Philosophies and Theories for Advanced Nursing Practice

Reflective Journal Week 7

Topic: Philosophies and Theories for Advanced Nursing Practice

Course objective:

1. Examine organizational theories utilized in the nursing discipline.

2. Explore possible applications of organizational theories in nursing practice, research, and theory development.

Discussion Question: 7 DQ 1

How can the DNP-prepared nurse apply the concepts of a complex adaptive system to individual patient care? Provide examples.

Complex Adaptive Systems

The science and theory of complex adaptive systems, also known as complexity science, has emerged as an alternative to existing paradigms. Complex adaptive systems demonstrate identifiable characteristics: embeddedness, self-organization, non-linearity, unpredictability, and others. These systems exhibit emergent behavior that arises from simple rules and interconnections among diverse elements with porous boundaries, as they interact with and respond to the environment. The health system and the profession of nursing can be viewed as complex adaptive systems, and when done so, new insight can be gained. While several authors have stated they believe nursing is indeed a complex adaptive system, a visual model has not yet been advanced.

Health care organizations are complex adaptive systems where things that happen are unique, dynamic, and unpredictable; they also have diverse agents including providers, patients, and other stakeholders that serve as a source of creativity and problem-solving solutions but can also create communication difficulties (McDanial, Lanham, & Anderson, 2009). The Meikirch model uses five components that spontaneously arrange themselves with interactions; these interacting components include life’s demands, biologically given potential, personally acquired potential, social determinants, and environmental determinants.  An example of how the adaptive process works in looking at how life itself is an evolutionary process starting from conception and ending at death with the demands of life, social, and environment constantly evolving with numerous adaptive processes that occur as different complex interactions happen in an individual’s life.

Complex adaptive systems (CAS) comprise five major components, and as a rule, they are labelled from “a” to “e”. The first component (a) represents the demands of life that people seek to address sufficiently. They respond to these needs by using their (b) biologically given potential and (c) personally acquired potential. These two kinds of potentials are significantly dependent on the (d) environmental and (e) social health determinants. These components are coupled with interactions that link various healthcare agents to the components (Bircher & Hahn, 2016). Therefore, DNP-prepared nurses can effectively apply the CAS to individual patient care.

DNP nurses can apply the CAS approach in problem solving by recognizing an organization’s networks and complexities and the relationships between the components of the system (Ghazzawi, Kuziemsky, & O’Sullivan, 2016). For example, they can apply the CAS in the general assessment of patient health while assessing all the important aspects of health. As such, the patients can effectively assess their lives and how their lifestyle impacts their current health condition (Bircher & Hahn, 2016). In addition, DNP-prepared nurses are able to relate the components and interactions within the healthcare system; therefore, they can help patients to understand their health, social and environmental situation better. Finally, the patients are provided more opportunities to understand the possible avenues they can use to achieve better healthcare by themselves (Bircher & Hahn, 2016).

DNP nurses are prepared to support the development and revision of healthcare policies. Therefore, they develop and evaluate patient-care models, and contribute to the assessment of cost effectiveness of patient care (Edwards, Coddington, Erler, & Kirkpatrick, 2018). This role is greatly supported through CAS. For instance, nurses get more opportunities to make informed decisions, as they understand the organizational behaviour at different levels in the healthcare setting (Ghazzawi et al., 2016). As such, nurses can identify the gaps in healthcare quality and strive to address them so as to improve patient care at different levels. In general, DNP nurses are well prepared to address healthcare issues by applying the CAS model.

Discussion Question: 7 DQ 2

Research change theories in scholarly literature and on the Internet. Develop a scenario and describe application of a change theory from the perspective of an advanced practice nurse leader.

Kurt Lewin propositioned a change theory that is highly applicable to the nursing field. A dvanced practice registered nurses (APRNs) are tasked with extensive obligations in healthcare delivery under the guidance of their nurse leaders. Lewin’s theory involves instances where change is managed by APRNs’ leaders in a process of ‘unfreezing,’ ‘moving/shifting,’ and, finally, ‘refreezing’ certain abstractions, intellections, and concepts. Lewin’s theory is contingent on the manifestation of leading and resistance forces that reverberate around the healthcare arenas.

The healthcare industry has been implementing considerable changes in the practice and techniques of patient care. Brown et al. (2017) acknowledge that technological advancements have led to the use of sophisticated machinery and gadgetry in patient recognition, identification, and diagnosis. With these implementations being significantly proliferated internationally, nurse leaders have had devastating consequences of anxiety, apprehension, and trepidation because of the shifts in paradigm and the challenges they encounter in promoting such advances to the nurses in their fraternity. Reliance on Lewin’s theory by nurses and medical staff can palatably use the stages of ‘unfreezing,’ ‘moving,’ and ‘refreezing’ in countering the skepticism of change by accepting it.

The most endearing changes in the nursing field are the use of patient recognition bar-coded bands worn by patients for facilitating bar-coded medical administration. By unfreezing the conventional roster procedure that was susceptible to err in medication, APRNs’ leaders have the role of encouraging nurses to accept the new procedure of medical administration. Resistance by many nurses who are unfamiliar with the new technology has to be enforced by the nursing leaders. Stringent conformance to the new rules has to be enforced by compulsory training, and obligatory utilization of the scanning/bar-code medical administration. Burnes and Cooke (2013) theorize that changes in technology and procedures in professional domains need not be voluntary. Nurse leaders are encouraged to compel adherence to newer technology where its accorded to be the efficient method of delivering healthcare.

Lewin’s theory is a tool that is well suited for nursing leaders to introduce prevailing technological changes to a nursing environment burdened with procrastination of the implementation of technology in enhancing medical safety. By unfreezing the conventional practices susceptible to errors, nursing leaders are given the prerogative of inducing the learning of the new technologies in their staff. Eventually, when such technologies have been implemented and wholesomely accepted, nurse leaders can refreeze the new paradigm to a new normal.