thinking about change

Thinking about change1

Trevor Hussey MA (Oxon) DPhilPrincipal Lecturer in Philosophy, Buckinghamshire Chilterns University College, High Wycombe, Buckinghamshire, UK

Abstract Beginning by offering a conceptual analysis of change – a statement ofwhat change of any kind is – the paper sets out to examine possible waysof understanding a very common and important variety of change thatmay be called ‘evolutionary’. These changes include anything from theproduction of a clay pot on a potter’s wheel to the emergence of asystem of management, or from the effects of an analgesic drug to thedevelopment of a new programme of care. As few philosophers havediscussed such topics, theories are borrowed from the philosophy ofscience that attempt to explain the development and rationality ofscience. The ideas of Karl Popper and Thomas Kuhn are discussed andcriticized, before turning to evolutionary theories: Darwinian andLamarckian. The paper ends by offering a model that, it is hoped, mayhelp in thinking about a wide range of changes.

Keywords: change, theories of change, nursing, science, evolution.

Correspondence: Trevor Hussey, Buckinghamshire Chilterns

University College, Owen Harris Building, Queen Alexandra

Road, High Wycombe, Buckinghamshire HP11 2JZ, UK. E-mail:

[email protected] This is a modified version of a paper given at the Fifth

International Philosophy of Nursing Conference, Leeds,

18 September 2001.

Introduction

There can be no doubt about the importance ofchange: it is a ubiquitous feature of our world. Thevery possibility of change in our lives brings oppor-

tunity, anticipation and hope, or uncertainty, anxietyand even fear. Living through change can be anythingfrom exhilarating to deeply depressing. Change iswhat makes us know we are alive and conscious, andbelief that we can bring about change is central to ourunderstanding of ourselves as agents capable ofchoice.

Nursing could almost be defined as the activity ofbringing about change. The main point of caring forpeople is to guide and assist vital changes in theirlives: the movement towards health, or towards betterfunctioning, or towards a dignified death. Nurseswork amongst changes of all kinds and they have to manage, facilitate or resist them according to the

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circumstances. Hence the need for an understandingof change, for better ways of thinking about it.

The first philosophical question would appear to be‘What is change?’. As I have written about the con-ceptual analysis of change before (Hussey, 1994, 1998)I will not repeat myself here, but merely offer what Ibelieve is a feasible criterion without reciting myreasons.

The general criterion of change (GCC):

There is a change if and only if there is a subject S that

persists and retains its identity along a dimension from x1 to

x2, and there is a difference that is exhibited by a property,

state or part properly predicated of S, from x1 to x2.

Here the subject S is whatever can be said tochange, such as a pain, a managerial system, a theoryor a programme of care. Even a procedure such astaking blood pressure may be the subject of changeas different apparatus is introduced and skillsdevelop. x1 and x2 are distinct locations on a suitabledimension that, in the cases with which we are con-cerned, will be time.

Changes take many different forms: they may berevolutionary, repetitive, cyclical, chaotic or random.The kind of change most frequently met with couldbe called ‘evolutionary’. By this I do not mean merelybiological evolution; I mean any change that is fairlycontinuous, lacking the sudden fractures of revolu-tionary or chaotic change. Each ‘segment’ of an evo-lutionary change starts from where the previous oneended and novelty emerges in a fairly smooth way. Ahuge variety of changes are ‘evolutionary’ in thissense. Examples include such things as: a dance; thedevelopment of a series of (say) Jaguar sports cars;the evolution of a pot on a potter’s wheel; the devel-opment of science; the induction of a student nurse;the effects of an analgesic drug as pain subsides; theimprovement of a patient’s health; the developmentof nursing theories; and so on. Of course, biologicalevolution would also count as an example, as wouldsocial trends such as changes in fashions or govern-ment policies. Whether something is an example of an evolutionary change is a matter of judgement,but if it is identified as such, we can reasonably askthe nature of the process or mechanism that producedit.

As can be seen, evolutionary changes are such acommon and important phenomena that it will beuseful to have clear and accurate ways of thinkingabout them and the processes capable of bringingthem about. This will aid us in our desire to influenceor manage the change happening around us. In thispaper I shall discuss some of the philosophical ideasconcerning such changes and offer what I believe isthe most useful account. One set of explanations,the dialectical theories of Hegel and Marx, will not be considered as they would require a paper to themselves.

