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On successful completion of this module you will be able to:

1. Define the term system.
2. Outline several key features of General Systems Theory.
3. Describe a community in Systems Theory terms.
4. Discuss the use of Systems Theory in client assessments.
5. Explain various applications of Systems Theory in nursing practice.

1.0 Introduction

General Systems Theory was introduced in 1936 and is attributed to Ludwig von Bertalanffy (1950) who was a general biologist and philosopher. His work is amongst the most significant contributions to Western thought this century. Systems Theory has become so pervasive that we commonly use the term ‘system’ without any thought about its origin in this theory. Consider, for example, how many times we have already used the term in earlier modules. It is likely that you use the term in every subject in this course. You learned anatomy and physiology by studying various body systems such as the circulatory system, respiratory system, central nervous system and so forth. You will have also learned about various social systems in sociology. You may not be surprised to learn that Systems Theory has been adopted and applied directly to a wider range of fields or disciplines than any other theory or model. It has been used in fields as diverse as astronomy to zoology, from botany to geology, from engineering to nursing.

2.0 Definition of ‘System’

This is surprisingly quite simple. A system is basically an entity consisting of interdependent structures and functions where each component can communicate and respond as required for the good of the overall entity.

Did you get that? Easy isn’t it? Another way of expressing this definition is: "a system is a whole, which functions as a whole, by virtue of the interdependence of its parts" (Braden & Herban 1976, 5).

Let’s take a closer look. A system

• is a whole
• which functions as a whole
• by virtue of the interdependence of its parts.

It follows therefore, that a change at any point in a system can have an effect on all other parts of the system.

This may sound familiar. Perhaps that is because this concept was an important forerunner (in the West) to holistic thinking (which is actually whole_istic remember). Holism simply builds on the concept of a system by observing that if one wants to understand or relate to the whole of anything, one must grasp the reality that the whole is always more than the sum of its parts.

Our Western penchant for reductionism makes us good at analysing, that is, seeking to understand by breaking things down into parts. Unfortunately, minds that are good at reductionism find it difficult to put all the parts together to see the whole again and often really have difficulty with the idea that there can be something more than the sum of the parts! Nevertheless, this is the basic foundation for holism and its relationship to systems thinking is significant.

3.1 Introduction

Much of the terminology or language of systems theory has entered common usage and will be easily understood. Some, while not in common usage perhaps, will be familiar to you because of your nursing education. Systems Theory can be an absorbing study but here we shall concentrate only on essential concepts to enable a working use of the concepts.

3.2 Types and boundaries

All systems are identified as existing within a boundary. The boundary distinguishes a system from its environment. A system may be described as open or closed. An open system is one that experiences some exchange with its environment. Closed systems experience no exchange with their environments and are really of no concern to us, since all social systems (systems involving people), by definition, are open. Sometimes one hears of or reads about a social system being described as a closed system. It is important to realise that this is not a literal claim, but may be a rather negative description of a system thought to have inadequate or less than optimal exchange with its environment. Remember, all the systems we are concerned with are open systems.

System boundaries identify the system and filter exchanges with the environment. A system boundary may be visible, such as a line on a map, or physically obvious such as a river. For example, if we were concerned to identify a local government system we could refer to a council or shire map. If the local government area happened to be Albury or Wodonga, one part of the boundary would be a part of the Murray River. Another physical example would be the membrane surrounding what we identify as a human cell.

These boundaries are called visible, even though you may need a magnifying glass, binoculars or a good microscope to see them! The other type of system boundary can be thought of as ‘understood’. These boundaries are quite real but they can’t be seen. A good example would be membership of a group or organisation. In an organisation, a membership card may be used and is certainly visible, but it is not the membership, merely one piece of evidence of membership. ‘Membership’ functions to identify the system and acts as a filter. Clearly one is either in a group or not in a group. Think of a family system as an example. Membership may be by marriage, blood (consanguine), adoption, fostering, or some other agreement, but ultimately the members know who is in the family and who is not.

3.3 Hierarchical ordering

All open systems experience something called hierarchical ordering. Systems are organised:

Each sequential level in the hierarchy is interlocking and interacting. For example:

• Cells ® organs ® body systems ® whole body

• Individuals ® groups ® social systems ® community

This is illustrated in the following diagram.

Diagram 3.3.1

Adapted from Goldenberg and Goldenberg (1985)

Notice in the diagram that each higher level is made up of many instances of the level below. For example, many individual persons can make up a work team, many work teams can make up an industrial concern, many industrial concerns are found in one nation and many nations make up the Common Market. Here we have moved through system levels from organismic to group to organisational to societal to supranational.

