Can Someone Be a Nurse Without Jean Watson?? - page 10

Ok now, as I delve back INTO nursing philosophy and theories, I come across, again, the theories of Jean Watson that have been hailed as the greatest thing since polyurethane IV bags - The Caring... Read More

  1. by   rncountry
    Research based practice is different than nursing theory. Concrete scientific research is why we don't use betadine and suger to heal a wound anymore, not philosophical reasoning. Assessment, planning, implementing and evalution are not pie in the sky theory. It is concrete thinking, it is what nurses do every day put down so it makes an effective teaching tool. After time it becomes second nature through repetition.
    Providing care to a patient is much different than caring about that patient. I have had many, many patients I care a great deal for. There has been a minority of patients I have heartedly disliked. Yet given that situation care is still provided at the same level the patients I really care about emotionally were given.
    The vast majority of PhD prepared nursing have long ago left direct care nursing behind, and I feel it would benefit the career field much more if these nurses did scientific based research(and I know many do) that concretely benefits nursing practice, not nursing theory. As a wound and infection control nurse I actually enjoy reading new research regarding both of those practices, it enhances my abilities and enhances my ability to provide the best of wound care to my patient, based on scientific methods. In October perhaps November the CDC will be coming out with new hand hygiene guidelines, one of the things expected is not allowing direct care workers to wear artifical nails. Empirical data, and loads of it, point to articifical nails as a harbor for bacteria that has passed nosocomial infections on to patients. It is that type of research I feel I need, not a theory on fluffing aura's. I also believe that nurses do interepet labs as well as many other things. If you do not have the ability to do so it makes it very difficult to be a patient advocate if you cannot present to a physician why you believe doing or not doing something is important. Not to mention I wasted an awful lot of time and paper in nursing school while writing what my patients labs were and the likely reasons they looked like that. And of course there is the heparin protocal based on PT and INR results, if I could not interpet the results of these two labs I surely could not adjust the heparin rate if needed. Everyday I go through cultures on all the patients on my floor so I can track what bugs are out there, is the patient symptomatic, is this a nosocomial infection or do I have colonization, and that when looking particularly at MRSA and VRE. Is it appropriate to be treating this bug, do I have a new resistant form of something? Is the antibiotic ordered one that the microbe is sensitive to. And so on. My infection control practice is based on CDC guidelines as well as SHEA and APIC. All scientific based research and often done by nurses. Perhaps because I am more of a concrete thinker I have very little use for philosophical theory. I enjoy philosophical thinking in relation to many other aspects of life, religious theology springs to mind. But as far as my nursing practice I prefer concrete scientific reseach that allows me to better take care of the particular illness or illnesses of my patients.
  2. by   llg
    To rncountry:

    I can certainly appreciate your personal preference for the more empirical types of research. Go to it! We need more people doing it. However, to be "good science," all research needs to be grounded by "good philosophy" and usually, by "good theory." You rarely have good science without the other two.

    The principles that undergird the practice of science were/are developed by philosophers -- and that is true of all disciplines, not just nursing. It is the interplay between philosphy, science, art, etc. that drives knowledge development forward. That's why the highest academic degree in almost every discipline is called a "PhD" -- a doctor of philosophy. There is more to being an expert scientific researcher than just mastering the technical aspects of conducting a study. One must also demonstrate an understanding of its philosophical and theoretical foundations.

