Complex adaptive systems: a tool for interpreting responses and
behaviours

Ellis, Beverley Suzanne

doi:10.14236/jhi.v19i2.801

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…The majority of health services research conducted using complexity theory was based in the United States [ 31 , 32 , 34 , 36 , 37 , 42 , 43 , 46 , 50 – 63 , 65 , 66 , 68 – 70 , 73 , 74 ], followed by the United Kingdom [ 40 , 41 , 49 , 64 , 71 ], Canada [ 44 , 56 ], Norway [ 33 , 39 ], Brazil [ 38 ], Congo [ 45 ], Finland [ 67 ], Italy [ 47 ], Malta [ 35 ], South Africa [ 48 ], and Sweden [ 72 ].…”

Section: Resultsmentioning

confidence: 99%

“…The settings studied using complexity theory consisted of long term care facilities [ 32 , 34 , 36 , 37 , 39 , 42 , 51 , 54 , 57 , 59 – 61 , 69 , 70 ], primary care [ 31 , 33 , 40 , 41 , 44 , 46 , 47 , 50 , 55 , 62 , 68 , 71 ], hospital [ 35 , 38 , 43 , 45 , 52 , 53 , 58 , 63 , 64 , 66 , 67 , 73 , 74 ], community health centres [ 48 , 62 , 74 ], and other (e.g., not applicable, health care systems, health trusts) [ 49 , 56 , 65 , 72 ]. Despite most of the research being conducted with multiple professions and in settings that depend upon interprofessional collaboration, only 23 % of studies used complexity theory to explicitly explore interprofessional collaboration.…”

Section: Resultsmentioning

confidence: 99%

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Scoping review of complexity theory in health services research

Thompson

Fazio

Kustra

et al. 2016

BMC Health Serv Res

128

120

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BackgroundThere are calls for better application of theory in health services research. Research exploring knowledge translation and interprofessional collaboration are two examples, and in both areas, complexity theory has been identified as potentially useful. However, how best to conceptualize and operationalize complexity theory in health services research is uncertain. The purpose of this scoping review was to explore how complexity theory has been incorporated in health services research focused on allied health, medicine, and nursing in order to offer guidance for future application. Given the extensiveness of how complexity theory could be conceptualized and ultimately operationalized within health services research, a scoping review of complexity theory in health services research is warranted.MethodsA scoping review of published research in English was conducted using CINAHL, EMBASE, Medline, Cochrane, and Web of Science databases. We searched terms synonymous with complexity theory.ResultsWe included 44 studies in this review: 27 were qualitative, 14 were quantitative, and 3 were mixed methods. Case study was the most common method. Long-term care was the most studied setting. The majority of research was exploratory and focused on relationships between health care workers. Authors most commonly used complexity theory as a conceptual framework for their study. Authors described complexity theory in their research in a variety of ways. The most common attributes of complexity theory used in health services research included relationships, self-organization, and diversity. A common theme across descriptions of complexity theory is that authors incorporate aspects of the theory related to how diverse relationships and communication between individuals in a system can influence change.ConclusionComplexity theory is incorporated in many ways across a variety of research designs to explore a multitude of phenomena.. Although complexity theory shows promise in health services research, particularly related to relationships and interactions, conceptual confusion and inconsistent application hinders the operationalization of this potentially important perspective. Generalizability from studies that incorporate complexity theory is, therefore, difficult. Heterogeneous conceptualization and operationalization of complexity theory in health services research suggests there is no universally agreed upon approach of how to use this theory in health services research. Future research should include clear definitions and descriptions of complexity and how it was used in studies. Clear reporting will aid in determining how best to use complexity theory in health services research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Scoping review of complexity theory in health services research

Thompson

Fazio

Kustra

et al. 2016

BMC Health Serv Res

128

120

View full text Add to dashboard Cite

show abstract

“…Studies have reported the importance of having experienced staff [63] who are therapeutically engaged with the patient [58] and interchange between exerting control and building the therapeutic relationship during constant observation [64]. The findings reflect that HCPs cope with the complexity of safe protection by making trade-offs between higher-and lower-level goals [65] and by ensuring that protection is individualised by taking multiple considerations into account for each patient through adaptations [66]. Guideline development should acknowledge the expertise needed to provide protection safely for each individual.…”

Section: Individualising the Therapeutic Milieumentioning

confidence: 99%

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

et al. 2020

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Background: Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals' (HCPs') capacities to adapt to challenges and changes in clinical care. Methods: This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. Results: HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients' spoken words. They improved their understanding by seeking others' perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under-and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. Conclusion: HCPs' adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs' adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.

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“…A system in CAS theory has recurrent interactions between agents via both positive (stimulating) and negative (inhibiting) feedback loops 30. The process of information return from a feedback loop continues until the system achieves its purpose 32…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses

Kutahyalioglu

Scafide

Mallinson

et al. 2021

Advances in Neonatal Care

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Background: Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent–infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice. Purpose: The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses. Methods: This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments. Results: Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β= 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices (r =−0.199, P < .001). Implication for Research and Practice: Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.

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Complex adaptive systems: a tool for interpreting responses and behaviours

Cited by 4 publications

References 16 publications

Scoping review of complexity theory in health services research

Scoping review of complexity theory in health services research

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses

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