It is also becoming clearer that as nursing applies the science of nonlinear dynamics, it is putting less emphasis on finding chaos in the phenomena under study. In this issue, Zbilut underscores the elusiveness of finding chaos in real, noisy data sets, the world of nursing. Rather we are using nonlinear and linear techniques concurrently (see Davidson and Pollock) to discover what is the most meaningful from either view. This includes injecting traditional terms with fresh meaning - variables are dimensions, correlations are sine-like, return maps have forbidden zones, information is a binary string and photographs have complexity values.

 Currently, there are three centers of activity in the field: the East Coast, the Midwest and international sites. But theory would predict that there is a bifurcation in direction due soon. This should occur as the result of two nursing conferences - the first will be held in fall 1997 in Australia (see details in this issue) and the second will be in held next year in the United States (in the planning stages).

 But geography is not destiny. The dispersed, worldwide communities of nonlinear scholars are finding ways to communicate with each other and develop the field. To assist in the effort, Murray's article on the World Wide Web has been put on Complexity and Chaos in Nursing's own Website. Each Web address in the article is hyper-linked to another Web page - just click and you will be transported around the globe.

 Nurses of all ages and every educational level are interested in the lure of fractal thinking (see Hamilton). The broad base extends from this specialist publication, with a readership in the hundreds, to a forthcoming article in a more generalist publication (the American Journal of Nursing), with a readership in the hundreds of thousands. The variability in the size of each journal's audience is another indicator of the fractal and complex nature of the attraction. I hope that you enjoy this issue and that we get to meet each other, in person or via cyberspace.

The purpose of this research study was to explore the relationship between environmental complexity and well-being in the elderly. Photographs of the environments of participants (N = 32) living in community and congregate housing settings were analyzed for quantitative and qualitative complexity. The quantitative measure was based on the number of objects and their positions, rotations, shape, texture, motion and pattern. The qualitative measure was obtained from visual analogue ratings. It was found that community dwellers lived in more complex environments than congregate dwellers (p = 0.022). Community participants also had significantly higher cognitive function scores (p = 0.034) and locomotor activity (Mesor p = 0.029). Complexity was found to be a quality of the environment independent of aesthetics. Implications for nursing are discussed.

Ecologic Health Nursing for Community Health: Applied Chaos Theory

Connie Bellin, ARNP, CS, FNP; Martha Gagnon, RN, MN; Melinda Mich, RN, MN; Suzanne Plemmons, RN, MN; and Coleen Watanabe-Hayami, RN, BSN

A model of Ecologic Health Nursing based on Chaos Theory is presented as a model for community health nursing practice. The concepts of collaborating, empowering, cultural competency, capacity building, and caring are examined in relationship to the tenets of Chaos Theory. Multiple instances of commonalties among these concepts and the chaotic elements of nonlinearity, unpredictability, self-similarity, disorder, repetition, and mutuality are demonstrated. Central to Ecologic Health Nursing is the perspective that all actions are interdependent and that this model is a process of working in partnership with the community to promote the positive energy necessary for health. The Ecologic Health Nursing model allows for the appreciation of complexity and diversity within any community and emphasizes nurses working with, rather than doing to or for, the community.

This study applied statistical methods derived from nonlinear dynamics to analyzing and forecasting patient census. Daily, weekly and monthly census data (N = 736) for the years 1991 through 1994 were analyzed for an intensive care unit within a community hospital. The results of the nonlinear analyses using Lyapunov exponents, logistic regressions, capacity and correlation dimensions, phase plane maps, and return maps were compared to traditional time series analysis of the same data.

Traditional analysis failed to reveal pattern in the census data while nonlinear analyses identified a complex pattern with an estimated three to six independent variables (dimensions). Characteristics of a chaotic process, including a positive Lyapunov exponent and a fractal structure were also identified. Forecasts using nonlinear dynamical techniques, however, were no more accurate than linear regression forecasts.

The findings provided some useful insights for nurse administrators planning and budgeting patient care services. They include the futility of long-term forecasting, the need for contingency planning and the use of two-dimensional time series graphs and phase plane plots to enhance budget monitoring processes.

Nurses with an interest in chaos and complexity theories are naturally interested in what is available on the Internet and the World Wide Web. At present, there is little dealing with chaos, complexity or nonlinear dynamics related specifically to nursing, health or health care. This selective review outlines both nursing and non-nursing sites and materials available on-line, including Websites and discussion areas.