    llg
  3. by   prn nurse
    This has been the most interesting and thoughtful thread I have read in a long time.
    You scholars deserve a big "Thank You!" for representing nurses so well ! You certainly "know your stuff" and express yourselves articulately. It's inspirational.
    Don, I love that 1904 post. I saw it on the other thread & copied it for a discussion at work.
    When I was in school, I was encouraged by the Dean Emeritus at the Universitys' School of Nursing to write a history of the Nursing School and the part I remember best is the extreme difficulties she experienced attempting to get the nurses registered.
    She had to plead before the State Legislature many times, write and visit the governor of the state and state her argument before the schools' Board of Regents' and President.
    Just as with our Allnurses posters', she saw elevating the standards as her primary objective.
  4. by   rncountry
    llg, your point is well taken. However that does not mean I believe that nursing theory has reached that ideal. There is too much nursing theory based on pseudoscience, not theory, hypothesis etc...
    You likely know this but I will continue nontheless. The word philosophy is from the Greek meaning "love of Wisdom", and philosophy encompassed the love of ALL wisdom, only in recent centuries has it come to refer to special branches of enquiry. Since the history of philosophy is one in which the philosophers tackled questions on human nature, physical nature, spiritual nature it only reasons that philosophy is the granddaddy of the practice of science. It was a natural progression so one may attempt to prove the theory of the philosopher. And I think anyone who has done much reading of history would easily understand the impact philosophers have had on our lives. French socialism as well as the French Revolution was driven in large part by Voltaire and Jean-Jacques Rosseau. And even today one may competently argue the philosophical reasons of the French Revolution, though 20 million dead French from The Terror could care less about the philosophy of it.
    Adam Smith's Wealth of Nations is still cited when one discusses the philosophy of Capitalism, as well as it's impact on Western Culture. John Locke's philosophies were read and used by the founding father's of this country. David Hume still looms in the conciousness of Western philosophy. Classical German Philosophy is a hard read, though interesting and while I disagree with much of the religious theory of Kant, I still found it worthwhile to read. Each of the philosophers I have cited started with an education the was most often based on classical literature
    ie: Ancient Greeks. The Greeks had no written language before the Greek polis' and the only basis of empirical observation was the day to day observations of the philosophers. Socrates, though his works are actually only known to us through his students Plato and Aristotle. Much of the early Christian theologies were based on Greek Stoic philosophy. I understand perfectly "the principles that undergird the practice of Science" I also understand that philosophical theories can have major impact on society at large. That does not always mean, however, that those philosophies are something that are a good impact. While one can declare that Karl Marx's theories are good in principal, the implementation of those theories had disasterous consequences for million of people throughout the world. I will not pretend to know Jean Watson's theory intimately, I don't. But from the seat of my pants I humbly submit that her ideas, theories if you will, have served to undergird the idea that to be an appropriate nurse one must intimately care about a patient. The outgrowth of such a theory is the idea that nurses will give until we drop, all for that deep caring ideal for our patients. We will cheerfully submit to working hours that have been scientifically proven to be a hazard to our own health, a study done in 1914. And I don't mean a theory of what it does to the health of an employee but through rigerous empirical data. As nursing schools have stubbornly clung to the ideal of putting everything and everybody ahead of our own needs not only as nurses but as people, we have allowed everybody and their brother to control our practice, we continually look outside of nursing for validation and while the profession has been struggling for the last 10 years we have PhD nurses who have continued to put out reams of material that has had little impact for the nurses at the bedside. Last year I called the group Leapfrog in hopes that they may be willing to help in the push to eliminate mandatory overtime for nurses based on the idea it is harmful to patient care. However they were unwilling to get involved with that endeavor because there was not any real research at that time that could back up that statement. There is now research that is a beginning on the importance of appropriate staffing at the bedside, based on patient outcomes. Yet the research is still very little, we still have a long way to go to be able to competently point to relevent research to prove the importance of a educated professional nurse at the bedside. So while one can easily find various nursing theory the vast majority of it has not been able to actually provide a framework on what nurses actually do and how it impacts on patient care. So while nursing theory may provide intellectual exercises, it has provided very little of value to the nurse who is actually taking care of the patient, and thus very little of value to those that have traditionally made the decisions on where nursing resources are. And that has been not only a detriment to the profession, but to the patients my profession is supposed to be caring for. So even if I intimately care emotionally for each and every patient I have, the resources necessary to provide the best of care to those patients have been taken away bit by bit because my own field has not provided relevent research to prove that those resources make a difference on patient outcomes. And that is the biggest reason I feel nursing theory has been of very little value. While pie in the sky theory was being written I lost diabetic nurse educators, staff educators, patient to staff ratios increased, underskilled employees were given the duties I went to school to earn a license to be able to perform,patient worsened and my voice as a nurse saying this will harm patient care was ignored because there was no relevent research to prove the direct care nurses fears had any basis in fact.
    To state again, philosophy has a Greek meaning of "love of Wisdom" the love of ALL wisdom. Instead of distancing themselves from bedside practice issues perhaps they should have embraced them, and been more relevent to those patients we are supposed to care for so much. But than that would have meant delving into issues that would rock that precious view of nurses being all caring, and all giving. Utilizing research to be able to demand control over our practice, to be able to point to why it is important to have patient to staff ratios that allow time to educate, to actually spend time talking to the patient, would have rocked the boat. For way too long nurses have more or less been told to sit down, shut up and be the good little caring girl. Try to find something out there that is research on patient to staff ratio's. That result is so pitfully small it hardly is worth looking at. Instead we gave our power to the bean counters while nursing researchers were busy trying to put together theories that would make nursing relevent and respected, while ignoring the very issues that would have easily done those two things and more. Researching patient to staff ratios and patient outcomes as well as what type of staff is doing the primary care and education could have been incredibly relevent to this profession. Researching the use of mandatory overtime on patient outcomes could have helped us control our practice but it wasn't done.
    I say focusing on what nursing actually does and what the patient outcomes are based on the current practices is what should be done, and to a very large degree is not. Nursing diagnosis is not going to make my profession relevent to those who control the dollars or healthcare decisions in this country. The theory of caring for patients like my parents is not going to keep that diabetic nurse educator, or an extra public healthcare nurse. Theory that does not meet the needs of it's own profession is then nothing more than busy work that has no relevent meaning.
  5. by   Stargazer
    Theory that does not meet the needs of it's own profession is then nothing more than busy work that has no relevent meaning.
    Well, you put it more elegantly than I did, but that's essentially what I was trying to say a few pages back. Excellent post, Helen, thank you.

