Systems Thinking and Incivility in Nursing Practice: An Integrative Review

Background and Purpose There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient‐related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level‐headed thinking from which patient‐centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings? Methods Whittemore and Knafl\u27s integrative review method guided this study. The quality of articles was determined using Chu et al.’s Mixed Methods Assessment Tool. Results Thirty‐eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice. Implications for Practice This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety

Systems Thinking and Incivility in Nursing Practice: An Integrative Review

Background and Purpose There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient‐related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level‐headed thinking from which patient‐centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings? Methods Whittemore and Knafl\u27s integrative review method guided this study. The quality of articles was determined using Chu et al.’s Mixed Methods Assessment Tool. Results Thirty‐eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice. Implications for Practice This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety

Incivility and the Use of Systems Thinking To Promote Healthy Voluntary Organisations

Incivility in voluntary organisations is critically burdensome on a global level, but there is a dearth of literature on how to contend with the problem. This paper provides a description and an evaluation of and reflection on a workshop conducted to propose an evidence-based systems awareness model (SAM) for volunteers in professional organisations to use in mitigating incivility. Implications of the SAM model for a culture of caring in the voluntary sector are described

Systems Thinking for Transitions of Care: Reliability Testing for a Standardized Rubric

Purpose: The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists. Design: The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice. Methods: Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach’s α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric. Results: Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α’s ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section. Conclusion: The research team recommends using the rubric to reflect application of systems thinking across transitions of care

Incivility and the use of systems thinking to promote healthy voluntary organisations

© Policy Press 2019 Incivility in voluntary organisations is critically burdensome on a global level, but there is a dearth of literature on how to contend with the problem. This paper provides a description and an evaluation of and reflection on a workshop conducted to propose an evidence-based systems awareness model (SAM) for volunteers in professional organisations to use in mitigating incivility. Implications of the SAM model for a culture of caring in the voluntary sector are described

La lutte contre la tique du bétail en Nouvelle Calédonie : quelle stratégie pour l'an 2000 ? Rapport de mission en Nouvelle Calédonie du 15 au 22 janvier 1996

La tique Boophilus microplus est un des obstacles au développement de l'élevage bovin en Nouvelle Calédonie. L'apparition de résistances à la deltaméthrine dans quelques élevages est l'occasion de réfléchir à une meilleure stratégie à mettre en place. Un suivi du développement de la résistance dans des élevages représentatifs selon les protocoles standards doit être instauré, et la deltaméthrine remplacée par l'amitraze là où cette résistance est confirmée. Un effort de communication et d'information doit être fait auprès des éleveurs pour restreindre l'usage des acaricides, les initier à la biologie des tiques et aux principes de lutte, éviter les erreurs dans l'utilisation des systèmes de détiquage. Des méthodes de lutte complémentaire (vaccin, lutte génétique et agronomique) devront être vulgarisées. L'éradication ne semble pas réalisable dans la situation actuell

A Concept Analysis of Systems Thinking

PURPOSE This concept analysis, written by the National Quality and Safety Education for Nurses (QSEN) RN-BSN Task Force, defines systems thinking in relation to healthcare delivery. METHODS A review of the literature was conducted using five databases with the keywords “systems thinking” as well as “nursing education,” “nursing curriculum,” “online,” “capstone,” “practicum,” “RN-BSN/RN to BSN,” “healthcare organizations,” “hospitals,” and “clinical agencies.” Only articles that focused on systems thinking in health care were used. The authors identified defining attributes, antecedents, consequences, and empirical referents of systems thinking. FINDINGS Systems thinking was defined as a process applied to individuals, teams, and organizations to impact cause and effect where solutions to complex problems are accomplished through collaborative effort according to personal ability with respect to improving components and the greater whole. Four primary attributes characterized systems thinking: dynamic system, holistic perspective, pattern identification, and transformation. CONCLUSION Using the platform provided in this concept analysis, interprofessional practice has the ability to embrace planned efforts to improve critically needed quality and safety initiatives across patients’ lifespans and all healthcare settings

Teaching Innovations Using Systems Thinking to Guide Fieldwork Projects in RN-to-BSN Education

Background: A critical need exists to improve quality and safety within RN-to-BSN education through innovative teaching strategies. RN-to-BSN students are poised to improve patient outcomes through system-level awareness by use of scholarly fieldwork projects within practice settings. The purpose of this scholarship of teaching project was to use an adapted version of the Systems Awareness Model to develop and categorize RN-to-BSN students’ learning experiences and capstone-type fieldwork projects guided by systems thinking. Faculty members of the Catalysts for Change Community led this project. Methods: A modified Delphi technique using multiple iterations to reach consensus by faculty experts was used in the design of this scholarship of teaching project. The philosophical underpinning guiding this project was collaborative scholarship. The seven steps of the System Awareness Model adapted for leadership and management were used to guide faculty championing quality and safety of innovative teaching strategies in face-to-face, hybrid, or online teaching-learning environments. Results: Faculty described examples of evidence-based practice (EBP), change, and practice projects including ideas, titles, and descriptions in alignment with Quality and Safety Education for Nurses (QSEN) competencies and with newly adopted American Association of Colleges of Nursing Education Essentials. A grading rubric is provided for evaluating fieldwork student project outcomes. Conclusions: The teaching strategies and fieldwork projects described in this paper reinforce the American Association of Colleges of Nursing (AACN) RN-to-BSN White Paper and the Commission on Collegiate Nursing Education (CCNE) Teaching Standards. Suggestions for future research are offered

Teaching Innovations Using Systems Thinking to Guide Fieldwork Projects in RN-to-BSN Education

Background: A critical need exists to improve quality and safety within RN-to-BSN education through innovative teaching strategies. RN-to-BSN students are poised to improve patient outcomes through system-level awareness by use of scholarly fieldwork projects within practice settings. The purpose of this scholarship of teaching project was to use an adapted version of the Systems Awareness Model to develop and categorize RN-to-BSN students’ learning experiences and capstone-type fieldwork projects guided by systems thinking. Faculty members of the Catalysts for Change Community led this project. Methods: A modified Delphi technique using multiple iterations to reach consensus by faculty experts was used in the design of this scholarship of teaching project. The philosophical underpinning guiding this project was collaborative scholarship. The seven steps of the System Awareness Model adapted for leadership and management were used to guide faculty championing quality and safety of innovative teaching strategies in face-to-face, hybrid, or online teaching-learning environments. Results: Faculty described examples of evidence-based practice (EBP), change, and practice projects including ideas, titles, and descriptions in alignment with Quality and Safety Education for Nurses (QSEN) competencies and with newly adopted American Association of Colleges of Nursing Education Essentials. A grading rubric is provided for evaluating fieldwork student project outcomes. Conclusions: The teaching strategies and fieldwork projects described in this paper reinforce the American Association of Colleges of Nursing (AACN) RN-to-BSN White Paper and the Commission on Collegiate Nursing Education (CCNE) Teaching Standards. Suggestions for future research are offered