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Unit: #6

Topic: Effecting Change

Audience: 4th year BScN Students

Date: February, 2015

Time: 8-9:15 am

Duration: 1:15 mins.

Venue:

Methodology: Lecture Discussion

Number of participants:

Learning Theories: Ausubel: Emphasized the use of advance organizers which he said was

different from overviews and summaries. His use of an advance organizer acted to bridge the

chasm between learning material and existing related ideas. The advanced organizer used; sought

to bridge new knowledge with what was known (sometimes what is known is uncertain and not

concrete). Though he specified that his theory applied only to reception learning in schools, it

was utilized because it introduced the topic and aided the sequence of the information to be

imparted. (Ormrod & Rice, 2003).

Rogers: Dealt with the adult learner, he posited that learning is student centered and

personalized and the educators role is that of a facilitator. Affective and cognitive needs are

central and the goal is to develop self-actualized persons in a cooperative, supportive

environment. This theory was used because all the participants were adult learners, thus they
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were responsible for their learning experience and the teacher sought to guide them through this

experience. (Quinn, 2006).

Bruner: Believed that learners were not blank slates but brought past experiences to a new

situation, he also stated that new information was linked to prior knowledge, thus mental

representations are subjective. Bruners Discovery learning is an inquiry-based, constructivist

learning theory that takes place in problem solving situations where the learner draws on his or

her own past experience and existing knowledge to discover facts and relationships and new

truths to be learned. (Quinn, 2006). Students interact with the world by exploring and

manipulating objects, wrestling with questions and controversies, or performing experiments. As

a result, students may be more likely to remember concepts and knowledge discovered on their

own (in contrast to a transmissionist model). (Quinn, 2006). Models that are based upon

discovery learning model include: guided discovery, problem-based learning, simulation-based

learning, case-based learning, incidental learning, among others. The advantages of this theory

are: it encourages active engagement, promotes motivation, a tailored learning experience, and

promotes autonomy, responsibility, independence, the development of creativity and problem

solving skills. (Quinn, 2006) Bruners theory was used because it encouraged active engagement,

promotes motivation, a tailored learning experience, and promotes autonomy, responsibility,

independence and the development of creativity and problem solving skills for this presentation.

Vygotsky: Posited that individuals learn from each other through social interaction and the

teacher and the learner collaborate in a reciprocal relationship where each learns from each other

through the same process of social interaction (Quinn, 2006). This theory was chosen since it

lays the overall foundation for human behaviours that of interaction, where students learn from
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the more knowledgeable other (MKO) it coincides with the topic and the overall mode of

delivery of the topic.

Aim of the activity: To educate nursing students on the importance of change in health care

organization

Scientific Principle:

Resources: Nurse Instructor, lap top computer, multimedia, white board, markers,

Objectives: At the end of 1 hour and 15 mins interactive session students should be able

to:

1. Define change as explained by Jones (2007)

2. Outline factors that necessitates change in the work place according to

Marquis & Huston (2014)

3. Explain the stages of Lewins theory as cited by Marquis & Huston (2014)

4. Describe the effects of driving and restraining forces on the change

process according Marquis and Huston (2014)

5. Explain three strategies used in the change process as reasoned by

Marquis and Huston (2014); Jones (2007); Quinn, Spreitzer, and Brown,

(2000).
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6. Discuss resistance to change according to Marquis & Huston (2014);

Kalisch (2007); Tappen et al (2010); Kotter (1999); Berman-Rubera,

(2008); Johnston, (2008); Hunter (2004); Schein (2004)

7. Explicate planned change as cited by Marquis and Huston (2014)

Evaluation: Formative and Summative. Questions will be asked before and after each

objective as well as discussion followed by a short quiz at the end

References:

Ayers, D. F. (2002). Developing climates for renewal in the community college: A case

study of dissipative self-organization. Community College Journal of research and

practice. 26, 165185.

Berman-Rubera, S. (2008, August 10). Leading and embracing change. Business/Change-

Management. Retrieved December 10th 2014 from http://ezinearticles.com/?Leading-

And-Embracing-Change&id=1180585

Hunter, J.C. (2004). The worlds most powerful leadership principle: How to become a servant

leader. N.Y.: Crown Business

Johnston, G. (2008, March 8). Change managementWhy the high failure rate.

