Construction and initial evaluation of a systems model of nursing best practice from a complexity science perspective.

摘要

Despite the seemingly universal acceptance of best practice as a desirable standard for quality health care delivery, the exact nature of what constitutes best practice does not share universal definition or application. The purpose of this dissertation is to present a summary of existing conceptual representations and to propose an integrative conceptual representation of nursing best practice from a philosophical perspective grounded in complexity science.; A five-step concept clarification approach was used to address the objectives. Step one, identification of the concept, involved a comprehensive review of the literature employee key word search strategies. Step two, systematization of observations and descriptions, was accomplished by modified content analysis. Step three, development of an operational definition, and step four, construction of a model, involved deductive and recursive reasoning. Description and critical reflection was used for evaluation and recursive refinement of the proposed definition and constructed model. Step five, formulation of hypotheses, used an expert panel to explore preliminary validity of the definition and model.; Purposive recruitment of nursing clinicians and scholars familiar with complexity science and theory was conducted to obtain an expert panel. The expert panel was asked to rate the strength of model dimensions using a four-point Likert scale. The dimensions evaluated were adequacy, representativeness, consistency, clarity, simplicity, generalness, accessibility, importance, and relevance, as well as interest in development and application. Narrative data was collected from responses to open-ended questions and incorporated into the process of model refinement.; Although nursing best practice is represented across a diverse range of conceptualizations in the nursing literature, clinician properties and context properties emerged as two principle domains of interdependent influence. Key dynamic processes included critical thinking by which clinicians operationalize properties into practice choices, and informative reflection by which the organization monitors and improves performance through information flow and learning. All aspects of the conceptual model, with the exception of consistency of relationships, were ultimately rated as strengths by the expert panel. Relationships among constructs were identified as complex, diverse, and difficult to isolate.; Expert panel evaluation was employed to explore congruency of hypotheses suggested by the model with the perception of subject matter experts. Three general hypotheses were presented regarding the nature of the interdependency of clinician and context spheres of influence. (Abstract shortened by UMI.)