Journal of Advanced Nursmg, 1996,23,645-646
Guest editorial
CHAOS AND EVOLUTION IN NURSING
RESEARCH
The emerging theory of chaos and the consideration of
evolution theory in the context of ideas opens up new and
exciting views on nursmg practice and research The first
tells us that there are limits to prediction m complex areas
of study, and that the reasons why predictions are limited
are themselves deeply meaningful The second describes
an interpretation of social phenomena withm a wider evol-
utionary context which may offer deeper understandings
through the metaphor of a living, adapting system
The physical, psychological and social components
embodied in the art and science of nursing admit to an
immensely complex interplay of factors beneath our super-
ficial understanding of everyday nursing How deeply we
explore this interplay, and the tools we use to research it,
necessarily colours our understEinding of the larger picture
Traditional scientific models may not always be suitable
for the understanding or predicting of complex relation-
ships (Coppa 1993)
The theory of chaos may allow for better understanding
of the research process and the design of research tools for
complex environments (Phillips 1991) Chaos is not
simply random anarchy the persistent instability exhib-
ited m complex systems such as weather patterns, econ-
omics, ecology and galactic orbits follows the same very
simple rules (Gleick 1987)
One feature of chaos is that instead of exhibiting a linear
relationship, where a change m conditions results in a
proportional change m outcome, chaotic systems cein
change direction completely m response to minor vari-
ations m lmtial conditions The behaviour of complex
arrangements of people, or atoms, will therefore have
limits placed upon ultimate predictability
Another feature of chaos is its inbuilt flexibility
Recordings of heart and brain waves show a normal heal-
thy chaotic activity, able to adapt to change — illness pre-
sents with more periodic and regular rhjrthms (Goldberger
et al 1990) The significance for nursing is that this theory
illuminates new perspectives on all aspects of life pro-
cesses and interactions
The appeal to the biological sciences may be more appar-
ent The applied science of anaesthetics has been encour-
aged to consider the role of chaos by Goodman (1990) who
remarks that 'patients often get better despite us rather
than because of us' For example, patients show a large
variation in their responses to analgesics yet ngid rules
govern our thoughts and actions regarding drug adminis-
tration and the assessment of needs
© 1996 Blackwell Science Ltd
In any statistical distnbution there will be 'outliers',
people who don't quite fit the expected norm, and we may
not always adapt to accommodate them This can be as
true for work relationships as it is for patient care One of
the characterizing features of mcompetent military leader-
ship has been the inability to tolerate or place trust m
individuals who show lmtiative, or who are m any way
unconventional (Dixon 1994)
Chaos theory would predict that individuality steins
from the complex blending of countless factors — any one
of which, with the smallest degree of alteration, could have
resulted m widely different expressions of personality or
capability Why then should we be so intolerant and )udge-
mental of others and seek to constram with petty rules all
aspects of human behaviour'' Chaos theory should open
our minds to the creativity and flexibility inherent m
dynsunic situations and increase the sense of value we
have for others
If complex models which seek to control many variables
appear to move further away from real life, it may be
because chaos has been excluded from the picture
Sigmund (1993) argues that when researching any complex
area we should be trying to 'gain insight mto the basic
features of its dynamics' rather than finding ourselves
jinable to see the wood for the trees, and, quoting
Wittgenstein (1953), he asks if there is always an advantage
in replacing a blurred vision with a sharply focused one'
Another scientific theory which may have a place m
aidmg the understanding of nursmg phenomena is that of
natural selection
Cavalli-Sforza (1971) outlined the similarities of socio-
cultural and biological evolution, stating that this theory
may prove powerful in 'stimulating clear thinking and
giving rise to valuable predictions' m the analysis of socio-
cultural changes The central theme is that all things, be
they organisms or ideas, must compete with rivals, and
only those which best suit their environment will repli-
cate Dawkins (1976) promoted the theory of the 'meme',
which IS analogous to the gene in biology A meme is an
idea or concept that replicates in people's mmds, under-
going changes as it is shaped by new knowledge and m
response to outside pressures Only if conditions are nght
will ideas continue, and modifications are as a result of
many pushing and pulling, shaping forces
Relevance to nursing
To illustrate the relevance to nursuig, consider some of the
