Week Ten 03/23/15-03/29/15: Change Theory

According to Dr. Carter, a psychologist (2012), change is often a long, difficult, and chaotic process with many barriers, challenges, lessons, relapses, regressions, and advancements. However each small win is an accomplishment and every mistake is a learning experience. Persistence, strategy, organization, and motivation increases the likelihood of achievement and success, and success can be defined in many different ways (Carter, 2012). Kotter describes 8 Steps in Change Management to facilitate changes in healthcare: developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short term wins, don’t let up, and making it stick (Cambell, 2008). Prochaska and DiClemente developed the Transtheoretical Model or the Five Stages of Change to describe individuals in each stage and discusses strategies to facilitate progression to the next stage and strategies to maintain successful behavior change (Carter, 2012).

The 8 Steps in Change Management Model would be an appropriate conceptual framework to create buy-in from nurse practitioners to assist the Arizona Medical Marijuana Program to screen and appropriately certify patients for medical marijuana. This is important, because even if nurse practitioners were granted certifying privileges to certify patients for medical marijuana in Arizona, health care facilities or individual nurse practitioners may make it a policy or choose not to utilize their scope of practice to the fullest extent. If many nurse practitioners do not adapt and change to be competent in their role to certify and manage patients who need medical marijuana, then a change in law may not make a difference in access to care or increased safety and regulation of patients with medical marijuana cards.

The Five Stages of Change would be an appropriate conceptual framework to help an individual addicted to marijuana to abstain from marijuana or other substance abuse. Substance abuse for tobacco, alcohol, and illicit drugs costs the U.S. more than $700 billion in health care related costs, economic costs, and crime-related expenses (National Institute on Drugs, n.d.). According to the National Institute on Drug Abuse (2014), 9% of people who use marijuana will become addicted and this increases to approximately 17% if people start using marijuana in adolescence. Marijuana addiction increases to 25-50% if used daily (National Institute on Drugs, 2014).

According to Carter (2012), individuals with addiction in the pre-contemplation stage do not see a need for change or don’t want to change. Strategies for change in the stage include increasing awareness of the problem and recognizing that a change is needed to achieve future goals or aspirations. Awareness may develop over time, through encouragement, media, education, or court-ordered interventions. Contemplation is when an individual sees that they should change and they want to change, but they have not decided to do anything to start changing. They are weighing in the pros and cons of change. A strategy for this stage would be to encourage individuals to make a pro and con list and then brainstorm ideas on how to overcome barriers. Preparation is when the individual is motivated to make a change, starts to do research on how they can change, and takes steps towards change, such as developing a plan, and avoiding triggers (i.e. avoid hanging out with friends that encourage and engage in substance abuse). Action is plan implementation and management of challenges using planned strategies to prevent relapse. The maintenance phase is usually 6 months post intervention where the individual enjoys the new behavior and prevents return of the old behavior (Carter, 2012).

References

Campbell, R.J. (2008). Change management in health care. The Health Care Manager, 27(1), 23-39.

Carter, S.B. (2012). Change is heard, here’s why you should keep trying: Understanding the 5 stages of change can help you make long-lasting changes. Retrieved from https://www.psychologytoday.com/blog/high-octane-women/201210/change-is-hard-heres-why-you-should-keep-trying

National Institute on Drug Abuse. (n.d.). Trends & Statistics. Retrieved from http://www.drugabuse.gov/related-topics/trends-statistics

National Institute on Drug Abuse. (2014). Marijuana: Is marijuana addictive? Retrieved from http://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive

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4 thoughts on “Week Ten 03/23/15-03/29/15: Change Theory

  1. I know that changes can be drawn out and difficult, but maybe the real issue in Arizona is that healthcare policy makers in the state currently themselves are in the pre-contemplation stage (Carter, 2012). They do not see an issue with nurse practitioners not prescribing medical marijuana so they do not at this point feel the need to change. I agree with you in the fact that if we were allowed to prescribe, not all would. It would be a personal choice and not something forced on all practicing individuals so I personally don’t see a problem. With more media and public attention the policy makers might see that there is need for changes and move into the contemplation stage.

    Carter, S.B. (2012). Change is heard, here’s why you should keep trying: Understanding the 5 stages of change can help you make long-lasting changes. Retrieved from https://www.psychologytoday.com/blog/high-octane-women/201210/change-is-hard-heres-why-you-should-keep-trying

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  2. Lynn,
    I agree that a change in law may not make a difference in access to care or increased safety and regulation of patients with medical marijuana cards. Despite the autonomy granted to NPs in Arizona, NPs are not allowed to discharge a patient at my place of work. So when the patient is ready to be discharged a doctor will see the patient just to say goodbye and will write the order for discharge which, I thought is absolutely ridiculous because NP is doing all the patient care coordination and management and would be a better judge o see the readiness for discharge.

    Same is the case with Medical medical marijuana prescription privileges. May be in future we will be able to decide and prescribe what is best suitable for our patient population.

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  3. Hi Lynn. As your topic is controversial, I appreciate your comments that even if nurse practitioners (NPs) are awarded certification authority for medical marijuana, some may choose not to do so. Interestingly, “change theory” applies to all parties involved in relation to your topic. NPs may or may not want to change, lawmakers may strongly support or vehemently oppose medical marijuana, and the general public is at odds with the topic as well. I like you idea to make a pro and con list, although even if one list is shorter, it may have points that carry much more weight in shaping one’s opinion than others. Overall, you have tackled a very very sensitive topic with both sides having valid and persuasive points. Even policymakers cannot come to a consensus on the issue. It will be very interesting to see how this topic evolves in the coming years.

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