Nursing Theory??? - page 7
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Nov 19, '02Just an idle recollection that something Roland said triggered: in the dark ages when I went through nursng school (AA) Logic was a required class. It was a pretty universal requirement on the BSN level but not the AA. It's a pity the requirement has gone the way of all things. It is one way of teaching the young that just because they find something illogical doesn't mean it is when subjected to formal rules of logic.
Research in the hard or soft sciences doesn't prove anything. Rather it seeks to explain a set of observations. You want proof, look to the lower levels of mathematics. Even the highest levels of mathematics are not provable in the stirctest sense of the word.
We like to believe that science is far separated from belief (or religion) but in truth they are two sides of the same coin. Each sets forth an explanation of reality. They just start with different premises.
Peeps I am concerned though that you are not going to find what you are looking for in nursing. You say you want to get out there on the front lines with your own practice where you can diagnose and prescribe. Sounds a lot more like medicine than nursing to me. NPs do those things but they are also nurses. And, whether it is politically correct to say this or not, non-nurses tend to look at NPs as not quite doctors, people who couldn't make it in med school; NPs are good but not as good as a doctor; if you're really sick you'll want a real doctor. (This is not my opinion of NPs, but my take on what I have heard people say of them.) It takes a lot of work for an NP to change that perception, and part of what contributes to the change is the unique quality of holistic caring that nursing contributes to the medical expertise of a NP. Call it touchy-feely, but the facilitating the client's response and adaptation to physical and psychosocial changes is the purvue of nursing as I understand it.
Maybe it's time to bring back required viewing of "Mrs. Reynolds Needs a Nurse."
Nov 19, '02I, too, took a course in logic as a freshman in college. It was one of my favorite courses. It wasn't required: I just took it for fun -- as part of the 2 years of liberal arts education that was required for my BSN program.
Personally, I think everyone should take a course in logic. I also think everyone needs at least a little introduction to the philosophy of science. So many people misunderstand the process -- misunderstanding the nature of evidence, verification, proof, etc. They think that everything in the "hard sciences" is 100% "proven" and "correct" and everything else is all smoke and mirrors. Any real scientist knows that is not true.
Nov 19, '02quantified. However, I am asserting that to the very best of our ability that we should base our practice as health professionals upon an objective appraisal of reality. Thus, what is good or bad for nurses is simply not relevent in a search for truth. This means that we shouldn't adopt methodoligies or protocals that seek even in part to seperate ourselves from doctors. This may be a very valid goal for optimizing autonomy or increasing salary/working conditions, but it is a lousy way of conducting research. Don't misunderstand, I am very much in favor of aggressive action in terms of PR, political lobbying, litigation and the like to improve working conditions for nurses. It's just that I'm not willing to sacrifice essential truths upon the altar of transitory gain in this pursuit. When individuals wander from the light of rationality even in the pursuit of greater good it can leave them in a position where it is difficult to seperate that which is real from that which is only a manifestation of their desires. This sort of thinking can easily transfer over into society as a whole creating a void of irrationality which is soon filled by the forces of darkness.
I suspect that Peeps like myself understands the crucial differences between doctors and nurses in terms of respect and pay. However, I suspect that the frustration he/she experiences relates to the discontinuity between the expectation of scientific rationality and the reality of quasi-eastern-mysticism present in many . It would be like paying your fee to attend Physics class, buying your books, and then showing up only to find John Edwards and Miss. Cleo explaining the finer points of the human aura as it relates to out of body travel!Last edit by Roland on Nov 20, '02
Nov 19, '02Roland, I really think you are making way too broad of a generalization with regard to theory. Yes, we all know Martha Roger's theory is at the height of what you are referring to as far as "out of body travel" and "space nursing" etc. Her theory is not easily testable, if at all.
However, like Linda suggested, do a CINAHL or EbscoHost lit search and you will find hundreds of nursing research articles that have tested theory, and retested theory, complete with the quantitative, ANOVA type methodologies that you seem to be looking for.
