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

1. 1
CHANGES
By: Ms. Shanta
Peter

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. The Wheel Of Life
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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. 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. 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. 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. 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. 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. 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. 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. 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. 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

14. A SERIES of Actions, Changes, or
Functions bringing about a CHANGE
The 6 Steps Change Process
14

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. 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. 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. 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. 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. 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. 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

22. 22

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. 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. 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. 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. 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. KURT-LEWIN’s Theory
Unfreeze Change/ Refreeze
Move
28

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. • 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. 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. “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. 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. 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. Change Agent
35

36. Change Agent-…. Qualities
• Willing to experiment
• Ready to change
• Good understanding of educational
developments
36

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. 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. 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. 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

41. 41

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. 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. 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. 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. • Name one Change Agent(s) ..
at work –whom you are-
constantly in touch with–
from your beginning of
career in Kuwait…………
46

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. Changes & Challenges Explained
What is a change?
Types of Changes
Change Process and Response to Change
Theory of Change
Change Agent – … Role
48