Can Someone Be a Nurse Without Jean Watson?? - page 15

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   llg
    Originally posted by Susy K
    We just had a similar discussion in class, about having a curricula that teaches multiple world-views instead of one, and allow the students exposure to all and then decide on what best fits them.

    I tend to agree with this; afterall, I go to school to get educated about as much as I can. To leave out some information and in that same breath skew my thoughts by only including some of it doesn't seem right.
    I feel the same way that you do. It's when people get too dogmatic about a particular viewpoint or theory that many of the problems begin. The use of one theory only is simply to limiting and restrictive.

    However, I think we probably could and should try as a profession to find some common basis of agreement on a few fundamental issues. Without some sense of cohesive identify, it's hard for us to stick together as a group -- or to work together for common goals The challenge is to identify those commonly held beliefs, to articulate them in such a way as to promote cohesion, and then to use them to help build our knowledge base and our professional standards. ... and to do so without overly restricting ourselves and/or future generations.

    llg
  2. by   WashYaHands
    We just had a similar discussion in class, about having a curricula that teaches multiple world-views instead of one, and allow the students exposure to all and then decide on what best fits them.
    I agree that this is the best approach to theory and nursing education, which is why in some Master's programs you're required to write your own personal philosophy of nursing in order to clarify for your self which theories best fit into your personal ways of practice and world view. I would find it difficult to have someone present a theory to me and tell me this is how I have to practice nursing. I'd rather examine my own thoughts/beliefs and find a theory that is compatible with my own.

    Linda
  3. by   Glad2behere
    Great! llg, Suzy, WashYaHands, rncountry, I really like what is being done here.

    WashYaHands made a culimating point in her post...that I really like and was not aware even existed. Having a quick overview of all theories, and having a student write a paper on their own professional image of what they wish to be and what they aspire to contribute to nursing from that foundation. Somehow make it a standard of initiation into nursing. Summon a conference of all Nursing school deans so that a uniform policy is constructed so that Nusing Process is the core of our profession...how you get there is flexible. But together we all start here at this particular point and advance somewhat at the same rate. This would allow for more specificity and differentiation in practice much sooner, yet ally us together.
  4. by   llg
    Originally posted by Glad2behere
    Having a quick overview of all theories, and having a student write a paper on their own professional image of what they wish to be and what they aspire to contribute to nursing from that foundation. {snip, snip} Somehow make it a standard of initiation into nursing. Summon a conference of all Nursing school deans so that a uniform policy is constructed so that Nusing Process is the core of our profession...how you get there is flexible..

    I, too, like the idea of having all students envision how they plan to contribute. It might get more people thinking about contributing rather than just using.

    However, the problem comes in getting all nursing Deans (or all nursing "anythings" for that matter) to agree on any single approach. There will always be some disagreement. Just look at what's happened with "caring theory." A lot of people agreed that nurses provide a unique kind of holistic caring -- different from the generic caring that other people do -- and that "caring" should be the central concept around which to organize a curriculum. But yet, that agreement has not been sufficient to convince the majority of nurses participating in this thread to go along with it.

    Who gets to decide what that central concept or core should be? You have proposed the nursing process, but a lot of people would disagree with that because it is simply a re-statement of a basic problem-solving process that is not unique to nursing. Let's face it, Every profession uses a version of the same problem-solving process. People assess and diagnose situations, plan to do something, do it, and then evaluate whether or not what they did worked or not -- whether the activity is nusing, medicine, plumbing, or garbage collecting. So the "nursing process" in and of itself can not be used to distinguish nursing from any other profession. Besides, I doubt that there are many schools out there that don't already teach the nursing process in one form or another -- they just don't see it as the thing that defines nursing and distinguishes from other disciplines.

    Perhaps we just all need to learn to be comfortable with the fact that different theories and different ways of looking at something is a natural part of an open process -- a process that allows some indivuality and that allows for the introduction of new ideas. If we all get too much alike, that might make us stagnant.

    llg
  5. by   Glad2behere
    llg,

    Doctor, I agree that forming a consensus of nursing school deans to adopt such a policy would be difficult. However, it has been done before, that is how we became saddled by the nursing theories. I do believe I am correct though, that nursing process is a junction at which most theorists converge. Surely some agreement could be reached on that, and some coordination assimilated in a conference setting, and as a group decide what needs to be done. Sure, allow different factions to participate, have our own little "Constititional Congress". Wouldn't that be something! Isn't this how it should be done?

