Lewin's Change Theory Research Articles

Patient Readiness for Surgery: A Quality Improvement Initiative

ABSTRACTThe use of a surgical safety checklist can help prevent sentinel events; however, a lack of adherence to the checklist can result in inadequate preoperative patient readiness and negative outcomes. The purpose of this quality improvement project was to address preoperative concerns that prevent patient readiness in a military hospital. To change practice, the project involved the use of an evidence‐based practice model and Kurt Lewin's change theory. The primary investigator provided an educational initiative on the required checklist for perioperative personnel and collected data on key elements (ie, consent completion, laboratory test results, antibiotic availability, checklist completion) for 30 days after the initiative. Consent completion rates were 100% both before and after the intervention. Statistical analysis (chi‐square [χ2]) showed significant improvement for the remaining three elements. The results were the most significant for laboratory test results (χ21 = 33.496, P < .00001).

Indigenous Pedagogy for Developing Essential Life-Skills of Children in Masaka District, Uganda

Contemporary education practice is widely seen as practices that blend conventional approaches with either new innovations or culturally tested practices. In a situation where being cultural or modern has its own drawbacks, towing the middle position becomes an inevitable choice. The paper presents findings from an exploratory sequential study that examined the influence of Indigenous Pedagogy (IP) on developing children's life skills in Masaka District, Uganda. It was anchored on Lewin's (1922) change theory; likened to Manion and Cohen's (1975) reinvention theory and adopted as a restoration theory. Snow bowling, purposive and stratified random sampling were used to select 44 participants. Twenty (20) key informants including 6 parents, 2 elders, 6 religious, 2 District Education Officers; 2 Ministry officials and 2 local council leaders were interviewed. Twenty-four (24) other respondents participated in three-eight-member Focus Group Discussions (FDGs). The findings portray replicable practices of skilling based on deep-rooted beliefs set on standards that are supported by aspirations in harmony with nature. The study found that methods used by Masaka parents combined theory and practice daily; in lessons that happen where knowledge was situated, mainly through apprenticeship, attachment, heart-to-heart and one-to-one encounters. They also embraced global citizenry based on firm principles of what Africans value. The study concluded that indigenous methods were still useful in grooming children with life skills of productive work, character, positive attitudes, mental acuity and social orientation. It recommends that teacher education institutions require academic programmes blending contemporary with indigenous methods anchored on core African values to prepare pro-cultural-modern teachers. To link the valuable past to the inevitable contemporary ways of knowing, the application of hybrid pedagogy becomes imperative

Commitment to Organizational Change in Clinical Nurses: A Structural Model Applying Lewin's Change Theory

Purpose: In clinical settings characterized by constant change, systematic and planned change management in terms of human resources is necessary for clinical nurses to commit to change. Accordingly, this study used a structural equation model, applying Lewin's theory of change, to investigate the factors influencing commitment to organizational change among clinical nurses. The aim was to gather evidence to inform the development of strategies to strengthen this commitment.Methods: Surveys were conducted online and offline with hospital nurses from November to December 2022, resulting in 220 valid samples for analysis. SPSS 28.0 and AMOS 28.0 were used for data analysis.Results: The research showed support for six out of 14 research hypotheses, revealing significant paths from transformational leadership to organizational support, positive psychological capital, job crafting, and commitment to organizational change. Job crafting was found to directly influence commitment to organizational change, and high recognition of transformational leadership increased commitment through perceived organizational support, positive psychological capital, and job crafting.Conclusion: This study offers insights for developing strategies to promote commitment to organizational change among clinical nurses by considering positive psychological capital, job crafting, transformational leadership, and perceived organizational support. Mediation programs should be implemented based on the pathways in this model.

