2004 has been a year of change for me: I married, sent my first child to college, moved into a new home, adapted my editor role to new organizational decisions, and responded to new workforce needs within the university where I teach. I have always prided myself on being flexible and adaptable, but this year, I found myself struggling to manage and cope with these changes. Several colleagues pointed out to me even positive changes can be stressful, especially when coming one after another.
My personal experience has caused me to contemplate my nursing practice. I have always focused my nursing care on helping patients adapt to change. Unfortunately, I don't think I really understood they were most likely adapting to more than one change; adapting to the reality of being ill isn't the only "change" required. There may also be changes in the patient's roles (spouse/significant other, parent, employee, volunteer, etc.), financial status, or even much-loved social or recreational activities. Each of these changes is driven by the patient's health care status, but each also affects their health care status.
The effects of change on people's health care and life situation are reciprocal and offer a challenge for the individual dealing with the change as well as the nurse supporting the patient through the change. For example, a young adult recently diagnosed with inflammatory bowel disease (IBD) may now have decisions to make about career activities: serving as an airplane pilot or naval personnel would probably be very uncomfortable and challenging given the frequent need for toilet facilities during disease exacerbation. The same is true for patients diagnosed with gastroesophageal reflux disease. While these individuals may not find their career choices limited, the required lifestyle changes to control their disease may impact their quality of life. Diet changes that prevent them from enjoying favorite foods or drink, the need for weight loss and increased physical activity, and the expense involved with pharmaceutical management can result in the need for change that is stressful, unwanted, and negatively received.
Many behavioral theorists have explored change. Kurt Lewin (1951) is one of the most well-known and well-received change theorists. He suggests change that lasts must occur over time: change is a process that involves moving through stages (unfreezing, changing, refreezing). If successful, moving through the changes will result in permanent change. Prochaska and DiClemente's (1992) change model is often used by nurses and like Lewin, addresses change as a process with stages (precontemplation, contemplation, preparation, action, maintenance). Self-efficacy theory (Bandura, 1997) approaches change from an important perspective: change is not likely to occur if the person doesn't feel they have the capacity to make the change. Complexity (chaos) theory (Cambel, 1993; Gleick, 1997) seems to best fit my circumstances: resistance, confusion, and struggle are proposed in this theory to be necessary for change to occur during chaos!!
At the beginning of each year, many of us make resolutions for change. While most resolutions are driven by a desired change, many report the inability to follow through with their New Year's resolution. Most New Year's resolutions are soon forgotten and the desired change is never obtained. Our patients, however, often are not choosing to initiate change out of fun, like the tradition of a "New Year's resolution." Some patients' need for change is life threatening, while other's need for change would enhance their health status and quality of life.
The New Year's focus on change is a good time to examine our effectiveness as change agents: both in facilitating change and responding to change. One of the most important facts to remember is that change is a process. For change to be successful, it will usually involve awareness of the need to change, a choice to attempt the change, and the discipline to follow through with the change over time. In some cases, this may be easy, but most likely it will be challenging (or the change would have already been made).
As nurses work to facilitate change, it is important to acknowledge change is usually not unifocused, but has a ripple effect on other areas of life. In counseling patients, it is important to acknowledge the far-reaching effects of change, both positive and negative, and incorporate these into the patient's plan of care. Likewise, in our personal lives, we must also acknowledge change in one area will most likely affect many areas of our lives, and any change will require time to become permanent.
Change is inevitable and can be positive or negative, desired or undesired, necessary, or simply preferred. Regardless, the dawn of a new year typically involves an enthusiastic look at change via our New Year's resolutions. Along with your tradition of identifying a New Year's resolution or two, make an effort this year to place emphasis on facilitating and supporting change for your patients, recognizing the many facets and challenges of change, and helping them to realistically develop a plan for change that will succeed over time. And good luck with your own resolutions for 2005!! I hope your goals for change are successful.
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