Some philosophical accounts ofchange

The general criterion of change given above suggeststhat if we consider any change we need to ask whatit is that is changing (the subject of the change) andwhat differences are involved in what properties,states or parts of the subject. In extended ‘evolution-ary’ changes we need to be able to explain the patternor path that the change takes: what sorts of differ-ences occurred, when and in what order. To do thiswe need to determine what process or mechanism isat work bringing about the change.

Unfortunately few philosophers have discussedthese issues. The topic closest to this that has beenwidely discussed is the development of science. Overthe last century there has been a vigorous debateamongst philosophers of science in an attempt to dis-cover the nature of scientific method; how sciencediffers from pseudo-science; whether we are justifiedin believing that science is an especially rational activ-ity and, most relevant here, what explains the devel-opment or (purported) progress of science. Several ofthe leading figures have suggested theories or modelsof the processes at work producing change in science,and I have chosen two of these to see if they can begeneralized to cover changes other than those inscience.

Karl Popper

Few thinkers have contributed as much to the phi-losophy of science as Karl Popper. At the centre of

106 Trevor Hussey


his work is the rejection of the inductivist account ofscientific method favoured by many of the positivists(Popper, 1959, 1972, 1979). In its place Popper arguedthat the correct method in science is to postulatehypotheses or ‘conjectures’ about how the world is;deduce from them predictions, and then set abouttrying to falsify these by criticism and, most im-portantly, by empirical tests. Indeed, he argued thatbeing open to the possibility of falsification is whatdistinguishes genuine science from pseudo-science(Popper, 1974).

Popper encapsulated his account of the method bywhich science proceeds in what he called a ‘tetradicschema’ (Popper, 1965, 1979):

P1 Æ TS1 Æ EE Æ P2

TS2

TS3

••

TSn

where P1 is a problem, TS1 to TSn are tentative solu-tions, hypotheses or conjectures, EE is error elimina-tion by showing the hypotheses to be false, and P2 isa new problem. Thus EE may eliminate all of thehypotheses or leave us with some that have not beenfalsified.We cannot claim that these are true, but theyallow us to use them as a basis for further study, andso on.

Popper intended this schema to depict the funda-mental evolutionary sequence that applied to biolog-ical evolution as well as the development of science(Popper, 1965, 1979), so it is not unreasonable toborrow it and describe any process of ‘evolutionary’change. For example, it might describe a piece ofnursing research, the introduction of a new comput-erized managerial tool for maximizing bed occu-pancy, the development of a nursing theory or eventhe process of resolving disputes about duty rosters.In each case we begin with a problem, propose solutions, eliminate those that don’t work and moveon to a new problem. It is simply a kind of trial anderror.

The many objections to Popper’s philosophy ofscience are well known so I will not discuss them here, but most philosophers no longer accept hisaccount (Kuhn, 1970; Feyerabend, 1975; O’Hear,1980; Newton-Smith, 1981; Chalmers, 1982; Gillies,1993). We are concerned here with his description ofthe process bringing about evolutionary change, andthis may have some virtues irrespective of much ofthe rest of Popper’s philosophy. However, I suggestthat it is not an entirely satisfactory way of envision-ing change for the following reasons.

First, it is not obvious that the schema can beapplied completely generally to all kinds of evolu-tionary change. Words such as ‘problem’ and ‘tenta-tive solution’ are most suited to change involvingpurposeful agents such as ourselves; they suggest pur-poses or goals that are being frustrated and so needcareful translation before they can be applied to any

process.Secondly, even when Popper’s schema is applied to

changes produced by human agents, at best it must beseen as a prescription about how people ought toproceed if they wish to act rationally, for it cannotclaim to describe how they actually do. Popper (1974)himself acknowledged this and admitted that evenscientists do not always behave rationally. Most of uswill have had experience of managers, colleagues – oreven ourselves – pushing ahead with a pet schemeand refusing to accept obvious objections, let alonesystematically striving to falsify the ideas involved.

