course materials

1. Nursing and Area of Specialty Discussion HW
Nursing and Area of Specialty Discussion HWNursing and Area of Specialty Discussion
HWThese 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. Nursing and Area of
Specialty Discussion HWORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSThey
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 optimal health outcomes (2010). This week, students will be
introduced to complex adaptive systems. Different levels of systems will be introduced with

2. 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). 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. Nursing and Area of Specialty Discussion HWThe 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

3. 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. 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 ongoing
interactions and dynamic change within systems (Lis, Hanson, Burgermeister, & Banfield,
2014). Master’s-prepared advance practice nurses also have creative thinking and inquiry
skills. Nursing and Area of Specialty Discussion HWThinking 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

4. 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. 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). 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 master’s-prepared advance practice nurse’s contributions to high-quality
and safe practice outcomes (AACN, 2011).Nursing and Area of Specialty Discussion
HWSystems 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. https://doi.org/10.1016/j.profnurs.2014.05.003

5. 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,Nursing and Area of Specialty
Discussion HW