    My reasoning is this, you have stated your concerns about producing stagnation if this were instituted, surely that is no worse than division.

    Also, this could be mandatory for nurses at the doctorate level to attend, and them having to represent nurses of their specialty to cast a vote in favor of or against certain issues. The grunt nurses could hold meetings to adopt new resolutions to be presented to the voting congress.

    In other words, pattern it after our own political party system.

    Talk about increasing professionalism and gaining some respect and having some unity!

    The voting congress could have ideas submitted to them from the very bottom of core nursing, leadership and direction could be established. Research projects could be dealt out with some degree of accountability and worth, and money would be easier to raise for research with a united effort.

    No stagnation here!

    I'm saying make Nursing Rock!!!
  6. by   rncountry
    Too much the same definately breeds stagnation, I would say we need a curriculum at the BSN level though that is basicly the same so that all nurses start from the same basic framework. Then it is at the master's level where more education is provided in which the many divergent focus' of nursing can be explored more, I particularly like the idea of writing a personal philosophy. BSN programs ideally, would provide several different theories, and again that could be built on more in a Master's program. I know for myself when I go back to school it is with the thought that I am not going to simply go back for my BSN. I want to go into a program where I can become a CNS. At this time I think I would like to go with a focus on infection control, I recall hearing about a program through APIC. Though I enjoy wound care as well.
    I think it is vital to nursing to have many different focus', but I also think if too many focus' at once, it dilutes the core.
    This is a bit off the topic, yet isn't. I was watching a program on PBS tonight on the Civil War, very good one I might add. Anyway there was a piece about the Battle of Antietum, and there was a small part in it about Clara Barton, while tending a wounded soldier he was shot and killed, and then this quote, "I had to wring the blood from the bottom of my dress as I went from boy to boy just so I may walk." And it made me think of all the nurses in all the wars that stayed through the battles to tend to wounded and dying soldiers and it made me think that at it's extreme that is what nurses do. It is caring, though I don't think it is something that can be captured in a written way well. It is caring enough about fellow human beings that we seek to ease suffering in some manner. Yet it is not enough the simply care, if the practice is to be effective in easing suffering and pain it must be passed on strong scientific knowledge. Nursing as a profession cannot be one without the other. Call it Art and Science or whatever but it is that simple equation that makes nursing what it is. Perhaps because being able to quantify that elusive quality there will never be a theory in which nursing can ever be fully catagorized, in the strict sense of the word. I do think it is important to be able to have a firm foundation on which nursing practice is based, which in my mind must be more scientific in it's approach than many of the theories out there, but I don't know how much anyone can capture the caring qualities that make one decide to become a nurse, police, firefighters or EMT's. It is there but how does one realistically define it? I don't know that it ever can be. It's a bit like theology in my mind. It exists to provide a framework on which religion is based, yet the actual practice of religion rarely mets it's theortical goals. And some theories may have been relevent given the amount of understanding for their age, yet as people have learned more some theories are obviously wrong. St. Augustine's theory that women are only the carriers of a child, but did not actively contribute to the making of that child. In his time the science of sperm and egg did not exist. The theory that the sun revolved around the earth as the earth was the center of the universe, again something that people's of the dark ages knew nothing about. It took scientists who braved not only ex-communication from the church, but also the real threat of death, to do more investigation and uncover the way the body of both men and women worked and to look into the heavens and understand how they worked. It is always pertainent for any group to continue to question and reason out answers. So to the question who gets to decide, I would say all of us. When I see a theory like Martha Rogers that I feel is invalid, it is up to me to say so and not to only say so, but as to why. If I feel there is too much emphasis on the caring aspect of nursing than I must speak up on that as well. Much like societal norms change because of pressure from within a social group to do so, nursing will do the same. And much like social change, that happens not because the majority all suddenly think at the same thing at the same time, but because a few hardy souls are determined enough to push for those changes and once a majority of people feel it is appropriate then changes happen. Top down change rarely is what actually moves things forward.
  7. by   llg
    To Glad2BeHere: I'm sorry if my last post seemed a bit "contentious." After I sent it, I regreted my tone a little. I didn't intend to really disagree with what you had written: I was trying to say that the issues would not be solved so easily.

