It wasn't long after I started my classes that I was introduced to the term 'upstream thinking'. We were told that as nurses, we must be 'upstream thinkers' and we all nodded our heads, pretending that we knew what the instructors were talking about. Finally, my Health and Healing teacher explained the term last week, and I can now totally understand why this term is used so much. It's important!
I'll explain to you what upstream thinking is the same way our teacher taught us last week:
Imagine a flourishing little village of happy indians that live on the side of great big river. Their lives are very simple and easy. The land they live on is lush and bountiful, they hunt and gather for their food and there is never a shortage. Everyone is happy.
Then one day, as the villagers were each going about their daily activities, they heard frantic cries from the water, and they all ran to the bank of the river just in time to see a small drowning child being swept along by the current! The entire village mounted a big rescue party. Running down stream, the men were able to grab the child before he went over the edge of the water fall. Whew!
Well, after this incident, it wasn't long until the very same thing happened again a week later. All the villagers were drawn to the river bank by the frantic screaming of a little girl, unable to escape the fast water. Again, the village went after the child and were able to snatch her out of the water just in time.
Again and again each week this same event occurred. The peaceful, worry-free lives of the villagers was disturbed by desperate attempts to save children that were drowning in the river. Some of the time they were successful in their mission, but other times they heard the cries too late and the little boys and girls went tumbling over the waterfall to their deaths.
This went on for so many years that nobody in the village could remember a time when their lives were peaceful and they didn't have to worry about saving children from the river. But they never gave up, and always went after the kids in need.
Finally, one day after a failed attempt to save a small boy, one young man that was very troubled by the event sat down to think about the village's woes. Then he asked a question that no one had ever asked before:
"Where are these children coming from?"
That question caused quite a stir. No one had ever thought to try and find the source of the children! So the village formed a search party, and the group of strong men went off up river in search of the place the children came from. After many days of hiking through the rugged forest, they came to a village much like theirs and saw there that the villagers let their children play much to close to the slippery bank of the river, and that the same boys and girls were slipping and falling into the water. The men quickly sought out the chief of the village and explained the situation to him. He was shocked! For many years the children in their village had been going mysteriously missing and no one could discover where they went. The chief fixed the problem immediately and built a wall beside the slippery river side so that the children would no longer fall in.
The men returned home and delivered the good news. Everyone was happy again and the village could return to their simple, carefree lives again.
This is a long story to explain a simple truth. Nurses must be like the young man that thought to ask, "Where are the children coming from?" Instead of just treating the problems again and again and again, we have to ask, "Why is this problem occurring?" because maybe if we do, we can stop the problem before it happens. That's upstream thinking.
AN EXAMPLE:
Bobby has an infected arm.
-Why?
Because he got a cut on his arm and it got infected
-How did he get the cut?
He was playing in the junk yard and he fell on a piece of jagged scrap metal.
-Why was he playing in the junk yard?
Because it's close to his house and he and his friends go there often to play together, unattended.
-Why is there a junk yard to close to his house? Why is there no one to watch Bobby and his friends?
Bobby lives in a low income neighborhood of mostly single, working parents that are jut getting by. His mother works 2 jobs and can barely make ends meet, like the other parents in the neighborhood.
By going to the source of the problem, nurses can be advocates for change in their communities. They can see problems and raise their voices for the people that don't have a voice.
Interesting, isn't it? Does the concept make sense to you?
