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In the nursing profession, changes are often necessary in dealing with the recommended or necessary processes of particular evidence-based practices. It is very important to choose the best change theory in order to render a procedure because not all change theories correspond to every change process. The common change theory used in the nursing profession is that of Kurt Lewin. The main components of Lewin’s change theory imply the following stages:
- The unfreezing stage – In this stage, the problem is recognized and the need for a solution is distinguished therefore, the recognition and development of a solution or a proposed change occurs.
- The moving stage – In this stage, the proposed change or developed solution is adopted and carried out.
- The refreezing stage – In this stage, the change or solution which started as an applied proposed change is recognized by the whole medical force as a permanent part of the medical proceedings.
Kurt Lewin’s theory has two components. First is the driving force and second is the resistant force. The driving force is the one who facilitates the solution or change. It also includes the advocates of the proposed change. The advocates are the ones who promote the proposed change to others so that they will accept it. The second component is the resistant force. The resistant force consists of the nurses or health care personnel who stand in opposition of the developed solution or proposed change. For the competency of the theory, the driving force must control the resistant force. The facilitator and the advocates must ensure dominance over the opposing nurses and other health care personnel.
Change theories are adapted to derive a modification in the occurring process and to help recognize the necessary method to be used for the development of the change. An example of this is the evaluation and diagnosis of ventilator-associated pneumonia patients beforehand and the development of appropriate treatments for prevention. In this case, a comprehensive oral care intervention conforms to decrease the risk of ventilator-associated pneumonia in patients. Although no comprehensive standards in oral care performances may exists at the present time, the theory itself will direct the change process to develop and execute a standardized oral care protocol.
Use of Theory to Proposed Solution
In the nursing profession, change theories are used in the development of a designed or planned modification. Changes require both identification of the problem and development of a solution to the problem. In the example given above, patients receiving mechanical ventilation do not follow an oral care protocol. As a solution, health care professionals should create a standardized oral care protocol for these patients to encourage them to adopt an oral care routine needed for their medication.
For the implementation of the necessary modification, Kurt Lewin’s change theory, with its three stages, may be used to guide the health care professionals to direct the change and make it happen. In this case, the unfreezing stage is the identification and development of an oral care protocol; the moving stage is its implementation and; the refreezing stage is the adoption of the protocol as a permanent method.
To internalize Lewin’s change theory in the proposal, the person should understand the theory and the three steps first. The theory should be adopted step by step since it comes in stages. The first stage, which is the unfreezing stage, requires the health care professional to identify the problem and develop a change proposal. Then in the moving stage, the proposed solution to the identified problem will be applied. And lastly, in the freezing stage, the new response will be assessed by all concerned individuals including the management and will be recognized as a permanent part of the medical system’s policy and procedures.
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