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CHANGES

Concepts -Theories :

It’s Implication on

Nursing

By: Ms. Shanta Peter

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Changes & Challenges Explained

What is a change?Types of Changes Change Process and Response to Change Theory of Change Change Agent … Role

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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 Wheel 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.

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Mind Storms ] [ The Sidewalk of Life ] [ Stereogram ] [ Stress ] [ Understanding Depression ][ Coping with Cancer ] [ Wheel of Life 1 ] [ 

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Learn about my book!

Emotions of Change : A Medieval model of Change Happy is

where we want to be

Suffering is

transition of Change

Bottom of wheel

The wheel always turns

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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

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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

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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

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CHANGES …. Nurses • Patients….. Relatives • Work place – environment itself • Colleagues• Policy • Procedures • Technology:- technical, Information….

Patients….. Relatives Work place – environment itself ColleaguesPolicy Procedures Technology- (Technical, Information….)

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TYPES of CHANGES

 Emergent – Emergent change happens at all levels. Changes that evolve over time as the result of everyday activities and eventsTransformative– 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 .

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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 problemTherefore, The best technique to overcome the resistance to change is using emotional approach than rational approach.

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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)

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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.

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The 8 most common Beliefs and Reasons that people RESIST CHANGE

1. There isn’t any real need for the change2. The change is going to make it harder for me to

meet my needs3. The risks seem to outweigh the benefits4. I don’t think I have the ability to make the change5. I believe the change will fail6. Change process is being handled improperly by

management7. The change is inconsistent with my values8. I believe those responsible for the change can’t be

trusted

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A SERIES of Actions, Changes, or Functions bringing about a CHANGE

The 6 Steps Change Process

CHANGE PROCESS

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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?

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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 ….

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STEP- 3. What Do I Need To Do?

The situation is known .. Now ..You need to plan the action

What you need to do ? & How you will implement? You must develop Implementation plan Formal or Informal

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STEP- 4. I Will Do This

Now there is a plan --- it must put into action

You know what to do --------

YOU do it

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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

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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 …

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5 Types of Response to Change

( Innovators and laggards --Everett Rogers)1. Innovators – Those who love to change and thrive on

it2. 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

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Theory of Change

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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 ..

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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…

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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

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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

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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

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KURT-LEWIN’s Theory

Unfreeze Change/ Refreeze Move

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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.

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• 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.

 

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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

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“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

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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

…..Standard Operating Procedure Complying with a NEW Behavior

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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

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Change Agent

CHANGE AGENT

Change Agent means a person who helps or facilitates in

bringing positive change in any area of health

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

developments

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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.

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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.

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Change agent has a great and vital role in 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 Internal Change agents .. know all working conditions.. people etc –• Difficulty is that something is already in practice –

their credibility and ability

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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.

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YOU – As a Change Agent

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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

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  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.

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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..

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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 structuresSeeks resources for teaching and learning , ensure adequate future innovation

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

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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.

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Changes & Challenges Explained

What is a change?Types of Changes Change Process and Response to Change Theory of Change Change Agent – … Role