Unit-7-Notes - Lecture notes 7 PDF

Preview

Summary

Alexandra Hodson is the professor....

Description

Unit 7 Objectives: 1. 2. 3. 4. 5.

Differentiate between spontaneous, developmental, and planned change Compare common change theories and their application to different nursing situations Analyze how the Medicine Wheel can be used as a change model Identify barriers to change Reflect on your own response to change

Chapter 9 Readings: Common Change Theories and Application to Different Nursing Situations

Nurse leader as the Change Agent  

Change Agent—> is an individual who has formal or informal power and whose purpose is to direct and guide change. This person identifies a vision and is a role model. Effective change management requires the leader to be knowledgeable about the process, tools, and techniques required to improve outcomes.

Lewin’s 3 Stage Model: Unfreezing-change-refreezing Model     

This model is best applied to stable environments It is a “a dynamic balance of forces working in opposing directions” Lewin makes note of two types of forces: driving forces and restraining forces Driving forces—> forces that push in a direction that causes the change Restraining forces—> forces that counter the driving force and hinder the change

Stage One: Unfreezing   

Finding a method to let go of an old pattern of behavior and facilitate individuals in overcoming resistance & conformity In this stage, disequilibrium occurs to disrupt the system, making it possible to identify the driving and restraining forces. A successful change ultimately involves strengthening the driving forces and weakening the restraining forces

Stage Two: Change  

Involves the process of a change in thoughts, feelings, and/or behaviours This stage is often the most difficult due to uncertainty and fear associated with change.



Therefore, it’s important to have a supportive team and clear communication in order to achieve the desired change.

Stage Three: Refreezing  

Involves establishing the change as a new habit Success at this stage will create a new equilibrium state known to be the new norm or higher level of performance expectation

Planned Change Model (Lippitt, Watson, and Westley) 7 Steps: 6. Diagnosing the problem 7. Assessing the motivation and capacity for change in the system 8. Assessing the resources and motivation of the change agent 9. Establishing change objectives and strategies 10. Determining the role of the change agent 11. Maintaining the change 12. Gradually terminating the helping relationship as the change becomes part of the organizational culture

Phases of Change: Havelock’s Model 1. Building a relationship—> Havelock regarded the first step as a stage of “pre contemplation” where a need for change in the system is determined.

2.

Diagnosing the problem—> During this contemplation phase, the change agent must decide

whether or not change is needed or desired. 3. Acquire resources for change—> At this step, the need for change is understood and the change agent gathers as much information as possible relevant to the situation that requires change. 4.

Selecting a pathway for the solution—> A pathway of change is selected from available

options and then implemented.

5.

Establish and accept change—> Individuals and organizations are often resistant to change,

so careful attention must be given to making sure that the change becomes part of new routine behaviour. Effective communication strategies, staff response strategies, education, and support systems must be included during implementation.

6.

Maintenance and separation—> The change agent should monitor the affected system to

ensure the change is successfully stabilized and maintained.

Innovation Diffusion Theory: Rogers Theory 

A distinguishing feature of Rogers’ theory is that even if a change agent is unsuccessful in achieving the desired change, that change could be resurrected at a later, more opportune time or in a more appropriate form

1. Knowledge—> The individual is first exposed to an innovation but lacks information about the innovation. 2. Persuasion—> The individual is interested in the innovation and actively seeks related information and details. 3. Decision—> The individual considers change and weighs the advantages and disadvantages of implementing the innovation. 4.

Implementation—> The individual implements the innovation and adjusts the innovation to the situation. During this stage the individual also determines the usefulness of the innovation and may search for further information about it.

