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NRSE 4580 DB week 1
Managing change can be a very complex and taxing process. If the recipients of change
do not adapt well, this process can negatively impact all involved. Change is initiated through
human behavior; therefore, it is vital to understand how it occurs to be a successful process
(Sullivan, 2017). Understanding and effectively managing change and innovation are essential
skills for leadership. In this discussion, Kurt Lewin's Theory of Change will be explained using a
personal example, including the event's outcome.
Lewin's theory has three different stages known as unfreezing, change, and refreezing.
The theory is compared to a football field with forces working from opposite directions
(Sullivan, 2017). First, the added driving force is used as positive reinforcement and
encouragement in a specific direction. Next, the restraining force counters the driving force
creating the freeze method; however, to be successful with this, there needs to be an equal
balance of both driving and restraining forces. Finally, when the unfreeze stage occurs,
adaptation occurs, and the change is embraced by all parties involved. Lewin's three-step model
is talked about frequently throughout nursing literature, being portrayed as the framework that
transforms care at the bedside (Wojciechowski et al., 2016)
Working in the emergency room places your hands more on the patient and not as much
on charting. After a chart audit, it was found that many nurses were not charting discharge vital
signs when discharging their patients. Once reviewing the initial triage of the patient and one of
the vital signs being the reason for the visit, it became an even more significant issue. During
RSV season, pediatric patients were being discharged without a final temperature after the
intervention. In addition, the hypertensive urgency patients did not have their blood pressures
monitored hourly once the intervention was completed. Many of these vitals were obtained but
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were failed to be charted after further investigation. These ED nurses were in such a hurry to
discharge and turn rooms over for new patients the fine details within the charts were being
missed. Management initiated a plan that the charge nurse on shift and managers would monitor
current patients in the ED, watch the discharges that came up on the bed board, and then help
with friendly reminders to the direct care nurse if vital signs had not been charted. While the
charts were being reviewed, nurses were acknowledged and given positive reinforcement if the
chart was up to date before the review and no need for prompting for vital signs. Later on, this
was created in the chart as a "hard stop," which would not allow you to discharge a patient in the
computer system without completing this task. With the early help of the managers reviewing
real-time charting and the charge nurses, the transition to the hard stop became less painful and
aggravating due to most direct care staff already in the habit of completing. Lewin's unfreezing
process worked well here because it helped the direct care staff adapt to the change and accept it
for routine parts of patient care and documentation.
In conclusion, if changes are poorly executed, there will be no success. Therefore,
organizing and educating the steps that will be taken are vital components to the successful
implementation. With strong leadership qualities and experience, this task appears effortless and
natural to all involved.
References
Sullivan, E. (2017). Effective leadership and management in nursing (9th ed.). Pearson.
Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating
lewin’s theory with lean’s system approach for change. OJIN: The Online Journal of
Issues in Nursing, 21(2). https://doi.org/10.3912/ojin.vol21no02man04
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Unformatted Attachment Preview

1 NRSE 4580 DB week 1 Managing change can be a very complex and taxing process. If the recipients of change do not adapt well, this process can negatively impact all involved. Change is initiated through human behavior; therefore, it is vital to understand how it occurs to be a successful process (Sullivan, 2017). Understanding and effectively managing change and innovation are essential skills for leadership. In this discussion, Kurt Lewin's Theory of Change will be explained using a personal example, including the event's outcome. Lewin's theory has three different stages known as unfreezing, change, and refreezing. The theory is compared to a football field with forces working from opposite directions (Sullivan, 2017). First, the added driving force is used as positive reinforcement and encouragement in a specific direction. Next, the restraining force counters the driving force creating the freeze method; however, to be successful with this, there needs to be an equal balance of both driving and restraining forces. Finally, when the unfreeze stage occurs, adaptation occurs, and the change is embraced by all parties involved. Lewin's three-step model is talked about frequently throughout nursing literature, being portrayed as the framework that transforms care at the bedside (Wojciechowski et al., 2016) Working in the emergency room places your hands more on the patient and not as much on charting. After a chart audit, it was found that many nurses were not charting discharge vital signs when discharging their patients. Once reviewing the initial triage of the patient and one of the vital signs being the reason for the visit, it became an even more significant issue. During RSV season, pediatric patients were being discharged without a final temperature after the intervention. In addition, the hypertensive urgency patients did not have their blood pressures monitored hourly once the intervention was completed. Many of these vitals were obtained but 2 were failed to be charted after further investigation. These ED nurses were in such a hurry to discharge and turn rooms over for new patients the fine details within the charts were being missed. Management initiated a plan that the charge nurse on shift and managers would monitor current patients in the ED, watch the discharges that came up on the bed board, and then help with friendly reminders to the direct care nurse if vital signs had not been charted. While the charts were being reviewed, nurses were acknowledged and given positive reinforcement if the chart was up to date before the review and no need for prompting for vital signs. Later on, this was created in the chart as a "hard stop," which would not allow you to discharge a patient in the computer system without completing this task. With the early help of the managers reviewing real-time charting and the charge nurses, the transition to the hard stop became less painful and aggravating due to most direct care staff already in the habit of completing. Lewin's unfreezing process worked well here because it helped the direct care staff adapt to the change and accept it for routine parts of patient care and documentation. In conclusion, if changes are poorly executed, there will be no success. Therefore, organizing and educating the steps that will be taken are vital components to the successful implementation. With strong leadership qualities and experience, this task appears effortless and natural to all involved. References Sullivan, E. (2017). Effective leadership and management in nursing (9th ed.). Pearson. Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating lewin’s theory with lean’s system approach for change. OJIN: The Online Journal of Issues in Nursing, 21(2). https://doi.org/10.3912/ojin.vol21no02man04 3 Name: Description: ...
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