A Topic for Everyone

Audreyfay · Aug 31, 2003

Theory = ideal utopia

Practice = reality

Need I say more? :chair:

P_RN, ADN, RN · Aug 31, 2003

30 seconds? Well maybe, but 60 minutes to document. Most of my textbooks from the first time around were written in the late 40s early 50s and only updated rarely. There are thngs there that no one has seen in 50 years.

I am not, I repeat NOT knocking textbook/journal authors BUT it seems as if they are not bedside/clinical nurses. Every month in my journals I read what you MUST do and sometimes these are quite complicated tasks. a la' the "Nurse is a nurse."

I appreciate reading things from real people who have the frontline view.

Reality=FRED (frantically running to get everything done)

Ivory tower="expert witnesses" who will second guess and Monday morning quarterback every thing you do and everything you might have missed.

Marie_LPN, RN, LPN, RN · Aug 31, 2003

30 seconds? It might take that just to pull back the 10 layers (literally) of blankets a pt has on.

Rapheal · Aug 31, 2003

Not really possible.

Hellllllo Nurse, BSN, RN · Aug 31, 2003

Of course, we all know that nursing text-books and what you are taught in school are on a different planet than the reality of nursing.

However, there is one area in which I received no education at all, it was never mentioned in my schooling. That is supervising and managing others and being charge nurse.

When I asked about it in college, I was told "That area of nursing is for BSN nurses, not for you."

Of course, this came from a 68 yr old nursing instructor without a clue.

I've just had to totally wing it in this area, and I am uncomfortable with it.:stone

flame · Aug 31, 2003

The 30 sec assessment is used more for prehosp. settings and we use it for mostly a quick are they breathing and what is their major injurys. Its a shame to say but with the new computers, the multi assessment sheets and all the other paperwork one must do now it would take me 3 hours to assess a pt like some would like it done.

santhony44, MSN, RN, NP · Aug 31, 2003

When I think of theory-practice gap, the first thing I think of is the old "reorient the patient to reality" thing. I've seen a lot more disoriented folks become more agitated by this effort than helped by it. I'll never forget the patient I had as an LPN. She was the picture of everybody's granny, plump, round cheeks, twinkling blue eyes, beautiful white curls- I mean, she looked like Mrs. Santa! She had MID and would get very confused about where she was and what she was doing there. I can remember trying to orient her to reality. Suddenly I just looked at her face with the little smile and could read her mind! "Poor dear, she's just *so* confused!" I realized that she was *humoring me* while I was trying to orient her to reality!

Sekar · Aug 31, 2003

When I taught Nursing School we referred to this gap as "Ivory Tower Nursing". That is the nursing you learn in your pretty ivory tower school house and exists only in that environment. Real nursing, as we all very well know, is just a tad different. Whole books could be written on the difference between "Ivory Tower Nursing" and the real world. Hey! Now there's an idea. We should create such a book. Think what a boon it would be to new nurses everywhere to learn how it really is! I'd have paid alot for such a book when I first graduated Nursing School.

SharonH, RN · Aug 31, 2003

Originally posted by P_RN
Ivory tower="expert witnesses" who will second guess and Monday morning quarterback every thing you do and everything you might have missed.

I don't think I've ever seen anyone put it any better.

gwenith, BSN, RN · Sep 1, 2003

Originally posted by Sekar
When I taught Nursing School we referred to this gap as "Ivory Tower Nursing". That is the nursing you learn in your pretty ivory tower school house and exists only in that environment. Real nursing, as we all very well know, is just a tad different. Whole books could be written on the difference between "Ivory Tower Nursing" and the real world. Hey! Now there's an idea. We should create such a book. Think what a boon it would be to new nurses everywhere to learn how it really is! I'd have paid alot for such a book when I first graduated Nursing School.

That is sort of what I was hoping to start here by getting everyone to jot down their day to day observations on where the theory practice gap in nursing really is. One area we have difficulty with over here is long term care of the non-ventilated tracheotomy patient. So few texts really explain the difference between fenestrated versus non-fenestrated tubes with inner lumen versus those without variable flanges ETC.

Even measuring of cuff pressures is not done as well as it could be and this observation I make on the basis of how many colleagues I have to teach to use a stethoscope in listening for minor air leak, what to do when the cuff WILL not seal and so-on. There is virtually nothing in the texts about "weaning" a patient from a tracheotomy and there should be.

One of the BIG areas that is left out of general nursing is how to deal with the "borderline personality" patients. The ones that scream and rant and have hysterics because their water jug is half empty.

SmilingBluEyes · Sep 1, 2003

Like Dr. phil would say (and Tweety would appreciate this)'

GET REAL!!!!!!!!!!!!!!!!!!!!!!