Studying nursing theory, came across Jean Watson

Nurses General Nursing

Published

I haven't read much of her work, but what I've seen so far looks like the ravings of a schizophrenic. It looks like she rejects the medical model completely and believes in telepathy and mind reading over distances, and unmeasurable electromagnetic fields that are created when nurses care about their patients.

What is a "mindbodyspirit" and what am I supposed to do with it? Does she even believe in germ theory?

I'm having a hard time believing that this is taken seriously in graduate level classes.

Again, I point to theories that advocate spirit and life fields. Pseudoscience, no place in our profession. I can appreciate the caring approach; however, the concept is nothing new.

Specializes in Nursing Professional Development.

Why not find some good research and teach that?

Most good research is based on a theory of some type or other. If you don't like a particular theory ... fine. But that doesn't mean we should stop theorizing.

Specializes in Rodeo Nursing (Neuro).
Seriously? Air resistance is a very real thing in my world. Where do you live that it isn't?

Main Entry: grav-i-ta-tion

Pronunciation: \ˌgra-və-ˈtā-shən\

Function: noun

Date: circa 1645

1 : a force manifested by acceleration toward each other of two free material particles or bodies or of radiant-energy quanta : gravity 3a(2)

2 : the action or process of gravitating

— grav-i-ta-tion-al \-shnəl, -shə-nəl\ adjective

— grav-i-ta-tion-al-ly adverb

— grav-i-ta-tive \ˈgra-və-ˌtā-tiv\ adjective

Source: Gravitation - Definition and More from the Free Merriam-Webster Dictionary

Think practical application - discard the vacuum. We don't exist in a vacuum.

It's short hand for the cheap seats - a relatable analogy. Not everyone was a physics major in a former life and you didn't bother to mention anything about force either so it could be supposed that you've done a disservice here also. I've studied physics and I am quite familiar with the concept. A launch into the finer points of gravitational theory isn't relevant to this discussion.

I concede that pointing out your error was roughly on a par with pointing out a grammatical error or misspelling, and not strictly relevent to the discussion. For that I apologize. Nevertheless, you were wrong. A bowling ball and a baseball--unequal masses--fall at the same speed, even in Earth's atmosphere. On the other hand, a 10kg rock and 10 kg of feathers--equal masses--fall at very different speeds on earth, but at the same speed as a single feather on the moon. This law is pretty much true throughout the universe in which I live.

The point is interesting to me because Newton's law of universal gravitation is pretty much a foundation of the deterministic view of the universe and probably one of the best understood laws of classical physics, but also not entirely true. Einstein's theory of general relativity actually explains observed phenomena more accurately. But while Newton's science is adequate to put a man on the moon and Einstein's to explain the minute time discrepency he would experience, today gravity is the least understood of the physical forces. I don't mean to invoke the weirdness of quantum physics in the defense of pseudoscience, but I do argue that attempts to understand the human condition in strictly mechanistic, deterministic terms are not a great deal more accurate than some of the airy-fairy crap. Quantum effects in a macroscopic system like a human being may well be negligible, but I believe chaos theory (which is based in classical, not quantum, physics) is relevent. I mentioned diesel mechanics, and an automobile or truck is vastly simpler than a human, but really, anyone who has done much work on cars has probably experienced a little bit of voodoo in the process. In principle, you should be able to repair any engine by a straightforward algorithm, but in real life experience and intuition can save days of work.

On the whole, I do think evidenced-based nursing is the best foundation for real-life practice, but with the proviso that we keep in mind that evidenced-based nursing is inherently biased in favor of that which is measureable and repeatable. That's fine, as long as we understand that our patients are not measurable and repeatable. I work on a neurosciences floor, so the mind-brain connection is pretty central to my work, and it doesn't take a great leap of faith to extend that to a mind-body connection. And while I'm personally fairly agnostic, I believe the inherent intimacy of our work necessitates recognition of the patients' spiritual needs beyond simply being PC. It isn't just that they have a right to have their beliefs respected, but that they need their beliefs as part of their overall health. Apparently there's a lot more to Watson's theories than I've read, and from some of the posts here it sounds like it may get pretty goofy, but the early premise that caring is important to nursing practice makes sense to me and conforms to my experience. I've seen references to at least one study that found patients who were prayed for, even when they were unaware of it, had better outcomes than a control group. I'm not assuming that's a valid study, and I can imagine that nurses might unconsciously be more diligent in their care of patients they'd prayed for. Still, it's interesting, and might be an argument supporting my view that finding a connection with my patients helps me care for them more effectively.

