Abstract
The application of nursing and interdisciplinary theories is commonly promoted in modern nursing and healthcare practice. The change theory was developed by Kurt Lewin in the 1940s, and many experts recommend its translation into nursing actions to improve the quality of care. In this paper, the analysis of this theory is offered to discuss its unique concepts of unfreezing, moving, and refreezing, as well as forces and equilibrium.
Change in health care is an obvious requirement due to which nurses strengthen their skills and knowledge. Therefore, its application is one of the alternatives to understand how to control outcomes and achieve the best results in providing care for specific groups of patients. The evaluation of its pragmatic adequacy, social meaningfulness, and feasibility shows its compatibility with real-life settings like nursing homes with advanced practice nurses as care providers.
Introduction
The use of interdisciplinary theories is frequently required in the medical profession to explain human behaviors and diseases. Clinical collaboration between nurses and the medical staff is one of the main keys to success and understanding how to offer high-quality care to patients (Mahdizadeh et al., 2015). In this paper, the change theory by Kurt Lewin in the middle of the 20th century will be analyzed from the point of view of its scope, context, content, and application in modern nursing practice. This three-step model (unfreezing, moving, and refreezing) was originated in child psychology of the 1920s when the development of children from one stage to another was studied (Burnes, 2019).
It was used as a part of an ethnographic study to understand the nature of change and the worth of leadership in organizational management (Hussain et al., 2018). The same theory was applied to improve and influence change in healthcare facilities or support nurses in transitions. The worth of Lewin’s theory of change is the possibility of pushing participants in the necessary direction, predicting challenges, and achieving the desired success.
Summary of the Theory
People consider change as a complex process with several rules and unexpected outcomes. However, the application of appropriate theories and models aims at facilitating organizational change, and nurses find it effective to choose the best alternatives. The name of Kurt Lewin is associated with the best achievements in the fields of organizational change and social psychology (Burnes, 2019). His model introduces change as a dynamic force that motivates participants to use available resources and skills to achieve the best results.
Scope
In nursing, change is an obligatory process that has to be properly calculated, planned, and explained. Its implementation is characterized by unpredictable complications, and nurses find it helpful to use specific theories like the model offered by Lewin. Its central idea is that human behavior is a dynamic balance between driving and restraining forces to promote social self-regulation within a particular context (Lewin, as cited in Burnes, 2019).
Lewin was never a nurse, but he used his experience to develop a strong nursing model with three major steps to unfreeze human actions, move or apply the change, and refreeze the environment. According to this theory, prior learning is required to understand what ideas and movements have to be rejected or replaced and why. Lewin explained the need for motivation, explanation, and collaboration in nursing practice to prove the inevitability of change and improvements. His model has been successfully implemented in nursing, health care, business management, and many other areas where people cannot avoid change.
Context
The presence of interdisciplinary theories in nursing explains the appropriateness of Lewin’s change theory. This model is defined as a non-nursing theory due to its frequent application in other spheres where organizational management is a key activity. However, the analysis of the nursing metaparadigm concepts addressed by this theory shows why the medical staff should not neglect its usage in modern practice. There are four metaparadigm concepts to be applied in theory analysis. Nursing is defined as a process of unfreezing, change, and refreezing organized by nurses for patients to accept change in their well-being and health care.
A person is determined by the combination of personal characteristics and a social situation in which patients and nurses find themselves. Health is not only a curing process or a good condition of a patient but a transition when new patterns are introduced and influence individual well-being. The environment is a balance (or equilibrium) of forces that promote change, prepare participants, and enhance evaluation.
Content
There are several unique concepts developed by Lewin in his model. First, the process of change undergoes three specific stages, called unfreezing, moving (or change), and refreezing. In unfreezing, the participants aim at understanding their current condition and past experiences to overcome resistance and let old patterns go (Burns, 2019). The next stage is moving or changing when new ideas, approaches, and interventions (human feelings and behaviors) are offered to enhance productive outcomes (Hussain et al., 2018). Finally, refreezing is the step to establish change as a standard of care or behavior or explain the reasons for not accepting it and returning to old patterns.
Nurses have to consider three main elements – driving and restraining forces and equilibrium. Driving forces focus on facilitating change and motivating a person in the necessary direction. Burnes (2019) uses personal ambitions or the desire to spend more time with family as examples of such forces. Restraining forces are the opposite example of motivation, meaning that people like to maintain the status quo without any desire to change something (Hussain et al., 2018). Sometimes, people are not ready for the change in their lives or work, and Lewin suggests achieving a balance or equilibrium, a state when driving and restraining forces are equal to each other (Burnes, 2019). An understanding of all these concepts is an essential step to apply the change theory to healthcare and nursing practice.
