For most nurses, the only constant in their days is the fact that things are perpetually changing around them. However, the majority of the training they receive before reaching their hectic workplaces is based on stable, theoretical examples. One California professor is trying to change that.
Dr. Elena Capella, an assistant professor and the director of the online, 2-year Master in Nursing program at the University of San Francisco's School of Nursing and Health Professions, uses chaos theory and self-reflection strategies in her classroom to help guide the latest generation of nurses in a way that will ultimately reduce their stress and improve their effectiveness in the workplace. After decades as a practicing nurse, Capella recognized that the nursing field was changing very quickly and continues to do so as the healthcare industry evolves, meaning the nurses themselves must be willing and able to adapt accordingly.
"My profession in healthcare was in quality assurance and risk management, so I was always dealing with problems in healthcare -- where things go wrong, where we didn’t do what we intended to do, where there were errors and problems with delivering care," Capella told The Huffington Post. "So what's wonderful is to be able to train new nurses -- actually, the nurses I train are usually already working at some of the best hospitals in the Bay Area -- who are looking to reach a new level of practice where they can do more to help their patients."
In her collection of courses for the master's program, Capella introduces nurses to chaos theory to help them handle the intense needs of the emergency room, reaching a sense of calm in disaster situations.
"Chaos theory just says that things are loosely associated," said Capella. "We try and be organized and directed in our approach, we have a lot of science, we have a lot of protocols, we have all this standardization, but you’re dealing with people, and people introduce all sorts of complexities to the picture. There are patients that don’t follow protocols, there are patients that have different backgrounds and understandings, there are miscommunications, there are problems with coordination. When you start introducing so many different pieces to an environment like healthcare, then it starts to become disorganized and very chaotic."
It is at this point, according to Capella, that you need someone to step in as a reorganization force, someone who can redirect everyone's attention and energy in an efficient manner -- which is what she is training her nurses to do.
"We also talk about how it’s not bad for things to be chaotic -- that’s just natural," she said. "You definitely want to move it in the right direction. What’s so important about teaching this is that it really helps nurses to understand what they are dealing with when things just seem overwhelming and they’re at the maximum of their intellectual limits."
She also understands that in order to be a successful nurse, students have to reach an almost zen-like mindset. Thus, her coursework includes a fair amount of personal reflection practice as well.
"We really draw upon the students’ professional experiences," said Capella. "They’re often discussing what’s happened to them (in a very confidential way) and they describe these very murky situations they’re in, and how they either solved the problem or wished they would have solved the problem. For a lot of them, it’s really the first time they’ve reflected on their practice, and often times, you do feel as a teacher that nurses need this. They need to talk about the puzzling situations they were in where someone’s health was at stake. That reflection in the classroom is a transformational moment for students."
Capella has been teaching at the university for almost two decades, but only in the last two and a half years has her master's program and course offerings moved entirely to an online format. The change proved beneficial for her students; she experienced more direct communication with each of them, more students felt comfortable speaking up in online forums and conference calls than in the ground classroom setting, and many of them took more time to think through their responses to complex case study problems rather than blurting out the first answer that came to mind. Each online course remains relatively small in number, capped at 25 students per class.
"As students go through the program, they are being transformed," said Capella. "We are getting the students ready. We aren’t sure what for exactly, but we are giving them the skills and the confidence and the language they need to perform better in their practice. Over time, the students become better at their work, more scientific in their approach, they use evidence and research much better, and they are able to be champions and advocates for patients."
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