WHAT IS PARADIGM SHIFT?

Think of a PARADIGM SHIFT as a change from one way of thinking to another. It's a revolution, a transformation, a sort of METAMORPHOSIS. It just does not happen, but rather it is driven by agents of change.

WHAT IS PARADIGM SHIFT?

Agents of change helped create a paradigm-shift:
Ptolemaic system (the earth at the center of the universe) Copernican system (the sun at the center of the universe) Newtonian Physics Relativity Quantum Physics Scientific Theory

These transformations were gradual as old beliefs were

replaced by the new paradigms creating "a new gestalt."

WHAT IS PARADIGM SHIFT?

Agents of change are driving a new paradigm shift today. The signs are all around us. The introduction of the personal computer and the internet have impacted both personal and business environments & is a catalyst for a Paradigm Shift.

WHAT IS PARADIGM SHIFT?

Newspaper publishing has been reshaped into Web sites, blogging and web feeds.
The Internet has enabled or accelerated the creation of new forms of human interactions through instant messaging, Internet forums & social networking sites. We are shifting from a mechanistic, manufacturing, industrial society to an organic, service based, information centered society, and increases in technology will continue to impact globally.

Change is inevitable. It's the only true constant.

Accdg. to TechEncyclopedia
DRAMATIC CHANGE IN METHODOLOGY OR PRACTICE

Major change in thinking & planning which ultimately changes the way projects are implemented. Ex: Accessing applications & data from the Web instead of from local servers is a paradigm shift.

Accdg. to Barron's Business Dictionary

Change in a model or pattern that has been

nearly universally accepted Ex. Change in consumer buying habits from buying airline tickets through travel agents to buying them over the Internet would be a paradigm shift.

Accdg. to Investopedia Financial Dictionary

Major change in how some process is accomplished. A paradigm shift can happen when new technology is introduced that radically alters the production process of a good. EX. Assembly line created a substantial paradigm shift not only in the auto industry, but in all other areas of manufacturing as well.

Accdg. to Investopedia
A paradigm shifts can require that

entire departments be eliminated or created in some cases and

millions or even billions of dollars of new equipment purchased while the old equipment is sold or recycled. Paradigm shifts have become

much more frequent in the past hundred years, as the industrial

revolution has transformed many social and industrial processes.

This process is likely to become even more commonplace in the

future as our rate of technological advancement increases.

Accdg. to Thomas Kuhn

Fathered, defined and popularized the concept of

"paradigm shift."

Scientific advancement is not evolutionary, but rather is a "series of peaceful interludes

punctuated by intellectually violent revolutions," and in those revolutions "one conceptual world view is replaced by another."

Accdg. to Physicist Capra

Acknowledged the paradigm shift in quantum physics as an integral

part of a much larger cultural transformation

Generalized Kuhns definition of a scientific paradigm to that of a social paradigm defined as a

constellation of concepts, values, perceptions, and practices shared by a community, which forms a particular vision of reality that is the basis of the way the community organizes itself.

4 CONCEPTS OF THE NURSING PARADIGM

The nursing paradigm has developed over time from the practices & beliefs of professional practitioners to give structure to the body of knowledge that is necessary to successfully meet the goals of the profession.

4 CONCEPTS OF THE NURSING PARADIGM The paradigm defines 4 basic concepts: INDIVIDUAL - target of the care ENVIRONMENT - external influences HEALTH - goal of the care NURSING - care itself

4 CONCEPTS OF THE NURSING PARADIGM

INDIVIDUAL
Refer to a single person, a family, or any group of people who are in need of nursing care Individuals are in collaboration with the nurse & share the responsibility for their own health. individuals have a basic need for recognition and respect as well as a right to participate in decisions that affect their own wellness.

4 CONCEPTS OF THE NURSING PARADIGM ENVIRONMENT

Where the individual exists is an important influence on his health and well-being Includes the cultural, social, political, spiritual & economic influences on the individual Nursing care includes monitoring & sometimes modifying the interactions of the individual with the environment.

4 CONCEPTS OF THE NURSING PARADIGM

HEALTH
State of well-being Harmonious connection of the physical, psychological, social & spiritual parts of an individual within himself, w/ those around him & w/ his environment The health of the individual is

the goal of nursing

4 CONCEPTS OF THE NURSING PARADIGM

NURSING
Nursing is not a set of specific tasks but includes: Direct care giving Promoting health & patients Leading, Managing, Teaching Researching

Requires: Development of a concerned relationship between the individual & the nurse Use of state-of-the-art medical knowledge Exercise of good judgment to promote good health & healing

PRE-WAR to 1945
Concept of a Hospital
The Hospital has a morbid image to the people at this period. When someone is brought to the hospital, people feel the patient is dying.

