Nursing Complexity

Our 2nd annual Nursing "On the Edge" conference!

2008-12-29T08:44:00.000-08:00

Save the Date! and join us this summer at the picturesque Saint Joseph's College of Maine in Standish Maine for the 2nd annual Nursing and Complexity "On the Edge" conference series, July 12-14, 2009. We will be exploring the implications of complexity science for nursing and healthcare in the age of complexity. Learn together with our faculty and fellow conference participants who are applying cutting edge complexity inspired approaches and solutions to the most pressing issues in healthcare today.

Our list of facult, thus far, includes:

Ruth Anderson, Senior Fellow, Center for Aging and Human Development and Professor at Duke University School of Nursing.

Shona Brown, Director of Nursing and Governance at Whipps Cross University Hospital.

Pat Ebright, Professor at the Indiana University School of Nursing

Bruce West, Chief Scientist Mathematical and Information Science Directorate at the Army Research Office

Marjorie Wiggins, Vice President of Nursing, Maine Medical Center

Check our website for more information and how to sign up to receive news and updates on the conference.

All Conference Photos

2008-08-05T09:59:00.000-07:00

By Joseph Hannan

'On the Edge' Conference Winds Down

2008-08-05T09:34:00.000-07:00

By Joseph Hannan

The Plexus Conference, "On the Edge: Nursing in the Age of Complexity" is drawing to a close at Unity Village, Missouri. At this point, conference participants have had ample opportunity to take advantage of the beautiful facilities, thought-provoking presentations and engaging conversation.

This morning, MSN Mark Toles gave a presentation titled "Building Relationships to Improve Quality-Local Interaction Strategies." Toles is a doctoral candidate at Duke University and his presentation was a review of his innovative doctoral research.

The presentation was well received by conference participants. Toles fielded numerous questions.

Jim Begun also presented his findings from his "Wicked Questions" activity. His results were distributed and self-organized groups formed to review a particular category of "Wicked Questions" or any issue of their choice.

Here are some photos of the discussion groups:

Check back tomorrow for a conference summary and a slideshow featuring all conference photos.

Begun Reveals 'Wicked Questions' Findings

2008-08-05T07:24:00.000-07:00

By Joseph Hannan

Jim Begun unveiled his findings this morning from his "Wicked Questions" activity. You can download a Microsoft Word document containing the results here.

Begun's Posts 'Wicked Questions'

2008-08-04T14:30:00.000-07:00

Prior to the conversation cafe, Jim Begun posted categories of "wicked questions" at the front of the conference room. Throughout the rest of the evening and tomorrow morning, conference participants will each mark two questions they deem important. Begun will then analyze the results and determine a consensus.

Here are photographs of each posting:

Nurse Managers Confront Paradox

2008-08-04T12:25:00.000-07:00

Joseph Hannan

As a profession, nursing faces a number of paradoxes, particularly in the Nurse Manager position. In her chapter of "On the Edge," Deborah Tregunno and Brenda Zimmerman identified and explained nursing paradoxes through a Complexity Science lens.

Tregunno pinpointed several nursing paradoxes in her chapter, "A Mobius Band: Paradoxes of Accountability for Nurse Managers. She and Zimmerman wrote the following:

We have identified three areas of tension for nurse managers in today's demanding practice settings: 1) efficiency and effectiveness, 2) task and relationship, and 3) stability and change. Any of these can pose seemingly contradictory responsibilities for nurse managers in their daily activities.

Tregunno and Zimmerman defined each of the paradoxes in the following way:

1) "Do more with less."
2) "The tension between task orientation and relationship management."
3) "To innovate and adapt and yet to keep things on track and predictable."

Tregunno is aware of the usefulness of a good story and sought one that would help to illustrate paradox in nursing. "What story can I use to illustrate the complexity?" Tregunno asked. She immediately thought of the SARS outbreak in Canada, examining the different reactions to the outbreak in Toronto and Vancouver.

The chapter mentions two completely different reactions to the outbreaks in Tornoto and Vancouver, illustrating a paradox.

