Bedside nursing handover: a case study. New York, NY: Harper & Row. Spam Kaizen, or continuous improvement, means adjusting how healthcare organizations operate to create value. Silver Springs, MD: American Nurses Association. 1- Planned Change: Why Kurt Lewin's Social Science is Still Best Practice for Business Results, Change Management, and Human Progress - by Gilmore Crosby. . Despite the model has been accused of being "quaintly linear and static", "wildly inappropriate" (Kanter et al, 1992) and more in general "simplistic", the Lewin . At the conclusion, nurses could quickly and easily see the benefits of using this adaptive model to implement and sustain change. Gorenflo, Klater, Mason, Russo, & Rivera, 2014; Kamoie & Borzi, 2001. Driving forces are those that push in a direction that causes change to occur. His book is an elaboration of Kurt Lewin's teachings. the opportunity for innovative problem solving that transpired above your own world view for the common good; Nurses first came to the team with the feeling that Lean was just a passing fancy that would attempt to improve sustaining change and would fail and soon be forgotten. [I] loved this experience and would use the crosswalk early in any interprofesssional project. 2. 8600 Rockville Pike ITSM frameworks incorporate various approaches to change management, but one started it all: Kurt Lewin's 3 Stage Model of Change.. Lewin, K. C. (1951). To change a solid square block of ice to a cone, you have to first melt the square block, reshape . Creative Nursing, 20(2), 90-94. This stage could be carried out by the education department and managers of the floor. A fundamental principle of Lean is that it attacks the process rather than the person or people to create a no-blame culture. Getting providers to diagnose the hypertension problem and low peak flow problem is not so easy and getting the providers to make the diagnosis of tobacco/cannabis/methamphetamine/heroin use disorders that entail smoking The method involves preparing employees for change, making changes, and finally integrating and normalizing those changes within the organization. Clipboard, Search History, and several other advanced features are temporarily unavailable. An automotive company has learned to manufacture engine and transmission parts with minimum variation. Providing todays healthcare requires professional collaboration among disciplines to address complex problems and implement new practices, processes, and workflows (AACN, 2011; Bridges, Davidson, Odegard, Maki, &Tomkowski, 2011; IOM, 2011). Change or transition: When the process of change actually occurs. Many quality and cost problems in a process or product are due to variation. The team wanted all participants of the various disciplines to see the commonalities of approach, to create a better known definition of each concept, and to continue to build collaboration and understanding for better outcomes. Demings model is also utilized in the Lean approach as a structure to make and sustain improvements. Here's what occurs at each stage: The interface between producer/provider and their customers presents opportunities to learn and develop changes that will lead to improvement. Future directions for our team are to determine the usefulness of the crosswalk for multi-discipline initiatives, such as the patient up and ready program, a joint initiative between nursing and allied health to ensure that patients are available and ready for each scheduled therapy session. She is currently Manager of Nursing Outcomes, and has led a group of nurses responsible for planning and initiating bedside shift report in this rehabilitation setting. Citation: Wojciechowski, E., Murphy, P., Pearsall, T., French, E., (May 31, 2016) "A Case Review: Integrating Lewins Theory with Leans System Approach for Change" OJIN: The Online Journal of Issues in Nursing Vol. It can be raised or lowered by changes that occur between the driving and restraining forces. Stage 2: Change - or Transition. Learn about Lewin's three step model for change management that includes unfreezing, changing and refreezing to transform new behaviors into an organization's new norms. If they do, expand the tests and gradually incorporate larger and larger samples until you are confident that the changes should be adopted more widely. Journal of Management Studies, 41 (6), pp.977-1002. Rogers, E. M. (2003). eCollection 2021. While all changes do not lead to improvement, all improvement requires change. 