    llg, I understand what you're saying about the difference between scientific theory and a philosophical theory of nursing. But even a nonscientific philosophy can be based on sounder principles than clairvoyance and energy fields.
  6. by   WashYaHands
    I will not pretend to know Jean Watson's theory intimately, I don't. But from the seat of my pants I humbly submit that her ideas, theories if you will, have served to undergird the idea that to be an appropriate nurse one must intimately care about a patient. The outgrowth of such a theory is the idea that nurses will give until we drop, all for that deep caring ideal for our patients. We will cheerfully submit to working hours that have been scientifically proven to be a hazard to our own health, a study done in 1914.
    One of the assumptions of Watsons Theory, or philosophy, is that the nurse must first care for self before she can care for or about her patients. So, no, her theory does not advocate or entertain the idea that nurses submit to destroying our own health or well being, nor does she ever state that one is an appropriate nurse only if they utilize her theory.

    Researching patient to staff ratios and patient outcomes as well as what type of staff is doing the primary care and education could have been incredibly relevent to this profession. Researching the use of mandatory overtime on patient outcomes could have helped us control our practice but it wasn't done.
    This research has been done and has been published in many journals, including the New England Journal of Medicine. Research showing staffing mix has also been done. It is just recently been brought to forefront and is being used to promote safe nursing environments. We may not be there yet, but these issues have been brought into the open through these studies and hopefully will be addressed as the research grows and is published further.

    The Greeks had no written language before the Greek polis' and the only basis of empirical observation was the day to day observations of the philosophers. Socrates, though his works are actually only known to us through his students Plato and Aristotle
    Although Plato and Aristotle were both students of Socrates, Aristotle favored what is real and concrete, while Plato favored abstract concepts, such as those that could not be seen through observation alone. Their different philosophies have been an age old debate. It's cool that you brought these guys up. They differed in their philosophies and often debated with each other about them (concrete vs. abstract). Much like the view points on this thread.

