reply 1
Kurt Lewin’s theory of change can be used on nursing units to change processes to align with best-practice standards. The process includes three steps to successful planned change: unfreezing, moving, and refreezing.
McFarlan et al. (2019) used a combination of nursing literature and Lewin’s theory to demonstrate that hourly rounding in an emergency setting improves patient experience scores. The first step that was considered is the unfreezing phase, where the driving factors and restraining forces were considered. In this case, the restraining forces included the department being busy, nursing staff skepticism, and busy leader schedules. In this phase the leadership started with leading by example and taking time to do leadership rounds, as well as communicating the current patient experience scores and best-practice information with the staff. The moving phase was where the policies were changed to reflect the new process, as well as random audits completed. The refreezing phase continued with audits and feedback throughout the month the research was conducted. This concept was operationalized with the positive change in patient experience scores.
Lewin’s theory has not only been applied at the bedside, but also to guide nursing student practices. A group of students from the Master’s Entry Program in Nursing at the UC Davis School of nursing used Lewin’s theory to develop and pilot-test a student-led peer-mentorship program (Kumnoonsate et al. n.d.). The unfreezing started with recognizing a need for first year students to have more support. During the moving phase the mentorship program was put into place, followed by passing on the mentorship program to the next group of students. The theory was operationalized by putting the mentorship into action. This study does have limits as it a student project without an exact listed date, although it does report challenges related to the global pandemic, which has only occurred in the last two year. However, a study like this shows how this theory can be applicable in many different situations not only applied to patient care.
Kumnoonsate, M., Luc, W. L., & Scalzo, D. (n.d.). Peer-mentorship for master’s entry nursing students: Utilizing Lewin’s Change Theory for program development and pilot-testing. Sigma Theta Tau International. Retrieved on October 11th, 2021 from https://sigma.nursingrepository.org/handle/10755/21669
McFarlan, S., O’Brien, D., & Simmons, E. (2019). Nurse-leader collaborative improvement project: Improving patient experience in the emergency department. Journal of Emergency Nursing, 45(2), 137–143. https://doi-org.su.idm.oclc.org/10.1016/j.jen.2018.11.007
Reply 2
Middle-range theories in nursing fall between the practice and grand theories. They include fewer ideas and a narrower aspect of reality. That means they are defined to be operationalized since they can be tested empirically. The following two articles show how middle-range theory concepts are operationalized and be legible for measurement.
Jaarsma et al. (2017) wrote an article that reviewed the literature on various factors that impact self-care of chronic diseases according to middle-range theory. According to middle theory, this review identified the following factors as part of self-care that affect care for chronic diseases. They are habits, beliefs and values, confidence, access to care, cognitive and functional abilities, motivation, experiences, and skills. The article has explored these factors one by one with empirical and statical analysis to show their measurements and how they influence patients with heart failure diseases.
Middle-range theory in hypertension nursing was developed to improve the patients’ nursing and design research for hypertension management (Drevenhorn, 2018). According to Drevenhorn (2018), a middle-range theory was developed to meet the above objective using former literature. Various concepts concerning patients were presented. They include willingness to change their lifestyle, self-efficacy, locus of control, hardiness, sense of coherence, vulnerability level, and beliefs concerning sickness and health. These concepts were developed, defined in the study, and were part of the nursing system, which plays a crucial part in examining patients’ needs. Their incorporation into self-care means that they can help develop new behaviors through the nurse’s care. The nurse manages to help them use the patient’s factors developed through middle-range theory to planning the right interventions.
References
Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International journal of hypertension, 2018.
Jaarsma, T., Cameron, J., Riegel, B., & Stromberg, A. (2017). Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Current heart failure reports, 14(2), 71-77.
