HHII Theory: Change Theories & Decision Making Theories

What is the definition of change in the context of nursing?

The process of making something different from what it was, which can be positive or negative, planned or unplanned, and usually not welcomed.

What are some synonyms for the term 'change'?

Alter, transform, convert, renovate, revamp.

What is spontaneous change?

Reactive or unplanned change that is not fully anticipated and cannot be avoided, which may be long or short term with little or no time to plan or respond.

Provide an example of spontaneous change in nursing practice.

Care provided for unplanned illnesses such as flu or meningitis, and injuries like stroke or fractures.

What is developmental change?

Physiologic change occurring during an individual's life cycle or the growth of an organization as it becomes more complex, which is not consciously planned.

Give examples of developmental change.

Puberty, decreased physical capability of an older adult, or the growth/expansion of an organization.

What does planned change entail?

A purposeful attempt by individuals, groups, or organizations to influence the status quo, requiring problem-solving, decision-making, and interpersonal skills.

Provide examples of planned change.

Quitting smoking, policy change, or implementation of new technology.

What is an example of planned change in nursing practice?

Mandatory attendance at an agency workshop or completing a fall risk assessment for all clients in a long-term care facility.

What is the Empirical-Rational strategy for planned change?

Based on the beliefs that people are rational and will change if it is in their self-interest, relying on knowledge to influence change.

What is a primary shortcoming of the Empirical-Rational strategy?

People do not always act rationally.

What is the Normative-Re-educative strategy for planned change?

Change occurs if individuals develop new attitudes and values by acquiring new information, with a focus on interpersonal relationships and collaboration.

How does the Normative-Re-educative strategy reduce resistance to change?

By stimulating creativity and encouraging participation in one's own re-education.

What are the implications of change in nursing?

Change can affect care delivery, require adaptation to new practices, and necessitate ongoing education and training for nursing staff.

What role does a nurse play as a change agent?

Nurses facilitate and implement change in healthcare practices, policies, and patient care strategies.

What types of change can occur in nursing?

Spontaneous, developmental, and planned change.

What is a characteristic of spontaneous change?

It is not fully anticipated and often occurs without prior planning.

What is a characteristic of developmental change?

It happens naturally over time and is often related to growth or aging.

What is a key factor for successful planned change?

Effective problem-solving, decision-making, and interpersonal skills.

What is the significance of knowledge in the Empirical-Rational strategy?

Knowledge is seen as the power ingredient that influences change.

How does interpersonal relationships influence the Normative-Re-educative strategy?

They play a crucial role in reducing resistance and fostering acceptance of change.

What is the expected outcome of effective planned change in nursing?

Improved patient care and enhanced organizational efficiency.

What is a primary shortcoming of partially participative and democratic approaches to change?

Information and rational arguments are often insufficient to bring about change.

What is the power-coercive approach to planned change?

A command and control approach where power lies with individuals of influence, enforcing change, effective when survival depends on change.

What are the primary shortcomings of the power-coercive approach?

It can provoke resistance, decrease morale, involve minimal participation, and neglect feelings and values.

What is the Health Belief Model?

A model that examines factors contributing to a person's perceived state of health and their likelihood of making an appropriate plan of action.

What are the components of the Health Belief Model?

Individual perceptions, including perceived susceptibility, perceived seriousness, and perceived threat.

How do perceived susceptibility and perceived seriousness combine in the Health Belief Model?

They create the perceived threat.

Give an example of how the Health Belief Model applies to an individual's health perception.

A person with increased drug use living in an environment with AIDS might perceive a high threat due to increased susceptibility and seriousness.

How is the Health Belief Model related to change theories?

It challenges habitual unhealthy behaviors and highlights motivation and self-efficacy in making health-related changes.

What is self-efficacy in the context of health behavior change?

A person's belief in their ability to make a health-related change.

What did Kurt Lewin originate in 1948?

Lewin's change theory.

What are the two forces affecting the change process in Lewin's change theory?

Motivating/driving forces and resisting/restraining forces.

What happens when driving forces equal restraining forces in Lewin's change theory?

Equilibrium occurs, resulting in no change.

