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  1. Marrelli, Tina M. MSN, MA, RN

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There is no doubt about the truth in the title of this month's editorial. How many times have we wished we could give up chocolate (heaven forbid) or quit smoking? I have friends who still smoke, and it seems that no amount of valid research and data will help them take the plunge and truly quit-so change, be it good or bad, is very hard, and harder for some more than others.


Think too about practice changes. We would like to think that we have come a long way from doing things "because that is how they have always been done," and I would want to think that decisions are based on good data, but this is not always true, even when we know intrinsically that a change must be made.


An incredibly interesting book that drives this point home and is, at times, almost unbearably painful to read-given the topic and the trajectory that is now known-is entitled The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis. This complex young physician identified that there was a difference between the infection rates and subsequent mortality on two different wards of a hospital where he was training. Women would come to the hospital entreating not to be placed in a certain ward: the one of the two wards where more seemingly healthy young women died after delivering their infants. (The particularly dangerous ward where more women died was already known about in the community.) Because of the young doctor's personality (we might call him prickly or hard to get along with today), no one listened to his pleas and finally his irrefutable data. And later, as he grew in stature and experience, he decided he must have his work published.


Dr. Semmelweis bravely (it harkened the end of his academic and practice career in many ways) wrote in 1860 to his (still) unconvinced colleagues that they were the cause of this mortality: "[horizontal ellipsis]you have convinced me that the 'Puerperal Sun' which arose in Vienna in the year 1847 has not enlightened your mind, even though it shone so near to you[horizontal ellipsis]This arrogant ignoring of my doctrine, this boasting about your errors, demands that I make the following declaration: within myself I bear the knowledge that since the year 1847 thousands and thousands of puerperal women and infants who have died would not have died had I not kept silent[horizontal ellipsis]and you[horizontal ellipsis]have been a partner in this massacre. The murder must cease, and in order that the murder ceases, I will keep watch" (Nuland, 2003). So for 13 years, the practice of cleansing one's hands, equipment, and bed linens between patients was not uniformly or regularly adopted, although this one doctor had proven that the deaths (or using his term, "murders") were preventable, as proven when he changed his practices on the ward. And his writings influenced and subsequently, positively changed practices all over the world.


Though perhaps not as dramatic, in our practices we too can make a change based on reading and research. The story above tells of one practitioner's influence on practice and mortality. Interestingly, it was not until he published his papers and pointedly directed them at those colleagues who refused to make the noted change that the change process began.


And change is hard sometimes, in many different applications, including administrative and operational ones. On reading one paper in this issue, a thoughtful, enthusiastic reviewer called and stated, "This article should be mandatory reading for managers." The research article, entitled "Correlation Among Client Satisfaction, Nursing Perception of Outcomes, and Organizational Variables," is an innovative approach that basically correlates nursing jobs and agency satisfaction with patient satisfaction. Open communications (among and between management and nursing team members), a positive working relationship with one's supervisor, and attention to the psychosocial aspects of home care and other aspects of the relationships are more important than ever for staff retention and for nurses being the point person for helping patients and their agencies achieve positive outcomes. Such an article, in such a time of tremendous change for home care, can be the impetus for self-reflection and change within our organizations and ourselves. Although we may not be able to easily change policy or governmental reimbursement, we can empower staff and make effective changes in the spheres we can impact as managers and as clinicians.


Similarly, your own thoughts, research, and writings can make a difference and contribute to effective, important change. We welcome your submissions and remind you that, like Semmelweis, one person thinking, writing, and being published can be that change.




1.Nuland, S. B. (2003). Great Discoveries: The Doctors' Plague-Germs, Childbed Fever, and the Strange Story of Ignac Semmelweis. New York and London: W.W. Norton & Company [Context Link]