Organizational Structure & Facility

Highly centralized Absence of electronic devices

Nursing Service
1) No participation in operational

Nursing Education
A 3-year Graduate Nursing program solely existed. Conceptualization of BSN program & implementation in 1947 with the first graduate from UP College of Nursing in 1952

The hospital is for the sick and the dying

planning 2) No managerial knowledge, managerial practice was gained by experience 3) Task-oriented but ensures high quality & excellent bedside care 4) Multi-dimensional scope of responsibilities e.g. In-charge of linen, housekeeping & dietary at times 1) Nurses were highly disciplined but very few takes up Nursing 2) Nurses lack theoretical knowledge to back-up their skills 3) Nursing administrator holds a very demanding job; she must be strong & clever.

Professionalization of Nursing (1946-70s)

HOSPITAL NURSING SERVICE
1) Chief

NURSING EDUCATION

HEALTH DELIVERY SYSTEM

TECHNOLOGY

Hospital image gradually changed It maintained curative & rehabilitative function the preventive function was not emphasized Electronic age started, e.g. chemotherapy for TB & cancer, Radiation became available Hospital was still highly centralized in terms of control

Nurses had no voice in Operation Planning; no emphasis on qualification, tenure was the basis of succession 2)Many registered nurses enrolled in supplemental programs 3)Maintained highly appreciated bed care 4)Exodus of nurses started in the 50s 5)In late 70s, Standards for Nursing Practice were formulated

Nursing began to be recognized as a profession due to birth of the BSN Program. However, 2 types of programs existed (GN and BSN) for some time Abolition of GN Program came in the late 70s

Came in 3 Levels: Primary Secondary Tertiary This concept is premised on selfsufficiency at the primary level with the development of Barangay Health Workers. It aimed to promote proper utilization of the secondary and tertiary facilities.

Computerization made some job easy Electronic gadgets at the bedside became a necessity e.g. cardiac monitors Faster communication system was a great support in the Health care institution

Era of Care Fragmentation (80s-90s)

It is worthwhile to quote Dhorter Edwards:

"While medical knowledge has

rapidly expanded in recent years, but medical & nursing care has in certain ways deteriorated."

This is highly evident in the Philippine setting.

Era of Care Fragmentation (80s-90s)

Hospital
For the sick & the well many people come to the hospital for executive check-up. There is awareness of the public for heath maintenance & health promotion. Emphasis on diagnostic programs Decentralization departments were wellorganized & had autonomy in running their departments Facilities are high tech. Hospitals competed in their facilities. Highly specialized services came into reality (i.e. intensive care units)

Era of Care Fragmentation (80s-90s)

NURSING SERVICE
Exodus increased as USA, Canada, Australia, Middle East are all open

Understaffing was felt & became a big headache for Nursing Administration Public demand for quality care both in government & private hospitals are echoed Nursing care activities delegated to non-nursing personnel due to understaffing thus, contributing to poor quality of care rendered Continuing education Units, a prerequisite to licensure, a requirement which had never proven its worth Birth of "manager" title with unclear job description is a fashion. Almost all hospitals changed the title of supervisor/head nurse to manager. Nevertheless, there was no corresponding change in the content of their job description. Scarce local employment (in spite of the unemployment of nurses) Proliferation of health care workers/providers Specialization in nursing care with sophisticated equipment to support the nurses in their skills. To quote, Simon and Schuster: "fancy devices, new fangled diagnostic

procedures, esoteric jargon machinery, buzzers & beepers, play an important role in the medical & nursing practice. These technological tools, innovations & even miracles, while producing new hope for diagnosis & cure, tend to distance the caregiver from the patient."

