Despite the acceptance of best practice as a standard for quality health care delivery, the exact nature of what constitutes best practice does not share universal definition or application. The purpose of this dissertation is to propose an integrative conceptual representation of nursing best practice from the philosophical perspective of complexity science.A five-step concept clarification approach was used to identify the concept, systematize observations and descriptions, develop an operational definition, construct a model, and formulate hypotheses. An expert panel explored preliminary validity of the definition and model.Purposive recruitment of clinicians and scholars was conducted for expert panel membership. The expert panel rated the strength of the model dimensions of adequacy, representative-ness, consistency, clarity, simplicity, generalness, accessibility, importance, and relevance, as well as interest in development and application. Narrative data from open-ended questions was incorporated into model refinement.Clinician properties and context properties emerged as two principle domains of interdependent influence. Key dynamic processes included critical thinking by which clinicians operationalize properties into practice choices, and informative reflection by which the organization monitors and improves performance through information flow and learning. All aspects of the conceptual model, with the exception of consistency of relationships, were ultimately rated as strengths by the expert panel. Relationships among constructs were identified as complex, diverse, and difficult to isolate. Expert perception was that clinician and context properties most likely equally influence nursing best practice, but that context properties may have greater influence than clinician properties over time.This model incorporates a full range of interdependence across clinician and context domains of influence. This model requires further operationalization of constructs prior to formal validity testing. The application of complexity science introduces challenges to research and measurement in the study of complex adaptive systems. The model presented in this dissertation provides a perspective from which a better understanding of health care system interdependencies may arise.

The purposes of this qualitative descriptive study were to explore the meaning of spirituality as described by aging adults in various states of health, to describe the relationship between spirituality and health, and to explain client expectations for healthcare providers related to spirituality. All identified meanings and themes were compared to the characteristics of spirituality proposed by Betty Neuman in the Neuman systems model to determine the credibility of the model for assessing and guiding holistic nursing practice. Three themes were formulated: a) Spirituality is an individual, conscious, committed connection to God, requiring a human response; b) positive spirituality contributes to personal wholeness and health; and c) spirituality sustains and comforts in times of stress.

The authors of this column, leading members of the International Neuman Systems Model Association, provide an update on the use of Neuman systems model in Holland and document the various changes in The Netherlands that have influenced the use of the model in that country. The model's link to systems theory and stress theory are discussed, as well as a shift to greater emphasis on patient self-management. The model is also linked to healthcare quality improvement and interprofessional collaboration in Holland.

The column is an interview with one of the Neuman trustees. Dr. Lois Lowry shared her experience with the Neuman systems model in curriculum development and evaluation in this dialogue. She shared insights from the development of the international Neuman conference in Holland in June.

Human beings with unmet needs related to their health and illnesses are the central focus of the domain of nursing. It is proposed in this column that nurses who conduct their practice from a nursing theory base, while assisting individuals and families to meet their health needs, are more likely to provide comprehensive, individualized care that exemplifies best practices. The Neuman systems model has been widely acclaimed to guide practice, yet specific examples are few in the published literature. The purpose of this column is to present two case studies based upon Neuman systems model; one case is directed toward family care, and the other demonstrates care with an individual. Theory-based exemplars serve as teaching tools for students and practicing nurses. These case studies illustrate how nurses' actions, directed by Neuman's wholistic principles, integrate evidence-based practice and generate high quality care.

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Recent national surveys in the United States estimate one in five females will experience abuse by an intimate partner during her lifetime. Previous quantitative research linked childhood victimization to repeated victimization in adult relationships. This qualitative study explored the lived experiences of childhood in eight female victims of intimate partner violence who were born and reared in southern Appalachia. Interviews were analyzed using a descriptive-interpretative phenomenological method, as described by Van Manen. The three essential themes from childhood were identified as: living 'as if' an orphan; surviving in chaos; and, manifesting a devalued self. These themes were congruent with findings from quantitative literature regarding family violence. After analyzing the data, it was found that the Neuman Systems Model provided a comprehensive perspective for linking the data to a nursing theoretical framework that is used to guide practice, education and research; thus extending nursing science. Through increased awareness of personal stories, previous negative attitudes toward victims can be altered and behaviors changed, leading to improved nursing care.

There has been minimal Australian research focussed on the management and leadership aspects of directors' work in centre-based child care to date. In Australia, practices in early education have been largely drawn from studies in other cultural contexts, particularly research undertaken in the United States. It is timely that Australian research should inform its social policy about quality child care programs. The focus of this research was on the nature and characteristics of effective management and leadership practices in centre-based child care. Research (Jorde Bloom, 1992b; Morgan, 2000; Poster & Neugebauer, 2000; Rodd, 1994) indicates that quality of child care programs is influenced mostly by the leadership that the centre director can provide to staff within the centre. The conceptual framework adopted in this study views leadership from a Social Systems framework. Central to a Social Systems framework is the notion that organisations do not exist in isolation rather, leadership and management in these settings are embedded in a broader social context. A Social Systems Model has received little attention in contemporary research on child care in Australia, and this study aims to build a framework for future studies in this area. The aim was to investigate leadership and management in child care in social, legislative and economic context. The findings seek to inform researchers, policy makers and practitioners. Eight directors were purposively selected from community-based and privately based centres in urban and rural areas, and from accredited centres in South East Queensland. The selection of varying locations allowed the researcher to gain a broader perspective of the directors' daily lives, as different contextual and environmental conditions were anticipated to influence management and leadership within the child care centres. Within this study, case studies of directors of child care centres were developed through interviews with the directors. The interview methodology focussed on exploratory semi-structured, open-ended questions in relation to management and leadership in centre-based child care. Directors were interviewed on two occasions within a three month period. In the current context of the delivery of child care services in a market driven climate, the language of business and organisational theory has entered the lexicon of the early childhood field (Press, 1999). The findings indicate that the director of a child care centre needs to have training and experience in business management and leadership to enhance their competencies for management of centres in today's competitive environment. Growth in child care franchises is significantly changing and truly developing a "child care industry" (Murdoch, 2004). Also, consideration needs to be given to increasing accountability in child care service delivery, and how to better support directors in their role as advocates in the broader early childhood field. Further, families in specific communities have varying needs and early childhood programs should reflect the needs of the local community. Leadership models within child care centres should encompass the micro and macro influences on the operation of centres. Literature suggests that early childhood centres provide an opportune place to support families in a variety of ways through integrating support services to address the underlying social and policy factors that affect young children and their families (Commonwealth of Australia, 2003; Corter, 2001).

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