Abstract
Kurt Lewin, the father of social psychology, developed the change theory of nursing which is a three stage change model that necessitates the rejection and replacement of all prior learning. The stages in the model consist of unfreezing, change and refreezing. The change theory consists of three concepts which include driving and restraining forces and equilibrium. The driving forces ideally push a patient towards a particular direction hence facilitating change. The restraining force, on the other hand, tries to hinder the desired change by pushing the patient away from the driving forces in the opposite direction. The restraining forces' effect is to counter the driving force and thus bring about a shift in the equilibrium in a situation where no change occurs due to the equality between the driving and restraining forces. The nursing theory is composed of three stages which involve unfreezing or a process of generally disposing of the old patterns by either an increase in the driving forces, a decrease in the restraining forces or a combination of the two. The stage of change involves shifting or moving to new levels through changes in behavior, feelings or thoughts. The freezing stages reinforce the changes already made and establishing them as the new habits.
I had never worked with patients with cognitive impairments before. It was something I dreaded doing and there was a lot of discouragement from fellow volunteers and nurses who had cared for them on the difficulties that caring for patients with cognitive impairments posed. They were said to be violent, uncooperative, mean and generally difficult because they could not remember almost everything. I understood that if I desired to be a nurse I would be faced with a situation where I would have to care for such patients. I, therefore, embarked on a three- stage change cycle.
Stage 1: Unfreezing
Lewin describes this stage as that in which one lays out the pros and cons of the purported change and deciding if the change is necessary. It involves moving from our comfort zones and pursuing change (Mitchell, 2013). The decision to request placement in the cognitive impairment unit was both professional and personal. As a training nurse, it was likely that I would encounter similar patients where I would eventually be employed. Volunteering would help me be prepared for that opportunity. In addition, engaging in and having experience in caring for such patients would greatly increase my chances of getting employed as most nursing students avoided the patients. In essence, the reason for the change was mostly to increase my chances of employment in addition to working in a new environment and with patients who were generally avoided by both caregivers and hospital staff. Lastly, I had compassion on them because they were human and vulnerable and needed care since most did not have family who took care of them.
In practice, I always volunteered to care for patients who did not require special attention or specially trained nurses. This created a comfort zone where I would have been uncomfortable and inexperienced working with such patients had I gotten employment in such a facility. My parents urged me to focus on the patients who recieved less attention from hospital staff and nurses which would increase my chances of employment and level of experience.
Stage 2: Change
Lewin describes this stage as the transition stage that relates to the inner movement or process that occurs in reaction to a change (Sutherland, 2013). After I made the decision to step out of my comfort zone and volunteer in a place everyone dreaded, the change and transition begun. The hospital management was quite skeptical about me caring for the patients with cognitive impairments since I had no experience or training in caring for them. My requests were turned down the first few times and I was tempted to revert back to my comfort zone and do what I was used to. By luck, there was an opening the last school holidays and the hospital management decided to give me the chance.
Working with the cognitive impaired patients was not easy. In addition, there was no forthcoming help from other staff in the unit. Their only advice was to allow the patients to get used to me and trust me in their own time. The patients were difficult and violent and for the first few months, I dreaded working in the unit, I even considered asking to be re- assigned or just not showing up for a day or week. Every time I thought they were used to me they would forget and we would start from square one. It was frustrating and sometimes felt futile but I persevered until things got better and once in a while they would recognize me and started being kind to me.
The transition period was the hardest as it came with a lot of challenges. However, towards the middle of the stage, a new nurse came to the hospital who was trained and experienced and assisted me in caring for the patients. She also allowed me to borrow books and other material that were essential in learning how to care for patients with cognitive impairments.
Stage 3: Refreezing
This is the stage where the changes made bring about stability (Bowers, 2011). Perseverance and refusing to give up on the patients, in addition to the drive to want to dive into unchartered waters enabled me to form a rapport and trust with the patients in the unit. With the help I received and the knowledge I had gained throughout the change period, I was able to learn how to care for each patient differently depending on their needs and the level of impairment. It was not long before they at times recognized me and even trusted me enough to allow me to care for them and administer their medicine. I developed a routine with them which they accepted and submitted to freely. By the time my volunteering period was over, I had gained their full trust and was able to adequately care for patients with cognitive impairments. It took me some months and a lot of hard work and perseverance but in the end, I was able to make changes and establish new norms in the center and also mentally and personally. The changes I made will enable me to seek a clearer career path in addition to be able to care for a wide variety of patients in a hospital. It also enabled me to dispell the fear of trying new things and caring for a different kind of patient from the one’s I was used to caring for.
References
Bowers, B. (2011). Managing change by Empowering staff. Nursing Times; Vol. 107, No. 32/33, pp 19-21
Mitchell, G. (2013). Selecting the Best theory to Implement Planned Change. Nursing Management. Vol. 20, No. 1
Sutherland, K. (2013). Applying Lewin’s Change Management Theory to the Implementation of Bar- Coded Medication Administration. Canadian Journal of Nursing Informatics. Vol. 8, No. 1&2