Thirdly, even as a prescription the tetradic schemais questionable. Some of the objections to Popperhinge on the point that a systematic attempt to falsifya theory is not always a rational policy, even in science(Kuhn, 1970; Lakatos, 1970). It is often advisable toretain a theory even when there is some evidenceagainst it so long as it is generally useful, or if thereare no better alternatives. What is more, if experi-mental evidence appears to refute a theory it is oftenmore rational to make modifications to aspects of thetheory or to any auxiliary hypotheses involved, ratherthan reject the whole. Similar considerations wouldapply to nursing practices, procedures or manage-ment schemes.

Fourthly, as a prescription, the tetradic schemawould have to be supplemented by adding criteria of



rationality because, as it stands, rational behaviour is not guaranteed. For example, if a nurse had theproblem of staying awake while on night duty, andhypothesized that she could do so by sending herselfe-mails, eliminating all those with spelling errors, andif she arrived at a new problem situation – finding anew job – this would fit the pattern of the schema, butwould not count as rational behaviour.

Finally, Popper saw his schema as being a kind ofDarwinian process and he claimed that, by adopting it,human beings greatly improved their ability to survivein a hostile environment.We are able to put our theo-ries into linguistic form and test them by exposingthem to criticism.Unlike other animals we do not haveto act out our theories so, if they fail ‘. . . we can let ourtheories die in our stead’ (Popper, 1975, p. 87).This is anice idea and a perceptive point to make about theimportance of both language and the freedom to criticize. However, in activities such as nursing andmedicine, where we are often involved in applying

theoretical knowledge to the treatment of specificindividuals, it would be the patient who would die inour stead. In brief, there are serious difficulties intaking Popper’s tetradic schema as a model for changeeven in science, and certainly in nursing and medicine.

Thomas Kuhn

Kuhn was an historian of science as well as a philoso-pher and his objections to Popper’s “rationalist”account of scientific progress were primarily histori-cal (Kuhn, 1970, 1977). An examination of the historyof science shows that scientists have not pursued themethods prescribed by Popper, so either Popper’saccount is mistaken or science has been consistentlyunscientific! Unlike Popper’s tetradic schema, Kuhn’sdescription of the nature and development of sciencewas never intended to be extended to other kinds of change. However, his ideas, or at least the terms he introduced, have been borrowed by others andapplied with prodigality in other fields includingnursing, so it seems worthwhile to examine their use-fulness as an account of change outside their originalhome.

Very roughly, Kuhn (1970) argued that historicalevidence suggested that science is not a steady

progress towards the truth. Once a science emergesthere are typically two broad phases of activity.During what he called ‘normal science’, scientistswork within a ‘paradigm’: they apply their theories tovarious problems or puzzles, improve the accuracy oftheir measurements and extend their theories to theexamination of new phenomena. Within its ‘normal’phases science can be seen to make objective progressas more and more puzzles are solved and thoseinvolved can find agreement on what constitutes botha puzzle and a solution. If on occasions theoriescannot be reconciled with experimental findings or ifthey appear to make incorrect predictions, theseanomalies are ignored, set aside or explained away bymeans of ad hoc hypotheses: they are seen as failuresof the researchers rather than due to fundamentalinadequacies of the paradigm. There is certainly nosustained attempt to falsify theories in the wayPopper claimed. However, anomalies accumulate anddiscontent and dissatisfaction grow.

Eventually a new paradigm emerges and a periodof what Kuhn (1970) calls ‘revolutionary science’ensues. The new paradigm is radically different fromthe old; it is a new way of looking at the world witha new ontology, novel concepts or new meaningsgiven to old terms. During this revolutionary periodscientists begin to switch their allegiance from the oldto the new paradigm for a number of reasons. Someare attracted by a fresh approach to outstandingproblems, uncluttered by the accumulated anomaliesand the tangle of complications they had engendered;others see better career prospects in the exciting newapproach and so on. Kuhn did not believe that revo-lutions are driven by a choice between the rival paradigms based on a specifically scientific process ofrational decision making. There is not a Popperian‘crucial experiment’ that would falsify one and leavethe field clear for the other because, Kuhn claimed,paradigms are incommensurable. As they present dif-ferent ways of seeing the world and specify what is tobe a problem or a fact within their own ambit, theycannot be compared directly and there is no inde-pendent, neutral language in which to frame andsettle disputes. Consequently, the main processes thatbring about the switch of paradigms are psychologi-cal and sociological, rather than a rational scientific

108 Trevor Hussey


decision made in accordance with a methodologicalrule. It is this aspect of Kuhn’s ideas that has helpedto feed the growth of relativist philosophies thatportray science almost as a series of religions(Laudan, 1984; Sokal & Bricmont, 1998).

