is nursing theory important to nursing practice

llg, PhD, RN · Jul 10, 2009

Good point. A psychological theory might influence what type of therapy a psychologist chooses to use in any particular case. How much would one's choice of nursing theory affect the nursing action they choose to take in any given situation? Especially in acute care settings?

That's actually the first 2 discussion assignments in the theory course I teach in a BSN completion program. The students get a single case scenario -- and then have to explain how they would apply 5 different selected theories to that case. We cover 5 theorists with that assignment and students get to see how the patient would be approached differently as each of the 5 different theories is discussed.

How would Nightingale approach this patient?

What aspects of care would be emphasized if you were using Henderson's theory?

How would apply Watson's theory to this patient?

etc.

The students see that their assessment would be a little different and their care would be a little different depending on which theorist they were using as a foundation of their practice. Those 2 assignments (covered over the first month of class) really gets their attention. It's like the light bulb turns on. They see that the choice of theorist doesn't change the facts of the case or that the patient needs lab work, x-rays, etc. regardless of which theory is used. But they see that the choice of theory influences some of the focus of the nurse.

For example, with Nightingale, they are focusing on the environment. With Watson, they are focusing on expressing their caring and the spiritual aspects of care. When applying Abdullah, they are making a nursing problem list and focusing on that problem list. For Benner, they discuss how nurses with different levels of expertise would approach the patient.

Throughout the semester, as we discuss other theorists and have other discussion assignments, they often come back to that first case scenario and talk about how the patient care would be different if they were using whatever theorist they are discussing that week. It's a great academic excericise in that it relates theory to a concrete case scenario of a patient in the Emergency Department -- a place where some people would think that theory would be of little value. It also forcing the students to be flexible in their thinking -- to notice how the patient care would be influenced by the choice of theoretical perspectives.

By mid-semester, most students "get it" and are "on board." They see why theory matters. They also start seeing that many of the concepts and procedures that they learned in their first nursing program are actually based on somebody's theory -- they just didn't know it. They had simply been taught the priniciples without being taught the whole theory. They were using theory but not realizing it. They just thought it was "good practice" or "common sense" etc. As we go through the semester, we note those theoretical ideas that have become deeply embedded within our profession and they see where a lot of those ideas originally came from (or at least, they see the role that the theorists play in articulating those ideas clearly and bringing them into better focus for the world to see and study.)

Moogie · Jul 10, 2009

I appreciate your thoughtful response!
I agree with you about thinking and doing not being mutually exclusive. And I do see value in using nursing theory as a foundation for practice. However, as another noted, as ways of thinking become ingrained over time, sometimes the pendulum swings the other way.
I got pounded over the head in nursing school about autonomous nursing actions and nursing rationales (provide comfort, help acheive highest level of self care, etc) based on nursing theory. Meanwhile, we just whizzed by the medical side of things at lightening speed as if THAT was obvious and the cursory overview we got would more than suffice as a foundation that we'd build on once we started practicing. The medical side of nursing care was taught by assigning "pages 150-350 by next class" and requiring a page on pathophys & medical interventions in 8-page care plans or 30-page case studies. The rest of the content focused on autonomous nursing actions (read: anything that doesn't involve a physician getting involved) and/or describing how the listed nursing interventions fit within this or that nursing model of care.
In other words, I felt we got more than enough "critical thinking" & nursing theory and not nearly enough "practical knowledge." We hear many new grads complain that colleagues expect a lot more from them practically than they are able to perform. It seems to have come about that some nursing programs seem to primarily teach nursing as it relates to nursing theory (as opposed to providing a lot of practical training) on the basis that the new grads will learn the practical skills on the job anyway whereas they may never be exposed to nursing theory again.
I think that's a backlash to a history of nursing education focusing solely on practical knowledge. And I hope more of a balance can be found. But that's getting into a whole 'nother can of worms, isn't it?
Interesting discussion!

Indeed it is! I am certainly learning from you!

I started a MSN program in 2002 that was very research-oriented. I was disappointed with the theory component because it was pretty much glossed over for research. For various reasons I dropped out of that program but have decided to start over at a different school. I will be curious to see if the emphasis on research is as heavy as it was in my previous program.

Personally, I like theory because older theories tell us about the history of ideas in nursing. They tell us what nurses believed at various times and whether or not those theories changed practice or added to our knowledge base.

It may just be me. I may just be a theory nerd. But that's okay---I am passionate about theory.

As someone planning on teaching nursing, though, I find your thoughts about how students perceive theory in a very different way. Perhaps theory should be taught only at the graduate level....

