The nursing field is growing daily due to technological changes, among other factors. As a result, there is a need to implement changes in healthcare institutions. Knowing when, how, and why to implement change is important. Many organizations apply different change theories in nursing to guide them while implementing changes to ensure they succeed.

What are change theories in nursing?

Change theories in nursing include thoroughly explaining and demonstrating why and how a change initiative is anticipated to occur in a specific setting. It primarily focuses on outlining or “fitting in” what has been referred to as the “empty middle” between what a project or change effort performs and how these contribute to achieving desired goals.

Change agents achieve desired results by defining the intended long-term goals, then working backward from these to determine all the prerequisites (results), together with their causal relationships, that must be met for the goals to materialize. All of these are depicted in involvement in planning.

Change agents in nursing

A change agent in nursing is a person who implements changes that influence healthcare service. A nurse manager, staff nurse, or any other individual who collaborates with nurses could be the change agent who applies different change theories in nursing leadership.

Planned changes in nursing organizations are implemented using change theories in nursing. While the change theories that are now accessible in nursing do not apply to all nursing change circumstances, caregivers and nursing management must be knowledgeable of theories of change and be able to choose the appropriate change theory.

Change theories used in nursing

What are the different change theories in nursing? Here is a list of different types of change theories in nursing;

1. Lewin’s change theory

This is a commonly used theory in nursing. Kurt Lewin was a psychologist and founder who conducted research in experimental learning, group dynamics, and action research. Lewin’s theory’s three phases of change direct how planned change is implemented. The stages involve;

1. Unfreezing

Lewin and his study assert that effective change implementation involves planning, necessitating system unfreezing. When the agent of change stresses the necessity for change and persuades members of the group that change is required, the unfreezing process begins. Since the change agent causes others to react this way, making them aware that change is required, this stage is frequently referred to as dissatisfaction. This unhappiness, necessary to encourage change, may come from within or beyond.

The ability of the change agent to eliminate competing objectives and emphasize the necessity of change is crucial to the achievement of this change endeavor.  Also, the agent of change needs to be able to change effectively from individuals who are resistant to change. Individuals who resist change frequently get stressed out and need reassurance, which increases the burden on the transformational leader. When this happens, motivation wanes.  Instead of consoling such individuals, Rockwell asks the transformation leader, “What do you want to do about it?”

1. Movement stage

The movement phase is the next stage in Lewin’s theory. The change agent chooses, organizes, and implements the best strategies. Also, they make certain that the motivating impulses surpass the restraints. Due to the complexity of change, planning needs to be executed at the right time and progressively, whenever feasible.

When confronting and correctly reacting to the increased pressure felt by everyone impacted by the shift at this stage, the relevance of the change agent’s leadership qualities becomes clear. The change agent’s duties throughout the movement phase include inspiring others, defining goals, fostering trust, and prioritizing change.

1. Refreezing stage

Refreezing is the last stage of Lewin’s change theories in nursing. For the changes to be successfully incorporated into the established order at this stage, the change agent should help to stabilize the system. Incompleteness in this phase will result in ineffective transformation and a return of pre-change behaviors.

The agent of change must be highly supportive and encouraging during this time, boosting any adaptive actions being taken by all affected members of an organization. Many studies have demonstrated that people are the key factor in the effectiveness of change. No matter how well-designed the reform agenda is, the transition cannot be successfully implemented without support.

Kurt Lewin’s change theory can be applied to various situations where change is being implemented in the healthcare industry. Lewin’s Change Theory can be applied in a variety of situations, such as changing a surgical procedure to reduce the risk of infection following surgery or assisting a patient in changing their lifestyle to lose some weight. This paradigm has been essential in changing the medical field since the 1950s.

1. The Effective Change Theory of Bennis, Benne, and Chinn

Regarding behavioral techniques, Bennis, Benne, and Chinn outlined three strategies for successful change. The transformational leader must understand the phases of transformation and the application of behavioral techniques to promote change. Knowing who or what will be impacted by the shift can help the change agent choose the best action and maximize the likelihood of success.

The first category of behavioral techniques is rational-empirical, and it assumes that the change agent knows that others’ ignorance is the reason for opposition. Understanding this allows the change agent to present data supporting the change’s necessity. By informing a patient about the health issues connected to being overweight and offering resources to aid in dieting, this approach may be used to assist them in losing weight.

To shift the normative-educational techniques, peer pressure is applied. In terms of power, this technique differs from the energy strategy. In the normative-rehabilitative approach, the agent of change has no rightful influence over other people. The change agent encourages the patient’s partner and loved ones to be there for them during this time.

In the strength approach, the agent of change uses their position of authority to exert pressure. The change agent may serve each meal for the client attempting to lose weight in the strength strategy by controlling their menu options and forcing them to consume only healthy foods.

2. Theory of Complex Adaptive Systems Change and Complexity

Complexity theory has emerged due to rapid technological development, the discovery of the atomic world, and nuclear physics. According to this view, the world’s complexity matches that of its inhabitants. The theory examines human behavior, bodily functions, healthcare procedures, and thought processes, all of that must be considered when providing patient treatment. These variables are variable, complicated, and unique to the patient, enabling a more all-encompassing approach to medical treatment.

According to the Complex Adaptive Systems theory, which derives from science, the platform’s system components are unpredictable, and adjustments occur due to this volatility. Instead of attempting to establishments through developmental stages, CAS enables the adaption of ambiguity throughout the change.

Since these modifications are seen as linear, they are illogical and unmanageable. Using this in organizational transformation in healthcare should put more of an emphasis on the micro than the macro scale. With this update, the change agent must be able to concentrate on the connections between each component.

Because outcomes for patients are often unpredictable and treatment and goals depend on various customized circumstances, complexity theory, and complicated adaptive system change theory can be very helpful in the healthcare sector.

Healthcare providers may find it challenging to forecast the effects of various treatments when dealing with an individual with many chronic conditions. Still, a better result should be attained by focusing on the patient’s overall complaints and the bigger picture. Separate care for that patient’s diagnosis would not be helpful.

3. Chaos theory

In the 1960s, meteorologist Edward Lorenz sought to advance weather estimation methods, which later served as the foundation for the chaos theory. He concluded that even small changes in circumstances could have profound effects. He added that although these changes frequently seem chaotic and out of control, they are under control.

Discovering the inherent order in what appears to be static analysis is the goal of chaos theory. The theory seems more in line with how change happens throughout an individual’s existence. There are periods of predictability and turmoil but also periods of stability.

In the context of an emergency room, chaos theory is frequently quite helpful. While it frequently appears unorganized and chaotic, stabilization can happen if only one person, such as a change agent, steps in. Even though the emergency room appears in total disarray, the order prevails.

To sum up

Nursing is changing to serve patients’ demands better and deliver better results. There is also the need to lower treatment costs and retain employees at healthcare facilities. For change to be effective, various elements such as culture and population should be considered. This is where different change theories in nursing come in.

Examples of change theories in nursing practice are; Lewin’s model change theory, chaos theory, the theory of driving and restraining causes, and Bennis, Benn, and Chinn’s theory. It is essential for change agents to apply the theories while implementing planned or unplanned change where necessary.

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