and have no problem implementing it.

The need for innovation in medical care becomes a priority in a growing world, with the world population growing at an alarming rate, from 3.036 Billion to 7.125 Billion in just half a century from 1960 to 2013. The rapid increase in population has translated to congestion in urban centers leading to enormous waste production; a lot of pollution made due to excessive fumes from vehicles on roads and even water pollution due to a rapid increase in industrial activities in the quest to satisfy production. All these effects are increasingly resulting to higher frequency within which people acquire infections leading to the need for specialized medical care.

Kurt Lewin's Change Theory consists of three distinct and vital stages, "Unfreezing", "Moving to a new level or Change" and "Refreezing" (1995,Schein). The three step process provides a high level approach to change, as it help us implement a change effort with a framework. Unfreezing will involve finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. If a structure that is not secure has been in place for a long time, habits, and routines naturally settle in. It has been observed that St.Michael's Hospital nursing staff in M3 have a standard process that has strayed off course when it comes to hand off report. The SBAR sheet and verbal report as stated in the hospital protocol for shift report, is not being applied as stated. Nurses have shown to leave out important information from outgoing nurse to oncoming nurse and have been observed throughout the hallway and nurses station having discussions for hand off report, and a few have not used the SBAR sheet at all. The whole process of hand off report is unorganized and lacks in communication. Unfreezing will get nurses to gain a new perspective on

People generally like to stay in their comfort zone, they do not like changes. However, change is a necessary part of life, we see change in nature every day. Change can be positive or negative. We can choose to embrace the change or reject it, we also can choose to allow the change to have a negative or positive impact on our lives. Helmstetter lists six steps when dealing with change. First to recognize the change, then to decide if you are going to accept or reject the change. The next step is to choose your attitude toward the change, then choose how you are going to deal with it and what actions you are going to take. The last step is to evaluate your progress of accepting the change (Lamberton and Minor, 2012)

Only when it is absolutely necessary should a catheter be inserted into a patient. Every patient is assessed for the need for a Foley catheter. If the Foley is inserted, assessments are also then done daily to see if the need is still valid. If the reason is not justifiable the catheter must be removed from the patient (Joint Commission releases new NPSG for CAUTI, 2011). Nurses must follow guidelines while inserting indwelling catheters as well. Aseptic technique is critical to maintain during this process. The use of sterile equipment and a sterile procedure helps to reduce the risk of CAUTI. If in any way the catheter becomes contaminated during the process of insertion, the nurse should discard of the entire catheter and start with a new, sterile kit. Proper hand hygiene is very important before and after contact with indwelling catheters to decrease risk of infection. Maintenance of a close drainage is system is also important that way bacteria are not able to get in and cause infection (Revello & Gallo, 2013). Decreasing the number of times Foleys are inserted and how long they stay in for can help reduce the risk of CAUTI since the longer a Foley stays in, the higher the risk of infection becomes. Nurses must keep the catheter line patent, with no kinks to allow urine to flow freely through into the collection bag. When a urine sample must be obtained it must be done in a sterile

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

The metaparadigm of nursing consists of four parts comprised by Jacqueline Fawcett, in 1984, in her seminal work (Alligood, 2014). The metaparadigm she developed served to provide direction and guidance for the nursing framework already in use and became an organization tool for theories already in use (Alligood, 2014). The four parts being person, health, environment, and nursing. The four components of the metaparadigm concept of nursing is important to nursing theory because they are the key areas of focus of patient care, and the metaparadigm is designed to differentiate nursing from other specialties (Alligood, 2014). It is this use of theories that makes nursing a profession and guides professional nursing practice, research, and education (Alligood, 2014).

Throughout nursing, there are many theories that nurses may come across and use. Calista Roy’s and Betty Neuman are two theorists that use two different types of models to encompasses the health, person, and the environment. Callista Roy uses a theory that promotes adaptation to the stimuli a person may encounter. Betty Neuman uses a theory that promotes equilibrium in a time where a person will encounter stress. These theories allow the nurse to bring a knowledge to learn more about the person and the factors that influence their health. Although with any theory there are different approaches in how the nursing plan is done, but with the patient in mind, it makes the difference in care that is given and allows for better outcomes for the patient.

The Change Theory was developed by Kurt Lewin. He identified three stages in change: unfreezing, changing, and freezing. According to Lewin, in order to be successful in implementing a change, people must go through all three steps. The first step is understanding that a change is necessary. In the scenario, the staff may have been comfortable with their routine and disregarded the moderate sedation policy because no sentinel events had occurred previously. To unfreeze this behavior the staff must acknowledge their behavior and realize a change is needed. A thorough review of the findings that lead to the death of Mr. B will may assist the staff in recognizing the need for change. The second step is the “change”. In this stage the staff would update the moderate sedation policy and implement the recommended changes. Such as, one on one nursing monitoring, vital sign monitoring, and completing or updating required education. The third is “Freezing”. In this step the staff has implemented and performed the desired changes until they have become the standard practice. This will reduce the likelihood

P in the PICOT is patients with Foley catheter inserted at admission causing patients catheter-associated urinary tract infections (CAUTI). The aim is to build a nurse-driven protocol to remove Foley catheters early on will help reduce additional days of having the use of an unnecessary indwelling urinary catheter. For every extra day, a Foley catheter increases the risk to develop hospital-acquired catheter-associated infections in our patients ("AACN Competencies and Curricular Expectations for CNL Education & Practice,"

Implementing change can evoke stress, and nurses are not immune to this stress brought on by change, or this stress might be amplified due to the fact that nurses are usually at the forefront of change. Any change that is initiated in the healthcare industry will impact how nurse perform their duty, and can negatively can affect their workflow if extra precaution is not taken. Thus, nurses are a major force in resistance to

Transition theory is one of the most applied theories in the nursing practice. In fact, whether or not nurses are aware of this theory, it is often used in the nursing practice because nursing is all about helping people that are going through changes, whether they are physical changes like an illness or developmental transitions like the birth of a child. Meleis reiterates this point as he states “Nurses often are the primary caregivers of clients and their families who are undergoing transition. They attend to the changes and demands that transitions bring into the daily lives of clients and their families” (2000, p. 13). Before going any further in exploring Transition theory, we must define transition. Meleis states that “Transitions are both a result of and result in change in lives, health, relationships, and environments” (2000, p. 13). Transitions are the times when a nurse can step in and act as a therapeutic medium and help the individual have a smooth transition from one semi stable state of being to another semi stable state of being (McEwen & Wills, 2014, p. 237). This is the essence of Transition Theory. It is the process that goes on between people undergoing some changes in their lives, and the nurse who is guiding care for a stable outcome.

The purpose of this paper is to provide an introduction, purpose, and rational for selecting a nursing theory. I will describe the theory by identifying the purpose, concepts/definitions, relationships/structure, and assumptions. I will use the Chinn & Kramer evaluation criteria to critique this chosen theory. Finally I will describe a plan for implementing the theory into my practice setting, identifying any barriers and challenges.