Principles Of Complex Adaptive Systems Research Articles

The Nursing Theory of Complex Adaptive Systems: A New Paradigm for Nursing.

This article explores the theoretical and practical implications of the meaning of thinking, living, and acting within the framework of nursing in Complex Adaptive Systems. The Nursing Theory of Complex Adaptive Systems is grounded in the principles of Complex Adaptive Systems (CASs). It seeks to offer a new paradigm for nursing practice that addresses healthcare's dynamic and evolving nature. The Nursing Theory of Complex Adaptive Systems represents a new nursing paradigm capable of addressing the challenges of a constantly evolving healthcare environment. This theory promotes personalized care plans adaptable to patients' changing needs by emphasizing a holistic and interactive approach to care. It also underscores the importance of interprofessional collaboration and effective communication in improving the quality of care. The Nursing Theory of Complex Adaptive Systems has significant implications for nursing practice, education, and research. It provides a robust framework for developing adaptive and resilient nursing practices that can respond to the complexities of modern healthcare. By integrating the principles of CASs into nursing, the Nursing Theory of Complex Adaptive Systems fosters a more flexible, interdependent, and holistic approach to patient care, ultimately enhancing patient outcomes and improving healthcare systems. This theory has practical applications in various healthcare settings, offering a framework for personalized and adaptable care plans that respond to the dynamic needs of patients while improving overall system efficiency. Future research should focus on the empirical validation of the Nursing Theory of Complex Adaptive Systems and its practical implementation in various healthcare settings.

Fostering TBL Success at Alfaisal University: A Complex Adaptive Systems Approach.

This study explores the implementation of Team-Based Learning (TBL) at Alfaisal University's College of Medicine through the lens of Complex Adaptive Systems (CAS) theory. The research question investigates how the application of CAS principles can enhance the implementation and effectiveness of TBL in medical education. The study employed a convergent parallel mixed methods longitudinal design, integrating quantitative performance metrics and qualitative themes. Quantitative analysis revealed modest improvements in individual and team-based learning scores, with a promising trend of students moving from the lower to the higher quartiles over time. Qualitative insights aligned with CAS principles, highlighting the adaptive implementation, emergent outcomes, self-organization, positive feedback loops, and depth of learning facilitated by TBL. The findings demonstrate the value of a CAS-informed approach in navigating the complexities of educational change and fostering a more resilient and adaptive educational model. The study contributes to the understanding of how CAS theory can guide the successful implementation of innovative pedagogies like TBL in medical education.

Bilingualism-induced language change: what can change, when, and why?

Abstract Contact between languages has become increasingly recognized as a major source of historical change, as linguistic properties are introduced from one language into another. Yet contact does not necessarily lead to such changes. In fact, arguably most of the properties that contrast between two languages in contact at a given place and time do not change. This paper argues that historical and contact linguistics should now look more systematically at different kinds of bilingualism rather than contact per se and should incorporate recent sociolinguistic and psycholinguistic findings from this literature, since these can help us understand both when change occurs and when it does not. In this context we build on the general model of bilingualism, CASP (short for “complex adaptive system principles”), proposed by Filipović and Hawkins and explore its predictions for whether and when changes will occur in one or the other language of a bilingual. In the event that the relevant speech community comprises monolinguals in addition to bilinguals, these changes may then spread to the wider community when social and demographic circumstances favor this. The paper gives illustrative data supporting CASP’s predictions for change in both language usage and grammar among bilinguals.

Simplifying complexity science principles: developing healthcare faculty for using simulation as an educational method

Professional development in simulation-based education (SBE) is a complex process. Individual components have overlapping boundaries and relationships, rendering them suitable for Complex Adaptive Systems (CAS). This complexity is multifold in low-resource settings, unfamiliar with simulation, and augmented by hierarchical culture and linguistic diversity. This study aimed to conduct a professional development course through SBE using principles of CAS for faculty in a Pakistani medical college. A simulation educator team (six on-site, three online) from Pakistan and North America constructed and facilitated a 6-hour-long hybrid course following CAS in three phases. Planning phase consisted of needs assessment and inclusion of stakeholders in decision-making. Implementation phase involved remote facilitators joining the in-person team using Zoom and demonstrating evidence-based practices in case design, pre-briefing, facilitation and debriefing. In the evaluation phase, participants completed an immediate Twenty-three faculty members from basic medical ( We suggest using CAS as a framework for professional development programs to train faculty in simulation. A CAS framework can help the organizers to integrate systems thinking into educational interventions.