    It is my impression that the overwhelming majority of nursing schools already teach the nursing process -- and it hasn't led to that ideal world we are talking about. As it is only a generic problem-solving process, the nursing process does not at all address the "content" of what it is that the nurse is supposed to assess, the types of problems or needs the nurse is supposed to address, and the types of interventions the nurse is supposed to plan, do, and evaluate.

    In other words, nursing "bought into" the nursing process years ago -- but it is in the next step, the step of eludidating the substance that the divergence remains. And that's the realm that is addressed by theory.

    Also, as for the leaders getting together, having conferences, etc. that already happens and has been happening for years. Believe me, leading academics have their own conferences and meetings they attend at which they discuss these issues. Again, it has been done for years but has not lead to the unity we have been discussing.

    Finally, there are already broad nursing organizations that have addressed these issues for years. There is the ANA, the NLN, and groups for everybody. They have been around for years, and yet, there is still no unity.

    I appreciate your input. This discussion has moved my own thinking forward on these issues and again, I aplogize if I seemed a bit too contentious earlier. And please, please, don't keep referring to me as "Doctor." It's not that I take offense or that I am ashamed of it. It's just that some people have such a prejudice against nurses with doctoral degrees that I am reluctant to advertise mine in an environment which might not be safe.

    llg
  8. by   Glad2behere
    llg,

    First, I apologize.

    I realize that the ANA and NLN have been doing this for years with some degree of effectiveness, but also lacking a lot as far as a uniform policy or governing body. State Boards do the governing and interpretation of nurse practice acts and their enforcement.

    My message is a little different. I am proposing a mandatory membership upon certification as a nurse, and create a heirarchy similar to party politics. This would allow a channel of ideas to flow primarily from the bottom to the top. Have the caucuses and the whole nine yards, and elect one speaker for us all with a set term. I worked as a precinct chairman for several years and I am excited how much we could benefit from such a system. Anyone aware of party politics understands how a party platform is adopted..from the bottom up. I understand the NLN and ANA have done a lot, but they are similar to the League of Nations. Very good but no teeth. All these organizations only reflect isolated views of nursing and thus are unable to speak for us all, albeit because of their limited membership.

    Upon issue of license, a nurse would have to send in a fee and initiate membership. Attend a minimum number of meetings on a county or city level to offer, discuss, and vote on ideas. The results of the meetings rehashed again at the state level, then the national level. At the state level delegates are elected to voice and vote to the national level. To me it would be unbelievable what an organization of this caliber could achieve.

    Research in any discipline could continue and actually be fostered by the organization, or discouraged by it. I am not saying at all that theories would have no place. I am only saying that at the point of nursing process that is at least one point we could all agree to the extent to make such a body possible.

    This body would be able to articulate philosophical statements, espouse research, and put us on a leadership track and inherently have some clout from any point of view.

    I disagree that it would be impossible. I think a need has to be demonstrated and the concept sold to nurses. Do I think it would work? Without a doubt.
  9. by   Jonty45
    Originally posted by OBNURSEHEATHER
    Since I have never even heard of her, I would have to say yes.

    Heather
    Absolutely brilliant summation Heather..I would have been horrified to think that after 39 years practice I wasn't caring because I hadn't heard/read of Jean Watson!!
  10. by   llg
    Originally posted by Glad2behere
    llg,

    My message is a little different. I am proposing a mandatory membership upon certification as a nurse, and create a heirarchy similar to party politics. This would allow a channel of ideas to flow primarily from the bottom to the top.
    Ahhh... Now I see your point more clearly. As you well know, it would still not be easy. A lot of people would reject the idea of a MANDATORY membership &/or participation -- for the same reasons we don't have mandatory voting in the USA. People cherish their right to sit on the sidelines and criticize those who are actively trying to do something!

    I think that all we can realistically do is to give people the opportunity to participate -- and then respect their choice to either do so or not. Unfortunately, a lot of nurses prefer to not participate in discussions of nursing academic issues -- and even more choose not to become very knowledgeable about them. That's why a thread like this one has been is a bit unusual.

    llg
  11. by   canoehead
    That mandatory membership already exists in the form of state nursing boards...but still doesn't function in the way you envision.