Biological systems often present complex behavior whose interpretation is a dilemma. Casual inspection of EEG, heart rate or blood pressure traces may reveal occasional periodic components, but at the same time they are interspersed with random looking, bizarre components. In the past, the only quantitative analyses available were standard descriptive and inferential statistics, power spectrum, or autoregressive/moving average methods that often led to equivocal results. Recently, chaos theory has provided the possibility of a new model, which specifically capitalizes on the appearance of randomness for the explanation of these signals. One of the main ways to make a determination of chaotic dynamics from research data is by the calculation of dimension.

The Begun and White (1995) article "Altering Nursing's Dominant Logic: Guidelines from Complex Adaptive Systems" is a stimulating, interesting, if not a provocative one. I would, however, argue with the contents of Table I: Elements and Reinforcers of the Dominant Logic of Nursing (page 8). I do agree that the nursing profession is both complex and adaptive - the "dominant logic" resulting from adaptations to the environment. However, the items cited in Table 1 are recent efforts of the profession dating primarily to post World War II. The "dominant logic" that prevails has a much longer history; the authors failed to take into account the fifty years pre-World War II. Themes of the "dominant logic" were laid down then; the ones cited in Table 1 are countervailing efforts - a slow, and not yet effective, effort toward making nursing into a profession. I would call to the attention of the authors an important article by Peter Drucker (1994) that pertains to my comments.

In "Altering Nursing's Dominant Logic: Guidelines from Complex Adaptive Systems Theory," we argued that the profession of nursing can be conceptualized as a complex adaptive system of practitioners, professional organizations, and educational institutions that interact with each other and are united by their common pursuit of the goals of the profession of nursing. That system (the profession of nursing) is quite intransigent, characterized by tremendous inertial forces. The huge size, unrivaled internal diversity, and deeply held traditions of the profession of nursing impair the profession in times that require adaptation. We argued that the nursing profession must challenge its "dominant logic" in order to change itself (Begun & White, 1995).

I hope you will pursue for several years your larger question, "What drives the profession of nursing in its strategic behavior and how can it be more adaptive?" You focused on only one strategic behavior - "professionalize" nursing leadership - which I agree does not "permeate the profession." Indeed currently, the workplace, job security and governmental policy (state and federal) seem to be in the forefront. What you call an "industrial" worker mentality - and what some privately call "blue collar" - is a major factor. I agree that "the professionalization process in quite incomplete" and may not ever be realized. There is a current push that looks like the integration of nursing and medicine to be taken into account ("Columbia," 1995). The question posed at the onset of this paragraph is enormous and most significant, having past, current and upcoming dimensions.

The Lure of Modern Science - Fractal Thinking: Vol 3. Studies of Nonlinear Phenomena in Life Sciences by Bruce J. West and Bill Deering. 1995. (421 pp, illus, refs, index, appendices), River Edge, NJ: World Scientific, $58 in hardcover.

West and Deering describe their book as a montage on fractals and chaos rather than a "well argued scholarly work" (preface). Their stated audience includes students of biology, physics and the social sciences. The authors introduce these readers to a new way of thinking about phenomena - they call it fractal thinking. They point out that this is "a way of going beyond the continuous, homogenous and slowly changing models of the world we have in our heads into the discontinuous, heterogeneous abruptly changing world outside and incorporating the latter into a conceptual framework" (preface).

In order for the nursing profession to strategically adapt in a rapidly changing environment, it is important to consider its current dominant logic as a source of structural inertia. A system's dominant logic is a screen that filters information deemed relevant by historical antecedents and by those analyzing the data. The filtered data are then incorporated into the strategy, structures, values, expectations, and reinforced behaviors of the system. The dominant logic of the profession of nursing is deeply ingrained and powerful. Its elements include the ideology of professionalism, an emphasis on "caring," and a belief in oppressed status.

Recommendations for changing the dominant logic of nursing are offered, along with suggestions for further research. Recommendations include: abandoning false notions of control, particularly as assumed in traditional strategic planning efforts; fostering change in existing organizations and the growth of new, innovative organizations, journals, and other structures; and challenging or "unlearning" the dominant logic. Individual nurses and their organizations will require new proficiencies, marketplace savvy, and attention to the cost-effectiveness of their services.

We present a process method to analyze the electrocardiogram, and illustrate it with the longitudinal study of a patient with coronary artery disease. Comparisons are made with data collected in our laboratory for normal persons, patients with coronary artery disease, and cardiologically normal psychiatric patients. Using mathematical techniques derived from non-linear dynamics (chaos theory), the data were studied in frameworks of one, two, three and higher dimensions. These methods related ongoing temporal patterns of cardiac activity, and their integration with neurophysiological patterns, cycles and behavior.