Provide an example of a driving force and a restraining force in the context of immunization.

Driving force: Immunization eradicates debilitating disease; Restraining force: Needles hurt and concerns about severe side effects.

What are the three stages of Lewin's change theory?

Unfreezing, Moving, and Freezing.

What occurs during the Unfreezing stage of Lewin's change theory?

Motivation to establish change occurs, and individuals become aware of the need for change.

What happens during the Moving stage of Lewin's change theory?

Actual change is planned and started, involving gathering information and implementation.

What is the purpose of the Freezing stage in Lewin's change theory?

To integrate and stabilize the change, preventing backsliding into old ways.

Who developed the Transtheoretical Model of Change?

Prochaska and DiClemente in 1984.

What is the significance of identifying driving forces in Lewin's change theory?

They help to facilitate the change process by motivating action.

What is a common driving force in health behavior change?

The desire to improve health outcomes or prevent disease.

What is a common restraining force in health behavior change?

Fear of pain or negative side effects associated with change.

What is the role of motivation in Lewin's change theory?

It is crucial for establishing the need for change and overcoming resistance.

What is Force Field Analysis in the context of behavioral change?

It identifies driving forces that push towards change and restraining forces that hinder change.

What are Driving Forces in Force Field Analysis?

Forces that push in a direction that causes change to occur, shifting the equilibrium towards change.

What is the significance of trust in a nurse acting as a change agent?

Trust is a key element that enables the change agent to effectively motivate and implement change.

What are the five stages proposed by Prochaska & DiClemente's Transtheoretical Behavioural Change Theory?

1. Precontemplation, 2. Contemplation, 3. Preparation, 4. Action, 5. Maintenance.

How does change occur according to the Transtheoretical Model?

Change is a non-linear process that may require taking steps back before moving forward.

What skills should a nurse possess to act effectively as a change agent?

Skills include trust, critical thinking, big picture focus, flexibility, confidence, realistic thinking, honesty, vision articulation, interpersonal skills, and handling resistance.

What is the role of a nurse as a change agent?

To initiate, motivate, and implement change within healthcare settings.

What are some positive effects of change in nursing?

Improved patient outcomes, enhanced teamwork, and increased efficiency.

What are some negative effects of change in nursing?

Resistance from staff, potential confusion, and disruption of established routines.

What does it mean for a change agent to be flexible yet firm?

They should be adaptable in their approach while maintaining a strong stance against unproductive alterations to planned change.

What does realistic thinking involve for a nurse acting as a change agent?

Identifying both restraining and driving forces that affect the change process.

How can a nurse reduce resistance to change?

By devising strategies that increase motivation and address concerns of the staff.

What is the importance of interpersonal skills for a nurse as a change agent?

Good interpersonal skills help in building relationships, fostering trust, and effectively communicating the vision for change.

What is the first step in the decision-making process for nursing practice?

Defining the decision that needs to be made.

What is the relationship between decision making and nursing practice?

Decision making is critical for nurses to provide effective care and respond to patient needs.

What does the term 'change agent' refer to in nursing?

An individual who works to bring about change in healthcare settings.

What is the impact of change on healthcare organizations?

Change can lead to both improvements in care delivery and challenges in staff adaptation.

What is a key characteristic of a confident change agent?

They are not easily discouraged and can devise strategies to overcome resistance.

Why is it important for a nurse to articulate a vision for change?

Articulating a vision helps to inspire and guide others towards the desired outcome.

What is the significance of being accessible as a change agent?

Accessibility allows team members to approach the change agent for support and guidance.

What does it mean for change to be a non-linear process?

It indicates that individuals may experience setbacks and need to revisit earlier stages before achieving lasting change.

What is the role of motivation in the change process?

Motivation is essential for individuals to embrace and sustain new behaviors.

What is decision making in the context of nursing?

The process of selecting the best alternative from the available set of alternatives, involving a deliberate search for new knowledge.

What is evidence-informed decision making?

A continuous interactive process that involves the explicit, conscientious, and judicious consideration of the best available evidence to provide care.

What are the results of evidence-informed decision making?