Specializes in ICU.
I concede that pointing out your error was roughly on a par with pointing out a grammatical error or misspelling, and not strictly relevent to the discussion. For that I apologize. Nevertheless, you were wrong. A bowling ball and a baseball--unequal masses--fall at the same speed, even in Earth's atmosphere. On the other hand, a 10kg rock and 10 kg of feathers--equal masses--fall at very different speeds on earth, but at the same speed as a single feather on the moon. This law is pretty much true throughout the universe in which I live.

Dude, weight and mass are not the same thing.

Translation: I'm ******* with you at this point.

A metatheory of nursing theory, examining the needs of the foundational nursing theorists to define themselves fundamentally as "not-medicine", would be an interesting study.

That's the way foundational nursing theories came across to me as a student. They were written to counter the idea that nurses were just providing hygiene & comfort care and/or just assisting physicians. But if nursing is more than just hygiene & comfort care and physician assistance, then what is it? That's what some of these theories were addressing.

Those theories, though, are conceptual frameworks, not scientific theories. When it comes to empirical research, I don't see nursing as a separate, unique field. Instead nursing is an interdisciplinary field involving physiology, psychology, pharmacology, sociology, education, etc. If one wants to put forward a theory of caring, there's also no reason it should be limited to nursing care. Given this interdisciplinary nature of nursing, it would seem to me that there's little need for "nursing theory". Instead, nursing practice is both informed by and contributes to theory in a variety of different fields.

Specializes in ICU.

From NASA:

Terminal Velocity

Pay special attention to the last paragraph.

Anybody that takes Freud too seriously... come on. I have never wanted to have sex with my mother, and I have yet to talk to anybody else who has.... Years ago I worked for this bizarre company in Los Angeles that was run by a Scientologist and had to take their personality test and the Communications Course as a condition of employment. Guess what? It's crap. It's just crap, and that experience taught me that some things are totally worthless and should be ignored.

LOL, great minds and all that...I swear that two examples of pseudoscience that are usually forefront in my mind are Freudian psychossexual theory and Scientology. Any energy field theories (whether nursing or other) are right up there with those two. I recall my wry amusement when I got to my psych nursing course, and found that Freudian theory was taught as fact. In getting my previous degree (BA psych), I had been indoctrinated to view Freud in a historical light. In fairness, I am largely a Skinnerian at heart, which is a touch atavistic from the prevailing Cog Psy paradigm (although they largely acknowledge the predictive value of much of his behavior work).

Working closely with experimental psychologists has greatly influenced my views of theory and metatheory. Modern psychology has a long history of needing to justify it's rigor to the pure sciences (biology, chemistry, physics, math, &c.). The first half of the 20th century exemplified this effort, with the work of the Behaviorists here in America and the Gestalt psychologists in Germany. From this evolved cognitive psychology, evolutionary psychology, neurophych, etc., all grounded in a strongly reductionist scientific mold.

Contrast to the evolution of nursing theory, which has yet to decide if it wants to be a philosophy, religion, or science. The field is still very much in it's infancy, and has not fully grown out of it's roots in feminism and "not-medicine." As newer generations enter the ranks of academia, I have some confidence that (like psychology) nursing theories will continue to evolve and improve in rigor, logic, and applicability.

Specializes in ICU.
And while theories have supplanted QED, they haven't made reality more concrete. The distinctions between actual concrete and a vaccuum just get more and more vague.

Yeah, you're right...

I guess I won't be needing this parachute then..........

/splat

This is exactly the reason why "theory" makes me wanna eat nails.