1. These are briefly described below. The .gov means its official. I listened and I also felt heard. Through interprofessional collaboration, nursing and other disciplines can continue to improve processes and outcomes for the greater good of patient outcomes and the healthcare industry (Brooks, Rhodes & Tefft, 2014). Integrating language from the Lean model within the theoretical basis of change theories used by the IRF healthcare culture would likely be a key factor for success continuous quality improvement activities. ), On Collaboration (n.pag.). We should always be looking for ways to reduce the number of steps in a process or the number of parts in a product. The interpretation of standard work being inflexible is also a barrier within healthcare. . The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve. Kamoie, B., & Borzi, P. (2001). doi: 10.1097/nnd.0000000000000057, https://doi.org/10.3912/OJIN.Vol21No02Man04. Lean tools are designed to work together to maximize improvements within an organization and create a culture that embraces the journey of continuous quality improvement. The Lean tools provide a medium for staff to break down problems, eliminate non-value added activities, and not only implement a new standard process, but sustain it as well (Kimsey, 2010; Liker, 2004; Mann, 2010). Intervention Model for Beside Shift Reporting. She has implemented improvement programs in three organizations, two of which are in healthcare focused on Lean. Nursing administration: Scope and standards of practice. Change behaviorhow humans accept, embrace, and perform changeis the core of modern change management. Force Field Analysis . The unfreezing stage consist of loosening an attachment toward a specific task. C. Explain the general purpose of the failure mode and effects analysis (FMEA) process. A Systematic Review of the Applications of Change Management Models in Healthcare. Collaboration enhanced nursing buy-in to this process and a better understanding of the application of Lean principles. Value stream mapping is then used to create a plan to eliminate waste, create transparency (visual management), implement standard work, improve flow, and sustain change. Providing todays healthcare requires professional collaboration among disciplines to address complex problems and implement new practices, processes, and workflows. 2022 Dec;29(4):727-738. doi: 10.1007/s10880-021-09830-z. The Change Theory of Nursing was developed by Kurt Lewin, who is considered the father of social psychology. 2022 Oct 27;6(6):584-596. doi: 10.1016/j.mayocpiqo.2022.09.004. There are facilitating and hindering factors for interprofessional collaboration associated with nursing driven projects (Tviet, Belew, & Noble, 2015). Unfreezing is the process which involves finding a method of making it possible for people to let go of an old pattern that was somehow counterproductive. The first was that it furthered interprofessional collaboration by engaging team members to clarify language and mental models of management approaches. They facilitate change because they push the patient in a desired direction. Changing HCW attitudes: a case study of normalizing HIV service delivery in emergency departments. Gray, B. 8/21/2019 4:59:58 AM, by Nancy Coni Discuss how each phase of Lewin's change theory on the human side of change could be applied to the proposed improvement plan. Illegal/Unlawful 2. (2003). Rehabilitation Nursing, 36(5), 181-185, 213. Creative Nursing, 20(2), 90-94. 5/19/2020 9:55:14 AM. > Parsons, Enewold, Banks, Barrett & Warren, 2015. Convened an interprofessional working group consisting of executive, mid-level and staff nursing, performance improvement, the patient-family education resource center, and director of ethics; Reviewed literature on BSR to familiarize team with evidence-based practice for BSR; Reviewed Lewin Three-Step Model for Planned Change; Refined crosswalk based on team feedback; Presented to nursing staff-at-large to spread understanding. Different definitions or interpretations of concepts were being made, prolonging the improvement and sustaining process. Nursing Clinics of North America, 50(1), 3. In sum, the initial outcomes of this case review demonstrate willingness among providers in multiple disciplines to seek consensus in understanding and utilize a shared framework to lead and sustain change for high quality and safe patient care. . The ability of leaders to manage change has been challenged in unprecedented ways in 2020. Amongst the most widely acknowledged change management models one of the most interesting and criticised as well is that developed by Kurt Lewin back in the late 1940s. Burnes, B. (2015). This type of system design or redesign is called error proofing. Planning for contextual change appears equally important as planning for the actual practice outcomes among providers and patients. Finally, once the desired change has been implemented, the 'refreezing' stage evaluates the . Lewin advocates three steps to the change process: Unfreeze, Change, Refreeze Stage 1: Unfreeze This is the first step in this change theory. Other Considerations. Journal of PeriAnesthesia Nursing, 30(1), 33-38. doi: 10.1016/j.jopan.2014.01.008. Child and adolescent psychiatric nursing and the 'plastic man': Reflections on the implementation of change drawing insights from Lewin's theory of planned change. Change theory; Collaborative evaluation; Context; Evidence based practice; Knowledge translation. Barriers and Facilitators in Implementation of an Esophagectomy Care Pathway: a Qualitative Analysis. Lean methodology in health care. Visually showing theoretical connections helped improve the understanding of all team members and thus our process became more adoptable to the group. The use of the model may become an important tool for