Nursing and Area of Specialty Discussion

These are the discussion questions: Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your future practice specialty area, identify an issue or concern common to your future practice setting. In your initial response, please identify your specialty track, as well as the issue or concern. Discuss how this issue or concern impacts the system at the micro, meso, and macro levels. How will you address this issue or concern at the microsystem level? What is the expected impact of your solution on the meso- and macrosystems? Remember you can use an information technology-based solution to address the issue or concern. Please use my following clue to write a two paragraph discussion, more than 300 words. 1, Answer every question 2, Make sure you read the study materials attached especially in red color, and understand definitions of microsystem, mesosystem, and macrosystem. 3,my future microsystem: Patients, care teams in the department of surgery 4, my future mesosystem: Department of medicine 5, my future macrosystem: Chief finantial officer 6 , Use at least 2 outside reference in APA style Clue: My specialty area is Nursing Education. I work in the department of surgery right now, and I plan to be an educator in the same department after I graduate. There is a concern that is common: Staff including doctors, nurses and technicians tend to waste medical equipment and supplies. ( Sometimes they open by mistake, and then throw it away. They should check the procedure and make sure what exact equipment they are going to use, some of these equipment are not cheap. Also, nurses open new equipment kit to learn how to use it every time they teach a new nurse or technician. They should find a way to save all the kits and reuse it. Also, many times nurses didn’t stop patient care technician throw away the dirty gown and linen into trash bag, they should put it in linen bag.) Healthcare systems in the 21st century are complex, fluid, and flexible. The complex nature of current and future health care systems shapes the nurse’s knowledge and skills needed to practice in the system. The American Association of Colleges of Nursing (AACN) emphasizes that master’s-prepared advanced practice nurses must have foundational knowledge and skills in complexity science and systems thinking to communicate effectively and improve practice outcomes (2011). The National League for Nurses also explain the importance of using systems thinking to facilitate interprofessional team function and to support optimal health outcomes (2010). This week, students will be introduced to complex adaptive systems. Different levels of systems will be introduced with an emphasis on systems thinking skills needed to flourish in complex adaptive systems. Systems-Structure and Function Several definitions of healthcare systems exist. The definition of healthcare systems may vary depending on geographical location and practice setting. Geographically and on a global scale, the U. S. healthcare system is a mixed method payer system comprised of Medicare and Medicaid and private payer systems. In other countries, such as Australia and Canada to name a few, the healthcare system is universal in which all citizens are provided some equitable form of access to healthcare whether that country offers it at no cost or on a fee-based cost to its citizens (Torabi et al., 2014).

Healthcare systems can also be defined as structures or organizations that directly or indirectly influence health care through the delivery of services or the provision of care (Mensik, 2014), including but not limited to hospitals, health insurance companies, community-based care organizations, academic institutions, health insurance companies, pharmaceutical companies, technology companies, and legislative settings. These systems are comprised of components such as organizations, departments, and units (Mensik, 2014).

The systems can further be classified by levels: mesosystems, macrosystems, and microsystems. Regardless of specialty area, master’s-prepared advanced practice nurses work in systems. Understanding the systems and learning skills and attitudes that can help navigate the system will have a great impact on practice outcomes. Systems Theory Systems theory views a healthcare organization as a dynamic, complex set of intertwined elements continuously interacting with the environment in which it operates. A system takes inputs from the open environment in the form of various energy sources such as money, raw materials, information, and patients. A system then transforms the inputs via throughput processes and exports the products into the open environment in the form of outputs. Throughput occurs when the organization creates a new product, trains staff members, processes materials, or provides services to patients. These activities entail some reorganization of input. Systems export some products into the environment. For healthcare organizations, outputs consist of patients, insurance reimbursement, staff and patient outcomes, and so forth. The product exported into the environment provides the sources of energy for the replication of the cycle of activities (Marquis & Huston, 2017). Systems theory views a healthcare organization as multidimensional in their assumptions about cause-and-effect relationships. A change in any element of the healthcare system causes changes in other elements of the system (Marquis & Huston, 2017). Nursing and Area of Specialty Discussion

Furthermore, the pattern of activities of the energy exchanged within healthcare organizations has a cyclic character. The energy creating the cycle of activities is either derived from an exchange of the product in the external environment or the activity itself. Micro-, Meso-, and Macrosystems Organization systems can be further divided into different levels: micro-, meso-, and macrosystems. The systems can be viewed as unit, department, organization, or more globally as department, organization, and community. Each system level requires new adaptive responses from leaders to create an optimal practice environment conducive to quality outcomes. Microsystem: The inner core level represents a department within an organization such as the school of nursing within a college. In the healthcare organization, it is represented by patient care units where patients, their families, and care teams meet to create a collaborative approach to care delivery. The microsystem is where pointof-care or direct services are provided. Mesosystem: The second level represents either an organization such as a college, hospital, or community-based care organization. It can also represent the major divisions within the healthcare organization such as the department of nursing, department of medicine, and clinical service programs such as women’s health programs, oncology, neuroscience, and orthopedics. Nursing and Area of Specialty Discussion

