Answer

Application of Middle Range Theory and Borrowed Theory to a Problem

Introduction

            The purpose of this paper is to discuss how Self-Efficacy Theory (middle-range theory) and Lewin Change Model (borrowed theory) can both be used to resolve the issue of missing details on laboratory samples or specimens. Missing dates, time, patient’s identification, and/or initials of the staff member who collected the samples/specimens may delay care and at times lead to discarding and collection of fresh samples. To resolve this there ought to be minimization or total prevention of laboratory labeling errors or omissions. In the previous paper, it was described that lab labeling could have been resolved using Bandura’s (1997) Self-Efficacy Theory in which staff collecting laboratory samples or specimens could have improved their self-efficacy in labeling through mastery of their experiences, building resilience, social persuasion, and states of physiology.  In this paper, a description of the basic concepts and origin of Lewin Change Model is provided together with a description of how the Model can be applied to resolve the issue. In addition, an evaluation of both Self-Efficacy Theory and Lewin Change Model is also the focus of this paper and how combined concepts can be applied in correcting laboratory labeling issues. Application of combined concepts drawn from two frameworks can have additive effect in improving efforts to minimize or prevent labeling errors.

Borrowed Theory: Lewin Change Model

            Lewin Change Model describes organizations are complex adaptive systems that need the change in order to survive and maintain equilibrium. Organizations such as the healthcare organization in this case, must respond to an everyday-changing environment, in which change is considered as a complex process with variable degree of complexity as well as agreement across various disciplines (Wojciechowski et al., 2016). Lewin Change Model is commonly used by nurses across different specialty areas for different quality improvement projects to transform healthcare delivery and outcomes (Wojciechowski et al., 2016).

            Lewin Change Model proposes that group of individuals and individuals are influenced by impediments that counter driving forces or restrictive forces that are designed to keep the status quo. On the other hand, there are driving forces, which push in the direction of change. The tension between restrictive and driving forces is necessary to maintain an equilibrium (Wojciechowski et al., 2016). For organizations to change the status-quo, there is need to implement planned change activities using Lewin Change Model. The model comprises of three steps including unfreezing, changing or moving, and refreezing (Wojciechowski et al., 2016).

            Unfreezing involves creation of problem awareness, influencing people to let go of their old patterns or ways, and undoing the current equilibrium. The second step, known as the changing or moving, involves identification of alternatives ways of doing things, demonstration of change benefits, and decreasing forces, which affect change in a negative manner. Refreezing step encompasses integration and stabilization of a new equilibrium into a given system to make it a habit as well as to resist supplementary change (Wojciechowski et al., 2016).

History of the Origin of Lewin Change Model

            Kurt Lewin’s (1947) Change Model was developed in 1947 as a model in social sciences. However, Cummings, Bridgman, and Brown (2018), argue that the Change Model was developed after the death of Kurt Lewin in 1947; thus, he is unlikely, the one who developed the model. The model took form after Lewin’s death (Cummings et al., 2018). Regardless, Kurt Lewin is widely considered as the founding father of change management. Lewin is considered as an experimentalist and the man of science (Cummings et al., 2018). 

Application of Lewin Change Model

            Lewin Change Model has been applied in development of the Lean Systems Approach, which is a people-based system with focus on improving processes as well as supporting people via standardization of the work to improve process workflow, create predictability, and ways of resolving inefficiencies and defects. Lean Systems Approach can also be applied healthcare industry to create value (Wojciechowski et al., 2016). In addition, the Model has been applied in improve people’s worth, competency, and coping abilities. Besides, it has used to improve employee engagement and involvement. It can be applied to motivate change, manage a transition, and develop political support (Hussain et al., 2018).

            Lewin Change Model can be applied to minimize or prevent cases of missing details on labeled laboratory samples or specimens. In the unfreezing step, the causes and factors that contribute to the issue need to be identified and described. Besides, the healthcare staff should be encouraged to let go of their old ways of doing things in favor of new protocols or procedures. Besides, healthcare staff should be educated on new protocols and procedures aimed at minimizing or reducing labeling errors. In addition, the status quo should be challenged in this step (Wojciechowski et al., 2016).

            Step two of the Lewin Change Model involves seeking of alternative ways to improve labeling practices. Besides, the benefits of proper and complete labeling of laboratory samples or specimens should be made known to the involved staff. Besides, issues that contribute to missing details in labeling need to be identified and addressed adequately. This can be done through brainstorming, role modeling new ways, training, and coaching (Wojciechowski et al., 2016).

            Refreezing involves integration and stabilization of the new equilibrium into the organization. New procedures, patterns, behaviors, and/or protocols should be adopted in this stage until it becomes a habit. The success of implementation of should be celebrated in this step. There may be need of retraining and key performance indicators need to be monitored (Wojciechowski et al., 2016).

Critique and Evaluation of the Self-Efficacy Theory and Lewin Change Model

            Both Self-Efficacy Theory and Lewin Change Model can be used to improve labeling practices. Self-Efficacy Theory is a middle rage theory that aims to improve self-efficacy of healthcare staff in labeling of samples without errors or omission of critical information (Bandura, 1997). On the other hand, Lewin Change Model is a borrowed theory that aims to solve the labeling problem characterized by missing details in specimen vials (Lewin, 1947). While Self-Efficacy Theory can improve efficacy of staff by paying attention to details and following new protocols and procedures; Lewin Change Theory focus on impacting change towards adoption of new practices and procedures. In essence both theories can support achievement of better outcomes (Bandura, 1997; Lewin, 1947). There are three steps (freezing, moving, and unfreezing) in Lewin Change Model to influence change while Self-Efficacy Theory involves utilization of four ways or approaches (mastery of experience, building resilience, social persuasion, and states of physiology) to improve efficacy of individual staff members to label laboratory vials correctly with complete details (Bandura, 1997; Lewin, 1947).

Application of both the Self-Efficacy Theory and Lewin Change Model

Concepts derived from Self-Efficacy Theory and Lewin Change Model can be applied to solve the identified practice problem. The first approach offered by self-efficacy is the need for the staff to master self-efficacy skills in labeling of vials and documentation. The second approach to build resilience in working in a stressful and demanding environment. In addition, the staff requires mentors or role models who will inspire them to label lab via correctly and completely. The social persuasion approach of achieving self-efficacy will involve convincing relevant staff that they possess necessary knowledge and skills to correct the observed practice problem. The last approach of achieving self-efficacy known as states of physiology will involve addressing emotions and psychological stress, which contributes to the observed issue (Bandura, 1997). On the other hand, Lewin change model will be useful in implementation of desired goals or objects. The three steps that will be used to influence change for the better include unfreezing of old ways, moving or influencing adoption of the planned changes (Lewin, 1947).

Conclusion

            Middle Range and Borrowed theories can both be applied in their own right to address an observed practice problem. The observed practice problem is that many laboratory vials have missing or unlabeled details such as patient’s name, date of collection, initials of staff member collecting the sample and date of collections. Missing details may lead to rejection of the vials containing patient’s same. The can result in medical errors or discarding of sample. Integration of Lewin Change Model and Self-Efficacy Theory can increase the likelihood of success in minimization or reduction of labeling errors.