The open system theory describes a system that exists in a state of constant interaction with its environment. Open systems are found in natural sciences, but in social sciences, they are usually applied to organizations and describes the process which organizations use to exchange information, capital, people, or products, with its environment. In a study by Meyer and O’Brien‐Pallas (2010), the Nursing Services Delivery Theory (NSDT) was derived from the open systems theory as its parent theory to analyze the structural elements of NSDT and its clinical implications. The aim of their research was to understand how a healthcare organization works and how the nurses' work is organized and designed.
The open systems theory has five main concepts that describe how organizations utilize the open system model. They include inputs, throughputs, outputs, event cycles, and negative feedback. While Meyer and O’Brien‐Pallas (2010) used the theory to describe the internal processes in large healthcare facilities between the nursing units and the division and coordination between their work, an examination of subsystems is required to identify potential strategic interventions that would align the inputs, throughputs, and policies to maximize the outputs of nursing care delivery.
In the intensive care unit, the staff, materials, and resources can be considered the inputs. Studies showed that the nurses’ level of knowledge and experience were critical factors in improving the quality of their input in ICUs (Kendall-Gallagher & Blegen, 2009). The materials and resources, such as reliable telemetry devices, catheters, nasogastric tubes, external pacemakers, and monetary funds, are examples of material goods that provide value to the system.
According to Meyer and O’Brien‐Pallas (2010), throughputs occur within the healthcare systems, and their goal is to reorganize the inputs for the purpose of delivering desirable outputs. It is possible to conclude that a general term for throughputs in healthcare facilities would be nursing interventions. In the ICU, those interventions are also vast in number, but some of the examples of common throughputs in the unit are tracheotomy, pharmacological interventions, defibrillation, dialysis, or induced comas.
The outputs are usually the amount of patients treated. The quality of treatment delivered is also an important output to prevent relapses and recurring hospital visits. However, because of the nature of acute conditions, the ICU often has other responsibilities in patient care. In some cases, nurses are required to adhere to their Code of Ethics and reduce the suffering of their patients. Because some conditions are untreatable, reducing suffering is also a desirable output for terminally ill patients.
The cycle of events and negative feedback are similar because they renew the input based on analyzing the outputs. However, the renewal mechanism also includes accreditation and revenue, which are obtained by reaching outcomes and important for maintain the system’s functions. Negative feedback is a set of indicators that can be used to locate issues within a system. In the ICU, an example of negative feedback would be investigating the causes of adverse health effects, which may lead to identifying flawed policies and protocols or inputs from staff as the causes of undesirable outcomes that need to be dealt with.
One of the main issues in the ICU is human error. While only 2 percent of adverse outcomes in ICUs can be attributed to technical failure, the human element was responsible for 31 percent of adverse health effects because of poor planning, execution, or monitoring (Kendall-Gallagher & Blegen, 2009). Although some of the outcomes are connected to poor knowledge and skills, around 30 percent of the adverse outcomes related to rules (Kendall-Gallagher & Blegen, 2009). Some nurses did not adhere to protocol in those situations, but it is also important to consider the possibility that rules should be clear to the employees by avoiding possible contradictions and outdated policies. A desired outcome in the ICU would be to increase the amount of successful interventions by improving the inputs of the staff and regulations for
First, constant education is an important aspect of the nursing, so allocating more resources to expand the knowledge of the staff would improve the input they provide within the organization. Second, the size, role design, coordination, and care delivery models should be revisited to ensure adherence to professional policies and standards.
The size and role design among nurses are also important because the ICU is one of the most stressful environments for nurses. With a larger workforce in the unit, the nurses will face fewer chances for burnout and the clear definitions of nurses’ roles in the policies are required to enhance team coordination and priorities (Reader et al., 2009). Finally, hiring strategies and policies are essential for hiring ICU nurses because their level of competency directly influences the risk of adverse outcomes.
The proposed solution should improve the care delivery in the ICU because it focuses on the causes of adverse outcomes that occur in the unit. According to research on the topic, the staff inputs are the most important element of successful outcomes within the ICU. Because of that, it is important to take care of the staff’s education, emphasize teamwork over individual interventions, share experience, and provide clear protocols that explain the roles and models of care delivery to prevent violations of rules and standards that are related to positive treatment outcomes.
References
Kendall-Gallagher, D., & Blegen, M. A. (2009). Competence and certification of registered nurses and safety of patients in intensive care units. American Journal of Critical Care, 18(2), 106-113.
Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing Services Delivery Theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828-2838.
Reader, T. W., Flin, R., Mearns, K., & Cuthbertson, B. H. (2009). Developing a team performance framework for the intensive care unit. Critical Care Medicine, 37(5), 1787-1793.
