Cultural Cliques in Nursing: A Lewin's Change Model Approach

Introduction: Evidence-Based Practice and the Problem of Cultural Cliques

Evidence-based practice holds great promise for the professional nurse in the clinical setting. Learning through continuing self-education and peer-group education from evidence-based studies enables the nurse to operate at optimal efficiency in their job functions. However, given the demands of the profession, it is not always easy to come together in a learning atmosphere (Krugman, 2009). The use of evidence-based practice can be both clinically important and professionally advantageous (Leasure, Stirlen, & Thompson, 2008).

The problem addressed in this paper is the clustering of cliques among nurses in the clinical setting based on their cultural background, thereby creating a potential for missed communication, lowered patient care, and interpersonal strife. The change application used to address this problem is based on Lewin's change model and applies transactional leadership to guide the necessary stages of change. The optimal outcome is increased cultural awareness and respect among nurses of different cultural backgrounds, as evidenced by a decrease in cultural cliques in the work environment.

Dellasega (2009) reports on the relational aggression that occurs in the nursing environment. These types of aggression occur when two or more nurses band together and engage in aggression against other nurses. The forms of aggression are not physical — they are relational. These forms include gossiping, ostracizing nurses, and deliberately withholding information (Dellasega, 2009).

While all forms of relational aggression are psychologically distressing and contribute to disunity among nurses in the workplace, the deliberate withholding of information has the potential to harm not only the nurse being targeted, but also that nurse's patients. This is an unacceptable situation, as lives hang in the balance. Addressing this problem through a structured change process is therefore both an ethical and a professional imperative.

Relational Aggression in the Nursing Environment

The first stage of Lewin's change model is the Unfreeze stage. In the context of this problem, this stage involves the clear identification of the issue: the formation of cultural cliques among nurses in the workplace. Recognizing and naming the problem is the essential starting point before any meaningful change can be implemented.

The second stage, Move/Action, encompasses the active interventions designed to address the identified problem. The following steps are proposed:

The third and final stage, Re-Freeze, involves consolidating the gains made during the action phase. This requires identifying those action steps that produced meaningful change and standardizing the practices that have an evolutionary and sustaining effect — specifically, cultural awareness training, anonymous staff surveys, and job performance evaluations tied to conduct standards.

Lewin's Change Model: Stage One — Unfreeze

Change in the workplace can be a painful process for those who are resistant to it. However, change is a necessary process, as social, spatial, and temporal characteristics are dynamic and subject to multiple forces at any given moment. When a problem is clearly identified as a disruptive element in a professional setting such as a nursing work environment, there are several change model options for moving from problem to solution.

Stage Two — Move/Action

In this case, Lewin's three-stage model, guided by transactional leadership principles, provides a clear and actionable framework. By unfreezing the current state, implementing targeted interventions, and refreezing around improved norms, nurse leaders can effectively address cultural cliques, reduce relational aggression, and ultimately improve both the nursing work environment and patient care outcomes.

Dellasega, C. (2009). Bullying among nurses. American Journal of Nursing, 52–58.

Kritsonis, A. (2005). Comparison of change theories. International Journal of Scholarly Academic Intellectual Diversity, 1–7.

Conclusion

Leasure, A., Stirlen, J., & Thompson, G. (2008). Barriers and facilitators to the use of evidence-based practice. Dimensions of Critical Care Nursing, 27(2), 74–84.