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Professional Nursing Practice 6th Edition Blais Hayes Test Bank
ISBN-13: 978-0135080900
ISBN-10: 0135080908
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Chapter 14 Change Process
Learning Objective 14.1 Differentiate spontaneous, developmental, and planned change.
- Change can be described as which of the following?
- Positive or negative, planned or unplanned
- Prevented and managed
- Negative, doesn’t have to occur, easily managed
- Difficult and always negative
Answer: 1
Explanation: Change can be positive or negative, planned or unplanned. Change is a part of everyone’s life; it is the way in which people grow, develop, and adapt. Change is inevitable and can not be prevented. Change can be spontaneous or unplanned. Change can also be a planned event. Change can be seen as both positive and negative depending on the event that the change is related to. With careful planning, communication and ensuring employee confidence change can be managed.
Cognitive level: Comprehension
- The nursing unit on which Suzanne works has decided to purchase new IV equipment. Although Suzanne has been instructed on how to use the new equipment, she is still nervous about switching to the new machines. Which type of change is Suzanne being affected by?
- Planned change
- Spontaneous change
- Developmental change
- Pendulum change
Answer: 1
Explanation: Planned change is an intended, purposive attempt by an individual, group, organization, or larger social system to influence the status quo of itself, another organism, or a situation. Spontaneous change is not fully anticipated, it cannot be avoided, and there is little or no time to plan response strategies. Developmental change refers to physiopsychologic changes that occur during an individual’s life cycle or to the growth of an organization as it becomes more complex. Pendulum change refers to the ideal that, “I was wrong before, but now I’m right.”
Cognitive level: Application
Learning Objective 14.2 Explain the empirical-rational, normative-reeducative, and power-coercive approaches to change.
- The empirical-rational approach to planned change refers to which of the following?
- Using knowledge as the power ingredient and applying marketing strategies
- Using command and control
- Using sociocultural norms as the motivator
- Using personalized 1:1 education
Answer: 1
Explanation: The empirical-rational approach is based on two beliefs: that people are rational and that they will change if it is in their self-interest. Command and control are characteristics of the power-coercive approach to change. Using sociocultural norms as the motivator is the normative-reeducative approach to change. Using personalized 1:1 education is not a characteristic of the empirical-rational approach to change.
Cognitive level: Knowledge
- Which approach to change relies on interpersonal relationships as the power ingredient?
- Empirical-rational
- Technostructural
- Normative-reeducative
- Power-coercive
Answer: 3
Explanation: The normative-reeducative approach is based on the assumption that human motivation depends on the sociocultural norms and the individual’s commitment to these norms. The empirical-rational approach is based on two beliefs: that people are rational and that they will change if it is in their self-interest. The technostructural strategy alters the technology to access the social structure in groups or alters the social structure to get at technology. With the power-coercive approach, power lies with one or more persons of influence.
Cognitive level: Application
- Which is the change theory based on beliefs that people are rational and that they will change if it is in their self-interest?
- Power-coercive
- Persuasive
- Empirical-rational
- Facilitative
Answer: 3
Explanation: The empirical-rational approach is based on two beliefs: that people are rational and that they will change if it is in their self-interest. With the power-coercive approach, power lies with one or more persons of influence. With the persuasive strategy, the use of reasoning, arguing, and inducement are employed to bring about a change. The facilitative strategy provides resources critical to change. It assumes that people are willing to change but need the resources to bring it about.
Cognitive level: Comprehension
- Which is the most obtrusive approach to change?
- Empirical-rational
- Mandatory education
- Power-coercive
- Normative-reeducative
Answer: 3
Explanation: Power-coercive is based on the application of power from a legitimate source; there is minimal participation by target members, and resistance may occur and morale may decrease. With empirical-rational, influence moves from those with knowledge to those without; it is a noncoercive model. Mandatory education refers to the educational change strategies; this change strategy provides a relatively unbiased presentation of fact that is intended to serve as a rational justification for the planned action. Normative-reeducative recognizes that change must deal with feelings, values, and needs; this model is partially participative and democratic.
Cognitive level: Comprehension
- Which strategy to manage planned change is nonparticipative and undemocratic?
