Nurse – As the Change Agent

nurse informatics certification Nurse – As the Change AgentBeing a change agent is one of the major roles of the nurse in the health care system. The nurse takes effect on the transformations of different lives, for both ill and well, through the various functions they perform. Chin and Benne in 1985 formulated a theory on the strategies in effecting changes to other people and to one’s self. The General Strategies for Effecting Changes in Human Systems—namely, the Empirical–Rational Strategies, Normative–Re-educative Strategies and Power–Coercive Strategies—which are approaches to realize planned social and organizational change (Añonuevo et al., 2000; Walls, 1976).

Empirical–Rational Strategies

Self-interest primarily drives people to act, and they do so rationally (Chin & Benne, 1985). Every individual has the capacity to make decisions and to act—based on one’s will, motivation and perseverance—to change. When the proper information is emphasized in a convincing and engaging way, people will discover the reason of the change and act in line with such intent (Chin & Benne, 1985). Motivation pushes an individual’s desire to change. The nurse can assume the role of instructor-facilitator-motivator.

Credibility and reliability of the change agent are very vital to properly motivate and push a person to truly change. Of course, it would be very difficult (or impossible) to effect change if the agent is not credible and reliable. Brevity, clarity and some level of vigor are also essential factors in the transfer of information.

To ensure accuracy, specialists should gather information, which must reflect up to date methodological methods. Once gathered information is transferred, such process involves a one-way process, where the change agent actively facilitates the transfer, reception and understanding of the information (Chin & Benne, 1985).

Dialogue should support the process of understanding, not changing or redefining the facts as determined and advanced by specialists (Chin & Benne, 1985). Empathy best describes this. The most important principle here is that you want to change the person with thorough understanding, not merely because it is the right thing to do. A person should change not because you want to or he/she needs to and he/she has to, but because it is for his/her own good. Dialogue should not be done with force that must be followed, but an understanding to communicate that you make a person feel the freedom to choose and to decide. Encouragement should always promote democracy and autonomy.

Normative–Re-educative Strategies

Intelligence is social—not individual—in realm. People are directed in their behaviors by a normative culture, or socially endowed and communicated norms, meanings, and institutions. Within a person, internal values, habits and meaning guide his/her actions. Thus, any change in the behavior or actions is a change, not only in the rational communication tools, but also at the personal level, namely in his/her values and habits. Likewise, any change in a person also affects the social level, bringing forth changes which provide alternatives in institutionalized relationships and roles, normative structures, and perceptual and cognitive orientations (Chin & Benne, 1969).

All those involved in the system of change carry-out transformations based on their own direction (Chin & Benne, 1985). Support system is very vital for a person who wants to realize change. However, change is not easy to attain, and problems are encountered along the way. One way to address this is through a change in values, attitudes, relationships and norms between members of the system, as well as between the system and the external environment (Chin & Benne, 1985). Mutual collaboration is imperative among the members of the health care team in creating the final method to create change—no member of the system should dominate or use power on the others (Chin & Benne, 1985). Parts of the change process that must be assessed include the dynamics of the system (personality, privilege and power) and the deeper level of assumptions (Chine & Benne, 1985). One of the secondary objectives of the change process is to enhance the system’s general skills to manage its own change process in the future (Chin & Benne, 1985).

Power–Coercive Strategies

Power is legal and power has its privileges, so people must respect those in power (Chin & Benne, 1985). The nurse has the legitimate right and power to lead another person’s desire to change. Nurses have the power and responsibility to direct those in the system. In cases of non-compliance to directives, meting out reprimand is necessary (Chin & Benne, 1985).

Observing the organizational structure, particularly following the orders of one’s superior is crucial to address the best interest of the organization. Most mid-level and top-level leaders have more experience, and thus, naturally mean that they know better, if not the best (Chin & Benne, 1985).

Summary and Conclusions

The basic assumption underlying the empirical-rational model is that individuals are rational and will follow their rational self-interest. Thus, if a change “for the better” is suggested, people of good intention will adopt the change. This approach posits that change is created by the dissemination of innovative techniques. A primary strategy of this model is the dissemination of knowledge gained from research.

In the normative-re-educative approach, the individual is seen as one actively in search of satisfying his/her needs and interests. The individual does not passively accept what comes to him/her, but takes action proactively to advance his/her goals. Further, changes are not just rational responses to new information but occur at the more personal level of values and habits. Additionally, the individual is guided by social and institutional norms. The overarching principle of this model is that the individual must take part in his/her own (re-education) change if it is to occur. The model includes direct intervention by change agents, who focus on the client system and who work collaboratively with the clients to identify and solve their problems.

Two strategies are germane to the normative-re-educative model. First is the scheme to focus on improving the problem-solving capabilities of the system. Next is the strategy to release and foster growth in the persons who compose the system. There is no assumption that better technical information can resolve a client’s problems. Rather, the problems are thought more likely to be within the attitudes, values, or norms of various client-system relationships. The assumption of this model is that people are naturally capable and creative and, if obstructions are removed, will rise to their highest potentials. The model’s strategies are based on the potentials that are already inherent in people and the system for change; thus it is not necessary that change be leveraged from outside the system.

The power-coercive approach relies on influencing individuals and systems to change through rules, policies and external leverage, where power of various types is the dominant factors. Power-coercive strategies emphasize political, economic, and moral sanctions, with the focus on using power of some form to “force” individuals to adopt to change. Its perspective is grounded in concepts of power, authority, and competing interests, with an image of negotiation.

“Nothing is constant in this world but change.”

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References:

[tabsnice] [tabnice title="*"] Añonuevo, C.A. et al. (2000). Theoretical Foundations of Nursing. Los Baños, Laguna: UP Open University, 268–270. Chin, R., & Benne, K.D. (1985). General Strategies for Effecting Changes in Human Systems. W.G. Bennis, et al., The Planning of Change 4th Edition. New York: Holt, Rinehart & Winston, 22–45. Chin, R. & Benne, K.D. (1969). General Strategies for Effecting in Human Systems. W.G. Bennis (ed.), The Planning of Change, 2nd Ed. New York: Holt, Rinehart & Winston, 1969), 32–59. Walls, D.S. (1976). Models of Poverty and Planned Change: A Framework for Synthesis. Journal of Sociology and Social Welfare, 5(3), 316–325. [/tabnice] [/tabsnice]

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About Danela Cosejo

She is currently working as a medical-surgical nurse at Ministry of Health, Sultanate of Oman. A writer, blogger, researcher, correspondent and publication consultant for nursing journal and health-related educational websites. Her field of specialization focused on Intensive Care and Emergency Management. She is now taking up MAN major in Adult Health Nursing at the University of the Philippines Open University. A nursing professor for 8 years in the Philippines and served as a staff nurse at UST hospital. A caring and devoted nurse who introduced a “Pinay Nightingale” in the land of the pharaohs. A nurse by profession, an educator by devotion and a writer / researcher by passion.