ideas and concepts related to pain which, though not
always appropnate or useful, persist m nursmg ntual and
645
 Guest editonal
habit An understanding of the environment m which
those concepts replicate may allow for some modificabon
of that environment
It has been shown in many studies that nurses some-
times withhold prescribed analgesia mappropnately A
common theme is the fear that nurses have of promoting
drug dependency It has been shown that this is a highly
unlikely outcome of short-term analgesic therapy (Ferrell
et al 1992), yet in the minds of nursmg staff certain con-
ditions must be present which allow this fear to replicate
like a successful gene through the nursmg culture It may
be that the fear of turning patients into addicts persists
because of a specific combmation of factors, l e lack of
knowledge about analgesics, genuine fear of doing harm,
and the pressures of being personally accountable for
one's actions
Perhaps m some mdividuals the need to clmg to old
ideas gives security and reduces thinking time m
demanding situations (Dixon 1994)
A meme will display characteristics which vwll define
It for example, 'fecundity', the ability to spread rapidly
through the culture, 'longevity', the degree to which the
meme can be seen to last over time, 'copying fidelity', the
degree to which the meme remains unchanged as it is
replicated
How then could we overcome a meme such as 'Pam
relief will cause addiction"' After all, for it to have lon-
gevity, a high level of cultural penetrance and copying
fidelity it must have evolved m a supportive environment
Ideas may have pillars of support but can also have weak-
nesses m their foundations We may identify retrammg
needs for staff to up-date their medical knowledge, and we
could frame quality protocols which encourage individ-
ualized analgesia provision based on measured outcomes
such as the patients' assessments of their pam As this
meme is deeply rooted in the wider culture, we would
need to provide adequate patient information to allay
unnecessary fears and worries
By winning over the arguments m the minds of individ-
ual nurses, and by making changes in hospital protocols
to support new thmkmg, real change should occur as a
natural evolutionary process
In many ways this seeks to reduce the topic under study
to component processes This is not necessarily an overly
reductionist approach, what is important for the under-
standing of the phenomena is the degree and appropriate-
ness of the level to which that reduction takes place
Goslmg (1994) cites the example of how an understanding
of chemistry would be unnecessarily complicated by
reducing every reaction to the level of particle physics
646 © 1996 Blackwell Science Ltd, Journal of Advanced Nursmg, 23, 645-646
'each discipline defines its level beyond which it does not
choose to venture' The unportsint point here is that
reduction should result in explanations and paradigms
that are of 'tractable complexity and predictive value'
Trying to reduce a phenomenon to too low a level of
abstraction may not give satisfactory explanations of the
general pattern bemg seen on a larger scale
The challenge for nursing is to explore the use of new
research approaches, to re-examme nursing's theoretical
base by questioning assumptions associated with linear
thinking (Vicenzi 1994), and to develop ncher understand-
ings through the application of new concepts, whilst keep-
mg sight of the natural limitations that chaos places on
predictions m the real world
Ramon Pediaru
RGN BSc(Hons)
Clinical Nurse Specialist for Acute Pam,
Blackpool Victona Hospital NHS Trust,
Blackpool, England
References
Cavalh-Sforza L L (1971) Sunilanties and dissimilanties of soci-
ocultural and biological evolution In Mathematics m the
Archeological and Histoncal Sciences (Hodson F R, Kendall
D G & Tautu P eds), Edinburgh University Press, Edmburgh,
pp 535-541
Coppa D F (1993) Chaos theory suggests a new paradigm for nurs-
mg science Journal of Advanced Nursing 18(6), 985-991
Dawkins R. (1976) The Selfish Gene Oxford University ftess,
Oxford
Dixon N (1994) On the Psychology of Military Incompetence
Pimlico, London
Ferrell B R , McCaffery M & Rhmer M (1992) Pam and addiction
an urgent need for change in nursmg education Journal of Pam
and Symptom Management 7(2), 117-124
Gleick J (1987) Chaos Vikmg Pengum, New York
Goldberger A L , Rigney D R & West B J (1990) Chaos and fractals
in human physiology Scientific Amencan 262(2), 34-41
Goodman N W (1990) Chaos m anaesthesia Editonal
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Goslmg W (1994) Helmsmen and Heroes Control Theory as a
Key to Past and Future Weidenfield and Nicholson, London
Phillips J R (1991) Chaos m nursmg research Nursing Science
Quarterly 4(3), 96-97
Sigmund K (1993) Games of Life Explorations m Ecology,
Evolution and Behaviour Oxford University Press, Oxford
Vicenzi A E (1994) Chaos theory and some nursmg consider-
ations Nursmg Science Quarterly 7(1), 36-42
Wittgenstein L (1953) Philosophical Investigations Blackwell,
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