4 responses

Change Theories

1. When looking at change theories, is it possible to take a non-nursing theory and apply it to a nursing evidence-based practice project? Why or why not

2. Two important change theories prevalent in nursing practice include Lewin’s change theory and transtheoretical model of change. Lewin’s change model is a three stage model that includes unfreezing, change, and refreezing (Schein, 1999). The core concepts of this model are driving forces, restraining forces, and equilibrium. Lewin stated for this model that it is important to understand the “refreezing” process as without this, changes revert back to previous ways (Schein, 1999). In the transtheoretical model of change, the focus is intentional change. Specifically, this model helps to explain differences in success during treatment for a range of psychological and physical health problems. Some of the core concepts are: the process of change, decisional balance, self-efficacy, decisional balance, and temptation. The stages of change for this model include precontemplation, contemplation, preparation, action, maintenance, and relapse (Wilson, 2016).

These two models of change are similar in that both pertain specifically to human systems and focus on important steps of change to bring in new habits for better outcomes. However, they are very different in that the transtheoretical model pertains specifically to health care and health problems. The stages for this model are also more in-depth than those of Lewin’s model of change. My mentor stated that he most often utilizes the transtheoretical model in practice as a nurse. He stated that the stages of change, such as contemplation, allow him to understand the perspectives of patients and how he can tailor his care and education to their specific needs to allow for successful change.

Reference:

Schein, E. H. (1999). Kurt Lewin’s Change Theory in the Field and in the Classroom: Notes Toward a Model of Managed Learning. Reflections, 1(1), 59-74. doi:10.1162/152417399570287

Wilson, B. A. (2016). Transtheoretical model of behavior change. Salem Press Encyclopedia Of Health,

3. Muddiest Point

Last week you have started the process of your literature search for articles supporting your Evidence-based Practice (EBP) Change Proposal. You have also analyzed two different methods of evaluating evidence as well as comparing and contrasting them. These two components of your Change Proposal are very vital in the beginning of framing and structuring your proposal.

It is important to analyze the information from the selected articles of your Literature Search. You must identify important themes as well as the regularities and inconsistencies in the information (Polit & Beck, 2017). When constructing the summaries of your articles be sure to describe the findings of the study, validity of the evidence, any gaps in the evidence, and identify the contributions of the proposed change that will result in better patient outcomes.

Question:

What has been the “Muddiest Point” thus far in the process of structuring your Change Proposal? What would allow you to understand this process better?

References

Polit, D. & Beck, C. (2017). Nursing research: Generating and assessing evidence for nursing

practice, 10th edition. Lippincott Williams & Wilkins:
4. Understanding the health care system at a local level is important to consider when planning evidence based practice implementation because it requires various resources, organizational structure, and understanding of culture. It’s pivital that various resources such as funding are determined because health care facilities are paid by government programs such as Medicare and Medicaid but also rely on insurance plans, and out of pocket (Schreck, , , & , 2020). Without adequate funding, a health care facility will not be able to function accordingly which in turn could lead to closure of the facility but also hinder the ability to apply evidence based practice approaches due to inadequate staff or supplies. Organization structure is important for consideration because it will help indicate how evidence based practice will be utilized in the health care setting. In addition, organizing accordingly can help facilitate change properly because the process from start to finish has been established; including all the key components to make the implementation successful (Bonham, Sommerfeld, Willging & Aarons, 2014). Another aspect to consider when planning to implement evidence based practice is the culture; it’s important to assess willingness to learn and the policies of the environment to take into consideration which can play a significant role in influencing successful implementation; “because it influences the cooperation of the stakeholders in the process” (M., 2019).

An anecdotal that was presented by my preceptor was in regard to proper hand washing; the more frequent hand washing is performed, the less likely germs will spread between human to human interaction. Therefore, between patients it’s important to perform hand hygiene. This in comparison to prior when hand hygiene wasn’t so stressed, evidence practice showed it made a difference.