Is your nursing practice guided by nursing theory and research based evidence?

[kurume830]

Hello,

I am a graduate nursing student studying Advanced Public Health Nursing. I am doing a survey for my graduate nursing class regarding evidence-based practice. I'd like to ask the allnurses community whether you do (or don't) use research to guide your nursing practices. If so, how is your nursing practice guided by theoretical approach or researched-based evidence? Please include your title and field of nursing in your response (if you wish to share). Thanks!

[Flying ICU RN]

theory were later proved ineffective (intracardiac epi for example).

A perfect example of my point in post #4, the need and the nursing reaction are both the same despite the world changing around it all.

* Patient need, asystole.

* Nurse immediate reaction, sound the alert (code blue).

Hasn't changed since the days of Florence Nightingale, and never will.

[wtbcrna, MSN, DNP, CRNA]

I am nurse anesthetist/CRNA. I have found no use for nursing theory in my practice or anytime as a nurse, and I try to use the most up to date EBP to guide my practice.

[llg, PhD, RN]

I use a variety of theories all the time -- subconsiously, in many cases. Here are a few examples quickly off the top of my head.

1. I give people as much independence as they can handle. When they need assistance, I give them the help they need without taking away the independence they can handle. (Henderson and Orem)

2. I try to repect other people's spiritual views, cultural preference, etc. (Watson, Leininger)

3. I recognize the competence/experience level of colleagues and act accordingly. (Benner)

4. I try to provide comfort measures whenever I can to people in distress. (Kolcaba)

5. I try to keep the environment clean. (Nightingale)

6. I try to keep track of information, look at statistics to help make decisions, and integrate the latest research knowledge into my practice, etc. (Nightingale & Henderson)

etc.

etc.

etc.

I appreciate that nursing theorists of the past have shown the spotlight onto different aspects of practice while providing frameworks to help organize our body of knowledge. Without those organizing frameworks (models, theories, etc.), our knowledge would be a jumbled collection of random facts. Having it organized helps us to see that knowledge more clearly and develop it further.

The nurse theorists of today often take slightly different tracks than some of the previous generations and focus on different aspects of care. That's to be expected as we mature as a discipline and we react to changes in society. That's OK.

Also, let's not forget: the scientific research evidence that so often underlies the policies and procedures that we use daily in practice ... that research tends to be theory-based. So, even if we haven't read a theory in years, we are still basing our practice on theory when we follow institutional or profession-wide guidelines. We are just not seeing the theory directly as we apply it.

[elkpark]

I have always used Peplau's theory of interpersonal relations to guide my psychiatric nursing practice, and my psychotherapy practice as a psych CNS has also been heavily informed by psychoanalytic and object relations theory, and theory and research in child development and child psychiatry. I've made an effort throughout my career to keep up with the current literature and research in my field.

On a personal note, it's always v. discouraging to me to see how many nurses pooh-pooh the value of nursing theory (and theory from other fields) on this type of thread.

[kurume830]

Great discussion on the use of nursing theory! I see that there is a whole spectrum on opinions on the usefulness in practice.

It seems obvious that a lot of what nurses are expected to do is grounded in basic common sense. But there were times in nursing school when common practice baffled me.

For example, sliding scale insulin administration is something that is widely practiced in hospitals in my state, but when one looks at the research, its use has not been shown to lead to better patient outcomes.

So, though it may be hospital policy to use this technique, perhaps we as nurses should be questioning why we do it.

[Flying ICU RN]

On a personal note, it's always v. discouraging to me to see how many nurses pooh-pooh the value of nursing theory (and theory from other fields) on this type of thread.

My concern in this regard is not theory or definitions in and of themselves. My concern is when there is an attempt to micro-manage what I do at the bedside as a result.

As the saying (prevailing theory) goes, "No one knows better what shovel to use than the one who is digging the hole."

[LouisVRN, RN]

I would like to say as a bedside nurse I am always looking for the latest EBP that could effect my practice. Maybe it has to do with my being the chair of our shared governance council and I'm always on the lookout for future projects. :)

[epinephRN]

Research/evidence yes. Some nursing theories have value, but others I find laughable and completely divorced from the reality of nursing practice.

[rn/writer, RN]

Great discussion on the use of nursing theory! I see that there is a whole spectrum on opinions on the usefulness in practice.

It seems obvious that a lot of what nurses are expected to do is grounded in basic common sense. But there were times in nursing school when common practice baffled me.

For example, sliding scale insulin administration is something that is widely practiced in hospitals in my state, but when one looks at the research, its use has not been shown to lead to better patient outcomes.

So, though it may be hospital policy to use this technique, perhaps we as nurses should be questioning why we do it.

Yeah, sliding scale insulin based on BG readings encourages the patient to always be looking backward. I would love to see some EBP on a newish trend to dose forward, meaning that you teach diabetics to take short-term insulin based on what they are going to be eating rather than always trying to shut the barn door after the horse is gone.

This is an interesting topic.