Change Theories of Nursing
Change refers to things or circumstances that turn out differently after a specific time. It could be planned or unexpected. Unexpected changes result in unforeseen outcomes, whereas planned changes attain predetermined aims.
In the nursing context, one of the most challenging difficulties of complex healthcare organizations is dealing with change successfully.
Rising healthcare expenditure, decreased reimbursement, labor shortages, modern technology, and an aging population are just a few of the critical determinants that fuel change, whether in a clinical or hospital context.
For instance, modern healthcare organizations must constantly understand the need for change to modernize their structure, foster better quality, and retain employees.
However, it is imperative to note that not every organizational change program succeeds. Thus, several factors affect changes outcomes, including the content and method of change, the setting of the organization, and individuals inside the company who are associated with the change.
The following change theories of nursing help explain the aforementioned factors and outcomes.
1. Kurt Lewin’s Change Theory Nursing
A. Biography of Kurt Lewin
Kurt Lewin was a German-American psychologist widely regarded as the father of contemporary social psychology. He studied group dynamics, transformative learning, and active experimentation. Thus, Lewin’s three-phase change paradigm from the 1950s still guides planned change up to date.
This model explains the competing forces that seek to preserve the status quo while also pushing for change. The three phases of change indicated by Lewin in this concept are unfreezing, movement, and refreezing.
B. Major Concepts of Kurt Lewin’s Change Theory of Nursing
There are three primary concepts in the Change Theory: driving forces, restraining forces, and equilibrium.
- Driving Forces. Driving forces move in a path that results in a change. They promote transformation by pushing the patient in the preferred direction. They create a shift in the equilibrium in the direction towards change.
- Restraining Forces. The restraining forces are those that counteract the driving forces. They impede change by pushing the patient in the other path. They also induce a shift in the equilibrium that is reluctant to change.
- Equilibrium. Equilibrium is a condition in which driving forces are equal to restraining forces, and there is no change. It can be elevated or descended due to driving and restraining forces changes.
C. Subconcepts of Kurt Lewin’s Change Theory of Nursing
Lewin’s theory has three unique and critical stages. These are the following:
- Unfreezing. As per Lewin and his study, for an organization to effectively implement change, it must be planned, which necessitates the unfreezing of the system. When the change agent highlights the urgency for change and tries to persuade group members that change is essential, the phase of unfreezing begins. This phase is commonly attributed to the discontent phase since the change agent evokes such a response in others, helping them understand that change is required. This discontent phase is required to encourage change, and it might be extrinsic or intrinsic. Thus, to ensure the success of this change attempt, the change agent must manage conflicting interests and reinforce the necessity for change to occur. Additionally, the change agent must also prevent opposition from those who are terrified of changes. People who resist change commonly encounter heightened stress and demand comfort, putting an additional burden on the change agent. When this happens, motivation suffers. Instead of consoling such people, the change leader should rather ask, “What would you like to do about that?”
- Movement. The movement phase is the next stage of Lewin’s theory. The change agent develops, plans, and executes relevant strategies. They also make sure that the driving factors outnumber the restraining ones. Because change is a complicated process, it necessitates careful preparation, proper timing, and, if possible, progressive implementation. The relevance of the change agent’s leadership potential becomes clear at this phase when confronting and correctly responding to the heightened stress felt by all those impacted by the change. Lastly, during the movement phase, the change agent is accountable for providing motivation, defining goals, building rapport, and prioritizing change.
- Refreezing. Refreezing is the ultimate stage of Lewin’s theory. Since this phase aims to incorporate change into the status quo, the change agent must stabilize the system. If the phase is not completed, the change will be unsuccessful, and pre-change practices will continue. During this time, the change agent must be beneficial and strengthen the adaptive efforts of all concerned members of an organization. Many investigations demonstrated that the most crucial variable regarding change success is people, as without the support of people, no matter how well established the change program was, the change will not be accomplished fortuitously.
