Exam 2 - Chapter 18 Flashcards
When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management
team develop several acceptable goals/outcomes. This change in management approach is termed:
a. unfreezing.
b. nonlinear.
c. cybernetic.
d. linear.
ANS: B
While Lewin theory was designed to describe planned or first-order changes, many scholars think the theory is too simplistic to address how unplanned or second-order change occurs. In complex situations with an uncertain change environment, a nonlinear approach that involves flexibility improves overall outcomes. Linear change is appropriate to stable, less complex, and more predictable situations.
The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses
and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as:
a. trusted, quiet.
b. flexible, informal.
c. credible, enthusiastic
d. communicative, personable.
ANS: C
To influence the decision, the expert must be seen as having knowledge of what matters to the people that they lead and of the change area itself. The expert also must be enthusiastic and communicative and have referent power.
The nurse manager frequently interacts with staff and other hospice facility employees. Communication is purposeful because the
manager assesses current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathers available staff members to address similar learning needs. Many times,
staff members are found coaching other staff about improving use of the new system. According to Senge (1990), the activities
demonstrated in this example are:
a. dialogue, team learning.
b. resilience, personal mastery.
c. shared vision, systems thinking.
d. mental models, teachable moments.
ANS: A
Building shared vision occurs when leaders involve all members in moving personal visions of the future into a consolidated vision
common to members and leaders.
The clinical coordinator expects the position description of the new wound care specialist to change nurses’ responsibilities in
caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for
clients, staff nurses, and the organization, is to:
a. select one of the change models.
b. use Lewin’s model and principles of change.
c. apply both planned and complexity theory approaches.
d. form a task force of nursing staff and wound care specialists.
ANS: C
In the second stage, the moving or changing stage of Lewin theory, planned interventions and strategies, such as education, vision
building, and incremental steps towards the change, are executed to support the implementation of the change. This situation potentially also involves complexity theories that recognize that change involves engagement of individuals and subsystems
throughout the unit and organization.
Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to:
a. consciously evaluate invisible mental models.
b. allow for individual outcomes.
c. encourage cooperative activities.
d. operate between order and disorder.
ANS: A
Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment.
To effectively achieve a change goal/outcome in a change situation, the wound care specialist will:
a. preserve the status quo.
b. diminish facilitators and reinforce barriers.
c. weigh the strength of forces.
d. strengthen facilitating forces.
ANS: D
For change to be effective, the facilitators must exceed the force of the barriers; thus, strengthening the facilitating forces would achieve this aim.
The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. coordination. b. resistance. c. anticipation. d. participation.
ANS: D
Successful change means persistence and advancement of the change, which requires the undivided focus of all team members. Early involvement and participation are critical to capturing the undivided focus of team members.
The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their
attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is:
a. developing awareness.
b. experiencing the change.
c. integrating the change.
d. perceiving awareness.
ANS: C
This particular initiative assesses the success with which the change has been integrated into everyday practice after it has been
experienced, or the degree to which staff members have accepted using the new infusion equipment.
An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards,
early majority, late majority, and rejecters is to:
a. encourage teamwork.
b. transfer to a different unit.
c. require attendance at staff meetings.
d. delegate the roles and tasks of change.
ANS: D
According to Rogers’s work, the individual’s decision-making actions pass through five sequential stages. The decision to not accept the new idea may occur at any stage. However, peer change agents and formal change managers can facilitate movement
through these stages by encouraging the use of the idea and providing information about its benefits and disadvantages.
An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of
innovators and early adopters is to:
a. repeat the benefits of the change.
b. share change experiences early in the process.
c. initiate frequent interactions among staff.
d. provide select information to the staff.
ANS: B
Connecting innovators and early adopters to new ideas and with new peers keeps them at the cutting edge.
As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related
to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin’s stages of
change?
a. Unfreezing
b. Experiencing the change
c. Moving
d. Refreezing
ANS: A
Although you may be at a higher level of change in relation to your individual practice and knowledge of the use of change, in this
situation, you are recognizing the need for change in relation to practice on the unit that you are managing. This phase is the initial phase in first-order change and will involve listening to staff to see if they perceive a similar problem.
To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of
learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the
goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach?
a. Linear
b. First-order
c. Facilitative
d. Integrative
ANS: A
In the second stage, the moving or changing stage of Lewin’s first-order, planned change process, planned interventions and strategies are executed to support the implementation of the change. One commonly used method is educating staff about the need for the change.
To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of
learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the
goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. Staff nurses who gain information on current IV therapy practices are engaging in which phase of
Rogers’ decision-making process?
a. Persuasion
b. Knowledge
c. Confirmation
d. Decision
ANS: B
Rogers’ innovation—decision-making process involves five stages for change in individuals, the first of which is knowledge.
Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because “the unit has been using heparin for
years and there has never been any adverse effects.” According to Havelock (1973), this comment may originate from failure in
which phase of the six phases of planned change?
a. Generating self-renewal
b. Choosing the solution
c. Diagnosing the problem
d. Building a relationship
ANS: D
The first phase of this model of planned change involves building a relationship as a basis for later phases, which include diagnosing the problem and choosing the solution. At this point, as a new manager, the relationship may not have yet developed
sufficiently with Elizabeth.
Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because “the unit has been using heparin for
years and there has never been any adverse effects.” You follow up with Elizabeth and discover that she is really quite angry about
the information sessions because she feels that you are implying that “what she has been doing all these years means that she is
incompetent and doesn’t care about her patients.” Your response to her indicates that:
a. Elizabeth will never adopt the change.
b. Elizabeth is insecure in her practice.
c. Elizabeth requires more information about the practice.
d. change involves emotions.
ANS: D
Change, whether proactively initiated at the point of change or imposed from external sources, affects people. Responses to all or part of the change process by individuals and groups may vary from full acceptance and willing participation to outright rejection or even rebellion. It is critical to be able to “read” people and to recognize that communication should involve people’s emotions and feelings.
