A call to action means the leader knows when strategies for change need to be altered to foster effective followership. Theoretical Foundations of Nursing. Nurse leaders’ behaviours influence staff actions that contribute to change (Drucker, 1999; Yukl, 2013). Knowing how non-linear theories work can advance organizational functioning in health care organizations and systems in the twenty-first century. Likewise, any change in a person also affects the social level, bringing forth changes that provide alternatives in institutionalized relationships and roles, normative structures, and perceptual and cognitive orientations (Chin & Benne, 1969). While not everyone will embrace change, individuals respond on a continuum that ranges from a lack of enthusiasm to overt sabotage (Gaudine & Lamb, 2015). Despite the best of intentions to improve organizational function and improve quality and safety of patient care, contextual factors may not be fully explored or considered in the change process. (2007). How do you normally respond to change in your personal life? Cindy is an RN with three years’ experience working on a busy surgical unit in a large urban hospital. Rather, the problems are thought more likely to be within the attitudes, values, or norms of various client-system relationships. Navigating complex organizational structures through formal and informal power networks is foundational to setting the stage for a successful change. Weiss, S. A., & Tappen, R. M. (2015). We continue to discover that the most critical knowledge for all of us—and for leaders especially—turns out to be self-knowledge.

The Medicine Wheel nutrition intervention: A diabetes education study with the Cheyenne River Sioux Tribe. doi:10.1016/j.jada.2010.03.003. Kurt Lewin and complexity theories: Back to the future? The Teen Access and Quality Initiative: Improving Adolescent Reproductive Health Best Practices in Publicly Funded Health Centers. The change agent has two main responsibilities: to change oneself and to build capacity in others. This second stage is often the most difficult due to the fact that there is a level of uncertainty and fear associated with change (Shirey, 2013). Davis. The change process can be related to the nursing process and is described by Sullivan (2012) in four steps. Change theories can be linear or non-linear; however, even linear theories do not unfold in a systematic and organized pattern.

The six phases of Havelock’s model are as follows: Rogers’ five-step theory explains how an individual proceeds from having knowledge of an innovation to confirming the decision to adopt or reject the idea (see Figure 9.3.1) (Kritsonis, 2005; Wonglimpiyarat & Yuberk, 2005). MacPhee, M. (2007). The Journal of Nursing Administration, 43(92), 69–72. New York: Harper & Row. (2004). There is no assumption that better technical information can resolve a client’s problems. W.G. A change agent is an individual who has formal or informal legitimate power and whose purpose is to direct and guide change (Sullivan, 2012). This person identifies a vision and rationale for the change and is a role model for nurses and other health care personnel. Unfreezing is the first stage, which involves the process of finding a method to assist individuals in letting go of an old pattern of behaviour and facilitating individuals in overcoming resistance and group conformity (Kritsonis, 2005). Advocacy Guide for Nurses: How To Be a Change Agent. According to the classic model developed by Bennis, Benne, and Chinn (1960), three strategies can be used to facilitate change. Most mid-level and top-level leaders have more experience, and thus, naturally, mean that they know better, if not the best (Chin & Benne, 1985).

Success at this stage will create a new equilibrium state known to be the new norm or higher level of performance expectation (Shirey, 2013).

A guide to knowledge translation theory. Drucker, P. (1999). A support system is very vital for a person who wants to realize change.

Strategies are used to change the group dynamics to encourage members to act based on group decisions. The leader takes on an inspirational role, expressing confidence and recognizing staff as providing meaningful contributions to the change process.

“Nothing is constant in this world but change.”.

29–30, Kritsonis, 2005; Wonglimpiyarat & Yuberk, 2005, Thietart & Forgues, 1995; Wagner & Huber, 2003, https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/saskatchewan-health-initiatives/patient-and-family-centred-care, http://www.brighthubpm.com/change-management/86803-havelocks-theory-of-change/, Leadership and Influencing Change in Nursing, Lewin’s 3-Stage Model of Change: Unfreezing, Changing & Refreezing, Next: Using Advocacy to Galvanize Ethics into Action, Creative Commons Attribution 4.0 International License. The individual does not passively accept what comes to him/her, but takes action proactively to advance his/her goals. Addressing the next decade of nursing challenges. Further, changes are not just rational responses to new information but occur at a more personal level of values and habits.

Change management: Magic or mayhem? Nurses are on the floor seeing the effects medicine and the health care system is having on the patient. They are cautious in their adoption of change. Gilley, Gilley, & McMillan, 2009; Quinn, 2004, Estabrooks, Thompson, Lovely, & Hofmeyer, 2006, pp.

Field theory in social sciences. International Journal of Scholarly Academic Intellectual Diversity, 8(1), 1–7. New York: Harper Collins. The medicine wheel assists community members to connect with each other, while also supporting balance and harmony across the four dimensions of mind, body, emotions, and spirit for the individual and the extended community (Clarke & Holtslander, 2010). Although Lewin’s model on change is well known and widely accepted in health care settings, it is often criticized for being too simplistic and linear. This can be achieved by the use of three methods: (1) increase the driving forces that direct the behaviour away from the existing situation or equilibrium; (2) decrease the restraining forces that negatively affect the movement away from the current equilibrium; or (3) combine the first two methods. Quinn, R. E. (2004).

Several factors can influence resistance to change.
Wonglimpiyarat, J., & Yuberk, N. (2005). Government Information Quarterly, 22(3), 411–422. Change in today's health care landscape is a daily, if not hourly, reality. Saskatchewan Ministry of Health. Related Course Outcomes After completing this chapter, you should now be able to: Austin, M. J., & Claassen, J.

However, nursing has begun to explore non-linear models as a way of guiding more unpredictable change, as these models do not follow an orderly and predictable pattern.

Thus, if a change “for the better” is suggested, people of good intentions will adopt the change. You have entered an incorrect email address! The assumption of this model is that people are naturally capable and creative and, if obstructions are removed, will rise to their highest potentials. A primary strategy of this model is the dissemination of knowledge gained from research.

The leader uses guidance to set behavioural expectations for staff performance and provides feedback on performance in the change project.

Lewin (1951) describes three actions that can assist in movement: (1) persuading others that the status quo is not beneficial and encouraging others to view a problem with a fresh perspective; (2) working with others to find new, relevant information that can help effect the desired change; and (3) connecting with powerful leaders who also support the change (Kristonis, 2005). Teachings are similar between the nations; however there are slight differences regarding the location of the four dimensions on the wheel (Clarke & Holtslander, 2010). Implementing new clinical guidelines: the manager as agent of change.

(2013) introduced the idea of a change coach, which builds upon the traditional role of a nurse leader. Effective change management requires the leader to be knowledgeable about the process, tools, and techniques required to improve outcomes (Shirey, 2013). Assist staff in identifying with and valuing how the change will affect their practice (i.e., help them to assume ownership for the change) in order to ensure that the change is embraced and sustained. Thietart, R. A., & Forgues, B. Change agents may be either external or internal. A critical analysis of the data supports the need for change, at which point the change agent determines resistance, identifies potential solutions, and begins to develop consensus regarding change. (2007) Leading change: The nurse executive’s role in implementing new care delivery models.

The Journal of Nursing Administration, 33(9), 486–492. One way to address this is through a change in values, attitudes, relationships and norms between members of the system, as well as between the system and the external environment (Chin & Benne, 1985). The medicine wheel.


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