Lewin's Change Theory in Healthcare: Nursing Implementation
This paper examines the implementation of a change management process in a veterans' healthcare setting where patients with dementia and cognitive impairments exhibited challenging behaviors such as aggression, repetitive questioning, and impulsive acts. Using Kurt Lewin's Force Field Analysis as a theoretical framework, the paper traces how nursing staff moved through the unfreezing, moving, and refreezing phases to develop a consistent and dignified set of responses to these behaviors. Regular Challenging Behavior Meetings served as the vehicle for change, and the paper evaluates how explicitly adopting Lewin's model from the outset could have made the process more efficient and reduced resistance among staff.
- Introduction: Change management and resistance in nursing quality improvement
- Background: Challenging Behaviors in Veterans Care: Veterans with dementia exhibiting aggressive and disruptive behaviors
- Lewin's Force Field Analysis Overview: Three-phase model: unfreezing, moving, and refreezing
- Unfreezing Phase: Identifying the Problem: Staff identify driving and restraining forces for change
- Moving Phase: Implementing Change: Challenging Behavior Meetings and new staff strategies
- Refreezing Phase: Institutionalizing Practice: Stabilizing consistent, dignified responses to patient behavior
- Conclusion: Reflection on benefits of explicit theoretical framework use
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What makes this paper effective
- The paper grounds a real clinical problem — managing aggressive and impulsive patient behavior — in a well-established theoretical framework, giving the analysis both practical relevance and academic structure.
- It maps each phase of Lewin's model directly onto the staff's actual actions, making the theoretical application concrete and traceable rather than abstract.
- The conclusion adds reflective value by noting that explicitly declaring Lewin's framework from the start would have improved efficiency and reduced resistance, demonstrating critical self-evaluation.
Key academic technique demonstrated
The paper demonstrates applied theoretical analysis: taking an established management model (Lewin's Force Field Analysis) and systematically applying each of its three phases to a documented real-world nursing scenario. This technique is common in healthcare management writing and shows how theory can serve as a diagnostic and evaluative lens for practice.
Structure breakdown
The paper opens by contextualizing the problem — challenging patient behavior in a veterans' care unit — and introduces Lewin's theory as its framework. It then provides background on the clinical setting before walking through each of the three phases: unfreezing (problem identification and meeting formation), moving (the Challenging Behavior Meetings and information-sharing), and refreezing (stabilization of a consistent response menu). The paper closes with a reflective critique of the process.
Introduction
Bringing quality improvement processes to nursing practices invariably means that nursing leaders must give considerable attention to the management of change. Resistance to change is an integral aspect of any quality improvement effort. Sometimes the resistance stems from fear or an inability to see how things can improve. When patients present challenging behavior problems, staff may naturally be concerned for their own safety and worried that those behaviors are getting in the way of providing the best possible nursing care. This paper examines the implementation of a change process for addressing challenging patient behavior within the framework of Kurt Lewin's change management theory (Sare and Ogilvie, 2009).
Background: Challenging Behaviors in Veterans Care
Veterans with cognitive problems stemming from memory loss and dementia were regularly exhibiting hitting, kicking, biting, yelling, spitting, repetitious questioning of staff, and other impulsive aggressive behaviors. Staff began a series of Challenging Behavior Meetings twice a month to discuss ways of dealing with Veterans who exhibited this type of behavior. The purpose of these behavior-focused meetings was to establish a menu of responses that staff could use when dealing with challenging behaviors ("Behavior Chain," 2005; "eCaring," 2012).
While there was general understanding among the staff that any behavior response system needed to be flexible, there was also general appreciation for the need for a consistent system that would not be perceived as random or unanticipated by the Veterans ("Behavior Chain," 2005; "eCaring," 2012). Certainly the cognitive processing difficulties of the patients did not enable them to make a great deal of sense out of staff responses to their problem behaviors, but there was an overarching desire among staff not to add chaos to the Veterans' already disrupted lives by responding in ways that seemed capricious ("Behavior Chain," 2005; "eCaring," 2012). As staff considered various ways to approach this situation, a paramount concern surfaced: the establishment and maintenance of a care environment that would be safe for both the Veterans and the staff ("Keeping Patients Safe," 2004).
Lewin's Force Field Analysis Overview
Lewin argued that "group life is never without change, merely differences in the amount and type of change exist" (1947, p. 13). His theory about change in social groups and his model of change management provide a framework for considering the processes in which the staff participated as they worked to provide good nursing care in the face of challenging patient behaviors. Lewin's Force Field Analysis model encompasses three phases that groups move through when faced with change: unfreezing, moving, and refreezing. Each phase serves a distinct function in guiding individuals and organizations from an existing state to a new, improved one.
Unfreezing Phase: Identifying the Problem
The unfreezing stage lays the groundwork for change participants to understand the difficulties associated with the problem of interest (Jones, 2012). The primary tasks of this stage are to develop strategies that strengthen the forces driving the proposed changes and to weaken or reduce the forces that restrain the proposed change (Jones, 2012). Through the unfreezing phase, the key actors gather to discuss ideas and establish lists of the driving and static forces that have the potential to impact their proposed change project (Jones, 2012).
The nursing staff addressing the Veterans' challenging behaviors developed the idea for the Challenging Behaviors Meetings during their early discussions of the problem. Even though they were not using Lewin's framework in a deliberate and transparent manner, they did collectively identify many of the facilitating and constraining variables in their proposed plan. In this way, the nursing staff progressed through an unfreezing phase consistent with Lewin's model (Jones, 2012).
Conclusion
Taking a retrospective view of the change project for addressing the Veterans' challenging behaviors, it does seem that the process would have benefited — and reached fewer discouraging dead ends in people's thinking — if Lewin's Force Field Analysis had been openly declared as the guiding framework from the start. The process would have been more efficient and would likely have met with less overall resistance. Explicitly naming and following a recognized change model gives participants a shared language and a structured path forward, reducing ambiguity and building collective confidence in the change effort.
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