The mesosystem is managed by nurse managers and directors. Macrosystem: This system level is the highest level. This level represents the community or an entire organization. At the community level, leaders include government entities, regulatory agencies, and professional organizations. At the organizational level, leaders include the chief executive officer, president, chief financial officer, and chief operations officer. Example: Nursing education programs are complex adaptive systems within a larger educational institution. An educational institution is a complex adaptive system with a community. The educational institution has an internal system and the community is an external system to the educational institution. Changes occurring within the nursing education program (microsystem) affect activities and outcomes in the educational institution (mesosystem). Likewise, changes in the greater community (macrosystem) can influence activities and outcomes in the nursing educational program (microsystem). Systems Thinking The master’s-prepared nurse has the skills and knowledge to flourish in a complex adaptive system through the examination of patterns and relationships of health care delivery. Change related to emerging new patterns is an ongoing occurrence in complex adaptive systems. The master’s-prepared advance practice nurse must possess change management and decision-making skills to help guide the change process and lead interprofessional teams. Systems thinking shifts the focus from individual roles and functions to collective systems internal and external to an organization (Crowell, 2015). McCormack and McCance (2017) emphasize the importance of creating collaborative, inclusive, and participative ways of working within systems to promote relationships and engagement in decision making that promotes person-centered outcomes. Understanding the interconnections within systems, change leaders seek input from multiple diverse entities, embrace diversity and innovation, and form relationships that drive and support ongoNursing and Area of Specialty Discussioning interactions and dynamic change within systems (Lis, Hanson, Burgermeister, & Banfield, 2014).

Master’s-prepared advance practice nurses also have creative thinking and inquiry skills. Thinking outside the box allows for recognition of patterns and interconnections and the impact change will have within a system (Lis et al., 2014). Complexity Science Historically, mechanistic theory, based on the assumption that organizations run like machines, influenced thoughts on organizations. Stability was a foundational principle as organizations were thought to be static, structured, orderly, and linear. Likewise, organizational changes were predictable, planned, and controlled. This mechanistic approach prevails in traditional hierarchical hospitals and institutions, in which value is placed on inflexible structures rather than complex adaptive structures (Marshall, 2011). In contemporary organizations, a paradigmatic shift has occurred, in part due to the technological explosion, expanded knowledge, and increasingly complex healthcare. With this shift, new ways of understanding organizations as flexible and fluid systems must be considered. The structure of contemporary organizations can be explained through complexity science which is derived from a collection of ideas from studies including quantum physics, systems theory, and chaos theory (Crowell, 2015). Concepts of complexity science include self-organizing systems, multi-dimensionality, and interconnected relationships (Crowell, 2015). Master’s-prepared advanced practice nurses engage in complex issues and situations regularly. Complexity science can be used to help understand the complex nature of healthcare systems. Complex Adaptive Systems Complex adaptive systems are flexible and fluid in nature. Organizations are adaptive systems that are integral parts of their environments. They are not static, but rather, are in constantly shifting states which can create uncertainty and unpredictability. Nursing and Area of Specialty Discussion

Complex adaptive systems are learning organizations that embrace uncertainty and can adapt to emerging change. Master’s prepared advanced practice nurses must become comfortable with ambiguity and uncertainty and learn to accept, manage, and benefit from uncertainty which encourages creativity, innovation, and risk taking (National League for Nursing [NLN], 2010) that leads to emergence of new order and process within the organization. Common characteristics of complex adaptive systems include: parts of systems interact; new behaviors, patterns, and ideas emerge from relationships; results are nonlinear and unpredictable; and self-organization occurs with connective leadership and simple rules (Crowell, 2015). Nursing and Area of Specialty Discussion

From a complex adaptive system perspective organizations are living systems. Healthcare and healthcare related organizations must be open and receptive to the unpredictable, dynamic, and fluid nature of their environments if they are to survive. Health care in the 21st century is complex. Patterns and processes of change are dynamic, nonlinear, and fluid. A change in any element of the healthcare system causes changes in other elements of the system (Marquis & Huston, 2017). The interconnections within a healthcare system tend to be dynamic, unpredictable, and constantly emerging. Understanding complexity science and systems theory support master’s-prepared advance practice nurse’s contributions to high-quality and safe practice outcomes (AACN, 2011). Systems thinking is foundational to interprofessional leadership in complex healthcare environments. To flourish in complex adaptive systems, master’s-prepared advanced practice nurses build upon foundational skills of self-awareness, relationship building, and creative thinking (Lis et al., 2014) to influence positive change. Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your future practice specialty area, identify an issue or concern common to your future practice setting. In your initial response, please identify your specialty track, as well as the issue or concern. Discuss how this issue or concern impacts the system at the micro, meso, and macro levels. How will you address this issue or concern at the microsystem level? What is the expected impact of your solution on the meso- and macrosystems? Remember you can use an information technology-based solution to address the issue or concern. References American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Washington, DC: Author. Crowell, D. M. (2015). Complexity leadership: Nursing’s role in health care delivery (2nd ed.). F.A. Davis Company. Lis, G. A., Hanson, P., Burgermeister, D., & Banfield, B. (2014). Transforming graduate nursing education in the context of complex adaptive systems: Implications for master’s and DNP curricula. Journal of Professional Nursing, 30(6), 456-462. Nursing and Area of Specialty Discussion https://doi.org/10.1016/j.profnurs.2014.05.003 Marshall, E.S. (2011). Transformational leadership in nursing. Springer Publishing Company. Marquis, B.L., & Huston, C.J. (2017). Leadership roles and management functions in Nursing: Theory and application (9th ed.). Lippincott, Williams, & Wilkins. McCormack, B. & McCance T. (2017). Person-centred practice in nursing and health care. Theory and practice (2nd ed.). Wiley Blackwell. Mensik, J. (2014). Lead, drive, & thrive in the system. Silver Spring, MD: American Nurses Association. National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master’s, practice doctorate, and research doctorate programs in nursing. New York, NY: National League for Nursing. Torabi, M., Green, C., Nugent, Z., Mahmud, S. M., Demers, A. A., Griffith, J., & Singh, H. (2014). Geographical variation and factors associated with colorectal cancer mortality in a universal health care system. The Canadian Journal of Gastroenterology & Hepatology, 28(4), 191-197. http://search.proquest.com.proxy.chamberlain.edu/docview/1521708996?accountid=14 7674 .. Nursing and Area of Specialty Discussion