paradigm shift in nursing administration

PARADIGM SHIFT IN NURSING ADMINISTRATION

WHAT IS PARADIGM SHIFT?

Think of a PARADIGM SHIFT as a change from one way of thinking to another.

It's a revolution, a transformation, a sort of METAMORPHOSIS.

It just does not happen, but rather it is driven by agents of change.

WHAT IS PARADIGM SHIFT? Agents of change helped create a paradigm-shift:

Ptolemaic system (the earth at the center of the universe)

Copernican system (the sun at the center of the universe)

Newtonian Physics Relativity

Quantum Physics

Scientific Theory

These transformations were gradual as old beliefs were replaced by the new paradigms creating "a new gestalt."


Agents of change are driving a new paradigm shift today.

• The signs are all around us. • The introduction of the

personal computer and the internet have impacted both personal and business environments & is a catalyst for a Paradigm Shift.


• Newspaper publishing has been reshaped into Web sites, blogging and web feeds.

• The Internet has enabled or accelerated the creation of new forms of human interactions through instant messaging, Internet forums & social networking sites.

• We are shifting from a mechanistic, manufacturing, industrial society to an organic, service based, information centered society, and increases in technology will continue to impact globally.

• Change is inevitable. It's the only true constant.

Accdg. to TechEncyclopedia

DRAMATIC CHANGE IN METHODOLOGY OR PRACTICE

Major change in thinking & planning which ultimately changes the way projects are implemented.

Ex: Accessing applications & data from the Web instead of from local servers is a paradigm shift.

Accdg. to Barron's Business Dictionary

Change in a model or pattern that has been nearly universally acceptedEx.

Change in consumer buying habits from buying airline tickets through travel agents to buying them over the Internet would be a paradigm shift.

Accdg. to Investopedia Financial Dictionary

Major change in how some process is accomplished.

A paradigm shift can happen when new technology is introduced that radically alters the production process of a good.

EX. • Assembly line created a

substantial paradigm shift not only in the auto industry, but in all other areas of manufacturing as well.

Accdg. to Investopedia A paradigm shifts can require that

entire departments be eliminated or created in some cases and millions or even billions of dollars of new equipment purchased while the old equipment is sold or recycled.

Paradigm shifts have become much more frequent in the past hundred years, as the industrial revolution has transformed many social and industrial processes.

This process is likely to become even more commonplace in the future as our rate of technological advancement increases.

Accdg. to Thomas Kuhn

Fathered, defined and popularized the concept of "paradigm shift."

Scientific advancement is not evolutionary, but rather is a "series of peaceful interludes punctuated by intellectually violent revolutions," and in those revolutions "one conceptual world view is replaced by another."

Accdg. to Physicist Capra • Acknowledged the paradigm

shift in quantum physics as an integral part of a much larger cultural transformation

• Generalized Kuhn’s definition of a scientific paradigm to that of a social paradigm defined as “a constellation of concepts, values, perceptions, and practices shared by a community, which forms a particular vision of reality that is the basis of the way the community organizes itself.”

in Nursing

4 CONCEPTS OF THE NURSING PARADIGM

The nursing paradigm has developed over time from the practices & beliefs of professional practitioners to give structure to the body of knowledge that is necessary to successfully meet the goals of the profession.


The paradigm defines 4 basic concepts:

INDIVIDUAL - target of the careENVIRONMENT - external influences HEALTH - goal of the careNURSING - care itself


INDIVIDUAL

• Refer to a single person, a family, or any group of people who are in need of nursing care

• Individuals are in collaboration with the nurse & share the responsibility for their own health.

• individuals have a basic need for recognition and respect as well as a right to participate in decisions that affect their own wellness.


ENVIRONMENT

Where the individual exists is an important influence on his health and well-being

Includes the cultural, social, political, spiritual & economic influences on the individual

Nursing care includes monitoring & sometimes modifying the interactions of the individual with the environment.


