Nursing Theory

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    The students are gonna love this.

    I saw a response from someone here stating something to the effect of not having any idea what theory of nursing her school espoused. This got me going. Nursing theory has always been a bone of contention for me.

    I've been a nurse for twelve years and worked in 6 or 7 hospitals. I have no idea who (or what) any of those hospitals claimed as their nursing thoerist.

    I was taught nursing theory in my ADN program where I know they espoused what they called a "modified Roy model". I also had to take it in my BSN program. I have no idea who they liked best. I have friends in MSN programs who have to spend an entire semester, again on nursing theory. It always annoyed me to no end to have to base everything in school on a theorectical framework. I never saw the point.

    So, I'm curious. Do you know what theory your institution pracitces by? Do you care? Do you gravitate towards one theorist more than another?

    I, personally think nursing theory and the nursing process are a failed attempt at legitimizing the science of nursing. This is not to say that nursing is not science. I just don't think the theorists have got it right yet. Calista Roy is the closest I think, but really, how many of you go about your day thinking, "now what would Martha Rogers do in this situation?"
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  4. 11 Comments so far...

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    I may only be a student but I do see the use for nursing models already in my practice. No, I could never say "what would Florence do?" or any other theorist for that matter. However, we use these and variations of these models to guide our practice. It may not be a conscious action - for example your assessments and interventions may be automatic for you, but in reality they may be right from a model or two.

    I do agree with you, however, that some of them are quite, well, . Perhaps they are not quite on the money yet. I do know that I put them down for a long time until I worked through one with a patient and saw how much I had missed and how much more effective I became afterwards. Just a thought...........
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    Our rehab facility uses a modification of Roy. I only happen to know that because I started looking for it when I had to take theory. There are actually mission statements, etc to be found framed in the public areas and copies in new staff orientation materials. I've found it to be moderately interesting and slightly useful BUT I would have gained sooo much more if the different theories had been mentioned in passing and the time devoted to an entire, mandatory theory course had been used in extra clinical experience.
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    ferfer, I loved your response. It gives me hope that the next generation of nurses will have a healthy attitude towards theory. As you seem to have grasped, having a theoretical basis for practice doesn't have to mean that your actions are based on a recipe, with everything being overt and straightforward. A lot of people use theories and don't even know it.

    Theories (be they nursing or psychology or physiology or whatever) are just tools -- tools to use to help us understand the world a little better. They evolve as our understanding changes, our needs change, our focus changes, etc. They don't need to always lead to definite prescriptions for specific actions. Our discipline and profession is improved by the further development of theory, but it would be a mistake to allow ourselves to be locked into any one theory -- to stick with one theory at one stage of evolution for every situation forever. It's the flexible use of theory that enables growth and evolution -- a sign of an active mind, open to new possibilities. That doesn't mean that theory is bogus.

    I use lots of different theories in my practice -- whatever best fits the situation. At times, I use Nightingale ... sometimes Rodgers ... sometimes Benner .... sometimes Swanson-Kaufman ... sometimes others. They all have something valuable to add to our understanding of the human condition and people's response to health/illness/injury issues.

    llg
    Last edit by llg on Mar 19, '04
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    I absolutely agree with you

    Some of the names you mentioned I have not even heard of yet and I am almost done!! Are you in the US- that may explain different learning. Some of the models I have learned- Nightingale, CFAM, McGill, Roy, Orem, Watson

    Anyways, I agree, we do need to keep our eyes open to new possibilties and challenge ourselves to stay open minded. It is only when we close ourselves off that we stop learning
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    I don't have a clue what theory was used by my school. I don't ever remember them stating it at any point. But I remember care plans, lots and lots of long care plans, measurable goals, etc. I read the student boards here and think, do I really want to be a teacher? I think I do until I read those struggling with care plans and all the minutia attached to those. I will always consider them stupid. I still believe there has to be a better way to teach someone to think like a nurse than care plans. I just don't know what it is. I hope finishing a masters will lead me to an answer.
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    Our workplace has gone with an Evidence Based Practice model - which while not a threory in and of itself is the structure upon which theory can be grown. I have always felt that the current problems with nursing theory is that it has used a "top down" approach in setting the broad outline first. What we desperately need is a "bottom up" approach where we look at nursing activities in minute and keep developing broader and broader theorectical links until we have a coherent model which then can be translated to theory. Like curriculum development you can either build your curriculum by starting with a core "mission statement" and then fit all the pieces onto this like hanging a rod that you then add oranaments to to make a mobile - top down approach or you can build it like a house of building blocks - write down everything you think needs to be included and start to look for commonalities and coherencies and links - a bottom up approach.

    Like a mobile a top-down theory has the advantage of being more flexible and able to bend with the winds of change. Like the house of blocks bottom up theory is more solid but harder to alter.
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    Well - our hospital uses Watson's theory of caring. I'm also completing a BSN and that school uses Orem's theory and my ADN program used Sr. Calista Roy. Can't remember what my LPN program used. (My memory is stretched with just this - lol)
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    My undergraduate program uses Dorothea Orem's Self Care Deficit Theory as the underpinning of its entire program. I think the OP is correct in that nursing theory has not yet reached the realism of the science of nursing. In order for a theory to be successful, its use must be practical for the average nurse to employ in his or her practice on a daily basis. If one were to apply Orem's Self Care Deficit Theory to daily practice, one would be writing all day!

    As a model to teach nursing science, I think the use of Orem's Theroy is certainly appropriate, but I would really love to have a theorist that has recent and relevent experience that can be compared to nursing today. Many of the nursing theories are old and outdated models that have little, if any relevence for the practicing nurse in today's nursing profession. JMHO
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    It may well be that the response that you read was in reply to my "all hospital nurses" post. In it, I asked for a response to a question for a study I am doing, {and i'd very much like your own response to it!-I posted last night} and asked for the years experience, area of practice, and theory, if known, taught in their school of nursing. A respondent indicated that she couldn't remember the theorist utiilized in her nursing school.

    While I agree with you about theory, and that there is a fracture between schooling and practice that merits a whole 'nother thread, the truth is that the indoctrination of a nurse begins in school, and is fortified by the theory utilized, as it is cohesive to the entire program, and the philosophy of nursing taught. It presents an image of what nursing is or should be, in a way, and is part of the subconscious formation of the nurse. I think, far more important than the "science of nursing" a theory attempts to present, the nursing theory utilized helps form the nursing mind from incipience and so has great import in the subjective understanding each nurse has of the nurse role, and her job function within the general environment in which she works. Some theorists are more radical than others, believe it or not! It is not really expected that everyone will remember their theorist for my post...but it is possible that the answers I am seeking will have been given seed by the theorist of their school. I am seeking a correlation, in a way. If someone doesn't remember their theorist...i am not necessarily suprised. But as my particular theorist in my nursing school had a radical concept easily referred to for the response I am seeking...I asked for theorists as a way to cross correlate.


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