Change challenges for nurses 2


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Nurses face changes at all times.... change theories and its implications in nursing ....

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Change challenges for nurses 2

  1. 1. 1 CHANGES By: Ms. Shanta Peter
  2. 2. Changes & Challenges Explained What is a change? Types of Changes Change Process and Response to Change Theory of Change Change Agent … Role 2
  3. 3. The Wheel Of Life [ Home ] [ Attitude ] [ Awakenings Book Store ] [ The Cycle of Change ] [ Enneag ram ] [ The Labyrinth ] [ Lessons for Living ][ Midlife Metamorphosis ] [ Mind Sto rms ] [ The Sidewalk of Life ] [ Stereogram ] [ Stress ] [ Understanding Depressi on ][ Coping with Cancer ] [ Wheel of Life 1 ] [ Wheel of Life 2 ] [ Teaching ] [ Les sons:The Book ] [ Striving and Thriving ] [ Links ][ Take a Stress Test ] [ Media Page ] [ Contact Us ] [ Home ] A Medieval model of Change The Emotions of Change This is a brief version of the Wheel of Life It is a model for understanding the emotions of organizational change. For a more detailed presentation with a psychological and spiritual emphasis Click Here. The Wheel of Life is the medieval model of change. It describes the emotions of change. In the Middle Ages when many people were illiterate teaching took place through images or pictures. The Wheel of Life was often carved in the stone walls of cathedrals. People seeing the image received instruction about the change process. What was the lesson?At the top of the wheel is a well-dressed, smiling, kingly or queenly person. This person is in the position of Happiness. Things are normal and going well. The wheel turns with a clockwise movement. Change has occurred. The same person is now upside down and falling through space with a look of distress. This is the position of Loss. The wheel continues its movement and at the bottom of the wheel the individual is now nude and is being pulled along through the muck and mire of life. This is the position ofSuffering. The wheel turns and the person, who is again clothed, rises up to the position of Hope. There is hopeful anticipation of once again reaching the position of happiness. The wheel's lesson is that there are only four positions in life: happy, loss, suffering, and hope. We are always in one of these positions. Happy is where we want to be. Happy is where everything seems normal. Happy is where we all want to be. What we are doing is succeeding. There is a routine that works. We are comfortable. "Suffering" means to allow Loss is where the happiness of routine begins to fall apart. A variety of events have signaled change and we are being challenged to let go of the routine that worked. When loss comes we want to return to our lost happiness as quickly as possible. We want to regain our equilibrium by making the wheel go in reverse. The wheel, however, only moves forward with a clockwise motion. To regain happiness we must follow the wheel into suffering.Suffering is at the bottom of the wheel. Suffering is the phase of transition. The Latin root word for suffering means to "experience or allow." So, to suffer means that we go through and fully experience our loss as we make and then implement our plans for a return to normal. This is a process that we cannot short circuit and still achieve our goal. We cannot go over, under, or around the transition phase. We must go through it with the hard work of planning, implementing, and revising. This is often unpleasant and there is true suffering (tension, stress, anxiety, worry, frustration, anger, conflict, sadness). It is out of suffering (experiencing) that hope arises. The W heel always turns. Hope comes when our plan is working and progress can be seen. We begin to feel competent. Our goal comes into view and we have a vision of a return to the happiness of normalcy.The normalcy that we see will not be the same as the "old" normal. Through an effective process of change we return to balance but it is a new and different balance. Happiness is found in a new state of equilibrium. Once returned to normal we look ahead and get that uneasy sense that, "Something’s Up?" The winds of change continue to blow. The wheel always turns. Our happiness, normalcy, is not a permanent state. More change is coming and the journey around the wheel into loss, suffering, and hope begins again. Whenever change enters our life we experience the emotions of change. As we sense that loss is coming there is anxiety, apprehension, and worry. When loss arrives we feel sad, angry, irritated, and frustrated. Grieving needs to be done. With the experience of suffering through change may come stress, depression, burnout, helplessness, or even hopelessness. Eventually, hope brings a renewed energy, optimism, and enthusiasm and happiness brings a sense of satisfaction and contentment.The Wheel of Life teaches that we cannot get happy and stay happy. Change always comes. Change brings growth. The emotions of change are expected and normal. They cannot be avoided. Looking for and accepting them in yourself and others helps work through the process of change. Where are you on the Wheel of Life? ©1997 Daniel H. Johnston. All Rights Reserved. [ Home ] [ Attitude ] [ Awakenings Book Store ] [ The Cycle of Change ] [ Enneag ram ] [ The Labyrinth ] [ Lessons for Living ][ Midlife Metamorphosis ] [ Mind Sto rms ] [ The Sidewalk of Life ] [ Stereogram ] [ Stress ] [ Understanding Depressi on ][ Coping with Cancer ] [ Wheel of Life 1 ] [ Wheel of Life 2 ] [ Teaching ] [ Les sons:The Book ] [ Striving and Thriving ] [ Links ][ Take a Stress Test ] [ Media Page ] [ Contact Us ] [Home] Learn about my book! 3 Emotions of Change : A Medieval model of ChangeHappy is where we want to be Suffering is transition of Change Bottom of wheel The wheel always
