CHANGE THEORY IN NURSING

1. Who is the proponent of this theory?

- Kurt Lewin, who is considered the father of social psychology. This theory is his most
influential theory. He theorized a three-stage model of change known as unfreezing-change-
refreeze model that requires prior learning to be rejected and replaced.

2. What are the assumptions of this theory?

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3. Definition of terms related to this theory.
- Change: the process of altering or replacing existing knowledge, skills, attitudes, systems,
policies, or procedures
- Model: a simplified description, of a system or process, to assist calculations and predictions.

4. What are the nursing theories drawn from this theory?

- Lippitt’s Seven-Step Change Theory: Expands Lewin’s theory to place additional emphasis
on the role of the change agent

Step 1: Diagnose the problem by examining all possible consequences, determining who will be
affected by the change, identifying essential management personnel who will be responsible for
fixing the problem, collecting data from those who will be affected by the change, and ensuring
that those affected by the change will be committed to its success.

Step 2: Evaluate motivation and capability for change by identifying financial and human
resources capacity and organizational structure.

Step 3: Assess the change agent’s motivation and resources, experience, stamina, and dedication.

Step 4: Select progressive change objectives by defining the change process and developing
action plans and accompanying strategies.

Step 5: Explain the role of the change agent to all involved employees (e.g., expert, facilitator,
consultant) and ensure that expectations are clear.

Step 6: Maintain change by facilitating feedback, enhancing communication, and coordinating

the effects of change.

Step 7: Gradually terminate the helping relationship of the change agent

- Roger’s Five-Stage Change Theory

Stage 1: Impart knowledge in terms of the reason for the change, how it will occur, and who
will be involved.
Stage 2: Persuade employees to accept change by relaying essential information and note that
attitudes, both favorable and unfavorable, are formed.
Stage 3: Decide whether to ultimately adopt the change by analyzing data and implementing
a pilot study or trial of the new processes triggered by the change.
Stage 4: Implement the change on a more permanent or established basis as the organization
evolves to accommodate the change.
 Stage 5: Confirm adoption of the change by the employees responsible for and affected by
the change (Rogers & Shoemaker, 1971).

5. What is the importance of this theory to the nursing profession?

- Knowledge of planned change increases the likelihood that an advanced practice nurse will
make optimum use of advanced clinical knowledge
- The study of planned change helps advanced practice nurses create change for purposes of
consumer advocacy and in response to the professional practice opportunities and restrictions
they face
- Advanced practice nurses need planned change knowledge to skillfully manage and lead
practice changes that enhance the profession of nursing and contribute to the well-being of
consumers
(Planned Change Theories for Nursing: Review, Analysis, and Implications by Constance
Rimmer Tiffany, Louette R. Johnson Lutjens)

6. How can this non-nursing theory be applied to the nursing practice and our current health
situation? Cite some examples.
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Lewin’s change theory is a ‘planned change’ guide that consists of three distinct and vital stages:
Unfreezing Stage Moving to a New Level or Change Stage Refreezing.
Stage Unfreezing The first stage involves finding a method of making it possible for people to let
go of an old pattern that was counterproductive in some way. This is the stage where the desire to
change occurs, or at least the recognition that change is needed. An example is moving from a
paper based documentation system to an electronic system, in an organization where paper trails
have become unmanageable and archaic. Unfreezing the present Forces that maintain current
behavior are reduced through analysis of the current situation. Imperatives for change are realized
through dialogue and re-educational activities such as team building, personal development, and
brain-storming. The more transparent and inclusive the process is, the more readily people move
through the unfreezing stage.
Moving to a new level or Change The second stage involves a process of change–in thoughts,
feelings, behavior, or all three, that is in some way more liberating or more productive than doing
things the old way. During this stage, the people involved (change target group) are convinced
that the new way is better than the old. Having analysed the present situation, new structures and
processes are put in place to achieve the desired improvements. This is the most time-consuming,
costly, yet productive stage as far as tangible results go.
Refreezing The third and final stage consists of establishing the change as a new habit or process,
so that it now becomes the “standard operating procedure” or status quo. Without some process of
refreezing, it is easy to backslide into the old ways of doing things. Rewards, support, and
champion leadership continue to be important through this stage, which is essentially ongoing
until the next major change is needed. The changes implemented are ‘frozen’ in place to ensure
that they become part of normal working procedures. This is done by establishing supportive
mechanisms such as policies, rewards, ongoing support, and a solid orientation to the new system
for incoming personnel.