Clinical Nurse Specialist Integration of Complex Adaptive Systems Theory to Positively Influence the Achievement and Sustainability of Surgical Site Infection Prevention

2.50
Hdl Handle:
http://hdl.handle.net/10755/164157
Category:
Abstract
Type:
Presentation
Title:
Clinical Nurse Specialist Integration of Complex Adaptive Systems Theory to Positively Influence the Achievement and Sustainability of Surgical Site Infection Prevention
Author(s):
Sitterding, Mary
Author Details:
Mary Sitterding, MSN, CNS, Columbus Regional Hospital, Columbus, Indiana, USA, email: nacnsorg@nacns.org
Abstract:
Background/Rationale: To succeed, a clinical nurse specialist innovator will disturb the present. A kaleidoscope, not a computer, is the ultimate weapon to help clinical nurse specialists meet the challenges of the 21st century. Factors that drive the business case for the clinical nurse specialist innovator in the hospital include the following: patient/family expectations; public expectations based upon public reported indicators and outcomes; changing workforce; clinician dissatisfaction; and a drive for excellence. Innovation emerges as the clinical nurse specialist works with teams to apply basic principles of complexity science. The opportunity was for the clinical nurse specialist to utilize a complex adaptive systems approach to achieve and sustain excellence regarding public reported surgical site infection process indicators that include: antibiotic administration within 60 minutes of 1st incision; antibiotic selection; and the duration of antibiotic prophylaxis. Description: Complex Adaptive Systems (CAS) are collections of individuals or agents who act in ways that are not always totally predictable, and whose actions are interconnected so that one agents actions change the context for other agents (Plsek, P. & Greenhalgh, T., 2001). The clinical nurse specialist worked with the Surgical Site Infection Prevention Team to identify and modify structures, processes, and patterns influencing achievement and sustainability. Utilizing a complexity lens, surgical site infection process improvement was led by senior leadership who positioned surgical site infection as a strategic priority. The clinical nurse specialist used the CAS framework to engage bedside nurses using a "few simple rules" (Plsek, 2000). Simple rules include: 1) all of our work is patient-centered; 2) all of our work is evidence-based; and 3) solutions are derived from the bedside nurse. A good enough vision regarding surgical site infection prevention improvement initiative was clearly and frequently communicated informally and formally at nursing unit nursing practice councils as well as within leadership forums. With the initial improvements implemented, resistance to practice change was anticipated. The clinical nurse specialist designed strategies aimed at decreasing resistance i.e. incentive, information, intervention, indoctrination, and involvement (Hammer and Staton, 1995). Outcome: Among retrospective records reviewed, 90 - 100% of persons receiving an elective total joint replacement and coronary artery bypass graft receive antibiotic administration within 60 minutes of 1st incision. In addition, 90 - 100% of records reviewed suggest evidence-based selection of antibiotics for this population. Surgical site infection rates have decreased among target populations. Initial achievement was realized in 2001 and has been sustained as the team attempts spread across other eligible populations served. Conclusion: Providers and hospitals are complex adaptive systems. In complex systems, unpredictability and paradox are inherent. The machine metaphor doesn't allow us to understand fully the influence of non-disease based patterns influencing system outcomes. The clinical nurse specialist is well positioned to diagnose and manage non-diseased based patterns (knowledge deficit, self-efficacy, outcome efficacy, values, influencing provider practice. Understanding and applying basic concepts of complex adaptive systems broadens the clinical nurse specialist capacity to meet the expected patient, provider, and system outcomes. Implications for Practice: The clinical nurse specialist is well positioned to positively influence Centers for Medicaid and Medicare (CMS) public reported outcomes such as surgical site infection prevention process indicators by applying a complex adaptive systems approach to diagnosing, modifying, and/or eliminating structures, processes, and patterns influencing patient, provider, and system outcomes. CNS competencies demonstrated within this innovation include but are not limited to the following: 1) design system-level assessment methods and instruments to identify organization structures and functions that impact nursing practice and nurse-sensitive patient care outcomes; 2) diagnose variations in organizational culture (values, beliefs, or attitudes) that can positively or negatively affect outcomes; 3) plan for achieving intended system-wide outcomes, while avoiding or minimizing unintended consequences; and 4) design methods/ strategies to sustain and spread change and innovation.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2005
Conference Name:
CNS Leadership: Navigating the Healthcare Environment Toward Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Orlando, Florida, USA
Description:
Conference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleClinical Nurse Specialist Integration of Complex Adaptive Systems Theory to Positively Influence the Achievement and Sustainability of Surgical Site Infection Preventionen_GB
dc.contributor.authorSitterding, Maryen_US
dc.author.detailsMary Sitterding, MSN, CNS, Columbus Regional Hospital, Columbus, Indiana, USA, email: nacnsorg@nacns.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/164157-
dc.description.abstractBackground/Rationale: To succeed, a clinical nurse specialist innovator will disturb the present. A kaleidoscope, not a computer, is the ultimate weapon to help clinical nurse specialists meet the challenges of the 21st century. Factors that drive the business case for the clinical nurse specialist innovator in the hospital include the following: patient/family expectations; public expectations based upon public reported indicators and outcomes; changing workforce; clinician dissatisfaction; and a drive for excellence. Innovation emerges as the clinical nurse specialist works with teams to apply basic principles of complexity science. The opportunity was for the clinical nurse specialist to utilize a complex adaptive systems approach to achieve and sustain excellence regarding public reported surgical site infection process indicators that include: antibiotic administration within 60 minutes of 1st incision; antibiotic selection; and the duration of antibiotic prophylaxis. Description: Complex Adaptive Systems (CAS) are collections of individuals or agents who act in ways that are not always totally predictable, and whose actions are interconnected so that one agents actions change the context for other agents (Plsek, P. & Greenhalgh, T., 2001). The clinical nurse specialist worked with the Surgical Site Infection Prevention Team to identify and modify structures, processes, and patterns influencing achievement and sustainability. Utilizing a complexity lens, surgical site infection process improvement was led by senior leadership who positioned surgical site infection as a strategic priority. The clinical nurse specialist used the CAS framework to engage bedside nurses using a "few simple rules" (Plsek, 2000). Simple rules include: 1) all of our work is patient-centered; 2) all of our work is evidence-based; and 3) solutions are derived from the bedside nurse. A good enough vision regarding surgical site infection prevention improvement initiative was clearly and frequently communicated informally and formally at nursing unit nursing practice councils as well as within leadership forums. With the initial improvements implemented, resistance to practice change was anticipated. The clinical nurse specialist designed strategies aimed at decreasing resistance i.e. incentive, information, intervention, indoctrination, and involvement (Hammer and Staton, 1995). Outcome: Among retrospective records reviewed, 90 - 100% of persons receiving an elective total joint replacement and coronary artery bypass graft receive antibiotic administration within 60 minutes of 1st incision. In addition, 90 - 100% of records reviewed suggest evidence-based selection of antibiotics for this population. Surgical site infection rates have decreased among target populations. Initial achievement was realized in 2001 and has been sustained as the team attempts spread across other eligible populations served. Conclusion: Providers and hospitals are complex adaptive systems. In complex systems, unpredictability and paradox are inherent. The machine metaphor doesn't allow us to understand fully the influence of non-disease based patterns influencing system outcomes. The clinical nurse specialist is well positioned to diagnose and manage non-diseased based patterns (knowledge deficit, self-efficacy, outcome efficacy, values, influencing provider practice. Understanding and applying basic concepts of complex adaptive systems broadens the clinical nurse specialist capacity to meet the expected patient, provider, and system outcomes. Implications for Practice: The clinical nurse specialist is well positioned to positively influence Centers for Medicaid and Medicare (CMS) public reported outcomes such as surgical site infection prevention process indicators by applying a complex adaptive systems approach to diagnosing, modifying, and/or eliminating structures, processes, and patterns influencing patient, provider, and system outcomes. CNS competencies demonstrated within this innovation include but are not limited to the following: 1) design system-level assessment methods and instruments to identify organization structures and functions that impact nursing practice and nurse-sensitive patient care outcomes; 2) diagnose variations in organizational culture (values, beliefs, or attitudes) that can positively or negatively affect outcomes; 3) plan for achieving intended system-wide outcomes, while avoiding or minimizing unintended consequences; and 4) design methods/ strategies to sustain and spread change and innovation.en_GB
dc.date.available2011-10-27T11:43:05Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:43:05Z-
dc.conference.date2005en_US
dc.conference.nameCNS Leadership: Navigating the Healthcare Environment Toward Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationOrlando, Florida, USAen_US
dc.descriptionConference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.