  4. 4. The WHEEL of LIFE keep turning through 4 Phases HAPPINESS HOPE LOSS SUFFERING Balancing all of this intricacy of CHANGE is where the real CHALLENGE of CHANGE is focused 4
  5. 5. Cycles of Change affecting person New…..……Transitions...Resolved changes Changes in FAMILY 1.2.3.. Changes at WORK ..1.2.3. Changes in SOCIAL LIFE 1—2--3 Changes in COMMUNITY 1..2.3. Changes in POLITICAL aspects Emotional experiences of Loss….Regain hope 5
  6. 6. Change is necessary for growth— It produce feeling of anxiety, loss and doubt It create NEGATIVE STRESS – because it involves the EXPERIENCE of LOSS Most people prefer what is FAMILIAR and COMFORTABLE --- so they question any change In Health Care – some old habits die hard – Eg .. Pre-op fasting--- prolonged pre-op fasting 6
  7. 7. CHANGES …. Nurses • Patients….. Relatives • Work place – environment itself • Colleagues • Policy • Procedures • Technology:- technical, Information…. Patients….. Relatives Work place – environment itself Colleagues Policy Procedures Technology- (Technical, Information….) 7
  8. 8. TYPES of CHANGES Emergent – Emergent change happens at all levels. Changes that evolve over time as the result of everyday activities and events Transformative– Existing social and human behavior in the systems and structure is changed. It involves multi disciplinary groups .. designed and enacted over a period of time Planned An alteration of the status quo by means of a carefully formulated program . 8
  9. 9. CHANGE and RESISTANCE to CHANGE Like it or not … Change will happen in the course of time We can’t CONTROL the change – but we can control how we respond to or feel about the change Change is not the problem – Resistance to Change is the problem Therefore, The best technique to overcome the resistance to change is using emotional approach than rational approach. 9
  10. 10. Resistance to Change Why do people resist change ? Rational-Technical side – what needs to happen ? Emotional- Human side – What happens to me? “People don’t resist change- they resist being changed”(Peter Senge) 10
  11. 11. Then - how can I overcome the Resistance ? Expecting Resistance to Change and Planning for it --from the start of your change management will allow you to manage objections effectively. 11
  12. 12. The 8 most common Beliefs and Reasons that people RESIST CHANGE 1. There isn’t any real need for the change 2. The change is going to make it harder for me to meet my needs 3. The risks seem to outweigh the benefits 4. I don’t think I have the ability to make the change 5. I believe the change will fail 6. Change process is being handled improperly by management 7. The change is inconsistent with my values 8. I believe those responsible for the change can’t be trusted 12
  13. 13. 13
  14. 14. A SERIES of Actions, Changes, or Functions bringing about a CHANGE The 6 Steps Change Process 14
  15. 15. Step- 1. Something's Up ! Recognition of a coming CHANGE Everything is going well …………. and you are feeling normal. You begin to get the sensation that something is different ! Vague awareness ---- change is approaching ----- “Something’s” Up? 15
  16. 16. Step- 2 What is it? The Situation of change is …. Recognized-Clarified- Named– Described • You choose your point --- Problem or Opportunity …But- you need a Clear Understanding of the situation to decide the course of action (Tsunami –……. information –.. not yet arrived !!! • Raise the Alarm – and get a head start on preparation Early recognition could have enabled the action – otherwise Change will stuck …. 16
  17. 17. STEP- 3. What Do I Need To Do? The situation is known .. Now ..You need to plan the action What you need todo ? & How you will implement? You must develop Implementation plan Formal or Informal 17
  18. 18. STEP- 4. I Will Do This Now there is a plan --- it must put into action You know what to do -------- YOU do it 18
  19. 19. STEP-5. ‘I Am Able To Do This’ The plan is there and you … modify and make improvements .. So that there is a sense that it is working So… The realization is that the GOAL can be achieved 19
  20. 20. STEP-6. ‘I Got Through It. What's Next?’ Hooray…… Celebrate Change is implemented And things are normal again – (Not the old normal …. But a new normal ) Now you are looking ahead for a new CHANGE … 20
  21. 21. 5 Types of Response to Change ( Innovators and laggards --Everett Rogers) 1. Innovators – Those who love to change and thrive on it 2. Early Adopters. Those who are usually receptive to change -They are opinion leaders and willing to try out new ideas in a thoughtful way 3. Early majority. Thoughtful people who accept change more quickly than average 4. Late majority: People who initially resist change , but accept change after the majority 5. Laggards : Those who dislike change and are openly critical and antagonistic 21
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  23. 23. KURT-LEWIN ( 1952) Father of Social Psychology Change Management Model According to Lewin…. ”If you want truly understand something – Try to CHANGE it ..” Change is VITAL to Progress .. 23
  24. 24. Some Concepts of Lewin’s Theory The FORCES affect changes Force Field Analysis a) Driving Forces: Things that motivate you for change b)Restraining Forces: Things that hold you back from change—this cannot be removed So it should be countered only by increasing driving force Contd… 24
  25. 25. Forces… contd… c)Equilibrium: When (a) &( b ) are equal- NO change occurs Eg .Introducing new infusion pump The Change agent develop strategies to reduce restraining forces – fear of using a new device 25