HEALTH

• State of well-being • Harmonious connection of

the physical, psychological, social & spiritual parts of an individual within himself, w/ those around him & w/ his environment

• The health of the individual is the goal of nursing


NURSING

Nursing is not a set of specific tasks but includes:

Direct care giving Promoting health &

patients Leading, Managing, Teaching

Researching

Requires: Development of a concerned

relationship between the individual & the nurse

Use of state-of-the-art medical knowledge

Exercise of good judgment to promote good health & healing

PARADIGM SHIFT IN NURSING

ADMINISTRATION & CURRICULUM

PRE-WAR to 1945Concept of a

HospitalOrganizational

Structure & FacilityNursing Service Nursing Education

The Hospital has a morbid image to the people at this period. When someone is brought to the hospital, people feel the patient is dying.The hospital is for the sick and the dying

Highly centralizedAbsence of electronic devices

1)No participation in operational planning

2)No managerial knowledge, managerial practice was gained by experience

3)Task-oriented but ensures high quality & excellent bedside care

4)Multi-dimensional scope of responsibilities

e.g. In-charge of linen, housekeeping & dietary at times

5)Nurses were highly disciplined but very few takes up Nursing

6)Nurses lack theoretical knowledge to back-up their skills

7)Nursing administrator holds a very demanding job; she must be strong & clever.

A 3-year Graduate Nursing program solely existed.Conceptualization of BSN program & implementation in 1947 with the first graduate from UP College of Nursing in 1952

Professionalization of Nursing (1946-70s)

HOSPITAL NURSING SERVICE NURSING EDUCATION

HEALTH DELIVERY SYSTEM

TECHNOLOGY

Hospital image gradually changedIt maintained curative & rehabilitative functionthe preventive function was not emphasizedElectronic age started,

e.g. chemotherapy for TB & cancer, Radiation became availableHospital was still highly centralized in terms of control

1)Chief Nurses had no voice in Operation Planning; no emphasis on qualification, tenure was the basis of succession

2)Many registered nurses enrolled in supplemental programs

3)Maintained highly appreciated bed care

4)Exodus of nurses started in the 50s

5)In late 70s, Standards for Nursing Practice were formulated

Nursing began to be recognized as a profession due to birth of the BSN Program. However, 2 types of programs existed (GN and BSN) for some timeAbolition of GN Program came in the late 70s

Came in 3 Levels:PrimarySecondaryTertiaryThis concept is premised on self-sufficiency at the primary level with the development of Barangay Health Workers. It aimed to promote proper utilization of the secondary and tertiary facilities.

Computerization made some job easyElectronic gadgets at the bedside became a necessity e.g. cardiac

monitorsFaster communication system was a great support in the Health care institution

Era of Care Fragmentation (80s-90s)

• It is worthwhile to quote Dhorter Edwards:

"While medical knowledge has rapidly expanded in recent years, but medical & nursing care has in certain ways deteriorated."

• This is highly evident in the Philippine setting.


Hospital

For the sick & the well – many people come to the hospital for executive check-up. There is awareness of the public for heath maintenance & health promotion.

Emphasis on diagnostic programs Decentralization – departments were well-

organized & had autonomy in running their departments

Facilities are high tech. Hospitals competed in their facilities.

Highly specialized services came into reality (i.e. intensive care units)


NURSING SERVICE• Exodus increased as USA, Canada, Australia, Middle East are all open

Understaffing was felt & became a big headache for Nursing Administration Public demand for quality care both in government & private hospitals are echoed Nursing care activities delegated to non-nursing personnel due to understaffing –

thus, contributing to poor quality of care rendered Continuing education Units, a prerequisite to licensure, a requirement which had

never proven its worth Birth of "manager" title with unclear job description is a fashion. Almost all

hospitals changed the title of supervisor/head nurse to manager. Nevertheless, there was no corresponding change in the content of their job description.

Scarce local employment (in spite of the unemployment of nurses) Proliferation of health care workers/providers Specialization in nursing care with sophisticated equipment to support the nurses

in their skills. To quote, Simon and Schuster: "fancy devices, new fangled diagnostic procedures, esoteric jargon machinery, buzzers & beepers, play an important role in the medical & nursing practice. These technological tools, innovations & even miracles, while producing new hope for diagnosis & cure, tend to distance the caregiver from the patient."