D. Kurt Lewin’s Change Theory of Nursing: Theory and the Nursing Process
- Assessment. Once the problem has been identified in the Assessment stage, the change agent gathers as much external and internal data as required, such as patient satisfaction questionnaires, staff surveys. A careful review of the data validates the need for change, at which point the change agent assesses objections, discovers alternative approaches, and starts to make awareness of the need for change.
- Planning. The Planning stage involves the cooperation of employees whom the change will impact. Staff relationships may be altered if institutions, regulations, and policies are adjusted. These changes in workforce requirements may lead to a new diversity of skills, expertise, perspectives, and motives.
- Implementation. Plans are imposed at the Implementation stage. The change agent sets the standard for a positive and encouraging environment, and strategies such as giving information, education, and assisting with personnel changes are utilized to continue convincing individuals towards the change.
- Evaluation. When the intended result is achieved during the Evaluation stage, the change agent finishes the job by assigning authority to members. Rules and regulations may be required to integrate the changes into daily practice.
E. Analysis: Strength and Weaknesses of Kurt Lewin’s Change Theory of Nursing
There are strengths and weaknesses to consider, as with any theory, and this one is no exception. Kurt Lewin’s change model has both advantages and disadvantages.
Here are some of the advantages of employing Lewin’s change model:
- It is straightforward to comprehend. Several change paradigms require extensive training to master, and individuals might quickly become lost in a sea of abbreviations. Lewin’s change theory is relatively simple, with three primary stages to execute and a few procedures inside each.
- It concentrates on the behavioral aspect. The Kurt Lewin change model’s behavioral psychology goes to the core and leads people to oppose or favor change. This theory’s emphasis on individuals is consistent with many other change models that prioritize the human component of change.
- The theory is reasonable. Many people understand the Unfreeze, Movement, and Refreeze reasoning through the Kurt Lewin change model. Its simplicity allows people to gain a more profound knowledge of change management as a whole without becoming bogged down in technical terms or complex methods.
Organizations should also consider the drawbacks before employing the Kurt Lewin model since not everybody believes it is the most outstanding change model available. Here are some of Lewin’s change theory’s weaknesses:
- Kurt Lewin’s change theory is insufficient in terms of details. Some nursing theorists believe that Lewin’s change management paradigm is incredibly simplistic. The steps within each phase can also be described in various ways.
- Kurt Lewin’s change theory is too rigid and does not fit contemporary times. Some have criticized the Freeze stage of Kurt Lewin’s model as being too inflexible since it “freezes” behaviors that will only have to be unfrozen again in the coming years due to how quickly technology progresses and forces organizations to alter to keep up frequently. They believe that the final stage should be more permissive.
- Kurt Lewin’s change theory is perceived as confrontational rather than nurturing. With the focus on breaking the balance during the Unfreezing process and stirring things up, Lewin’s three-step model might be viewed as confrontational. Some argue that instead of promoting a fostering changing atmosphere, it focuses too much on the two conflicting forces striving for the overwhelming advantage.
2. Everett Rogers Change Theory in Nursing
A. Biography of Everett Rogers
Everett Rogers was a sociologist, writer, and teacher who specialized in communication. He is well renowned for his concept on the diffusion of innovations, in which he came up with the term “early adopter” or “pioneer.”
Moreover, he updated Lewin’s change theory and developed his unique five-stage paradigm. Knowledge, persuasion, decision, implementation, and confirmation are the five stages of Roger’s concept. This theory is used in long-term reform initiatives.
It is also considered successful when nurses who previously ignored the suggested change accept it due to what they heard from nurses who initially adopted the theory.
B. Major Concepts of Everett Rogers’ Change Theory
Rogers regarded the innovation-decision-making process in five stages:
- Knowledge – refers to being exposed to a new concept.
- Persuasion – the individual is intrigued by the concept and is looking for information/details
- Decision – the individual considers the importance of the concept and determines whether to accept it or refuse it but not always to gather evidence
- Implementation – the person takes up the idea that varies according to the situation and may look for additional information
- Confirmation – the person settles their decision to continue with the innovation and maybe use it to its full potential.
