DNP 815 Describe the application of a change theory from the perspective of a DNP-prepared nurse in relation to the proposed changes in your DNP Project

DNP 815 Describe the application of a change theory from the perspective of a DNP-prepared nurse in relation to the proposed changes in your DNP Project

DNP 815 Describe the application of a change theory from the perspective of a DNP-prepared nurse in relation to the proposed changes in your DNP Project

Change is inevitable in health care. A significant problem specific to health care is that almost two-thirds of all change projects fail for many reasons, such as poor planning, unmotivated staff, deficient communication, or excessively frequent changes. (Barrow, et al 2021). All healthcare providers, at the bedside to the boardroom, have a role in ensuring effective change. Using best practices derived from change theories can help improve the odds of success and subsequent practice improvement

Lewin.s change theory  singled out unfreezing, moving, and refreezing as significant phases of change.  The existing hospital fall prevention program with limited exercise/physical therapy is not efficient. Awareness of the problem leads to the demand for change. Thus, it is supposed that interventions of patient education and regular exercises can be effective for senior hospitalized patients. The second stage of the theory will contribute to the development of a detailed plan of patient education interventions. Moreover, this stage defines the responsible parties and outlines the expected outcomes. Also, it is important to assess the possible risks of the planned interventions. Finally, the third stage of the theory is used to manage the assessment of the planned interventions. In case they are efficient, it is possible to use them on a regular basis. On the whole, Lewin’s Three-Step Change Theory is useful for managing the process of change in nursing because it helps to follow all-important stages and make the change project more efficient.

Barrow, J. M., Annamaraju, P., & Toney-Butler, T. J. (2021). Change Management. In StatPearls. StatPearls Publishing

The planned behavior theory predicts an individual’s intention to engage in a behavior at a specific time and place. The theory was intended to explain all behaviors over which people have the ability to exert self-control. The key component to this model is behavioral intent which are influenced by the attitude about the likelihood that the behavior will have the expected outcome and the subjective evaluation of the risks and benefits of that outcome. 

Hence for this to be applied to my proposed DPI project on patient centered fall prevention the patient needs motivation and ability to perform. the patient is expected to have actual control over the behavior, this theory has been applied in a wide range of health behaviors and intentions including smoking, drinking, health services utilization, breastfeeding, and substance use, among others with great success and I believe it can be achievable through education and communication if applied to patients at fall risks who has certain behaviors that needs a change in attitudes (such as use of call lights,). and ability to exert self-control.

The proposed change model is Lewin’s change model, which offers a simplified approach to change implementation. This model proposes three fundamental strategies, i.e. unfreezing, movement and refreezing. This is considered valuable for successful implementation. This change model contemplates three distinct stages. The first is refreezing, which supposes disruption. It supposes creating awareness about the need for change, thereby promoting support for said change. The second stage is movement, which means deciding on how to proceed with actual implementation of the change intervention. The third and final stage, i.e., refreezing, implies assimilating and normalizing the change intervention as standard practice (Teguh et al., 2019).

For this change model to be achievable and successful been open to feedbacks , regular communication , education and getting everyone involved is the key .

Teguh, A., Hariyati, R. T. S., & Muhaeriwati, T. (2019). Applicability of Lewin’s change management model for optimization management function in nursing delegation between head nurse and team leader: A mini project in Jakarta military hospital. International Journal of Nursing and Health Services (IJNHS), 2(2), 66-74.

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Chronic diseases such as hypertension, diabetes, and end-stage renal disease are a few of the complex chronic conditions with high costs of chronic care, and health care organizations continuously demonstrate implementation of program designs to manage chronic conditions (Gilman, 2021). Chronic care management is a highly complex phenomenon requiring innovative frameworks. Complex adaptive systems (CASs) as a means of interactions within chronic care environments and understanding relationships can help develop a more comprehensive chronic care model to improve service excellence, quality of care, and quality of life of individuals with chronic conditions (Gilman, 2021).