Thanks for the interesting discourse. I am enjoying getting to know your point of view.

Moogie · Jul 10, 2009

I somewhat question your sincerity. I apologize in advance, because I'm probably mistaken. Three things raise concerns for me. Antiquated and archaic mean two really different things. Being able to find relevant information and whether or not you can link it to a theoretical model has two different meanings. Finally, do you sincerely believe that you must know the nursing theory before you can do a review of the literature?
I should also say that given that you are sincere, we probably should move this to another thread.

Well, actually, dear Woodenpug, I am too tired to be much of anything right now! I think I'm sincere----I do know I am sincerely sleepy!

I am interested in what you have to say. I do appreciate the difference between antiquated and archaic. I take it that you have problems with certain archaic theories. Um---do you have any you'd like to discuss?

Yes---I want to see how you find relevant information whether you can or cannot relate it to a theoretical model.

Before I do a lit review----there you've got me. When I do a lit review, I look for articles that are relevant to my topic, not looking for a certain framework. The exception is---if I'm teaching a class on theory and need to provide examples of research articles that follow various frameworks.

I would love to discuss this further with you. We might not ultimately agree but I think we could learn a lot form each other. Want to move it to PM or to visitor messages? LMK! I'll answer when I am not so tired. :yawn:

llg, PhD, RN · Jul 10, 2009

When I do a lit review, I look for articles that are relevant to my topic, not looking for a certain framework.

Yes ... but you are hoping that the material you find is based on a solid foundation of theory. :specs:

classicdame, MSN, EdD · Jul 10, 2009

I agree with jjjoy. The nursing process is simply that, a process. I mentioned this theory because it seems to be the one I turn to most frequently as it is so versatile.

Home Health Columnist / Guide · Jul 10, 2009

Another classic AN thread started in 2002 may help in your arguments

Can Someone Be a Nurse Without Jean Watson??

jjjoy, LPN · Jul 10, 2009

That's actually the first 2 discussion assignments in the theory course I teach in a BSN completion program. The students get a single case scenario -- and then have to explain how they would apply 5 different selected theories to that case. We cover 5 theorists with that assignment and students get to see how the patient would be approached differently as each of the 5 different theories is discussed.

That sounds like a great way to approach teaching theory. Especially using an ED patient as opposed to home health or psych where preventative care, education, therapeutic listening, behavior issues, psychsoc issues tend to be the emphasis as opposed to acute care nursing where medical needs are immediate and intensive and often take priority over other nursing needs. I do believe that small things may vary in one's practice depending on one's underlying theory, even if an unconsciously held theory. But I am curious, in regard to the medical side of nursing (responding to emergent physiologic needs), how much of a difference one's nursing theory makes. Various theories relating to pathophys and treatment modalities definitely lie beneath the standard medical interventions (determining that X, Y & Z symptoms probably means problem A and so do B).

Many nurses work in environments where medical needs, hands on tasks and administrative work make up the largest percentage of their job responsibilities. Making sure a patient is comfortable, feels safe, has a satisfactory environment etc tend to fall to the bottom of the list. They are still there and are definitely important and not be ignored; but when responsible for several different patients at the same time, there are many needs competing for the nurse's attention and the reality is that patients will not get the full spectrum of nursing care as described by many theories. Meanwhile, being able to recognize symptoms, having confidence that one will know what to do in an emergent situation, to have commonly used skills mastered are very important to being successful as an acute care nurse. I'm not saying nursing theory has no place. But in acute care nursing, a lot more than nursing theory needs to be mastered to be successful.

And again, I'm coming from a background where coming out of school, I could pull a case apart in regard to the various nursing needs... be empathetic, promote pt comfort, educate, take measures to prevent skin breakdown, DVTs, constipation, urinary tract infections, etc. And those ARE important aspects of nursing care. However, acute care nurses may find that those aspects of their job only make up a small percentage of their work and that they often delegate that care to CNAs. So all of those things emphasized as being the crux of nursing care end up as just one part of one's job as a nurse. Again, those aspects ARE crucial, but the forces of today's work environment for nurses (eg high ratios, tons of paperwork, high acuity, tons of meds, etc) means that much of what nursing theory emphasizes doesn't address the reality that working nurses are dealing with.

llg, PhD, RN · Jul 10, 2009

jjjoy ....

I totally agree with a lot of what your write. I think nursing has a long way to go before we can say that our theory base is what it should be. We need to keep working on it, providing better education about it so that current and future generations of nurses can take it where it needs to go.

