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The Impact of System & Diffusion


Theories in Evidence Based Practice

Romaine L. Martin, D.Min, JD, MS, BSN


rlmcenter@gmail.com
[June 7,2011]
A. Introduction
Nursing has made significant strides as a unique profession that is vital to the future of
health care delivery. These strides are attributed to the emergence of concepts derived from in-
depth investigation, compilation and application of scientific theory. The research of nurse
theorists largely contributed to this status for the intention of advancing nursing education and
practice. For the unity of purpose, theoretical models did not discredit but complement the art
and science of nursing (Jones, 2011). System theory and diffusion of innovation theory are
examples of scientific concepts that emerged to advance nursing practice and health care delivery
(Kitson, 2008; Blakeney, Carleton, & Coakley, 2009). Theory is germane to this essay in addition
to an explanation of the research conducted.

Evidenced based practice (EBP), is an essential principle in nursing education and


practice. Leading nursing organizations recommend evidence based practice in all aspects of
education and patient care services (Reavy & Tavernier, 2008). Schoenfeolder (2007) illustrates
EBP as dynamic and progressive to predict and influence the best patient outcomes. System
theory and diffusion of innovation is employed to bring to light the enormity of nursing as an
EBP for the advancement of health care delivery.
B. Systems Theory in Healthcare Delivery
Systems theory developed from historical ideas. In the early 1900’s, Ludwig von
Bertalanffy, a renowned philosopher and theoretical biologist, modernized the significance of
general systems theory (Drack et al., 2007). Von Bertalanffy formalized biological and
mathematical concepts to demonstrate the validity of general systems theory (Bertalanffy, 1972).
The phenomenon functions to unlock conceptual thinking. The premise is all levels of an
organism, whether living or environmental, comprise a logical homology that should be studied
as an organized whole. For that reason, a study solely on the order of parts is isolated and
incomplete to fully determine the complexity of a problem. In health care delivery, system
theory influences patterns of care, policies and practices to influence change in the whole
organization (Bertalanffy, 1972).
The work of Batalden & Mohr (1997) serves to channel planning and decision making.
The study relied on system theory to emphasize the capability of information systems in health
care delivery in meeting changing patient demands and innovation. Similarly, Hatcher &

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Heetebry (2004) uses system theory to give insight into technological factors and barriers in
health care delivery.

These researchers utilized systems theory to draw attention to best practices in healthcare
delivery. Case in point, technology is vital to health care delivery. Based on system theory,
technology should be studied as an organized whole to achieve greater efficiency. A narrow
approach will limit the potential impact of technology and, unintentionally, create additional
gaps and errors. Flaws will be inevitable and compromise the full extent of technology as a
whole system. Hence, the theory guided a holistic examination of technology. As shown in
Hatcher & Heetebry (2004), there are technological possibilities in health care delivery that
comprise patient management, simulation, imagery, remote medical diagnosis, mobile health
care, telemedicine, internet & intranet programming, security, distance learning, data mining and
security.

C. Diffusion Theory and Healthcare Delivery

Another important theorist is Everett M. Rogers, a sociologist, who introduced diffusion


and innovation theory. Rogers’s theory is utilized to create change in health care delivery
(Sanson-Fisher, 2004). The premise is the necessity of 100% adoption of innovation for effective
and embedded change to occur (Robertson, 1967). The literature reveals diffusion theory as a
fundamental to change. Rogers stipulates the essentials of five distinct elements for effective
change; these are relative advantage, compatibility, complexity, trialability and observability
(Sanson-Fisher, 2004, p. S55). Diffusion theory is powerful; in addition to offering guidelines for
leading and entrenching change, the theory has the capacity to frame evidence & employ
findings (Leeman et al, 2006).