 Complex adaptive systems (CAS), as a framework for an integrated patient-care model, incorporates a holistic approach to strategies to improve health outcomes, improve quality of life, and decreased health care costs. The healthcare burden of chronic disease remains high, wherein the healthcare system’s resources continue to be challenged. Patient engagement in health care results to lower healthcare costs and better clinical outcomes. The self-care theory of Virginia Henderson would definitely benefit the population of patients with chronic conditions such as adherence to nutrition, lifestyle, and compliance with medications, and patients would feel empowered by their self-managed care actions (Santana, 2020).  

As DNP-prepared nurses, we need to identify any areas for improvement and develop care models and innovative programs to promote quality of life and improve health care quality for individuals with chronic conditions and continually assess best strategies or explore new horizons to decrease or reduce health care costs.

References

Gilman, P. (2021). Complex adaptive systems: a framework for an integrated chronic care model. Advances in Nursing, 44 (4), 330-339.

Santana, M.B.A., Vieira da Silva, D.M.G., Echevarria-Guanilo, M.E., Lopes, S.G.R., Romanoski, P.J., & Boelli, J.E.W. (2020). Self-care in individuals with chronic kidney disease on hemodialysis. Revista Gaucha de Enfermagem, 41.

A DNP-prepared nurse is equipped with adaptive features of leadership, restructuring of healthcare services, and transformation of research into clinical practices. It is, however, supposed that DNP nurses are having the capacity of generating innovative techniques through the integration of nursing knowledge and skills into nursing practice for the attainment of quality improvement outcomes in the clinical environment. The major requirement of healthcare

services is collaboration at a professional level and among different disciplines while addressing complicated issues leading to the application of advanced practices, processes, and actions.

Normally, the intra-professional collaboration is built on certain theories and strategies to sustain change management in addition to the application of continuous quality improvement in healthcare services (Andersen & Rovik, 2015).

Change theory is based on three stages known as unfreezing, moving, and re-freezing. Following the supposed changes in the DNP project, a DNP-prepared nurse can apply the change theory not only to manage transformation in the framework of the healthcare system but also to cope up with the dynamics in nursing. The nurse can utilize the concept of the first stage of change theory to overcome the overall resistance and facilitating the acceptance of change

among responsible individuals (Edwards et al., 2018). In this way, the proposed changes in the

DNP project can be accepted broadly and let the nurse find out a successful framework while strengthening the driving forces and reducing the restraining factors. Hence, the utilization of a positive attitude and less use of restraining activities which are negatively affecting the achievement of the project can help the nurse to meet up the requirements of proposed changes.

Furthermore, the change can be acquired effectively when an individual can bring change in his behavior or his or her attitude. The perceptions of the individuals can be changed along with the encouragement to view the problem or the issue and their retrospective solutions. Furthermore, the nurses can create an affirmative environment to change through the dissemination of relevant information supporting the change. Similarly, the connectivity among

the powerful leaders can help the nurses to bring out the change process. Hence, the presence of supportive team members and inter-team communication can help the nurses to acquire their desired results.

References

Andersen, H., & Rovik, K. A. . (2015). Lost in translation: A case study of the travel of lean thinking in a hospital. BMC Health Services Research, 401. DOI: 10.1186/s12913-015-1081-z.

Edwards, N., Coddington, J. and Erler, C. (2018). The Impact of the Role of Doctor of Nursing Practice Nurses. Nancy E. Edwards Medical Research Archives, 1-11.

Change theories play a huge role in how leadership not only notices where changes are necessary in the clinical setting but also how to appropriately initiate said change. Change can be quite challenging to many staff members in the clinical setting as we become accustomed to a routine. Leaders need to find a change theory or model that is best suited for the facility that will not create a lot of strife and discouragement in the facility, which can then lead to safety concerns. For my project, as mentioned in previous discussion posts and papers, the change theory that makes the most sense is Roger’s Theory Change Model which has also been termed the Diffusion Theory. In this theory, as said by Udod and Wagner in 2018, there are five main steps and are as follows: knowledge, persuasion, decision, implementation, and confirmation (Udod & Wagner, 2018). These steps allow this learner to implement this new change, then evaluate whether or not it is beneficial and made a difference, then if it did find a way to implement it permanently or discard it if it did not prove beneficial to client care and safety. This learner has already spoken with the department leads and they agreed that this change model is most appropriate and if the project intervention proves beneficial, then they will permanently implement this into their units to improve staff communication and client safety.