C. Subconcepts of Everett Rogers’ Change Theory
Rogers discovered intrinsic features of changes impacting adoption or rejection decisions:
- Relative advantage. This feature explains the extent to which change is regarded positively.
- Compatibility. This feature perceives the ease of incorporating new ideas into a person’s life.
- Level of complexity. This feature is the apparent difficulty of accepting changes.
- Trialability. This feature shows whether or not there is a chance to test the innovation.
- Observability. This feature explains whether or not the innovation will be noticed, visible to others, and, as a result, conveyed within the individual’s connections with either reaction, whether good or negative.
D. Everett Rogers’ Change Theory: Theory and the Nursing Process
- Assessment. The first nursing process is assessment, which entails critical thinking skills and data collection, both subjective and objective. Therefore, the first phase of Roger’s change theory is usually observed in this stage since a new concept is introduced.
- Planning. The planning stage develops goals and outcomes that directly impact patient care based on specific recommendations. These patient-specific goals and their achievements help ensure a happy outcome. Thus, the Persuasion and Decision phase of Roger’s theory is usually noticed in this stage because the nurse starts to look for additional details or information from the patient.
- Implementation and Evaluation. In Implementation and Evaluation the person takes up various ideas depending on the circumstances and may seek additional details, and the person decides whether or not to proceed with the innovation and maybe apply it to its maximum potential.
E. Analysis: Strength and Weaknesses of Everett Rogers’ Change Theory
- The application of diffusion of change theory is one of its main strengths.
- An expansive series of research across many disciplines have used the idea as a paradigm; similar results have been obtained throughout the board, from journalism studies to health communication, verifying the change process.
However, Rogers change theory has various drawbacks, which include the following:
- Most of the data for this concept, including the adopter classifications, did not come from public health, and it was not designed to specifically relate to the adaptation of innovative behaviors or health advances.
- It does not encourage a collaborative framework for implementing a public health program.
- It is more effective with behavioral adoption than with behavioral discontinuation or prevention.
- Does not consider an individual’s wealth or support networks in adopting the new behavior or innovation.
3. Lippitt’s Change Theory
A. Biography of Ronald Lippitt
Ronald Lippitt, a pioneer throughout his successful career, was a founding partner of the National Training Center for Group Dynamics at the Massachusetts Institute of Technology and later was a co-founder again of the Center on the Research for the Utilization of Scientific Knowledge at the University of Michigan.
He is regarded as an innovator in the establishment of contemporary social psychology, best known for his classic work on the effects of democratic, authoritarian, and laissez-faire administration in small clusters and his later work on change initiatives.
B. Major Concepts of Lippitt Change Theory Nursing
According to Lippitt, there are seven processes to implementing change within a customer. The seven processes are explained further below:
Phase 1: Identifying the necessity for change and identifying the issue
- The establishment of problem awareness and a strong sense of need for improvement in the patient is the best way to identify the issue.
- Recognizing the presence of any communication barriers between the patient and the practitioner
- Creating at least some trust in the client that their position can be improved and confronting defeatist ideas
- The client must be persuaded that external assistance or assistance from the practitioner is essential, accessible, and connected to that.
- Working with the client to overcome reluctance to help, the patient may regard this as a failure for not resolving change to a positive outcome alone.
Phase 2: Assessing motivation and capacity for change in the relationship
Lippitt contends that one of the most critical aspects of this phase is how the client begins to consider their working relationship with the practitioner and their first perception of the practitioner.
It is critical to reassure the patient and communicate warmly and openly that is not domineering. This phase covers the patient’s mindset toward and opinion of career guidance/counseling. During this stage, it is critical to establish trust.
Furthermore, the client may be unsure about the procedure and want the practitioner to provide reasonably fast and easy solutions. They must assist the patient in developing reasonable expectations.