In addition to systems theory, Rogers’s diffusion of innovation theory is utilized to


advance technology in health care delivery. There is sufficient research to illustrate the
advantage of telehealth to improve health care access & costs (Walker & Whetton, 2002; Wang
et al, 2005). Nonetheless, traditional and conservative views of health care delivery remain a
barrier particular in highly structured institutions such as hospitals. For this reason, the
innovation of telehealth is minimized or disregarded and, regrettably, the opportunity for
improved patient outcomes is avoided or under developed (Walker & Whetton, 2002). The

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power of Rogers’s theory as a change process has boosted innovation in the face of resistance.
According to Walker & Whetton, 2002, “innovation is more likely to be adopted if: perceived as
having a relative advantage over the method it supersedes and as being compatible with existing
values and needs” (p. S3:74).
D. Systems Theory and Nursing Practice
The benefits of systems theory in nursing practice are unmistakable. Concepts of
wholeness and openness are consistent with nursing principles. The basic idea of system theory
is an Aristotelian view that states, “The whole is more the sum of its parts” (Bertalanffy, 1972
p.407). Nurses employ the concept of wholeness in problem solving. For instance, system theory
evaluated the influence of family anxiety on patient recovery (Mitchell et al, 2003). The analysis
revealed the weight of family anxiety and uncertainty on patient clinical outcomes in the
intensive care unit (Mitchell et al, 2003). Hence, system theory illustrated the family as a key
component influence patient recovery.

The results evidenced best practices in achieving patient outcomes. Here, the relationship
between systems theory and EBP is suggested. As stated in Schoenfeolder (2007), “EBP is
defined as the integration of best research evidence with clinical expertise and patient values” (p.
7). Moreover, systems theory is invaluable for critical thinking and decision making. The theory
channels higher thinking to consider and balance the complexity of a problem. This is implied in
the literature review of Nelson (2011), who examines the circular and balancing affect of theory.
Likewise, Bertalanffy (1972) draws attention to a multiplicity of factors in system theory and not
the vacuity of insular thinking.

E. Diffusion Theory and Nursing Practice

Equally significant is diffusion of innovation theory for offering a systematic course of


action to elicit change. Contrary to system theory, diffusion theory maps a process to achieve
change. While system theory opens the boundaries of critical analysis, diffusion theory is
directive to entrench change, i.e. new behavior. Although both theories are relevant for health
care reform, diffusion theory fulfills the intention of change. Nurses, as change agent, will make
powerful accomplishments to innovate global health systems by undertaking diffusion theory
(Blakeney et al, 2009).

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Too often, nurses predict and plan innovation that fail or the actual results are less
favorable. The articles provided insight on processes to strengthen approaches for improving
nursing education and practice. Without a doubt, the application of theory will lead to more
effective nurse leadership and change management to advance the quality of patient care. I
suspect that greater inclusion of Rogers’s five distinct elements for effective change will open
new opportunities for advanced nurse practice (Sanson-Fisher, 2004).

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Bibliography

Batalden, P. B., & Mohr, J. J. (1997, Summer). Building knowledge of health care as a system.

Retrieved April 28, 2011, from Quality Management in Health Care:

http://journals.lww.com/qmhcjournal/Abstract/1997/05030/Building_Knowledge_of_Hea

lth_Care_as_a_System.1.aspx. This article follows a system approach to resdesign the

operation of health care delivery by presenting a 10 step process that builds knowledge of

organizational elements.

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April 24, 2011, from The Academy of Management Journal: http://links.jstor.org/sici?

sici=0001-427328197212%2915%3A4%3C407%3ATHASOG%3E2.0CO%3B2-4. A

leading general system theorist presents historical views and clarifies philosophical

principles that are mathematically illustrated and applicable to biological, technological,

psychological, cultural and linguistical areas of interest.

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are renaissance thinkers in system biology.

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of Medical Systems , 28 (6), 673-687. The authors employ system theory to present a
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comprehensive analysis of obtainable technological sources that should be considered to

innovate health care delivery.

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facilitate the use of findings in practice. Journal of Clinical Scholarship , 38 (2), 171-177.

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findings have sufficiently evidenced the need to innovate.

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for greater utilization.

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adoption and diffusion of innovation in evidence based practice.

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technology.