Ficha Técnica de la Sistematización del Programa de Acción

Imogene King’s Systems Theory envisions nursing as a profession that would facilitate the health and welfare of all individuals, as nurses can promote health through their

understanding that human beings are open systems constantly interacting with their surrounding environments (King, 1981). In Systems Theory, each human being perceives and interacts with the world as a “total” person who constantly makes “transactions” with their environment. Transactions are defined as interactions in which an individual perceives a situation, actively interacts in that situation, and is then changed in the process of these experiences. Systems Theory proposes that a person is influenced by three interactive systems: personal, interpersonal, and social. When referred to within the discipline of nursing, these terms are used to promote health and influence the personal health of nurses.

Concepts inherent in Systems Theory influenced the creation of Christina Sieloff’s Theory of GOAWO (2007), which provides a framework in which to evaluate nurses’

process and that a group of people simply consists of individuals and their transactions with the outside world. In looking at nursing within the context of this theory, Sieloff views nurses as the personal system, and their direct interactions with others in the organization as the interpersonal system (Sieloff, 2007). Nurses’ interactions with other groups and the organization as a whole are viewed as the social system.

The GOAWO evaluates outcome attainment (power) from two main areas: nurses’ Capacity and their Capability to achieve their goals (Sieloff, 2007). Each of these areas will be described separately (see Figure 1).

Controlling the Effect of Environmental

Forces Position Resources Role    

Outcome Attainment Capacity

   

Communication Outcome Attainment Capacity Competency  Communication Competency Outcome Attainment Outcome Attainment Capacity Perspective  Outcome Attainment Perspective Goals/Outcomes Outcome Attainment Capacity Competency  Goals/Outcomes Competency Group Leader's Outcome Attainment Capacity

Outcome Attainment  Group Leader's Outcome Attainment Competency Competency

  

Outcome Attainment Capability/Empowerment Figure 1. Group Outcome Attainment within Organizations (GOAWO)

2.3 Capacity

The Capacity to achieve one’s goals is evaluated by examining a person’s Position in the organization, Role in the organization, Resources available to achieve the goal, and Controlling Effects of Environmental Forces influencing nurses’ abilities to achieve their goals.

2.3.1 Position

As the first component of Capacity, Position refers to how nurses define their Role within the communication network in which they are employed (Sieloff, 2007). For example, do nurses value their expertise or have the ability to communicate their expertise and opinions? Are nurses viewed as the center of all quality care delivered in an organization? Where essentially does nursing fit within the functional dynamics of an organization? Position may have a direct impact on nurses’ coping strategy as a result of physician-perpetrated verbal abuse. Nurses view

themselves in relation to their role, and their perceptions of that role directly influence their feelings and thoughts related to the abuse. For example, if nurses view themselves as powerless, the perceived lack of power may cause them to perceive abuse differently than nurses who feel valued. Some nurses may be apathetic about help, not accepting it even if offered, or perceiving they are undeserving of help. This would also influence how they handle and perceive

physician-perpetrated verbal abuse.

2.3.2 Resources

Resources, the second component of Capacity, refers to nurses’ perceptions of factors that influence the abilities to achieve one’s goals (Sieloff, 2007). This includes financial needs tied to the organization, staffing, effective leadership, or anything else a nurse may need to achieve goals, including organizational policies to deal with abuse. The existence of these policies could potentially influence nurses’ thoughts and feelings regarding their ability to cope

or the manner of coping with physician-perpetrated verbal abuse. For example, if the facility is not adequately staffed, there is an increase chance of errors or at least less than perfect care provided to the patient. This less than perfect care produces an environment in which a physician is more likely to become upset and use verbal abuse toward the nurse related to care delivered. However, if the nurse has no power to correct the staffing issues, then they are powerless to correct and/or prevent the problem. If nurses do not feel that they can rely upon management for support in dealing with physician-perpetrated abuse and have the resources to correct the problem, then their ability to cope may be diminished and produce feelings of powerlessness.

2.3.3 Role

The third component measuring nurses’ Capacity is Role, which refers to their Position in the organization to accomplish the goals of their employer (Sieloff, 2007). This includes their perception of responsibility for the quality and method of delivery of patient care. Do nurses control themselves as distinct, though interdependent, professionals within the organization? Lack of autonomy and management by physicians may directly affect the coping mechanisms a nurse chooses to use.

2.3.4 Controlling Effects of Environmental Forces

The fourth component examining nurses’ Capacity is Controlling Effects of

Environmental Forces. Environmental Forces, or factors, influence nurses’ abilities to achieve their goals (Sieloff, 2007). For example, how the organization adjusts to change within the healthcare arena is an environmental factor; it affects nurses’ perceptions of dealing with the change. The nurse-physician relationship and how nurses perceive their interactions with a

physician also are factors. Verbal abuse within interactions can cause stress (Rosenstein & O'Daniel, 2006) and may diminish nurses’ perceptions of their own power.