# NR 500 Week 6 Discussion Systems-Structure and Function

## NR 500 Week 6 Discussion Systems-Structure and Function

NR 500 Week 6 Discussion Systems-Structure and Function

Many of you have experience in complex adaptive systems whether you realize it or not. Thinking about your future practice specialty area, identify a situation in which an issue or concern common to your future specialty would impact that system. (Note: This can be the same practice issue identified in Week 5.) In your initial response, please identify your specialty track, as well as the issue or concern. Discuss how this issue or concern will impact the system at the micro, meso, and macro levels. How will you address this issue or concern at each of those levels? What is the expected impact on each of these system levels using your solution(s)? Remember you can use an information technology-based solution to address the issue or concern.

### System and Structure

The system and its elements. A system is an internally organised whole where elements are so intimately connected that they operate as one in relation to external conditions and other systems. An element may be defined as the minimal unit performing a definite function in the whole. Systems may be either simple or complex. A complex system is one whose elements may also be regarded as systems or subsystems.

All things, properties and relations that strike us as something independent are essentially parts of some system, which in its turn is part of an even bigger system, and so on ad infinitum. For example, the whole of world civilisation is no more than a large and extremely complex self-developing system, which comprises other systems of varying degrees of complexity.

Every system is something whole. So anything that corresponds to the demands of unity and stability—an atom, a molecule, a crystal, the solar system, the organism, society, a work of art, a theory—may be regarded as a system. Every system forms a whole, but not every whole is a system.

We usually call the parts of a system its elements. If in investigating a system we wish to identify its elements we should regard them as elementary objects in themselves. Once we have established them as something relatively indivisible in one system, elements may be regarded in their turn as systems (or subsystems), consisting of elements of a different order, and so on.

The concept of structure. The aim of scientific cognition is to discover law-governed relations between the elements forming a given system. In the process of this research we identify the structures peculiar to that system. When studying the content of an object, we enumerate its elements such as, for example, the parts of a certain organism. But we do not stop at that, we try to understand how these parts are coordinated and what is made up as a result, thus arriving at the structure of the object. Structure is the type of connection between the elements of a whole. It has its own internal dialectic. Wholeness must be composed in a certain way, its parts are always related to the whole. It is not simply a whole but a whole with internal divisions. Structure is a composite whole, or an internally organised content.

But structure is not enough to make a system. A system consists of something more than structure: it is a structure with certain properties. When a structure is understood from the standpoint of its properties, it is understood as a system. We speak of the “solar system” and not the solar structure. Structure is an extremely abstract and formal concept.

Structure implies not only the position of its elements in space but also their movement in time, their sequence and rhythm, the law of mutation of a process. So structure is actually the law or set of laws that determine a system’s composition and functioning, its properties and stability.

Structure and function. The life of a structure manifests itself in its function, they condition each other. The structures of the organs of the body, for instance, are connected with their functions. Any breakdown in structure, any deformation of an organ leads to a distortion of the function. In the development of organisms changes begin with the reorganisation of an organ’s function under the influence of changing conditions of life, while its structure may survive for a time without any substantial modification. However, change of activity sooner or later leads to a change in structure.

Functional disturbances in organs precede their morphological distortions. The contradiction between the organism’s new mode of life and its structure is resolved by a modification in the latter. All the organs and functions of a bird, for example, are adapted to an aerial mode of life. The amazingly purposeful feather structure protects the bird from cold during the rapid changes of temperature in flight. The fact that a bird can fly is observable even when it is on ground.

We can see this from its streamlined body, its fine-boned structure which allows it to pass through the air with minimum expenditure of energy, and from the design of the wings. The whole structure embodies the idea of flight. But a colourful butterfly resembles a flying flower. And this too is understandable because a butterfly feeds on the nectar of a flower and its resemblance to a flower protects it from birds when it is sitting motionless on a blossom. The life of the bird is associated with air and the life of a butterfly is bound up with flowers. Their functions, their ways of life determine their structure.