    Linda
  7. by   NurseMark25
    I knew that I would receive some lashings for my opinion, and I appreciate them. Please allow me to re-iterate that nursing is not medicine. I don't think highly of those nurses who enter management or hospital administration and have nothing better to do but point out what nurses could be doing better when we are literally drowning in work. These same holier-than-thou people who whimped out of bedside nursing only to point out that you are not doing your job well enough. Many of these people have Master degrees in nursing... so tell me how they help our profession. And many of you out there know that what I am saying here is correct, and it is like this in many hospitals, not just the one I work in now. I do think highly of myself, I am a great nurse. But once again, I see nurses on this website who are trying to make nursing more than what it is. I too worked neonatal ICU, and we had a CNS who seemed to do absolutely nothing, other than talk about her personal life and be-bop around the unit. I loved NICU nursing, but I hated the people I worked with. I fail to see how CNS's advance the profession. No I am NOT ignorant... I have researched the CNS role and many CNS schools, and I am unimpressed. How exactly does a CNS advance the nursing profession? Other than the Psychiatric CNS who can perform psychotherapy, they seem to be able to do little more than what a hospital social worker does (I am sure to be educated on this by some of the CNS's here). As far as prescription privileges for CNS's, I know for a fact that this is a rare phenomenon, and something that is not likely to happen in all fifty states of the United States, as CNS's are not educated the same way as a nurse practitioners. (And no, Dr. llg, I am not attcking you personally.) Furthermore, I applaud the so-called "physician extender" roles of the NP and CRNA. Why? Simply because I see CRNA's and NP's as an entirely different breed of provider, providers that take a wholistic approach to a patient as a person, not just as a disease or a symptom like so many of the medical doctors I work with. I want to see nurse practitioners separate themselves from physicians all together, and use them only for patient referral. NP's should have their own niche, like naturopathic doctors (ND's), and podiatrists(DPM's), and optometrists(OD's).

    I will concede that research is important, but I fail to see why having a doctorate degree is so necessary for research when you are taught nursing research in BOTH baccalaureate and graduate nursing programs. This is not ignorant, I think there is a good point here.

    Now to reply back to some of the posts:

    From Dr. llg:

    "Ok. Here goes. To NurseMark25: I feel sorry for you. You are apparently in a dead-end job in a work environment that does not stimulate you to think or act beyond the performance of some basic technical skills. In my hospital's ED, we have EMT's and Paramedics who do that job. The nurses spend some of their time doing those technical skills, too, but we encourage them to have a more "global management of the patient" role as much as possible. "

    - Sounds great. I would love to work in a hospital that allows nurses to have such a role. Here in the real world, nurses take on total management of the patient including almost all of the technical skills. I spend most of my day starting IV's, giving medications, cleaning and bandaging wounds, performing all of the tasks of patient care. We do not have paramedics who can start IV's. We have a few EMT's who can draw labs and place foley catheters, but they are so overworked they have little time. So who is left to do that work? That's right, the nurses. I have worked MANY ER's, and they all pretty much have the nurse doing the same thing. Worst of all is the charting, which is cumbersome, time-consuming, and the only protection a nurse has for his or her nursing license against all of the old crohnies at the state board. Please do not feel sorry for me, someone has to work in such an environment or the people in this community will not get the care they need.


    "I have never been one to stand on the sidelines and criticize the people who run the unit -- or the hospitals. I have been one who joined the committee, got involved, gave my time, and got myself the best education I could get in an effort to make things better. Can you say the same? "

    -Yes, I have joined committees. Yes, I go to the ER meetings. I offer suggestions for improvement. I give recommendations. Unfortunately, the committee's answer to almost everything is to institute more paperwork, which leads to wasting more of the nurse's valuable time. They call the paperwork "tools", I call them making the problem worse, and have said so in many a meeting. I criticize management because they sit down with a pen and paper, pretend to listen to the nurses, pretend to act as though the nurses' ideas are helpful and interesting, and again, do nothing. THEY DO NOTHING. And yes, I have participated in meetings at other hospitals in which I have worked. The same thing seems to happen. Why? Because nursing management does not run the hospitals, business people do. The bottom line is the almighty dollar, not the patient, and as a very well-educated and articulate person, I know that you know this. What I see nursing managment doing is brown nosing to the business people running the hospital, and NEVER standing up for the nurses. Respect them? NO. Crticize them? YES. Try to effect change? Still working on it. As far as advancing my education, I am still working on it, and I am attempting to get my... yes, you guessed it... NP.