Competing factors in SLA: how the CASP model of SLA explains the acquisition of English restrictive relative clauses by native speakers of Arabic and Korean

Abstract The Complex Adaptive Systems Principles (CASP) model of SLA claims that L1 transfer results when language processing effort is minimized. This claim was investigated by a self-paced on-line sentence judgment task in which L1 Arabic and Korean speakers and a control group of L1 English speakers read and judged English subject, direct object, and oblique relative clauses (RCs) in gapped and resumptive pronoun (RP) conditions. It was hypothesized that L1 influence would cause the Arabic speakers to accept English RCs with RPs more frequently than Korean speakers because RPs are acceptable in Arabic direct object and oblique RCs, whereas Korean bans RPs in these RC types. It was also hypothesized that the L2 English speakers would accept RPs more often than the L1 English speakers because RPs would ease L2 sentence processing. As predicted, L1 Arabic speakers accepted RPs more frequently than L1 Korean speakers, a transfer effect, and both L2 English groups accepted RPs more frequently than L1 English speakers, a processing effect. The results thus support the CASP model’s claim that L1 transfer is conditioned by language processing and other complex SLA processes that interact with one another.

Uncertainty, emergence and adaptation: A complex adaptive systems approach to quality improvement

The healthcare quality improvement (QI) literature is replete with examples stating that continued failure to regard healthcare as a complex adaptive system (CAS) reduces the effectiveness of quality improvement initiatives. Recommendations and strategies for managing change within CAS exist, but the specific mechanisms that bring about successful change within CAS and the implications for quality practitioners are under-explored. This article presents a generalizable model for QI within CAS and provides a specifically CAS explanation for incremental change. We develop a conceptual model from foundational CAS principles that is then operationalized as an agent-based simulation model. Our model captures critical complex system behavior in a generic manner easily applied to different improvement contexts. We tested the simulation model using a recognizably complex healthcare improvement case: reducing antipsychotic prescribing levels in aged residential care. Nonlinear phase transitions were observed in the agent network, conditioned on the network’s ability to learn solution options and simultaneously maintain cooperation. We believe that a CAS explanation of change can assist practitioners navigating complex QI activities.

Complexity theory of psychopathology.

There is a renewed interest for complex adaptive system approaches that can account for the inherently complex and dynamic nature of psychopathology. Yet a theory of psychopathology grounded in the principles of complex adaptive systems is lacking. Here, we present such a theory based on the notion of dynamic patterns: patterns that are formed over time. We propose that psychopathology can be understood as a dynamic pattern that emerges from self-organized interactions between interdependent biopsychosocial processes in a complex adaptive system comprising a person in their environment. Psychopathology is emergent in the sense that it refers to the person-environment system as a whole and cannot be reduced to specific system parts. Psychopathology as a dynamic pattern is also self-organized, meaning that it arises solely from the interdependencies in the system: the interactions between countless biopsychosocial variables. All possible manifestations of psychopathology will correspond to a wide variety of dynamic patterns. Yet we propose that the development of these patterns over time can be described by general principles of pattern formation in complex adaptive systems. A discussion of implications for classification, intervention, and public health concludes the article. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Resilience in advanced cancer caregiving promoted by an intimate partner’s support network: insights through the lens of complexity science. A framework analysis

