DNP 805 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors
DNP 805 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors
DNP 805 Select one informatics theory from the areas of Communication Theories, Change Theories, or Human Factors
The study of human factor theory focuses on human interaction with equipment within an organization with the goal of increasing safety and satisfaction. Example: Theories on accident causation demonstrate that accidents can be caused by chains of human errors. Factors that can lead to human errors include lack of experience on how to do the job (Chung & Williamson, 2018).
Reference
Chung, A. Z. Q., Williamson, A. (2018). Theory versus practice in the human factors and ergonomics discipline: Trends in journal publications from 1960 to 2010 Academic Journal In Applied Ergonomics. 66:41-51. DOI: 10.1016/j.apergo.2017.07.003,
Unfreezing, moving or transitioning, and refreezing are the three processes in Kurt Lewin’s Theory of Planned Change. The first stage, unfreezing, involves acknowledging that change is required and that the equilibrium will be disrupted (Chen, 2021). The initial stage is the most difficult and time-consuming because restraining factors might prevent the change from progressing (Chen, 2021). A great example would be introducing the electronic health record. During the first stage, the old ways such as paper charge would be let go. Unfreezing the necessity for the change to be discussed in dialogues and through educational sessions. The second phase is moving or transitioning. This phase necessitates a clear action plan and may create anxiety and worry (Chen, 2021). During this phase, it would be critical to work with the stakeholders (Daly, 2017). For instance, if a facility were to transition to electronic health records versus paper charting, this step is crucial as it enables the analysis of the present situation, new structures, and other processes that are put into place to attain the desired outcome (Daly, 2017). The last stage is refreezing, during which it is critical to reinforce and incorporate the change while also conducting an efficacy audit (Daly, 2017). The change is stabilized at this point, and a new equilibrium is established (Chen, 2021). In other words, the changes made are frozen in place and become part of the normal workflow. One of the strengths of Lewin’s change model is that it is simple for others to understand. Unfreezing, transition and refreezing are easy steps to follow when implementing a change within an organization (Daly, 2017). Although its simplicity is its strength, it can also be a downfall. Some changes need a more detailed process other than just unfreezing, transitioning, and refreezing (Chen, 2021).
References:
Chen, P. (2021). A new horizon: Transitioning from an experienced to novice nurse. Journal of Radiology Nursing, 40(4), 368–369. https://doi-org.lopes.idm.oclc.org/10.1016/j.jradnu.2021.08.007
Daly, S. (2017). Development and implementation of person-centered nursing documentation. International Journal of Integrated Care (IJIC), 17, 1–3.
Kotter’s change theory goes thru a series of eight steps on how to effectively prepare the team for change and to be adaptable to the change (Carpenter et al., 2021). This theory can be instrumental in the success of using technology in advanced practice. Without setting the environment for change. One example is how the change theory was used to in a healthcare system wide practice of primary care to reduce the overall amount of opioid prescriptions among patients with chronic pain. It was vital in starting and sustaining a change long term (Carpenter et al., 2021).
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This theory really provide a solid framework with eight steps to follow for a sustainable change. It guides step by step how to prepare for the change, get buy in, and the solidify the change. This is easily used an any change planning. It is apparent that this would be successful in change implementation. This theory is so important because without the foundation work then it will not likely result in a lasting transformational change. The step that I find the most important to not miss is the development of short term wins. It is sometimes overlooked and can lead to discouragement resulting in and reverting to old practices. There are not any identified weaknesses to this theory. It is an excellent foundation to be used when planning an implementation of change.
References
Carpenter, R. E., Silberman, D., & Takemoto, J. K. (2021). Transforming prescription opioid practices in primary care with change theory. Health Services Insights, 14, 117863292110582. https://doi.org/10.1177/11786329211058283
Communication is the exchange of information and can be achieved verbally, in the written word, and even through technology. In 1986 Fred Davis was credited with the Technology Acceptance Model (TAM). This communication theory bases the success of any new technology on its perceived ease of use and perceived usefulness in the environment being used. For healthcare, we see this theory of use with electronic health records (EHR) and telemedicine. (Rahimi et al., 2018) These are two prevalent forms of communication used in healthcare today.
