TOWARDS A GENERAL SYSTEMS THEORY OF NURSING: A LITERATURE REVIEW

Abstract

Although systems thinking in nursing is a vital tradition there have been no previous attempt to understand this systemically.  This paper addresses nursing as a disciplinary matrix by systematic reviewing the relevant literature.  The search engine ‘CINHAL with Text’ 1990-2011 is used along with a search of foundation and primers texts.  There are both first-order homeostatic and second-order dynamic and to a much more limited extent third-order social contextual cybernetic systemic theories in the nursing literature.  The development of nursing theory over time resulted from the personal perspectives of the nurse theorists, for example, Martha Rogers (1970), rather than phases of development.  The practice development of family systems nursing, developed by Wright and Leahey (1984) and Marie-Luise Friedmann (1989) arose through international academic-practitioner networking.  The systemic nursing management literature demonstrates open systems, complex adaptive systems and chaos theories.  The literature reviewed suggests systemic ideas arose to address the problematics of specific domains.  Specifically, the problematic of professionalization resulted in the development of systemic nursing theories in the academic domain and family systems nursing in overlap between the practice and academic domains, and the problematic of cost-containment and risk management in the governance and government domains.  There is limited connection between systemic thinking by nurses in the largely domain specific literature.  The conclusions of this review are that: first, there appears to be some consensus about the value of attachment (Bowlby 1951) and ecological developmental theories (Bronfenbrenner 1979)  in nursing practice: and secondly, the slow development of nursing as an academic project can be viewed as an opportunity for transdisciplinary considerations of biological, psychological, sociological and political systems in nursing theory and practice. This paper is an expression of an attempt to address the puzzle of considering the coherence of systemic thinking in nursing from the author’s position as academic and practitioner.  The potential for  developing a general systems theory of nursing practice, nursing administration, healthcare administration, and global healthcare  remains, and may be of value in positioning the profession’s practices in its policy and political environments.