Now we can add the terms sub-system and suprasystem. Take any level on the diagram above, say the group system level for example. This level is made up by many group systems. Each system at this level is in turn made up by many sub-systems which are at the next level down, the organismic system level. Now refer again to our reference system level, group systems. If we look above this level we find the organisational level, which is referred to as the suprasystem. The dashed or broken lines on the diagram illustrate the sub-system and suprasystem relationships between the levels.

It is important to note that what is a subsystem, system or suprasystem depends entirely on the reference system level chosen at the time. So in our example, group systems could also be referred to as the subsystems of the organisational systems or the suprasystem of the organismic system level. ‘Sub-’ and ‘supra’ are merely prefixed in order to indicate a relative relationship to any given system being discussed.

3.4 Inputs, outputs, energy exchange, feedback and quasiequilibrium

All open systems have both inputs and outputs. Open systems interact with their environments. They take inputs into the system and they send outputs from the system back into the environment. The environment is everything surrounding the system, and may have a variety of characteristics. These exchanges take place through the system boundary. Some examples could be:

• Inputs – energy, materials, information
• Outputs – "products" or services

Systems function at varying rates of energy exchange with the environment. Some energy is always used for what is called boundary maintenance. This is essential if the system is to survive. Variations in the energy exchange will have predictable consequences (with which we are all familiar!). These are as follows:

• ­ energy input ® ­ output or a bigger system
• ¯ energy input ® ¯ output or a contracted system

We all know individuals who increase their energy input without increasing their energy output and pay for the consequences of their ‘bigger system’ at the clothing store!

Systems regulate their energy flow based on feedback. There are two possible conditions as shown in the following table.

A system that is very sensitive to feedback will be less stable than one that is less sensitive. Open systems can receive positive or negative feedback and this feedback may be internal or external.

Consider our poor friend at the clothing store. Several physiological and psychological internal systems operate to regulate the amount of energy input. These are internal feedback systems. In addition, our friend may encounter someone who says "my goodness, you’re putting on a lot of weight!" (not one of us of course, we’re more subtle!) which would be external feedback. Our friend’s sensitivity to all of this internal and external feedback will determine their stability (perhaps in more ways than one!).

All open systems aim for a condition or state referred to as quasiequilibrium. Expecting equilibrium would be impossible because that would be attempting to make a system, which is dynamic by nature, into something that is static. Hence, the aim is for quasi or almost equilibrium. Another way this could be understood is as state or condition of dynamic balance.

3.5 Entropy and negentropy

These rather odd sounding terms are very simple to understand. Entropy refers to the observed tendency of all systems to break down or wear out or in some way fail or die. Entropic forces are always at work to do this. The signs of ageing and wear-and-tear, for example, are evidence of entropy.

Negentropy, just as the word seems to suggest, refers to the forces or whatever action is taken to negate entropy. When we engage in maintenance, for example, our efforts are examples of negentropy, that is, they are negentropic.

Recall that all systems have boundaries. Each system needs to engage in what is called boundary maintenance, which is considered required negentropy, for system survival. Some of the energy taken as part of the input for a system must be used by the system on negentropy. Some systems, when very stressed or stretched, consume a great deal of their energy on maintenance, leaving less available for productive system functions.

3.6 System requirements

For systems to function properly they require certain conditions. The main conditions are as follows:

• Some similarity amongst members
• Reasonable member proximity
• Effective internal communications

Clearly, these conditions are closely related, especially the last two perhaps. If we take a hospital system as an example, and focus on the nursing subsystem, we can identify the conditions above. The members all have some similarity. For example, they all share levels of approved qualifications, language, certain skills and so on. They have reasonable member proximity in that they have sufficient numbers within the hospital itself and no doubt are organised within clusters to enhance this feature, such as within wards and departments. They will also have, we trust, effective internal communications; that is, they will be able to communicate with one another as required to be able to carry out their function, whether interpersonally, by nurse’s call system, public address, alarm, telephone, or whatever.

3.7 Structure and purpose

All open systems have some form of structure, that is, an organised set of roles that provide direction. Typically these role structures will be organised along lines of leadership – followership. This is fairly easy to identify in organisations or communities but it is also true within an individual where certain roles (physiological functions) are led by nervous or endocrine functions or by predetermined sub-system operation such as the way the alimentary system proceeds from input to output.

Finally, all open systems have purpose, that is, they exist to achieve something. We could say they are goal oriented. As you observe various systems throughout this subject, form the habit of asking yourself: What is this system’s goal, what does it exist to do? The answer can be very useful in your assessment and subsequent steps of the nursing process.

3.8 Application to linear model

The following diagram is a linear model of an open system in interaction with its environment.