This brief account of Kuhn’s theses gives theimpression that he is engaged merely in describingthe historical patterns he had observed. If this wereso it would be of limited use as a more generalaccount of change. No doubt it is possible to pick outexamples of change that fit the picture but merely todescribe them would be of limited value. However,Kuhn also held that the different phases of scienceserve important functions. It is vital that there areperiods of normal science during which the prevail-ing paradigm is developed and applied with increas-ing sophistication and precision. The researchersinvolved are allowed to pursue this detailed workundistracted by broader debates about the truth oftheir paradigm. Indeed, Kuhn suggests that the devel-opment of a paradigm and a subsequent phase ofnormal science is the only obvious criterion of anactivity being a science (Kuhn, 1970). Equally, revo-lutionary science is important because it allows newworld-views to emerge. No single paradigm can givethe definitive account of how the world is and alleventually become exhausted. Scientific progress, forKuhn, is not the accumulation of timeless truths,but the movement to new paradigms by successiverevolutions.

Seen in this way it appears more reasonable toadopt Kuhn’s ideas and generalize them to apply to awide range of changes. For example, a nursing proce-dure is established that appears to work reasonablywell and it is elaborated and improved until itbecomes standard practice. However, problems andanomalies begin to show up. Those committed to itpersist and apply it with remarkable sophistication,but there are rumbles of discontent. Eventually a newprocedure appears and the young and the disgruntledswitch to that. In this way the best is got out of theold methods and eventually we progress to the new.Similar patterns might be discerned in a range ofactivities from nursing and medical techniques tomanagement regimes.

On closer examination Kuhn’s account becomes

less attractive when borrowed in this way. Kuhn’stheses have been subjected to strong criticisms (forexample Lakatos, 1970; Newton-Smith, 1981; Laudan,1984; McMullin, 1993). One important criticism is thatthe history of science does not support the view thatthere are two sharply distinguished phases of science,‘normal’ and ‘revolutionary’ (McMullin, 1993). Thereare very few examples of revolutions in the strongsense originally described by Kuhn, in which it wasimpossible to make a rational choice between twoincommensurable paradigms. Instead, history givesexamples of a whole range of innovations and dis-coveries, which brought about changes in the sciencesconcerned, of a virtually continuous range of magni-tude and significance. Much the same can be saidabout changes in general.

We might argue that the shift from one nursing ormedical procedure to another is, or ought to be, arational process of replacing the less effective withthe more effective. Evidence-based practice is the sys-tematic application of this rule. Of course, in realitythis is not what always happens but we can reason-ably hope to ensure that it does. However, this showsthat such changes are clearly not equivalent to theparadigm shifts in revolutionary phases of science.They are merely improvements of techniques withina given area of practice. The two procedures are notincommensurable; they can be compared becausethey share the same basic world view and can beapplied in similar situations. Something closer toKuhn’s account of normal science applies throughoutbut it tells us little about what is producing thechanges.

What kind of change in nursing would be equiva-lent to a revolution? Here we meet another of themajor objections to Kuhn’s theses. Kuhn was ratherimprecise in his definitions of some of his key terms, especially ‘paradigm’ and ‘incommensurability’(Shapere, 1964; Lakatos, 1970; Masterman, 1970;Newton-Smith, 1981). If ‘paradigm’ is defined asincluding a set of laws, heuristic models, metaphysicalcommitments, values and methodological prescrip-tions, an established use of certain instruments and a repertoire of exemplars for use in initiating new-comers, and if it has to be accepted or rejected as acohesive whole, then there are very few examples of



paradigms even in science. To use ‘paradigm’ outsidethe sciences, for example to describe the differentbroad views within nursing, would be very question-able. It is possible only if it is used with sufficientvagueness (Hussey, 2001).