  26. 26. The individual accept new systems of values and beliefs -- when there is an acceptance in the group--- According to Lewin…. To understand the behaviour – The Person and the Environment have to be considered as one constellation of interdependent factors Eg. New nurses 26
  27. 27. Lewins theory helps nurses to assess and change patient’s health behaviour… Barrier to change …. How to help the patient become more accepting to change Finally completing the change E.g smoking ……….Obesity 27
  28. 28. KURT-LEWIN’s Theory Unfreeze Change/ Refreeze Move 28
  29. 29. Unfreezing : When CHANGE is needed UNFREEZE Old habits Unproductive ? – let them go…………… Find a method for unfreezing. • Unfreezing is necessary to overcome the strains of individual resistance and group conformity. 29
  30. 30. • Unfreezing can be achieved by the use of three methods. –First- Increase the driving forces that direct behavior away from the existing situation or status quo. –Second- Decrease the restraining forces that negatively affect the movement from the existing equilibrium. –Third- Find a combination of the two methods listed above. 30
  31. 31. Nurses The techniques that motivate staff to be aware of the coming change – that build recognition of the need for change. • Feel discomfort with the present state when status quo is questioned 31
  32. 32. “MOVEMENT ” - When change is initiated- “Moving to a new level or Changing” Thoughts-- Feelings---Behaviours --- all actions towards a goal – This stage involves a process of change in all 3… thoughts, feeling, behavior, that is in some way more liberating or more productive. Nurses Patient’s Health Problems are assessed, analysed- options and alternatives are identified and actions occurs 32
  33. 33. Re-FREEZING When Equilibrium is established CHANGE is established as a new habit- so that it now becomes the – Without this stage of refreezing, it is easy to go back to the old ways 33 …..Standard Operating Procedure Complying with a NEW Behavior
  34. 34. Theory and phases are inter related and use in Nursing Process…. Assessment – Planning – Implementing – Evaluation Assessment Lewin’s Unfreezing stage Planning & Implementation Lewin’s Moving stage Implementation & Evaluation Lewin’s Refreezing stage 34
  35. 35. Change Agent 35
  36. 36. Change Agent-…. Qualities • Willing to experiment • Ready to change • Good understanding of educational developments 36
  37. 37. Change agents are responsible for facilitating the change through: • Gaining commitment for the changes. • Facilitating evaluation activities. • Monitoring and reporting progress of change. • Consulting and identifying sources of resistance. • Disseminating lessons learned. 37
  38. 38. Change Agent ? A Change Agent can help with Change Efforts People resist Change --- they fear the unknown Change agents from inside or outside the facility This person is well versed in the system and can help, guide and assist in change process. 38
  39. 39. Change agent has a great and vital role n implementation of change Eg. Head Nurse Vs New nurse When agents of change are supported in more balanced lives -- they are empowered to create more effective, lasting change in the world nternal Change agents .. know all working conditions.. people etc – • Difficulty is that something is already in practice – their credibility and ability 39
  40. 40. Change agent….. Outside Personnel as Change Agent Disadvantage Challenged with the norms and beliefs and accepted behaviours. They do not have knowledge of the policies--- and when they leave – the work should continue Advantage is—objectivity --and give honest feedback without fear of reprisal. They have broad experience to share. 40
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  42. 42. Characteristic of a Change Agent 1. Clear Vision A ‘Change Agent’ does not have to be the person in authority, but have a clear vision and be able to communicate clearly with others. • To tap into the strengths of the people and ways to work toward a common purpose. *** Must have thorough knowledge of change theory….& Concepts 42
  43. 43. 2. Patience yet Persistent Change that is meaningful to people-- to embrace change and see importance. Most people need to experience something before they really understand it. Many can get frustrated that change does not happen fast enough The persistence comes in that you will take opportunities to help people get a step closer often when they are ready, Not just giving up on them after the first try. 43
  44. 44. 3. Asks tough questions – • —- Have accountability. There should be an emotional connection – when they move truly ahead. 4.Knowledgeable and leads by example • Active in learning and working with learners and can show by example- what learning will have much more credibility. • Put themselves in the situation.. where they are actually involved in that type of learning.. 44
  45. 45. 5. Strong Relationships built on Trust – • People will not accept - if they do not trust the person that is pushing the change. • The change agents should be extremely approachable and reliable. 6. Builds supporting structures Seeks resources for teaching and learning , ensure adequate future innovation 45
  46. 46. • Name one Change Agent(s) .. at work –whom you are- constantly in touch with– from your beginning of career in Kuwait………… 46
  47. 47. Yes it is Staff Development Unit …. Support the change process. • Help support the change. • Be an important vehicle to communicate the reasons for change. • Provide a mechanism for obtaining feedback. 47
  48. 48. Changes & Challenges Explained What is a change? Types of Changes Change Process and Response to Change Theory of Change Change Agent – … Role 48