Theories Are Developed for The Next Twenty Years Peer Responses
DQ2 1It will be interesting to see how many more theories are developed in the next twenty years. I think the behavioral change theories are interesting as well. Another change theory is Prochaska and DiClemente’s (1983) transtheoretical model of behavioral change. This theory looks at the client’s enthusiasm and eagerness to make healthier lifestyle changes (Heiss, 2013). Because patients have to make a conscious decision to quit drinking or to quit using drugs, it requires a behavioral change. “Lifestyle modification programs encourage self-responsibility for health and represent the action phase of health behavior” (Heiss, 2013, p. 479). The patient will need to make frequent appointments with a substance abuse counselor for support, so the patient can make behavioral changes. There are five stages of change, for example, precontemplation (no desire for change), contemplation (thinking about change), preparation (plan for change), action (beginning to change), and maintenance (change in lifestyle has been made for over 6 months (Heiss, 2013). This theory could be used for this nurse’s project because screening, brief intervention, and referral to treatment (SBIRT) depends on the patient’s willingness to make lifestyle changes. This nurse’s mentor uses this theory when she works with her prenatal patients who use drugs during pregnancy. She educates her patients and those who are willing to make lifestyle changes do abstain. Those who are not ready to make a change will keep getting education until the prenatal patient decides to change. Sometimes they do not. There have been many prenatal patients that have stopped using marijuana until after they deliver their baby, so this has been successful.
DQ2 2- In order to implement an evidence-based practice project, the nurse needs to decide which change theory to use. Using a theory helps organize and structure the way change is implemented. According to Mitchell (2013), “”¦managers, or change agents, identify an appropriate change theory or model to provide a framework for implementing, managing and evaluating change” (p. 32; Pearson et al., 2005). One theory is Kurt Lewin’s (1951) change theory that can be described as unfreezing, moving, and refreezing. In this theory, if the nurse needed to change a workflow, it would require unfreezing so that the change could be made. While the new workflow is being used and tested, this would be called moving. Once the new workflow is being used routinely, then refreezing would happen. The manager or nurse could then monitor the change to make sure staff do not go back to the old ways of doing things.
A second theory is Rogers’ (2003) innovation theory. There are five stages of this theory which include: (1) having knowledge about a new evidence-based practice, (2) forming thoughts about the new evidence-based practice, (3) deciding whether to use or not use the new evidence-based practice, (4) using the new evidence-based practice, and (5) adopting the new practice or stop using the new practice (Garon, 2014).
The nurse can provide education about the importance of the new EBP. Individuals will adopt the change at different times during implementation, and managers can work with individuals who are having a difficult time making the needed change. Some staff may be excited to try the new change and help implement it. Once the problems are worked out, then the staff will evaluate the change to see if it improves practice. If it does, they will use the new EBP, and if it does not, the staff could go back to the old way of doing things or make changes to the new EBP until it improves the practice.
This nurse’s mentor has used Roger’s (2003) innovation theory with her OB patients. She has used this theory to develop her OB workflow for patients who have positive drug screens. She knows it is important for her OB patients to get counseled on the effects of drugs on the unborn baby (knowledge about EBP). For patients who have positive urine drug screens, she tries to have the patient see the behavioral health counselor during their prenatal appointment. The behavioral health counselor has limited time to see patients, which can be frustrating for this nurse’s mentor (forming thoughts). It is hard to run the OB clinic and communicate with the counselor on who needs to be seen (deciding whether to use EBP). Sometimes the counselor has to leave to go to a meeting, so the OB nurse recently changed her workflow to include a huddle sheet for the counselor, so that he or she knows which patients need to be seen (using the EBP). She has yet to adopt this practice because she is monitoring the outcome. Janie would probably use Roger’s implementation theory because she would have to work with the behavioral health team and nurses to implement any changes for SBIRT. It would require feedback from the staff in