Diagram 3.3.8.2

(French & Bell 1973, 75)

There are some observations to make on the above model. The system boundary is shown as a broken line to indicate that it enables exchange with the environment. The component referred to as the transforming mechanism represents whatever in the system exists and is organised to achieve the purpose for which the system exists. Another label applied to the transforming mechanism is throughput (Altschul 1978). Some people are confused to find the inputs and outputs within the system boundary. It is a common mistake to draw a linear model and place these outside the boundary. For inputs to be used by the system they must be within the boundary. Similarly, if a system produces outputs they must be shown within the system boundary. They may not be held for long before being sent out to the environment, but they may be accumulated for some time. Of course stockpiling outputs is a way of storing a form of energy and this will mean the system grows larger in the process.

4.0 Community in System Terms

When one examines a community one usually first observes the big picture, that is, takes in an overview. Subsequently the focus shifts to consider more of the detail. Systems Theory provides an excellent tool to guide this process. Indeed, Gillies (1982) suggests that:

The following diagram of a community shows that it is made up of many major subsystems.

Diagram 3.4.1

(Spradley 1990, 373)

In this diagram we see that the whole community system is made up of many subsystems, such as legal, communication, health, and so on. These in turn are made up of subsystems, which themselves contain subsystems (here shown as organisations), which also contain subsystems (shown as roles), and so on. This clearly illustrates hierarchical ordering.

Another systems view which concentrates on the health system will reinforce the idea that a whole system can be understood as the complex combination of a number of interacting subsystems.

Diagram 3.4.2

(Spradley 1990, 376)

Here we see the health system comprised of subsystems such as the health finance system, the public health system, the professional training system, etc. These are further comprised of subsystems. The professional training system is comprised of medical schools and nursing schools for example. Although this is just one analyst’s conceptualisation and is very simplified it helps to reinforce some systems’ concepts. It is easy to imagine, for example, a nursing school system or a children’s hospital system or a pharmacology and medical technology system. Each of these is a system in its own right, is a subsystem of the health system and has its own subsystems. It should also be easy to recognise using these examples, that these subsystems all interact in many and various ways and that a change in any one can (and will) effect the others.

Activity 3.4.1

5.0 Systems Theory in Client Assessments

Client assessments in PHC practice vary considerably and there are no unifying tools that can be relied upon to meet everyone’s need. Part of the reason for this is the diversity in client type and focus. For example, the client may be an individual, a family or group, or a whole community which itself may geographic or based on common interest. Several tools do exist of course, but their diversity is such that they each have limited usefulness. It is in this situation that Systems Theory has something to offer.

Systems Theory provides a set of concepts that can be applied to any and all systems. Since all clients of every type can be conceptualised in systems terms all PHC practitioners can utilise Systems Theory in their analysis and description of clients. Based on this, the whole process from assessment, planning and implementation to evaluation can acquire conceptual clarity. It can also provide a common language to support practitioner communication. What is especially attractive, is that systems concepts are not difficult for people to grasp, which means the language is open, enabling clients to fully participate. The use of Systems Theory in PHC practice can therefore be client empowering.

6.0 Applications of Systems Theory in PHC

As we have already seen, Systems Theory can play a central role in PHC by informing practice. It has been employed in a formal way to inform some models of professional nursing practice. Perhaps the best example of such an application is Neuman’s (1980) health care systems model. Whilst this model was focussed on individuals, Neuman (1982) discussed various ways in which it could be adapted and explicitly illustrated its application to family practice (Neuman 1983).

Neuman’s contribution has been significant and is firmly based on systems theory. A model is an as yet unverified, or unverifiable, theory, which seeks to provide answers to questions such as: what is nursing, what is health, what is care, what practice is legitimate for nurses, what are our goals, and so on. It is easy to see how relevant this can be in developing rationales for practice. Remember, all good practice depends upon good theory.

It is possible at a more general level to appreciate that systems theory guides assessment. By its nature, systems theory helps to ensure that assessment is comprehensive or broad based. It also supports depth in analysis, helping to avoid problems of oversimplification and uni-causality.

Activity 3.6.1

Another application of systems theory can be in both the guidance of intervention and understanding of its achievement. For example, workers within the health system can become aware that their contribution is in fact influencing the whole community. Similarly, one can appreciate that each small contribution adds to other contributions which accumulate for the benefit of the whole system.

For example:

Finally, systems theory helps PHC practitioners to recognise the multi-sectoral approach that is needed to deal with many problems. For example, consider the following.

Now complete the following self-test to conclude this introduction to Systems Theory.

Module 3 Self-Test

If you had difficulty with more than a couple of these questions you are advised to repeat the entire module.

Use this link if you want to send e-mail to the Subject Coordinator. (removed)

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