Era of Care Fragmentation (80s-90s)

At this point in time Nursing Service became complicated to manage & thus: 1) Demand for better management of nursing service 2) Change in role expectations heightened calling for: Business management Clinically oriented Labor relation which demands for strong orientation to legal aspects of Nursing Administration Educator of patients & staff Nursing Management Systems that respects the major administrative principles of Planning, Organizing, Directing & Controlling Service coordinator with other departments Operational planning was felt needed by some nursing administrators Budgetary planning is a must but barely done due to inadequacy in the technical know-how

Era of Care Fragmentation (80s-90s)

ENVIRONMENTAL FACTORS AFFECTING PATIENT CARE & THE ROLE OF THE NURSING ADMINISTRATORS Socio-economic condition Poor health condition in the midst of rising health care cost Corporatization of Health care by the year 2000 is shaping up Social disintegration of the society where Nursing Administration is not prepared to take care of the victims. High tech; high cost of health facilities Home Care (USA) due to high cost of hospitalization. Philippine setting the hospital will remain as the biggest employer of nurses.

Era of Care Fragmentation (80s-90s)

TECHNOLOGY Work simplification, but weak clinical practice because every data needed is available in the computer Fast communication system, thus, easy access to developments in Nursing in other countries Health tremendous problems, communicable diseases & social disintegration are persistently rising. These have great impact in planning for patients service both in hospitals & in the community.

21st Century Nurse Executive

10 Directions, the Millenial Mega trends: Gateways to the 21st Century: The blooming Global Economy of the 1990 A Renaissance in the Arts The Emergence of the Free Market Socialism Global lifestyles and cultural nationalism The privatization of the welfare state The rise of the Pacific Rim The Decade of Women in Leadership (will nurses be on the lead?) The Age of Biology The Religious Revival of the Millenium The Triumph of the Individual

21st Century Nurse Executive

Increase Corporatization of Health Care
Nursing Administrators must have the following qualifications: 1) Grounded on 2 domains: Nursing Science Nursing as a science and an art must be rich in scientific knowledge in order to render high quality of care. Business for better understanding of her fiscal responsibility. 2) Good clinical knowledge and business skills 3) Describe positive balance sheet and positive patient outcome. 4) Manage Nursing's contribution as a business unit that is to treat nursing like any other profit-generating segment of the organization.

It is imperative to note that Clinical knowledge in peso tied to a

patient outcome will be the key to the survival of Nursing as a profession.

The assessment of the 21st Century is the advanced clinical degree and the MBA degree.

21st Century Nurse Executive

Preparation of Patients in the Next Millennium
Vision to create the great need for the care coordination & continuity Many opportunities to focus in practice, thus nursing will even be more rewarding Increasing responsibilities for the clients, particularly those who are best prepared will have the most impact in nursing practice Calls for professional competence & self-direction in:
Clinical procedures Leadership Critical thinking Continuous program improvement

21st Century Nurse Executive

Preparation of Patients in the Next Millennium
New roles of Nursing Administrators: Supporter Reinforcer Facilitator Ethical Dilemmas of Nursing Administrative Practice: Conflict between moral obligations of administrative practice & moral obligations of professional nursing practice Situation: Shortage of staff there are some items but the hospital administrators freeze hiring Application of technology in administrative & technical nursing practice. We would want nurses to be able to make comprehensive Nursing care documentation, not just a checklist.

21st Century Nurse Executive

Nursing Administration Perspective
COST & RESPONSIBILITIES: Assessing and planning appropriately Education and Training Collaborating with the staff and other health discipline Politically active in matter concerning violence in the organization for reforms DECISION SUPPORTS DATABASE: Determine nursing management decision support system, one that is: User friendly Flexible Accessible and integrated with other institutional databases Note that available database will enhance ability to evaluate

changes in programs, personnel, policies, staffing, organizational and nursing culture

21st Century Nurse Executive

Nursing Administration Perspective
PREPARE TO LEAD IN MANY AREAS SUCH AS: Adopt technology-based conditioned data sets of nursing practice Articulate outcomes and accelerate pace of information flow Reengineer basic model of nursing practice LEADERSHIP ATTRIBUTES IN A WORLD OF CHANGE: Inspires and encourage rather than control and convince Use imagination rather than control and convince Provocative, intuitive and innovative rather than conforming Takes responsibility with pioneering spirit will arrive at new ways of meeting organizational goals Note: "Change is inevitable but choosing to grow is optional." By Kwamoto, Kristi

21st Century Nurse Executive

Nursing Administration Perspective
US Setting Year 2000, migrants, women & minorities will account to 85% of the net growth in Labor force with more than 25% comprising of people from the 3rd world countries, thus the need for Transcultural Nursing Administration in health care setting. Transcultural Nursing Administration - process of assessing, planning & making decision and policies that will facilitate the provisions of educational and clinical services that take into account the cultural caring values, beliefs, symbols, references and life ways of people of diverse and similar cultures for beneficial or satisfying outcomes.