At this point in time Nursing Service became complicated to manage & thus:1) Demand for better management of nursing service2) Change in role expectations heightened calling for:

Business managementClinically orientedLabor relation which demands for strong orientation to legal

aspects of Nursing AdministrationEducator of patients & staffNursing Management Systems that respects the major

administrative principles of Planning, Organizing, Directing & Controlling

Service coordinator with other departmentsOperational planning was felt needed by some nursing

administratorsBudgetary planning is a must but barely done due to

inadequacy in the technical know-how


ENVIRONMENTAL FACTORS AFFECTING PATIENT CARE & THE ROLE OF THE NURSING

ADMINISTRATORSSocio-economic condition – Poor health

condition in the midst of rising health care costCorporatization of Health care by the year

2000 is shaping upSocial disintegration of the society where

Nursing Administration is not prepared to take care of the victims.

High tech; high cost of health facilitiesHome Care (USA) due to high cost of

hospitalization. Philippine setting – the hospital will remain as

the biggest employer of nurses.


TECHNOLOGY Work simplification, but weak clinical

practice because every data needed is available in the computer

Fast communication system, thus, easy access to developments in Nursing in other countries

Health – tremendous problems, communicable diseases & social disintegration are persistently rising.

These have great impact in planning for patients service both in hospitals & in the community.

21st Century Nurse Executive

10 Directions, the Millenial Mega trends: Gateways to the 21st Century:

The blooming Global Economy of the 1990A Renaissance in the ArtsThe Emergence of the Free Market SocialismGlobal lifestyles and cultural nationalismThe privatization of the welfare stateThe rise of the Pacific RimThe Decade of Women in Leadership (will nurses be on the lead?)The Age of BiologyThe Religious Revival of the MilleniumThe Triumph of the Individual


Increase Corporatization of Health Care

Nursing Administrators must have the following qualifications:

1) Grounded on 2 domains:• Nursing Science – Nursing as a science and an art must be rich in

scientific knowledge in order to render high quality of care.• Business – for better understanding of her fiscal responsibility.

2) Good clinical knowledge and business skills3) Describe positive balance sheet and positive patient outcome.4) Manage Nursing's contribution as a business unit that is to treat nursing

like any other profit-generating segment of the organization.

It is imperative to note that Clinical knowledge in peso tied to a patient outcome will be the key to the survival of Nursing as a profession.

The assessment of the 21st Century is the advanced clinical degree and the MBA degree.


Preparation of Patients in the Next Millennium

Vision to create the great need for the care coordination & continuity

Many opportunities to focus in practice, thus nursing will even be more rewarding

Increasing responsibilities for the clients, particularly those who are best prepared will have the most impact in nursing practice

Calls for professional competence & self-direction in: – Clinical procedures– Leadership– Critical thinking– Continuous program improvement


Preparation of Patients in the Next Millennium

New roles of Nursing Administrators:•Supporter•Reinforcer•Facilitator

Ethical Dilemmas of Nursing Administrative Practice:• Conflict between moral obligations of administrative

practice & moral obligations of professional nursing practice

• Situation: Shortage of staff – there are some items but the hospital administrators freeze hiring

Application of technology in administrative & technical nursing practice. We would want nurses to be able to make comprehensive Nursing care documentation, not just a checklist.


Nursing Administration Perspective

COST & RESPONSIBILITIES:• Assessing and planning appropriately• Education and Training• Collaborating with the staff and other health discipline• Politically active in matter concerning violence in the

organization for reforms DECISION SUPPORTS DATABASE:• Determine nursing management decision support system, one that is:

User friendlyFlexibleAccessible and integrated with

other institutional databases• Note that available database will enhance ability to evaluate

changes in programs, personnel, policies, staffing, organizational and nursing culture



PREPARE TO LEAD IN MANY AREAS SUCH AS: Adopt technology-based conditioned data sets of nursing

practiceArticulate outcomes and accelerate pace of information flowReengineer basic model of nursing practice

LEADERSHIP ATTRIBUTES IN A WORLD OF CHANGE:

Inspires and encourage rather than control and convinceUse imagination rather than control and convinceProvocative, intuitive and innovative rather than conformingTakes responsibility with pioneering spirit will arrive at new ways

of meeting organizational goals • Note: "Change is inevitable but choosing to grow is optional."