- Normative-reeducative
- Empirical-rational
- Power-coercive
- Legitimate power
Answer: 3
Explanation: The power-coercive approach is based on the application of power from a legitimate source and has minimal participation by target members. The normative-reeducative approach is based on the assumption that human motivation depends on the sociocultural norms and the individual’s commitment to these norms. The empirical-rational approach is based on two beliefs: that people are rational and that they will change if it is in their self-interest. Legitimate power is not a strategy to manage change. Legitimate power references the source of authority in a structured organization.
Cognitive level: Analysis
Learning Objective 14.3 Compare the change process models of Lewin, Lippitt, Havelock, and Rogers.
- Lewin’s change theory differs from Rogers’ theory by identifying which of the following as steps of change?
- Instruct, manage, and reward
- Chaos, change, and control
- Trust, autonomy, and initiative
- Unfreezing, moving, and refreezing
Answer: 4
Explanation: Lewin’s three basic steps or stages are unfreezing, moving, and refreezing. Lewin based his theory on the concept that within the physical sciences change is a result of forces within a field or environment (driving and restraining forces). It is the job of the change agent to reduce the restraining forces or increase the driving forces. Instruct, manage and reward are elements that a change agent may use to reach desired behaviors, these elements are not in Lewin’s theory of change. Chaos, change and control are not elements of Lewin’s theory. Trust, autonomy and initiative are skills needed by change agents but are not elements of Lewin’s theory.
Cognitive level: Analysis
- In Lewin’s Force Field Analysis Model, which two forces affect change?
- Power and coercion
- Driving forces and restraining forces
- Reward and punishment
- Discontentment and challenge
Answer: 2
Explanation: Lewin’s theory contained explanations from both psychology and the physical sciences. The Force Field Analysis Model examined two forces affecting the change process: driving forces that attempt to move action and static or restraining forces that attempt to maintain the status quo.Power and coercion is an approach to manage planned change. Rewards are elements that a change agent may use to reach desired behaviors, these elements are not in Lewin’s theory of change. People may challenge change or become discontented with having to make changes, a change agent needs the necessary skills to handle both behaviors, these behaviors are not forces as noted by Lewin’s Force Field Analysis Model.
Cognitive level: Knowledge
- In the diffusion-innovation theory, what does change come about through?
- Planned change by a change agent
- Driving forces
- Social change and spread of new ideas
- Restraining forces
Answer: 3
Explanation: Rogers defines diffusion as the process by which an innovation is communicated through certain channels over time among the members of a social system. There are three phases of the theory: invention (collecting of information), diffusion (communicating information to others), and consequences (adoption or rejection of the change). Lewin’s force field theory covered driving forces and restraining forces. Lippitt expanded Lewin’s theory and focused more on what the change agent must do rather than on the evolution of the change.
Cognitive level: Knowledge
- Managers who focus on their own objectives to complete a change process are utilizing whose change theory?
- Lewin
- Lippitt
- Havelock
- Rogers
Answer: 2
Explanation: Lewin focused on change theory based on a belief that change is a result of forces within a field or environment. Lipitt extended Lewin’s theory and focused more on what the change agent must do rather than the evolution of change. Havelock modified Lewin’s theory regarding planned change by emphasizing planning the change process, and Rogers developed a diffusion-innovation theory rather than a planned change theory.
Cognitive level: Application
Learning Objective 14.4 Discuss types and characteristics of change agents.
- Which is a key element for a change agent?
- Formal power
- Coercive power
- Trust
- Charisma
Answer: 3
Explanation: Change agents must be honest about goals and problems; they must demonstrate trustworthiness and have a track record of integrity and success with other changes. The change agent must trust the participating parties and the participants must trust the change agent. The change agent may be formally or informally designated. Coercive power is utilized in reacting to a planned change the model is nonparticipative and undemocratic a change agent following this model would not be successful in his endeavor. Change agents should display skills in human relations; well-developed interpersonal communication, group management, and problem- solving skills; charisma alone will not make the change agent effective.
Cognitive level: Knowledge
- A consultant hired to recommend organizational changes in a healthcare institution would be an example of which of the following?
- Leadership
- Legitimate authority
- Internal change agent
- External change agent
Answer: 4
Explanation: An external change agent is hired from outside the organization that is undergoing the change process. He or she is able to view the situations objectively and without biases. An internal change agent is a person who is part of the situation or system. Leadership would be the administrative organization of the healthcare institution. Legitimate authority references the source of authority and power in a structured organization.