21st Century Nurse Executive

Nursing Administration Perspective
REAL CHALLENGES TO NURSING IN THE NEW

MILLENNIUM:

1) Setting Standard of Care (Service and Education) 2) Ensure quality care by supporting research efforts to prove Nursing's real worth, that is the value of Quality Nursing 3) Develop awareness of Cost, Quality and Nursing 4) Shift to health promotion approach - cost-effective & consistent with Nursing values & concerns 5) Involvement in policy development in health care delivery system 6) To re-energize to answer the call of challenges of globalization 7) Learning Nursing thru the internet

21st Century Nurse Executive

Nursing Administration Perspective
Turn-over & intermobility, a major factor in today's Nursing Administration This is inevitable and healthy, however, if it is too much, the results are: 1. Reduced productivity 2. Demoralized incumbent 3. Expensive 4. Quality Care suffers If it is too little, the results are: 1. Slows employees ambition 2. Slow rate of separation of old hands 3. Slow rate of new blood results to failing or dying organization

Transcultural perspective in Nursing Administration is essential for

survival, growth, satisfaction and achievement of goals in the multicultural workplace.

21st Century Nurse Executive

Nursing Administration Educators
PROFOUND & STRUCTURAL cultural changes require new knowledge & skills for nurses in administrative & leadership positions thus, changes in Nursing Administration curricula PROLIFERATION OF SOPHISTICATED INFORMATION TECHNOLOGY APPLICANTS where nurses are the integrators of patient information management techniques including internet utilization FOCUS MUST BE IN DEVELOPING THE STUDENT'S ANALYTIC & DECISION-MAKING SKILLS and provide foundation in business skills, e.g. Cost benefit analysis Negotiation People management skills with effective communication, management skills that increase productivity

21st Century Nurse Executive

SELF-DEVELOPMENT; FLEXIBILITY & ADAPTABILITY

LEADERSHIP FOR THE FUTURE:

Provide shared leadership Has Decision-making autonomy Creates the vision and mission of Nursing service Can bring about the best in the subordinates Charisma Promote individual growth Provides intellectual stimulation and do research Can transform problems into opportunities and challenges Has strong and visionary leadership who can elevate Nursing Management in the context of National Health System

21st Century Nurse Executive

THE CHANGING WORLD OF THE NURSE ON

ADMINISTRATIVE PRACTICE BRINGS HOPES, DREAMS & OPPORTUNITIES IN THE NEW MILLENNIUM: 1) REFLECTION looking at the map of Nursing

Administration, there are more questions than answers because of the rapid rate of change. 2) THOUGHTFUL ACTION how to achieve the purpose to fulfill the mission, purpose and vision of Health Care. Planning and implementing the mission must lead to quality Health Care 3) RECOGNITION OF OUR STRENGTH People and Outcomes. Transitions from Nursing Services to Patient Services accountability builds collaborative relationships.

21st Century Nurse Executive

THE FUTURE OF THE NURSING DIRECTOR NEEDS TO

BE MORE FOCUSED ON PATIENT-CENTERED CARE & STRATEGIC INNOVATIONS.

There is a fast-growing competition as many hospitals are coming up. Globalization (as some of these hospitals) have foreign funding and foreign partners in Asia's challenge to rise to world-class standards of efficiency, productivity and quality. The impact of globalization is not only on the management practice, but extends beyond to lifestyles and values of the people. It should be realized then, that Nursing Services will be

serving the most demanding group of health care consumers in the world.

21st Century Nurse Executive

PARADIGM SHIFT in Nursing
50'S 60'S TO 80'S 90'S 2000'S TO 21ST CENTURY TO THE UNKNOWN
1. Reengineering Care" Processes 2. Realigning in the Infrastructure to support changes

Period of Professionali Age of Ideology sm marked Technology Humanistic decline in "Mechanistic Care quality care Caring"

21st Century Nurse Executive

Lastly, Nursing Administrator needs to turn around & face the challenges of transformational nature relative to her role & expectations to be visionary: One who can discover, redesign &

redirect their services and training activities to achieve organizational effectiveness in the 3rd millennium.

Who is that Nurse? The characteristics that she should possess are the characteristics of a Future Leader.