I agree that a person's theoretical perspective will have little or no impact on the technique of starting an IV or giving a medication (as examples ... to use my ED patient in this discussion). However, nurses who have incorporated Nightingale's theory into their practice will be sensitive to the environmental conditions of the room -- cold, light, noise, etc. -- and may help to create an ED environment that helps the patient feel comfortable, cared-for, and a little less frightening. A nurse who has incorporated Jean Watson's caring theory into their practice would be more sensitive to the patient's and families emotional and spiritual needs during this frightening situation and may consciously choose to go a little out her way to provide that something "a little extra" to express her care and concern -- even if it is only to squeeze the patient's hand briefly, give a reassuring smile, etc. .

Even in today's busy (and often understaffed) workplace, the theoretical perspective of the nurse can be seen. Flow sheets and other documentation forms can be designed to emphasize key elements found in selected theories. etc.

I think the closest theoretical match to the types of topics you are talking about in your most recent post is the "Synergy Model" developed by the Association of Critical Care Nurses. It is a theory that basically says that the best outcomes happen when the needs of the patient are in sync with the abilities of the nurse and the resources that are available. The 3 key "players" in this theory are the patient, the nurse, and the system. It's the job of the system to provide the patient with a nurse who has the skills and resources needed to meet the patient needs -- and to provide the nurse with the resources to do the job.

Note that the Synergy Model was developed by intensive care nurses and designed to serve as a foundation for the practice of intensive care nursing. They use it as the foundation for their certification exam, educational programs, etc. If you are not familiar with this theory, you might want to look into it as it addresses those issues of acuity, resources, staffing, etc. in the real world of contemporary hosptials you wrote about in the end of post #66. You might really enjoy knowing that contemporary theorists ARE trying to accommodate today's realities.

That's for the great dialog.

rngolfer53 · Jul 11, 2009

I agree with Jolie.
Besides, I would be of no help because I firmly believe nursing theory is important to practice. Thing is, it's hard to see that when you're in school---and you don't always see the value of theory until you've practiced for a while.

I guess a good indicator of one's side in this debate is the quality of the nursing theory instructors in each nurse's school.

We had a couple, one of whom was quite good and well-regarded, while the other was all but universally disrespected.

So, I'm on the fence! :bugeyes:

llg, PhD, RN · Jul 11, 2009

I guess a good indicator of one's side in this debate is the quality of the nursing theory instructors in each nurse's school.
We had a couple, one of whom was quite good and well-regarded, while the other was all but universally disrespected.
So, I'm on the fence!

I am an adjunct professor who teaches a theory class to BSN completion students while I work full time in a hospital. I am trying to be like the "good one" you describe above. If we could get better theory education throughout the nursing profession, better theories would be developed that would be seen as useful by nurses at the bedside and the average staff nurse would have the skills necessary to apply those theories to provide an even higher level of care.

Woodenpug, BSN · Jul 12, 2009

I know this is one of the "sacred cows" here on all nurses, so opposing thoughts are poorly tolerated. Still, I don't see nursing theories as important to nursing practice. Nursing theories are useful to nursing practice. Nursing theories are also useful to cleaning the garage or doing yard work. I can describe how a positive outcome is related to a nursing theory. That positive outcome is not dependent on the nursing theory and would have happened anyway.

Would I be able to support my position by saying, "I must be right, because my theory professor was excellent?" If I could prove that my theory professor was excellent and that I got an A, would that make my opinion more correct?

llg, PhD, RN · Jul 12, 2009

Would I be able to support my position by saying, "I must be right, because my theory professor was excellent?" If I could prove that my theory professor was excellent and that I got an A, would that make my opinion more correct?

No, I'm afraid not. The "correct-ness" of a proposition is not established by the quality of the teacher who taught you a class on the topic. Veracity just doesn't work that way ... but that's getting us into a serious discuss of philosophical theories of veracity. Just because you don't choose to use nursing theory directly much doesn't mean that they are not useful to a lot of other people. It also doesn't mean that the people who developed the practice guidelines, policies and procedures, etc. that you use every day didn't use nursing theories to develop those practice guidelines.

If all nurses were well-educated in nursing theory, the quality of the theories would rise and their application by nurses would both increase and improve. Eventually, the use of theory at the bedside would be commonplace and obvious to just about everyone.

You are personally free to go through life as a-theoretically as possible, if that is what you like. But most of the profession is moving in the other direction, towards a more theory-based profession of nursing.