星期三, 十月 21, 2009

Change Theories in Nursing

Change means making something different from the way it was originally. Change may be planned or unplanned. Unplanned changes bring about unpredictable outcomes, while planned change is a sequence of events implemented to achieve established goals. In nursing a change agent is a person who brings about changes that impact nursing services. The change agent may be a nurse leader, staff nurse or someone who works with nurses. Change theories are used to bring about planned change in nursing. Nurses and nurse leaders must have knowledge of change theories and select the right change theory as all the available change theories in nursing do not fit all nursing change situations.
  1. Lewin's Change Theory

  2. Kurt Lewin's change theory is widely used in nursing and involves three stages: 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 be successful, the driving force must dominate the resistant force.
  3. Rogers' Change Theory

  4. Everette Rogers modified Lewin's change theory and created a five-stage theory of his own. 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.
  5. Spradley's Change Theory

  6. This is an eight-step process for planned change based on Lewin's theory of change. It makes provision for constant evaluation of the change process to ensure its success. The steps are: recognize the symptoms, diagnose the problem, analyze alternative solutions, select the change, plan the change, implement the change, evaluate the change and stabilize the change.
  7. Other Theories

  8. Reddin's, Lippitt's and Havelock's theories are based on Lewin's theory and can be used to implement planned change. The first two have seven stages, while the third has six.
  9. Real Life Application

  10. An article titled "Managing change in the nursing handover from traditional to bedside handover---a case study from Mauritius" details the use of Lewin's and Spradley's theories to implement a change in the process of handover reports between nurses. The driving force in this case was dissatisfaction with the traditional handover method, while the resistant forces were a fear of accountability, lack of confidence and fear that this change would lead to more work. Evaluation of the implemented change showed that the new process was successfully implemented.

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