Similarly, if ‘incommensurable’ is used in a strongsense to mean a situation in which those workingwithin different theories cannot understand or trans-late each other’s language or frame an agreed test to decide between their respective paradigms, thenthere have been few, if any, such occasions in thehistory of science. To suggest that such incommensu-rability can be found within nursing is unconvincing.There may be groups that will not talk to each otherbut not that cannot.

In summary, attempts to generalize accounts of sci-entific development and apply them to all examplesof evolutionary change have proved unconvincing.2

Popper’s tetradic schema does not serve as a generalaccount of change. It is best suited to a model ofchange brought about by rational agents but, evenhere, it would have to be supplemented by criteria of rationality before being useful. Kuhn’s theses concerning the development of science were neverintended as a general account of change but they areoften bandied about as if they are. However, the greatvariety of changes, from the profound to the trivial,make his ideas of little practical utility in under-standing the phenomena. We need to look elsewherefor a useful model.

Evolutionary theories

It seems obvious that theories of evolution are themost likely candidates as theories of evolutionarychange, but the principal candidates, those of Darwinand Lamarck, were both intended for the specificpurpose of explaining biological evolution, not evo-

lutionary change in general (Darwin, 1859; Lamarck,1809). Nonetheless, several philosophers of sciencehave turned to evolutionary theory in attempts toexplain and justify their belief in the progress andrationality of science. It is well worth considering ifthey can be further generalized to throw light on thegeneration of other kinds of evolutionary change.

Darwinian evolution

Darwinian theory is very attractive. Not only is itextremely elegant and powerful, it has the kudos ofbeing ‘scientifically respectable’, as it almost certainlydescribes the principal process at work in the organicworld, bringing about both wonderful adaptationsand new species. One of the remarkable features ofthe Darwinian process is that it can explain the emer-gence of intricate complexity without having toinvoke a designer. So, for many philosophers it hasbeen the natural choice as a description and expla-nation for not just the development of science but awide range of social change.

Philosophers such as Popper (1961, 1965, 1967,1975, 1984), Campbell (1960, 1974, 1977) and Toulmin(1972) all invoked a Darwinian model in which sci-entific theories and concepts are seen as analogous tospecies competing in a hostile environment of criti-cism and experimental tests. After the early 1960s,when Kuhn’s critique of the various attempts to givea rational account of scientific method and the growthof science first appeared, this evolutionary accountseemed even more attractive. Now the rationality ofscience could be located in the process generating sci-entific change, rather than in the behaviour of indi-vidual scientists. No matter how irrational or biasedthe scientists were and whatever ideas they had aboutscientific method, so long as their theories were sub-jected to severe selective pressure from empiricaltesting and the criticism of other scientists, progresswas assured.

Although I fully acknowledge that biological evo-lution is an essentially Darwinian process and thatthere are other changes that are brought about in thisway, I do not accept that it is the best choice of theoryfor understanding change in science or in many othercases, especially in human activities such as nursing.

2 There are, of course, other accounts that might be tried. One of

the most convincing attempts to understand the growth of

science is the ‘methodology of scientific research programmes’

due to Imre Lakatos (1970) but this is very specifically confined

to science and, unlike Kuhn’s work, it has not been widely plun-

dered for use elsewhere.

110 Trevor Hussey


As I have argued the case extensively elsewhere(Hussey, 1994, 1998, 1999) I will just pick out some ofthe main reasons here.

First, in Darwinian theory, evolutionary change ismade possible by the fact that organisms vary, evenwithin the same species, and that many of these vari-ations are heritable. The sources of these variationsare gene mutations and recombinations. It is an essen-

tial feature of the theory that these innovations are‘blind’ and virtually random. They do not anticipatethe needs of the organisms or guide them towards an evolutionary goal. If this were not so we wouldrequire another theory to explain how just the rightvariations were introduced at just the right time.However, in human activities such as science andnursing, we deliberately introduce innovations so asto overcome difficulties, in anticipation of problemsand to achieve our goals. Scientists modify their theories and experimental techniques according totheir understanding of scientific method and of thenature of the problems involved. Thankfully (I speakas a potential patient) few nurses make randomchanges in a procedure, in the hope that it will beimproved thereby.