By Kwamoto, Kristi


Nursing Administration Perspective US Setting – Year 2000, migrants, women & minorities will

account to 85% of the net growth in Labor force with more than 25% comprising of people from the 3rd world countries, thus the need for Transcultural Nursing Administration in health care setting.

Transcultural Nursing Administration - process of assessing, planning & making decision and policies that will facilitate the provisions of educational and clinical services that take into account the cultural caring values, beliefs, symbols, references and life ways of people of diverse and similar cultures for beneficial or satisfying outcomes.



REAL CHALLENGES TO NURSING IN THE NEW MILLENNIUM:

1) Setting Standard of Care (Service and Education)2) Ensure quality care by supporting research efforts to prove

Nursing's real worth, that is the value of Quality Nursing3) Develop awareness of Cost, Quality and Nursing4) Shift to health promotion approach - cost-effective &

consistent with Nursing values & concerns5) Involvement in policy development in health care delivery

system6) To re-energize to answer the call of challenges of

globalization7) Learning Nursing thru the internet



Turn-over & intermobility, a major factor in today's Nursing Administration

This is inevitable and healthy, however, if it is too much, the results are:1. Reduced productivity2. Demoralized incumbent3. Expensive4. Quality Care suffers

If it is too little, the results are:1. Slows employees ambition2. Slow rate of separation of old hands3. Slow rate of new blood results to failing or dying organization

Transcultural perspective in Nursing Administration is essential for survival, growth, satisfaction and achievement of goals in the multicultural workplace.


Nursing Administration Educators

PROFOUND & STRUCTURAL – cultural changes require new knowledge & skills for nurses in administrative & leadership positions – thus, changes in Nursing Administration curricula

PROLIFERATION OF SOPHISTICATED INFORMATION TECHNOLOGY APPLICANTS where nurses are the integrators of patient information management techniques including internet utilization

FOCUS MUST BE IN DEVELOPING THE STUDENT'S ANALYTIC & DECISION-MAKING SKILLS and provide foundation in business skills,

e.g.•Cost benefit analysis•Negotiation

• People management skills with effective communication, management skills that increase productivity

21st Century Nurse Executive SELF-DEVELOPMENT; FLEXIBILITY & ADAPTABILITY – LEADERSHIP FOR THE FUTURE:

• Provide shared leadership• Has Decision-making autonomy • Creates the vision and mission of Nursing service • Can bring about the best in the subordinates• Charisma• Promote individual growth• Provides intellectual stimulation and do research• Can transform problems into opportunities and challenges• Has strong and visionary leadership who can elevate Nursing Management in the context of National Health System


THE CHANGING WORLD OF THE NURSE ON ADMINISTRATIVE PRACTICE BRINGS HOPES, DREAMS & OPPORTUNITIES IN THE NEW MILLENNIUM:

1) REFLECTION – looking at the map of Nursing Administration, there are more questions than answers because of the rapid rate of change.

2) THOUGHTFUL ACTION – how to achieve the purpose to fulfill the mission, purpose and vision of Health Care. Planning and implementing the mission must lead to quality Health Care

3) RECOGNITION OF OUR STRENGTH – People and Outcomes. Transitions from Nursing Services to Patient Services accountability builds collaborative relationships.


THE FUTURE OF THE NURSING DIRECTOR NEEDS TO BE MORE FOCUSED ON PATIENT-CENTERED CARE & STRATEGIC INNOVATIONS.

There is a fast-growing competition as many hospitals are coming up.

Globalization (as some of these hospitals) have foreign funding and foreign partners in Asia's challenge to rise to world-class standards of efficiency, productivity and quality.

The impact of globalization is not only on the management practice, but extends beyond to lifestyles and values of the people.

It should be realized then, that Nursing Services will be serving the most demanding group of health care consumers in the world.


PARADIGM SHIFT in Nursing

50'S 60'S TO 80'S

90'S 2000'S TO 21ST CENTURY TO THE

UNKNOWNPeriod of Ideology

“Humanistic Care”

“Professionalism” marked

decline in quality care

Age of Technolog

y "Mechanistic Caring"

1. Reengineering “Care" Processes 2. Realigning in

theInfrastructure tosupport changes


Lastly, Nursing Administrator needs to turn around & face the challenges of transformational nature relative to her role & expectations to be visionary:

One who can discover, redesign & redirect their services and training activities to achieve organizational effectiveness in the 3rd millennium.

