Comment: Planned Change In Nursing Practice Is Necessary Whe

Comment1planned Change In Nursing Practice Is Necessary When Focusing

Planned change in nursing practice is essential when focusing on evidence-based practice (EBP). Implementing change through a structured approach increases the probability of success by ensuring efforts are strategic, deliberate, and collaborative (Roussel, 2006). However, despite careful planning and the application of change theories, executing change remains a complex challenge. Evidence suggests that up to two-thirds of organizational change projects fail, highlighting the difficulties faced in translating planning into effective action (Szabla, 2007).

Kurt Lewin’s foundational model of change, developed in 1951, outlines three critical stages: unfreezing, moving, and refreezing. The unfreezing stage involves recognizing the need for change; moving encompasses the initiation and implementation of new practices; and refreezing stabilizes these changes into the organizational culture. Lewin’s model is praised for its simplicity and clarity, offering a straightforward framework that can be easily integrated into both personal and organizational change efforts. Moreover, the model addresses potential barriers—referred to as forces—such as cultural resistance, financial constraints, structural issues, and attitudinal factors that can impede change (Lewin, 1951).

Following Lewin’s foundational work, Lippitt’s change theory offers a more detailed, nursing-specific approach. This model emphasizes stages such as assessment, planning, implementation, and evaluation, providing clear direction for executing change at the bedside or within organizational units. Lippitt’s framework employs nursing language that resonates with staff nurses, making it particularly effective for fostering understanding and acceptance among clinicians. It also allows customization for stakeholder engagement by adjusting terminology and focus depending on the audience.

In practical terms, using a change theory tailored to the nursing context—such as Lippitt’s—facilitates organized, strategic, and professional implementation of evidence-based practices. For example, when instructing nursing and security staff on recognizing mental health decompensation, applying a structured change theory ensures clarity, buy-in, and effective execution. This approach not only streamlines communication but also increases the likelihood of sustainable change, ultimately improving patient outcomes.

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Change in nursing practice is vital for advancing healthcare quality and patient safety. As healthcare environments evolve, nurses are often at the forefront of implementing new practices derived from evidence-based research. The necessity for planned change stems from the need to adapt to emerging clinical evidence, technological advancements, and shifting patient populations. Structured change theories serve as vital tools to guide nurses and healthcare organizations through the complex process of implementation, ensuring that efforts are coordinated, purposeful, and sustainable.

Among various change models, Lewin’s three-stage theory provides a foundational framework that emphasizes the social and psychological aspects of change. The unfreezing stage involves creating a perceived need for change, often through data and dialogue that challenge the status quo. During the moving phase, change agents implement new policies or practices, requiring clear communication, training, and resource allocation. The refreezing stage consolidates change, embedding new behaviors into routine practice and cultural norms. Lewin’s model is appreciated for its simplicity and adaptability but has been complemented by more detailed theories tailored to specific disciplines.

Lippitt’s change theory extends Lewin’s work by offering a detailed, step-by-step process that aligns with nursing practice. It emphasizes assessing the readiness and capacity for change, planning strategies collaboratively, executing interventions, and evaluating outcomes. Using nursing jargon within this framework facilitates staff understanding and engagement, particularly when changes occur at the bedside or within team dynamics. Lippitt’s approach underscores the importance of interpersonal processes, leadership, and communication—elements critical to healthcare settings where multidisciplinary collaboration is essential.

In addition to these theories, Rogers’ diffusion of innovations theory offers insight into how new practices and innovations spread within organizations. Rogers proposed five stages: awareness, interest, evaluation, trial, and adoption. This model highlights the importance of early engagement and the role of change agents in fostering acceptance among healthcare providers. It underscores the importance of understanding individual and collective readiness to embrace change, which can significantly influence implementation success.

Combining these models provides a comprehensive approach to planned change in nursing practice. For example, Rogers’ focus on communication and adoption can be integrated with Lippitt’s detailed planning and Lewin’s stepwise change process to create a robust strategy that addresses both individual and organizational dynamics. This hybrid approach ensures that change initiatives not only are well-structured but also account for human factors that influence acceptance and sustainability.

In practice, the application of these theories has demonstrated success in various healthcare improvements, such as implementing electronic health records, adopting new clinical protocols, and improving mental health interventions. For instance, evidence shows that engaging staff early (Rogers), providing clear assessment and planning (Lippitt), and fostering a culture receptive to change (Lewin) significantly enhance the likelihood of successful adoption.

In conclusion, change theories are essential in guiding effective nursing practice transformations. They offer frameworks that address the psychological, social, and organizational barriers to change, ultimately promoting successful implementation of evidence-based practices. Utilizing a combination of models like Lewin’s, Lippitt’s, and Rogers’ can lead to more comprehensive, strategic, and sustainable changes within healthcare settings, improving patient care and staff satisfaction.

References

• Lewin, K. (1951). Field theory in social science. Harper & Row.
• Lippitt, R., Watson, J., & Westley, B. (1958). The dynamics of planned change. Harcourt, Brace & World.
• Mitchell, G. (2011). Change management in healthcare: Strategies and approaches. Journal of Healthcare Management, 56(4), 241-253.
• Roussel, L. (2006). Management and leadership for nurse administrators. Jones & Bartlett Learning.
• Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.
• Szabla, D. (2007). Managing organizational change. Harvard Business Review, 85(10), 86-97.
• Mitchell, G. (2011). Strategies for successful healthcare change initiatives. Healthcare Quarterly, 14(1), 12-19.
• Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581-629.
• Craig, J. V., & Smyth, R. L. (2012). The evidence-based practice manual for nurses (3rd ed.). Churchill Livingstone.
• Walker, K. (2013). Leading change in healthcare organizations. Nursing Management, 20(2), 28-32.