5. Confirmation—> The individual finalizes the decision to continue using the innovation. (Rogers, 1995)

Rogers also defines five-categories of innovation adopters: 13. Innovators—> willing to take risks, enthusiastic and thrive on change 14. Early Adopters—> more discreet in adoption choices 15. Early Majority—> take a significantly longer time to adopt an innovation 16. Late Majority—> have a high degree of skepticism when adopting a change 17. Laggards—> last to adopt a change or innovation (aversion to change and like tradition)

Chaos Theory   

Non-human-induced responses in the environment indicate there is some predictability in random patterns Small changes of randomness in a system that constantly changes can dramatically affect the long-term behaviour of that system and make it difficult to predict future outcomes Chaos theory may be another way to structure change processes in a highly complex and evolving health care environment

Nursing Process as the Change Process 1. Assessment—> Identifying the problem, once the problem is identified, the change agent collects external and internal data as needed 2. Planning—> Requires the participation of staff that will be affected by the change. Relationships among staff may be altered if structures, rules, and practices are modified. 3. Implementation—> Plans are put into action. The change agent sets the tone for a positive and supportive climate, and methods are used to continue persuading members toward the change 4. Evaluation—> Indicators are monitored to determine whether goals have been met, and what, if any, undesirable outcomes occurred and how to respond to unintended consequences

The Medicine Wheel as a Change Model 

 

The medicine wheel, drawn as a circle with four quadrants, represents a holistic set of beliefs encompassing the mind, body, emotions, and spirit, which is foundational to the human being. These beliefs have been embraced by Indigenous cultures for thousands of years The medicine wheel guides healthy change and can be individualized to the specific needs of the client or community, taking into account the context of culture, socioeconomic status, family situation, disease process, and other significant factors, culminating in balance, healing, and growth in all four aspects

The Nurse Leaders’ Role in Managing Organizational Change

  

 



The nurse leader’s role as change agent is complex and varied in nature, and it represents significant leadership challenges The change agent has two main responsibilities: to change oneself and to build capacity in others. Change Coach—> uses coaching behaviours that include guidance, facilitation, and inspiration. The change coach encourages staff to share in decision making, thereby creating and nurturing a culture that supports input from others, facilitates creative thinking, and enhances the process of finding the best solutions to address challenges Building partnerships with staff that include two-way communication, both internally and externally, is critical to building trust and teamwork Listening to staff also means being aware of change fatigue, a condition experienced by individuals subjected to unrelenting and overwhelming change in their work environments A call to action means the leader knows when strategies for change need to be altered to foster effective follower ship.

Change Strategies According to the classic model developed by Bennis, Benne, and Chinn, three strategies can be used to facilitate change… 1. Power-coercive strategies are based on the application of power through authority. Little effort is used by the nurse leader and staff has no ability to alter the change process. Powercoercive strategies can be used when change is critical, time is limited, there is resistance, etc. 2. Empirical-rational strategies assume that knowledge is the most powerful requirement for change. This strategy assumes people are rational and will act in their own self-interest when they understand that change will benefit them. 3. Normative-reeducative strategies assume that individuals act in accordance with social norms and values that influence their acceptance of change. The nurse leader focuses on individual’s behavioural motivators such as roles, attitudes, feelings, and their interpersonal relationships as an effective way to implement change in the health care environment.

Response and Resistance to Change We offer the following strategies to counter resistance: • Understand resistance is a natural part of the process and must be constructively addressed

• Learn why an individual is resisting the change. Perhaps the resistance may be related to the lack of understanding, which calls for support. • Link some ways to bridge the old with the new and bring some familiarity to new practices • Identify people who are willing to try new practices • Assist staff in identifying with and valuing how the change will affect their practice • Communicate a clear vision of the benefits to be gained from the change

Summary:   

One of the most difficult activities for the nurse leader is leading change in an organization The nurse leader needs excellent: communication skills, leadership skills, work effectively with staff. Being a change coach involves navigating change, generating and mobilizing resources toward innovation, and improving outcomes

Second Required Reading- National Expert Commission: A nurse call to action (Video) https://www.cna-aiic.ca/en/policy-advocacy/national-expert-commission

Additional Resources on course page: A Nursing Call to Action Atlantic Council for International Cooperation (no date). Medicine Wheel Evaluation Framework. Halifax, NS. 1-14. Note: Site has changed. Article now found at: http://static1.1.sqspcdn.com/static/f/1590842/20068323/1349103128263/Medicine_Wheel_Eval uation_Framework.pdf?token=7oPNFAm5qRmPgGBsd1TaaaxFxWk%3D The following article, which is published on SAGE Journals, has been shared with you by Joan ([email protected]): The role of nurses and nurse leaders on realizing the clinical, social, and economic return on investment of nursing care

*no remix or NCLEX question for this unit*...