Improvement of Pain-Free Walking Distance with Implementation of Treadmill Protocol

Peripheral arterial disease (PAD) may cause lower extremity pain that can impair activities of daily living. At a vascular clinic in rural New Mexico, peripheral arterial disease patients are managed but their symptoms continue to worsen so an evidence- based solution was sought. The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the translation of McDermott et al.’s published research on the Gardner-Skinner Protocol will impact the pain-free walking distance when compared to current practice among peripheral arterial disease patients with intermittent claudication in a university activity center in rural New Mexico over four weeks. Dorothea Orem's self-care theory and Kurt Lewin's change theory provided the project's theoretical foundations. Data on walking distance was measured using the Six-Minute Walk Test in PAD patients (n = 12) and were compared at baseline and four weeks post-implementation of the intervention. A paired t-test showed no statistically significant difference in pain-free walking distance from baseline (M = 267.85, SD = 244.05) to post-intervention (M= 339.58, SD= 191.42), t (11) = -1.27, p= .23. Despite the lack of statistical significance, there was clinical significance in that the mean increase in pain-free walking distance increased by 70.83 feet. Therefore, the implementation of the Gardner-Skinner Protocol may improve walking distance in this population of patients. Recommendations are to continue the implementation and continue to analyze data for six months prior to dissemination.

Evaluating the effects of implementing a hospital-acquired pressure injury risk assessment hand-off tool

More than 2.5 million patients suffer from pressure ulcer injuries each year, estimating that 60,000 die from complications (Joint Commission Center for Transforming Healthcare, 2021). Hospital acquired pressure injuries (HAPI) present as skin and muscle damage, slowed healing, and increased pain and infections that result from delayed wound care and treatments to fragile areas. Reports from Rondinelli et al. (2018) showed that implementing a HAPI risk assessment hand-off tool worked to reduce such events.
 In 2021, a coastal community hospital located in Southeast Texas recorded 5% HAPI events, which resulted in the creation of a student developed HAPI risk assessment hand-off tool. The aim of this quality improvement (QI) project was to decrease HAPI events in the Cardiothoracic IMU to 0% by February 2022. Kurt Lewin's Change Theory was used to guide project interventions.
 After receiving project approval, four changes were implemented. A unit champion, responsible for monitoring the accuracy of Braden Score documentation was designated. Nurses implemented interaction-based patient repositioning every 2 hours and participated in monthly HAPI prevention and education meetings. Lastly, nurses completed the hand-off tool to verify staff compliance. Chart audits and a student developed questionnaire was used to determine the usefulness of the HAPI risk assessment hand-off tool. After one month of chart audits, and use of the hand off tool, the HAPI occurrence rate decreased to 3%. This project concluded that the student developed HAPI risk assessment hand-off tool had no significant effect on the reduction of HAPI occurrences within the cardiothoracic IMU.

Implementing a Standardized Workflow Process to Increase the Palliative Care to Hospice Admission Rate.

Palliative care is a precursor for hospice care, an underutilized Medicare benefit that has been shown to improve quality of life, decrease health care costs, and provide expert symptom relief at the end of life. Palliative patients transitioning to hospice services were experiencing delays within the admission process. To determine whether standardizing the workflow process with chart completion leads to increases in the hospice admission rate for palliative care patients transitioning to hospice care. This quality improvement project adapted Kurt Lewin's change theory and the Plan-Do-Study-Act (PDSA) cycle for implementation. Preintervention patient data were collected from May 2021 through August 2021, and postintervention data were collected from September 2021 through December 2021. Standardization of the workflow process included assigning an urgency level to the hospice referral and deactivation (close) of the electronic medical record (EMR) chart, signaling completion of the workflow process. The palliative care to hospice admission rate increased by 11.5% in the postintervention group. The EMR chart deactivation rate increased by 55.3%, which was statistically significant ( P ≤ .001). The standardized workflow process increased the number of palliative care to hospice admissions and improved the effectiveness of transitioning palliative care patients to hospice services.

Postdischarge Nausea and Vomiting Risk Assessment in Breast and Gynecological Surgical Patients