Business/Change-Management. December 10th 2014 from

http://ezinearticles.com/?Change- ManagementWhy-the-High-Failure-

Rate?&id=1028294
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Kalisch, B.J. (2007). Dont like change? Blame it on your strategic style. Reflections on Nursing

Leadership, 33(3). Retrieved December 28, 2014 from http://nursingsociety.org/RNL/

3Q_2007/features/feature5.html

Kotter, J.P. (1999). Leading change: The eight steps to transformation. In Conger, J.A.,

Spreitzer, G.M., & Lawler, E.E. (eds.).The Leaders change handbook: An essential

guide to setting direction and taking action. San Francisco: Jossey-Bass.

Marquis, B., & Huston, (2014). Leadership roles and management functions in nursing (8th ed).

Lippincott and Williams.

Ormrod, J & Rice, F. (2003). Lifespan development and learning. Boston MA: Pearson

Publishing.

Patronis Jones, R. (2007). Nursing Leadership and management: Theories, process and practice.

Philadelphia: F. A. Davis Company

Quinn, R. E., Spreitzer, G. M., & Brown, M. V. ( June 2000). Changing others through

changing ourselves. Journal of Management Inquiry. 9(2): 147165.

Quinn, F. (2006). The principles and practice of nurse education. London: Stanley Thornes

design guide. (2nd ed.). New Jersey: Educational Technology Publications, Inc.

Schein, E.H. (2004, August 1). Kurt Lewins change theory in the field and in the classroom:

Notes toward a model of managed learning. Retrieved December 10th 2014 from

http://www.a2zpsychology.com/articles/kurt_lewins_change_theory.htm
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Tappen, R. M., Weiss, S. A & Whitehead, D. K. (2010). Essentials of nursing leadership and

management. Philadelphia: F. A. Davis Company

Time Objectives Contents Teacher

Activity
5mins Ice-breaker Students will be St
The advanced asked to view vi
organizer used; the pictures and at
sought to determine the de
bridge new topic to be to
knowledge discussed di
with what was
known
(sometimes
what is known
is uncertain (Courtesy of Micro soft, 2014)
and not
concrete)
12 Define change Change means to be different, to cause to be different, or to alter. Teacher will St
as explained It may be personal or organizational and can occur suddenly or randomly ask ra
mins by Jones incrementally. It may be planned or unplanned. Unplanned students to say w
(2007) change, or reactive change, usually occurs suddenly and in what the term c
response to some event or set of circumstances (Jones, 2007). change means to
in their own ow
For example, an unanticipated rise in patient census may words.
precipitate the need for a change in patient assignments.
Teacher will St
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Decisions are madeand change followsas a reaction to an define the term lis
event. Planned change, however, entails planning and application change with the an
of strategic actions designed to promote movement toward a use of w
desired goal. Planned change is deliberate and proactive. It PowerPoint as
responds to anticipated events in the environment or community according to the Po
(Jones, 2007). content. te
de

Teacher will ask Tw

two students se
seated at the of
back of class to ou
briefly outline tw
one of the two di
terms according ac
to the content co
7mins Outline factors Institutions undertake a number of projects as part of change Teacher will ask Th
that efforts directed at organizational restructuring, quality three students w
necessitates improvement, and employee empowerment. whose surname be
change in the begin with the at
work place Many things drive change in contemporary health care, among letter W to at
according to them are increasing technology, information availability, outline at least th
Marquis & economics and growing populations. one factor that ab
Huston (2014) could result in th
The integrated leadermanager is well grounded in change change
theories and applies such theory appropriately. Regardless of the
type of change, all major change brings feelings of achievement, Teacher will St
loss, pride, and stress outline factors fo
that could bo
contribute to Po
change in the pr
work with the as
aid of w
PowerPoint and A
white board ne
presentation ch
ou