BackgroundThe tremendous physical and mental burden that comes with caregiving puts the intimate partners of patients diagnosed with advanced cancer at risk for mental disorders. However, most partners seem to be protected by resilience. Such a resilience process is promoted by certain individual characteristics (e.g., flexibility, positive attitude, internal strength, capacity to balance incoming and outgoing information, and ability to ask for and accept support and advice) and by the availability of a support network, consisting of family, friends, and healthcare professionals. Such a heterogeneous group striving towards the same goals can be considered a complex adaptive system (CAS), a concept stemming from complexity science.AimsTo study the behavior of the support network through the lens of complexity science and to provide insights to the means by which an available network may promote resilience.MethodsNineteen interviews with members from the support networks of eight intimate partners were analyzed deductively using the CAS principles as a coding framework. Subsequently, the quotes under each principle were coded inductively to concretize patterns in the behavior of the support networks. Eventually, the codes were charted into a matrix to identify intra- and inter-CAS similarities, differences, and patterns.FindingsThe network’s behavior adapts dynamically to the changing circumstances as the patient’s prognosis worsens. Furthermore, the behavior is based on internalized basic rules (such as reassuring availability and maintaining communication without being intrusive), attractors (e.g., feeling meaningful, appreciated, or connected), and the history of the support network. However, the interactions are non-linear and often unpredictable due to the context member’s own concerns, needs, or emotions.ConclusionsApplying the lens of complexity science to the behavior of an intimate partner’s support network gives us insight into the network’s behavioral patterns. Indeed, a support network is a dynamic system that behaves according to the principles of a CAS and adapts resiliently to the changing circumstances as the patient’s prognosis worsens. Moreover, the behavior of the support network appears to promote the intimate partner’s resilience process throughout the patient’s care period.

Question storming: The power of Questions-A method to increase options for action in uncertainty.

Question Storming offers a method that enables one to hold the condition of uncertainty in reflection without the need for resolution. Global interdependencies and unprecedented access to information, social mediaand multiple forms of communications challenge our ability to see, understandand influence change effectively and efficiently. The tension and need to cope effectively with massive uncertainties cannot be resolved with current methods leading to a necessity for people to seek new ways to transform their understanding and explore new options for action. Problem-solving and facilitation of the past are not flexible or rapid enough to meet the current demands of decision making and action taking in the face of massive uncertainties. As a result, people face 'wicked unsolvable' issues in their personal and professional lives. An international group of scholar-practitioners has adapted and tested an enquiry process. Question Storming-The Power of Questions is based on principles of complex adaptive systems, human systems dynamics, and self-organization. A three-step method of inquiry and reflection opens new possibilities. Question Storming has helped people see their wicked issues from new perspectives, understand them in useful waysand generate new options for action. This paper introduces Question Storming-the Power of Questions as a practical method for group inquiry in the presence of individual and group uncertainties/wicked issues. The Container, Difference, Exchange (CDE) model and Pattern Logic are presented to explain the paradigm-shifting dynamics experienced by participants, both individuals and members of the group. It concludes with emerging questions for future consideration. Question Storming generates a divergent problem space that decreases constraint and increases degrees of freedom to allow practical exploration of new and often surprising options for action.

Lost in translation, apparently: Bilingual language processing of evidentiality in a Turkish–English Translation and judgment task

AbstractWe investigated how bilingual speakers process evidentiality information in a dual language activation setting (Green & Abutalebi, 2013) using a translation production and confidence judgment task. Due to interaction of multiple factors in bilingual processing a multifactor model CASP (Complex Adaptive System Principles) for Bilingualism (Filipović & Hawkins, 2019) was used as a theoretical frame. Evidentiality indicates the source of information about past events, i.e., whether they were witnessed firsthand or non-firsthand and it is marked obligatorily in the grammar of Turkish and optionally in English using verbs, adverbs or constructions. The results show that firsthand information is translated more correctly than the non-firsthand in both directions and that different bilingual populations all gravitate towards a shared pattern in both languages but in different ways due to the different proficiency (English vs. Turkish as the stronger (L1) language) and different acquisition histories (early heritage vs. migrant late bilingualism).

