Using Lewin s Change Model for Nursing Interventions

DNP PROJECT HYPERTENSION - Week 4: Theoretical Framework & Change Model

Identifying Evidence-Based Advanced Practice Nursing Culturally Sensitive Interventions for Hypertension

Theoretical Framework

One of the harsh realities facing any nursing leader is the fact that despite its inevitability, change invariably involves resistance from stakeholders, even when it is in their best interests. In fact, the historical record, empirical observations and hard experiences confirm that some individuals will actively seek to derail changes since they involve extra effort and the unknown (Clark-Maxwell, 2022). Therefore, identifying efficacious nursing interventions that take this constraint into account represents the first step towards determining which theoretical framework is best suited for a given intervention (Pregmark, 2022). For this purpose, Lewin’s Change Model developed by Kurt Lewin, can be a valuable framework to guide the implementation of culturally sensitive interventions for hypertension management in minority populations, when properly implemented and administered (Dickey et al., 2022).

The theoretical framework developed by Lewin emphasizes the necessity of rejecting and replacing prior learning to facilitate meaningful change. In sum, Lewin’s model consists of three primary components: driving forces, restraining forces, and equilibrium. In this context, driving forces represent the factors that push individuals or organizations in a desired direction, catalyzing change by shifting the equilibrium towards a new state.

Conversely, restraining forces act as obstacles, resisting change by pushing in the opposite direction and maintaining the current equilibrium. Equilibrium refers to a state where the forces for change (driving forces) are balanced by the forces resisting change (restraining forces), resulting in a state of stability with no significant change. The equilibrium can be altered by adjustments in the balance between driving and restraining forces, ultimately influencing the likelihood and magnitude of change (Ernstmeyer & Christman, 2022). The model developed by Lewin and its three-step approach to effecting meaningful change is described further below.

Change Model

The change model developed by Lewin consists of three main stages, unfreezing, changing, and refreezing (Abd El-Shafy et al., 2019), which are operationalized for the purposes of the proposed study below.

Step 1: Unfreezing stage

It is useful for nursing leaders to conceptualize healthcare organizations of any size and purpose as monolithic entities that defy easy change. Indeed, even beneficial changes may be met with strong resistance and even sabotage since it requires stakeholders to leave their comfort zones and learn something new. Therefore, “unfreezing” this situation represents the first step to effecting meaningful change. For instance, according to Ernstmeyer and Christman (2022), “Unfreezing is the process of altering behavior to agitate the equilibrium of the current state. This step is necessary if resistance is to be overcome and conformity achieved” (para. 4.3). In other words, the first step of the Lewin change model requires “shaking things up” to prepare for the introduction of the change.

During the unfreezing stage, nursing leaders can work towards creating awareness and motivation for change among stakeholders, such as healthcare providers, community members, and policymakers. This can involve highlighting the urgency of addressing hypertension disparities in minority populations and the need for culturally tailored interventions. Strategies such as data analysis, community assessments, and fostering open communication can help identify the driving and restraining forces for change.

Irrespective of the specific strategy adopted, it is essential to reinforce the driving forces that propel behavior away from the current status quo while diminishing the restraining forces that impede movement from the existing equilibrium. For this purpose, nursing leaders can play a pivotal role in initiating actions to support the unfreezing process. These actions may include motivating participants by adequately preparing them for impending changes, fostering trust, and garnering recognition for the necessity of change. In addition, nursing leaders can also encourage active participation within groups by facilitating the identification of problems and collaborative brainstorming of potential solutions. These types of sustained efforts help create an environment conducive to overcoming resistance and preparing individuals for the subsequent stages of change (Ernstmeyer & Christman, 2022).

Step 2: Changing stage

The changing stage involves implementing the proposed culturally tailored, nurse-driven hypertension self-management education program. In this regard, Ernstmeyer and Christman (2022) report that:

Change is the process of moving to a new equilibrium. Nurse leaders can implement actions that assist in movement to a new equilibrium by persuading employees to agree that the status quo is not beneficial to them; encouraging them to view the problem from a fresh perspective; working together to search for new, relevant information; and connecting the views of the group to well-respected, powerful leaders who also support the change

For this purpose, nursing leaders can leverage their expertise in patient education, care coordination, and population health to develop and deliver the program in collaboration with interdisciplinary teams and community organizations. This stage may also involve addressing potential barriers that adversely affect minority populations, such as systemic biases, socioeconomic factors, and environmental determinants, through targeted strategies like policy advocacy, resource allocation, and partnership building (Ernstmeyer & Christman, 2022).

Step 3: Refreezing stage

Finally, the refreezing stage aims to establish the new behavior or practice as the norm. It is essential to ensure that this step is completed in a timely and effective fashion lest all of the previous efforts be lost to complacency. For instance, Ernstmeyer and Christman (2022) emphasize that, “This step must take place after the change has been implemented for it to be sustained over time. If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium” (para. 4.3).