References

Udod, S. A., & Wagner, J. (2018). Common Change Theories And Application To Different Nursing Situations. Go to the cover page of Leadership and Influencing Change in Nursing. Retrieved August 21, 2022, from https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-9-common-change-theories-and-application-to-different-nursing-situations/

Improving the workplace requires that employees be actively engaged, and innovation never stopped or be maintained. For this happen, change in this direction becomes inevitable. A thorough grasp of organizational theory provides insightful information on the application of change theory from the perspective of a DNP-prepared nurse in relation to proposed changes in my DNP project. Dziak (2020) noted that organizational theory describes how organizations, a group of people who shared common goals, work, operate, and change. Additionally, organization theory integrates the system theory and affords the opportunity to view change theory as an interconnected network of higher and lower order. Change theory provides a better way of viewing the world and its accompanying intricacies. Additionally, certain leadership style is needed to guide a proposed DNP-project in its implementation to a complete success

Planned change is imperative for numerous reason in the practice of nursing; however, the process can be very daunting or challenging given the complexities inherent in the implementation of the change. It, therefore, becomes unavoidable that a proper understanding and the use of a change theoretic foundation can guide agents involved in the implementation of the change to a success (Mitchell. 2013). Change cannot be fully achieved without a certain type of leadership style. Countless number of forces drive changes in healthcare. Shortage of clinical professionals, scarcity of medication, cost-shifting, new federal policies, environment of care, among many other factors, drive change. Irrespective of the change, a change theory and the appropriate leadership style, especially a change vector, guides implementation and the overall success of a change. My leadership style is transformational and as a DNP-prepared nurse, I shall deploy the work of Lewin to guide my proposed DNP project in its implementation.

References

Dziak, M. (2020). Organizational theory. Salem Press Encyclopedia.

Mitchell, G (2013). Selecting the best theory to implement planned change. Nursing Management, 20 (1), 33-37.

Change is inevitable in any healthcare system. If a healthcare organization does not change to reflect current practice, then patients do not receive the best care. An organization must identify a change method to format the change process needed, or there may not be successful. Kurt Lewin’s change theory is the theory that will be used in my DNP project. There are three steps to Lewin’s theory, Unfreezing, Moving, and Refreezing (Burnes, 2020). The unfreezing process is challenging as those involved must alter their thinking and behavior to equip them for future change. This process allows the fluidity that is required for change to take place. The moving process occurs when the forces pressing for change are greater than those resisting the change. In the freezing process, there is stability in the behavior that allows for the transition to continue. It is challenging because it requires a permanent shift in policies, behaviors, and practices.

Organizational change using Lewin’s theory allows for continual necessary change to keep up with the ever-changing healthcare environment. As a DNP-learner, with the DPI project, it will be crucial to create a vision for change, motivate those at the practice site, get the necessary support, and manage the transition needed throughout the project (Hussain et al., 2018). In the Unfreezing stage, necessary steps include identifying the benefits to the patients and the organizations, getting leadership support, education, and implementing a communication plan. In the Moving stage, implementation will occur, but there must be open communication between the staff, providers, and this learner to address any issues or concerns. Leadership, including this learner’s mentor, will still need to assist with any problems that would keep the project from moving forward. Refreezing would occur should this project become a part of daily practice once the project ends. This will take a commitment from the organization to ensure the necessary supplies and policies/procedures are needed to continue.

