[jjjoy]

I ran across an interesting article that questions the drive to carve out a unique field of "nursing science" as opposed to a more patient-centered "health care science" or "caring science." Any thoughts on the idea in the excerpt? (I hope it's okay to quote this much)



Nevertheless, a unique theoretical base, exclusive to nursing, appears to be most important for those theorists who emphasize nurses’ professional competence. When focus is moved from nurses towards patients it is more urgent to discuss patients’ needs, goals and unexplained discomfort, etc. From this point of view it seems fair to assume that all professional care providers, i.e. physiotherapists, physicians, nurses, therapists and so on, must put an effort in meeting patients’ needs in order to give adequate support. Hence, it does not seem constructive to talk about nursing science as exclusive to nurses, but healthcare science, or caring science, as a cross-professional concern.

Nystrom, Maria "A patient-oriented perspective in existential issues: a theoretical argument for applying Peplau's interpersonal relation model in health care science and practice" Scandinavian Journal of Caring Science 2007; 21; 282-28

[llg]

Whenever this question or similar ones are posed, I always have the following question:

If there is to be no uniquely "nursing theory" or "nursing perspective" or "nursing knowledge" ... then what makes nursing different from the other professions? The author mentions physiotherapists, physicians, nurses, therapists, etc. ... but ... What is the feature that distiguishes one discipline from the other if there is no scientific or philosophical perspective that sets it apart from the others?

[BBFRN]

I agree with llg. This has been the biggest barrier as the nursing model attempts to move further away from the medical model. We need to continue to carve out our own model, with our own theories & guidelines.

[llg]

Certainly, there are a lot of overlapping areas of interest among the various health care disciplines -- a lot of overlapping areas. But each discipline should have a different perspective on those areas, a perspective that is unique to that discipline. They share many scientific facts, but maintain unique identities through the maintenance of unique perspectives that serve as a foundation for the discipline and a lens through which to view the world. It is that unique disciplinary perspective (which might be more philosophical than scientific )that defines each discipline.

Without that unique disciplinary perspective, there is no distinction between the disciplines -- and that contradicts common sense and every-day common experience. For example, while Respiratory Therapists and Nurses share many concerns, common experience tells us that they are not the exactly the same discipline.

[jjjoy]

But what IS nursing?

To me, nursing is (predominantly) 24/7 care of the infirm. It covers the spectrum from basic hygiene to adjusting cardiac drips in the ICU. A nursing assistant carries out the most basic nursing care. Family members often participate in basic nursing care as well. Parents with technologically dependent children often carry out more complex nursing care. Many skills are needed in this 24/7 care and often include things like IV administration of medicine, dressing changes, varying degress of physical assessment and monitoring - from vital signs to ecgs and more. These skills are useful and transferable. Thus, nurses are well-suited to home health care - IV meds, dressing changes, monitoring physical status. With so much time spent with patients, nurses then are well-placed to deal with patient psychological issues (eg coping with illness) and to play a big role in patient education. However, we all know that in a crunch, both of these are the first to go when the nurse has to prioritize patient care needs. With first hand bedside experience, nurses have lots to offer other areas such as health insurance (case management) and law (legal nurse consultant). Even Nightengale's great contribution to health care falls more in the realm of infection control than that which is unique to the nurse role.

So where do occupational health nursing, school health nursing, and the like fit in? I don't have a simple answer. While I can see that nurses are well-suited to fill such positions, I don't see that they are the unique domain of nursing. These can easily fit under first aid/emergency care and preventive health care/health promotion. An MD who wanted a change of pace could fill such roles as well as most RNs. An EMT or health educator could be well-suited as well with some extra training in the area in which they are weak. Nurses who enter these positions also need to engage in extra study to fill these roles. In regard to office nursing, we see that this role is shrinking as physicians have decided that medical assistants can fill many of the needed roles in the back office.

Thoughts?

[llg]

I don't define nursing as restrictively as you do. My personal favorite definition of nursing is that of the contemporary nursing theorist, Kristin Swanson. She defines nursing as "informed caring for the well-being of others" and then elaborates on how each element in the nursing metaparadigm (as articulated by Jacquiline Fawcett) relates to that definition -- nursing, health, humanity, and environment. When I combine the work of those 2 contemporary nurse scholars, I get a broad philosophical perspective of nursing that accomodates the reality of all practice situations -- even those that relate to health promotion in healthy people, intensive care, comatose patients, infants, etc.

The questions you are asking have been the focus of much scholarly work in nursing -- particularly during the last half of the 20th century. Some scholars still work to develop our thinking on the topic. Unfortunately, many practicing nurses and young scholars are not interested in this type of academic work, which hinders our efforts to further develop this aspect of our nursing knowledge base.

[pickledpepperRN]

I think all states use the Nursing Process.

A registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process, as follows:

(1) Formulates a nursing diagnosis through observation of the client's physical condition and behavior, and through interpretation of information obtained from the client and others, including the health team.

(2) Formulates a care plan, in collaboration with the client, which ensures that direct and indirect nursing care services provide for the client's safety, comfort, hygiene, and protection, and for disease prevention and restorative measures.

(3) Performs skills essential to the kind of nursing action to be taken, explains the health treatment to the client and family and teaches the client and family how to care for the client's health needs.

(4) Delegates tasks to subordinates based on the legal scopes of practice of the subordinates and on the preparation and capability needed in the tasks to be delegated, and effectively supervises nursing care being given by subordinates.

(5) Evaluates the effectiveness of the care plan through observation of the client's physical condition and behavior, signs and symptoms of illness, and reactions to treatment and through communication with the client and the health team members, and modifies the plan as needed.

(6) Acts as the client's advocate, as circumstances require by initiating action to improve health care or to change decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided.
http://www.rn.ca.gov/practice/pdf/npr-i-20.pdf

[RNperdiem]

Yes indeed, that is the Ivory Tower. While I respect their contributions to nursing and its professionalization, so much is not relevant to what I do every day with my patients.

[llg]

Originally Posted by RNperdiem

Yes indeed, that is the Ivory Tower. While I respect their contributions to nursing and its professionalization, so much is not relevant to what I do every day with my patients.

Unfortunately, many nurses who practice in direct-care rolls not only believe that such topics are irrelevant to them -- buy they choose to bash the nurses who do want to work in the realm of nursing theory and philosophy. That negativity within the profession towards most things philosophical and/or theoretical handicaps our discipline in our efforts to further that branch of our scholarship. And without a strong foundation of nursing philosophy and theory ... our other academic work, such as research and teaching, is hindered. And with our research and teaching hindered, that holds everybody back.

Also, few people successfully balance themselves between the 2 realms of the nursing profession and discipline -- the theory side and the practice side. Focusing too much on either one at the expense of the other causes problems. However, there are few jobs that allow you focus on both. I see that as a huge causative factor in the problem.

[pickledpepperRN]

Sadly I think too many nurses are spread so thin they aren't able to think about what they are doing.
Of course we observe out patient, analize and synthasize data, plan care to ensure our patients safety, comfort, and hygiene. We do our best to educate and teach our patients and their families, perform skills and tasks necessary to improve their health. We advocate for the best interests of our patients as much as the system allows.
And some of us "troublemakers" try to change systems that are against the interests of our patients.

The syatems that ask us to do the best we can with insufficent staffing, inadequate eaquipment, and little respect for our work.

I am glad the nursing process is in writing. It is what we do.