Social structure, patterned effects determine change Myrna West, operating room supervisor at Broadview Memorial Hospital, asked Lucy Miller, an OR staff nurse, if she would like to attend a seminar on preoperative interviews. Lucy was ecstatic; she had been wanting to attend an AORN seminar for quite some time and could hardly wait. Lucy had a pleasing personality, was wellliked by nurses and surgeons, and showed leadership potential. She also demonstrated concern for patients and had been greeting them on their arrival to the operating room, introducing herself and making every effort to humanize their care. Before Lucy left for the seminar, Myrna, the supervisor, told her she would be expected to initiate a preoperative interview program when she returned. Once on her way, Lucy began to think about the program, and she tried to focus on what would be involved in implementing it. She recalled that in the past when new policies or procedures were developed it had been difficult to get other staff members to adapt to the proposed changes. Myrna was a good supervisor and was respected by her staff, but she wasn't one to stick to her guns and enforce changes; therefore, the staff often reverted to the old ways of doing things. Lucy began to think about herself and how difficult it was for her to change her own
attitudes, beliefs, and behavior. She remembered what she had read about change and that many social scientists think human beings are governed by deep and relatively unchanging components of personality or self. They trace the roots of behavior to components of the personality formed early in life usually based on needs, defenses, or identifications. If changes take place during adulthood, they are superficial or a new expression of an unchanging system of values. Lucy decided that to implement change she would have to gain more knowledge regarding the dynamics of change, the strategies involved, and ways to overcome resistance. Some theorists believe adults do change and attribute this change to social structure and its patterned effects on human experience. These two processes are identified as situational adjustment and commitment. Situational adjustment hits hard at the social structures in health care agencies, more specifically operating rooms. As an operating room nurse moves in and out of a variety of social situations, she or he learns quickly what behavior is accepted and required to remain in the structure. The nurse with a strong desire to continue working in the operating room must assess accurately what is required and deliver the required performance. This is congruent with other theories of learning adult roles. One learns to be a nurse or a teacher, the definition of status involved, and the appropriate behavior accompanying these roles. The social structure in schools of nursing, for instance, forces students to
AORN Journal, December 1976, Vol 24, N o 6
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compete for high grades, offices, and to belong to sororities or fraternities. The hospital situation is another social structure that forces nurses to behave in a certain manner. Nurses entering the OR environment must adjust their performance or behavior into what is already established. The process of situational adjustment, therefore, is not always an individual one but can be a collective one. In implementing a preoperative interview program, Lucy must contend with this collective adjustment. How will she alter the behavior of her peer group? As a member of the group, she has experienced group pressure and has even been party to forcing new employees into behavior patterns. Lucy becomes encouraged as she realizes that people do alter their behavior and adjust to a new environment. It makes sense that individuals do change. Lucy has also found that most individuals exhibit some resistance to change. The degree of resistance depends on how drastic the proposed change is and what it does to daily routine. It also depends on the ego involvement of the nurses as determined by their past experiences with change. Nurses may truly believe they can plan individual patient care without seeing the patient preoperatively. They feel that if no personal benefits are derived, why try this new effort. Lucy recognizes that involvement creates possessiveness. She must involve as many nurses as possible in the planning phase of the preoperative interview program. By participating, nurses become committed to a project and are interested in selling it to other staff members. They acquire a feeling of belonging and a real sense of worth. What new skills will be required to prepare patients for surgery? Operating room nurses are experts in asepsis but do they have skills needed to interview patients? Do they have skills in developing a plan of care by utilizing the nursing process, which includes assessment, planning, implementation, and evaluation? Lucy understands why she was sent to the seminar. Resistance to change is reduced when someone from within the group introduces it. Lucy is respected by her fellow
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workers and has the knowledge and skill needed to implement the program. She has the ability to get the entire staff involved in planning and implementing preoperative visits. Lucy knows her peers can change and that change is more acceptable when0 it is understood; 0 it is created by the people affected by it rather than externally imposed; 0 it follows a series of successful changes rather than a series of failures; 0 it results from application of previously established impersonal principles rather than dictated by personal order; 0 it is inaugurated after previous changes have been assimilated rather than during the confusion of other major changes ; 0 it is planned rather than haphazard; 0 its benefits are widespread; 0 it provides improvement as a constant procedure rather than a sporadic procedure. Lucy has undertaken a big task. Not only is she on her way to a seminar to learn how to implement a preoperative interview program, but also she must remember to remain flexible, keep a good sense of humor, and go slow. After all, God only made the world in seven days.