Introduction Postdischarge nausea, vomiting or retching (PDNV) occurs after the time of discharge from the post anesthesia care unit (PACU) for patients who have undergone out-patient surgeries. Consequences include increased healthcare costs, rehospitalizations, and decreased patient satisfaction. Identification of the Problem At a large mid-Atlantic academic hospital, 40% of gynecological out-patient surgical patients had PDNV as identified by a separate quality improvement project. EBP Question/Purpose The PICO question guiding the project was: In out-patient surgical populations, does the implementation of a PDNV risk assessment tool improve early identification of patients at risk for PDNV? Databases utilized included PubMed, Ovid MEDLINE and CINAHL. The purpose of this quality improvement project was to implement and evaluate the effectiveness of and staff compliance with the Apfel Postdischarge Nausea and Vomiting Risk Assessment tool in order to improve PDNV screening in the PACU. Methods/Evidence As part of Lewin's Change Theory, key stakeholders and unit champions, were recruited. All PACU registered nurses received education on the risk assessment protocol utilizing the Apfel risk assessment tool. The Apfel risk assessment tool is validated to identify five independent risk factors for PDNV in out-patient ambulatory surgical populations. Implementation of the tool with data collection occurred over eight weeks on all scheduled out-patient breast and gynecological surgical patients. Staff compliance was measured throughout implementation. Significance of Findings/Outcomes In patients with at least three risk factors present, the Apfel tool correctly identified the risk for PDNV in 68% of patients. In patients with four and five risk factors present, the tool correctly identified the risk for PDNV in 88% and 100% of patients respectively. Compliance of the tool was high with the average compliance rate of 92% over the eight-week data collection period. Additional outcomes included improved follow up phone call completion rate, and increased administration of preventative pharmacological interventions in patients at high risk for PDNV. Implication for Perianesthesia Nurses and Future Research The Apfel tool adequately predicted the risk for PDNV in out-patient surgical breast and gynecological patients. Lewin's change theory was successful in maintaining a high compliance rate throughout implementation. Efforts toward sustainment include expansion to all out-patient surgical populations and implementation of a PDNV prevention and management guideline. Postdischarge nausea, vomiting or retching (PDNV) occurs after the time of discharge from the post anesthesia care unit (PACU) for patients who have undergone out-patient surgeries. Consequences include increased healthcare costs, rehospitalizations, and decreased patient satisfaction. At a large mid-Atlantic academic hospital, 40% of gynecological out-patient surgical patients had PDNV as identified by a separate quality improvement project. The PICO question guiding the project was: In out-patient surgical populations, does the implementation of a PDNV risk assessment tool improve early identification of patients at risk for PDNV? Databases utilized included PubMed, Ovid MEDLINE and CINAHL. The purpose of this quality improvement project was to implement and evaluate the effectiveness of and staff compliance with the Apfel Postdischarge Nausea and Vomiting Risk Assessment tool in order to improve PDNV screening in the PACU. As part of Lewin's Change Theory, key stakeholders and unit champions, were recruited. All PACU registered nurses received education on the risk assessment protocol utilizing the Apfel risk assessment tool. The Apfel risk assessment tool is validated to identify five independent risk factors for PDNV in out-patient ambulatory surgical populations. Implementation of the tool with data collection occurred over eight weeks on all scheduled out-patient breast and gynecological surgical patients. Staff compliance was measured throughout implementation. In patients with at least three risk factors present, the Apfel tool correctly identified the risk for PDNV in 68% of patients. In patients with four and five risk factors present, the tool correctly identified the risk for PDNV in 88% and 100% of patients respectively. Compliance of the tool was high with the average compliance rate of 92% over the eight-week data collection period. Additional outcomes included improved follow up phone call completion rate, and increased administration of preventative pharmacological interventions in patients at high risk for PDNV. The Apfel tool adequately predicted the risk for PDNV in out-patient surgical breast and gynecological patients. Lewin's change theory was successful in maintaining a high compliance rate throughout implementation. Efforts toward sustainment include expansion to all out-patient surgical populations and implementation of a PDNV prevention and management guideline.

Postdischarge Nausea and Vomiting Risk Assessment in Breast and Gynecologic Surgical Patients

