Managing Transition Fiona Couper Florence Nightingale School of Nursing & Midwifery Managing Transition Fiona Couper

Theories of Change Linear Models Lewin (1951) Unfreezing Moving Refreezing Allen (1996) Current state (diagnosis) Transition state (intervention) Desired state (rienforcement

Process of Change Assessment - a period of reflection, identification of need. Planning - the ‘who,how and when’, of change. Implementation - the strategies or methods. Evaluation - assessing outcomes,effectiveness

Strategies for Change The strategies will vary depending on the power of the change agent and the level of engagement of the client. Bennis, Benne,and Chin (1969) described 3 strategies Rational - empirical reasoning action based belief that people will do what is best for them Normative - reeducative

Normative-re-educative need for commitment active participation of those involved in the change time to re-evaluate attitudes,values,behaviours Power-coersive demand for change non-negotiable

Responses to change Acceptance-Innovators, people that thrive on change. early adopters, people that are receptive. Desire for security-Majority of people eventually accept Resistance (valid and habitual)-Openly antagonistic people that dislike change Potential for grief response

Bushy and Kamphuis (1993) 6 behavioral patterns as a response to change Innovator Early adopter Early majority Late majority Laggards Rejectors

Change implementation SWOT analysis-used to assess the current situation and to highlight the potential barriers to change. Strengths Weaknesses Opportunities Threats

Force Field Analysis(Lewin) Used to assess the potential success or failure of a new initiative and to highlight the barriers to implemetation. Driving Forces Aim or objective Restraining Forces

Stages of change for Health Promotion Pre-contemplation-unwilling to change or lack of recognition Contemplation-considering pro’s and con’s of making change. Patient is able to identify risks and benefits. Starting to discuss potential change. Preparation-Commitment to change in near future.High degree of motivation towards desired outcome. Recognition that the adverse costs of maintaining current behaviour are greater than the benefits. Move from thinking about it to doing something.

Action- change/modification of behaiour takes place Maintenance- 3-6 months after change implemented. Shift of focus to avoid relapse. (DiClemente and Prochaska 1998)

References. (These refer to classic change theory) Allen J (1996) Between trapezes-making the most of change. Journal of Nursing Management 4(1) 39-43 Bennis W. Benn K. Chin R.(1969) The planning of change. (2nd ed). New York:Holt,Rinehart and Winston Bushy A. Kamphius J. (1993) Response to innovation:Behavioral patterns. Nursing Management.24(3) 62-64 DiClemente C & Prochaska J (1989) Towards a comprehensive transtheoretical model of change. In Miller W and Healther N(Eds.) Treating Addictive Behaviours. New York: Premium Press(pp3-24) Lewin K (1951) Field theory in social sciences .New York :Harper & Row