is nursing theory important to nursing practice - page 4

by precious nikz 34,414 Views | 73 Comments

hello everyone...pls help me with our debate this Monday.. our clinical instructor gave us the topic,,"IS NURSING THEORY IMPORTANT TO NURSING PRACTICE?,, and we are in the negative side,.the decision was given through toss coin,.... Read More


  1. 6
    Quote from multicollinearity
    Every profession has theories that provide conceptual foundations and frameworks for their profession. I was just off in google-land reading about grounded theories within medicine, theories in medical anthropology, theories within clinical psychology, etc.

    Not specific to a single profession, but I suppose the germ theory of disease seems pretty basic, but it sure wasn't at one time. Just because it's basic and commonly known doesn't mean it shouldn't have a name and label.

    I suppose we could exist OK without any theories of our own, but then wouldn't we exist as borrowers from other professions' theories?
    Quote from ♪♫ in my ♥
    Perhaps. Would that necessarily be a bad thing?
    I think so. In order to be recognized as an academic discipline, separate from medicine and other health sciences, nursing needs to have its own body of knowledge. Grand theories act as the foundation for nursing practice; mid-level theories are utilized to develop nursing actions in specific clinical areas.

    Nursing has been struggling to be recognized as an academic discipline ever since the 1960s, when the ANA published a position paper that supported baccalaureate education as the entry level to practice. What does this have to do with actually being a nurse? Plenty. When most nursing education took place in hospital schools (diploma programs), the profession was very much under the control of medicine. Now, there's a lot to be said in favor of diploma programs, mostly the fact that diploma grads typically have much more clinical experience---and are therefore more technically skilled---than other entry-level graduates. But the biggest downside of these schools was that they didn't teach nursing theory---sure, they touched on Florence Nightengale and Hildegard Peplau, but for the most part, the curricula were medically based. Nurses were taught---TRAINED---to be the handmaidens of the physician. In many cases, they were taught specifically what their doctors wanted, how to take care of their doctors' patients, how to anticipate and carry out their doctors' orders. Indeed, physicians often taught some of the nursing classes, mostly anatomy, physiology and pathophysiology.

    Moreover, nursing has been struggling to be recognized as its own profession. One of the characteristics of a profession is that there is a specific body of knowledge to that profession. If nursing research would cease and all nursing theories vanished, we would be back to borrowing theories from a plethora of other disciplines. Where, then would we find knowledge specific to nursing?

    These arguments may seem silly to those who are working in direct patient care, some of whom seem to follow a sort of Zen-like philosophy of nursing. They practice nursing and nursing is defined by their actions. And, for the individual practitioner, that works. But looking at the larger picture---at nursing as a profession and a discipline---we can't just do. We have to think and express ourselves in academic language---yes, in order to obtain legitimacy among academia as well as among other health professions.

    Is the quest for legitimacy just for show? No. Look at the respect other health care professionals give each other. How are pharmacists and physical and occupational therapists respected in comparison to nurses? Administration often sees nurses as expendable, a "dime a dozen." Have any of us ever heard administration say that about master's prepared physical therapists? Do we EVER hear administrators think of doctors as expendable?

    Additionally, nursing theory provides the foundation for nursing research, which is important to help develop nursing practice. If it wasn't for nursing research, we'd still be putting Maalox on decubiti like we did thirty years ago when I was in school. Now I'd like to think that my education from eons ago is still relevant; in terms of clinical knowledge, what I learned was obsolete before I hit my five year anniversary as an RN. But in terms of basic nursing knowledge---the theoretical foundations---it's still there. What I learned in school was refined and made relevant through my experience---which has led to an increased desire for more knowledge so I can be a more effective, current nurse.

    Believe it or not, I really do use nursing theory as a basis in my practice, whether that practice is teaching students or passing out meds in LTC. Jean Watson's ideas remain as influential to me now as they were when I first learned about them. I also look to Benner's theories, especially her Novice to Expert model, and I've used Pender as the foundation for community health nursing. Now, is the day ever going to come when we see Moogie's Grand Theory of Nursing and the Universe? Probably not. But I do have my personal philosophy of nursing that has been born out of my education, my experiences, my core values in life, and every little thing that has to do with nursing, no matter how grand or trivial.

