Complexity Theory As Applied To Nursing

Complexity Theory as Applied to Nursing, 2005

Abstract

Many conventional ideas about the world we live in have been shaken to their foundations by the emerging concepts of chaos and complexity. Insights are now being gained from the application of complexity theory into phenomena varying in scale from the natural sciences such as biology to the concept of caring in the nurse-patient relationship. These new scientific ideas have significant implications for the theory and practice of nursing.

This paper will cover four key concepts from complexity theory that will be introduced as relevance to nursing. These include: unpredictable dynamic systems; the whole is greater than the sum of its parts; fuzzy and permeable boundaries; and, the centrality of paradox in all of life.

Introduction

Many conventional ideas about the world we live in have been shaken to their foundations by the emerging concepts of chaos and complexity. These new scientific theories are being applied with startling results in the social and natural sciences, particularly in the biological field.

Insights are now being gained from the application of complexity theory into phenomena varying in scale from ventricular fibrillation to the spread of epidemics to the concept of caring in the nurse-patient relationship. Nursing therefore needs to be aware of these new scientific ideas as they have significant implications for the theory and practice of nursing.

Chaos and complexity theory encompasses a large field. However, in this paper four key ideas will be introduced which are of relevance to nursing:

1. Dynamic systems behave in an apparently unpredictable and chaotic fashion, making predictions of future behavior impossible unless the rules governing chaotic systems are understood. Health can be argued to be a dynamic system.

2. The whole is greater than the sum of the parts; therefore reductionism is severely limited in its use as a tool in health care.

3. Boundaries between dynamic systems are naturally fragmented and fuzzy, consequently trying to draw sharp lines between nursing and medicine, for example, is fruitless.

4. Paradox is part of life and health care is no exception, both at the micro and macro levels; therefore it is important for nurses and other health care professionals to understand paradox and its central nature in all matters.

Dynamic Systems and Chaos

One of the earliest and most accessible works which popularized chaos theory came from Gleick (1988) (Stacey, Douglas, & Shaw, 2002). He points out that science had in the past assumed that the real world progressed in a predictable way, governed by laws and mathematical formulae which allowed accurate predictions to be made. The growth in computer power enabled scientists to push their equations further as more elaborate calculations became possible.

This led to the discovery by some scientists that, although they thought they understood some types of systems, when they tried to run them forward and predict future behavior, very strange things happened. Predicting the weather with any accuracy beyond a few days, for example, defied the most powerful computers, despite a solid understanding of the laws governing the behavior of the atmosphere. It became apparent that in certain systems what happens next is heavily dependent on what happened last. These systems are very sensitive to feedback and even the slightest variation can become magnified to produce major disturbances.

This is known as sensitive dependence upon initial conditions or the 'butterfly effect' - so called because it has been said that a butterfly flapping its wings in the tropics can cause disturbances in air flow which become magnified so many times over by sensitive feedback mechanisms, that the result several weeks later is a tropical hurricane! This notion is central to chaos theory (Stacey, Douglas, & Shaw, 2002).

Such systems are known as dynamic systems and are distinct from linear systems which have the characteristic of proceeding in a straight line. An example of a linear system might be the catabolic processes occurring within the body after major infection or trauma. If nothing is done, body mass will decline at a steady and predictable rate due to a catabolic metabolism. However, dynamic systems can produce startling variability over short time-scales due to their sensitivity to feedback.

This variability can make the system appear chaotic and unpredictable, rather like the weather. However, computer analysis of such systems reveals that there is a deeper underlying order within the apparent chaos.

There are rules governing the behavior of the system over a short range in space and time, therefore it is referred to as deterministic or predictable chaos. The challenge is to discover the rules and determine how they operate so that we might gain insight into the apparently chaotic behavior before us. Deterministic chaos should be distinguished from unpredictable chaos which refers to random fluctuation or background noise, often distractingly superimposed upon the bigger picture. This is often the case over long ranges and periods of time and cannot be predicted. It is not possible in human experience (Stacey, Douglas, & Shaw, 2002).

An individual's health behavior is influenced by feedback from his or her actions. Small decisions made today can have major, unforeseen consequences tomorrow. A moment's reflection also reveals that the health care system and nursing has the characteristics of a dynamic system in that what happens today affects what happens tomorrow, often in a very powerful and unexpected way. Sensitive dependence upon initial conditions frequently exists together with a feedback linkage between events. The basic ingredients are therefore present which allow us to view health and nursing at least by analogy, as potentially chaotic systems.

The implications of this insight are simple and far-reaching; small changes today can have major and unforeseen consequences tomorrow. The corollary of which is that it is not possible to predict with any accuracy what may be all the effects of any healthcare reforms 10 or 20 years into the future, just as nobody can predict the weather, even a few days ahead. Instructional and Faculty development could have far reaching effects on the success or failure of future nurses and philosophical underpinnings of health care approaches such as critical thinking in health