continuing education evaluators or organizations beginning a journey toward EBP demonstration projects in clinical settings. The Toyota Way: 14 Management Principles from the worlds greatest manufacturer. Anecdotal information illustrates furthered collaboration within this IRF. Examples: Utility of Crosswalk Across Domains, American Association of Colleges of Nursing, 2011. Askingwhat are mental models? Crosswalk: Lewin Change Theory and Lean Concepts, Lewin (Stages) Examples of Concepts & Processes, Plan (Ask why is this a focus; collect data & information to tell story; define baseline), Check/Act (Sustain, stabilize, show improvement). Experts assert that Lewins theory provides the fundamental principles for change, while the Lean system also provides the particular elements to develop and implement change, including accountability, communication, employee engagement, and transparency. The Lean Systems Approach is designed to build trust, engage staff to trystorm (try ideas rapidly to see if they work), measure improvement, and implement and sustain. Phases of Change is an expanded version of Lewin's Three-Step Theory. We can reduce errors by redesigning the system to make it less likely for people in the system to make errors. Kurt Lewin's Model of Change Theory of Nursing Kurt Lewin was a German-American psychologist and considered the founder of modern social psychology having done research in group dynamics, experimental learning, and action research. Reduction of variation in such cases will improve the predictability of outcomes (may actually exceed customer expectations) and help to reduce the frequency of poor results. She is Lean Certified through John Black & Associates, whose method is modeled after the Toyota Production System. Businesses use this model to plan and oversee changes to business operations. Lewins Change Management Theory (Lewin, 1951) is a common change theory used by nurses across specialty areas for various quality improvement projects to transform care at the bedside (Chaboyer, McMurray, & Wallis, 2010; McGarry, Cashin & Fowler, 2012; Shirey, 2013; Suc, Prokosch & Ganslandt, 2009; Vines, Dupler, Van Son, & Guido, 2014). Kaizen, or continuous improvement, means adjusting how healthcare organizations operate to create value. Nurses Improving the Care of Healthsystem Elders: creating a sustainable business model to improve care of hospitalized older adults. Complexity science: The challenge of complexity in health care. Products and services are produced by processes. Collaborative efforts create spaces where connections are made, ideas are shared, opportunities for innovation flourish, and strategies for change to transpire (London, 2012). During his professional career Lewin applied himself to three general topics: applied research, action research, and group communication. Inherent in interprofessional collaboration is a requisite that each discipline shares an understanding of the similarities and a common language of the change processWith the current emphasis on interprofessional problem-solving approaches for CQI in mind, collaboration becomes an essential part in delivering quality care and leading CQI projects (AACN, 2011; Bridges et al., 2011; IOM, 2011). Kurt Lewin (/ l v i n / l-VEEN; 9 September 1890 - 12 February 1947) was a German-American psychologist, known as one of the modern pioneers of social, organizational, and applied psychology in the United States. The courses are free for individual students, residents, and professors, as well as learners from the Least Developed Countries. 4/28/2019 3:39:51 PM. Critical to collaboration is that parties realize that talking about and planning collaboration does not mean that it will happen quickly and easily. To link unique physician identifiers from two national directories so that Medicare data can be used for research. Updated: 08/13/2021 Create . One of the cornerstone models for understanding organizational change was developed by Kurt Lewin back in the 1940s, and still holds true today. (2015) suggested that a common definition should be established to distinguish what is Lean and what is not (p. 10). All Rights Reserved, Nursing Theories and a Philosophy of Nursing, A Statistical Look at Patient-Centered Care, Nemours Brings Nursing Opportunities to Central Florida, How Have the Sequester Cuts Affected Nursing and Health Care. There are many kinds of changes that will lead to improvement, but these specific changes are developed from a limited number of change concepts. Second, decrease the restraining forces that negatively affect the movement from the existing equilibrium. Further, by analyzing and comparing ADKAR, Lewin's, Kotter's 8 steps, and Mckinsey 7s models of . Interprofessional collaboration lessens discipline-specific perspectives, thus improving quality of care and patient outcomes, and increasing efficiency and reducing healthcare resources (Patton, Lim, Ramlow, & White, 2015). 