一位護理長正在推行一項針對「預防中心靜脈導管關聯血流感染 (CLABSI)」的全新實證醫學草案。幾位資深護理師積極抗拒這項改變,並表示:『我們一直都是用舊方法做的,而且我們的感染率明明很正常。』根據勒溫 (Lewin) 的變革理論,克服這種抗拒的最佳初始管理策略為何?
A nurse manager is implementing a new evidence-based protocol for central line-associated bloodstream infection (CLABSI) prevention. Several senior nurses are actively resisting the change, stating, 'We have always done it the old way and our infection rates are fine.' According to Lewin's Change Theory, what is the best initial management strategy to overcome this resistance?
- AImmediately physically replace all old medical supplies with the new kits to aggressively force the staff to change behaviors entirely overnight.立即以新式醫療用品實體替換所有舊有醫療用品,以強迫員工一夜之間完全改變行為。
- BCompletely abandon the new protocol implementation temporarily until every single senior staff member naturally decides to willingly consent.暫時完全放棄新協議的實施,直到每位資深員工自然決定自願同意為止。
- CMandate mandatory heavy disciplinary actions strictly for any staff member directly refusing to swiftly adopt the new protocol.嚴格規定對任何直接拒絕迅速採用新協議的員工實施強制性嚴厲紀律處分。
- DPresent compelling, concrete unit-specific data showing the actual rising hidden infection rates and demonstrating the urgent need for a better solution.✓ 正解呈現具說服力、具體且符合單位的數據,顯示實際上升的隱藏感染率,並證明尋求更佳解決方案的迫切性。
本題測驗護理行政管理:Lewin 的變革理論 (Lewin's Change Theory)。該理論將變革分為三個極為經典的階段:解凍 (Unfreezing)、移動/改變 (Moving/Changing)、以及再凍結 (Refreezing)。當員工抗拒改變並說「舊方法沒問題」時,團隊正處於起初的僵局。護理理長的第一步是啟動『解凍 (Unfreezing)』階段。此階段的核心目標是「讓員工意識到現狀是不完美的,且改變是急迫且必須的」。最科學且強大的管理手段就是:拿出冷冰冰的數據!當經理拿出單位內部實際隱藏的感染率數據,證明舊方法其實已經失效且危害病人安全時,這會瞬間打破員工的舊有認知盲點,產生要求進步的動力(選項 D 正確)。選項 C 的強制懲處不屬於變革理論,這會引發更深層的惡意反撲。選項 A 強行換掉物資是未經溝通的獨裁手段。選項 B 完全放棄則代表管理者的徹底失職與軟弱。
According to Lewin’s Change Theory, the 'unfreezing' stage is essential to overcome resistance by helping staff recognize that current practices are inadequate. Presenting specific, compelling data regarding hidden infection rates effectively challenges the belief that the old method is sufficient, thereby creating the necessary urgency for change.
「Lewin 的解凍/移動/再凍結理論」是台美護理行政學大四必修的統御理論。遇到抗拒,第一步永遠是溝通現狀的危機,拿 Data 出來壓人,這點全球護理長都懂。