Developing a Nursing Theory of Change from Lewin - Essay Example

Change is inevitable in all spheres of life. In the healthcare sector, there have been myriad of changes due to technological advancements and globalization. People are often not comfortable with change and may resist the same in order to hide in their comfort zones. There are various theories of change, but the paper will discuss Kurt Lewin’s force field model, how it has evolved and how it has influenced change theories of nursing. Lewin (1951), conceptualized the force field theory to have three distinct stages, namely; unfreezing, moving and refreezing. He also argued that in order to realize desired change, the change agents should suppress the restraining forces but promote the driving forces of change. This model has been widely used in the health sector to introduce and implement change. Developing nursing theory of change from Lewin (1951), Force-Field Model, and its application in the medical/surgical floor. Change is a common occurrence in our society and natural environment all over the world. It is a common saying that the only permanent phenomenon is change. Change generally means the alteration of something or an organism in any of its aspects. For example, when one alters his or her behavior for any reason, then that is change. Since change is a very important phenomenon in our society, there has been a lot of debate about it in political, social and economic spheres. IIes and Sutherland (2001), observe that change can either be planned or emergent; the former denotes conscious reasoning plan to attain desirable change due to the flaws of the status quo. In contrast, emergent change happens spontaneously without plan and this type of change is fueled by both external and internal forces in an organization. Numerous theories have been developed to explain change and to give room for empirical research. Before we proceed, it is important to know what a theory is. A theory is a formal set of ideas that are intended to explain why something happens or exists (Hornby 2003). Lewin (1951), developed force-field model of change. The force field model was a major development for nursing change theories since it has influenced many of them. The nursing force field theory is considered to be the mother of nursing theories. The paper will explore the force field theory, its applications, and how it has evolved in the medical sector. According to IIes and Sutherland (2001), there is need for change in the health service and this need has been expressed by professionals, governments and researchers. Lewin (1951), developed force field theory and it has had a great influence on nursing change theories. He offered an elaborate explanation on the behavior human beings through his force-field model of change. In the theory, Lewin conceptualized three steps, unfreezing, moving and refreezing, when he described the process of change (Bozak 2003). At the unfreezing stage the problem is identified. There have been many problems that nurses encounter during their practice like data management, poor working conditions, poor relationship with the hospital administration, and exposure to health risks among others. At this stage, the particular problem is identified and brainstorming is done to determine the most appropriate way of solving it. Once the problem has been identified, its solution is required through change to avoid breakdown or deterioration of an organization. When solving a problem, there are often obstacles that are met. Many often resist change due to fear of the unknown and the desire to maintain the status quo. At this stage strategies are put in place to ensure that the resistance is appropriately dealt with. Generally, people resist change when they feel that they have been left out of the process. Change agents at this stage are to make nurses own the change by involving them in the negotiations and receiving their feedbacks on the intended change. Lewin classified factors causing change into two categories, driving and restraining forces. Driving forces include the underlying benefits or the advantages the change. They are the factors that motivate the change agents to plan and implement the change. On the other hand, restraining forces are factors that suppress the desired change. After identifying the driving and restraining factors of change, the next step is the analysis of the strengths of each force. Steps should be taken to weaken the restraining forces while strengthening the driving forces in order to realize the desired change. Lewin (1951), concurs with this fact by documenting that in order to plan for change it is essential that strategies of change aim at increasing driving forces but decreasing the restraining forces. The second stage, moving, involves planning and implementation of the change. Caution should be taken to ensure that there is effective communication to make all stakeholders feel part of the change process. Resistance often occurs during change process, and the same should be dealt with tactically. Change agents must understand why nurses are skeptical about the change and deal with their fears. Bozak (2003), documents that many nurses were skeptical about technological change since they wanted to retain their routine way of operations. Nurses should be made to understand and appreciate the benefits of the change, and motivated to adopt it. Caution should be taken against forcing change on nurses because this may lead to sabotage. There should be a pilot implementation of the change to establish whether it is the best for the nursing practice and to determine the best way of implementation. For instance, when introducing a technological change for data management in the nursing practice, the change agents may decide to start with malaria cases to find out how effective the change is. If it is found to be doing well, then the whole change program is rolled out at the institution. On the contrary, when loopholes that may lead to the failure are identified, they should be dealt with in order to improve the effectiveness of the intended change. At this stage, there should be training on the change, for example, when introducing computers in medical institutions, nurses should be