To sum up, function organises structure. The methods of morphology are subordinate to the methods of physiology. The function of sight organised the eye, while labour was responsible for the structure of the hand. But being an organised function, structure in its turn determines function.

Whole and part. We call something a whole that embraces all its parts in such a way as to create a unity.

The category of part expresses the object not in itself but as something in relation to what it is a part of, to that in which it realises its potentials and prospects. For example, an organ is part of an organism taken as a whole. Consequently, the categories of whole and part express a relationship between objects in which one object, being a complex and integral whole, is a unity of other objects which form its parts. A part is subject to the influence of the whole, which is present, as it were, in all its parts. Every part feels the influence of the whole, which seems to permeate the parts and exist in them. Thus, in a tragic context even a joke becomes tragic; a free atom is distinctly different from an atom that forms part of a molecule or a crystal; a word taken out of context loses much or all of its meaning.

At the same time the parts have an influence on the whole. The organism is a whole and disfunction of one of its organs leads to disbalance of the whole. For example, against a background of rational thinking an obsessive idea may sometimes have a very substantial effect on the general condition of the individual.

The categories of whole and part are relative; they have meaning only in relation to each other. The whole exists thanks to its parts and in them. The parts, in their turn, cannot exist by themselves. No matter how small a particle we name, it is something whole and at the same time a part of another whole. The largest whole that we can conceive of is ultimately only a part of an infinitely greater whole. Everything in nature is a part of the universe.

Various systems are divided into three basic types of wholeness. The simplest type is the unorganised or summative whole, an unsystematic conglomeration of objects (a herd of cattle, for example). This category also includes a mechanical grouping of heterogeneous things, for example, rock consisting of pebbles, sand, gravel, boulders, and so on.

In such a whole the connection between the parts is external and obeys no recognisable law. We simply have a group of unsystematic formations of a purely summative character. The properties of such a whole coincide with the sum of the properties of its component parts. Moreover, when objects become part of an unorganised whole or leave such a whole, they usually undergo no qualitative change. For this type of whole the characteristic feature is the varying lifetime of its components.

The second, more complex type of whole is the organised whole, for example, the atom, the molecule, the crystal. Such a whole may have varying degrees of organisation, depending on the peculiar features of its parts and the character of the connection between them. In an organised whole the composing elements are in a relatively stable and law-governed interrelationship. Its properties cannot be reduced to the mechanical sum of the properties of its parts. Rivers “lose themselves” in the sea, although they are in it and it would not exist without them.

Water possesses the property of being able to extinguish fire, but the parts of which it is composed, taken separately, possess quite different properties: hydrogen is itself flammable and oxygen maintains or boosts combustion. Zero in itself is nothing, but in the composition of a number its role is highly significant, and at times gigantically so, by increasing 100 into 1,000, for instance. A hydrogen atom consists of a proton and an electron. But strictly speaking, this is not true.

The statement contains the same error as the phrase “this house is built of pine”. The mass of an atom of hydrogen is not equal to the total mass of the proton and the electron. It is less than that mass because in combining into the system of the hydrogen atom the proton and the electron lose something, which escapes into space in the form of radiation.