Breakout session participants said the balanced scorecard approach to nurse management may actually be affecting patient care. "We don't focus on patient care," one participant said. Under the demands of the balanced scorecard approach, patient care may take a back seat to the completion of paperwork--an area that the Joint Comission scrutinizes.

"If we only pay attention to these measures, then we can be missing a lot of things," Tregunno said.

This breakout session really came alive with discussion, particularly with the introduction of R. Cook and J. Rasmussen's "Going Solid: A Model of System Dynamics and Consequences for Patient Safety."

Participants discussed challenges of working within the present healthcare system--particularly the inability of nurses to refuse to take on additional demands, the inability "to say no," as one person said.

"There is a finite resource to our time," one participant said. It would seem that paradox is an issue nurse managers will continue to confront in the ever-evolving healthcare system.

Breakout Session Photos

2008-08-04T11:35:00.001-07:00

By Joseph Hannan

Lindberg & Lindberg Explore Compexity Science Through Stories

2008-08-04T09:28:00.000-07:00

By Joseph Hannan

Perhaps you're new to Complexity Science. This afternoon, "On The Edge" authors hosted informal breakout sessions on various topics including "Nursing Theory and Complexity" by Mary Gambino, "From Doing To to Entering Into Collaborative Partnership informed by Complexity" by Sue Nash, "The Art, Science and Complexity of Clinical Reasoning" by Dan Pesut and a "Primer on Complexity" hosted by Claire and Curt Lindberg.

I sat in on the Lindbergs' session to provide readers with a summary of their introduction to Complexity Science. Here is what I found.

As Claire Lindberg suggested in her opening remarks at the onset of the conference, all conference attendees have come to this year's gathering because they are leaders and innovators within their respective fields. The conference participants gathered here today are an indicator of what nursing is doing right.

Each of these participants brings a distinct set of experience to the conference including specific sets of successes and challenges each of their organizations face. Claire Lindberg introduced the concept of positive deviance (PD) in dealing with these challenges.

She used the following example: Claire Lindberg often asks students to think of people who are adept at consoling grieving patients and family members. She said many students say they don't have the time to deal with this particular issue, but all are able to name other nurses or hospital employees who are great at providing support for the grieving.

Curt Lindberg explained that this is PD in action. He and Claire Lindberg said that through this form of shared sensemaking, new intellectual discoveries can be realized. In this particular situation, nursing students and nurses can learn how to better console grieving patients and families by conversing with other healthcare employees and among themselves.

"This science can be very overwhelming," Curt Lindberg said. He added that the use of stories can help to explain concepts of the science of complexity. "By asking (students) to uncover stories of that principle it really makes it real to them.

"Stories can convey the complexity of a situation much better than a Powerpoint or an outline," Curt Lindberg said.

Claire Lindberg also said it is important for students to understand the concept of embeddedness. "Let the students go through the exercise of going through those layers that either facilitate or interfere" with the provision of care, she said. She asked students to consider a nurse and then branch outward, exploring the other layers of care at the family or even cultural level.

Participants in the breakout session seemed receptive, sharing their own stories and career experiences. The informal conversation generated numerous new ideas that will prove beneficial.

Additional Items from Day One

2008-08-04T07:52:00.000-07:00

By Joseph Hannan

Here are some additional photos from yesterday's proceedings, including the author panel and Jim Begun's presentation, "Positioning Nursing for Leadership in a Complex Healthcare System":

Begun Seeks 'Wicked Questions'

2008-08-04T07:16:00.001-07:00

By Joseph Hannan

Jim Begun hosted this morning's recap of yesterday's conference items. This was done in a thought provoking, innovative way.

He asked conference participants to come up with "wicked questions" about nursing--questions that would help move nursing forward by tackling difficult issues. Here is a sample of those questions:

-- "If we're so compassionate, why are we so mean to each other in the workplace?"

--"How we balance evidence-based practice with the art of nursing?"

--"Why do we as a profession value other disciplines more?"

--"Why is education not seemingly valued by practicing nurses?"

--"How do we give the best possible care with using the least possible resources?"

--"How do we as nurses leverage what I know and do to keep the whole profession moving
forward?"