    BTW, just a quick note to the OP and other nursing students---just remember that your instructors might be lurking on these boards as well, so don't just ask any of us for the answers. Look, listen, read, reflect---and then make your own conclusions.
  2. 0
    "Let's hope the caring ideal continues to seem like common sense to you -- and to many others. But don't forget the fact that it seems like common sense to you because somewhere along the line, you acquired that value and internalized it -- probably from Jean Watson or someone like her that taught you about the importance of caring." orig poster, llg

    Thanks for your post llg. Guess I sounded negative, but I didn't mean to be. But these things do just seem so basic to me. I did not learn to care about people from a theorist. My mother was an LPN, and sisters old enough to be my mother were a physician and a nurse practitioner. Caring was understood. It didn't matter if it was a patient, a neighbor or a stray kitty I rescued...you cared and were expected to always show that. Same as the theory of helping patients do as much for themselves as possible, same as behavioral theories, etc. It was just all part of my life. And I guess I have no understanding of the person who does not care. Yes, in reading some posts, and in being a director of nursing, I see nurses who do not seem to care. I wonder why they are nurses. And if they are working for me, they are quickly terminated. I think the only theorists I have enjoyed reading about were the very first ones...it was all new for them.
  3. 0
    Quote from Penguin67
    But without theory, nursing as a profession cannot and will not advance. We used to have to "borrow" theories from other professions and disciplines and we don't have to do that as much now that nursing theory is emerging.

    To help my students understand nurisng theory, I ask them to think of their own religion and how it pretty much guides your life, the decisions you make, the way you live, etc...That is how nursing theory should be for nurses.
    I do think some of these nursing models are useful tools to framing nursing as a profession... although sometimes they might end up constraining it... such as models that specifically separate nursing from medicine by cutting out medical diagnoses and treatments, and where does that leave nurse practitioners?

    I think nursing theory is one of many ways the field can advance; the question is how much do they impact each individual nurse's professional practice? If a nurse doesn't learn or embrace any formal nursing theory, can they still adequately practice nursing?

    Drawing a parallel to religion would seem to hurt the argument for the necessity of nursing theory. Clearly, not everyone practices a religion and they still lead what they consider to be meaningful, productive and satisfactory lives.

    Finally, if a "borrowed" theory (tweaked to fit nursing) works, who cares if it's "borrowed"? Nursing by nature overlaps with many fields such as education, public health, & medicine.
  4. 4
    Quote from CraigB-RN
    2. We teach theory wrong. It should only get a mention in undergrad nursing education. The average nursing student doesn't have the framework to really understand, integrate, synthisise the concepts. (can you tell I'm in grad school?) Nursing theory is probably best delivered at higher levels of education. I can't remember any of my origional theory classes, they were over 30 years ago. I do remember the day were I thought, hmm there is something to this theory stuff. That's when I decided to pursue grad school.
    Interesting point. I was taught minimal theory in my ADN program, a bit more in my BSN program, but got the full treatment when I started grad school. The concepts I learned in grad school totally changed the way I think about nursing---but there is no way I would have been ready to absorb any of them when I was still learning the fundamentals of nursing.

    I knew I was a nursing nerd when I realized I no longer thought of theory as bull**** but as something fascinating and relevant to my career. I'm even comfortable with mid-range theories and that sort of scares me. (Bwahahahahaha---invasion of the nursing body snatchers....)
    MedSurgeMess, NRSKarenRN, Scrubby, and 1 other like this.
  5. 1
    Quote from Moogie
    I think so. In order to be recognized as an academic discipline, separate from medicine and other health sciences, nursing needs to have its own body of knowledge. Grand theories act as the foundation for nursing practice; mid-level theories are utilized to develop nursing actions in specific clinical areas.

    Moreover, nursing has been struggling to be recognized as its own profession. One of the characteristics of a profession is that there is a specific body of knowledge to that profession. If nursing research would cease and all nursing theories vanished, we would be back to borrowing theories from a plethora of other disciplines. Where, then would we find knowledge specific to nursing?

    Look at the respect other health care professionals give each other. How are pharmacists and physical and occupational therapists respected in comparison to nurses?
    Can't you have a body of knowledge specific to a profession without having any grand theories? Do pharmacists have a grand theory of pharmacy? Do civil engineers a grand theory of civil engineering? Nurses can publish research on topics relevant to nursing without any grand theories in the background... such as ways to reduce the incidence of pressure ulcers or effective post-op teaching strategies.