References

Burnes, B. (2020). The Origins of Lewin’s Three-Step Model of Change. The Journal of Applied Behavioral Science, 56(1), 32-59. https://doi.org/10.1177/0021886319892685

Hussain, S., Lei, S., Akram, T., Haider, M., Hussain, S., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

I am not sure where this statement comes from but, I was often told “until the pain of no change exceeds the pain of change there will be no change.” I say this because, my DPI involves hypertensive patients thus, the change theory is difficult as HTN is often symptom free. That being said, I believe the transtheoretical change model best applies to the needed outcome. The theory begins with the premise that triggers promote change (LaMorte, 2019). These triggers are often developmental, situational, organizational or illness related. People in this stage make decisions that ultimately affect their lives (LaMorte, 2019). Of course, change is a process not instantaneous as the personal, community and societal conditions differ with each patient the time line for goal achievement will also vary. DNP should remember to inspire confidence and celebrate small victories(LaMorte, 2019). This process often includes clarification of the nurse role, using the patient’s support system and being aware of the patients health literacy (LaMorte, 2019). Nurse remember that the base of the theory includes six components: precontemplation, contemplation, preparation, action, maintenance, and termination (LaMorte, 2019). Hence as we prepare for our DPI project we work through each phase of the patient’s journey with our intended outcome being a termination of the process as the change is now an imbedded practice (LaMorte, 2019). LaMorte. (2019). The Transtheoretical Model (Stages of Change). The Transtheoretical Model (Stages of Change). https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html#:~:text=The%20TTM%20is%20not%20a%20theory%20but%20a,change%3A%20precontemplation%2C%20

Change is essential in all aspects. It is the ability to modify and or alter. This is important as it is the opportunity to move forward and experience new things. If it does not occur, stagnant feelings can arise. As the environments surrounding us are continuously changing, negative emotions and outcomes will appear if change does not happen. For instance, if a company fails to evolve to meet clients’ needs, the organization will fail. Despite its known benefits, it is difficult for this to be a complicated process for many reasons. Individuals are afraid of the unknown, and this is a step that can cause unforeseen circumstances. With change, things such as failure are a possibility, and this is an evident and challenging event to risk encountering. The process of being successful entails time and effort. If there is a lack of motivation or impatience, this can cause increased stress. The required task can seem exhausting for some; giving in to what is already part of a routine may seem easier at times. 

Change can be a process made more accessible by following steps that have been proven to be effective such as nursing theories. Rogers’s diffusion and innovations theory include five stages knowledge, persuasion, decision, implementation, and confirmation (Hits et al.,2022). Hits et al. (2022) used this model to implement a brief tobacco sensation intervention in community pharmacies. The study identified that the intervention was feasible, but workflows have significant challenges (Hits et al.,2022). 90% believed that community pharmacies should promote tobacco quitlines (Hits et al.,2022). Additional research was suggested to identify and evaluate systems (Hits et al.,2022). Lewin’s three-stage change model is another theory of use. The steps include unfreezing, movement, and refreezing (Tuyet & Gandolfi, 2020). Tuyet & Gandolfi (2020) used this theory to implement change in an academic division by having professors change the quality of student preferences added to lectures by investing time in preparing lessons. The study participants showed higher job satisfaction and commitment (Tuyet & Gandolfi, 2020).

Applying these two theories in the project can be pertinent in several ways. Rogers’s approach is vital as it provides a guide on how, why, and the rate of the project. The study above demonstrated that it was effective, but workflows had to be considered. As per Lewin’s theory, it can be more specific to the organization, ensuring that staff does not return to the old, advanced directive workflow. 

References:

Hilts, K. E., Corelli, R. L., Prokhorov, A. V., Zbikowski, S. M., Zillich, A. J., & Hudmon, K. S. (2022). Implementing brief tobacco cessation interventions in community pharmacies: an application of Rogers’ Diffusion of Innovations Theory. Pharmacy (Basel, Switzerland), 10(3). https://doi.org/10.3390/pharmacy10030056

Tuyet Thi Tran, & Gandolfi, F. (2020). Implementing Lewin’s Change Theory for institutional improvements: A Vietnamese case study. Journal of Management Research,20(4), 199–210.