Searching for sustainable change.

Change in nursing practice has been dogged by factors which have been perceived to be outside the autonomy of nurses. Consequently, projects have been initiated which have then faltered or even ceased altogether This paper reports on an action research study that was carried out in Newcastle from 1997 to 1999 and used the process within a focus group setting to rekindle and sustain an innovative change. The aim of the study was to look at staff perceptions surrounding development of the practice of self-administration of medication for patients. The findings support the view that all disciplines need to be involved in health service change. Health service employees should have a knowledge of the theory associated with the change process and be open about their views of proposed alterations in practice. They also need to have a sense of dissatisfaction with the present, a clear outline of what the problem is and the direction which they intend to take. Change involves many complex issues. It should be worked through from a bottom-up approach and consist of repeated evaluation exercises which are akin to a cyclical strategy and include a reflective process.