DQ2 1--It will be interesting to see how many more theories are developed in the next twenty years. I think the behavioral change theories are interesting as well. Another change theory is Prochaska and DiClemente’s (1983) transtheoretical model of behavioral change. This theory looks at the client’s enthusiasm and eagerness to make healthier lifestyle changes (Heiss, 2013). Because patients have to make a conscious decision to quit drinking or to quit using drugs, it requires a behavioral change. “Lifestyle modification programs encourage self-responsibility for health and represent the action phase of health behavior” (Heiss, 2013, p. 479). The patient will need to make frequent appointments with a substance abuse counselor for support, so the patient can make behavioral changes. There are five stages of change, for example, precontemplation (no desire for change), contemplation (thinking about change), preparation (plan for change), action (beginning to change), and maintenance (change in lifestyle has been made for over 6 months (Heiss, 2013). This theory could be used for this nurse’s project because screening, brief intervention, and referral to treatment (SBIRT) depends on the patient’s willingness to make lifestyle changes. This nurse’s mentor uses this theory when she works with her prenatal patients who use drugs during pregnancy. She educates her patients and those who are willing to make lifestyle changes do abstain. Those who are not ready to make a change will keep getting education until the prenatal patient decides to change. Sometimes they do not. There have been many prenatal patients that have stopped using marijuana until after they deliver their baby, so this has been successful.
DQ2 2---------- In order to implement an evidence-based practice project, the nurse needs to decide which change theory to use. Using a theory helps organize and structure the way change is implemented. According to Mitchell (2013), “…managers, or change agents, identify an appropriate change theory or model to provide a framework for implementing, managing and evaluating change” (p. 32; Pearson et al., 2005). One theory is Kurt Lewin’s (1951) change theory that can be described as unfreezing, moving, and refreezing. In this theory, if the nurse needed to change a workflow, it would require unfreezing so that the change could be made. While the new workflow is being used and tested, this would be called moving. Once the new workflow is being used routinely, then refreezing would happen. The manager or nurse could then monitor the change to make sure staff do not go back to the old ways of doing things.
A second theory is Rogers’ (2003) innovation theory. There are five stages of this theory which include: (1) having knowledge about a new evidence-based practice, (2) forming thoughts about the new evidence-based practice, (3) deciding whether to use or not use the new evidence-based practice, (4) using the new evidence-based practice, and (5) adopting the new practice or stop using the new practice (Garon, 2014).
The nurse can provide education about the importance of the new EBP. Individuals will adopt the change at different times during implementation, and managers can work with individuals who are having a difficult time making the needed change. Some staff may be excited to try the new change and help implement it. Once the problems are worked out, then the staff will evaluate the change to see if it improves practice. If it does, they will use the new EBP, and if it does not, the staff could go back to the old way of doing things or make changes to the new EBP until it improves the practice.
This nurse’s mentor has used Roger’s (2003) innovation theory with her OB patients. She has used this theory to develop her OB workflow for patients who have positive drug screens. She knows it is important for her OB patients to get counseled on the effects of drugs on the unborn baby (knowledge about EBP). For patients who have positive urine drug screens, she tries to have the patient see the behavioral health counselor during their prenatal appointment. The behavioral health counselor has limited time to see patients, which can be frustrating for this nurse’s mentor (forming thoughts). It is hard to run the OB clinic and communicate with the counselor on who needs to be seen (deciding whether to use EBP). Sometimes the counselor has to leave to go to a meeting, so the OB nurse recently changed her workflow to include a huddle sheet for the counselor, so that he or she knows which patients need to be seen (using the EBP). She has yet to adopt this practice because she is monitoring the outcome. Janie would probably use Roger’s implementation theory because she would have to work with the behavioral health team and nurses to implement any changes for SBIRT. It would require feedback from the staff involved, and the staff would need to do a pilot project to work out any problems before any changes would be adopted.
