Nursing Theory??? - page 4

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  1. by   Vsummer1
    Originally posted by Peeps Mcarthur
    There are careplans on a program that only require that you know the patients medical DX. After that you're just checking appropriate boxes with the click of the mouse.

    You will never use them.

    You may pause for a second and think that you used some theory, but it will just be a feeling that you forgot something you learned sometime for something.

    I think what we will find is that we will be taught all this nursing theory crap and then later in the real world, will need all the medical knowledge that they shyed away from because "nurses don't do that" and not have a clue as to what really makes people sick, and how medical science will heal them.

    Maybe that's why new grads suck................ya think?
    I am sorry that you feel that way, but I do hope you realize that the new grads really don't have much of a choice in what their instruction was! It is what they teach us (and what they fail to teach us). So even when I am a sucky new grad, give me a chance. I really do want to learn all those skills from you, and I hope you will have the patience to teach me what I wasn't able to learn in school.

    I didn't figure I would really NEED all this theory, but I have to play by their rules while I am in their game. And then when I graduate, and pass the NCLEX they have prepared me to pass, I get a whole new playing field with new rules. Be kind to me please when I get there is all I ask :kiss
  2. by   Peeps Mcarthur
    Vsummer,

    I wasn't trying to imply that I'm a nurse. I am a student nurse.......for now.

    I was implying that, as you said, we are not prepared to be nurses. I don't really think the nursing theories are worth putting all this effort into when it is obvious we will not be able to use any of it in a pratical sense, like we would real pharmacology, pathophysiology, gross anatomy. For gawds sakes, I dissected a frigging cat! I have to find various IV sites from having seen them in a text, palpate an abdomen, lymph.......etc without ever actualy seeing those structures.

    I just think it's despicable that we are servants to the academic nursing setting so we can get licensed and then start learning real nursing. We will be barely usful to anything other than deep contemplation of psychosocial variables with a smattering of psychomotor skills with barely a whisper of usful medical knowledge.

    The program will get the money, we'll get the license..........................and we'll both try to forget we ever met.
  3. by   Sourdough
    ....NP=I can diagnose and treat
    A Nurse Practitioner is an advanced practicing RN. You need the experience of having worked in the nursing profession in a wide variety of clinical areas. Ask any RN that has worked in their area of expertise and they can rhyme off diagnosis and treatment options before the doctor. You really learn continuously on the job. The scope of practice is enormous. I'm sure there are a lot of experienced nurses out there that could be called NP's without taking any course. I became an NP by default I guess. I chose to do outpost nursing in the arctic...that means i work alone without any back-up, in areas so remote and isolated that anyone who hasn't been there could never comprehend...newspapers are 2 weeks behind... I have to rely on my common sense and the skills that i have acquired as a practising RN...and an NP HAS to be the social worker, the doctor, the hospice nurse, the veterinarian, the psychologist, the pharmacist, the drug and alcohol counselor, the grief counselor, the funeral home director,the midwife, the lab tech,the x-ray tech,to name a few...you are working and on-call 24/7...you need to have compassion and understanding..you are working with diverse cultures and languages which you need to respect...working in downtown hospitals in Toronto helped to prepare me. If you want to get away without all the "emotional" stuff that goes with nursing and NP, go to medical school. Sure, they have doctor's offices in the south (southern Canada) where NP's do all the pre-natal,post-natal patient care for doctor's, make good money, work 9-5 monday to friday, but there are also RN's doing the same job. Education lays the groundwork for you to get out there and practise your profession. Experience is the great equalizer. :roll
  4. by   Vsummer1
    Originally posted by Peeps Mcarthur
    Vsummer,

    I wasn't trying to imply that I'm a nurse. I am a student nurse.......for now.

    I was implying that, as you said, we are not prepared to be nurses. I don't really think the nursing theories are worth putting all this effort into when it is obvious we will not be able to use any of it in a pratical sense, like we would real pharmacology, pathophysiology, gross anatomy. For gawds sakes, I dissected a frigging cat! I have to find various IV sites from having seen them in a text, palpate an abdomen, lymph.......etc without ever actualy seeing those structures.

    I just think it's despicable that we are servants to the academic nursing setting so we can get licensed and then start learning real nursing. We will be barely usful to anything other than deep contemplation of psychosocial variables with a smattering of psychomotor skills with barely a whisper of usful medical knowledge.

