Organizational adaptation in the VNA: paradigm change in voluntary sector

The organizational history of the visiting nurse association (VNA) is reviewed from the perspective of paradigm change. A paradigm is a behavioral and structural model that comes to characterize a field because of its compatibility with environmental conditions. The concept is applied to interpreting adaptation among the VNA's. Four distinct paradigms are identified which comprise the overlapping but sequential course of VNA adaptation to changing circumstances. These paradigms are "public health nursing," "community nursing service," "the home health agency," and the "home care enterprise." The emergence of each is examined with emphasis on the continuity and discontinuity of elements. Particular focus is given to the durability to date of the voluntary auspice and its future prospects in light of ongoing paradigmatic change is discussed.