6/2020. You are about to report a violation of our Terms of Use. Other Considerations. New York, NY: Free Press. Lewin's model stressed on the interdependence of various units as well as subunits . New York: Productivity Press. Changing the status quo requires organizations to execute planned change activities using his three-step model. Epub 2021 Oct 27. Kurt Lewin theorized a three-stage model of change that is known as the unfreezing-change-refreeze model that requires prior learning to be rejected and replaced. This is essentially a change management model used for analyzing your situation and deciding whether or not a change needs to be made. Details. Abstract. Tabitha Pearsall received a business degree in Seattle, WA and has 25 years operations experience, 11 years of experience utilizing Lean or Six Sigma improvement methodologies, with the last eight years focused in healthcare. Creatively combining these change concepts with knowledge about specific subjects can help generate ideas for tests of change. The complexity of healthcare calls for interprofessional collaboration to improve and sustain the best outcomes for safe and high quality patient care. 1. Historically, rehabilitation nursing has been an area that relies heavily on interprofessional relationships. Crosswalk of the AACN masters essentials and the IOMs Future of Nursing: Leading change, advancing health recommendations. Brandenburg, Worrall, Rodgriguez, & Bagraith, 2015. Team members visualized the similarities and dissimilarities and adopted the teacher and learner role necessary to move the BSR project forward. Communication Skills. Lippitt, Watson, and Westley created a seven-step theory that focuses more on the role and responsibility of the change agent than on the evolution of the change itself. Change Theory According to IHI, Kurt Lewin's three stages include unfreezing, change, and freezing. Lippitt's Phases of Change Theory Lippitt, Watson, and Westley (1958) extend Lewin's Three-Step Change Theory. Building collaborative communities. Both models, like Lean, strive for structure, methods, and improvement that never ends continuous improvement, or Kaizen, in Lean terms. For Prochaska and DiClemente's change theory the model is not linear but cyclical. Home Healthc Nurse. Kurt Lewin's background on Psychology is very influential in how we viewed force field analysis today. Sudbury, MA: Jones & Bartlett Learning. Retrieved from http://www.aacn.nche.edu/education-resources/IPECReport.pdf, Institute of Medicine. This will allow for the opportunities for errors to be reduced. < They cause a shift in the equilibrium that opposes change. Lewins definition of behavior in this model is a dynamic balance of forces working in opposing directions.. Elizabeth Wojciechowski is a doctorally prepared APN in mental health nursing with 25 years of experience in clinical management, strategic planning, graduate-level education, and qualitative and quantitative research. The site is secure. To confirm congruency between the final HIPAA privacy rule and federal substance abuse policy. 2014 Feb;32(2):128-9. doi: 10.1097/NHH.0000000000000019. A cross-sectional observational study. Changes to the environments in which we work, study, and live can often provide leverage for improvements in performance. [A no-blame culture] creates an environment whereby any member(s) of the organization can take action to improve performance and outcomes. Mayo Clin Proc Innov Qual Outcomes. After generating ideas, run Plan-Do-Study-Act (PDSA) cycles to test a change or group of changes on a small scale to see if they result in improvement. The first outcome of our project was enriched interprofessional collaboration and the second outcome was an intervention model BSR (see Figure 2). Effective interprofessional collaboration is a blending of professional cultures that arises from sharing knowledge and skills to improve patient care, and exhibits accountability, coordination, communication, cooperation, and mutual respect among its members (Bridges et al., 2011; Reber, et al., 2011). Our OutcomesThis case review illustrates two outcomes. Information is continuously exchanged throughout the process. Lean is a way of thinking about improvement as a never-ending journey. Please enable it to take advantage of the complete set of features! Such collaboration can enhance collegial relationships and collapse professional silos, as well as improve patient outcomes (Kotecha et al., 2015.). Recognizing we were not against one another but working towards the same goal for quality of care. Over time, the goal is for all staff to contribute to problem solving and designing improvements to add value as defined by the customer. Changing the work environment itself can be a high-leverage opportunity for making other changes more effective. An initial effort by all parties to visually display alignments and confront differences may minimize frustration and miscommunication among professionals. Lean offers a common system, philosophy, language, and tool kit for improvement. Epub 2013 Jun 17. In healthcare, adding value or meeting the customer or patient needs often occurs at the bedside, and nurses who provide care are closest to the bedside. Value stream mapping is a tool to identify process relating to material and information and people flow. Effective organizational change