Cognitive level: Application
- During a large merger of two community hospitals, the nurse-manager was challenged with merging the two very different medical-surgical units into one unit. During the process, she held staff meetings assuring the nurses that staffing would be held as a top priority, that time would be taken to educate all staff members of changes, and that she had faith in the nurses’ abilities to implement the change. This nurse-manager was utilizing what tactic to “unfreeze” the system?
- Producing discomfort
- Providing psychological safety
- Critical thinking
- Inducing guilt and anxiety
Answer: 2
Explanation: Providing psychological safety involves being able to build a relationship and develop trust with the people affected by the change; the people immediately affected by the change must be given attention and support.When unfreezing a target system the change agent may meet with small groups of nurses (target system) to discuss the inadequacies of the system of concern (e.g., staffing) this is known as producting discomfort. Inducing guilt and anxiety may also unfreeze a target system; the change agent would do this by demonstrating how the system is not meeting the clients’ needs for care and explaining that the administration wants the new system. Critical thinking may be used to determine which tactic to use to unfreeze the target system but is not an example of tactics used to unfreeze a target system.
Cognitive level: Analysis
Learning Objective 14.5 Identify ways to manage change by enhancing motivating forces and decreasing resistive forces.
- To implement a change in policy, many managers resort to utilization of force. What does
this demonstrate?
- Educational change strategy
- Coercive change strategy
- Data-based change strategy
- Facilitative change strategy
Answer: 2
Explanation: In the coercive strategy, there is an obligatory relationship between planners and adopters. Power is used to bring about change. Educational strategies provide presentations of fact intended to justify the need for change. Data-based strategies collect and use data to make social change. The facilitative strategy assumes that people are willing to change but need the resources to bring it about.
Cognitive level: Application
- When change results from cognitive dissonance, why does the change come about?
- The desire to regain feelings of consistency and balance
- Recognition by the organization
- Social diffusion of a new idea
- Monetary reward
Answer: 1
Explanation: Cognitive dissonance involves four concepts: (1) people like consistency, (2) dissonance is experienced as discomfort, (3) dissonance drives people to action, and (4) dissonance stimulates people to attain consistency and reduce inconsistency<P>Cognitive dissonance is believed to be a powerful motivator for change.</P></ITEM>
The degree of dissonance experienced is directly related to the importance of the issue. To reduce these feelings of imbalance, people often change attitudes or behavior to regain that feeling of consistency (Gruber, 2003). Recognition by the organization, social diffusion of a new idea
and monetary rewards are all motivating factors to move toward change as described by Lewin’s change theory.
Cognitive level: Application
- Over which of the following types of change does the change agent have the most
control?
- Spontaneous change
- Crisis
- Developmental change
- Planned change
Answer: 4
Explanation: According to Lippitt, planned change is intended and purposive; plans to accommodate the change can be made prior to the “change event” occurring. Other forms of change such as spontaneous and crisis occur as a result of an unexpected event; there is not time for planning of response strategies. Developmental change is not consciously planned; it just happens.
Cognitive level: Knowledge
- To manage resistance to change, the change agent may use which of the following strategies?
- Defend the status quo.
- Provide evidence to challenge the status quo.
- Reject opposition to the plan.
- Eliminate from the organization those who are opposed.
Answer: 2
Explanation: To unfreeze the system, and upset the balance of the restraining forces, the change agent may use any of these three tactics: (1) create discomfort, (2) induce guilt or anxiety, or (3) provide psychological safety. An example of creating discomfort is to confront the participants with evidence that challenges the status quo thought process. Reducing restraining forces usually is more effective than increasing the driving forces.The status quo is challenged during the unfreezing stage not defended. The change agent should communicate with those who oppose the change. The change agent should not reject opposition to the plan but, should focus on getting to the root of their reasons for opposition. The change agent should keep resisters involved in face-to-face contact with supporters. Encourage proponents to empathize with opponents, recognize valid objections, and relieve unnecessary fears to move people opposed to the change through the change process and active within the organization. </P></ITEM>
Cognitive level: Application
- Restraining forces for change could include which of the following?
- Fear of loss or threat to security
- Perception that change is challenging
- Potential for self-growth
- Economic gain
Answer: 1
Explanation: Fear of loss or threat to security is a restraining force for change; perception that change is challenging, potential for self-growth, and economic gain are all motivating forces for change.
