Breakpoints and continuities: A case study of reactive change

Abstract

In 1987, nursing administrators effected radical changes on a pediatric psychiatry ward: A bachelor's degree in nursing science became mandatory for nursing staff, family systems nursing was introduced, and postdischarge nursing follow-up was instituted. To convey how they accomplished the changes, a case history of change on the ward is presented. It suggests that there were many driving forces. Factors most important to nursing's success included a strong vision of nursing, sufficient pain or discomfort to motivate change, the ability to recognize and seize opportunities, and the linking of change to existing institutional practices, policies, and values.