    As you note, many theories were initially developed as a way to legitimatize nursing as a profession as it struggled to pull itself from being considered subject to physicians. Creating theories that cut medical diagnoses and ordered treatments out of the picture was one way to prove that nursing was more than just one small subset of medicine. I definitely think such theories played an important role in the development of nursing as a profession. But how much of a role do such grand theories play in the *practice* of nursing several decades later?
    Scrubby likes this.
  6. 0
    Personally, I believe many of the nursing theories are kind of outdated. Also, the theories are not necessarily applied while practicing nursing, Roach's 6 C's don't exactly cross my mind when i enter a patients room. Additionally I think that some of the theories are kind of wacked.. i dont exactly remember which, maybe one about transpersonal caring? Not sure. Anyway, it can be argued both ways, as Florence Nightengale's practice of making patients as comfortable as possible in a tranquil environment (etcetc) is still applied in nursing today.
  7. 3
    Quote from ♪♫ in my ♥
    I didn't acquire the value of caring from Jean Watson or some other theorist in nursing school, I acquired it from my parents - neither of them nurses.
    OK. I figured that might be the case -- but that doesn't invalidate my point. Somebody TAUGHT you about caring. When Watson first starting working on caring, people in nursing were not talking about caring -- or incorporating it within nursing education. There was such a strong focus on physiology that caring was disappearing from nursing. We should all appreciate the fact that somebody (Watson and others) stool up and said, "Hey, wait! We can't forget about caring. In fact, we should put it front and center."

    Also, we should appreciate that in order to teach caring to those for whom it does not come naturally ... and in order to develop systems of caring ... and in order to document the benefits of caring so that hospitals and insurance companies will provide the resources needed to provide caring to our patients ... we need frameworks with which we can discuss it, do research on caring, teach caring, show the beneficial outcomes of caring, etc. Those frameworks that are needed to discuss it etc. are the theories of caring. Without them, we can not discuss, teach, research, document, validate, etc. the caring that you seem to think is so important. And if we don't do those things, then we don't get the resources we need to provide caring to our patients.
  8. 3
    Quote from travel50
    "Let's hope the caring ideal continues to seem like common sense to you -- and to many others. But don't forget the fact that it seems like common sense to you because somewhere along the line, you acquired that value and internalized it -- probably from Jean Watson or someone like her that taught you about the importance of caring." orig poster, llg

    Thanks for your post llg. Guess I sounded negative, but I didn't mean to be. But these things do just seem so basic to me. I did not learn to care about people from a theorist. My mother was an LPN, and sisters old enough to be my mother were a physician and a nurse practitioner. Caring was understood. It didn't matter if it was a patient, a neighbor or a stray kitty I rescued...you cared and were expected to always show that. Same as the theory of helping patients do as much for themselves as possible, same as behavioral theories, etc. It was just all part of my life. And I guess I have no understanding of the person who does not care. Yes, in reading some posts, and in being a director of nursing, I see nurses who do not seem to care. I wonder why they are nurses. And if they are working for me, they are quickly terminated. I think the only theorists I have enjoyed reading about were the very first ones...it was all new for them.
    I think it is very easy to forget that when most nurse theorists first publish their work ... it is new to the world ... or at least a new way of looking at an old idea. However, over time, as those ideas become imbedded in our profession, those ideas become old and commonplace. Everybody knows them. Everybody assumes them. The ideas get passed down through our culture and we don't need to read the original scholarship that produced.

    We forget that not too long ago (in human history terms) nobody washed their hands or any health care equipment between patients because the "germ theory" did not exist. Now, little kids grow up knowing that you should was your hands to get rid of the germs. They grow up thinking of it as "common sense" -- but it didn't start out that way.