Who is that Nurse? The characteristics that she should possess are the characteristics of a Future Leader. YOU

in Nursing Education:

A NEW MODEL

A PARADIGM SHIFT IN NURSING EDUCATION:

A NEW MODEL

Nurse educators are being inspired to rethink historically teacher-centered curriculum designs & to embrace new ideologies that have a stronger focus on student-centered learning.

The paradigm shift is reflected in the National League for Nursing's (NLN) call for nursing education to respond to the changing needs of our student population by providing an educational learning environment substantiated in evidence for both curriculum and pedagogical practice.

To meet these expectations, education should provide active learning that promotes critical thinking and analysis and problem-solving skills.

CHANGES IN HEALTH CARE DELIVERY

Information technology & demands for evidence-based practice have fueled the need to provide increased content in nursing programs.

A myriad of issues face nurse educators as we confront inclusion challenges in an already content-laden curriculum.

Current literature attests to nursing content saturation contributed by the following: Content repetition Teacher-centered education Academics-practice gap Changes in health care delivery

Information age

http://www.apple.com/iphone/business/profiles/doylestown/

CHANGES IN HEALTH CARE DELIVERY

Responding to these & other factors, educators who are teacher-centered curricular are embracing new ideologies that have a stronger focus on student-centered learning.

Nursing education model must demonstrate this paradigm shift in teaching via 3 key concepts: the learner the instructor outside learning modalities

REVISING THE TRADITIONAL CURRICULUM

Nursing curriculum has traditionally focused on behavioral outcomes, following the content-weighted Tyler model created in 1949.

In response to calls for health care reform in the 1990s, the curriculum:

Shifted to a community-based model increased course content.

Expanded to include health promotion & wellness across all settings.

Subjects related to genetics, bioterrorism, mass casualty response, cultural competency, health policy & leadership are incorporated to provide competencies viewed by educators as curriculum requirements.

Content must be critically evaluated, allowing inclusion of current competencies and mandates while promoting the sifting of unneeded material.

Must expand beyond linear thinking and include content that is adaptable to the changing health care environment.


Traditionally, a teacher-centered philosophy transference of knowledge has typically included:

• Memorization• Repetition• Recitation of information The NLN position statement in 2003 "Innovation in

Nursing Education: A Call to Reform“ calls for schools of nursing to "challenge their long-held traditions by designing evidence-based curricula that are flexible, responsive to students' needs, collaborative & integrate current technology."

A push for innovative pedagogy now floods the literature reflecting a shift away from the "Sage on the Stage" to "Guide on the Side" perspective.

The emergence of learning-centered & concept-based curricula encourages student-centered learning & the development of critical thinking skills.


As students become seekers of knowledge, the focus is no longer on content coverage.

Rather, teaching provides a plethora of knowledge to be perused & applied toward analytical thinking.

Ironside (2001) stated that "the use of alternative instruction begins by challenging the self-evident assumptions of conventional approaches to nursing education."

She noted that when the focus is on content, the dissemination of information is disregarded and student-centered learning, through pedagogical practice, is lost.

In contrast, a push for interpretative education through critical, feminist, postmodern and phenomenological practice allows the educator to shift from traditional teaching strategies and redirect the educational focus toward the learner and meaning of the content.

DISTANCE EDUCATION, EMERGING TECHNOLOGIES & NON-TRADITIONAL STUDENTS

As the nature of nursing education has changed, so has the construct of how we teach our students.

Web-based classrooms have opened the door for innovative instruction.

Commonly, the teacher assumes the role of facilitator as students engage in cooperative and cognitive learning through peer interaction via discussion boards.

Emerging technologies are the cornerstone of the current teaching paradigm shift.

Our consumer-driven, information-rich society has paved the way for distance learning, whereby students are able to be active learners in a classroom-free environment, thus, allowing for the accommodation of a variety of student learning styles.


Students and educators both benefit from distance learning as it provides: Self-pacing Higher order thinking skills Active involvement Increased learner attention Incorporates cooperative & collaborative

learning within the student's environment Learning becomes inclusive from the

student's perspective & integrates personal experiences

Instruction


Today's students are typically nontraditional. They come from diverse cultural backgrounds

and bring with them into the online environment a variety of rich & varied life experiences.