trained on how to use them. During the implementation stage, it is important that the change agents receive and respond appropriately to the feedbacks from nurses, patients and other stakeholders on. Criticism should also be welcomed since it is a vital tool for enabling improvements. Further, the change agents at this stage need to motivate the nurses to embrace the change, for example, by offering incentives for those who excel in adopting the change. The last phase is the refreezing stage, which comes after the implementation of change, and it majorly entails ensuring the stability of the change coupled with its evaluation. Issues of sustainability of the change have to be taken very seriously. It is ridiculous to implement change and fail to ensure its stability. When change like using computers in data management is introduced in nursing, the pioneers of the change should ensure that there are adequate resources to sustain the change. At the refreezing stage, the change agents also evaluate how the introduced change is fairing on. They must establish whether the change is achieving its intended purpose or not. Feedbacks from the nurses, patients and other stake holders are very critical at this stage for they will inform the change agents on their perceptions about the change. The change should be monitored until when it is considered stable. When the change becomes an integral part of nursing practice or when it becomes an institutional nursing culture, then it is safe to leave the change to stand as this is the last stage that marks the exit of the change agents. Having understood the Lewin’s force field model, it is appropriate to relate it to other nursing theories and to examine how is has evolved and its current application in the medical sector. The contemporary society has witnessed immense technological advancements. One of the major revolutions is the invention and adoption of computers that are used to perform numerous tasks. Due to globalization many organizations today use computers to promote efficiency and effectiveness of work. The medical sector also needs to embrace this communication technology. Bozak (2003), states that, “the computerization of nursing systems is one aspect of the changes taking place in the information revolution.’’ Nurses are already using this technology, and their organizations use force field change theory to introduce and sustain this change. This model has evolved with the technological change and is today very vital in change management. For instance, there maybe a problem of lack of accurate medical history of a patient that is used to dispense treatment. Using papers and books is cumbersome and obsolete, and there is a shift to communication technology where data is entered in data management systems and retrieved easily when required. Further, Bozak (2003), documents other areas where technology has been used in the medical sector to include: use of internet as a source of health and medical information for nurses and patients, using wireless bedside documentation systems, and use of integrated delivery networks. Force field model is very essential since it has helped in the implementation of computer technology in the nursing sector through utilizing unfreezing, moving and refreezing phases. According to Maysoon (2009), force field model has also been in postoperative pain assessment and management. After surgical operations, patients often have pain on the surgical wounds and medical practitioners are obligated to properly manage the pain. Maysoon (2009), states that, “The force field model provided a framework for planning to introduce change into the work place of nurses working with patients suffering from pain in the post-surgical period.” It is clear that the pain management was poor and therefore, it was imperative to introduce change to improve the situation. The main issue in postoperative pain management is to make pain visible (Maysoon 2009). To make pain visible, nurses are required to make elaborate documentations as they monitor the effectiveness of pain treatment. It is also important for the nurses to receive feedbacks from the patients and to ensure that patients are satisfied with the treatment. Force field theory has been successfully used to plan and implement change in the management of postoperative pain. This is a major stride in the medical sector since many patients undergo surgical operations and there is need to manage their pain with professionalism. IIes and Sutherland (2001), categorizes change into three groups which are developmental, transitional and transformational. Developmental change endeavors to improve the existing skills or processes in an organization. Transitional change strives to attain a desired state that is different from the initial one. Finally, transformational change is radical in nature meaning a form of revolution, and requires change of assumptions of an organization and its members. IIes and Sutherland (2001), document that, transitional change model which was dominant 1980’s had its foundations from the works of Kurt Lewin. It utilizes the three stages of change, unfreezing, moving and freezing as coined by Lewin (1951). At the unfreezing stage, “transitional change involves disconfirmation of expectations, creation of anxiety and provision of psychological safety that converts the created anxiety desire and morale to change (IIes and Sutherland 2001). At the moving stage where planning and implementation of change takes place, transitional change achieves an alteration or a new desired position through mental restructuring by taking after a role model, and understanding the environment to be acquainted with the information that may help in adopting the change. Finally, refreezing in transitional change model occurs when the change is integrated into one’s personality meaning the change becomes an essential part of the person. Transitional change model borrows heavily from Lewin’s force field theory, and demonstrates how the theory has evolved overtime. Transitional change is very important in the medical sector. Let us relate transitional change with the nursing practice. When the hospital administration desires to change the perception of nurses on negligence in the course