    The nursing theorists each contributed ideas into our discipline's discussion of topics important to the provision of nursing care. Each added something to the conversation of value -- or their ideas would not have been accepted. That's why theory is never a "done deal." It's always evolving as the conversation continues, with old ideas refined, new perspectives added, etc. New generations learn the new ideas of the previous generations. They internalize those ideas and those new ideas become old ideas. The newer generations add their own ideas and perspectives to the conversations -- often based on ideas that were once "new" and "innovative" even if they don't always know it.
  9. 3
    Quote from jjjoy
    Can't you have a body of knowledge specific to a profession without having any grand theories? Do pharmacists have a grand theory of pharmacy? Do civil engineers a grand theory of civil engineering? Nurses can publish research on topics relevant to nursing without any grand theories in the background... such as ways to reduce the incidence of pressure ulcers or effective post-op teaching strategies.
    Yes! While we do know much about how pharmaceuticals work within the body, much of pharmacology is based on theories that must be tested through the scientific process. Scientists have learned tremendous things about the body, especially with the discovery of the human genome, but even that started with ideas, theories. And the grand theory behind civil engineering is the theory of gravity.

    Nursing theory guides nursing research. Without it, nurses are basing their research on "hunches" or conventional wisdom, which simply don't stand the test for scientific rigor. Let's say, jjjoy, you and I decided to do a research project on effective post-op teaching strategies. How would we start? We would determine exactly what it is that we wanted to study. How do we define "effective"? How do we define "post-op teaching"? What is our patient population? How do we come up with our strategy? Do we want to look at post-C-section written instruction for first-time mothers who don't speak English as their first language? Do we want to look at ways to reinforce verbal instructions in middle-age men who live by themselves and have had TURPs? We'd look at scientific literature, nursing research published in peer-reviewed journals. (And, not to be elitist, but AJN doesn't count as a "research" journal.) Anyway, we would look at other studies, to see if what we're doing is something completely different or if others had made similar journeys in their work. We'd decide if we wanted to try to replicate the results of a previous study.

    We'd use theory as a way to determine our approach. Would we use Pender's theories of health promotion as a guide for our teaching materials? How might we approach this issue if we followed, say, Rogerian theories or the Neumann Systems Model? The Roy Adaptation Model? You see, without theory, someone else might pick up the research and decide that, while they are also interested in post-op teaching strategies, they can't use what you learned because you were talking about middle-age men with TURPs and they're interested in helping post-vaginal hysterectomy women in their forties. But----a nurse researcher doesn't look only at the details. A nurse researcher looks at the underlying theory to see if the study is relevant to his/her clinical or research needs.

    The thing is, to do actual research, it's necessary to follow certain scientific and academic standards. You need to use <gasp> statistics to analyze your data. (I hated statistics at the undergrad level and in grad school---but it's a necessary evil in order to understand and conduct nursing research.) Otherwise, how can you tell if what you did actually made a difference? Certainly nurses can publish the things they learn, their approaches in certain situations and how they handled things. But, unless those nurses follow the guidelines of conducting actual research, all their work can be dismissed as anecdotal, working for one patient or one situation, but not necessarily applicable in other persons in other clinical settings.

    In regards to Watson's theories of transpersonal caring, I remember sitting in a class one time and nurses were debating whether or not caring was necessary to be a nurse. A debate ensued over the differences between sympathy, empathy and caring. Was it all just semantics, an academic exercise? I don't believe so. I was stunned to discover that many nurses (this was in grad school) did not understand the differences between these concepts and some stated that they felt they could be adequate nurses without caring at all. That goes against my core beliefs and I disagreed with those classmates who said nurses didn't need to care. How does that help me in practice? If I'm working with someone who mistakes empathy for sympathy, it matters in the care our team delivers. If I'm working with someone who believes caring is optional, I might have problems when they don't understand why I felt it necessary to sit at the bedside of a confused, elderly person who was crying at night.

    I respect the opinions of those who disagree (but remember, we aren't supposed to be doing anyone's homework here!) but I value theory as a foundation for nursing practice. I honestly don't believe thinking and doing have to be mutually exclusive in the nursing profession.
    NRSKarenRN, precious nikz, and llg like this.
  10. 1
    You can teach a student how to provide care for patients , but if a student enters nursing does not know how to be caring towards others , it's a bit late in the day , to try to teach them this personality trait . I don't think being caring is a trait that can be taught in the classroom , it is something that should be a basis of a persons personality , that is transparently genuine , not a theory the student has learned and can check off their skill set .
    MedSurgeMess likes this.


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