PurposePostdischarge nausea, vomiting, and retching often occur after the time of discharge from the postanesthesia care unit (PACU) in patients who have undergone outpatient surgeries. At a large mid-Atlantic Academic Hospital, 40% of gynecologic outpatient surgical patients had postdischarge nausea and vomiting (PDNV). The purpose of this quality improvement project was to implement and evaluate the effectiveness of and staff compliance with the Apfel Postdischarge Nausea and Vomiting Risk Assessment tool to improve PDNV risk screening in the PACU. DesignThis quality improvement project was part of an evidence-based practice project. MethodsAfter identification and recruitment of key stakeholders and unit champions, a force-field analysis, as part of Lewin's change theory, was completed to identify the driving and restraining forces. All PACU registered nurses received education on the risk assessment protocol using the Apfel risk assessment tool. The Apfel risk assessment tool has been validated to identify five independent risk factors for PDNV in outpatient ambulatory surgical populations. Implementation of the tool with data collection occurred for 8 weeks on all scheduled outpatient breast and gynecologic surgical patients. Staff compliance was measured throughout implementation. FindingsIn patients with at least three risk factors present, the Apfel tool correctly identified the risk for PDNV in 68% of patients. In patients with four and five risk factors present, the tool correctly identified the risk for PDNV in 88% and 100% of patients, respectively. Compliance with the tool was high with an average compliance rate of 92% for the 8-week data collection period. ConclusionsData analysis demonstrated that the Apfel risk assessment tool adequately predicted the risk for PDNV in outpatient surgical breast and gynecologic patients. Use of Lewin's change theory was successful in maintaining a high compliance rate throughout implementation. In addition, this quality improvement project resulted in increased compliance of the standing follow-up phone call policy. Efforts toward sustainment include expansion to all outpatient surgical populations and implementation of a PDNV prevention and management guideline.

Improving the Accuracy of Newborn Weight Classification

PurposeThe purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). DesignQuality improvement methods using Lewin's Change Theory guided the process. Setting/local problemAt an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. PatientsAll term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. Intervention/measurementsNewborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. ResultsUse of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. ConclusionUse of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.

Follow the Blue Feet: Nurse Implemented Postoperative MOBILITY Program.

To establish the effectiveness of a nurse-led postoperative MOBILITY program implemented on the Burn/Surgical/Trauma unit at our facility to increase documentation of patient mobility and to develop nurse and patient understanding of the importance of movement in postoperative recovery while increasing patient satisfaction with mobility. The MOBILITY program was implemented on a 24-bed Burn/Surgical/Trauma unit. Lewin's Change Theory guided the development of the program, while the Iowa Model of Evidence-Based Practice for Quality Care was the framework for the project. Nursing staff (n = 20) on the Burn/Trauma unit completed pre/postimplementation MOBILITY surveys. Pre/postimplementation MOBILITY patient (n = 9) satisfaction questionnaires were completed by postoperative patients. Retrospective chart (n = 10) audits were performed pre/postimplementation. Included in the chart audits and patient satisfaction surveys were patients 72 hours or less postoperatively without lower limb weight-bearing restrictions. Those excluded were patients on complete bed rest, or those with bilateral or unilateral nonweight-bearing orders. Documentation of mobility improved by 233.3%, while ambulation distance documentation increased by 700%. Mobility orders entered by the medical team rose by 66.7% postintervention. Nurses' comfort level with assessing mobility improved by 38.5%. Knowledge of where to document patient postoperative mobility improved by 80%. Postintervention patient satisfaction with postoperative mobility saw a 60% change. Patients performing postoperative mobility increased by 80%. Implementation of a nurse-led postoperative MOBILITY program on a Burn/Surgical/Trauma unit showed a marked increase in nurse and patient understanding of postoperative mobility, patient satisfaction with postoperative mobility, and nursing documentation of patient mobility.

Experience of a Smoking Cessation Program Among High School Students in Taiwan

In Taiwan, the prevalence of smoking among teenagers has led to a required smoking cessation program in schools. Students caught smoking in school are required to participate in a weekly smoking cessation class. The purpose of this study was to explore the experience of high school students in a smoking cessation program. Fifteen adolescents participated in a one-on-one in-depth semistructured interview, and the content was analyzed for patterns based on the methods of Miles and Huberman. In addition, Lewin's change theory of drive forces and restraining forces was used to describe the change in behavior as a result of the program. Five major themes were identified: the onset of smoking-change influenced by families and friends; intention to quit smoking-driving force; the irresistible temptation to smoke-restraining force; limited change effects-more attention and assistance needed; and change in attitude rather than behavior-smoking remained unchanged. Changes were seen in the perceptions and attitudes of these students toward smoking at the end of the program; however, none of them were able to really quit. Most participants revealed that they used improper means to pass the carbon monoxide test requirement that was used as a measure of not smoking. Alternative future intervention strategies for further study include change in health policy to support nicotine replacement methods for heavy adolescent smoker, use of teacher support, and exercise programs to support students going through the smoking cessation period.