    The program will get the money, we'll get the license..........................and we'll both try to forget we ever met.
    OMG you sound as happy about your nursing program as I am about mine! When I was submitting my application, I asked about pharmacology. They said, oh you will learn pharmacology in the program. I question this, since I had a pharm class years ago (as a requirement for a different RN program) and they haven't taught any of it in the program I am in now. They have in the syllabus that we are to know the drugs and give us the drug names, but NOTHING else - we self teach pharmacology??!!

    If they would get rid of their obsession with Orem I would be much happier. I hate D. Orem and wonder how in the world she ever found that much time to write the drivel they are pouring down my throat. FOR NOTHING!

    They do teach the systems well... and I am getting 12 hours per week with patients. In a LTC. Hey, at least I can say I learned bed making 101.
  5. by   Roland
    say how much my program emphasizes theory. HOWEVER, I cannot help but recognize how much more I would benefit were I able to take more phsiology and pharmacology classes as opposed to drivel like Ed Psych. and Sociology. The damXXX thing is that if these Ph'd nurses REALLY wanted to improve the pay and respect accorded to RN's then they would push for MORE hard core science classes such as Organic Chemistry, and Pathophysiology. Requiring more hard science classes and less theory would further reduce the supply of nurses, and further push the equilibrium of supply and demand more in favor of the profession.

    That's the thing about extreme liberals, they never figure it out! Just look at the Democrats picking Nancy Pelosi for their speaker, and Al Gore now embracing a single payer system. You can't convince me that even ONE of these theorists has ever voted for a Republican. As a lot they make the CNN news room seem like Rush Limbaugh by comparison.
    Last edit by Roland on Nov 16, '02
  6. by   adrienurse
    Sorry, but I don't buy in to the whole nursing theory being a sham thing. Yes they have to grow and be improved upon, but these were people who changed what nursing is. The choise is yours as to what kind of nurse you want to be. If you want to ignore the big scheme of things and see nursing as a series of tasks, you certainly won't be the only one. Stay out of the degree programs, you will find diploma studies much more to your liking.
  7. by   Q.
    Wow Adrie - good post, and I agree!

    I myself have been disenchanted with the theories that are OUT there, but alot of them were written for the times, and yes, most of them revolutionized nursing. While we can argue that some theories aren't practical, the *idea* of theory for nursing is paramount for our profession. A lot of what we have been studying in my program is the theory-practice gap; I hope to narrow this as I continue in this profession.

    I agree, theory needs to constantly be improved in such a dynamic environment as nursing, but it's relevance to our profession we can't ignore.
  8. by   Peeps Mcarthur
    By Adrienurse

    If you want to ignore the big scheme of things and see nursing as a series of tasks, you certainly won't be the only one.
    And just what is a nursing diagnosis, if not a series of tasks?

    The formation of psychosocial assessment is in fact a complicated series of tasks that are convieniently diferrent for everybody.

    Neither one of those functions are readily used in the real world because a hospital exists to treat pathophysiological responses to disease and nurses are the pillars that hold it together.

    At the root of the problem are academics that think they need something unique and separate from that real world for some reason.

    Someone that I know very well treated a patient this past week by knowing and anticipating the physioligical changes, signs, symptoms. There were no lengthy nursing theories helping him along, since he has never understood them, poor uneducated person that he is. The patients oral mucosa was red and swollen. There was difficulty swallowing (likely pain) but the patient was not capable of communicating that. The patient was on oxygen with no humidity. The patient had pneumonia so administering oral medications, especially the psyllium, with water was not nearly as effective as orange juice...........why? Was it the psychosocial assessment or some grand nursing theory? No, he'll not win a pulitzer prize, Orange juice is a mucolytic, but he had to know the real pathology and the mechanical dysfunction in order to use this knowledge.

    The patient produced the sputum that was blocking thier airway and facilitating more growth by creating a nice moist dark nest for the pneumonia. With the increase in ventillation the patient could now swallow without difficulty and feed herself, and shocked the staff when he got her to the bathroom. More ventillation from ambulation= more sputum production=patient sitting up by end of shift speaking to him asking if he'll be her doctor tommorow.......cute LOL.

