reply to each 2 discussions regarding change theory implementation.
The issue Blue Group selected for practice change focused on applying group education as opposed to individual education for patients with type 2 diabetes based on the Diabetes Self-Management Education and Support (DSMES) curriculum in order to attempt to achieve a greater decrease in hemoglobin A1C. Currently, the typical clinical practice involves providing pamphlets of information and a quick rundown of the condition on an individual basis before sending the patient off into the world to manage their new health issue, often with little support and/or full understanding of both the condition and how to engage in proper self-management of their diabetes. Blue Group proposed a practice change in how healthcare providers approach diabetes education that would involve the implementation of group-based diabetes education courses as the normal, first-line approach to type 2 diabetes management.
To implement this practice change in an organized manner, one could utilize a theory of planned change such as Lewin’s 3-Step Model for Change. The major concepts of this theory are simple and straightforward with a linear process that leaves room for the adaptability and flexibility needed to suit various types of healthcare organizations (Wojciechowski et al., 2016). The first step in this model of planned change is “unfreezing” in which a problem or need for improvement and change in a process becomes known. As a growing patient population with this chronic condition has increased to the point where it is now considered a global pandemic with adverse health and global economic impact, it should come as no surprise that the healthcare community may need to address how they are managing the burden for education an issue of this enormity presents (Bellou et al., 2018). The second step of the model is the “changing” or “moving” step in which alternatives to the current approach are explored and the benefits of employing a specific change are emphasized (Wojciechowski et al., 2016). For example, one could impress upon healthcare providers the benefits of utilizing group-based diabetes education classes as a first-line option for education. These benefits could include items such as increased patient support, cost-effectiveness, and higher levels of patient engagement in learning. The last step in Lewin’s model is referred to as “refreezing” in which the selected change or new approach is integrated and made the new standard protocol for care (Wojciechowski et al., 2016). This model can then be repeated as needed and monitored for efficacy. As healthcare is an evolving practice, so too should our adaptability and approach to care be ever evolving and growing. Lewin’s 3-Step Model for Change can be employed to address a growing need for education for an increasing population of patients who need education and support with this chronic and potentially devastating condition as clearly, the current one-on-one minimalist educational approach is not adequately addressing the issue. For reference for this article, Blue Group’s PICOT Question is provided below.
“In adult patients with type 2 diabetes, does group diabetes education, based on the DSMES curriculum, compared to individual education, based on the same curriculum, decrease hemoglobin A1C below 6.5 within the first year of implementation?”
Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PloS one, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127 (Links to an external site.)
Wojciechowski, E., Murphy, P., Pearsall, T., French, E. (2016). A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change. The Online Journal of Issues in Nursing, 21(2). DOI: 10.3912/OJIN.Vol21No02Man04
Kotter and Cohen’s Model of Change
The Kotter & Cohen’s Model is a step-by-step model that focuses on developing and acquiring change; the model uses an eight step approach. “The first three steps of Kotter’s 8 Step Change Model are about creating the right climate for change, steps 4 up to 6 and link the change to the organization. Steps 7 and 8 are aimed at the implementation and consolidation of the change (Mulder, 2012)”. “Kotter’s model is grounded in his observation that people and organisations generally resist change and omit some of the steps needed for successful and sustained change (Aziz, 2017).” The model highlights the importance of creating a vision to obtain change and the need for the employees to be on board for it to be successful. The model considers that implementing change can be difficult. Examples of barriers can include: poor teamwork or leadership, workplace cultures, vain attitudes, and fear. These barriers can disrupt any change implementation project (Athuraliya, 2020).
In patients with indwelling urinary catheters (P), what is the effect of chlorhexidine gluconate (I) on the rate of CAUTIs (O) compared to soap and water (C ) within a six month period (T)?
Proposed Direction for Practice Change
A vision would need to be created and shared regarding best practices using CHG vs soap/water to prevent CAUTI. Bedside nurses would need to be employed and motivated in changing indwelling catheter insertion/care. Utilizing nursing leadership to continue motivating and promoting the proposed changes is essential, a long with continually checking for barriers. Patience and short term goals should be made along with way to continue on a positive path towards the proposed change. The long term goal would be a downward trend in CAUTIs seen in the facility.
Athuraliya, A. (2020). Kotter’s 8 Step Change Model: A Comprehensive Step-by-Step Guide. Retrieved from https://creately.com/blog/diagrams/kotters-8-step-change-model/
Aziz A. M. (2017). A change management approach to improving safety and preventing needlestick injuries. Journal of infection prevention, 18(5), 257–262. https://doi.org/10.1177/1757177416687829 (Links to an external site.)
Mulder, P. (2012). Kotter’s 8 Step Change Model. Retrieved [insert date] from toolshero: https://www.toolshero.com/change-management/8-step-change-model-kotter/
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