A Multi-Factor Approach to the Study of L2 Acquisition of Motion Verbs and Motion Constructions: Integration of Typological, Psycholinguistic and Sociolinguistic Aspects

Talking about motion events in L2 is done in different ways by different speakers on different occasions. This is due to multiple factors, typological, psycholinguistic and sociolinguistic, which interact and play a role in L2 acquisition and use. These factors can sometimes lead the same types of L2 speakers to produce very different outputs and sometimes very different L2 speakers to produce the same or similar outputs. In order to capture this diversity of outcomes the CASP (Complex Adaptive System Principles) for Bilingualism model was proposed and we illustrate how this model helps us formulate predictions about motion event verbalizations, set up experiments and account for results in a holistic manner, taking into consideration the relevant multiple factors. Furthermore, a lot of effort in the field has gone into contrasting monolingual and bilingual populations while more knowledge is needed about how different bilingual populations compare. These different bilinguals, including L2 learners, need to be tested under different conditions in which they use their languages (e.g., when only one or both is actively used with vs. without the possibility to code-switch) in order to understand the variability of L2 verbal behaviours and the underlying factors at play under different circumstances of acquisition and use. This perspective paper provides both theoretical and empirical indications how this can be done, with the key message that future research into L2 acquisition (and bilingualism in general) must be based on a multi-factor approach.

The Power Law in Operating Room Management.

The Acute Care Surgery model has been implemented by many hospitals in the United States. As complex adaptive systems, healthcare systems are composed of many interacting elements that respond to intrinsic and extrinsic inputs. Systems level analysis may reveal the underlying organizational structure of tactical block allocations like the Acute Care Surgery model. The purpose of this study is to demonstrate one method to identify a key characteristic of complex adaptive systems in the perioperative services. Start and end times for all surgeries performed at the University of Vermont Medical Center OR1 were extracted for two years prior to the transition to an Acute Care Surgery service and two years following the transition. Histograms were plotted for the inter-event times calculated from the difference between surgical cases. A power law distribution was fit to the post-transition histogram. The Kolmogorov-Smirnov test for goodness-of-fit at 95% level of significance shows the histogram plotted from post-transition inter-event times follows a power law distribution (K-S = 0.088, p = 0.068), indicating a Complex Adaptive System. Our analysis demonstrates that the strategic decision to create an Acute Care Surgery service has direct implications on tactical and operational processes in the perioperative services. Elements of complex adaptive systems can be represented by a power law distributions and similar methods may be applied to identify other processes that operate as complex adaptive systems in perioperative care. To make sustained improvements in the perioperative services, focus on manufacturing-based interventions such as Lean Six Sigma should instead be shifted towards the complex interventions that modify system-specific behaviors described by complex adaptive system principles when power law relationships are present.

First language versus second language effect on memory for motion events: The role of language type and proficiency

Aims and objectives/purpose/research question:This research probes for language effects on witness memory in bilingual speakers whose languages are typologically distinct, English and Spanish. The key question is whether speakers’ memory for agentive motion events is influenced by first language (L1) or second language (L2) patterns, or both, when the L2 is used for descriptions.Design/methodology/approach:Four groups were tested in an event verbalisation and recognition memory task: English monolinguals, Spanish monolinguals, Late L1 English/L2 Spanish bilinguals and late L1 Spanish/L2 English bilinguals. The video stimuli depicted complex motion events (three manners of motion per event) because complex rather than simple events have been shown to elicit language effects.Data and analysis:The data for analyses include (a) the number of mentions and the type of detail included in the verbalisation of the manner of motion (the key typological difference) and (b) recognition error rates in the memory task. Recognition errors occurred when the pairs of target videos were deemed the same while in fact they were not.Findings/conclusions:Speaking in a L2 that makes it difficult to verbalise a component of an event (manner of motion) can have a negative effect on the memory for that specific component in L2 speakers, while at the same time benefiting memory for some other event features.Originality:This work shows, for the first time, negative effects of a L2 on memory for motion events and offers a hitherto elusive explanation and theoretical justification for the reasons when and why we do, or do not, get beneficial effects on memory in bilinguals.Significance/implications:The findings contribute to understanding of the effects of late (adult L2) acquisition on cognition. They support predictions of the Complex Adaptive System Principles (CASP) for Bilingualism model, advocating fine-grained typological approaches to lexicalisation of cognitive domains and explicit teaching of typological differences that affect information content.