    Furthermore, I wish to speak to all of you that have advanced degrees, like I will soon have, and make a point. It is easy to point a finger and look down on the nurses who are not in possession of an advanced degree (other than an NP or CRNA) and say that the system is in the state that it is because of a lack of education and the nurses are not trying hard enough to effect change. I say to them, " You ARE in a position to effect change too. Have you forgotten what it's like to be a floor nurse? Are you really better because you have a desk job or because you have some power? Someone has to be in the trenches and caring for these people. Why did you stop? Why do you not stand up for your nurses? We need you just as badly as you need us."

    To the research nurses, keep up the good work. To the bedside nurses, keep fighting the good fight.

    To the NP's and CRNA's, keep advancing the profession. Your services are just as important as the physician's.

    To the nursing managers, defend your nurses. Support them. We need you. Don't be a boot licker and a chastiser. It doesn't help us.

    To Dr. llg, you made some great points. I enjoyed your responses. Please do not feel that I don't feel what you do is important... CNS's are great educators and strong clinicians, and definitely have a place in the NICU. I just see nursing differently than most other people.

    Mark
  8. by   WashYaHands
    How exactly does a CNS advance the nursing profession? Other than the Psychiatric CNS who can perform psychotherapy, they seem to be able to do little more than what a hospital social worker does (I am sure to be educated on this by some of the CNS's here). As far as prescription privileges for CNS's, I know for a fact that this is a rare phenomenon, and something that is not likely to happen in all fifty states of the United States, as CNS's are not educated the same way as a nurse practitioners.
    I'm currently in a program with a CNS focus. I do not think of myself as better than any other nurse, and I do not agree with your assessment of what a CNS does. The hallmark of a CNS is an in-depth knowledge of a particular cinical client, specialty or group. This in-depth knowledge includes accepted practice for the treatment of illnesses. The clinical expertise of the CNS allows for recognizing subtle changes in patient status and meanings the illness might have for the patient. The CNS differs from expert practice in the range and depth of knowledge, anticipation of patient response, judgement about nonclinical variables, clarity of clinical decision making, and the ability to articulate the rationale. the CNS is able to care for patients with complex physiological and psychosocial problems and able to treat skillfully with a broader and deeper range of responses. CNS's also develop innovative approaches to clinical practice, promote interdisciplinary collaboration, and advance the profession of nursing. They serve as a patient advocate as well as advocate for the staff that they work along side of. The CNS is has the ability to articulate information and share knowledge with others in all areas of the health care system. The CNS interprets research findings for problem solving, especially as a base for clinical practice. These problem solving skills also serve as a basis to resolve conflict and facilitate change. Involvement in multidisciplinary patient care allows the CNS to educate other health care professionals to nursing's unique role in meeting patient needs. Most CNS programs have the same basic curriculum as the NP and CRNA in terms of advanced assessment, advanced pathophysiology, advanced pharmacolgy, research and theory. Once the basic curriculum is completed, each specialty moves on to study what is specific to their roles in the health care system. CNS's diagnose illness, create a plan of care, and prescribe treatment. They provide direct patient care as well as serve in other roles, such as educator, researcher, consultant, and advocate. More states than not do offer prescriptive authority and the authority to prescribe durable medical equipment with the same criteria as an NP.

    This thread is a discussion about a nursing theory. This very same debate echos in nursing classrooms across America. What we are discussing here is not new, the differing views are actually common in discussions such as this. Mark, there is no need to make insulting remarks about any level of nursing. Each of us makes our own choices in regard to what it is we want to do in life. If I choose to further my education and become an advance practice nurse, and don't have the support of my colleague nurses.....how does that promote the profession of nursing as a whole?

    Linda
  9. by   globalRN
    This is such an interesting thread and I have really enjoyed:

    Washyahands: your input about Jean Watson's theory is right on the money; noone ever advocated being a martyr to nursing. In fact, those who sacrifice selflessly will burn out. Get a life!

    llg: loved your comments on scientific and philosophical research. Good science IS grounded on sound theory and philosophy. Just because there are a handful of people, if that, who understand theory of relativity...does that mean it is hogwash...just because Joe Average doesn't think on it?
    llg, you sound like the type of nurse whom I would love to call a colleague

    RNcountry: Outcomes research seems to be the big thing in nursing. Both qualitative and quantitative research methods have their place in contributing to nursing knowledge.

