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Assignment: Patient Teaching Paper
passes from first knowledge of an innovation to confirmation of the decision to adopt or reject a new idea. His framework emphasizes the reversible nature of change: participants may initially adopt a proposal but later discontinue it, or the reverse—they may initially reject it but adopt it at a later time. This is a useful distinction. If the change agent is unsuccessful in achieving full implementation of a proposal, it should not be assumed the issue is dead. It can be resurrected, perhaps in an altered form or at a more opportune time.
Rogers stresses two important aspects of successful planned change: key people and policy makers must be interested in the innovation and committed to making it happen. Erwin (2009) found that organizational change in hospitals could only be successful and sustained if senior administrators were fully committed to the change.
Used primarily as a tool for patient teaching, Prochaska and DiClemente (2005) proposed a transtheoretical model of behavior change. Five stages characterize their model. The stages occur in sequence, and the person must be ready for change to occur, according to this model.
The Change Process Steps in the change process follow the same path as the nursing process: assessment, planning, implementation, and evaluation (see Table 5-2).
Assessment Emphasis is placed on the assessment phase of change for two reasons. Without data collection and analysis, planned change will not proceed past the “wouldn’t it be a good idea if” stage.
Identify the Problem or the Opportunity Change is often planned to close a discrepancy between the desired and actual state of affairs. Discrepancies may arise because of problems in reaching performance goals or because new goals have been created.
Opportunities demand change as much as (or more than) problems do, but they are often overlooked. Be it a problem or an opportunity, it must be identified clearly. If the issue is perceived differently by key individuals, the search for solutions becomes confused.
TABLE 5-1 Comparison of Change Models
Lewin Lippitt Havelock Rogers Prochaska & DiClemente
1. Unfreezing 1. Diagnose problem 1. Building a relationship 1. Knowledge 1. Precontemplation
2. Moving 2. Assess motivation 2. Diagnosing the problem 2. Persuasion 2. Contemplation
3. Refreezing 3. Assess change agent’s motivations and resources
3. Acquiring resources
4. Choosing the solution
3. Decision
4. Implementation
3. Preparation
4. Action 4. Select progressive change
objects
5. Choose change agent role
5. Gaining acceptance
6. Stabilization and self- renewal
5. Confirmation 5. Maintenance
6. Maintain change
7. Terminate helping relationships
CHAPTER 5 • INITIATING AND MANAGING CHANGE 59
Start by asking the right questions, such as:
1. Where are we now? What is unique about us? What should our business be?
2. What can we do that is different from and better than what our competitors do?
3. What is the driving stimulus in our organization? What determines how we make our final decisions?
4. What prevents us from moving in the direction we wish to go?
5. What kind of change is required?
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