An overview & synthesis of disaster resilience indices from a complexity perspective

Identifying Disaster resilience indices (DRI) for cities and communities remains a common approach for assessing their structural ability and inherent capacity to cope with, recover from, and adapt to disasters. Particularly popular are composite DRI methodologies that are quantitative, top-down, and geographically mappable. DRI have become more comprehensive as the complexity of urban systems is increasingly acknowledged. However, DRI remain criticized as static, reductive, and inadequate when viewed under a complexity paradigm, which views urban systems as Complex Adaptive Systems (CAS), where observed properties (like resilience) emerge from many interactions among heterogenous agents in a network. Literature reviews have covered the state and trends for DRI development. Our objective is to synthesize literature at the nexus of these reviews, CAS, and Socio-ecological Systems (SES) to determine the extent to which commonly adopted indicators relate to widely accepted tenets of CAS. Findings show that DRI indicators usually relate more closely to temporal snapshots of vulnerability, and alternative framings of current indicators along with interdisciplinary approaches could better capture CAS aspects of urban resilience. Research and development should strive to develop DRI based on underlying principles of CAS and SES, and consider adapting top-down quantitative approaches with thick data, network models, and mixed-method triangulations. Explicitly associating complexity theory with DRI can (i) help researchers in socio-technical and socio-ecological domains develop improved resilience indicators and assessment methods that are clearly differentiated from vulnerability metrics, and (ii) guide policy and decision-makers, amid future uncertainty, to better identify, implement and track capacity-enhancing measures.

Improving quality in a complex primary care system-An example of refugee care and literature review.

Applying traditional industrial quality improvement (QI) methodologies to primary care is often inappropriate because primary care and its relationship to the healthcare macrosystem has many features of a complex adaptive system (CAS) that is particularly responsive to bottom-up rather than top-down management approaches. We report on a demonstration case study of improvements made in the Family Health Center (FHC) of the JPS Health Network in a refugee patient population that illustrate features of QI in a CAS framework as opposed to a traditional QI approach. We report on changes in health system utilization by new refugee patients of the FHC from 2016 to 2017. We review the literature and summarize relevant theoretical understandings of quality management in complex adaptive systems as it applies to this case example. Applying CAS principles in the FHC, utilization of the Emergency Department and Urgent Care Center by newly arrived refugee patients before their first clinic visit was reduced by more than half (total visits decreased from 31%-14% of the refugee patients). Our review of the literature demonstrates that traditional algorithmic top-down QI processes are most often unsuccessful in improving even a few single-disease metrics, and increases clinician burnout and penalizes clinicians who care for vulnerable patients. Improvement in a CAS occurs when front-line clinicians identify care gaps and are given the flexibility to learn and self-organize to enable new care processes to emerge, which are created from bottom-up leadership that utilize existing interdependencies and interact with the top levels of the organization through intelligent top-down causation. We give examples of early adapters who are better applying the principles of CAS change to their QI efforts. Meaningful improvement in primary care is more likely achieved when the impetus to implement change shifts from top-down to bottom-up.

Energy transition complexities in rural and remote Indigenous communities: a case study of Poplar Hill First Nation in northern Ontario

ABSTRACTThe First Nation communities in northern Ontario have unique energy-related challenges within an interdisciplinary context, including historical, geographic, cultural, technological, and regulatory. Presently, undergoing an energy systems transition from off-grid to grid-connection and scoping renewable energy options, these remote communities are exhibiting characteristics of complex adaptive system principles. This is exhibited through non-linear interactions and connectedness among agents and components in the emerging energy system. This paper explores these interfaces through a case study of Poplar Hill First Nation, an Independent Power Authority community. The potentials of the complexity science through a community engagement process is used to encode and enhance understanding of the “contextual” complexities in the development of local economies, adapting to technology advancement, and social changes. The findings will help better appreciate the efforts made by Poplar Hill in their transition to self-sufficient systems with deliberations that may provide practical outcomes. This paper reflects on the deeper trajectories of the human elements embedded within the energy transition process. In conclusion, the paper adds to the academic dialogue on energy system transition adaptations in marginalised Indigenous communities in rural and remote locations.