Twenty-four-hour Holter recordings were obtained, and beat-to-beat time was measured by R-R intervals. A decrease in the standard deviation of R-R intervals preceded re-infarction in the coronary subject and a further decrease was found following re-infarction. Two-dimensional analysis indicated a decrease in beat-to-beat variability in this and other coronary patients, versus a narrowing in the total range of variation in psychotic subjects. High-dimensional portraits of cardiac rhythms, using recurrence methods, indicated a reduction in complexity in coronary subjects. In the longitudinal study, records obtained one week following re-infarction indicated significant reductions in complexity, with progressive recovery three and six months later. These observations illustrate the potential usefulness of process methods in the continuous assessment of cardiac patients.

Complex nonlinear dynamical systems ("complexity") theory provides a framework that may facilitate uniting biology and biography in nursing research. The assumptive bases of complexity theory and the dominant paradigms of positivism and naturalism used in nursing inquiry are compared. Within a complexity framework, nurse researchers may combine assumptively consistent quantitative methods such as repeated measures, spectral analyses, and time series with qualitative methods such as grounded theory and narrative analysis to unify biology and biography.

The purpose of this article is to review published manuscripts dealing with chaos theory and nursing and to speculate on future applications. It serves as a summarization of principles of this new science by nurse scientists. Twenty-two articles published from 1990 through 1994 are reviewed focusing on authorship, outline, use of hypothetical example, use of theory derivation and data analysis. Challenges encountered in the application of chaos theory to nursing are discussed. These include understanding terminology, choosing scales and analytic techniques, and using mathematical and computer skills. The positive aspects of discovery, interdisciplinary collaboration, and creative thinking are also examined.

"The Searchers" charts the course of dissatisfied "linearists" who, through Chaos Theory, have found an answer for some of their frustrations. Elements of the poem foster agreement, disagreement and controversy - as does the science. The intent is to offer food for thought and conversation.

The open systems metaphor, with its assumption that organizations are equilibrium-seeking systems, provides a limited perspective for understanding phenomena of interest to nursing systems researchers. In contrast, chaos theory describes dynamical or non-equilibrium seeking systems, which challenge the reductionist assumption that management interventions lead, inexorably, to a predictable future. This article examines the utility for nursing systems research of several ideas from the emerging science of "chaos". First, three classic examples are used to illustrate the general characteristics of chaotic systems. Then, the key concepts of sensitive dependence on initial conditions, bifurcations, strange attractors and dissipative systems are discussed. An example of the application of chaos theory to nursing systems research is then described and implications for nursing systems research are discussed.

The research described here was conducted to describe, in detail, the pattern of adolescent births in Texas and to demonstrate and evaluate the application of advanced analytic procedures derived from mathematics and physics which are now available to nurse scientists. These procedures include power spectral density analysis, singular value decomposition and return maps.

Traditional methods of analysis of birth data have been limited by underlying assumptions of linearity. In other words, it was thought that small changes in input would result in small changes in output of complex processes. This preliminary investigation of the occurrence of births to adolescents in Texas suggests that irregularities observed in the data may be traceable to intrinsic nonlinearity or chaos within the process.

Changing perspectives on the nature of nursing within the emerging science of complexity, the metaphysical reexamination of nursing, and caring as the focus of inquiry promise to revolutionize nursing. This article provides an explanation of the epistemological basis of complexity science and complex caring inquiry in nursing. It speaks to the complex and dynamical nature of nursing as facilitating choice-patterning within a relational, caring perspective. Further, a unifying model of Complex Caring Dynamics is presented to illuminate the complexity of inquiry. The model illustrates four dynamical processes that can be selected as research approaches either separately or in combination: Technical, Practical, Critical and Creative Caring Dynamics. They are used to reflectively see, map, and recognize the different choice patterns in the human health experience.

Process theory provides a comprehensive method and practical technique to integratively evaluate and impact biological, social and psychological processes in clinical care. The process theory concepts of asymmetry, opposition and organizational diversification lead to a focus on distinguishing and comparing changes in a process rather than isolated moments within a process, and on co-creation through the interaction of opposites over time. Conceptualizing life as a process provides a framework to facilitate active participation of patients. Act, do not simply react. Respond, do not ignore. Co-create novel alternatives. Diagnostic and therapeutic interventions are organized by giving priority to the simpler, biological processes while at the same time considering the supremacy of the more complex psychological ones. This bio-socio-psychological approach differs from systems theory's biopsychosocial paradigm. Giving supremacy to personal and creative processes, the method is person-oriented, and focuses on interventions for illness prevention, health maintenance and health promotion. Health is defined by the spontaneity, adaptability and complexity of behav(c)òor. This is contrasted to the notion of health as equilibrium and illness as disorder. Persons who are ill are also healthy in many respects. Here we present process theory and illustrate its application through a case study.