of duty, with an objective of reducing it then, this type of change can be used; at unfreezing stage guilt may be created on nurses by demonizing negligence during work and outlining its consequences. The consequences of negligence may include loss of life, unnecessary pain and development of clinical complications among others. When nurses are tactfully made aware of such repercussions, an anxiety will be developed in them to shun the bad practice of negligence and they will strive to change. This anxiety can be changed into motivation to change by exposing the benefits of diligence in the course of duty coupled with giving incentives to hard working nurses. This practice will be an impetus to nurses and they will work hard and treat patients will great care that they deserve. At the moving stage, the hospital administration may identify those who excel in their work and reward them for example by promoting them. Other nurses will in turn want to imitate their recognized counterparts as their role models, and they embrace the desired change in the process. Once this favourable nursing practice has been adopted, with time, it becomes a personality of nurses and it develops into a culture in the hospital. Action research model of change is today being used in the health sector to initiate, implement and sustain change. IIes and Sutherland (2001), observes that action research model can be traced back to Lewin’s force field theory and it elaborates on the unfreezing, moving and refreezing stages that were conceptualized by Kurt Lewin. Action research is a strategy that entails bringing change through action by developing and improving practice, and at the same time formulating and developing theory. Action research model of change entails scientific collection of data that relates to the goals and objectives of the system. After collecting the data, it is analyzed and fed back to the system with the aim of altering selected variables in order to make the system to function more efficiently and effectively. After effecting the change, its results are evaluated to find out they are suitable or to identify its flaws and initiate improvements on it through research. In this case, researchers work as informers and initiators of change. IIes and Sutherland (2001), argues that action research model has been widely used successfully in numerous change programmes and they single out how it has been used in changing mental health service delivery. Note that, once research has been done, the change process is actualized using the Lewin’s force field model by going through unfreezing, moving and refreezing processes. Lewin’s force field theory has also influenced group level change intervention models. IIes and Sutherland (2001), have discussed two approaches of group level change interventions. They are parallel learning structures and self management teams. Let us discuss parallel learning structures model. It is also known as collateral structures model. IIes and Sutherland (2001), quote from Zand (1974), that “parallel learning structures are created especially for planning and guiding change programmes that operate in tandem with the formal organization.” The parallel learning structure consists of a change committee that examines the needed change and gives suggestions on how the change is to be implemented and improved. The committee is also charged with the responsibility of monitoring the change efforts to establish whether it is on the right course. Typically, the committee should comprise of a top executive and a collection of working groups in an organization. In large organizations there is red tape bureaucracy that makes it cumbersome to implement change since there are procedures, guidelines and protocols to be observed. The model helps members of the organization to break from the constraints that are imposed on them by the organization. It provides a framework for effective communication that facilitates standard ways of solving problems together with developing innovations that enable desirable change. When implementing change, the parallel learning structures model borrows from Lewin’s force field model when handling the driving and restraining forces to change. Lewin force field change theory has had immense influence on nursing theories of change, but the paper has only discussed a few of them. The model consists of unfreezing, moving and refreezing stages, which have been instrumental in initiating, implementing and evaluating change in the nursing sector. It gives a framework for systematic adoption of change. The paper has also explored a vital aspect of the force field model that emphasizes on the suppression of the restraining forces and the promotion of driving forces to change to ensure that the change takes place successfully as planned. Examples of areas in the nursing sector where the model has been used have also been discussed. Finally, the paper has discussed how the force field model has evolved by examining various nursing change theories, which have been influenced by it. Change is inevitable, and force field model should be used appropriately and effectively to ensure that there is quality service in the nursing sector. In addition, it should be improved to cope up with the environmental, political, technological, social and economic alterations and advancements in the society. References. Bozak Marilynn. (2003). Using Lewin's Force Field Analysis in Implementing a Nursing Information System Florida:University of South Florida. Retreived from http://journals.lww.com/cinjournal/fulltext/2003/03000/using_lewin_s_force_field_analysis_in_implementing.8.aspx Hornby, A.S. (2000). Oxford Advanced Learners’ Dictionary of Current English. New York: Oxford University Press. IIes Valerie and Sutherland Kim (2001). Organizational Change; A Review for Health Care Managers, Professionals and Researchers. London: London School of Hygiene and Tropical Medicine. Lewin, K. (1951). Field theory in social service: Selected theoretical papers. New York: Harper Brothers. Maysoon S. Abdalrahim ( 2009). Postoperative Pain Assessment and Management;The Effects of an Educational program on Jordanian nurses’ practice, knowledge, and attitudes. Sweeden: Intellecta Infolog. Read More