Philosophy of Nursing Change

Just as change occurs in the natural order of life, so nursing changes. Not only does it modify itself, but will actively seek to undergo its own transformation. To understand the statement made by this author, one has to look back at the history of the profession.
Early nursing leaders such as Florence Nightingale (1830-1910) challenged the establishment to change the process of providing care to the sick. Even when women had few rights, she challenged the established military officers to change the way treatment was delivered to the injured. By using the rules of basic hygiene and nutrition, she proved that mortality could be decreased. Nightingale cared enough about the suffering of helpless people to follow her own personal ideology and changed the path of her life.
The assumption of caring was described by Jean Watson, a nursing theorist (Watson, 1999). She wrote of the intangibility of the concept of caring and stated that it is central to nursing. She as well as other nursing theorists has attempted to elevate the profession above the stage of simply performing tasks as handmaidens.
Historically, a physician directed the care of an individual using a paternalistic style to treat the sick and injured. Since nursing was largely a female profession, this approach coincided with the general powerlessness of that gender to make decisions about their clients. However, they continued to find improved methods to advance the outcomes of their clients. Nurses have always used a scientific approach in their practice. The intangibility of the concept of caring is joined with science to form the union of a person who views the whole client instead of just a disease or an illness. The difference between the past and the present is in the ability to present the information orderly and logically.
An ancient Greek philosopher, Heraclitus (Waterfield, 2000), approached change by noting that the underlying characteristic of nature was change or flux. He argued that nothing stays the same and that everything moves and changes. Parmenides (Waterfield, 2000), another philosopher, believed that nothing could change. Things or objects could not become anything other than what they were. Water was water and could not become anything else. He believed that natural change must be no more than a perceptual illusion. A third philosopher, Empedocles (Waterfield, 2000.), argued that the previous two were both right and wrong. He reasoned that the basic elements of earth, air, fire, and water do not change. It is the way these elements combine when something grows and separate when it dies proves that change does occur. By extending this parable to the nursing change process, the reader can see that Heraclitus represents not just the change agents in a health care system that want change, but those who argue that continuous change is a fact of life. Parmenides is the ultimate rational manager and only counts facts as being real. Lastly, Empedocles (Waterfield, 2000), the third philosopher, shows the way to combine opposing arguments into a workable solution.
A basis of this change philosophy of nursing is interpreted by this author’s proactive approach used these past thirty years. Personal assessments of a previously held belief system during the initial years of my professional life demonstrated the necessity to modify a mistaken attitude about change. Nurses as change agents must learn to take apart and reassemble an operation or system in a novel way, and then determine the effectiveness and ease of what they have altered. Conversely, they must be able to start with some need or goal, and make their way quickly to that system so that when it is reconfigured, the desired effect is reached. Those who master these two techniques have learned a trade that will be in demand for the near future. It is an explanation called Solution Engineering that is used in business and translates well to health care. As Fred Nickols, a business consultant, states, “a solution is a course of action that, once carried out, brings about some desired state of affairs” (Nickols, 2000, para. 6).
According to the Roy Adaptation Model developed more than 30 years ago by Sister Callista Roy, a nurse and sociologist, individuals adapt or change according to their own unique abilities to respond to specific stimuli (Senesac 2003). Life events that cause irreversible personal changes such as the birth of a child, a death or divorce force a shift from the status quo of everyday routines. Roy’s humanistic adaptation model shows that the nursing process involves an active search by the nurse to identify, interpret, and respond to the human coping processes (Hanna 2001). However, change may not only happen externally but can be a deliberate internal decision. An internal personal struggle will always be present, but the intellectual side of oneself will be aware of that resistance as long as one maintains a healthy attitude.
In the current health care environment, those who are unable or unwilling to change to meet its needs will have a profound negative impact on those around them. Progress will be impeded with their reminiscences of the past. Nurses, for the most part, dislike change just for the sake of change. There has to be a demonstrated rationale for them to welcome this adjustment. In a busy workday, nurses will use the familiar path to accomplish their goal unless they can be shown a better method and given specific rationale for the improvement. However, if one is not immediately apparent, resistance will follow. The manner and reason of presentation is helpful in soliciting their acceptance.
During the 1980’s, when the health care climate at my own hospital began to transform from a small center city facility to a regional trauma center, the focus of nurses also altered. This author observed the move from nurses providing daily personal care of their clients to delegating those tasks to unlicensed assistants. The expanded expectation was to include critical thinking on a higher level than ever before. This increased their accountability. Thus, a higher level of education became more important than in the past. Internally, this author was conflicted. The previous role as practiced provided a spiritual fulfillment at some level. For change to occur, the intellectual side was required to look within for answers.
In the author’s practice as a Licensed Practical Nurse, as long as very little or no change was required, none occurred. The safety of maintaining the status quo sustained this author’s personal life needs at that time. The result of stagnation, however, created an increasing frustration that led the author to continue her education. As knowledge increased, the concept of learning being a life-long process became evident.
Returning to another example from ancient Greek philosophy where Plato (Waterfield, 2000) describes the allegory of the cave, there was no turning back. Increased knowledge meant that this author was no longer satisfied with the status quo. After a period of grieving for simpler times, the future was clear. This author chose to be a part of the process that actively seeks to lead the way toward improved health care for all clients. Awareness of new information brought understanding of an increased responsibility to the profession. To remain in denial would mean not understanding the philosophy of change being the natural order of life.
The motivation of current applicants to nursing schools in recent years has changed its diversity. Women have increased choices of vocations. They are not trapped into nursing or teaching as had been the case historically. Young women of the current generation come to the profession with different expectations than their predecessors. The demands are greater. The profession of nursing will rise to meet the new challenges of the diverse applicants by looking forward. Kahlil Gibran, a poet, (1923), states, “For life goes not backward nor tarries with yesterday (p.17).”
The economics of the current society is another factor for the change. Layoffs and the decreased availability of higher paying jobs have brought more men into the field. In this author’s point of view, men prioritize work differently than women. While this author does not claim to understand a man’s motivation, her observations in the workplace are clear. They are not as detailed oriented as women but tend to be more flexible. However, this is not a denial of their contribution. Changes brought about by them have improved and enlightened society’s attitude about nursing’s value to humanity.
The present environment of health care will continue to transform as new and better technologies develop. By persevering in the tradition to embrace new information, outcomes for their clients will improve; and nursing will lead the way to make those changes.


References
Gibran, K., (1923). The Prophet. (p.17). New York: Knopf Publishing.
Hanna, D.R. & Roy, C., (2001, January). Roy Adaptation Model Perspectives on the Family. Nursing Science Quarterly vol. 14, iss. 1, pp. 59-67(9).
Nickols, F., (2000) Solution Engineering: Basic Terms, Key Concepts, and the Process [Electronic version]. Solution Engineering: Reengineering the Problem Solving Process. Performance Improvement Quarterly 1994, Volume 4.
Roy, C., (1976) Introduction to Nursing: An Adaptation Model. New Jersey: Prentice- Hall.
Senesac, P., (2003, Spring) Implementing the Roy Adaptation Model: From Theory to Practice. Roy Adaptation Association. Link: Roy Adaptation Model in Practice. Retrieved March 29, 2004, from http://www2.bc.edu/~royca/htm/
Waterfield, R., (2000). The First Philosophers: The Presocratics and Sophists. Oxford University Press. Oxford, U.K.
Watson, J., (1999) Nursing: Human Science and Human Care: A Theory of Nursing
Massachusetts: Jones & Bartlett Publishers.