The Nature of Nursing in the Health Care Structure

Abstract

THE purpose of my remarks in initiating this first symposium of the conference is to look at some of the structural factors which are important in affecting the nature of nursing care and the implications these have for the delivery of health services. By structural factors, I mean the kinds of system characteristics within which we work in nursing and through which we try to provide health care. I will be making some suggestions for system change from our present pattern. Many of these are not going to be new ideas but perhaps we can place these ideas within a logical framework to permit the elaboration of a nursing role or roles in our discussions tomorrow, based upon the implications of structure. In order to gain a perspective upon our present structural characteristics with respect to health services and to project future change, we have to begin with the historical developments of the profession of nursing and of other health professions, for the delivery system evolved to create the type of facilities which these professions felt they required. I would like to emphasize the important distinction which I am making and to which I will refer later, when I suggest that the system of health care delivery has been built around the need for facilities as expressed by the professionals rather than the need for facilities as expressed in accordance with requirements of the citizens, for clearly these are not synonymous. Historically we can trace the kind of health care delivery system we have at the moment back to attempts of society to deal with the kinds of health problems with which it was faced. In other words the system was a response oriented around the curing of disease or of illness. The story of health care is not really that but the story of illness care. This becomes another