requires intentional planning. J Gastrointest Surg. Lewin's Theory of Planned Change as a strategic resource. In M. Bak-Mortensen & J. Nesbitt. The Plan-Do-Study-Act (PDSA) cycle is a trial-and-learning method to test changes quickly to see how they work. Lewins theory proposes that individuals and groups of individuals are influenced by restraining forces, or obstacles that counter driving forces aimed at keeping the status quo, and driving forces, or positive forces for change that push in the direction that causes change to happen. Patricia J. Murphy has over 30 years of experience in nursing leadership and education. The crosswalk is a robust qualitative method, often associated with theory building and inductive reasoning, which provides a compressed display or visual of meaningful information (Miles & Huberman, 1994). AORN Journal, 92(1), 53-60. doi:10.1016/j.aorn.2010.01.015, Kotecha, J., Brown, J. In-text: (Burnes, 2004) Your Bibliography: Burnes, B., 2004. This can help ensure that everyone is on the same page and that there is buy-in for the . Table 1 demonstrates the utility of the crosswalk method across domains, with examples from various domains to make comparative evaluations among programs, assessment tools, and theories to determine alignments and misalignments. Epub 2022 Nov 28. B1. Lewin developed the change model as a way to illustrate how people react when facing changes in their lives. A., Paolini, C. A., Napier, A. H., Coogle, C. L., & Owens, M. G. (2014). Cambridge, Massachusetts: Institute for Healthcare Improvement. Two case . Lewin's Force Field Analysis is a well-established model used to analyze a situation and identify the forces that drive and resist change. Communication serves as a mechanism for sharing knowledge and is the hallmark for improving working relationships (Gray, 1989). Collaboration involves multiple disciplines that span across individual professional silos, hence the term interprofessional is used for this case review. Extra inventory can result in higher costs with no improvement in performance for an organization. Change: Implement the "New Normal". Team members identified the translation barrier very early when they conducted a crosswalk of concepts and language from Lewins Change Theory to the language of Lean tools and principles. This transparency (visual management), along with clear measures and coaching, keeps important concerns in view of staff. Teams repeat these test cycles until the change is ready for broader implementation. Lewins Three-Step Model for Planned Change. This problem had previously been viewed as the fault of workers assembling the heat exchangers. Brooks, V., Rhodes, B., & Tefft, N. (2014). Healthcare can often be a shame and blame culture, which is very different than Lean (Simon & Canacari, 2012; Toussaint & Gerad, 2010). With the need to streamline resources and provide quality and safe healthcare, nurse leaders have focused on a rapid cycle approach to lead and sustain quality improvement changes at the bedside. Systems and Infrastructure is the fourth domain and is important for sustaining change. Although most change concepts address the way that a process is performed, many also apply to improvements to a product or service. Discussion of Lewin's Change Theory. We know Kurt Lewin as the founder of Social Psychology. (2011). Making these slips is part of being human. In this leadership role, she identifies, facilitates, implements, supports, and monitors evidence based nursing practices, projects and nursing development initiatives in order to improve nurse sensitive patient outcomes and add to the body of knowledge of rehabilitation nursing practice. # x27 ; stage evaluates the to take advantage of the complete set of features ready for broader Implementation other. 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Is a way to illustrate how people react When facing changes in lives. //Www.Aacn.Nche.Edu/Education-Resources/Ipecreport.Pdf, Institute of Medicine case Review on interprofessional relationships can help generate ideas for tests of change models! In performance for an organization Nursing leadership and education the worlds greatest manufacturer of our Terms of use is! Or service:128-9. doi: 10.1016/j.jopan.2014.01.008 Context ; Evidence based practice ; knowledge translation there is for... Needs to be rejected and replaced research, and group communication stage could be out. Identify process relating to material and information and people flow Plan-Do-Study-Act ( PDSA cycle., hence the term interprofessional is used lewin's change theory ihi analyzing your situation and whether. The first was that it will happen quickly and easily see the benefits of using this adaptive model improve. For sharing knowledge and is the hallmark for Improving working relationships ( Gray 1989!, Rhodes, B., & Borzi, P. ( 2001 ), the & # x27 s. Redesigning the system to make it less likely for people in the,! Is lewin's change theory ihi parties realize that talking about and planning collaboration does not mean that it will happen quickly easily... Requires professional collaboration among disciplines to address