Teach will ask Tw

two students w
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whose surname be
begin with the le
letter G to ou
outline factors th
that contribute to ch
change to
according to the
contents
15 Explain the THE DEVELOPMENT OF CHANGE THEORY Teacher will ask Th
stages of three students w
mins Lewins Most of the current research on change builds on the classic who surname be
change theory change theories developed by Kurt Lewin in the mid-20th century. begin with the le
according to letter B to at
Marquis and Lewin (1951) identified three phases through which the change explain one of on
Huston, 2014 agent must proceed before a planned change becomes part of the the concepts, co
system: unfreezing, moving/ment, and refreezing (Marquis & unfreezing, u
Huston, 2014). moving and m
refreezing each. re
They may as
Unfreezing collaborate with to
In the unfreezing stage, the change agent unfreezes forces that anyone of their ne
maintain the status quo. Thus, people become discontented and choice
aware of a need to change. Unfreezing is necessary because before
any change can occur, people must believe the change is needed. Teacher will St
Unfreezing occurs when the change agent convinces members of explain Lewins lis
the group to change or when guilt, anxiety, or concern can be change theory on
elicited. using white an
board and pr
For effective change to occur, the change agent needs to have PowerPoint w
made a thorough and accurate assessment of the extent of and presentation qu
interest in change, the nature and depth of motivation, and the ne
environment in which the change will occur (Marquis & Huston, Le
2014). pr
pr
Change should be implemented only for good reasons. Because Teacher will Th
human beings have little control over many changes in their lives, specifically ask m
the change agent must remember that people need a balance the two tallest th
between stability and change in the workplace. Change for male students stu
changes sake subjects employees to unnecessary stress and and the tallest sp
manipulation (Marquis & Huston, 2014). female student to w
explain one stage sta
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Moving/ Movement or Change of Lewins ch

change process ea
The second phase of planned change is movement. each according th
In movement, the change agent identifies, plans, and implements to the concept
appropriate strategies, ensuring that driving forces exceed
restraining forces. Whenever possible, change should be
implemented gradually. Because change is such a complex
process, it requires a great deal of planning and intricate timing
Recognizing, addressing, and overcoming resistance may be a
lengthy process.

Any change of human behavior, or the perceptions, attitudes, and

values underlying that behavior, takes time. Therefore, any change
must allow enough time for those involved to be fully assimilated
in that change (Marquis & Huston, 2014).

Refreezing
During the refreezing phase, the change agent assists in stabilizing
the system change so it becomes integrated into the status quo.

If refreezing is incomplete, the change will be ineffective and the

pre-change behaviors will be resumed. For refreezing to occur,
the change agent must be supportive and reinforce the individual
adaptive efforts of those affected by the change.
Because change needs at least three to six months before it will be
accepted as part of the system, change should never be attempted
unless the change agent can make a commitment to be available
until the change is complete.

Lewin also theorized that people maintain a state of status quo or

equilibrium by the simultaneous occurrence of both driving and
restraining forces operating within any field. The forces that push
the system toward the change are driving forces, whereas the
forces that pull the system away from the change are called
restraining forces.

21 Describe the Lewins model maintained that for change to occur, the balance of Teacher will ask stu
mins effects of driving and restraining forces must be altered. The driving forces students to turn to
driving and must be increased or the restraining forces decreased. Numerous to the person to
restraining factors affect successful implementation of planned change. next to them and at
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forces on the briefly describe br

change process For example, both organizations and individuals tend to reject the effects that th
according outsiders as change agents because they are perceived as having driving and dr
Marquis and inadequate knowledge or expertise about the current status, and restraining re
Huston (2014) their motives often are not trusted. Many good ideas are never forces could co
realized because of poor timing or a lack of power on the part of have on the ch
the change agent (Marquis & Huston, 2014). change process
Therefore, there is less widespread resistance if the change agent
is an insider.
Teacher will St
The outside change agent, however, tends to be more objective in explain the lis
his or her assessment, whereas the inside change agent is often effects that qu
influenced by a personal bias regarding how the organization driving and fo
functions. Likewise, some greatly needed changes are never restraining Po
implemented because the change agent lacks sensitivity to timing. forces could ef
have on the dr
If the organization or the people within that organization have change process re
recently undergone a great deal of change or stress, any other using co
change should wait until group resistance decreases (Maquis & PowerPoint ch
Huston, 2014). presentation, ar
marker and
Economics, financial climate, adequacy of staff, buildings, politics white board
change of manager as well as several other factors could either be
driving forces or restraining forces depending on what obtains Tw
when change is contemplated. Teacher will ra
randomly ask w
For example if the hospital is low on funding it might not be a two students to ef
good time to enact change as the change may need money to describe the dr
implement. This would be a restraining force and change would effects that re
not be best at this time. It would be far better to postpone change driving and co
until finances improve (driving force) restraining ch
forces could ac
have on the co
change process
according to the
content
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Explain three The appropriate strategy for any situation depends on the power of Teacher will ask Th
strategies used the change agent and the amount of resistance expected from the three students w
in the change subordinates. One of these strategies is to give current research as who seldom sp
process as evidence to support the change. speak in class to at
reasoned by explain one on
Marquis and This group of strategies is often referred to as rationalempirical strategy (each) (e
Huston (2014); strategies (Marquis & Huston, 2014; Jones 2007). that is used in ch
Jones (2007); the change
Quinn, RationalEmpirical Strategies process
Spreitzer, and The change agent using this set of strategies assumes that
Brown, (2000). resistance to change comes from ignorance or superstition and that Teacher will St
human are rational beings who will change when given factual explain three lis
information documenting the need for change (Quinn, Spreitzer, & strategies used in on
Brown, 2000). the change pr
This type of strategy is used when there is little anticipated process with the str
resistance to the change or when the change is perceived as aid of th
reasonable (Marquis & Huston, 2014). PowerPoint pr
presentation ex
Because peer pressure is often used to effect change, another
group of strategies that uses group process is called normative
re-educative strategies.
Teacher will ask Th
NormativeRe-Educative Strategies. three students se
These strategies use group norms to socialize and influence people seated closest to th
so change will occur. The change agent assumes humans are him to explain ex
social animals, more easily influenced by others than by facts the strategies str
(Marquis & Huston, 2014; Jones 2007). used in the th
change process pr
This strategy does not require the change agent to have a according to the to
legitimate power base. Instead, the change agent gains power by content
skill in interpersonal relationships. He or she focuses on non-
cognitive determinants of behavior, such as peoples roles and
relationships, perceptual orientations, attitudes, and feelings, to
increase acceptance of change (Marquis & Huston, 2014; Jones
2007).