These students need a curriculum that supports their working lifestyle & that provides another venue for accessing higher learning education.

Learning must be directed toward a focus on skill attainment that reinforces critical thinking, problem solving, and the careful analysis of information.

Our technology age is ever changing; the skills necessary to navigate this dynamic flow of information must be fluid and versatile.

DEVELOPING A NEW NURSING EDUCATION MODEL

To bridge the chasm between academic preparation and nursing practice, nurse educators, as agents of change, must understand the changing health care environment and the needs of students.

Current technology and the ability to bring learning to the student offer a platform for providing alternative learning approaches to today's student population.


Content in schools of nursing must reflect the dynamic changes of today's health care system. It must be:

Current Relevant Based on evidence Examined critically With expectation that today's students will

be lifelong learners Incorporate a learner-centered curriculum

in both clinical & classroom environments Identifies key components students need

to know as they apply their knowledge to real-world scenario


Curricular content in nursing programs must:

Guide and reflect the school's educational framework

Transcend factors that influence teaching Provide a common thread in curriculum

development

Philosophy or way of life is influenced by social, political and community forces.

These influences play a role in instruction; education must be aware of the interaction these components have on the learner, instructor and influencing systems.


Green (2006) describes the relationship between the learner, educator and the system as a means of providing improved outcomes for nursing practice in the clinical setting.

Green's Synergy Model of Education places the student as the focal point of learning, using competencies of both the student and the educator to guide learning outcomes.

The nursing model introduced here reflects the needs of learners and supports educational outcomes that reflect the technological modalities used in instruction.

It looks at 3 key concepts: the learner, the instructor & the outside learning modalities.


Learners are not just students but represent consumers of education:

• They come to this process with real-world experiences & preexisting ideas that are the foundation for their learning in & outside the classroom.

• They also come to education with generational differences, both with peers & instructors.

• As consumers of knowledge, they can no longer devote their time solely to studying in an educational setting.

• Their working lifestyles predetermine their availability and direct their educational options.


The shift from content-laden curriculum to teaching key concepts allows:

Students to focus on need-to-know, or essential content that will be applicable to nursing once these students have graduated

Instructor's role to provide a curriculum that is dynamic, fluid and grounded in evidence-based practice, at both the level of clinical nursing practice and educational teaching

Students to become active learners in the educational setting

Both instructor & learner now share similar goals

Learner becomes a seeker of knowledge & a lifelong learner

Critical thinking analysis & problem solving become the shared focus of both learner & instructor outcomes.


Influencing systems reflect the varied technological modalities affecting the learner, instructor & educational environment, as well as community influences that shape educational outcomes.

These include:1) Internet access & online classrooms - bring

education to the distance learner2) High & low-fidelity simulation - adds realism

to nursing instruction as students work with mannequins that portray humanlike afflictions

3) Virtual interaction joins gaming with simulated scenarios - allow students to experience situations via computer programs

4) Community influences - promote multicultural & diversity awareness that can be explored through community partnerships and service-learning opportunities


Nurse educators can no longer teach the way they were taught: The student as consumer views education as a

commodity & a service that provide tools for future employment.

Students want to be taught key concepts and the theoretical and practice knowledge of their discipline that can be directly applied to practice.

With the understanding that nursing education must

provide active learning experiences that:Promote critical thinkingAnalysis Problem-solving skills

This model provides an alternative guide for higher education that takes into account : the learnerthe instructorthe systems that influence their relationships

To provide congruence for educational outcomes.

CONCLUSION

• For millions of years we have been evolving and will continue to do so.

• Change is difficult. Human Beings resist change; however, we are not restricted by this, for THE PROCESS TO CO-CREATE has been set in motion long ago so, we can change.

• Today, we are moving at an accelerated rate of speed and our state of consciousness is transforming and transcending. Many are awakening as our conscious awareness expands.

Royal College of Nursing General Secretary and nurses’ union leader, Dr. Peter Carter, said a “paradigm shift” is needed to improve failing hospitals. Dr Carter added: “People have tinkered around the edges and not made the paradigm shift that’s required.”

paradigm shift in nursing administration

Documents