DQ: How can the DNP-prepared nurse apply the concepts of a complex adaptive system to patient care?
DNP 815 Topic 7 DQ 1
Explain the common characteristics of complex adaptive systems. How can the DNP-prepared nurse apply the concepts of a complex adaptive system to patient care?
REPLY TO DISCUSSION
Organizational and clinical procedures such as innovations, suppliers, new technologies, and growing knowledge are seemingly growing complex in today’s health systems. Complex adaptive systems (CAS) theory to nursing practice has a significant impact on the processes and structures of health services, where nurses increase their focus on creative adaptation promotion, diversity, and information flow (Kvilience & Blazeviciene, 2019). Variables increase the flow of information through the nursing process and the promotion of timely nursing, leading to improve patient outcomes, whereas barriers can lead to adverse events and errors. The health system and the nursing profession can be viewed as CAS to gain new insight. One characteristic of the CAS is emergence, where the system develops new patterns of behavior over time and emerges in response to internal and external factors (Munro et al., 2020).
Healthcare developed complex science as a theoretical framework to better understand complex situations. The principles in CAS provide a framework enabling insight into how those operating within social networks communicate with each other to manage any concerns that are relevant to determining actions. It is very important to pay attention to the nurses’ work (Kiviliene & Blazeviciene, 2019). When caring for an
individual patient, the nurse must always keep in mind to look at the bigger picture of the possibility of being disturbed by unexpected possibilities.
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The use of complex adaptive systems as a tool such as process optimization and quality assessment is taking an
important role in nursing and health care, which can be used to guide nurses in assessing the needs of the patients, nursing process optimization, improving teamwork, and learning needs analysis (Kiviliene & Blazeviciene, 2019). A DNP nurse should look into the inclusion of complexity science into nursing leadership practice and encourages new ways of looking at the organization and the ideals and expected results of skilled nursing.
References
Kiviliene, J., & Blazeviciene, A. (2019). Review of complex adaptive systems in nursing practice. Journal of Complexity in Health Sciences, 2(2), 46–50.
https://doi-org.lopes.idm.oclc.org/10.21595/chs.2019.21169
Munro, S., Kornelsen, J., Wilcox, E., Kaufman, S., Bansback, N., Corbett, K., & Janssen, P. (2020). Implementation of shared decision-making in healthcare policy and practice: A complex adaptive systems perspective. Evidence & Policy: A Journal of Research, Debate and Practice, 16(3), 393–411.
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Replies
Yet another strong post from you. Two important characteristics of complex adaptive system worth mention are that the system is self-organized and control is distributed rather than centralized. Self-organization is a cardinal characteristics of complex adaptive system that operates on stability-instability dynamics (Butts & Richs, 2017), requiring an appropriate condition far from equilibrium or on the chaotic edge. This is simply a point where change needs to occur as the system is closer to instability. Further, control in complex adaptive system is distributed rather than centralized. Here agents or components of the system cannot operate from a blueprint or direction within or outside the system. Better explained, there exists no central control that accounts for emergent behavior or structure. Complex adaptive system is a system consisting of agents working together without any central control.
Thanks for sharing.
Butts, J. B., & Rich, K. L. (2017). Philosophies theories and for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.
Complexity science belongs to the latest generation systems thinking. Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members. The way clinicians handle uncertainty during the diagnostic process, the way physiological processes regulate, for instance, blood glucose levels and the way healthcare practices organize themselves according to a number of simple rules are examples of complex system behavior that cannot be fully understood through linear thinking alone.
Reference
Pype, P., Mertens, F., Helewaut, F.(2018) Healthcare teams as complex adaptive systems: understanding team behaviour through team members’ perception of interpersonal interaction. BMC Health Serv Res 18, 570 . https://doi.org/10.1186/s12913-018-3392-3
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Complex adaptive systems in health care are networks that interact with one another but are seen as independent and join with a common goal. This system has principles that define it. Paype et al. (2017) explain it with seven principles. First, it must have multiple components in which rich interaction must occur. It does not include only understanding the organization’s structure. Second, the interactions that occur are not always predictable behaviors. Third, there is a history and sensitivity, including initialing conditions. Fourth, their interactions are influenced by the environment. Fifth, an interaction that occurs is non-linear. Therefore, the result is dependent on elements and the input. If minor inputs occur, they can have significant effects, and major effects can have negligible effects. Sixth interactions create emergent behaviors, but this does not mean that the study of elements can explain and cannot be predicted. Lastly, as the systems are open when they are being observed, the individual that is an observer is part of the system.
A doctoral nurse prepared (DNP) nurse can use these concepts to improve the delivery of patient care. This tool assists in adapting to an ongoing change. With the increased needs of patients and changing societal contexts, a DNP must understand this system to effectively implement change and identify clinical needs. For example, Paype et al. (2017) use this approach with a focus on increasing interpersonal interaction. They implemented a Complex Adaptive Leadership Organisational Capability Questionnaire. The tool was demonstrated to be feasible for evaluating day-to-day operations and identifying quality improvements.
Another example is Munro et al. (2020) study which used complex adaptive systems to implement shared decision-making. They found that this approach goes beyond the limits of reductionism and disentangled. It fragmented the problem into barriers, facilitators, and outcomes. They were also able to have greater insight into implementation and address challenges. It explored patterns, self-organization, and interactions. In this study, this approach helped to identify solutions to address the patients, providers, and policy factors that influence the implementation of shared decision-making. These are two great examples of how this complex adaptive system can improve patient care.
Clinical care and healthcare organizations can be gleaned from emerging paradigm integrated into healthcare literature as an approach in nursing practice. Traditional science entails the laws of science compared to complexity science that emerges from simple rules (Butts & Rich, 2017). Complexity science finds usefulness in neuroscience, social and organizational behavior, and economics. Complex adaptive theory has application of complexity that shares similarity with the systems theory. “The science based in physics and mathematics that uses basic principles such as simple rules or functions to explain the relationship between variables, and that allows for variations and emergent behaviors that are not fully predictable” (Butts & Rich, 2017, p. 168). For that reason, the complex adaptive theory could be extrapolated and related to nurses as a theoretical framework.
Complex adaptive system integrates individual patient, family, and the whole healthcare system, one that resonates with nurses. Systems theories are theories of organization, and they provide the framework for the integration of different fields in science (Lalande & Baumeister, 2021). Complex adaptive system is a special type of complex systems applicable to research in physical, biological and social science. Like complex system, complex adaptive system could be adopted to solve real-life problems. Complex adaptive system is made up of agents (nurses) and pattern (formed by agents acting from a set of internalized rules). As a DNP-prepared nurse, work and work products, including change, would be carried out using complex adaptive systems theory as a theoretical foundation. Adaptation occurs through the learning system that could be fitted for a dynamic changing environment, allowing an organization to respond to the stimuli of change.
Reference
Butts, J. B., & Rich, K. L. (2017). Philosophies theories and for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.
Lalande, D., & Baumeister, R. F. (2021). Systems theories (psychology). Salem Press Encyclopedia of Health.