This theory stands out because it refers to the “perceived” ease of use and “perceived” usefulness. No matter how wonderful and easy the developers or those who choose a piece of technology think it is if the end-users have issues, then can it indeed be that good. Even more so, how complex will implementation be? Applying the TAM model, we can look at what the perceptions are to guide teams through deciding what to and what not to use. The plans for successfully bringing the team on board with a new system can be developed early on. One study conducted found that the perception of technology by nurses caused issues with the acceptance of said technology. The introduction of a new EHR system was perceived to be difficult and time-consuming and therefore was challenging to gain acceptance in its use. (Tubaishat, 2017)
This theory reminds us to look at the overall picture when implementing new communication technology. The programs and dynamics may be superior, but success can be hard to find without a well-thought-out introduction and implementation plan. With things such as EHR, we are trying to find a way to exchange information in the easiest, most complete way possible. I found it interesting that the most straightforward informatics theory made a powerful statement. Perception is just as crucial as actual use. Effective communication only happens when all involved are working together and have the same understanding of the tools being used.
References
Rahimi, B., Nadri, H., Lotfnezhad Afshar, H., & Timpka, T. (2018). A systematic review of the technology acceptance model in health informatics. Applied Clinical Informatics, 09(03), 604–634. https://doi.org/10.1055/s-0038-1668091
Tubaishat, A. (2017). Perceived usefulness and perceived ease of use of electronic health records among nurses: Application of technology acceptance model. Informatics for Health and Social Care, 43(4), 379–389. https://doi.org/10.1080/17538157.2017.1363761
Lewin’s model of change is essential in healthcare informatics as change is the norm versus change being abnormal. This model of change provides teams with a clear transition path in order to hardwire new processes for improvement or organizational change that is required. “The action research model, the positive model, and Lewin’s change model indicate the stages of organizational change. This study examined the three stages of Lewin’s model: unfreezing, movement, and refreezing”, (Hussain, 2018).
In my current position as a corporate nurse executive I am implementing a full electronic record in 7 hospitals. This requires intense planning and onsite support to leaders and direct care staff. Using a model such as Lewin’s model of change provides structure in order to implement a huge change such as moving from a full paper record to a full electronic record. The theory is very structured which could be a challenge when the plan does not work as organized.
Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Hussain S.T., Lei S., Akram T., Haider M.J., Hussain S.H., Ali M.
(2018) Journal of Innovation and Knowledge, 3 (3) , pp. 123-127.
Human factors that affect the implementation and use of health care technology include workforce perception, attitude, motivation, stakeholder support, and appropriate training. (Matthews & Proctor, 2021).
A study done by Matthews & Proctor reaffirmed findings that the user’s biggest barriers are time and technology barriers. For example, system compatibility, state requirements, and interoperability between devices. (Matthews & Proctor, 2021). The study discussed several models. The model is most related to the healthcare Health Belief Model (HBM). Health care professionals should believe that the new technology will improve confidence in work, and new technology should be taught in a self-paced environment to improve chances of success and sustainability. (Matthews & Proctor, 2021). One of the main things to consider when implementing healthcare technology is to remember the people who actually use the programs/system. (Matthews & Proctor, 2021). Based on the article ways to overcome challenges to human factors include training must be clear, understandable, flexible, and easy to become skillful in use. (Matthews & Proctor, 2021) Without research in human factors, there will be an increase in unsuccessful implementation. (Matthews & Proctor, 2021).
As a DNP student and hopefully graduate, understanding the human factor of health technology is important. As a DNP graduate using core values will assist in applying a Christian World view through humility, empathy, and compassion when teaching/facilitating new technology to staff. Having an understanding that human factors such as system compatibility, state requirements, and interoperability between devices are often beyond the end-users.
