Shift 1: Recognizing the ‘Person’ inside me: A trigger to see the ‘patient as person’
The Workshop Space (Koodam process) not only creates an enabling environment for emotive learning but also enables participants to recognize the ‘person’ inside. The ‘person inside’ and ‘the person outside’ are usually two different facets; of which, ‘the person outside’ dominates ‘the person within’ more often than not. ‘The person inside’ is overpowered by ‘the person outside.’ Through conscious and concerted effort the participants were facilitated to interact with the person inside. This process triggers to see the person inside in others.
The participants determined not only to treat the patient as person but also with ‘Dignity’
Shift 2: System centered to citizen centered:
Most of the Government schemes are implemented as a system centered scheme but not as a citizen centered scheme. The system centered schemes are implemented without interpreting and innovating the scheme in which the beneficiaries dignity is not considered, in fact her/his dignity is at stake.
The participants were enabled to make conscious shift from ‘system centric to citizen centric.’ This was one of the major perspective shifts were was effected through the workshop space. Everyone in the Koodam resolved to move from system centring to citizen centric approach.
Shift 3: A shift from instrumental relationship to ideological relationship with the Nursing Profession:
Instrumental relationship is a kind of ‘give and take’ formulae. “I receive salary; therefore, I need to deliver certain tasks.” In contrast to the Instrumental professional relationship, Ideological working relationship is totally different. “I work because I have a Vision, I value my profession in terms of certain ideology, and I do the work with conviction.” The participants were facilitated to initiate a move from ‘Instrumental working relationship’ to ‘Ideological working relationship.’
Ordinarily the motive for change in behaviour is the attraction of gain or the avoidance of pain. This form of motivation is referred to as instrumental relationship, where the perceived or experienced gain or profit or avoidance of pain becomes the motivation for the changed behaviour. Normally, this is how a behavioural change starts. An instrumental or use relationship cannot be sustained without continuously increasing the gain [salary increases] or reducing the pain [not reprimanding poor performance]. The other form of motivation is to form an ideological relationship between people in a group which sustains changed behaviour. Very simply, an ideological relationship is ‘I do because intellectually and emotionally I conclude that the behaviour is good for me and the others’. When a group or community is ideologically related, behaviour is sustained by strengthening the belief in the value of the behaviour, e.g. [I exercise conscious constraint on generation of waste not because I will be punished but because I believe I have a duty to conserve scarce resources for the coming generations]. Hence sustaining behaviour requires ensuring the shift from an instrumental relationship between members of the group [adequate clean water] which is the initial reason for changed behaviour to ideological relationships in the group [water is a right of present and future generations and our duty is to conserve it].
Shift 4: Valuing the Nursing Profession / Mentor Nurse Profession:
The value of the nursing profession or Mentor Nursing profession is not in terms of salary that they get. Each staff nurse of a PHC treats a minimum of 10 to 12 people and pregnant women in a day. Staff nurses’ value, therefore, is valued in terms of lives that they are saving. When a mentor nurse trains a team of staff nurses in a PHC, she reaches 20 to 25 people and pregnant women in a day, in a month it is 600 to 700, in a year it is 7200 to 8000. The value of mentor nurses is quite huge in terms of people and pregnant women that they reach through their respective trained staff nurses. Each Mentor Nurse who have attended Change Management workshop of EKAM so far, have been enabled to realize their values with the above stated perspective. After this small exercise, each Mentor Nurse felt proud about what they have been doing and doubly energized to proceed with new vigour and enthusiasm. Each Mentor Nurse took a pledge to transfer the same perspective to the staff nurses who are working in PHCs and community level.
EKAM Foundation, Chennai