Application of Theory to Healthcare
The results of the application of theory to a particular healthcare environment are hard to predict. Even though there is no specific formula for translating theories into practice, Butts and Rich (2018) identify several critical steps to implement an evidence-based action and criteria for the setting. Lewin’s change theory is not hard to use, but even the most experienced nurses should take preparatory steps and evaluate their knowledge, as well as expected outcomes.
Description of the Setting
There are many examples of settings that can be appropriate for the application of the chosen theory. The offered setting is a healthcare facility (a nursing home) with advanced practice nurses (APNs) who offer care to older adults who do not require hospital care but cannot receive support and care at home. The goal of APNs in this setting is to enhance the dignity and comfort of residents. In the majority of cases, end-of-life care is promoted for people who have been assessed in hospitals, and no particular treatment has been offered. Change turns out to be a significant element in nursing homes because people are not always able to understand why they have to live in a new facility and reduce their communication with family members. Nurses are responsible for clarifying the situation to every patient and create the conditions under which care and quality are combined.
Pragmatic Adequacy
One of the criteria for a successful application of the theory is pragmatic adequacy. It is the extent to which change theory could be used as evidence for the practical actions of nurses (Butts & Rich, 2018). In nursing homes, Lewin’s theory plays a crucial role because it helps nurses to identify driving and restraining forces in patients’ necessity to live here. Not many older adults are ready to accept this change, and the task of nurses is to stay confident, caring, and professional at the same time. It is hard to meet all preferences of patients, and their expectations may vary. Therefore, nurses unfreeze the environment (prepare patients), change (explain new rules and conditions), and refreeze (describe benefits and focus on improvements). Communication with patients and families and regular cooperation should reduce resistance to staying in nursing homes for a long period.
Social Meaningfulness
As soon as the change is implemented, APNs should evaluate the desired outcomes and patient needs. To complete this type of assessment, Butts and Rich (2018) offer an analysis of the social meaningfulness of the theory. Health-related experiences, positive emotions, and socially appropriate behaviors are the factors according to which care in nursing homes is determined. In this case, social meaningfulness has to be connected with such outcomes as the establishment of trust in nurse-patient relationships, the promotion of the sense of well-being, and the demonstration of dignity among old adults.
Quantitative studies are developed to identify statistical significance (p-value) and clinical significance (costs spend on patient care). Not all families are ready to provide their older adult members with care, and nursing homes with a properly implemented change intervention can be successful substitutes in the social context.
Feasibility
The next step in translating the change theory into nursing practice includes the evaluation of its feasibility. According to Butts and Rich (2018), this type of assessment is based on clinical judgments about the interventions based on the theory. Nurses have to be properly trained to meet new patients and know how to talk to them in a clear and supportive way. The number of APNs should be adequate to work with patients simultaneously and give explanations. Contact with families cannot be interrupted because old adults should feel the presence of their beloved ones, even distantly.
Compatibility with Real-Life Nursing Practice
Finally, compatibility with real-life situations is important for assessing the effectiveness of the change theory. In this setting, change is a constant activity when nurses and patients develop their relationships and adapt to new living conditions (Butts & Rich, 2018). Human behaviors in this situation are unpredictable, and nurses must know when to offer change, unfreeze the environment, deal with driving and restraining forces, and introduce a new idea or situation.
Conclusion
In general, the application of the change theory developed by Lewin in the 1940s becomes a significant contribution to modern nursing practice. Taking the three stages to change the environment, nurses have to consider forces and a balance in their work. Many people ask for care because of different reasons, and the task of a nurse is to evaluate a situation, choose the best alternative, and make sure patient needs and expectations are met. The change theory is one of the best options to use in nursing care for either old adults or other participants.
References
Burnes, B. (2019). The origins of Lewin’s three-step model of change. The Journal of Applied Behavioral Science, 56(1), 1-28. Web.
Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123–127. Web.
Mahdizadeh, M., Heydari, A., & Moonaghi, H. K. (2015). Clinical interdisciplinary collaboration models and frameworks from similarities to differences: A systematic review. Global Journal of Health Science, 7(6), 170-180.