Implementing a Birth Kangaroo Care Policy in Labor and Delivery: Bringing Evidence‐Based Practice to the Bedside

Poster Presentation Purpose for the Program The birth of an infant is one of the most meaningful experiences in a woman's life. Birth kangaroo care (BKC), early skin‐to‐skin contact between mother and infant from birth until first breastfeeding is accomplished, is recommended by the American Academy of Pediatrics and many other organizations. Research shows that BKC provides physiologic and emotional benefits for both mother and infant. Newborn thermoregulation and blood glucose stabilization are enhanced when infants are kept skin‐to‐skin with their mothers. They cry less and breastfeed easier. Mothers report more confidence, stronger attachment, and distraction from discomfort when they hold their infants immediately after birth. Yet, despite the evidence, most hospitals still practice routine separation of mothers and infants. How can a team of nurses create a policy and change the culture of childbirth in a community hospital? Proposed Change Making BKC part of the labor and delivery unit's normal routine requires more than writing a policy. It requires using change theory and evidence‐based research to bridge the gaps between “the way we've always done it” and family‐centered maternity care. This community hospital wanted to make skin‐to‐skin contact between mothers and infants part of their normal routine for vaginal and cesarean births. Implementation, Outcomes, and Evaluation By using evidence‐based research, a team of nurses wrote a policy that made BKC the standard of care for vaginal and cesarean births. Key issues addressed in the policy include management of the third stage of labor while the mother maintains skin‐to‐skin contact with her infant; caring for the newborn (vital signs, medications, glucose monitoring, and bathing); time management; and providing BKC while caring for a patient who has had a cesarean delivery. In addition to logistics, change theories were used to deal with the resistance to change in practice and culture within the institution. Lewin's Change Theory and Roger's Diffusion of Innovation Theory were used to bring staff and physicians on board. While the policy was being implemented, management supported staff by ensuring ratios allowed nurses the time they needed as they adjusted to the change. Breastfeeding rates went up initially from 59% to 75%. Maternal satisfaction was enhanced as indicated from the positive letters, surveys, and in‐person feedback. Implications for Nursing Practice Cultural shift within the unit was facilitated with Lewin's concepts of unfreezing, moving, and refreezing and Roger's concepts of early adopters. Implementing BKC benefited the families served and staff were empowered by the process.

Change theory for accounting system reform in health sector: a case study of kerman university of medical sciences in iran.

Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin's change theory or not. This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin's change theory and the model presented in this paper underpins the change management in any organizations.

Cultivating Quality: Implementing Standardized Reporting and Safety Checklists

Developing processes to create a culture of safety. It's estimated that as many as 98,000 hospitalized patients lose their lives each year in the United States because of medical errors that could have been prevented. While standardized reporting and safety checklists have been shown to improve communication and patient safety, implementation of these tools in hospitals remains challenging. To implement standardized nurse-to-nurse reporting along with safety checklists at Mission Hospital, a 522-bed facility in Mission Viejo, California, using Lewin's change theory and Knowles's adult learning theory. Nurses were tested to assess their knowledge of the standardized nurse-to-physician reporting method called SBAR (Situation, Background, Assessment, Recommendation), their understanding of the concept of the nurse-to-nurse reporting method called SBAP (Situation, Background, Assessment, Plan), and the use of safety checklists. Then, after viewing a 22-minute educational video, they were retested. A total of 482 nurses completed the pretest and posttest. On the pretest, the nurses' mean score was 15.935 points (SD, 3.529) out of 20. On the posttest, the mean score was 18.94 (SD, 1.53) out of 20. A Wilcoxon matched-pairs signed-rank test was performed; the two-tailed P value was < 0.001. The application of Lewin's change theory and Knowles's adult learning theory was successful in the process of implementing standardized nurse-to-nurse reporting and safety checklists at Mission Hospital.