    No, he won't, but I guess he won't be a nurse either because he just can't utilize those wonderful, complicated, theories.
  9. by   Peeps Mcarthur
    Just wanted to add that there are those "degree program thinkers" that would have treated her "dimentia" and psychosocial dysfunctionality, in fact it was suggested that was a factor in her treatment course and that he wasn't expected to do much besides clean her up and try to get her to swallow something for two days.

    If he gets counted among the diploma nurses for using medical ideas to treat patients, then maybe that is the more honorable road.
  10. by   Roland
    perspective would stick to diploma programs! No such luck. I'm a 4.0 student and I instead intend to persuade others of the lack of a logical basis for most of these theories. Were I to offer a "theory" of nursing (and perhaps I will one day, wouldn't that be a hoot) it would be that nurses act as the primary individuals with regard to IMPLEMENTING patient care. This also entails a plethora of actions including but not limited to coordination of diverse medical protocals and medical input directed BACK towards doctors (hopefully where it is intelligently acted upon). In addition, nurses can be seen as a "check and balance" within the medical system. Thus, if the doctor makes an incorrect diagnosis or calls for the wrong medication, it is our job to take notice and if necessary intervene.

    The REALITY of nursing is indeed much more grand than most of these theories would even dare to dream. Best of all it is empirically based, and can be supported with copious statistics.
  11. by   adrienurse


    I need to further explain myself, it would appear. Okay, I sounded like an eletist snob in my last post, I admit. Wasn''t my intention to start a degree vs diploma debate (been there done that). Just wanted to point out that if you don't have your heart in it, you may be doing yourself a disservice by studying in a theory driven program. It was not so long ago that I was an undergrad student, and I thought most of it was a pile of shyte as well. An overloaded student does not take kindly to having a whole lot of stuff that they fail to see as significant shoved down his/her throat.

    I'm just coming at this from the point of viesw of the semi-experienced RN currently revisiting the world of nursing education. It is unfortunate that you see nursing diagnoses and your assessment skills as being useless. Hopefully with time you will appreciate what you have learned. Yes, you will be required to modify your skills in order to do individual assessments that is what being a practitioner vs. a machine is all about. Not all nursing jobs are about carrying out the direct orders of the MD. I happen to have quite a lot of autonomy in my present job and the MD is just someone we consult.

    By my comments on those who see nursing as a series of tasks, this is the danger of just going through the motions of providing the required care without putting thought to the general outcome. I work with a lot of nurses who do this and it annoys the hell out of me, because it adds to my own workload. This is the difference between being a professional and being a drone.
  12. by   kmchugh
    My .02:

    When I studied nursing theory back in my undergrad program, I formulated my own theory about nursing theory. It is:

    Nursing theory can generally fall into two classifications. The first are theories that are essentially restatements of known fact, intermingled with pretty prose, and statements of the obvious. The second (of which Martha Rogers is the leader) are theories that are so far out there, they either only apply in alternate universes, where the laws of physics as we know them are fundamentally different or they were written on a serious, week long acid trip.

    Let us all face facts. As "theories," nursing "theories" hardly are on a par with, oh, say the "theory" of general relativity. Einstein developed his theory through long years of study and research, and the theory was founded on hard science, and was testable.

    I graduated from my BSN program in 1996, and have since then, completed my Master's in Nurse Anesthesia, and have found nothing to change my mind. Essentially, I have found most nursing theory to be a desperate attempt to separate nursing from medical practice. There are, however, unfortunate downsides to this. The first is that as nurses have more nursing theory classes, there is less time for the real fundamentals of nursing (i.e. anatomy, physiology, pathophysiology, biochemistry, pharmacology, etc). Next, as we stray farther afield from the sciences (as listed above) on which we base our treatment of patients, we become less able to think critically about what we are doing, and why. Hence, we become a greater danger to our patients. An example: Where I live, a few years ago, a nurse read an order to give a patient a 10 mEq bolus of potassium. So, she took out the vial, drew up the 10 mEq, and gave it. Bolus. Over about five seconds. Fortunately, the patient had a few arrhythmias, and was otherwise fine. But, it could have ended much differently, like, in cardiac arrest. During the review of the incident, the nurse was questioned about why she did what she did, and her response was "I'm very busy. I don't have time to know about every drug I give." Certainly, that is not in keeping with accepted nursing practice. But, perhaps in her degree program, instead of teaching this nurse the theory of unitary human beings, we could have taught her electrolyte balance in the human body. Then she would have understood, at a physiological level, why she was being told to give a potassium bolus, and what the outcome could have been to her giving that bolus IV push.

