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

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

3. 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

4. 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

5. 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

6. 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

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

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

9. 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

10. 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.

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

12. References. (These refer to classic change theory)
Allen J (1996) Between trapezes-making the most of change. Journal of Nursing Management 4(1) 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) 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