    When I studied nursing theory I was appalled that most of the theorists were psych nurses, and that their theories were used to describe care of physically ill patients. I think psych and med surg come with different priorities. Most of the theories I read helped with care of M/S patients, but only after the physical was taken care of.

    Nurses DO need to find and embrace a vision of themselves as being uniquely prepared to fill a role in health care. As I see it, nurses are where the buck stops in day to day care- no matter what the specialty. We coordinate knowledge from all the specialized disciplines, and incorporate the patient's personal priorities, and bring everyone together to make an effective holistic plan.

    We could probably all agree that anyone can start an IV, but if you get a nurse to do it they are prioritizing all the tasks needed from other departments, tending to psychosocial needs, aware of all the respiratory, cardiovascular etc, and may be giving direction to several team members, at the same time. The unique contribution of nursing can be found if you contrast a nurse in charge of his/her patient's care as opposed to the doc writing all the orders and having separate people come in to do their own tasks. Without nursing it all gets done, but the quality outcome doesn't exist.

    I believe that the difference between experienced and new nurses has less to do with physical tasks, and more to do with gaining an understanding of how caretaking interventions and professionals mesh together, and how to "work the system" for a smooth, efficient flow. The best nurses will pull in family strengths, community resources, and hospital depts. We even know the quirks of individuals, and have the skill and finesse to get what we need from people in the system.

    Maybe we should market ourselves as the professionals that put it all together to make the system work. It's a unique position and role that nursing already takes care of- but we only get credit for taking orders. We all know that's not what we do- in fact if the nurses doesn't regularly look at the big picture for each patient they often end up with conflicting instructions.

    There is a place for research in how to best pull together expertise to benefit the patient and decrease LOS. Even a NP is often successful because he/she looks at family, culture, environment instead of just physical exam and intervention. The result may be that the family says "That nurse really CARED about what happened to our mom." Maybe thats why we have been defining ourselves as the "caring" profession- we take a look at interventions from the receiver's perspective- do they make sense? do they all coincide? are they prioritized properly?

    I think this is a role unique to nursing, essential for healthcare, and absolutely requires education and the outlook of a group of committed professionals. Hope this all makes sense as putting it into words is difficult- but my own personal vision of nursing is coming together as a result of our discussion.

    Thanks for the great thread.
  12. by   Stargazer
    canoehead said

    I believe that the difference between experienced and new nurses has less to do with physical tasks, and more to do with gaining an understanding of how caretaking interventions and professionals mesh together, and how to "work the system" for a smooth, efficient flow. The best nurses will pull in family strengths, community resources, and hospital depts. We even know the quirks of individuals, and have the skill and finesse to get what we need from people in the system.

    Maybe we should market ourselves as the professionals that put it all together to make the system work. It's a unique position and role that nursing already takes care of- but we only get credit for taking orders. We all know that's not what we do- in fact if the nurses doesn't regularly look at the big picture for each patient they often end up with conflicting instructions.


    Great post, canoehead. This is an excellent point, and it's similar to what has been proposed for years as a way to keep both the ADN and BSN as entry-level degrees, but distinguish between the two. It's also similar to the clinical ladder program that my hospital implemented the year before I left--nurses had the option to be hourly or salaried employees, and the salaried employees were slotted into the ladder based on a number of factors. The more continuing ed (as learner and teacher), involvement in unit- and hospital-based shared governance committees, involvement in research projects, and documentation of evidence-based practice you logged, the higher on the ladder you were and the higher your salary was. It was really a much more professional model than the typical hourly-employee-clocking-in model, and it seemed to encourage greater responsibility and accountability, while also being a flexible system.
  13. by   rncountry
    Exactly Canoehead. It is that "guardenship" of the patient that glad2tobehere stated earlier. I believe it is from that aspect that we must begin to educate the public to, and to an extent our fellow nurses who have difficulty in expressing what it is we do daily. I firmly believe a theory of nursing can be based on it. It is more than process, which is incredibly important, but we must take it further.
    The question would be how. The idea's and ideals being expressed here are quite stimulating to the brain. I hope to see more.

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