Phase 3: Clarification; diagnosing the problem with the patient system
According to Lippitt, the client often has to deal with a broader and deeper diagnosis and the resulting change at this stage. Thus, the patient may begin to believe that their situation is too intricate to be resolved and that change will not occur or be impossible to achieve.
Phase 4: Creating alternate routes
The customer begins to translate ‘the diagnosis’ into potential next steps. Alternative courses of action are discussed between the patient and the practitioner.
- Motivation is essential in evaluating multiple options and deciding which one is best. While commitment necessitates an emotional and practical engagement, the customer will estimate the required resources.
- There is an acceptance that old habits and practices must be abandoned. This phase may cause the client to revert to familiar habits and practices, or it may cause anxiety or fear of failure.
Phase 5: Putting intentions into action to effect change
So far, success has been judged by the extent to which intentions and aspirations for change or achievement have been converted into actual action.
Lippitt does not seem to have much to say about this valuable phase in a professional setting. Other than that, the practitioner may not recognize the client’s attempts for environmental changes in which they must implement them.
Phase 6: Change Stabilization
Lippit perfectly asserts that one crucial element in the stabilization of modification is the expansion or ‘non-spread’ of the changes to adjacent systems or subsystems, which can be translated into whether the changes are incorporated within the patient’s framework of habits and surroundings.
Phase 7: The terminal relationship
Lippitt contends that when concluding a connection, the patient’s reliance on the practitioner is significant. This phase could indeed be a problem in counseling and other situations when there has been an intentional and long-term working relationship between the patient and the practitioner.
C. Subconcepts of Lippitt’s Change Theory
Schlossberg distinguishes between predictable and unpredictable changes, whereas Lippit begins with planned change, anticipating resistance from those affected by the change. On the other hand, Lippitt’s model is more detailed than Lewin’s. He also employs a standardized approach, which arises from his previous experience with leading systems such as committees and organizations rather than individual clients in a career context. In addition to this, Lippitt’s theory has also been applied in nursing in the United Kingdom since it corresponds well with their planning system.
D. Lippitt’s Change Theory: Theory and the Nursing Process
- Assessment. The nurse director, nursing assistant, or health care professional detects and evaluates a problem in this stage. The need for change is then communicated to those staff members who may be impacted, and discussions are conducted to make a final decision.
- Planning. Determine whether individuals who will be affected by the change are willing to accept it or are reluctant to it. Come up with solutions that will handle all potential issues that may arise on the path to change.
- Implementation. Make a plan to put the change into action. The strategy should include explicit actions with timeframes and deadlines. Responsibilities are then allocated to all parties involved in bringing about the transformation. The change agent’s responsibilities include coaching and training to assist people in developing the dispositions and abilities required to be successful and remain in their employment.
- Evaluation. Keep the change going. The progress of the change project is evaluated in this step of Lippitts’ change theory. All parties involved in implementing the project communicate with one another and with the change agent to remain updated on the status of their specific duties.
E. Analysis: Strengths and Weaknesses of Lippitt’s Change Theory
Lippit did not even consider his model a series of phases to be completed in order. He contends that some can coincide, and some phases may become mixed up. This concept differs significantly from Lewin’s and other models in which the various steps or phases must be followed in order.
Moreover, Lippitt further suggests that this theory could be a cyclic rather than a linear process putting it in line with the work of Prochaska and DiClemente, as well as Schlossberg’s 4Ss cycle.
The healthcare system is constantly evolving to satisfy patients’ requirements. Changes in the nursing field and healthcare setting also aim to provide optimal benefits, better services at a lower cost and promote employee retention.
Thus, individuals and organizations must evaluate many elements for effective change. These elements include culture, population understanding, a real need for change, suitable timing, and the change theory to deliver the most favorable outcome.
The change agent’s abilities, expertise, and leadership will also significantly influence implementing the changes. It is also critical for healthcare practitioners to grasp the significance of the change, the theories used to achieve change, the responsibility of the change agent, the implications of change, and why this is essential in the healthcare system.
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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