Don't let the ONE or TWO theorists that you have been exposed to in school cloud your critique of nursing theory.
Nov 19, '02my opinion on nursing theory until I have a more complete grasp of the subject. Thanks for the input.
Nov 19, '02Suzy,
Looked up CINAHL and that's a hoot. There was only one referrence to "psychosocial," so it may be safe to surf sometime:uhoh21:
Nov 19, '02Peeps: glad you looked at CINAHL. Since you seem to be into critical care, try looking at research articles from Heart and Lung. In fact, a nurse I know published several articles in there; her name is Laura Burke.
Anyway, one last point to make with regards to "non-medical" aspects of care and why they are important. A lot of nursing studies and literature has focused on "being" in the universe and society, and our whole aspect of "person" etc. This has actually been somewhat relevant. There has been a phenomenon known as the Black Monday Syndrome, in which heart attacks have been more likely to occur on Monday mornings between 08 and 09. Job dissatisfaction also has been mentioned as a significant risk factor for heart attacks, as well as anger. All these aspects could be/should be just as important to evaluate as cholesterol levels, smoking and obesity.
So...there just may be some relevance to psychosocial, more than we realize, after all.
(I know, just what you wanted to hear, Peeps).
Nov 20, '02I'd like to highlight a couple of things said by Dr Kate, and present an opposing viewpoint.
Originally posted by Dr. Kate
"But, if you really like the hard sciences as applied to health care why not think about medicine or pharmacy or biomendical reseach? Nursing just isn't a hard science."
Sorry, but this is just wrong. Frankly, that there are nurses who believe this frightens me for the patients of those nurses. And, as an added bonus, attitudes such as these could easily lead to the downfall of nursing. Consider: The treatment of patients is becoming ever more technical, ever more based on advanced research. Medicine, pharmacology, and physiology are making advances almost every day. These advances are making a huge difference in the lives of patients. 20 years ago, removing a gall bladder was a major operation, that involved enormous amounts of pain and a minimum week long hospital stay. The patient was levt with a big, disfiguring scar as a result of the surgery. Now, the procedure is done laparoscopically, with three to four small scars left on the abdomen. As a result of these kinds of advances, gall bladder patients often go home without difficulty within a few hours of leaving the operating room.
This is just one, relatively insignificant example. The care of the sick is moving ahead at a rapid pace. The idea the "nursing isn't a hard science" is going to lead to nurses being left behind. Nursing schools can continue to teach whatever they want, and can continue to focus less and less on the scientific basis of the treatment of disorder. It's a free country. But, if nursing continues down that path, I can forsee a day when hospitals will tell nurses "we can no longer use you, as your knowledge base has no application to what we are doing." This attitude leads to nurses believing that "I don't have time to know about every drug I give." Every day, three and four times a day, I intentionally give medications that, if no other action is taken, will kill my patients. But, after giving these medications, I intubate the patient, I support the patient's respiration. I monitor the patient, and intervene as necessary to keep the patient stable. Everything I do is based on the hard sciences of physiology, pathophysiology, pharmacology, and biochemistry. Without a firm grasp of these topics, I am a dangerous practitioner. That's true not only for anesthetists, but for ALL nurses.
We must keep much of the psychosocial aspects of nursing, for they are what make us nurses. But, we must learn and stay abreast of the hard sciences involved in patient care as well. Above all, we must do so for the good of our patients. All the psychosocial intervention in the world will be for naught if the patient is dead because we gave a 40 mEq bolus of potassium IV push.
"We like to believe that science is far separated from belief (or religion) but in truth they are two sides of the same coin. Each sets forth an explanation of reality. They just start with different premises."
This is a newer idea that has come out of some "new age" thinking. Essentially, it says that science is just a new religion, no more or less valid than other religions. Again, sorry, but the premise itself is false.
Belief (or religion) bases itself on faith. Articles of faith are above testing, and in fact, in most religions, testing articles of faith can be seen as blasphemous. Facts are accepted as facts based on faith, and nothing else. Belief (or religion) can be classified as humankind's search for "truth."