Bobbie Rodriguez

Feb 6, 2018Feb 6 at 10:01pm

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Dr. White,

Transitioning NICU care from where parents are ‘allowed’ to participate in simple care tasks to embracing them as partners in the primary care of their baby will empower the family unit. Improved support for each individual family, sharing and collaborating on care decisions will be evidenced at the microsystem level. While it may be a newer concept at first, I believe over time it would result in accepted practice at the micro level, much like kangaroo care became an accepted and now encouraged practice over time. D’Agata & McGrath (2016) described a study where this complex adaptive approach was implemented in a NICU setting. After 21 days of this type of intervention, a decrease in retinopathy was recorded as was an increase in breast feeding at discharge (D’Agata & McGrath, 2016). Decreased parental stress levels at discharge would also be a likely outcome at the micro level. At the mesosystem level, hospital leadership will likely see better patient outcomes and improved hospital ratings through standard survey methods that are sent out. This would open the door towards more administrative support of evidence-based practice at the micro level. At the macrosystem level, there has already been a trial called COPE (Creating Opportunities for Parent Empowerment) that supports “educational-behavioral intervention” focused on improving the mental and behavioral development of the child and supporting parent interactions (D’Agata & McGrath, 2016). Further funding and promotion of such programs will increase community awareness and healthcare systems will take notice and become more open to change.

Reference

D’Agata, A., & McGrath, J. (2016). A framework of complex adaptive systems: Parents at partners in the neonatal intensive care unit. Advances in Nursing Science, 39(3), 244-256. doi: 10.1097/ANS.0000000000000127

Sabrina Hodge

Feb 11, 2018Feb 11 at 9:52pm

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Bobbie,

It is great to see members of upper level management taking an active part in delivering care to patients. When leaders such as DON’s and Unit mangers participate in caring for patients it makes fellow nurses want to become better leaders and caregivers within their profession. Teamwork, is one of the greatest benefits to nursing because it allows individuals to feel confident, prideful, and empowered. When upper level management takes an interest in the delivery of patient care nurses within the organization feel a sense of commitment to excellence and dedication to the organization for which they serve. Team work is considered to be a dynamic process encompassing an interplay of several factors (Polis, Higgs, Manning, Netto, & Fernandez, 2015). The benefits of effective teamwork for both patients and nurses are well documented and have proven to improve patient safety, reduce errors, and reduce mortality. At a system level micro, meso, and macro nursing education and team work interact hand and hand to deliver quality care.

Reference:

Polis, S., Higgs, M., Manning, V., Netto, G., & Fernandez, R. (2015). Factors contributing to nursing team work in an acute care tertiary hospital. Collegian,doi 10.1016/j.colegn.2015.09.002.

Sabrina Hodge

Feb 10, 2018Feb 10 at 11:45am

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Bobbie,

NICU family care centers is a great concept for nurses and families to assist with the bonding and healing between the infant and parent. Parents with infants in NICU at times feel guilty, anxious, fearful, and lost. Many times parents are not sure how they can help assist with the recovery of their infant and shy away from bonding and offering assistance. The monitor, cords, IV’s, and pumps connected to a tiny infant; to parents seem intimating and overwhelming. NICU care centers allow for the bonding and promote education needed to assist parents feel empowered and confident to help with simple task such as changing diapers, clothing, and cuddling with the infant. The American Family Children’s Hospital is one of many pediatric medical facilities that promotes a family friendly, nonthreatening place specifically designed to be patient and family centered in the care of sick infants and children (Pediatric Care Center, 2018).  This concept of caring have proven to help improve the patient’s well-being and clinical outcomes (Pediatric Care Center, 2018). The NICU patient care concept can be properly designed at all systems level. The micro level is where the nurse educate and promote bonding between the infant and parent, in the meso level the directors and managers implement policies and procedures to promote a patient center unit, and at a macro level wide spread system change of care is promoted.

Reference:

PEDIATRIC CARE CENTER. (2014). Healthcare Design, 14(7), 180-183.

Lauren Spears

Feb 5, 2018Feb 5 at 8:43pm

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My specialty track is Family Nurse Practitioner (FNP). The issue that I have identified that is related to my specialty track is the increasing rise of opioid-related deaths and opioid addiction related to the over prescribing of opioids. Opioids are prescribed more frequently for pain that non-opioids or other non-pharmacological methods. Opioid over prescribing affects every level of system and by finding solutions for one level the others will be affected.  As stated by Marquis and Huston (2012) a change in any element of the healthcare system causes changes in other elements of the system.