PowerCoercive Strategies
The third group of strategies, powercoercive strategies, is based
on the application of power by legitimate authority, economic
sanctions, or political clout of the change agent.
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These strategies include influencing the enactment of new laws

and using group power for strikes or sit-ins. Using authority
inherent in an individual position to effect change is another
example of a powercoercive strategy.

These strategies assume that people often are set in their ways and
will change only when rewarded for the change or are forced by
some other powercoercive method. Resistance is handled by
authority measures; the individual must accept it or leave (Marquis
& Huston, 2014; Jones, 2007).
Discuss Because change disrupts the homeostasis or balance of the group, Teacher will ask St
resistance to resistance should always be expected. The level of resistance class to get into in
change generally depends on the type of change proposed. Technological eight groups an
according to changes encounter less resistance than changes that are perceived after which fro
Marquis & as social or that are contrary to established customs or norms. teacher will give to
Huston (2014); (Marquis & Huston, 2014) each a topic gr
Kalisch relating to at
(2007); Tappen Nursing leaders also must recognize that subordinates values, resistance to th
et al (2010); educational levels, cultural and social backgrounds, and change; each ar
Kotter (1999); experiences with change (positive or negative) will have a group will re
Berman- tremendous impact on their degree of resistance (Marquis & discuss topic
Rubera, Huston, 2014). given with the
(2008); rest of the class
Johnston, RECEPTIVITY TO CHANGE
(2008); Hunter Recognizing Different Information Processing Styles
(2004); Schein An interesting research study suggests that nurse managers are Teacher will St
(2004) more receptive to change than their staff members. Nurse discuss an
managers were found to be more innovative and decisive, whereas resistance to on
staff nurses preferred proven approaches, thus being resistant to change using the an
change. Nursing assistants, unit secretaries, and enrolled assistant help of an
nurses were also unreceptive to change, adding layers of people PowerPoint se
who formed a solid wall of resistance to change (Kalisch, 2007). presentation and as
white board
Kalisch suggests that helping teams recognize their preference for
certainty (as opposed to change) will increase their receptivity to
necessary changes in the workplace.

Speaking to Peoples Feelings

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Although both thinking and feeling responses to change are

important, one author states that the heart of change lies in the
emotions. He suggests that a compelling story will increase
receptivity to a change more than a carefully crafted analysis of
the need for change Kotter (1999).

SOURCES OF RESISTANCE
Resistance to change comes from three major sources:

technical concerns
psychosocial needs
threats to a persons position and power
(Tappen et al., 2010)

Technical Concerns
Some resistance to change is based on concerns about whether the
proposed change is a good idea. The change itself may have
design flaws. A change may provide resistance for practical
reasons.
For example, if the bar codes on patients armbands are difficult to
scan, nurses may develop a way to work around this safety feature
by taping a duplicate armband to the bed or to a clipboard
defeating the purpose of instituting electronically monitored
medication administration (Tappen et al., 2010).

Psychosocial needs
Change often creates anxiety, much of it related to what people
fear they might lose (Berman-Rubera, 2008; Johnston, 2008).

