Nursing, Caring, and Complexity Science: For Human ... - Axon

14 NURSING, CARING, AND COMPLEXITY SCIENCE
affect profound internal changes within the system and the system can
dramatically self-organize. Continuing this analogy Mishel theorizes that
entropy, or the degree of disorder and disorganization in life, increases
in persons who are in the midst of unabating uncertainty. Persons cannot
withstand this mounting uncertainty and are pushed to a bifurcation point
when there is either death or a change toward a more complex level of
self-organization.
Vicenzi (1994) suggested that chaos theory could provide a new synthesis
for nursing and community health; she was one of the first to
relate the concepts of chaos theory to nursing theory and health-related
phenomena. For example, she suggests that perhaps nursing intuition is
a prereflective sensing of chaos and that heart rate variability, neutrophil
counts, epilepsy, and schizophrenia exhibit chaotic dynamics. Sensitive
dependence is a concept in chaos theory sometimes called the “butterfly
effect,” referring to the phenomenon that small change can lead to
extreme effects in the long term (p. 38). She relates these concepts to
Rogers’ (1990) postulates of unpredictability and irreducibility, and suggests
that nurse scientists might increase their use of longitudinal research
designs and computer modeling to come to understand the wholeness
and complexity of human patterning.
Ray (1994) situates her theory of complex caring dynamics within the
context of complexity science and chaos theory. The foundations of her
theory are in a relational ontology patterned by love. She states that “selforganization
in chaos theory, although seemingly without a goal, is influenced
by creativity—a vision of a purposeful love, a purposeful God, a force
or spirit of life expressing itself intelligently in the universe” (Ray, 1994,
p. 25). Ray argues effectively that the concepts of relationality, belongingness,
holism, self-organization, human–environment integrality, patterning,
stages of organization–disorganization stages, unidirectionality of change, and
pattern recognition are contained within nursing and consistent with complexity
theory (Ray, 1994, p. 25). Caring is defined as “the energy by which choice
is facilitated to bring order (healing or well-being) out of chaos (disease, disease,
need, pain, or crisis)” (Ray, 1994, p. 26). Ray describes the caring
relationship as an attractor that draws the system away from chaos and toward
well-being and healing. In this relationship, the nurse instills hope, leading to
choice making that changes the pattern so that both nurse and client are “more
alive and authentic” than before (Ray, 1994, p. 26). She identifies four life pattern
forms related to pattern seeing: technical, practical, critical, and creative
caring dynamics. Each has its corresponding methodological frameworks for
pattern mapping and integrative synthesis or pattern recognizing. The theory
of complex caring dynamics highlights the primacy of relationships or love as
the pull of the universe toward creative emergence or healing.
Turkel and Ray (2000, 2001) developed a theory of relational complexity
that describes and explains the importance of caring in the complexity of