    NurseMark25: Please don't think of my feedback as 'a lashing'; it's just my view.
    CNSs are really important...they have educational preparation on staff education, research program design/evaluation and clinical expertise. They add a lot to any unit lucky to have them. I have a BSN and completed a MS as a NP, we had research courses but in no way does it prepare you for research the way a PhD does. I have a whole lot of respect for those who do a PhD, the coursework is rigorous. Baptism by fire.
    Good luck in your NP program. Some nurses feel NPs and CRNAs
    aren't really nurses. My understanding is that the PA role came about because nurses resisted the idea of the NP role so the MDs created the PA role without them.
    Last edit by globalRN on Oct 7, '02
  10. by   Q.
    Originally posted by WashYaHands
    Each of us makes our own choices in regard to what it is we want to do in life. If I choose to further my education and become an advance practice nurse, and don't have the support of my colleague nurses.....how does that promote the profession of nursing as a whole?

    Linda
    Excellent point, and I couldn't keep myself away from this discussion, hard as I try.

    NurseMark, while you state that advanced degree nurses try so hard to make nursing something it isn't, I respectfully submit that perhaps you are trying too hard to do the same.

    I have heard arguments before, that bedside nurses are the "backbone" of the profession. I haven't quite formed an opinion about that but part of me thinks that the nurse researchers could arguably be the backbone - as they research and explore treatment modalities that you use on a daily basis that have come to be effective via research findings, ie they help to define our practice. As a bedside nurse, I used the findings of a nurse researcher on the effectivness of infant warming using the kangaroo hold or skin on skin. It seems obvious to you now but it always wasn't. In addition, isn't it great to have your practice reinforced with provable, documented research findings?

    Had someone not done the "heavy lifting" as Glad2behere pointed out, nursing would still be regarded as physician handmaidens. I know I am more than that, both personally and as a professional nurse.

    Finally, in regards to your statement about why having a doctorate is so important when research is taught in bachelor degree programs. First, research is not always taught in those programs, and, we have quite a few nurses around who are not BSNs at all. Secondly, I have taken stats/research as an undergrad, but learning it now in grad school it takes on a whole new meaning for me. Thirdly, and finally: history tells us that a Bachelor's degree is so named because it's the beginning of one's education. As I progress in my program I find that there are so many things that were left out of my BSN program simply due to time constraints. Also, outside of the nursing profession, society respects advanced degrees. They place a value on it. You are listened to when you hold those degrees. Right or wrong, that is how it is. I feel in order for nursing to be heard, and in order for someone outside of nursing to be able to place a "value" on some of our writings, the advance degree helps give a "common ground" for others to compare.
    Last edit by Susy K on Sep 18, '02
  11. by   purplemania
    Dean at UT knows Ms. Watson so her theory is biblical to nursing school. How can you teach someone to care? I applaud her for creating a theory but I do not base my practice on that. Sometimes, ideal or not, it is just a job and part of the job is to care (or pretend to).
  12. by   Glad2behere
    Hey Suzy,

    Here's something, construct a poll. Could ya would ya?

    Do physicians care? Do they have to care? Does it make them any less a good/bad physician?

    Do CNA's care? Same questions?

    How about policemen? Firefighters?

    What is the single most quality desired by the public that is embraced and rewarded by ANY profession? If this quality is identifiable (assessment) how do we plan as a profession to achieve that, how do we implement that plan, and what criteria are we to use to successfully evaluate the results.?

    I'll paraphrase the previous poster.

    Nurse to new patient "Hi, my name is Caring L Aura, I am your nurse today, I care so much about you and empathize so deeply with you, and it saddens me immensely. I have watched many episodes of "Saved by Angel", so believe me, I know how to do it.
    If this gets really involved here, please be on notice that I practiced and practiced the Vulcan Mind-meld on my spouse and am proficient in that as well. Oh, gosh, we are going to start this IV on you, and it will be very emotionally draining. Can you believe I have this down to only three attempts before I am successful?"
  13. by   Q.
    This poll - what, posted for the public or posted here?
    Last edit by Susy K on Sep 18, '02

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