DOI
https://doi.org/10.1016/j.outlook.2008.06.010

Summary
A review of scientific literature on complex systems (CS) and applications of CS theory in nursing systems are provided in the article. Firstly, complex systems are defined as a highly connected network of entities with non-linear behavior. Similarly, complex adaptive systems (CAS) are introduced as complex systems which can adapt to the changing environment. Secondly, the literature review covers research on CAS in physical and natural sciences. The examples in healthcare are provided to represent CAS characteristics, such as self-organization, emergence, nonlinearity, chaotic and turbulent behavior. The authors state that a very important part of CS research is experimental and correlation studies, therefore, computational modeling and simulation, data analysis are important tools to investigate the clinical and administrative performance metrics. Moreover, the computational modeling and simulation of CAS help to improve decision-making and problem-solving skills. The virtual worlds enable to identify the patterns, relations, and behavior. In addition, decision simulators can help to foresee the result and reduce the negative impact in real life. Thus, the CS theory and applications are important part of nurse leader education, practice, and research.

Relevance for Complex Systems Knowledge
The clinical and administrative processes of patient care are defined as complex adaptive system in this article. The authors note that humans are not able to accurately interpret the structure and dynamics of complex system due to limited memory, attention and time and define causal relations between the parameters. However, skills such as system thinking, organizational behavior, decision making, problem solving are essential for nursing leaders. Thus, computational modelling is employed to investigate the impact of information systems on clinical and administrative performance metrics. As knowledge about physical and human behavior in complex system is required to build an appropriate computational model, the development of the model covers fields of mathematics, physics, and engineering as well as cognitive and social psychology. The authors note that using computational modelling and simulation in nurse training process enables better decision making and effective execution. The technological innovations in simulation techniques and equipment improved nurses’ ability to adapt to a changing environment as parameters of the model can be easily manipulated.

Point of Strength
The importance of computational modelling and simulation as a tool to improve systems thinking in the field of nursing education is reasoned in this article.