Matthews, S. D., & Proctor, M. D. (2021). Public Health Informatics, Human Factors and the End-Users. Health Services Research and Managerial Epidemiology. https://doi.org/10.1177/23333928211012226
I also found these knowledge about change theories. Change theories represent a framework of theoretical and empirically grounded knowledge about how changes occur that goes beyond any one project that is supported by evidence. It is a subset of change research which is any scholarship that focuses on how to make change happen. Change theories also represent generalized knowledge about how change works. Some theories are mature, with a strong empirical basis, whereas other theories may have emerged from a single context and thus are supported by more limited evidence. In the realm of educational change, there are relevant theories that deal with many different components and processes related to change. In contrast, a theory of change is project-specific and related to evaluation and it is informed by change theories. This makes the underlying rationale of a project explicit, which supports planning, implementation, and assessment of the project. In addition, a theory of change is often required by funding agencies as part of grant proposals (Reinholz, & Andrews, 2020).
Also, the consensus from the growing body of theory is that the value of learning, and its evolvement, is dependent upon environmental change. Change takes many forms – spatial or temporal, biotic or abiotic, constituting one or more parameters – and often times change is interrelated and autocorrelated However, when comparing models on the evolution of learning, it is clear that what is meant by change and how change is incorporated into these models is highly variable (Dunlap, Austin, & Figueiredo, 2019).
References:
Dunlap, A. S., Austin, M. W., & Figueiredo, A. (2019). Components of change and the evolution of learning in theory and experiment. Animal Behaviour, 147, 157-166.
Reinholz, D. L., & Andrews, T. C. (2020). Change theory and theory of change: What’s the difference anyway? International Journal of STEM Education, 7(1). https://doi.org/10.1186/s40594-020-0202-3
Change Theory
I would like to explore Kurk Lewin’s Change theory. Kurk Lewin’s change theory is a thorough change model to comprehend why change takes place and what should be done to deliver change in the best possible way. Lewin established the change model to demonstrate how people react when facing changes in their lives.
There are 3 stages of this process. They are unfreezing, changing, and freezing or refreezing stage.
Unfreezing stage. In this stage, the person has an existing state and should be ready and willing to make a change. For example,it could entail anything from finding out about a problem to receiving permission to make a change. This step is to prepare an establishment for the change that is necessary. This is an essential step and can be accomplished by initially recognizing the need for change, then, later establishing that crucial step which can be achieved by firstly recognizing the need for change. It would be imperative to create an awareness of the need for change among the staff. The goal is to establish a key to establish a compelling narrative to outline why the current way of performing tasks cannot continue the way that they are done.This stage requires you not to look at the ideas, values, attitudes, and behavior that define the company. By the utilization of a constructive analogy, you can assess and prepare to adjust the current foundations since they may not sustain the additional floors. If this is not done, the entire structure may collapse. This is probably the most difficult part of the change. This process may upset the routine of the staff (Aktas, 2021).
Phase II – Change
Change/ Moving to a New Level of Change
The second stage entails a process of change–in thoughts, feelings, behavior, or all three, that is in some way more liberating or more valuable than doing things the old way. Throughout this stage, the people involved are persuaded that the new way is better than the old.
Having investigated the current situation, new structures and processes are put in place to achieve the required improvements. This is the most time-consuming, costly, yet productive stage as far as tangible results go (Kaminski, 2011).
3rd Stage is Refreezing
The third and final stage comprises creating the change as a new habit or method to become the standard operating procedure or routine. Without some process of refreezing, it is easy to relapse into the old ways of doing things. Rewards, support, and champion leadership continue to be significant through this stage, which is essentially constant until the next major change is needed. The changes employed are ‘frozen’ in place to ensure that they become part of normal working procedures. This is done by instituting encouraging structures such as policies, rewards, ongoing support, and a solid orientation to the new system for incoming personnel (Kaminski, 2011).
In our fast-changing healthcare industry, we can utilize Kurk Lewin’s change theory to guide the advancement of our nursing practice. Medication administration through the usage of paper can be dangerous and lead to medication errors. Technological improvements and computer-assisted devices can assist in safer medication administration. Executing a change in practice within the healthcare system to prevent medication errors is essential. Medication errors in this industry can be detrimental for both nurse and patient. This can be reduced significantly using technology to enhance patient care and create better time management for busy nurses. Bar-coded medication administration is one type of technology that uses a scanning device to compare bar codes on patient identification bands with bar codes on prescribed medications, electronically verifying the medications against the medication records, thereby reducing medication errors significantly (Sutherland, 2013).
