title: Nursing Services Delivery Theory: an open system approach.
abstract: OBJECTIVE
  This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations.
  
  
  BACKGROUND
  The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a 'black box' that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations.
  
  
  METHODS
  A search of CINAHL and Business Source Premier for the years 1980-2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included.
  
  
  CONCLUSIONS
  The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems.
  
  
  CONCLUSIONS
  THE Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects.
  
  
  CONCLUSIONS
  The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations.
authors.affiliation: Nursing Early Career Researcher Ontario Ministry of Health & Long-Term Care, Lawrence Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada. raquel.meyer@utoronto.ca
authors.forename: Raquel M
authors.initials: RM
authors.lastname: Meyer
authors.forename: Linda L
authors.initials: LL
authors.lastname: O'Brien-Pallas
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D019277:Entropy; D006801:Humans; D017146:Models, Organizational; D015401:Nursing Administration Research; D009739:Nursing Services / Q000458:organization & administration*; D009742:Nursing Theory; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000458:organization & administration*; D016526:Workload