Cognitive level: Comprehension
- According to Tomey (2009), how should an individual be supported as he or she is going through the change process?
- Recognition of his or her contributions to build self-confidence
- Given only a small amount of information concerning the change so as not to overwhelm
him or her
- Instruction on any new processes within 6 weeks of the change occurring
- Referral to the employee-assistance program
Answer: 1
Explanation: Change is most threatening in the presence of insecurity. Informing personnel of reasons for change can help reduce resistance. Helping them cope and recognizing their contribution also minimizes resistance to change. An individual facing chang needs information clarified and accurate and timely feedback should be given. Individuals should be kept up to date on the change process, being told 6 weeks after the change is implemented will increase insecure feeling of the individual. When managing change the employee assistance program is not an appropriate referral. The goal should be to maintain a climate of trust, support, and confidence. </P></ITEM>
Cognitive level: Application
Learning Objective 14.6 Identify steps in the change process.
- When major change is implemented in an organization, what is the first reaction likely
to be?
- Acceptance
- Losing focus, confusion, and disorientation
- Confidence and freedom
- Comfort with the change
Answer: 2
Explanation: The seven stages of change identified by Manion follow: stage 1: losing focus, stage 2: minimizing the impact, stage 3: the pit, stage 4: letting go of the past, stage 5: testing the limits, stage 6: search for meaning, and stage 7: integration. The first stage, losing focus, is usually short and initially presents with confusion and disorientation, making decisions during this stage difficult. Newly found confidence and freedom ocurr when the individual is able to look back and realize that the change was painful but can find meaning in the experience. Acceptance and comfort with the change ocurr in the final stage of change; integration.
Cognitive level: Comprehension
- According to Manion, employees who are able to focus on the future are in which stage of change?
- Minimizing the impact
- The pit
- Integration
- Testing the limits
Answer: 3
:
Explanation: The seven stages of change identified by Manion follow: stage 1: losing focus, stage 2: minimizing the impact, stage 3: the pit, stage 4: letting go of the past, stage 5: testing the limits, stage 6: search for meaning, and stage 7: integration. In the seventh stage, integration, people are oriented toward the future and have made the necessary transition to accommodate the change into everyday life or work situations. In the second stage, minimizing the impact, some denial is used to reduce the significance and portray the event as no big deal. The third stage, the pit, is the lowest point on the mood curve. In the fifth stage, testing the limits, people try new coping skills and deal with the situation in more creative ways.
Cognitive level: Application
- After receiving an in-service on wound care, the nurse was overheard stating, “I learned to massage injection sites with alcohol pads, but I never thought about the alcohol causing additional pain at the injection site. I’m glad the instructor told us about decreasing the painful experience for the patient by using only a sterile 2 × 2 pad to massage after giving an injection. These in-services are always helpful!” This is an example of what type of change process?
- Pendulum change
- Change by exception
- Incremental change
- Paradigm change
Answer: 4
Explanation: Paradigm change combines what is useful about old ways with what is useful about new ways and keeps us open to looking for even better ways. Change is viewed as no longer threatening. Pendulum change refers to the thoughts of, “ I was wrong before, but now I am right”. Change by exception demonstrates the belief that the person is right in all but one aspect of concern. Incremental change is demonstrated by the thought, “ I was almost right before, but now I’m right”.
Cognitive level: Analysis
- After going through a major hospital merger, a nurse manager joined a support group for nurse managers who had experienced significant changes in their work environment over the past year. This demonstrates a positive reaction to which stage of change as identified by Manion?
- Search for meaning
- The pit
- Integration
- Letting go of the past
Answer: 1
Explanation: The seven stages of change identified by Manion follow: stage 1: losing focus, stage 2: minimizing the impact, stage 3: the pit, stage 4: letting go of the past, stage 5: testing the limits, stage 6: search for meaning, and stage 7: integration. In stage 6, search for meaning, there is an ability to look back and realize that even though the change was painful, meaning can be seen in the experience; there is a newly found confidence and freedom and sometimes a desire to reach out to others who are still experiencing difficulty. The third stage, the pit, is the lowest point on the mood curve. By stage 7, integration, the transition is complete.and the change has been integrated into life, people are oriented toward the future. In the letting go phrase energy starts to return and people begin to see the end of the change process.
Cognitive level: Application
