Running head: NON-NURSING THEORIES IN HEALTHCARE 1

Non-Nursing Theories in Healthcare

Charmaine Enerio

University of Texas Arlington College of Nursing

In partial fulfillment of the requirements of

Nursing Theory N 5327

Kathy Speer PhD, RN, PPCNP

October 20, 2017

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Non-Nursing Theories in Healthcare

There are several non-nursing theories that can be applied in health care these days such

as structural empowerment, chaos, quality improvement, change, and many more. The evolution

of nursing science and practice has utilized various non nursing theories to explain and broaden

the discipline. This paper aims to identify the key points of various theories that have made a

huge impact in the nursing profession.

Theory of chaos

The knowledge of chaos has been utilized in various disciplines that affect health care

delivery practices all over the world. Chaos theory is, in itself, a dynamic system and its

application has evolved with time. The theory of chaos has been used to define complex systems

that exist in nature. Gleick (1987) postulates that chaos is made up of complex systems with

simple rules. These small changes can produce big differences, which aren’t proportional to the

degree of change. This phenomenon brings forth a nonlinear relationship.

Nursing science is made up of human, physiologic, and health care systems. Chaos theory

can be used by nurse theorists to explain the operation of nonlinear systems. Chaos theory can

help expand nursing theory by explaining random events with association patterns, such as in

epidemiology and demographics (Lett, 2000). Nursing management can also benefit from the

tenets of chaos theory. This can be seen in situations where nurse managers are formulating

contingency and emergency plans for their respective organizations. We follow protocols,

guidelines, and procedures in the hospitals, and yet, we are still prone to chaos. And when you

add the complexities of dealing with unique human beings, the hospital experience becomes

chaotic. We can never predict at a hundred percent the outcomes of our treatment plans. The
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slightest changes can alter our results drastically and this is why health care continues to be a

dynamic, nonlinear system.

Theory of Change

Change often is an unwelcome phenomena in established work systems. It usually brings

forth uncertainty and doubt that can be challenging for nurses. When unexpected changes

happen, it can threaten and undermine an individual’s sense of purpose. There are several change

theories that have been utilized by nursing research and health care organizations these days to

improve outcomes.

Popularly known as the “Father of Social Psychology”, Kurt Lewis postulated the change

dynamics n human systems. He proposed the unfreezing, change, and refreeze model that needs

prior knowledge to be removed and replaced. The unfreezing stage involves understanding the

need for change and preparing the environment for change. Organizations can start the process of

“unfreezing” by increasing the driving force that direct behavior from status quo, minimizing the

forces that negatively impact the equilibrium, and a combination of the above mentioned

methods. The “movement” stage happens when people begin embracing new work methods and

learn new attitudes, values, and behaviors. The last stage involves “refreeze” where the

organization returns to stability and the advantages of change has been realized (Kristonis,

2011).

Everett Rogers diffusion of innovation theory is one of the most famous classic change

theory. According to this theory, change is more accepted when it is compatible with an

organization’s present beliefs, culture, and methods. His theory also postulated the innovation-

decision process which is made of five stages, namely knowledge, persuasion, decision,

implementation, and confirmation (McDonald, Graham, & Grimshaw, 2004).

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Quality Improvement

A big portion of Quality Improvement (QI) systems in health care comes from Shewart

and Deming’s theory on total quality management. The new age of health care QI started when

researchers and theories realized that practice guidelines and their dissemination did not produce

any change in organizational practices. Today, QI is more focused on manipulating the

environment where professionals practice (Kleinman & Dougherty, 2013).

QI is made up of continuous and systematic activities that enables organizations to

measure improvement and outcomes in health care (HHS, 2011). It is an essential program

implemented by health care organization to assess, monitor, and advance the quality of health

services. It helps an organization determine and assess its current practices, analyze systems, and

offer solutions to prevent unwanted errors and improve outcomes. QI systems are designed to

promote innovation and creativity among organizations. The U.S. Department of Health and

Human Services (2011) has listed four key concepts of every QI program namely focus on data

use, focus on being part of a team, focus on patients, and QI work as systems and processes.

For an organization to make an improvement, it must first examine its own care delivery

systems and processes. QI concepts identifies both resources (inputs) and activities (processes)

are carried out together to enhance quality of care (outcomes). Health care organization

processes are mainly divided into two essential parts: the type of care provided and how it is

delivered. Organizations can address either one of these components, but tackling both at the

same time yields the best results.