Julie A Kneedler, RN, EdD Assistant director of education
AORN Journal, December 1976, V o l 2 4 , No 6
attitudes, beliefs, and behavior. She remembered what she had read about change and that many social scientists think human beings are governed by deep and relatively unchanging components of personality or self. They trace the roots of behavior to components of the personality formed early in life usually based on needs, defenses, or identifications. If changes take place during adulthood, they are superficial or a new expression of an unchanging system of values. Lucy decided that to implement change she would have to gain more knowledge regarding the dynamics of change, the strategies involved, and ways to overcome resistance. Some theorists believe adults do change and attribute this change to social structure and its patterned effects on human experience. These two processes are identified as situational adjustment and commitment. Situational adjustment hits hard at the social structures in health care agencies, more specifically operating rooms. As an operating room nurse moves in and out of a variety of social situations, she or he learns quickly what behavior is accepted and required to remain in the structure. The nurse with a strong desire to continue working in the operating room must assess accurately what is required and deliver the required performance. This is congruent with other theories of learning adult roles. One learns to be a nurse or a teacher, the definition of status involved, and the appropriate behavior accompanying these roles. The social structure in schools of nursing, for instance, forces students to
AORN Journal, December 1976, Vol 24, N o 6
1041
compete for high grades, offices, and to belong to sororities or fraternities. The hospital situation is another social structure that forces nurses to behave in a certain manner. Nurses entering the OR environment must adjust their performance or behavior into what is already established. The process of situational adjustment, therefore, is not always an individual one but can be a collective one. In implementing a preoperative interview program, Lucy must contend with this collective adjustment. How will she alter the behavior of her peer group? As a member of the group, she has experienced group pressure and has even been party to forcing new employees into behavior patterns. Lucy becomes encouraged as she realizes that people do alter their behavior and adjust to a new environment. It makes sense that individuals do change. Lucy has also found that most individuals exhibit some resistance to change. The degree of resistance depends on how drastic the proposed change is and what it does to daily routine. It also depends on the ego involvement of the nurses as determined by their past experiences with change. Nurses may truly believe they can plan individual patient care without seeing the patient preoperatively. They feel that if no personal benefits are derived, why try this new effort. Lucy recognizes that involvement creates possessiveness. She must involve as many nurses as possible in the planning phase of the preoperative interview program. By participating, nurses become committed to a project and are interested in selling it to other staff members. They acquire a feeling of belonging and a real sense of worth. What new skills will be required to prepare patients for surgery? Operating room nurses are experts in asepsis but do they have skills needed to interview patients? Do they have skills in developing a plan of care by utilizing the nursing process, which includes assessment, planning, implementation, and evaluation? Lucy understands why she was sent to the seminar. Resistance to change is reduced when someone from within the group introduces it. Lucy is respected by her fellow
1042
workers and has the knowledge and skill needed to implement the program. She has the ability to get the entire staff involved in planning and implementing preoperative visits. Lucy knows her peers can change and that change is more acceptable when0 it is understood; 0 it is created by the people affected by it rather than externally imposed; 0 it follows a series of successful changes rather than a series of failures; 0 it results from application of previously established impersonal principles rather than dictated by personal order; 0 it is inaugurated after previous changes have been assimilated rather than during the confusion of other major changes ; 0 it is planned rather than haphazard; 0 its benefits are widespread; 0 it provides improvement as a constant procedure rather than a sporadic procedure. Lucy has undertaken a big task. Not only is she on her way to a seminar to learn how to implement a preoperative interview program, but also she must remember to remain flexible, keep a good sense of humor, and go slow. After all, God only made the world in seven days.
Julie A Kneedler, RN, EdD Assistant director of education
AORN Journal, December 1976, V o l 2 4 , No 6
