Nurse as a change agent “You must be the change you wish to see in the world. ” – Mahatma Ghandi Overview The theoretical foundations of change theory are robust: several theories now exist, many coming from the disciplines of sociology, psychology, education, and organizational management. Kurt Lewin (1890 – 1947) has been acknowledged as the “father of social change theories” and presents a simple yet powerful model to begin the study of change theory and processes. He is also lauded as the originator of social psychology, action research, as well as organizational development.

Lewin’s change theory consists of three distinct and vital stages: •Unfreezing •Moving to a New Level or Changing •Refreezing. “Unfreezing”- involves finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. “Moving to a new level” – involves a process of change–in thoughts, feelings, behavior, or all three, that is in some way more liberating or more productive. “Refreezing” – is establishing the change as a new habit, so that it now becomes the “standard operating procedure. Without some process of refreezing, it is easy to backslide into the old ways. Change Model Categories In general, three categories of change models exist: empirical-rationale, power-coercive, and normative-educative models (see table 1 below). Change Model ParadigmCharacteristics Power CoerciveLeader orders change, subordinates comply Change agent must have authority Origin of regulations and laws May be used to force a change, ie: desegregation laws May fail due to high resistance Empirical RationaleEmphasis on Reason and Knowledge

Based on premise that people will change once they realize it serves their rationale self interest Recipients are not actively involved in change process but are educated about the values Often used for technological change Ignores beliefs, feelings, values Normative EducativeChange only really occurs once attitude, values, skills, relationship changes are made Those affected by the change MUST be involved in the planning Mutual trust and collaboration needed Conflict must be resolved amicably Kurt Lewn’s theory is an example M.

D. Hohn (1998) identified four different types of change: Change by exception, Incremental Change, Pendulum Change and Paradigm Change. Change by Exception: occurs when someone makes an exception to an existing belief system. For instance, if a client believes that all nurses are bossy, but then experiences nursing care from a very modulated nurse, they may change their belief about that particular nurse, but not all nurses in general. Incremental Change: change that happens so gradually, that an individual is not aware of it.

Pendulum Changes: are changes that result in extreme exchanges of points of view. Paradigm Change: involves a fundamental rethinking of premises and assumptions, and involves a changing of beliefs, values and assumptions about how the world works. A Change Agent is someone who deliberately tries to bring about a change or innovation, often associated with facilitating change in an organization or institution. To some degree, change always involves the exercise of power, politics, and interpersonal influence.

It is critical to understand the existing power structure when change is being contemplated. A change agent must understand the social, organizational, and political identities and interests of those involved; must focus on what really matters; assess the agenda of all involved parties; and plan for action. Change occurs over time, often fluctuating between intervals of change then a time of settling and stability. Source: http://www. nursing-informatics. com/N4111/LA1. html This video represents a nurse as a change agent. Dominic the nurse uses a unconventional tool to his patient to feel better.

Hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Different people need different hemodialysis treatment schedule. Some may need to have it three times a week 3-5 hours. He tries to bring about a change or innovation in the way he attends to his patient. A change agent must understand the social, organizational, and political identities and interests of those involved; must focus on what really matters; assess the agenda of all involved parties; and plan for action. Source: http://www. youtube. com/watch? v=Mqf9c52ib9U