Promotes healthy communities, improves clinical practice, achieves cost-effective nursing care, and ensures accountability and transparency in decision making.

What is evidence-informed practice?

The integration of the most informative research evidence with evidence from expert clinical practice and other sources to produce the best possible care for clients.

Where can information for evidence-informed practice be sourced from?

Journals, textbooks, research studies, quality improvement data, chart reviews, standards, clinical expertise, and client care.

What are some tools that contribute to a holistic decision-making process in nursing?

AC BSN Decision Making for Nursing Practice Framework, Gordon's Functional Health Patterns, and Critical Thinking Model.

What does the nursing process (ADPIE) stand for?

Assessment, Diagnosis, Planning, Implementation, Evaluation.

What is the BSN Decision Making Framework?

A complex, cyclical, and interactive process of knowing, being, and doing, through which the nurse and client maximize health and healing.

What components are included in the BSN Decision Making Framework?

Client-centered approach, coming to know the client, salience/pattern recognition/health issues, healing initiatives, and critical reflection/practice.

How does the BSN Decision Making Framework approach decision making?

It is deliberate, non-linear, and integrates all components to discover new knowledge.

What is the significance of critical thinking in nursing decision making?

It enhances the ability to analyze situations, make informed decisions, and provide quality care.

What is the role of best practice guidelines in nursing?

They provide evidence-based recommendations to improve patient care and outcomes.

What is the importance of having a solid knowledge base in decision making?

It supports informed practice and enhances the ability to ask relevant questions.

What does 'coming to know the client' involve in the decision-making process?

Understanding the client's unique health issues and needs to tailor care effectively.

What is meant by 'salience/pattern recognition' in nursing?

The ability to identify significant health issues and patterns in client care.

What are healing initiatives in the context of nursing?

Actions and strategies aimed at promoting the client's health and well-being.

What is critical reflection in nursing practice?

The process of analyzing one's actions and decisions to improve future practice.

How does the decision-making process in nursing differ from a linear approach?

It is non-linear, allowing for integration and back-and-forth flow between components.

Why is accountability important in evidence-informed decision making?

It ensures that nursing practices are transparent and based on the best available evidence.

What is the purpose of the AC BSN Decision Making for Nursing Practice Framework?

To guide nurses in making informed decisions that enhance client care.

What is the significance of asking questions in the decision-making process?

It facilitates discovery and understanding, leading to better-informed clinical decisions.

What is the focus of client-centered nursing?

The client (individual, family, community, society) is the center of focus, being the expert in their health and healing.

What role does the nurse play in client-centered care?

The nurse acts as an inquirer, listener, and equal partner, engaging in dialogue and bringing personal and professional knowledge, skills, and ethics.

What does 'Coming to Know the Client' involve?

It involves learning about the client's lived experience, including their meaning of health and healing, characteristics, culture, strengths, vulnerabilities, and health goals.

How can nurses learn about their clients?

Through observation, written records, assessment tools, storytelling, conversation, and analytical thinking.

What is salience in nursing practice?

Salience refers to what is important, stands out, and is most critical to attend to for both the client and nurse.

What is pattern recognition in nursing?

The ability to see how relevant events and information fit together as a complex whole.

What are healing initiatives based on?

They are based on pattern recognition and understanding what is salient in the situation through coming to know the client.

How are healing initiatives identified?

They are identified based on salient patterns of behaviors observed and mutually identified with the client and nurse.

What is critical reflection in nursing?

An ongoing, cyclical, reciprocal process of reflection and action that envisions possibilities for change and informs decisions regarding further action.

What is the significance of the case scenario involving Mary?

It illustrates the application of nursing concepts such as coming to know the client, salience, pattern recognition, health issues, healing initiatives, and critical reflection.

What is the importance of understanding a client's environment in nursing?

It influences the promotion and protection of health.

What are some ways of knowing in nursing?

Empirical, aesthetic, ethical, and practical ways of knowing inform interpretation, reasoning, and decision-making.

What is the role of storytelling in understanding clients?

Storytelling allows clients to share their lived experiences, providing insight into their health and healing.