    As for nursing diagnoses, they are an extension of that pitiful attempt at validation. I know of no health care facility that actually uses them. They have no value. Particularly when we allow such nonsense as "energy field disturbance" into NANDA, for which the only approved "therapy" is therapeutic touch (another load, but this is getting long). Adequate proof that much of nursing has strayed way to far afield from the basic sciences that underlie what we do.

    My advice is simple. If you want to be a nurse, go for it. I applaud you, and frankly, we need you. K123456, just remember thi. As you go through your nursing program, like any other program, you will learn things that are necessary, like the sciences I mentioned above. Study those hard, immediately put that knowledge into long term memory, and keep it fresh. There will be other things that are less useful. Don't ignore those things. One great value I found in nursing theory was a better understanding of nusing history. Knowing where your profession came from is always valuable. But, as you learn these things, think about them critically. As you perform in the clinical arena, ask yourself whether some of these things, such as theory and nursing diagnosis have any real application. Look at the nurses you find whom you admire, and see whether they use these things. You will find in nursing, as in many other things, there are areas that you can put in short term memory, get through the tests and the semester, then do a brain dump.

    I have personally used my knowledge of physical science to benefit patients. As a nurse anesthetist, like most other advanced practice nurses, I put my knowledge of these sciences to work every day. Without this knowledge, I would be a severe danger to my patients. Nursing theory? Nursing diagnoses? They are good for a chuckle, and not much else.

    One other quick point. Psych is not everyone's cup of tea. Its not mine, either. But, it IS valuable, in that even if you don't work on a psych unit, it gives you an understanding of why some people do what they do, and an ability to interact with your patients and their families in a manner that helps them. So, be careful. There will be things you may not enjoy in nursing school, but not enjoying them does not equate to their being useless. As a CRNA, I still use my lessons in basic psych nursing every day.

    Kevin McHugh
  13. by   Q.
    Since the discussion seemed to have moved toward the nursing process in particular, I'd like to comment, seeing as I just wrote a paper on that very theory.

    As I've stated, and Kevin stated, nursing theory, just like any theory, has it's useful ones and it's not so useful (and almost embarassing ones). But that is not to dismiss why having a theory or theories is important. Like Adrie, I too wasn't terribly concerned with them in undergrad, but speaking from a semi-experienced RN currently in grad school, I see things from a little different perspective. Oddly enough, my experience as an RN and my grad school education made me realize some of the problems with nursing today, and how we can fix it.

    To Kevin's point, comparing the theory of relativity to nursing theory; a good nursing theory is indeed, testable. Most of the theories nurses learn and know about are the "grand theories" like Orem, Watson, and Rogers. "Grand theories" are considered more abstract and are therefore only testable indirectly through what's called "middle range theories" and those are theories spawned from the grand ones.

    Here's an example. Kristen Swanson wrote and developed a theory on caring in perinatal nursing. Sounds obvious, doesn't it? And why would caring really be any different perinatally? Well don't let the title fool you. Swanson worked off of the seemingly "obvious" beliefs of Watson related to caring, and found patterns of behavior within patients who experienced miscarriage. Again, obvious? Sure..NOW. Was this obvious in Nightengale's era? No. So I think to dismiss most theories as "restating the obvious" might be a bit of an overstatement. They are obvious now because these theories are 46 years old. But SOMEONE needed to write them.

    Anyway, back to Swanson. Her theory is used in the development and implementation of Resolve Through Sharing, a national based program that helps nurses help parents recover from perinatal loss. Resolve Through Sharing has had a very positive effect, from patient feedback, on coping with this kind of loss. So here, theory was useful in someone taking those concepts and making a useful,applicable program for nurses to use out of it.

    There are more...but the point I am trying to make is that, to me anyway, theories can be generated from the top down, meaning, you have an academic who hasn't touched a patient in years or has no clue on current nursing issues write a theory and attempt to implement it in practice, or, you can generate from the bottom up (like Swanson and Orlando) who observed nurses and patients and studied behavior, to write a theory based on repeated patterns. I'd prefer the latter myself. But there are many instances where theory has shaped, and can continue to shape, nursing.

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