Maslow’s Theory of Human Motivation

Known as one of the biggest names in humanistic psychology, Abraham Maslow is the

author of the theory of human motivation. He popularized a conceptual model for human needs
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through a pyramid with several levels in ascending order- physiologic needs at the bottom,

followed by safety and security, love and belongings, self-esteem, and self-actualization at the

peak. A person is not able to move up to the top needs until he meets the needs at the lower

levels (Venes, 2009).

When nurses do not feel like their basic physiologic needs are being met at work, they are

less motivated and aren’t able to progress to optimum level of functioning (Chinnies et.al, 2001).

A study conducted by Paris and Terhaar (2011) revealed the different levels of need according to

Maslow’s conceptual framework. This includes the need to provide safe patient care and a safe

workplace, a sense of belongingness in the organization, and the need for empowerment in

autonomy and practice. Maslow’s hierarchy theory suggests that a nurse can achieve higher

levels needs (e.g. self-esteem and self-actualization) when his or her basic needs are being met in

the workplace. Paris and Terhaar (2011) adapted a pyramid model that lists breaks, work flow,

schedules, and overtime expectations as a nurse’s basic needs. This is followed by technology,

acuity, nurse-patient relationships, and physician-nurse relations on the second level. The next

level consisted of teamwork, communication, and collaboration at work. On top of pyramid, they

listed empowerment, autonomy, decision-making, and control over practice.

Empowerment Theory

With an aging population, increase in health care demand, and staff shortage across the

United States, nurse burn out is a common dilemma that health care organizations experience

these days. Complex working environments and staff shortages make it hard for nurses to remain

engaged and empowered. Hospitals and other health care organizations need to help nurses strive

in stressful, demanding workplaces to promote safe, efficient, and quality care outcomes.

According to Kanter’s (1979) structural empowerment theory, empowering work environments

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are those that offer staff easy access to resources, support, and opportunities to help them do their

jobs efficiently. Empowered employees are more able to do their jobs efficiently, accountable,

and committed to their organization. Kanter (1993) has identified key structures that lead to

workplace empowerment:

 Access to resources (materials, time, and supply)

 Access to support (guidance and feedback from peers and managers)

 Access to information (technical knowledge, policies, and procedures)

 Access to opportunity (continuing education, career growth & development)

Structural empowerment is at its peak when employees have access to these structures in

their workplace. There have been various studies showing a relationship between positive

workplace behaviors and empowerment. A study by Laschinger and Havens (1997) revealed that

empowerment has lowers job tension among nurses and decreased emotional exhaustion at the

workplace. Empowerment may be an efficient way to reduce staff burn out, enhance positive

workplace attitudes, and increase productivity. Another study by Laschinger and Sabiston (1995)

showed a direct relationship between empowerment and nurse autonomy. According to their

study, nurses who feel empowered at work have a better sense of autonomy and power in their

practice.

General Systems Theory

Postulated by Ludwig van Bertalanffy, the general systems theory (GST) pertains to a

study of “wholeness”. He stated that it is vital to look at systems holistically (Bertalanffy, 1986).

The ultimate goal of his theory was to combine different disciplines, such as social and natural

sciences, to explain the metaphysical concepts of science. It was developed to determine

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universal principles that can be applied to systems in general. The general systems theory

identifies two kinds of systems: open and closed systems. Open systems are those that interact

with its environment and closed systems are those that isolate from its environment.

The systems theory looks at an organization like that of an organism made up of different

parts that function together as a whole. The systems theory states that success can be achieved by

synergy, subsystem interdependence, and interconnections within the organization itself and the

environment.

Healthy Work Environment

A healthy work environment (HWE) plays a vital role in nursing and the overall quality

of care. Healthy work settings promote healing, trust, and confidence among employees and

organizations. According to the American Nurses Association (2017), a healthy work

environment is empowering, safe, and satisfying. Culture of safety is of utmost importance,

where managers, health care professionals, and staff are working harmoniously together with a

sense of accountability, efficiency, transparency, and involvement. Everybody is mindful of the

safety and health of the patients and the people working in an organization, leading to a sense of

respect and empowerment for all (ANA, 2017).

The American Association of Critical Care Nurses (AACN) has developed six key

strategies in developing a healthy work environment, namely skilled communication, effective

decision making, true collaboration, authentic leadership, meaningful recognition, and

appropriate staffing. With proper implementation, these standards help ensure that nurses have

the necessary resources, authority, and skills to make decisions that promote excellent nursing

care and optimal patient outcomes (Wilkin, 2016).

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A healthy workplace does not only promote patient outcomes but improves staff retention

and empowerment as well. It is imperative that organizations build a culture of support,

communication, and collaboration among employees. Standards of HWE should be implemented

in every level of the system, from beside to boardroom. Success can only be achieved when a

mutual partnership has been achieved between employees and organizations. Health care

organization should strive to provide healthy work environments for their employees and

patients.