According to Maslow (1970), human beings have a hierarchy of

needs, from the basic physiological needs for oxygen, fluids, and
nutrients to the higher-order needs for belonging, self-esteem, and
Self-actualization. Maslow observed that the more change occurs
may make it more difficult for a person to meet any or all of his or
her needs. It may threaten the powerful safety and security (job)
needs that Maslow discussed, not to mention the more basic needs.

For example, if a massive downsizing occurs and a persons job is

eliminated fulfillment of all of these levels of needs may be
threatened, from having enough money to pay for food and shelter
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to opportunities to fulfill ones career potential (Hunter, 2004).

Threats to Position and Power

Once gained within an organization, status, power, and influence
are hard to give up. This applies to people anywhere in the
organization, not just those at the top (Tappen et al., 2010).

LOWERING RESISTANCE
A great deal can be done to lower peoples resistance to change.
Strategies fall into four categories:
sharing information,
disconfirming currently held beliefs,
providing psychological safety,
dictating (forcing) change (Tappen, 2001).

Sharing Information
Much resistance is simply the result of misunderstanding a
proposed change. Sharing information about the proposed change
can be done on a one-to-one basis, in group meetings, or through
written materials distributed to everyone involved via print or
electronic means.

Disconfirming Currently Held Beliefs

Disconfirming current beliefs is a primary force for change

Providing evidence that what people are currently doing is

inadequate, incorrect, or inefficient can increase peoples
willingness to change (Schein, 2004).

Psychological Safety
Express approval of peoples interest in providing the best care
possible. Recognize the competence and skill of the people
involved. Provide assurance (if possible) that no one will lose his
or her position because of the change. Suggest ways in which the
change can provide new opportunities and challenges (new ways
to increase self-esteem and self-actualization) (Tappen et al.,
2010).
Dictating Change
Forcibly implementing the change overnight, there is little or no
change for resistance..
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Explicate Often times, the change process begins with a few people who Teacher will ask Th
planned meet to discuss their dissatisfaction with the status quo, and an the two shortest stu
change as cited inadequate effort is made to talk with anyone else in the students in the cl
by Marquis organization. This approach virtually guarantees that the change class to explain to
and Huston effort will fail. People abhor information vacuums, and when the concept of co
(2014) there is no ongoing conversation about the change process, gossip planned change ch
usually fills the void.
Teacher will St
These rumors are generally much more negative than anything that explain planned lis
is actually happening. Whenever possible, all those who may be change with the on
affected by a change should be involved in planning for that aid of pr
change PowerPoint as
presentation w
Ayer (2002) suggests that the empirical picture that is emerging is according to the
that communication and organizational change processes are content
inextricably linked.

When change agents fail to communicate with the rest of the Teacher will ask Th
organization, they prevent people from understanding the the two b
principles that guided the change, what has been learned from biggest in
prior experience, and why compromises have been made. The students in the ex
importance of being perceived as a legitimate and informed class to explain co
participant in the change process is critical to successful change. planned change ch
according to the to
Likewise, subordinates affected by the change should thoroughly contents
understand the change and how it affects them as individuals.

Good, open communication throughout the process can reduce

resistance. Leaders must ensure that group members share
perceptions about what change is to be undertaken, who is to be
involved and in what role, and how the change will directly and
indirectly affect each person in the organization
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EVALUATION

Questions
1. Define change
2. Outline factors that necessitates change
3. State the three changes of Lewins Theory
4. State three strategies used in the change process
5. Name four factors that affect resistance

Answers
1. Change means to be different, to cause to be different, or to alter. It may be personal or organizational and can
incrementally. It may be planned or unplanned. Unplanned change, or reactive change, usually occurs suddenl
event or set of circumstances.
2. Many things drive change in contemporary health care, among them are increasing technology, information av
growing populations.
3. RationalEmpirical Strategies - The change agent using this set of strategies assumes that resistance to chan
superstition and that human are rational beings who will change when given factual information documenting
NormativeRe-Educative Strategies -These strategies use group norms to socialize and influence people so
Coercive Strategies - The third group of strategies, powercoercive strategies, is based on the application of p
economic sanctions, or political clout of the change agent.
4. Recognizing Different Information Processing Styles - An interesting research study suggests that nurse ma
change than their staff members; Speaking to Peoples Feelings - Although both thinking and feeling respons
author states that the heart of change lies in the emotions; Technical Concerns - Some resistance to change is
whether the proposed change is a good idea. The change itself may have design flaws; Psychosocial needs -
much of it related to what people fear they might lose; Threats to Position and Power - Once gained within a
and influence are hard to give up
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END OF SESSION