Secondly, in Darwinian theory, natural selection isequally blind. In the hostile and competitive environ-ment, those organisms with some variations have agreater chance of surviving to reproduce than otherslacking them, so their variations will appear in ahigher proportion in the next generation. However,the selective process has no direction or purpose: itdoes not deliberately select organisms that are an‘improvement’ on what has gone before. However, inscience, while the most important factor in the selec-tive mechanism is the obdurate nature of reality – asmet with in empirical tests and measurements – part

of the hostile environment consists of critical scien-tists. They evaluate their colleagues’ work accordingto their theories and their view of scientific methodand, in so doing, may encourage innovations of themost suitable kinds. Similarly in nursing, changes areguided, for better or worse, by senior staff, managers,various other ‘experts’, including outside consultants,and even politicians.

Thirdly, in Darwinian evolution, the new variationsspread through the population by means of repro-

duction: new individuals are produced with the newattributes. In science and other human social activ-ities such as nursing, propagation is possible by inter-action between existing individuals: by teaching,copying, publishing accounts and so on.

Finally, Darwinian theory is a theory of change notprogress. It describes a non-rational, process and so itis not a good model for the rationality of science orany other intentional human activity. It may explainhow we evolved our capacity for rational thought butit does not offer us a model of how we use it.

For reasons such as these I suggest that a general-ized Darwinian model is not the best choice forexplaining most of the evolutionary changes we areinterested in, outside that of organic evolution. If weare concerned with human activities such as science,business, medicine and nursing, the ideas of Lamarckare more plausible candidates for adaptation.

Lamarckian evolution

Lamarck has always been seen as ‘the man who gotit wrong’ and, as far as biological evolution is con-cerned he certainly did: his theory has quite rightlybeen ousted by that of Darwin. However, when weturn our attention elsewhere, especially to purposefulhuman activities such as science and nursing, some ofhis ideas are worth serious consideration.

I say ‘some of his ideas’ because Lamarck’s theo-ries are quite complicated and various (Lamarck,1809, 1815–1822; Jordanova, 1984). Some, even thosehe most favoured, are of little value. For example, heproposed that the chief force driving biological evo-lution was the ‘power of life’, which made living thingsprogress along a continuous spectrum of formstowards perfection. This has no explanatory power: itsays merely that organisms evolve because they havethe power to do so. However, his ideas about howorganisms respond to the changing conditions of theirenvironment, while mistaken in that instance, arecapable of being generalized and applied more plau-sibly elsewhere.

According to Lamarck, when a change occurs inthe environment of an organism it impinges upon theorganism and induces in it a need to modify itself soas to cope with the new demand. In response the



organism will change its behaviour so as to satisfy the need. The new behaviour eventually becomeshabitual and the organs it involves will grow andstrengthen because of the increased use, while othersmay wither due to disuse. These newly acquiredattributes are then passed on to any offspring theorganism may have and thus evolutionary change willhave occurred. For example, suppose climate changecaused soils to be wetter and less friable. Moles wouldfind it more difficult to dig and tunnel so they wouldneed to modify their behaviour. If they responded byhabitually digging harder, this would exercise theirshoulder muscles, which would then enlarge.This newcharacteristic would then be passed on to the nextgeneration of moles and the species would havechanged.

The criticism most often made of this theoryfocuses on the impossibility of passing on attributesacquired during life. Only modifications to genes inthe reproductive cells can be inherited. Anotherpopular (but probably unjustified) objection is thatLamarck based evolutionary change on the desire oforganisms to change. The most damning observationis that the theory has no explanatory power. It claimsthat organisms will respond to environmentalchanges in certain ways but does not explain why. Forexample, why do muscles grow when exercized? Dar-winian theory can explain such phenomena – thoseorganisms that possessed a mutation that gavemuscles this capacity were more likely to survive than those that did not – but Lamarck’s theory issilent. Clearly Lamarck has not explained organicevolution.

However, if we take this much neglected theoryand generalize it for application to other kinds of evo-lutionary change it has considerable virtues. At itssimplest, Lamarck’s theory says merely that if thereis an input to a suitable causal system, then an outputwill result and hence change will occur. Of course thisdoes not explain where the ‘suitable causal system’came from, but that does not deny the fact that innu-merable such systems exist; many brought about byDarwinian evolution; many by human design. Forexample, sunlight impinging on a white skin provokesa mechanism to bring about a change in its colour,and turning an ignition key starts a car engine. Many

examples of what I defined as ‘evolutionary changes’are generated in this way: the clay on a potter’s wheelevolves into a bowl; the release of carbon dioxide produces an evolution in the world’s climate, and so on.

