The Need for Evidence Based Nursing

Health care delivery in the United States follows the systems theory approach. Systems theory was developed by Bertalanffy who used the approach to study the nature of systems. The theory could be utilized with a number of varying disciplines as the approach is applied to the use of systems which exist everywhere. Bertalanffy discussed the various ways in which systems theory could be applied. “The first is called “systems science,” or the scientific exploration and theory of systems in various sciences. The second is called “systems technology,” or the problems arising in modern technology and society. The third aspect is called “systems philosophy” and refers to the reorientation of thought and world view” (Von Bertalanffy, 1972 407). The systems approach can be utilized to describe the way in which the health care system functions.

The complex system of healthcare can be characterized by what goes into the system and what is ultimately produced. Within the system of healthcare there are inputs such as patients or financial resources which are needed to keep the system going. The throughputs are the process through which the inputs are turned into an output. Treatments for the patients or finance mechanisms can be considered some of the throughputs that are utilized. The output in these examples would be healthy patients or functioning health care systems which will be able to finance the hospital and its operating system. All procedures that keep the hospital a functioning system can be analyzed through the systems perspective. By utilizing this perspective areas that are not working can quickly be identified and solutions can be found so that the system is maintained. However, healthcare does not revolve just around the financial or “Decision support systems have been incorporated in healthcare information systems for a long time, but these systems usually have supported retrospective analyses of financial and administrative data” (Berner 2007, 3). 

The systems approach can also be directly applied to the current practice of nursing. Various theories have developed which discuss the nursing profession as a system within which care is provided to the patient. Orem (2003) developed the Nursing Systems theory to explain the way in which nurses provide care to their patients. She developed three distinct systems within that framework. Orem distinguished the role of the nurse and patient in provided treatment. In her wholly compensatory model the nurse provides all of the care for the patient. This might occur in cases where patients are in a vegetative state or in another condition where they are unable to care for themselves. Within the partial compensatory model both the nurse and the patient share the responsibility of providing care. This might occur in cases where the patient is required to follow certain directions in order to maintain the quality of their health while the nurse continues to maintain the role of administering medication. The supportive education model is one which the patient is solely responsible for their treatment. This model may exist for clients who see nurses on an outpatient basis and they must provide the treatment themselves. The systems approach can be utilized in a number of different ways to distinguish the nursing profession from other fields.  “The transaction process helps individuals and groups identify goals and outcomes that lead to effective nursing care, evidence-based practice, and cost-effectiveness” King, 2006 104). Through this process nursing can be demonstrated to be evidence based which will hold it up along with other scientific professions. 

While the systems approach can be utilized to describe the way in which the healthcare system is run. The diffusion of innovations theory can be utilized to explain the way in which healthcare system has incorporating certain technologies or practices. The theory was developed by Rogers to explain the way in which certain ideas have travelled over times throughout various cultures. Rogers theorized that there were four steps for an idea to become entrenched within a culture or system. The first is the idea which he referred to as the innovation. Then you would need communication channels through which the idea can be spread.  Time is then needed for individuals to be able to discuss and think the idea through. Finally a social system is needed which would agree upon the idea and its utilization within their society. Through these steps an idea can become widely adopted by its social system. The idea will then be taught to future generations who will continue the idea.

The theory can be utilized to discuss the way in which certain ideas have become implanted in the United States healthcare system. This theory can also be utilized to discuss the ways in which new ideas and changes can be difficult to implement. Lindstrom (2003) discussed a way in which understanding the theory can lead to the development of models which could work with introducing new concepts within the health care system. ”Complex, adaptive systems (CAS) theory is first addressed as an appropriate lens to reframe our conceptualization of the health system. Then, in contrast to negotiation, dialogue through participatory planning and decision-making is introduced” (Lindstrom, 2003, 29). Through understanding how an idea is changed over time short term strategies can be implemented in an effort to implement change early on. As healthcare reform is being discussed at this moment the ideas for reform are being created. Through the use of the media politicians are able to spread their ideas for what is needed for reform to occur. Time is needed for individuals to be able to understand the importance of the reform. With the support of the social system healthcare reform can then be adopted as the policy and can be widely adopted.

The diffusion of innovations theory can also be applied within the nursing profession. Pearcey (1996) found that although there was a considerable amount of research on the nursing profession there was a lack implementation of the strategies posed by the research that was conducted. “However, less emphasis is given to ways to facilitate utilization. It seemed possible that non-utilization could be due not only to lack of knowledge, but also to the method of implementing change towards research-based practice” (Pearcy, 1996, 714). This could be partly due to the diffusion of innovation theory in that although the research and ideas currently exist other aspects of the model are not being utilized. In order to make change within the field of nursing directly communication between nurses would be needed to spread the idea around. It would then take time for these ideas to become implemented and adopted as beneficial. Nurses would then have to provide the human capital of supporting the idea which could be done through their unions. The diffusion of innovation theory provides the model through which change can occur within the nursing profession - something that needs to happen for the future of nursing.

In order to gather information on the theories I was able to utilize Google Scholar and the CINAHL database. Google scholar required that I change the keywords that I was using before I was able to obtain the article that were directly related to the research topic. CINAHL database was more beneficial with finding the information directly. I was surprised to find the amount of research that has been done on systems theory and how it has been utilized within the nursing profession. The diffusion of innovation model provided less information related to nursing although there were a vast number of resources that discussed the theory as a whole. Most of the research did coincide to say that although the research was conducted it has not been implemented within the nursing profession. Some ideas were suggested on how implementation can occur while for others it was assumed that implementation of the ideas may not occur within the health care system as it stands now. The research provided insight into the topic of evidence-based nursing.

References

Berner, E. S. (Ed.). (2007). Clinical decision support systems: theory and practice. Springer Science+ Business Media.

King, I. (2006). A systems approach in nursing administration: structure, process and outcome. Nursing Administration Quarterly, 30(2), 100-104. 

Lindstrom, R. R. (2003). Evidence-based decision-making in healthcare: exploring the issues though the lens of complex, adaptive systems theory. HealthcarePapers, 3(3), 29.

Orem, D. E., Renpenning, K. M., & Taylor, S. G. (2003). Self-care theory in nursing: selected papers of Dorothea Orem. Springer Publishing Company.

Pearcey, P., & Draper, P. (1996). Using the diffusion of innovation model to influence practice: a case study. Journal of Advanced Nursing, 23(4), 714-721.

Sanson-Fisher, R. W. (2004). Diffusion of innovation theory for clinical change. Medical journal of Australia, 180(6), S55.

Von Bertalanffy, L. (1972). The History and Status of General Systems Theory. Academy of Management Journal, 15(4), 407-426.