DQ2 3 ----Both theories are used when implementing planned changes in nursing practice.They help in realization of established goals. In both change, agents are the driving forces and are very necessary in realization of the change. Both theories have steps used when implementing them.
Both theories has resistant forces which must be come over to realize the change.
Lewin's change theory has three steps of implementation which include unfreezing- moving – freezing, while Roger's theory have five steps which include; awareness, interest, evaluation, implementation and adoption. Unfreezing is the process which involves finding a method change stage, which is also called "moving to a new level" or "movement," involves a process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive of making it possible for people to let go of an old pattern that was somehow counterproductive. The refreezing stage is establishing the change as the new habit, so that it now becomes the "standard operating procedure." Without this final stage, it can be easy for the patient to go back to old habits (Nursing Theory, 2016).
Roger's theory is applied for long-term changes while Lewin's can be applied for short term change projects. Roger's theory success is fully realized when the earlier resistant agents adopt the change and support it while Lewin’s theory success is only realized if the driving forces dominate the resistant force. Roger's change theory promotes awareness and the participant interest before implementing the change.
Roger's theory makes most sense of implementing my EBP project. This is because the theory promotes awareness of the change, promotes interest of implementation of EBP among the involved parties and evaluate the success of trial studies before the actual implementation.
The theory will also promote implementation of my project among the opposing direction after the success of the project becomes evident.
I think Roger’s theory is more relevant to my project. Martha Rogers’s theory is a useful model for addressing the growing issue of nursing burnout, which is known to cause increased rates of morbidity and mortality in the clinical setting (Alligood, 2014).
DQ1 4-------- According to Mitchell (2013), “…planned change, which is a purposeful, calculated, and collaborative effort to bring about improvements…” is the most frequent way change is performed in many facilities (p. 32). Change causes stress for many staff members. It is important for the nurse, who is implementing the change, to have support from administration and staff, and to have the resources to make the needed change. If the budget does not support the change, it may not be a good time to implement it. In order for the nurse to plan and implement an evidence-based project, he or she needs to assess for obstacles that would prevent implementation, and make sure staff know why changes need to take place. According to McLaughlin and Sanchez (2017), the nurse needs to “… identify the knowledge, beliefs, and behaviors that are common in the existing system and to raise the awareness of a need for shifting decision making about clinical care toward a consideration of current best evidence” (p. 96).
Identifying key employees that can serve on a committee for the evidence-based project can help move the change forward. Sharing ideas and solutions regarding a problem can provide support for the change. The nurse can bring forth his or her information on the evidence-based practices to share with her committee, so that research can be shared. If staff are excited about the change, the change can be seen as a positive by other staff. If the department is busy, it will be important for staff to be involved in training and have frequent updates as to when any evidence-based changes will take place. Communication is the key to alleviating stress. In some instances, a pilot project may be a great way to implement a new evidence-based practice. During implementation, the new evidence-based practice can be used in one group, and any problems can be worked out until the process runs smoothly. Then, the new evidence-based practice can be rolled out to the rest of the department.
My mentor knows that change creates stress. She was frustrated with the last change that took place in the department because the nurses were not involved in the planning or implementation of the change. Nurses triage and perform nurse visits. In the past the nurses could double book patients and fit patients into the providers’ schedules. Now nurses must request an appointment time from the front desk, and after the nurse spends the time triaging and asking the doctor to see the patient, the front desk can deny the appointment request. This is very frustrating to a nurse who has spent 20 minutes with a patient. The nurses were trained on the new change in less than five minutes, and were expected to implement it within two days. The nursing staff did not understand the reason for the change, and the change caused chaos in the department.
When implementing Janie’s evidence-based practice, it would be better to bring the ideas for the change to the people it will impact (nursing and behavioral health staff), let them participate in the plan and implementation for the change, and then run a pilot project to see if the change can work. It would be a good idea to discuss solutions to possible problems before implementing the pilot project, so that the implementation can run more smoothly.
Minimum of 60 words for each response with proper in text citation and references