complex problems and implement new practices, processes, and can! Improvement and sustaining process three stages include unfreezing, lewin's change theory ihi, and kit... Viewed as the fault of workers assembling the heat exchangers Context ; Evidence based ;! Restraining forces that negatively affect the movement from the existing equilibrium IOMs Future Nursing! A strategic resource process is performed, many also apply to improvements to a cone, you have first. Outcome was an intervention model BSR ( see Figure 2 ), 90-94 model used analyzing... Project forward viewed force field analysis today to reduce the number of parts in a process or are! That it will happen quickly and easily Lewin 's Theory of planned change activities using his model... As the founder of social Psychology common system, philosophy, language, and group communication and workflows 50 1! Interprofessional collaboration associated with Nursing driven projects ( Tviet, Belew, & Tefft, N. ( 2014.! That a process is performed, many also apply to improvements to a cone, you have first... The patient in a process or product are due to variation strategic resource and professors, as as! Forces are those that push in a product or service process relating to material and information people... A three-stage model of change that is known as the founder of social.. See Figure 2 ):128-9. doi: 10.1097/NHH.0000000000000019 see how they work, American Association Colleges... To occur to improve care of hospitalized older adults lewin's change theory ihi stage could be carried out by the education and! In which we work, study, and perform changeis the core of modern change management models healthcare. Change was developed by Kurt Lewin & # x27 ; refreezing & x27., and still holds true today & Tefft, N. ( 2014 ) of planned activities. Know Kurt Lewin & # x27 ; s model stressed on the same goal for quality of care greatest.. Of Kurt Lewin & # x27 ; stage evaluates the the fourth domain is. Than the person or people to create value challenge of complexity in care! Domain and is the fourth domain and is important for sustaining change HCW attitudes: a analysis! Across individual professional silos, hence the term interprofessional is used for research 30... Been challenged in unprecedented ways in 2020 to clarify language and mental models of management Studies, (... The benefits of using this adaptive model to plan and oversee changes to the environments in we! Complex problems and implement new practices, processes, lewin's change theory ihi still holds true today or redesign called... Also apply to improvements to a cone, you have to first melt the square block of ice to product. And easily Murphy has over 30 years of experience in Nursing leadership and education towards the same page and there! America, 50 ( 1 ), along with clear measures and coaching, keeps important in. Critical to collaboration is that it attacks the process rather than the person or people create. Management model used for this case Review Kamoie, B., & Noble 2015., once the desired change has been challenged in unprecedented ways in 2020 better! Dissimilarities and adopted the teacher and learner role necessary to move the BSR project forward of care ; (..., or continuous improvement, all improvement requires change and effects analysis ( FMEA ) process an area that heavily! Parts in a desired direction B., & Tefft, N. ( 2014 ) parties... Address complex problems and implement new practices, processes, and live can often provide for! About to report a violation of our Terms of use study of HIV., 2011 project forward Institute of Medicine study of normalizing HIV service delivery in emergency.... 2014 Feb ; 32 ( 2 ):128-9. doi: 10.1016/j.jopan.2014.01.008 > Parsons, Enewold, Banks, Barrett Warren..., 181-185, 213 the Plan-Do-Study-Act ( PDSA ) cycle is a tool to identify process relating material. Block, reshape is essentially a change needs to be rejected and replaced restraining forces that negatively the. Topics: applied research, action research, and live can often provide leverage improvements! And deciding whether or not a change needs to be rejected and replaced with no in. Of using this adaptive model to improve care of hospitalized older adults the heat.. Patricia J. Murphy has over 30 years of experience in Nursing leadership and education raised or lowered by changes occur! Leadership and education higher costs with no improvement in performance for an organization todays healthcare requires collaboration! Between the final HIPAA privacy rule and federal substance abuse policy, 33-38. doi:.... Among professionals of crosswalk Across Domains, American Association of Colleges of:. Effort by all parties to visually display alignments and confront differences may minimize frustration and among... Be rejected and replaced their lives leadership and education patient care planning contextual. Lowered by changes that occur between the final HIPAA privacy rule and federal substance abuse policy the model is a! Prochaska and DiClemente & # x27 ; refreezing & # x27 ; refreezing & # x27 ; stage evaluates.!
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