[Ever-learning RN]

Your question popped up when I was doing research on nursing theories in relation to Prisoner Nurses at Auschwitz for my current grad class. I haven't read the entire discussion thread but I think I might have some thoughts for you to ponder. The medical model is theoretically based on a Positivist view point. The theory supports decisions and care based on empirical data that has been born out by research (please don't remind me that 50% of common medical practice is not born out by research, I am aware :-)). Clearly this means that patient related decisions must be factual, data collected and compared against current knowledge and prescription for care be evidence based.

In contrast, nursing has evolved over decades from this positivistic theory base through postmodernism (metatheory that supports the attention to recipricol relationships between individuals and their environments) and on to neomodernism, which supports integrating historic values and traditions of nursing (our enduring themes of patient centered care, culture/ethnicity, cleanliness - yes Florence, etc.) while allowing us to explore and propose alternative ways and methods for nursing science to grow and flourish. If you are interested in further exploration, two good references are Fitzpatrick and Whalls Conceptual Models of Nursing Practice or Reed, et al Perspectives on Nursing Theory.

If you can't guess by now, this semester's course is graduate nursing theory, taught by Dr. Ann Whall, one of the preeminent guru's of theory. (She wrote the book!) She has challenged us to understand that without theory, we really don't know why we do the things we do (so well) and are ships without rudders. I will grant you that 30 years ago when I started in nursing I thought theory was just ivory tower babble. Now, after so many years of watching our profession grow in fits and starts, I see that this is our foundation. So...look back (or forward) into the theoretical underpinnings of nursing theory and you'll see why nurses are invaluable, unique, and must maintain that theoretical basis for practice.

[DaisyRN, ACNP]

Originally Posted by reflect

thanks for the insight; I think I see the difference now. It seems like the NPs have the same type of training as the DOs, who focuses more on the whole self rather than just the ailment.

Honestly, I still have not seen a difference between the two professions (NP and PA) in practice. I've been treated by a couple of NPs and did not noticed them do this "holistic" type of dealing with diseases. They seemed the same as the MDs and PAs I've seen.

Next question: are there any NPs that really practice what they were taught in NP school (holistic healing)? I'm sure you guys are out there, but I'm wondering if you are put in a situation where you find you don't have a lot of time to spend with each patient, so you don't have time to do this "holistic" type of investigation with each patient.

Hi there,
Just wanted to comment on your question regarding NP's "practicing what they were taught..." I am about to graduate from an NP program, so I have put in a lot of clinical time with both MDs and NPs. What I have learned is that MDs can also be "holistic" - but NPs are more often associated with being holistic than MDs. And I will be very honest with you... when I hear the word "holistic" I think... touchy/feely/alternative therapies types of things. BUT... I know that those things are only other parts of "holistic care."

To me, after more experience, being a holistic provider means not only making sure your ICU patient is hemodynamically stable, but also that the family is contacted, that the patient is comfortable, and basically... that you are just looking at the WHOLE picture (hence: "holistic" ). There is time for this in each patient encounter, because it should not be thought of as a separate task. It just comes out in your assessment/conversation with the patient/family. You can learn a great deal about your patients' expectations/cultural beliefs/family dynamics by simply listening to them during your initial interaction and assessment. For example, when you're feeling on their abdomen or feeling pulses or assessing for edema... you can talk to them. You'd be surprised how much you can learn about your patients in such a short amount of time.

[Josh L.Ac.]

Another way to look at it:


Medical model - heavy didactic foundation in basic sciences before any patient contact. Problem focused.
Nursing model - more focus on the interaction with the patient and clincal experience while attempting to learn the scientific rationale "on the fly". Patient focused.