Guest Author - Lorraine Hover
Nursing is a unique and challenging arena. The profession embraces its past and yet is in constant change. While nurses expect to have to make changes it is not easy to do. What steps can help smooth the path and assist in not only implementing change but in making it a permanent change? Kurt Lewin's Change Theory is simple yet provides a clear path for implementing change in nursing or in your own personal life. Lewin's theory helps leaders identify potential challenges along the journey.
Lewin's Change Theory is a three-step process. The unfreezing-change-refreeze theory is based on the concept that learning replaces what we knew with what we are in the process of learning and examines the ways to transition and freeze the changes into place. Lewin's states behavior as "dynamic balance of forces working in opposite directions" (Current, 2011, para. 9). Harnessing these forces is the key to success.
What exactly does each of the three steps involve? Let's take a closer look.
The unfreezing stage is making it possible to let go of "the way we've always done it" or an old procedure which is now outdated or even found to be harmful to the patient's recovery. This stage allows a better method or skill to replace the old way or standard. The manager or director needs to look at what barriers might exist to the proposed change.
Some ways to decrease potential challenges includes:
* Identifying both official and unofficial leaders of the unit and involving
them in the change.
* Provide staff with the reasons for the change especially emphasizing how
the change will benefit both the nurse and the patient.
* Providing the nurse a way to be vested in the program will help increase
the odds of the overall success.
The change process (also known as the movement process) requires nurses and other staff members to change the way they think, feel and/or behave in regards to the process undergoing change. Accomplishing this task depends on helping staff to embrace the change because it will improve their ability to be a nurse caring for their patients in a more effective manner, thus increasing positive, quality outcomes.
The final stage of Lewin's theory is refreezing. This final step is when the nurse makes the change desired into a new and consistent habit. If this final phase is not accomplished, any change accomplished will be short-lived. Many studies state that it takes approximately 28 days for a new practice to become a habit.
Let's look at implementing a new policy on your nursing unit using Lewin's Change Theory through a real-life scenario.
The manager receives information on a new wound care protocol which has been shown to reduce development of pressure ulcers and speed healing of existing wounds. Nurses are happy with the current procedure and see no need for change. To initiate the unfreezing stage, the manager enlists the help of the charge nurses and provides each a copy of the proposed protocol and research articles supporting the change. After educating the charge nurses a nursing staff meeting is called and the manager introduces new protocol. Prior to sharing the new policy/procedure the manager reviews the Medicare reimbursement guidelines regarding nosocomial ulcer development and research showing effectiveness of new procedure. The manager displays posters and other educational materials throughout the unit. After allowing the staff to look over the materials and consider the changes another staff meeting is called. The policy and procedure "go live" date is announced. Mandatory education is scheduled for all nursing staff. During the first 3 months of implementation the manager and charge nurses closely monitor charts, do walking rounds and discuss any difficulties the nurses may be having regarding the new procedure; each monthly staff meeting involves some discussion of the new policy. Once the three-month mark has been reached the oversight continues to ensure compliance, all new staff are educated and quarterly statistics are provided to the nurses as encouragement and proof that the new policy has been effective. Continued oversight ensures that the freezing remains and old habits do not slip back into practice.
The three stages of unfreezing-change-refreezing has successfully occurred. The nurses are excited by the improved patient outcomes and decreased time spent caring for wounds and it has become a permanent change on your nursing unit.
What changes might your unit need to make?
I recommend both of the following references. The Current website is an easy to read, basic outline of many nursing theories, providing excellent information for those wishing to learn about nursing theory or comparing a variety of theories. The Kaminski article is a more in-depth article detailing how Lewin's Change Theory can be applied to nursing informatics and to other situations. Both sites are excellent and worth the time to look up.
REFERENCES AND RECOMMENDED READINGS
Current. (2011, September 12). Change theory: Kurt Lewin. Retrieved from,
Kaminski, J. (2011, Winter). Theory applied to informatics Lewin's Change
Theory. CJNI:Canadian Journal of Nursing Informatics, 6(1),