Discussion

Without a doubt, all of the theories mentioned above have made major contributions in

the field of nursing research, education, and practice. Most of these theories ultimately lead to

the establishment of safe and efficient patient care. Based on its importance to healthcare, here is

how I would rank the following theories: (1) Maslow’s hierarchy of needs, (2) structural

empowerment, (3) healthy work environment, (4) quality improvement, (5) change, (6) systems,

and (7) chaos.

As a biological system, nurses should first address their own basic needs such as food,

water, shelter, and air. This concept also applies with the needs of our patients in health care

settings such as hospitals, urgent care centers, and clinics. Without addressing our basic human

needs, we are unable to progress to a higher level of functioning. Health care organizations are

unable to perform efficiently when their employees are functioning poorly because of inadequate

staffing, interrupted breaks, and overtime expectations.

When health care organizations invest in their employees through empowerment and

providing healthy work environments, employees are happier with their jobs and are more likely

to stay in their respective companies. Empowered nurses experience higher level of autonomy
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and are able to provide quality patient care, which is the goal of every health care organization.

Providing an environment that fosters communication, growth, and collaboration is a great way

of building trust between organizational leaders and staff nurses. We would want to work in a

culture that promotes safety, unity, autonomy, collaboration, and professional growth.

Focus on quality improvement cannot be overemphasized in health care settings. At its

very core, QI is a team process that relies on the collaboration of its members. Organizations that

implement QI programs have improved patient and health outcomes, enhanced clinical and

managerial processes, and provide safe, high quality health care services (HHS, 2011).

How do organizations achieve quality improvement and healthy working environments? I

believe it is through transformational leadership and change. Change must start from employees

themselves before it can reach to an organizational level. Increasing health care costs, nurse

shortages, an aging population, advances in medicine, and professional obligations are some of

the driving forces for changes in health care delivery (Burritt, 2005). In order for health care

organizations to survive, changes in systems and structures, culture, and delivery must be done in

effective manner.

Health care organizations and human beings should be viewed as complex systems-

harmonious interplay of its parts. A system is composed of parts that are related and dependent

on one another. The health care system is made up of policy makers, decision makers, and

organizations that influence the way it is delivered to society. Health care services are delivered

by multiple professionals, like therapists, doctors, nurses, pharmacists, and social workers.

Managers should be system thinkers to enable sustainable changes in their companies (Cordon,

2013).
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Health care as a dynamic system is constantly being bombarded with chaos and

uncertainties. Without chaos, there can be no change. In our everyday practice, we cannot

perfectly predict the outcomes of our treatment and interventions. The theory of chaos plays a

major role in nursing research and in examining our current practice delivery systems.

The theory that resonates significantly to me and my nursing practice is Maslow’s

hierarchy of needs. Organizations are not going to survive without their employees. Manpower is

at the very core of every organization. Without people, organizations will not exists. I believe

that organizations are able to thrive and progress when they efficiently address their employees’

physiologic, social, mental, and developmental needs. One of the biggest predictors of nurse job

retention and satisfaction is the level of stress and support in the clinical environment.

Teamwork, efficient communication, professional empowerment, and increased autonomy have

been found to enhance satisfaction and job retention among nurses (Paris & Terhaar, 2011). At

the basic level, organizations should promote a safe and nourishing workplace that allows nurses

to meet their basic needs such as uninterrupted breaks, clean and functional spaces, adequate

staffing, and reasonable overtime expectations. Leaders and managers should also foster a

culture of safety, collaboration, and professional growth to help employees function efficiently.

Nurses also apply Maslow’s theory at the bedside in their everyday practice. We use the

theory in the application of the nursing process. In emergent situations, we are trained do focused

assessment based on airway, breathing, and circulation. At the bedside, we are expected to help a

patient fulfill his or her physiologic needs to maintain life and overcome illness. Although we

practice holistic care, physiologic needs and safety are still our utmost priorities. As nurses, we

understand that human beings are open systems that interact with the environment constantly. A

very small change in the physiologic equilibrium can eventually affect a person’s state of health
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and well-being. Nurses should address fundamental needs first in order for individuals to achieve

high level functioning.

Conclusion

Health care organizations are complex adaptive systems- unpredictable and constantly

evolving. Through the years, theories have been used to study health care organizations in an

attempt to explain phenomena, enhance practice, and promote research and development.

In organizations, change must always come from the employees themselves. Companies have an

inherent obligation to provide a work environment that cultivates change, collaboration, and

professional growth. Empowered nurses lead to better care and patient outcomes. The impact of

these non-nursing theories will continue to develop and expand nursing science.
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