Adopting a personal digital assistant system: application of Lewin's change theory

This paper reports a study exploring nurses' perceptions of adopting an information system using handheld computers (personal digital assistants) in their daily practice. Handheld computers have recently been used in nursing information systems for patient care, but few studies have explored their impact on users. By understanding clinicians' experiences of using this technology, strategies can be implemented to smooth the change process in adopting their use, thus achieving optimal patient outcomes. A descriptive, exploratory approach was used to study nurses' perceptions of using personal digital assistants as part of a hospital information system. A purposive sample of 15 nurses participated in one-to-one, in-depth interviews from February to March 2004. Nurses' perceptions of the adoption process were analysed using Lewin's force field theory of change as a framework. Nurses initially resisted using the personal digital assistant system (unfreezing stage), then came around to using it (moving stage), and finally adopted the system in their daily practice (re-freezing stage). However, an anticipatory stage also occurred and this could serve as a feedback mechanism to improve the system for current and future use. Educational programmes should be provided and strategic planning should be done in the early stage of implementing a policy to adopt new technology. In addition, the adoption process and learning period could be shortened by improving the system's content design. During this transition stage, dual charting should be used as a backup only for a limited time to avoid adding extra work to nurses' already heavy workload. Finally, the concept of confidentiality should be reinforced and stressed early in the educational programme to protect patient data, which can easily be accessed in computerized systems.

Escalation and de‐escalation of commitment: a commitment transformation analysis of an e‐government project

Abstract. This paper presents a commitment transformation framework for analysing the change in actors’ commitment during the transition from escalation to de‐escalation in information technology projects. De‐escalation is potentially a more important issue than escalation because de‐escalation provides remedies for the ills of escalation. Therefore, it is important to understand how stakeholders may bias facts in the direction of previously accepted beliefs and thus prevent an organization from de‐escalating. Here, we adopt Lewin's change theory to examine the commitment transformation during the transition from escalation to de‐escalation of an e‐government project in a local council in the United Kingdom. By conceiving actors’ commitment transformation as an ‘unfreezing–changing–refreezing’ process, researchers may develop a deeper understanding of how actors may give up previous failing course of action and accept an alternative course of action. Practitioners can also utilize the framework in post‐mortem analyses of projects which have faced escalation to devise useful de‐escalation strategies for future project development.1

Changing Unit Culture: An Interdisciplinary Commitment to Improve Pain Outcomes

Patients discharged from The Methodist Hospital, Houston, TX, are contacted post discharge and asked to assess the care provided; specific questions are focused on pain management. Responses to these questions were initially unfavorable: only approximately 72.4% of patients were completely satisfied. An interdisciplinary team was developed on an acute-care unit at the hospital to individualize pain management through daily rounds and improvements in nursing assessment. Kurt Lewin's change theory was utilized to improve patient outcomes and to bolster staff commitment to control pain more effectively--as evidenced by improved patient satisfaction scores to a high of 86% only 3 months following implementation of this new interdisciplinary program.

Implementing audit in palliative care: an action research approach.

To investigate the factors that influence the successful implementation of audit in a palliative care setting. Quality assurance is a necessary component of contemporary health care. In the past, palliative care has not generally been subject to systems of audit and quality management. However in recent years the need for all health care organizations to have clear policies and procedures for maintaining quality has become more pressing. An action research project was conducted to investigate the implementation of audit in a palliative care setting, which involved the application and modification of the Support Team Assessment Scale (STAS). A collaborative approach was adopted and this facilitated the identification of factors vital to successful introduction of the audit methodology into the unit. These included effective teamwork, the input of an external facilitator, good relationships with management and prompt and relevant feedback on progress. The use of STAS was fully integrated into the work of the unit and a robust programme of audit has been established. Combining the cyclical nature of action research methodology and the audit process with Lewin's change theory provided a clear conceptual framework for the research. This approach would be applicable in a range of health care settings to bring about improvements in quality management.

Kurt Lewin's Change Theory in the Field and in the Classroom: Notes Toward a Model of Managed Learning

This paper discusses some of Lewin's basic dictums and their influence in the author's work and that of others. Specifically, the paper expands on Lewin's change model. It also discusses process consultation and clinical research and describes a design to teach the management of planned change. The paper concludes that planned change might be better conceptualized as managed learning.

Kurt Lewin's change theory in the field and in the classroom: Notes toward a model of managed learning

This paper discusses some of Lewin's basic dictums and their influence in the author's work and that of others. Specifically, the paper expands on Lewin's change model. It also discusses process consultation and clinical research and describes a design to teach the management of planned change. The paper concludes that planned change might be better conceptualized as managed learning.