Appreciating the complexity and interrelationships of the people, social institutions, and organizations giving health care will enable you to understanded your role in giving health care. As a nurse, you will have a twofold purpose: to adjust at times to the system as it exists, and at other times to work with people to produce necessary changes. Increasingly the public expects you to do the latter to meet their needs.
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| Nursing systems theory |
Systems theory takes the major responsibility for change from you as an individual person and recognizes the importance of the total situation in creating and maintaining problems that hinder change and are beyond the power of the individual to correct. Each aspect of life is so interrelated and people are so interdependent that you are unlikely to make much change in a situation unless you work with others and consider many factors.
Fundamental changes come from within the individual or system. They cannot be imposed from without, although an outsider can be an influence. The push for maintaining the status quo and the push for change exist simultaneously. If you strive for better conditions in a health agency, you may find that they can only be achieved by pressures for policy and administrative change on a high level (Gesellschaft). Through your educational preparation, understanding of communication patterns, and experiences as a nurse you will be in a position to promote changes in the health care system.
As a number of various health, education, welfare, and regulatory agencies in the community, you may function in the health care system in the following ways :
a. As an advocate for the person or family needing health services.
b. As a concerned, active community member.
c. As an expert in health affairs.
d. As a consumer of health services.
If you understand and are comfortable with Systems Theory you can work more effectively for furtherance of health. You can also better understand the relationships that exist within the person you care for, in the agency where you work, and in the total health care field. The hospitalized patient may appear as a complex of unrelated parts while various specialists are examining his lungs, heart, head, or kidneys. You can help other health professionals perceive the patient as a whole. Disease affects all of the person, not just a single part. Community surveys, assessments, and demographic studies are tools that will help you use the nursing we process in the social system of the community and specific health agency.
Intervention on the systems level includes talking with the nursing supervisor, clinical specialists, or dietitian about cold food at mealtimes, or getting a wheelchair for a patient so he can get out of the confining four walls of his room. You may be instrumental in creating a patient council that has at least some effect on improving the environment of a unit. Outside the institution you can participate in starting organizations for older or disabled persons that help to meet their individual needs as well as have an impact on the political life of their community.
While you will not always strive for big institutional upheavals, also avoid accepting the present situation as an unalterable fact. Often when you have worked at the same place for some time , you adapt to distressing situations so that you do not even notice them, even though they cause considerable discomfort or suffering for the patient. Periodically survey your work environment as if you were a stranger to it. You might keep a diary of your reactions to the work setting when you are first employed and then refer to it periodically to determine changes you wish to initiate. In that way you can better work as your patient`s advocate.
You may not always be able to make constructive changes in the system. Some changes take longer than others, but you need to keep trying. Often an idea must be proposed several times before it gains acceptance by others.
Systems Framework helps you to remember that each patient is a system, interrelates with other system, and is a part of a family, various groups and organizations, a job, and a community. In turn, the patient is affected by the various systems in which he participates. Therefore, while you directly care for one system, you are indirectly caring for other systems as well.
Keep Systems Theory in mind as you read the rest of this book. The systems surrounding the person affect his behavior and ultimately his health. Nursing is a system because it consists of elements in interaction-the patient, family, nurse-communicating of exchanging information, engaging in the teaching-learning process or group work. A system must be adaptive to survive.
References :
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
Hazzard, Mary, “An Overview of Systems Theory,” Nursing Clinics of North America, 1971.
