DNP PROJECT HYPERTENSION - Week 4: Theoretical Framework & Change Model

Identifying Evidence-Based Advanced Practice Nursing Culturally Sensitive Interventions for Hypertension

Theoretical Framework

One of the harsh realities facing any nursing leader is the fact that despite its inevitability, change invariably involves resistance from stakeholders, even when it is in their best interests. In fact, the historical record, empirical observations and hard experiences confirm that some individuals will actively seek to derail changes since they involve extra effort and the unknown (Clark-Maxwell, 2022). Therefore, identifying efficacious nursing interventions that take this constraint into account represents the first step towards determining which theoretical framework is best suited for a given intervention (Pregmark, 2022). For this purpose, Lewins Change Model developed by Kurt Lewin, can be a valuable framework to guide the implementation of culturally sensitive interventions for hypertension management in minority populations, when properly implemented and administered (Dickey et al., 2022).

The theoretical framework developed by Lewin emphasizes the necessity of rejecting and replacing prior learning to facilitate meaningful change. In sum, Lewins model consists of three primary components: driving forces, restraining forces, and equilibrium. In this context, driving forces represent the factors that push individuals or organizations in a desired direction, catalyzing change by shifting the equilibrium towards a new state.

Conversely, restraining forces act as obstacles, resisting change by pushing in the opposite direction and maintaining the current equilibrium. Equilibrium refers to a state where the forces for change (driving forces) are balanced by the forces resisting change (restraining forces), resulting in a state of stability with no significant change. The equilibrium can be altered by adjustments in the balance between driving and restraining forces, ultimately influencing the likelihood and magnitude of change (Ernstmeyer & Christman, 2022). The model developed by Lewin and its three-step approach to effecting meaningful change is described further below.

Change Model

The change model developed by Lewin consists of three main stages, unfreezing, changing, and refreezing (Abd El-Shafy et al., 2019), which are operationalized for the purposes of the proposed study below.

Step 1: Unfreezing stage

It is useful for nursing leaders to conceptualize healthcare organizations...

Indeed, even beneficial changes may be met with strong resistance and even sabotage since it requires stakeholders to leave their comfort zones and learn something new. Therefore, unfreezing this situation represents the first step to effecting meaningful change. For instance, according to Ernstmeyer and Christman (2022), Unfreezing...…all of the previous efforts be lost to complacency. For instance, Ernstmeyer and Christman (2022) emphasize that, This step must take place after the change has been implemented for it to be sustained over time. If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium (para. 4.3).

Nursing leaders can work towards reinforcing the adoption and sustainability of the hypertension self-management education program through ongoing monitoring, evaluation, and continuous quality improvement efforts. This may involve incorporating the program into routine clinical practice, developing training and mentorship programs for healthcare providers, and fostering community ownership and engagement (Ernstmeyer & Christman, 2022).

Throughout this stage, nursing leaders can apply Lewins principles of driving and restraining forces, ensuring effective communication, involving key stakeholders, and providing support and resources to facilitate the successful implementation of the culturally sensitive intervention for hypertension management in minority populations. Following the introduction of the necessary changes, it is also important to integrate the new practices into the system, aiming for them to become the new standard and resist further change. This stage involves celebrating and communicating successes, providing additional training as required, and monitoring key performance indicators to ensure…