Kurk Lewin’s change can be an advantage to the DNP program. The DNP program is another level of learning which requires a change in how we process pieces of information and apply them. To propel through the DNP program, we are required to let go of how we routinely function, make the new change, and solidify the new change to become successful. For example, we will be assessing the criteria, and different levels of reviews when we conduct research studies, by making sure that they are appropriate for the situation. I functioned at the basic level in technology. The application of Kurk Lewin’s change model can help to advance my technological skills when I moved from my current stage to my desired state to become successful in the DNP program.
The weakness to prevent this change to be used is the resistance to the change. To make the change happen, I must identify the obstacles and balance them with a driving force. This driving force can be self-motivation as well as inspiration from everyone on this platform.
Our lives consist of all events in our past, present, and future that impacts our developments, attitudes, and behavior. From a Christian Worldview, all these aspects should be considered when making change. Therefore, we need to be patient with each other and ourselves. I believe that even our professors and peers will be mindful of this fact to give us grace and mercy as we propel through this challenging and intensive program. Thank you very much for your consideration. It would be essential to persist with faith, believing that changes come with practice, time, and determination. We must endeavor to endure through this DNP program and bear in mind that God’s promises are sure. He promises that if we commit our plans to him he will make them succeed. He is a rewarder for those who diligently seek him.
Reference
Aktas, Mert. (2021). Lewin’s Change Model – everything you need to know (userguiding.com)
Kaminski, June. (2011). Theory applied to informatics – Lewin’s change theory | Canadian journal of nursing informatics (cjni.net)
Sutherland, Karen. (2013). Applying Lewin’s change management theory to the implementation of bar-coded medication administration | Canadian journal of nursing informatics (cjni.net)
The rising use of the Internet and information technology has made computerized interventions an attractive channel for providing advice and support for behavior change. Health behavior and behavior change theories are a family of theories which aim to explain the mechanisms by which human behaviors change and use that knowledge to promote change. Among the best-known of these theories are the Social Learning and Social Cognitive theories, the Health Belief Model, the Theory of Reasoned Action, and its successors the Theory of Planned Behavior and the Reasoned Action Approach, and the Transtheoretical model (Stephanie Medlock, Jeremy C Wyatt, 2019).
The five stages of human behavior change are precontemplation, contemplation, preparation, action, and maintenance. Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future. Many individuals in this stage are unaware of their problems. Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to act. Preparation is a stage that combines intention and behavioral criteria. Individuals in this stage are intending to act in the next month and have unsuccessfully acted in the past year. Action is the stage in which individuals modify their behavior, experiences, or environment to overcome their problems. Action involves the most overt behavioral changes and requires considerable commitment of time and energy. Maintenance is the stage in which people work to prevent relapse and consolidate the gains attained during action. For addictive behaviors this stage extends from six months to an indeterminate period past the initial action (Cane, J., O’Connor, D., & Michie, S. 2012).
The three examples of how behavior change theories have been applied in computer-based interventions: a system to aid users to quit smoking, a decision aid for choice of breast cancer therapy, and an internet-based exercise program for reducing cardiovascular risk. Behavior change theory can be applied in health informatics interventions in several ways; for example, to select participants for a particular intervention, to shape the content of the intervention to effectively influence behavior, or to tailor content to individual needs. Application of these theories to provide personalized advice is a young but promising area of research, and could inform other decision support interventions, including those that provide support for clinicians (French, S. D., Green, S. E., O’Connor, D. A., McKenzie, J. E., Francis, J. J., Michie, S., Grimshaw, J. M. 2012)
References
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behavior change and implementation research. Implementation Science, 7, 37. doi:10.1186/1748-5908-7-37
French, S. D., Green, S. E., O’Connor, D. A., McKenzie, J. E., Francis, J. J., Michie, S., … Grimshaw, J. M. (2012). Developing theory-informed behavior change interventions to implement evidence into practice: A systematic approach using the theoretical domains framework. Implementation Science, 7, 38. doi:10.1186/1748-5908-7-38
Stephanie Medlock, Jeremy C Wyatt (2019) Health behavior Theory in Health Informatics: Support for Positive Change: https://pubmed.ncbi.nlm.nih.gov/31411160/