Healthcare teams as complex adaptive systems: understanding team behaviour through team members\u2019 perception of interpersonal interaction

BackgroundComplexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members’ interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members’ interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour.MethodsAn interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle.ResultsAll CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members’ interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified.ConclusionsThis study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.

A complex adaptive systems governance framework for regional supply networks

PurposeThis paper aims to propose an empirically grounded governance framework based on complex adaptive systems (CAS) principles to facilitate formation of well-connected regional supply chains that foster economic development, adaptability and resilience of mining regions.Design/methodology/approachThis study is an exploratory case study of the South Australian (SA) mining industry that includes 38 semi-structured interviews with the key stakeholders and structural analysis of the regional supply network (RSN).FindingsFindings demonstrate the applicability of the CAS framework as a structured approach to the governance of the mining industry regional supply chains. In particular, the findings exemplify the relationship between RSN governance, its structure and interconnectivity and their combined impact on the adaptability and resilience of mining regions.Research limitations/implicationsThe data set analysed in the current study is static. Longitudinal data would permit a deeper insight into the evolution of the RSN structure and connectivity. The validity of the proposed framework could be further strengthened by being applied to other industrial domains and geographical contexts.Practical/implicationsThe proposed framework offers a novel insight for regional policy-makers striving to create an environment that facilitates the formation of well-integrated regional supply chains in mining regions through more focussed policy and strategies.Originality/valueThe proposed framework is one of the first attempts to offer a holistic structured approach to governance of the regional supply chains based on CAS principles. With the current transformative changes in the global mining industry, policy-makers and supply chain practitioners have an urgent need to embrace CAS and network paradigms to remain competitive in the twenty-first century.

The Complex Adaptive System Principles model for bilingualism: Language interactions within and across bilingual minds

Aims and objectives/purpose/research question:We propose a model that captures general patterns in bilingual language processing, based on empirical evidence elicited in a variety of experimental studies. We begin by considering what linguistic outputs are logically possible when bilingual speakers communicate based on the typological features of two languages in the bilingual mind. Our aim is to explain why some outputs are more frequent or more likely than others in bilingual language use.Design/methodology/approach:Our empirically derived multi-factor model combines insights from various empirical studies of different bilingual populations and it includes a variety of methodologies and approaches, such as lexical categorisation, lexical priming, syntactic priming, event verbalisation and memory, historical language change, grammaticality judgments and observational reports.Data and analysis:We critically discuss both lexical and syntactic processing data, as well as data that reflect bilingual type differences and different communicative situations (i.e. who the bilingual speakers are talking to and for what purpose). Crucially, we explain when the relevant factors collaborate and when they compete.Originality:There are three main reasons why this paper can be deemed original: 1) it offers a unified model for understanding bilingual language processing that is not focused on a single factor or a single linguistic level, as has most often been the case in the past; 2) it brings together the study of bilingualism from both psycholinguistic and sociolinguistic perspectives and in a unifying fashion, which is rare in the literature; and 3) it creates a platform for testing numerous predictions that are not dependent on any one theory.Significance/implications:This new model opens up new avenues for research into bilingual language processing for all types of bilingual speakers and in different communicative situations. It captures and explains the variety of outputs in bilingual communication and enables us to make predictions about communicative outcomes.

Innovative Approach to Reconstruct Bedside Handoff: Using Simple Rules of Complexity Science to Promote Partnership With Patients.

When nurses integrate patient expertise, nurse-to-nurse handoff becomes patient-centered (nurse and patient), and the weak link between quality and safety is mitigated. The existing paradigm for handoff is an ineffective measure to minimize errors. This article describes a reimagined bedside handoff-transitioning handoff from its prescriptive nurse-centered interaction to a patient-centered partnership using the principles of complex adaptive systems, simple rules, and partnerships that address the uniqueness of each patient and nurse interaction.