Clinical situation

This assignment will look at how the change theory of Lewin can be applied to a clinical situation that has ethical, advocacy and legal ramifications. The elder care facility it will be applied to provides all staff with the same uniform regardless of their designation, also, within this facility all staff are referred to as nurse whether they are or not. This makes identification of staff designations very difficult. The change theory developed by Kurt Lewin in 1951 will be applied to change and improve this situation and an analysis of the situational factors that impact on change will be explored. The principals of change theory will be discussed and applied to the planned change and conclusions about determining the success of the change will be made.

Whilst on clinical placement with first year students in an elder care facility it was noticed that all the staff members, except the nurse-manager who wore contemporary clothes, wore the same uniform. Only one nurse was seen to be wearing her badge and inquiries regarding the uniform were met with the response “we all want to look the same – no hierarchy here”. Furthermore, all staff were referred to as “nurse” whether they were nurses or not.

Being unfamiliar with the staff, students were further disadvantaged by being unable to rely on uniforms and badges to determine the staffing designations. It was also noticed that visitors to the facility had these same problems. Having staff designations identified by different uniforms would enable patients, visitors and other staff to instantly know whether they were talking to a registered nurse, a care associate or chatting to the cleaner.

The theory of change was developed by Kurt Lewin, who identified three phases to accomplishing change (Marquis & Huston, 2003). The first of these phases is that of unfreezing, when “the change agent unfreezes forces that maintain the status quo” (Marquis & Huston, 2003, p. 82). For this phase to be successful, an accurate assessment of the problem must be made along with a decision to change. In this phase people become disenchanted and become aware of a need for change. In the initial unfreezing phase of change the individual becomes aware of the need for change through three mechanisms.

Hein and Nicholson, (1994) identify the first as occurring when the individuals expectations fail to be met (lack of confirmation). The second occurs when the individual feels uneasy about a certain action or lack of action (guilt/anxiety), and the third is when an obstacle to change has been removed (psychological safety). Change must then be planned to satisfy an existing need or to reduce stress. The change agent may even use strategies to initiate this process.

Movement is the second phase of this trilogy. This involves the change agent developing a plan, setting goals and objectives, knowing who will be supportive and where to expect resistance (Marquis & Huston, 2003). This is also the phase where the planned change is implemented, evaluated and modified if necessary. With change comes resistance. The values, perceptions and attitudes of those involved in the changes must be acknowledged, barriers discussed and solutions identified. The third and final part of the change theory is termed refreezing. This is a supportive role, requiring the change agent to reinforce individuals in their efforts to adapt to the change, so that the change is maintained (Marquis & Huston, 2003).

Marquis and Huston (2003), state that there are ten emotional phases of the change process. These are similar to those of the grief cycle and state that change is often accompanied by a sense of loss and grief. These emotional phases include the sense of stability that is achieved when professional and personal goals meet. Denial occurs when the reality of change is faced followed by anger, and bargaining occurs when those affected by the changes attempt to eliminate or reduce the change.

Loss of security and powerlessness result in feelings of depression and chaos (external locus of control). As new roles emerge openness occurs and there is a sense of readiness, renewed energy and emotional reunification. The individual feels empowered (internal locus of control) and begins to introduce new ideas and projects. This phase is termed re emergence. If the change is a big one involving many staff members then the change agent may have to take into consideration that the staff members may move in and out of the various emotional phases and this may happen at different times for individual staff members.

Initiating change requires good leadership skills. Leadership requires ability, skill, vision and confidence and the ability to lead is best nurtured in an environment that provides opportunities for recognition of performance, constructive feedback about performance and supported risk taking, (Crew, 1999). Hardiness is a quality Marriner-Tomey (1993) describes as being a characteristic of a good leader. Hardy leaders believe they have control or influence over the events of their lives, an internal locus of control, as opposed to others who feel powerless in various situations, an external locus of control (Marriner-Tomey, 1993).

Managers who are willing to empower their staff and staff who are willing to accept the challenges inherited with empowerment will have an internal locus of control and are therefore less likely to feel as unsettled by the effects of change in their workplace as those with an external locus of control. Leadership style is significant. Transformational leaders motivate and empower staff to work to their full potential and enable individual staff members to be accountable for their work practices (Wilson, 1992). This allows for risks to be taken and mistakes to be viewed as learning opportunities, providing a supportive workplace that nourishes new ideas and supports change.

For change to occur a leader must have vision and direction and the ability to induce people to follow their direction and understand their vision (Clarke, 1994). One of the most difficult tasks for the manager is to enable staff to view the changes as a challenge instead of a threat (Marriner-Tomey, 1993). To successfully accomplish this there must be a degree of trust within the organisation. Trust arises from the mutual understanding that the actions taken by the organisation will not be detrimental to the employees (Hein & Nicholson, 1994).

If staff members feel they are a valued part of the organisation they will be more inclined to accept changes rather than oppose them. Trust between the manager and staff is a key factor in implementing and maintaining changes. A trusted manager will gain the respect of their staff and colleagues and in return will offer them trust and respect. For change to be effective, all people involved in the change must feel valued, supported and feel they are being listened to.

One of the critical factors to ensuring successful change is communication. The breakdown of communications is cited at the most common reason for the failure of change programs in organisations (Clarke, 1994). Clarke (1994) states that “information is power to the people, information is control over your own destiny, information is understanding why change is necessary, information is the antidote to fear” (p. 158). This is an important observation because staff do not like to feel that changes that affect them are happening and they have no say in them. Regardless of whether the change is small or large staff members like to have a voice and want management to acknowledge that.

According to Clarke (1994), research shows that when communicating change, an open, two-way type of communication is the most effective in ensuring a lasting and irreversible change. This type of communication opens the way for management and staff to engage in a dialogue rather than the manager being responsible for informing staff of the change and expecting them to obey. In an environment that encourages open two-way information, staff who will be affected by the proposed change may express any doubts or fears regarding how the change may impact on them. It is also important that the communication begins even if all of the facts are unknown at that point because this demonstrates a consideration for staff by acknowledging feelings of insecurity, and lack of control over ones destiny (Clarke, 1994). This proves to staff that they are trusted by the management and are considered a valuable part of the organisation.

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