YOU

A PARADIGM SHIFT IN NURSING EDUCATION:

A NEW MODEL
Nurse educators are being inspired to rethink historically teacher-centered curriculum designs & to embrace new ideologies that have a stronger focus on student-centered learning. The paradigm shift is reflected in the National League for Nursing's (NLN) call for nursing educational learning environment substantiated in evidence for both curriculum and pedagogical practice. To meet these expectations, education should

education to respond to the changing needs of our student population by providing an

provide active learning that promotes critical thinking and analysis and problem-solving skills.

CHANGES IN HEALTH CARE DELIVERY

Information

technology & demands for evidence-based practice have fueled the need to provide increased content in nursing programs.

A myriad of issues face nurse educators as we confront inclusion challenges in an already content-laden curriculum. Current literature attests to nursing content saturation contributed by the following: Content repetition Teacher-centered education Academics-practice gap Changes in health care delivery Information age

CHANGES IN HEALTH CARE DELIVERY

Responding to these & other factors, educators who are teacher-centered curricular are embracing new ideologies that have a stronger focus on studentcentered learning. Nursing education model must

demonstrate this paradigm shift in teaching via 3 key concepts:

the learner the instructor outside learning modalities

REVISING THE TRADITIONAL CURRICULUM

Nursing curriculum has traditionally focused on behavioral outcomes, following the content-weighted Tyler model created in 1949. In response to calls for health care reform in the 1990s, the curriculum: Shifted to a community-based model increased course content. Expanded to include health promotion & wellness across all settings. Subjects related to genetics, bioterrorism, mass casualty response, cultural competency, health policy & leadership are incorporated to provide competencies viewed by educators as curriculum requirements. Content must be critically evaluated, allowing inclusion of current competencies and mandates while promoting the sifting of unneeded material. Must expand beyond linear thinking and include content that is adaptable to the changing health care environment.

REVISING THE TRADITIONAL CURRICULUM

Traditionally, a teacher-centered philosophy transference of knowledge has typically included: Memorization Repetition Recitation of information The NLN position statement in 2003 "Innovation in Nursing Education: A Call to Reform calls for schools of nursing to "challenge their long-held traditions by designing evidence-based curricula that are flexible, responsive to students' needs, collaborative & integrate current technology." A push for innovative pedagogy now floods the literature reflecting a shift away from the "Sage on the Stage" to "Guide on the Side" perspective. The emergence of learning-centered & concept-based

curricula encourages student-centered learning & the development of critical thinking skills.

REVISING THE TRADITIONAL CURRICULUM

As students become seekers of knowledge, the focus is no longer on content coverage. Rather, teaching provides a plethora of knowledge to be perused & applied toward analytical thinking. Ironside (2001) stated that "the use of alternative instruction begins by challenging the self-evident assumptions of conventional approaches to nursing education." She noted that when the focus is on content, the dissemination of information is disregarded and studentcentered learning, through pedagogical practice, is lost. In contrast, a push for interpretative education through critical, feminist, postmodern and phenomenological practice allows the educator to shift from traditional teaching strategies and redirect the educational focus toward the learner and meaning of the content.

DISTANCE EDUCATION, EMERGING TECHNOLOGIES & NON-TRADITIONAL STUDENTS

As the nature of nursing education has changed,

so has the construct of how we teach our students.

Web-based classrooms have opened the door for innovative instruction. Commonly, the teacher assumes the role of facilitator as students engage in cooperative and cognitive learning through peer interaction via discussion boards.

Emerging technologies are the cornerstone of the current teaching paradigm shift.
Our consumer-driven, information-rich society has paved the way for distance learning, whereby students are able to be active learners in a classroom-free environment, thus, allowing for the accommodation of a variety of student learning styles.

DISTANCE EDUCATION, EMERGING TECHNOLOGIES & NON-TRADITIONAL STUDENTS

Students and educators both benefit

from distance learning as it provides:

Self-pacing Higher order thinking skills Active involvement Increased learner attention Incorporates cooperative & collaborative learning within the student's environment Learning becomes inclusive from the student's perspective & integrates personal experiences Instruction

DISTANCE EDUCATION, EMERGING TECHNOLOGIES & NON-TRADITIONAL STUDENTS

Today's students are typically nontraditional. They come from diverse cultural backgrounds and bring with them into the online environment a variety of rich & varied life experiences. These students need a curriculum that supports their working lifestyle & that provides another venue for accessing higher learning education. Learning must be directed toward a focus on skill

attainment that reinforces critical thinking, problem solving, and the careful analysis of information.

