Planned Change Models for DNP Practicum Project

                           Planned Change Models

Lewin’s Theory of Change

 

Lewin’s Theory of Change (1951) provides a starting point for implementing nursing theory and research into clinical practice. In this course, you have identified a specific nursing theory that you believe would provide a scientific underpinning (theoretical foundation) for your eventual DNP project. Now, reflect on the process of change. There are many planned change models available for you to consider for your eventual DNP project.

According to Lewin (1951), there must first occur an unfreezing of the old pattern of doing things. Unfreezing is then replaced with the moving phase of change and followed by refreezing as people adjust to the new ways of doing things.

 

Rogers’ Diffusion of Innovation Model

Rogers expanded on Lewin’s work and proposed the diffusion of innovation model in 1995. This model has five stages in the diffusion process: knowledge, persuasion, decision, implementation, confirmation. In the diffusion of innovation model, there are five adopter categories for any population or social system. These include the innovators, early adopters, early majority, late majority, and laggards.

Kotter’s 8-Step Change Model

Kotter developed the 8-step process for leading change model in his 1995 book Leading Change. The eight steps for leading organizational change include: establish a sense of urgency, form a powerful guiding coalition, create a vision, communicate a vision, empower others to act on the vision, plan for and create short-term wins, consolidate improvements and produce still more change, and institutionalize new approaches. Kotter emphasizes that for change to be successful, there needs to be buy-in from 75% of a company’s management, so the first step—creating a sense of urgency—is critical to the success of the change project.

 

Evidence-based Practice Models for Guiding Change

Schaffer, Sandau, and Diedrick (2012) highlight relevant EBP models for guiding change including the ACE star model of knowledge transformation (Stevens 2004, Kring 2008), the advancing research and clinical practice through close collaboration (ARCC) (Ciliska et al., 2011), Iowa model (Titler et al., 2001), the Johns Hopkins nursing evidence-based practice model (JHNEBP) (Newhouse et al., 2007), the promoting action on research implementation in health services framework (PARIHS) (Rycroft-Malone 2004), and the Stetler (Stetler 2001, Ciliska et al. 2011) model.

Schaffer, M.A., Sandau, K.E. & Diedrick, L. (2012). Evidence-based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197–1209. doi: 10.1111/j.1365-2648.2012.06122.x

Quality Improvement Models

Donabedian Structure, Process, Outcomes Model (1966).

This widely recognized conceptual model provides a framework for examining health services and evaluating quality of care. According to the model, information about quality of care can be drawn from three categories: structure, process, and outcomes.

Plan-Do-Study-Act Cycle (PDSA).

The PDSA cycle is a systematic process for testing a change.

P, Plan: Plan a change or test of how something works.

D, Do: Carry out the plan or test.

S, Study: Observing and learning from the consequences, look at the results.   What did you find out?

A, Act: Decide what actions should be taken to improve.

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