### Transcription of A CASE FOR CHAOS THEORY IN NURSING - …

1 Australian Journal of Advanced **NURSING** 2001 V olume 18 Number 3A B S TR A C TThis paper addresses the question of why nursesshould understand **CHAOS** **THEORY** . A critique of theliterature is used to demonstrate how **CHAOS** **THEORY** hasbeen utilised in a number of disciplines, includingnursing. Possible applications of **CHAOS** **THEORY** innursing are proposed in order to demonstrate whereit might assist nurses, in particular researchers,educators and policy makers. The appropriateness ofthe application of **CHAOS** **THEORY** as a framework forknowledge generation is also discussed. I N T R O D U C T I O NChaos **THEORY** has been developed from thedisciplines of mathematics, computer science andmeteorology and stems from earlier work by anumber of mathematicians.

2 During the last two decades ithas been identified as one of the new sciences (Gleick1987). **CHAOS** **THEORY** is a science of the global nature ofsystems which enables simple mathematical equations tomodel complex systems. Small differences in input canhave dynamic responses in output. This phenomenon hasbecome known as sensitive dependence on initialconditions (Gleik 1987 ). **NURSING** practice involves complex dynamic systemsand it can be argued that it would be amenable to analysisusing the methods of **CHAOS** **THEORY** . However, few nursingarticles use **CHAOS** **THEORY** as a framework for understandingthe **NURSING** context. This paper will argue that nurseswould benefit from understanding **CHAOS** **THEORY** andthrough its application gain a greater understanding oftheir practice.

3 A number of questions are addressed: Whatis **CHAOS** **THEORY** ? How has **CHAOS** **THEORY** been appliedwithin the **NURSING** literature and is this an appropriate useof the **THEORY** ? How can it assist **NURSING** ? Is it anappropriate theoretical construct for **NURSING** knowledgegeneration?Why should nurses understand **CHAOS** **THEORY** ?The question of why any researcher needs tounderstand **CHAOS** **THEORY** is one of importance. It can beargued that in order to gain new insights into phenomenaof interest, underlying frameworks of analysis have to beunderstood. This is not unique to **NURSING** . The newersciences, such as quantum mechanics and **CHAOS** theoryhave been, and will increasingly be, used as such aframework.

4 **CHAOS** **THEORY** is argued by a number of nurseresearchers to offer a new paradigm science perspectiveand to provide new ways to examine the world (Copnell1998; Pediani 1996; Barker 1996; Coppa 1993; Phillips1991). The **THEORY** must be understood before it can beapplied to any **NURSING** context. Without this understandingtheory will be adopted without due regard to theSCHOLARLY PAPER14 Margaret Lett, RN, BAppSc (Adv Nur), MNSt, MRCNA, isLecturer in **NURSING** , Australian Catholic University, St Patrick sCampus, Fitzroy, Victoria, AustraliaAccepted for publication November 2000A CASE FOR **CHAOS** **THEORY** IN NURSINGKey Words: **CHAOS** **THEORY** , **NURSING** , knowledge development, nonlinear systemsAustralian Journal of Advanced **NURSING** 2001 V olume 18 Number 3applicability of the concepts and therefore informeddiscussion, evaluation or critique becomes impossible.

5 New applications for **CHAOS** **THEORY** are being proposedand these will directly influence the knowledge base andpractice of nurses. **CHAOS** **THEORY** has already been used asa framework for research in areas such as physiology,demographics, economics and business planning, theologyand leadership **THEORY** . Some of these have a direct effecton is **CHAOS** **THEORY** ? **CHAOS** **THEORY** explains how complex systems (1987) believes that **CHAOS** is not simple anarchy butthat complex systems follow some very simple changes can result in large differences, which arenot proportional to the magnitude of the change. Thiscreates a nonlinear relationship. For example, a smallchange in wind turbulence can lead to large changes inweather in another area.

6 These charges are not random butcan be predicted using computers and simple mathematics. The **NURSING** literature on **CHAOS** theoryOn searching the computerised library databases forchaos **THEORY** in **NURSING** , 49 articles were highlighted. Anumber of these had to be excluded on the grounds thatthey were not **NURSING** related. Excluded were articles inthe areas of homoeopathy, chiropody and rehabilitationcounselling. A PhD thesis in **NURSING** was also excluded onthe grounds of availability. The earliest article found waspublished in 1991 and since then there has been aprogressive increase each year. A selection of articles,from the Journal of Theoretic and Applied **CHAOS** inNursing , were included in this review.

7 This particularjournal is, as the name suggests, a very specialised journaldevoted to **CHAOS** **THEORY** and its application to **NURSING** . Thefirst issue of this journal appeared in 1994. Murray (1997),supports the view that there is little **NURSING** literature onchaos **THEORY** and has stated that there is minimal **NURSING** -related material which deals with **CHAOS** , complexity ornonlinear dynamics. This could be used as supportingevidence for the notion that there is therefore no need fornurses to study **CHAOS** **THEORY** , but this is a short-sightedview. More articles are appearing each year and at thisstage the possibilities **CHAOS** **THEORY** offers **NURSING** havenot been fully 1991 nurses who have made a contribution to thenursing literature on **CHAOS** **THEORY** include Murray (1997,1992), Phillips (1992, 1991) and Vicenzi (1994) andVicenzi et al (1997).

8 In 1991, Phillips discussed thepossibilities **CHAOS** **THEORY** offered to **NURSING** research andparticularly qualitative research. This discussion wasbased on the opinion that an understanding of naturalisticinquiry and nonlinear statistical models will enable nurseresearchers to gain insights into the instability andunpredictability of systems. This article provoked a rebufffrom Puskar et al (1992) who reminded Phillips that chaostheory was a mathematical concept, and that they believedthe greatest contribution that **CHAOS** **THEORY** could make tonursing research was in quantitative designs. Theirreasoning would appear sound as statistical modelsprovide quantitative data that enable researchers to modelcomplex chaotic systems using simple mathematicalequations.

9 Phillips (1992) further explored **CHAOS** **THEORY** inhis response to this rebuff and stated that they had failed toappreciate the beauty of nature s **CHAOS** , and had notunderstood linear article by Murray (1992) discusses the need for acritical care curriculum to include **CHAOS** **THEORY** . Murray(1992) has drawn upon the literature that uses **CHAOS** theoryas a way to understand complex systems. He highlightsthe use of the **THEORY** by Goldberger et al (1990) to explainphysiological systems but also asks the question: Howmight **CHAOS** **THEORY** be useful for **NURSING** within criticalcare? He subsequently identified areas such asepidemiology, physiology and risk assessment.

10 While atpresent he is unsure of **CHAOS** **THEORY** s usefulness due to alack of available research evidence, he stated that nursesat least should have **CHAOS** **THEORY** as part of theirknowledge base in order to critique the literature. Hence,he believes that **CHAOS** **THEORY** should be included in thecritical care curriculum. Analysis of the more recent **NURSING** literature suggeststhat **CHAOS** **THEORY** has moved from being a possibility fornursing, to a theoretical approach that has been applied tonursing practice. The **THEORY** has been applied in threediscrete ways by various disciplines, including the purposes of this analysis three categories have beenadopted; the mathematical constructs, the properties thatchaotic systems exhibit (the tenets of the **THEORY** ) and thenotion of **CHAOS** .