Healthcare professionals can face many issues at their workplace. While many problems such as staff shortage, long working hours, or exhaustion are common for all units, some concerns arise in specific departments more frequently than in others. The problem of violence, for example, is undoubtedly present in all areas of healthcare, but Intensive Care Units (ICUs) can have higher rates of almost all its types – verbal abuse, physical violence, and threats (Park, Cho, & Hong, 2015). Thus, this issue has to be addressed to reduce the rates of violence and mitigate the possible outcomes to such negative occurrences. Many change models and strategies can be chosen to achieve success, but Lewin’s Change Theory may be the most suitable one. This essay aims to present a realistic plan for healthcare professionals in ICUs focused on training and communication skills development to reduce the rate of violence in the unit.
Identified Problem and a Realistic Change
The identified issue is violence in the workplace. As Park et al. (2015) state, violent incidents may be perpetrated by different types of people. However, the majority of all cases feature patients and their family as the primary aggressors. Notably, many incidents also involve physician-nurse violence, where a physician physically or verbally abuses a nurse. Nevertheless, as cases with patients and visitors are prevalent, they are the basis for the discussed planned change. Park et al. (2015) also find that ICUs have many cases of patient-nurse violence because these departments usually host individuals experiencing intense pain, anxiety, and fear. Therefore, this specific unit in the organization has to provide its workers with an effective strategy for change.
While it is virtually impossible to completely eradicate this problem because it is based not on workers’ but patients’ behavior, some improvements can be considered. For instance, nurses who communicate with visitors more often than other employees may learn specific tactics to relieve tense situations and avoid conflicts that can lead to violence. Some researchers have investigated the effectiveness of such instructional approaches. According to Adams, Knowles, Irons, Roddy, and Ashworth (2017), clinical education can assist staff in evaluating patients’ behavior and identifying risks for violence as well as present them with some ways to solve conflicts. Therefore, planned change may be focused on developing and implementing a training course for the unit’s staff to learn specific communicational approaches such as verbal de-escalation.
Change and the Organization’s Values
The implementation of this change supports the discussed organization’s mission and values. The hospital strives to provide care that is safe and accessible. Staff’s education to deal with complex situations can produce only positive results for these objectives as trained healthcare professionals will be able to ensure their well-being as well as that of their other patients. This change also aligns with the professional standards such as the use of knowledge-based research and ethical care. The first standard is followed because the plan uses relevant and recent studies that confirm the benefits of the used approach. The program adheres to the principles of ethical practice as it aims to encourage respectful communication, improve nurse-patient relations, and resolve arising conflicts.
Change Model and Strategy
Numerous change theories can be used to implement the plan outlined above. For example, Mitchell (2013) compares change models created by Lewin, Rogers, and Lippitt to determine which may be more suitable for planned change. Lewin’s theory has three major steps divided into multiple smaller objectives. These points are “unfreezing, moving, refreezing” (Mitchell, 2013, p. 32). Other theories propose similar activities, although they may be called differently. Nevertheless, they all have stages where the problem is recognized and described (unfreezing), the plan for change is devised and implemented (moving), and the outcomes are evaluated and institutionalized (refreezing). The program can use Lewin’s theory because it is simple to understand and use. Also, this approach is focused on people and their experiences which can be seen in its smaller objectives. For example, it outlines such valuable steps as information dissemination, continuous feedback, and collaborative decision-making (Shirey, 2013). Thus, Lewin’s theory of change is chosen as the most appropriate approach to reducing violence through education.
Apart from adopting a model of change, a strategy can also be considered. Marquis and Huston (2017) describe three main types of change strategies, the first being a rational-empirical one. This particular approach uses people’s critical thinking and rationality. It is based on the belief that people will recognize the benefits of change upon being educated about it. The second strategy is normative-re-educative. It uses peer pressure and treats people as social creatures (Marquis & Huston, 2017). Finally, the last possible classic strategy group is power-coercive. According to this method, people can be influenced to change by organizations or individuals with authority and political or economic influence. The described plan is heavily reliant on education and actions of the unit’s management. Therefore, it combines both rational-empirical and power-coercive strategies.
Change Implementation
The steps in the process of change implementation will follow the chosen model created by Lewin. Therefore, the first major step is to bring awareness to the problem of violence in the ICU. According to Marquis and Huston (2017), an official should be appointed to supervise all activities related to change. He/she will become a person that combines people’s ideas together. The unit’s management or the selected official should develop a survey that will help them understand the current situation. Next, the stakeholders of the department have to be evaluated regarding their contribution and possible outcomes. The official should deliver gathered data to the highest level of management in the unit. Furthermore, all concerns regarding the plan need to be addressed.
The second part of the intervention deals with the actual change. Here, the official and appointed workers from the unit’s staff will develop a training program based on existing research. The information about the plan will be disseminated among healthcare professionals. The management will allocate time for nurses’ education, and the latter will undergo training. The staff should be made aware of change’s benefits and results to ensure compliance.
Finally, the change will be “refreezed” – workers will be interviewed again to collect their opinions about the program. Then, regular evaluations and feedback gathering will take place in the following months to see whether the training course produced positive outcomes. To implement this change, staff and management need to be involved in promoting coherence. The ability to understand organizational culture and climate and interact with healthcare professionals to institutionalize the changes will be essential for the elected official to have (McAlearney et al., 2013). The plan will be completed if the management focuses on empowering staff and ensuring they understand the benefits of this plan.
Conclusion
Workplace violence is a pressing issue in healthcare organizations. ICUs may suffer from this problem the most because of their stressful environments. An educational program for nurses and other workers may improve their communication with patients and their families and lower the rate of such incidents. This planned change can be facilitated using Lewin’s theory and a combination of rational-empirical and power-coercive strategies. The unit’s management needs to be open, rational, and positive about this change for the program to succeed.
References
Adams, J., Knowles, A., Irons, G., Roddy, A., & Ashworth, J. (2017). Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence. Australian Journal of Advanced Nursing, 34(3), 6-15.
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
McAlearney, A. S., Terris, D., Hardacre, J., Spurgeon, P., Brown, C., Baumgart, A., & Nyström, M. E. (2013). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Quality Management in Healthcare, 22(2), 86-99.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32-37.
Park, M., Cho, S. H., & Hong, H. J. (2015). Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment. Journal of Nursing Scholarship, 47(1), 87-95.
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72.