Science, contrary to popular belief, has nothing to do with the search for "truth." Science concerns itself with the search for "fact." Science accepts (or should accept) no facts on faith. In fact, many of the greatest advances in science have come from the testing of facts accepted on faith. In science, theories are formulated, but are not accepted until they are tested, retested, and retested again.
A great example of what I am saying can be found by looking at the most often cited research piece done on therapeutic touch (TT), the Turner Burn Study, and comparing it to any drug research.
TT is, no matter what anyone says, a faith, rather than science based practice. This is proved by the Turner study. In her study, Turner asked patients before ever beginning her study, whether the patients believed in the potential of TT. All patients answers were scored, and this score was factored into the data, giving the responses of those who believed in TT greater statistical weight than those who did not believe in TT. At the end, Turner measured pain on at least four different scales, at intervals throughout the study. On one pain measurement scale, at ONE interval measurement, TT did moderately better than sham TT for pain relief. There is much more to this, but consider. Essentially, the pain of each patient was measured using four different tools, at three different intervals in the study. 12 measurements per patient. On ONE measurement, TT did slightly better. Based on that result, Turner concluded that TT was a success, and research should proceed on how to best implement TT. That's faith, not science.
On the other hand, look, for example, at what would happen to penicillin were it introduced today. In testing the drug, patients with infections would receive either PCN or a physiologically inert placebo. Neither the researcher nor the patient would know what they were receiving. No questions would be asked about the believability of the therapy. Measurements would be taken as to whether or not infections were cleared up, and if so, were they cleared more rapidly in the patients receiving PCN over those receiving placebo. Results would be tabulated, and conclusions drawn over the entirety of data. Science. Pure and simple. The conclusion of whether or not PCN worked would depend not at all on whether the patient believed in it, the provider believed in it, or the bacteria believed in it. Knowing what we know about PCN, the result is the bacteria is just as dead in the patient who believes in it as the bacteria in the doubtful patient. The hypothesis is formed and tested. Belief plays no role.
No, science and belief are not two sides of the same coin, no matter how the politically correct want to believe it to be so. Testable facts, in the treatment of patients, are always the preferred course, for both physicians and nurses.
Kevin McHughLast edit by kmchugh on Nov 20, '02
Nov 20, '02To kmchugh: I think there is a "middle ground" -- though that might not be the best term for it. Perhaps I misinterpreted Dr. Kate's post, but I never thought that she meant that nursing shouldn't be based on science. I thought she meant that nursing was not based only on the "hard" sciences, which is an expression that typically refers to those sciences that can be studied in a lab with inanimate objects. Nursing also includes the "soft" sciences (sometimes refered to the "human sciences") such as psychololgy, sociology, anthropology, etc. They, too, are sciences but sciences that are often not as clear cut as the hard sciences.
As nurses, we must deal with the emotional and spiritual aspects of our patients as well as with their physiology. That's one of the things that makes nursing (and medicine) so complex. Our minds must grasps all realms of human existence and incorporate all types of knowledge if we are going to practice the "art" as well as the "science" of nursing at its highest levels.
Nov 20, '02Thanks llg. You're quite right on about what I meant.
Nursing is based on and utilizes the hard and soft sciences. But it is not simply a science, it is also an art. Both nursing and medicine describe themselves as an art and a science. That's why we can talk about practicing nursing or medicine. Like an artist who practices and gets better at what they are doing so too do nurses and physicians practice and become better practitioners.
Try this for a not too scientific observation. My best friend is a pediatrician. Years ago, when she was first in private practice and I had about 6-7 years experience, I recall listening to her fielding calls from patients. Over and over she dealt with things that were within the scope of practice of any nurse. I've never done Peds, my clinical background is M/S and ICU. It was also clear to me for a lot more years that what she knew about psychosocial issues was pitiful. Fast forward. In the last 5-7 years, she is finally getting those psychosocial things. I figure with a few more years experience she might just know as much as a beginning nurse does about the psychosocial aspects of patient care.