Complexity Science: Understanding the Implications for Critical Care Nursing Ruth Trinier, BScN, RN, CNCCP(C) Lori Liske, BScN, RN Vera Nenadovic, RN(EC), MN, MScPhD
Objec&ves Complexity Science Complex Adap&ve Systems Complex Environment of Cri&cal Care Nurse Pa&ent Feedback Loop Variables that enhance flow Barriers to informa&on flow
How Wolves Change Rivers
Complexity Science Complexity science examines systems comprised of mul&ple and diverse interac&ng agents and seeks to uncover the principles and dynamics that affect how such systems evolve and maintain order (Lindberg & Lindberg, 2008, p.32)
Complexity Science Ø Chaos theory order emerges from disorder Ø Complexity interrela&onships organized into pauerns no ra&onal predictable behaviour new, more complex structures spontaneous ac&vity holis&c universe, complex, interdependent
Complexity Science Ø Hysteresis phenomena dependent on earlier historical past states ini&al condi&on unpredictable possible future Ø Neo- Newtonian prac&ces standardiza&on, rou&nes assume processes as predictable tradi&onal health care model
Complex Adap&ve Systems Interconnected individual components React in an unpredictable fashion Influence other members of the group Each component is a CAS embedded within another CAS Changes in one system affect and shape all connected systems
Complex Adap&ve Systems community hospital nursing unit nurse healthcare system
Complex Adap&ve Systems Dynamic, unstable Adapta&on and evolu&on Small changes may have large effects Large changes may have small effects Self organizing
Complex Adap&ve Systems
Delivery of Pa&ent Care Treatment Surveillance Educa&on Experience Standards Competencies Communica&on Technology and Tools Policy and Procedure Phronesis Expecta&ons Experience Energy Hysteresis
Pre- Arrest: Raw data & Standard devia&on Raw Data 140 120 100 80 60 40 20 0 5:00 5:02 5:04 5:06 5:08 5:10 5:12 5:14 5:16 5:18 5:20 5:22 5:24 2:26 5:28 5:31 5:33 5:35 5:37 5:39 5:41 5:43 5:45 5:47 5:49 5:51 5:53 5:55 5:57 5:59 HR O2 Sat RR MAP Standard Devia.on in 10 minute intervals 60 minutes pre- arrest 35 30 25 20 15 10 5 0 T- 10 T- 20 T- 30 T- 40 T- 50 T- 60 HR O2 Sat RR MAP
Ques%ons?
References Begun, J. W., Zimmerman, B., & Dooley, K. (2003). Health care organiza.ons as complex adap.ve systems. In S. M. Mick & M. WyMenbach (Eds.), Advances in health care organiza.on theory (pp. 253-288). San Francisco: Jossey- Bass. Curley, M. A., & Hickey, P. A. (2006). The Nigh.ngale metrics. American Journal of Nursing, 106(10), 1-5. Retrieved from hmp://childrenshospital.org/clinicalservices/site1544/documents/metricsajn%20.pdf Davidson, A. W., Ray, M. A., & Turkel, M. C. (2011). Nursing, caring, and complexity science: For human- environment well- being. New York, NY: Springer Publishing Company. Dykes, P. C., Rothschild, J. M., & Hurley, A. C. (2010). Medical errors recovered by cri.cal care nurses. Journal of Nursing Administra.on, 40 (5), 241-246. doi: 10.1097/NNA.Ob013e3181da408e Ebright, P. R., (2010). The complex work of RNs: Implica.ons for healthy work environments. The Online Journal of Issues in Nursing, 15(1). doi: 10.3912/OJIN.Vol15No01Man04. Retrieved from hmp://www.nursingworld.org/mainmenucategories/ ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Complex- Work- of- RNs.html? css=print Gill, F. J., Leslie, G. D., Grech, C. & Latour, J. M. (2013). Health consumers experiences in Austrailian cri.cal care units: Postgraduate nurse educa.on implica.ons. Nursing in Cri.cal Care 18(2), 93-102. Hawley, P. M. & Jensen, L. (2007). Making a difference in cri.cal care nursing prac.ce. Qualita.ve Health Research, 17(5), 663-674. Henneman, E. A., Gawlinski, A., Blank, F. S., Henneman, P. L., Jordan, D., & McKenzie, J. B. (2010). Strategies used by cri.cal care nurses to iden.fy, interrupt, and correct medical errors. American Journal of Cri.cal Care, 19(6), 500-509. doi: 10.4037/ ajcc2010167 Henneman, E. A., Gawlinski, A., & Giuliano, K. K. (2012). Surveillance: A strategy for improving pa.ent safety in acute and cri.cal care units. Cri.cal Care Nurse, 32 (2), e9- e18. doi: 10.4037/ccn2012166 Kirsch, V., VanSell, S., & Grant, R. (2002). Synergy or complexity theory: Which one belongs in the ICU? ICUs and Nursing Web Journal, 11, 1-14. Nigh.ngale, F. (1860). Notes on nursing (Dover ed., pp. xvi). New York: Dover Publica.ons Rothschild, J. M., Bates, D. W., Franz, C., Soukup, J. R., & Kaushal, R. (2009). The costs and savings associated with preven.on of adverse events by cri.cal care nurses. Journal of Cri.cal Care, 24(3), 471 e471-477. Rothschild, J. M., Hurley, A. C., Landrigan, C. P., Cronin, J. W., Martell- Waldrop, K., FoskeM, C.,... Bates, D. W. (2006). Recovery from medical errors: the cri.cal care nursing safety net. Joint Commission Journal on Quality & Pa.ent Safety, 32(2), 63-72. Rothschild, J. M., Landrigan, C. P., Cronin, J. W., Kaushal, R., Lockley, S. W., Burdick, E.,... Bates, D. W. (2005). The Cri.cal Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care. Cri.cal Care Medicine, 33(8), 1694-1700. Rogers, A. E., Dean, G. E., Hwang, W. T., & ScoM, L. D. (2008). Role of registered nurses in error preven.on, discovery and correc.on. Quality & Safety in Health Care. 17(2), 117-121. doi: 10.1126/qshc.2007.022699 Schindler, C. A., Mikhailov, T. A., Kuhn, E. M., Christopher, J., Conway, P., Ridling, D., ScoM, A. M. & Simpson, V. S. (2011). American Journal of Cri.cal Care. 20(1), 26-34. Shever, L. L. (2011). The impact of nursing surveillance on failure to rescue. Research and Theory for Nursing Prac.ce: An Interna.onal Journal, 25 (2), 107-126.