The Power of Normal

By Wilkinson, Jill; Jones, Mark | Nursing Praxis in New Zealand, July 2016 | Go to article overview

The Power of Normal


Wilkinson, Jill, Jones, Mark, Nursing Praxis in New Zealand


There is a drive within each of us towards normality. What is usual, typical, standard, average, natural, regular or conventional shapes our lives in many varied and important ways. We have laws, regulations, codes, guidelines and rules (written, spoken and unspoken) that specify in detail what constitutes normal behaviour. There is often a degree of comfort associated with this, even a sense of safety. As nurses we assess growth and development, indicators of health and well-being, and presenting symptoms against established norms. We can describe performance and outcomes statistically using terms such as deviation from the mean on a normal distribution curve. Normality is central to our lives in so many ways and we value the status quo; when it is challenged we tend to want to 'get back to normal'.

Normality then is a powerful construct embracing everything and everybody (Rabinow & Rose, 2003). Institutions and groups to which people belong require their members to behave in particular ways. Professional groupings (not only in health contexts) require their members to conform to established norms through regulatory means and the judgement of their peers. Disciplinary measures, both formal and informal, are exercised on members for deviation from accepted practice (Dreyfus & Rabinow, 1983). These measures are essential for a safe and quality health service, but create particular challenges when it comes to transforming the workforce to meet burgeoning population health need.

In New Zealand a patient's normal expectation and experience of first contact primary care is to be seen by a general practitioner (GP). It's an expensive model characterised by periodic consultations with attempts at curative medicine and perhaps once did meet most people's immediate health needs. Over recent decades, however, the new normal of population health and socio-economic inequalities has left the traditional GP model wanting. The norm patients should experience for integration of complex health and social needs, is a multidisciplinary approach in which nurses play a central role. Yet where it does exist (usually servicing deprived populations) and where it pushes traditional boundaries, it is tolerated as innovative and subject to funding mechanisms that lack longevity.

The Institute of Medicine (2011) report on the Future of Nursing states that nurses have a fundamental role in the transformation of health services, and to advance health, should practice to the full extent of their education and training. Yet transformation of our outmoded system status quo will require a revolution of thought, attitude, custom, practice and policy to properly enable a way of working that should be normal in the first place. The issue of prescriptive authority has perhaps become something of a 'touchstone' in this context with the nurse practitioner (NP) role having made considerable progress in recent years toward disrupting the norm of diagnosis and prescribing as the sole purview of medicine. Later this year prescribing authority will also be available to registered nurses (RN) working in primary health care and in specialist teams. However, the use of advanced practice roles without the autonomy to align services with community need is, as Carryer and Yarwood (2015) point out, at risk of merely shoring up a system we know to be wanting. Smarter use of the nursing workforce is important, but is only one aspect of the revolution this country needs.

The whole of system primary health care revolution we need is one that aligns services to community need and where all health professionals work to the full extent of their education and training. Nurse practitioners, with their population health focus and as the leaders of primary health care services, could lead a team of nurses (e.g. practice nurses, district nurses, Plunket nurses, public health nurses, occupational health nurses, clinical nurse specialists, mental health nurses), health care assistants and allied health professionals and refer to medical colleagues when particular expertise is needed. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

The Power of Normal
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.