The Lamarckian model is particularly useful whenapplied to purposeful human activities such as scienceand nursing. Here the human agents concerned,together with the social institutions in which theywork, provide the mechanism by which change is produced in response to the demands of their ‘envi-ronment’. For example, in science the failure of anexperiment to give the expected result will induce aneed to respond in the scientific community involved.They will do so according to what they perceive theproblem to be and what they believe about their theories, apparatus, experimental method and so on.Their research programme will evolve as such prob-lems arise and criticisms are made.

The Lamarckian model is not a simple one but Isuggest that it does offer a realistic way of under-standing a huge range of changes with an evolution-ary form. Suppose we wish to understand and copewith change in, say, a nursing procedure such as assist-ing the recovery of stroke patients, or a change on amuch larger scale, such as the introduction of a newregulatory system for the nursing profession, then themodel indicates what elements we must consider.

First, the general criterion of change tells us toidentify the subject or subjects of the change: theprocesses, practices, institutions and so on, to whichthe change is happening and which preserve theiridentity through the change. Secondly, we must iden-tify what differences are occurring to these subjectsto constitute that change. These may be fairly simpletasks in the case of a nursing procedure: the subjectof the change may be the process of giving an intra-venous infusion of fluids and the difference may bethe introduction of a new type of pump. However, inthe case of change on a larger scale, the task of iden-tifying exactly what is changing and what differencesare involved may be very difficult. We are presentlywitnessing a major change in the regulation of thenursing profession in the UK: the United KingdomCentral Council for Nursing, Midwifery and HealthVisiting (UKCC) is being replaced by the Nursing

112 Trevor Hussey


and Midwifery Council (NMC).Thus, at one level, thesubject of the change is a system of regulation, whilethe difference is the replacement of one institution byanother, but we might also identify a change in thelevel of accountability to the public, with the main dif-ference being an increased public representation onthe council, or we might see the process as one of centralization, with the main differences being theelimination of national boards for England, Wales,Scotland and Northern Ireland. At lower levels thereare going to be many other changes, from personnelto disciplinary procedures (O’Dowd, 2002), but ineach case it should be possible to distinguish betweenthe subjects of the change and the differences theyexhibit.

The Lamarckian model then helps us to identifythe mechanism that generated the evolution. (i) Whatpressures induced the change? In the case of thereplacement of the UKCC with the NMC, what wasperceived to be wrong with the existing system? Didrank and file nurses argue for change, or was therepublic demand, or was the change sought by the gov-ernment, or some combination of these? (ii) Whatneeds were being generated by those pressures andto whom did they belong? For example, did thosewithin the UKCC recognize the need for change andwork towards it, or did it occur only to outside agen-cies? (iii) What decision procedure existed to bringabout responses to those needs and what bodies hadthe power to take and implement decisions? Forexample, what groups were consulted in the design ofthe NMC and by whom? (iv) What factors acted soas to influence the decision-making procedure? Herewe might identify: the aims, values and motivations ofthe parties involved; the beliefs, theories and knowl-edge that they employed; the resources, materials ortools that were available; and the constraints that hadto be faced, such as the prevailing institutional ethos,established practices, traditions, vested interests andso on.

Applied in this way the Lamarckian model turns itsvices into virtues. The criticism that it involves theinheritance of acquired characters looses its sting, asgood practice evolved in one place can be, indeedought to be, shared immediately with other interestedparties. This helps to explain the speed with which

humans change their social and cultural world in con-trast to the slowness of their biological evolution. Forexample, there is already talk of extending the scopeof the NMC to include healthcare assistants (Akid2002). The appeal to the desire (or reluctance) tochange which is wrongheaded when applied to evolv-ing organisms is very apt in the case of purposefulhuman activities. The lack of explanatory power con-cerning biological evolution no longer applies: ourability to form groups and engage in social activitiessuch as science and nursing, rationally or otherwise,may have arisen by Darwinian evolution, but theprocesses involved when such activities generatechange are essentially Lamarckian.

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