Our technology age is ever changing; the skills necessary to navigate this dynamic flow of information must be fluid and versatile.

DEVELOPING A NEW NURSING EDUCATION MODEL

To bridge the chasm between academic preparation and nursing practice, nurse

educators, as agents of change, must understand the changing health care environment and the needs of students.

Current technology and the ability to bring learning to the student offer a platform for providing alternative learning approaches to today's student population.

DEVELOPING A NEW NURSING EDUCATION MODEL

Content in schools of nursing must reflect the dynamic changes of today's health care system. It must be:
Current Relevant Based on evidence Examined critically With expectation that today's students will be lifelong learners Incorporate a learner-centered curriculum in both clinical & classroom environments Identifies key components students need to know as they apply their knowledge to realworld scenario

DEVELOPING A NEW NURSING EDUCATION MODEL

Curricular content in nursing programs

must:

Guide and reflect the school's educational framework Transcend factors that influence teaching Provide a common thread in curriculum development Philosophy or way of life is influenced by social, political and community forces. These influences play a role in instruction;

education must be aware of the interaction these components have on the learner, instructor and influencing systems.

DEVELOPING A NEW NURSING EDUCATION MODEL

Green

relationship between the learner, educator and the system as a means of providing improved outcomes for nursing practice in the clinical setting.
(2006) describes the

Green's Synergy Model of Education places the student as the focal point of learning, using competencies of both the student and the educator to guide learning outcomes. The nursing model introduced here reflects the needs of learners and supports educational outcomes that reflect the technological modalities used in instruction. It looks at 3 key concepts: the learner, the instructor & the outside learning modalities.

DEVELOPING A NEW NURSING EDUCATION MODEL

Learners are not just students but

represent consumers of education:

They come to this process with real-world experiences & preexisting ideas that are the foundation for their learning in & outside the classroom. They also come to education with generational differences, both with peers & instructors. As consumers of knowledge, they can no longer devote their time solely to studying in an educational setting. Their working lifestyles predetermine their availability and direct their educational options.

DEVELOPING A NEW NURSING EDUCATION MODEL

The shift from content-laden curriculum to

teaching key concepts allows:

Students to focus on need-to-know, or essential content that will be applicable to nursing once these students have graduated Instructor's role to provide a curriculum that is dynamic, fluid and grounded in evidence-based practice, at both the level of clinical nursing practice and educational teaching Students to become active learners in the educational setting Both instructor & learner now share similar goals Learner becomes a seeker of knowledge & a lifelong learner Critical thinking analysis & problem solving become the shared focus of both learner & instructor outcomes.

DEVELOPING A NEW NURSING EDUCATION MODEL

Influencing systems reflect the varied technological modalities affecting the learner, instructor & educational environment, as well as community influences that shape educational outcomes. These include: 1) Internet access & online classrooms - bring education to the distance learner 2)High & low-fidelity simulation - adds realism to nursing instruction as students work with mannequins that portray humanlike afflictions 3)Virtual interaction joins gaming with simulated scenarios - allow students to experience situations via computer programs 4)Community influences promote multicultural & diversity awareness that can be explored through community partnerships and service-learning opportunities

DEVELOPING A NEW NURSING EDUCATION MODEL

Nurse educators can no longer teach the way they were

taught: The student as consumer views education as a

commodity & a service that provide tools for future employment. Students want to be taught key concepts and the theoretical and practice knowledge of their discipline that can be directly applied to practice.

With the understanding that nursing education must

provide active learning experiences that: Promote critical thinking Analysis Problem-solving skills This model provides an alternative guide for higher education that takes into account : the learner the instructor the systems that influence their relationships
To provide congruence for educational outcomes.

CONCLUSION

 For millions of years we have been evolving and will continue to do so. Change is difficult. Human Beings resist change; however, we are not restricted by this, for THE PROCESS TO COCREATE has been set in motion long ago so, we can change. Today, we are moving at an accelerated rate of speed and our state

of consciousness is transforming and transcending. Many are awakening as

our conscious awareness expands.

Royal College of Nursing General Secretary and nurses union leader, Dr. Peter Carter, said a paradigm shift is needed to improve failing hospitals. Dr Carter added: People have tinkered around the edges and not made the paradigm shift thats required.