The overuse of opioid treatment for pain affects the system at the micro level by introducing opioids to opioid naive patients. By doing so this increases the risk of addiction to opioids. It also increases the probability of requesting opioids in the future for pain management. Opioid addiction can cause financial problems by the costliness of the prescriptions and resulting to buying opioids on the street if unable to get a prescription. Opioid addiction also causes family conflict and strains. At this level I would address the issue by decreasing the amount of opioid prescriptions for pain and use alternatives such as non-opioid treatment or non-pharmacological methods such as physical therapy, massage etc. Thompson (2017) stated that non-pharmacologic methods help to lessen patients’ focus on the time remaining until their next dose of opioids. By implementing this solution the amount of opioid prescriptions will decrease thus decreasing request for opioid prescriptions and opioids as first line of treatment for pain.

The overuse of opioid treatment for pain affects the meso level by increasing visits to the emergency department for chronic pain management. It also impacts the hospital by increasing opioid overdose and death related visits/admissions to the hospital. Psychiatric related visits are also increased due to opioid related addiction. Incidents involving violence in the hospital are also increased by opioid addiction. I will address these issues by not treating chronic pain in the emergency department. By not treating chronic pain in the emergency room setting there will be less visits for patients drug seeking thus decreasing incidents involving violence.

The overuse of opioid treatment for pain affects the macro level by increasing the cost to community through increasing cost of health insurance and home insurance. Increasing addiction rate correlates with increasing theft thus increasing home insurance. Emergency department wait times are increased with opioid addiction and drug seekers. HCAHPS scores asks about pain management and if the patient feels pain wasn’t properly managed than some organizations get decreased reimbursements. Legislation has started to decrease over prescribing of opioids. To address this issue I will advocate for increased legislation on opioid over prescribing. I will also increase education to the population of the dangers of opioids and alternative treatments to pain.

Marquis, B.L., & Huston, C.J. (2012). Leadership roles and management functions in Nursing: Theory and application (7th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

Thompson, C. A. (2017). HCAHPS survey to measure pain communication, not management. American Journal Of Health-System Pharmacy: AJHP: Official Journal Of The American Society Of Health-System Pharmacists74(23), 1924-1926. doi:10.2146/news170084

Sabrina Hodge

Feb 9, 2018Feb 9 at 3:24pm

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Lauren,

I agree that the miss use of opioids over that last couple of years have affected the health care system through all system levels: microsystem, mesosystem, and macrosystem.  Confronting this opioid overdose epidemic that kills nearly 100 Americans every day takes a combination of guts and interventions across all sectors and systems (Krisberg, 2017). This opioid crisis have left many health care providers, workers, patients, and family pondering: How this crisis get so bad? How can we resolve this epidemic? How can we place accountability on the prescribers and abuser? The resolution to these questions come with no quick fix. Law makers, health care provider, the community, and patients all want resolvable solutions that not only save lives but also maintain patient’s rights to these medications if disease processes and uncontrolled pain warrant the use of opioids.  Viewing the opioid epidemic as an epidemic of addiction similar to a disease outbreak where containing the opioid miss use is warranted. In fact, Kolodny stated; “You have to contain the outbreak by preventing new people from becoming infected and make sure everyone already infected gets the best possible care so they do not die from the infection” (Krisberg, 2017). As a FNP, being aware of the issue and assessing the patient’s needs as it relates to pain control can be challenging; because as nurse we are taught that the patient’s pain is subjective. At a microsystem level I think nursing education is needed to facility understanding of opioid abuse, patient assessment of pain, and community resources for patients. At a meso level as you stated opioid addiction increase a patient’s visits into the hospitals for pain medications and drive hospital cost up. At a macro level law makers, health care providers, insurance companies seek cost effective resolution to the opioid addiction.

Reference:

Krisberg, K. (2017). Prevention in Health Responses to Opioid Epidemic. American Journal of Public Health, 107 (9), 1351.