--"Why is compassion the core of nursing?"

--"Why is practice not valued in the practice setting?"

--"Why is it so hard for us all to come together for the same goal?"

--"Can we move to the edge without leaving the mainstream?"

--"The high level of responsibility versus the power that nurses have."

--"If nursing is so good at connecting, exploring and making sense, why is the healthcare system so maladaptive?"

--"Why do we spend so much time on externals and not on our internal development?"

--"How can nursing become so highly technological and still retain our wholisitc focus on the patient and the family?"

Please post your friendly, non judgmental responses to these questions in the comments field of this entry. Let's keep this discussion moving forward so that solutions can emerge.

Pesut Advocates for Complexity-Inspired Practice

2008-08-03T12:05:00.000-07:00

By Joseph Hannan

Nursing exists on a verge, according to Dan Pesut. He said many of the participants in this year's conference have come "to embrace the complexity and the diversity of the relationships (they're) engaged in."

In his opening remarks, Pesut said historically, nursing has been torn between many different practice approaches including rule-based and evidence-based methods. Pesut advocated for a non-linear, wholisitc approach that will help nurses to improve their work--an approach that embraces creativity and complexity.

He referred to Complexity Science as being a "second-tier value development"--a wholistic lens through which a new understanding can be achieved. Pesut said the science of complexity has great potential for nursing in terms of addressing issues faced by the modern nurse. He asked conference participants to self-organize into groups and discuss both personal nursing values and applications of Complexity Science for nursing.

Through group discussion, new ideas about Complexity Science and how it will benefit nursing emerged. Nurses, nursing professors, nursing administrators, communications professors and even an engineer shared their thoughts on how the linear world view is no longer applicable.

The stories that emerged from the discussion seemed to suggest that the conference participants each had an inherent knowledge of the science of complexity as it applies to their professions. Dramatic results in the form of new insight are emerging early on in the conference.

Editors Kickoff Nursing Conference

2008-08-03T11:42:00.000-07:00

By Joseph Hannan

Three years ago, "On the Edge: Nursing in the Age of Complexity" began at a conference just like this. Innovation occurs during events in which leading thinkers gather and share their ideas--Complexity Science in action.

This year's nursing conference is sure to produce similar results. Curt Lindberg, Claire Lindberg and Sue Nash, 'On the Edge' editors, each said this year's conference will rely extensively on the ideas of its participants.

Claire Lindberg said the presence of so many healthcare professionals, including doctors, nurses and administrators among others, indicates the forward-thinking nature of the healthcare industry.

These passionate members of the healthcare community will discuss various issues and colaborate to produce astonishing results throughout the coming days. It will be interesting to see what results the "On the Edge" conference will produce.

'On The Edge' Conference Begins

2008-08-03T09:38:00.000-07:00

By Joseph Hannan

Greetings from Unity Village. It's a beautiful day in Kansas City, Missouri--sunny with the temperature climbing into the upper 90s.

We're currently working on setting up for the conference. We've been given an enormous room which we've filled with concentric semicircles.

The conference will begin at 1:30 p.m. Check back frequently for more updates.

How Do You Choose the Best Nursing Home for your Parents

2007-09-12T08:53:00.000-07:00

If you had to put your parent[s] in a nursing home, how would you go about choosing the right nursing home? Well here is a great resource for you. Dr. Ruth Anderson, Professor of Nursing at Duke University and a Plexus Scientific Advisory Board member and Dr. Reuben McDaniel, Jr. professor of management science and information systems in the McCombs School of Business at the University of Texas in Austin and a Plexus Scientific Advisory Board member, in studying the impact of management practices on health care organizations, have found what makes for a great nursing home.
The article is beautifully written by Arvind Singhal, [Plexus trustee, and the Samuel Shirley and Edna Holt Marston Professor of Communication, and Senior Research Fellow at Sam Donaldson Center for Communication Studies, University of Texas, El Paso] and is published by Plexus.

So what did they find? That the quality of care depends on the quality of relationships among staff members. Intrigued?.... read the full article here.

And if you have any stories re finding a nursing home, working in one, what you think of this article.... just click on comment!