Theory doesn't save lives. It won't save me from a free fall without a parachute, and it won't save a patient from an MI. It's a great place to start, but it doesn't end there. In order for theory to be useful (in the tangible world in which we live), it needs to lead to practical application. In other words, it needs to conform to our world, our environment, our current tools of measurement, and our current understanding.

Specializes in Nursing Professional Development.

Contrast to the evolution of nursing theory, which has yet to decide if it wants to be a philosophy, religion, or science. The field is still very much in it's infancy, and has not fully grown out of it's roots in feminism and "not-medicine." As newer generations enter the ranks of academia, I have some confidence that (like psychology) nursing theories will continue to evolve and improve in rigor, logic, and applicability.

I share this view. Nursing scholarship is very young... and unfortunately, maturing very slowly as our culture tends to be anti-intellectual. It's taking us a long time to get up to speed ... and so many of our undergraduate faculty members and leaders in practice setting have such limited education in theory that there knowledge level is still back in the 1970's and 1980's (and earlier) -- focused on theories OF nursing instead of theories IN nursing.

In the theory class that I teach, I try to get students to view the theories as products of their times. What were big issues in nursing and society at the time the theory was first developed? Why did the theorist develop this theory? What question or problem was the theory developed to be addressed.

Then I move on to ... What ideas and concepts did this theory contribute to nursing? Are those ideas and concepts relevant today -- even if in a revised, updated form? We see that Nightingale made some valuable contributions. So did Henderson ... so did Watson.

Recognizing the contributions of the major nursing theorists added to our profession doesn't mean we have to "adopt their religion." But all nurses should be at least a little aware of who these theorists are and the major ideas/concepts they have contributed to our body of knowledge.

I end the semester by encouraging the students to continue to think about the ideas and concepts within nursing that are important today ... in their practice. Hopefully, my course has helped them to appreciate that in order to study the concepts and ideas that are important in their practice today, we need to have some organizing frameworks that define the terms and express the key relationships between the concepts. We need theories to help us organize our thoughts, our communication with each other, and our work. I encourage them to remain open-minded, recognizing that a theory that doesn't suit them well might suit someone else in another situation ... and that even a "bad theory" might have a couple of good ideas buried in there somewhere.

The vast majority of the course evals say that the students appreciate the course and the new perspective I have given them on the theories. They report being less overwhelmed by them and more open to exploring the world of theory and wish we could spend more time exploring some of the more current work in nursing theory. (That's one of my long-term goals for the course.) They report having a more positive attitude about theory once they realized they didn't have to swallow everything "hook, line, and sinker" or not at all. They generally have a more positive attitude about theory.

I guess that's why I am so adamant in my belief that many people who "hate theory" would feel better about it if the teaching of it were better. I wonder how many people hate it so much because they were never taught to view it from a good perspective that works in the real world of nursing practice.

Specializes in Rodeo Nursing (Neuro).
Yeah, you're right...

I guess I won't be needing this parachute then..........

/splat

This is exactly the reason why "theory" makes me wanna eat nails.

Theory doesn't save lives. It won't save me from a free fall without a parachute, and it won't save a patient from an MI. It's a great place to start, but it doesn't end there. In order for theory to be useful (in the tangible world in which we live), it needs to lead to practical application. In other words, it needs to conform to our world, our environment, our current tools of measurement, and our current understanding.

Well, I've survived numerous free falls without a parachute, but I've never remotely approached my terminal velocity. And I'm not saying superstrings open the door for all manner of new-age fun. If I go to the hospital with an MI and the nurse wants to reallign my chi, I'm gonna ask for a different nurse. But if I survive the acute phase and have a nurse during my recovery who sees me as a purely mechanistic system for which input x must always result in outcome y, I'm probably going to be giving fairly low Press-Gainey scores.

My real-world experience has been that when a patient is calling out repeatedly for pain meds and reporting no relief after exhausting all available PRNs, just pulling up a chair and listening to them gripe awhile leads to fewer calls and less reported pain. My conjecture is that demonstrating care relieves aspects of pain that are more psychological than physical, and makes the physical part more tolerable. I recognize that there are usually some clear physiological reasons why one patient gets complete relief from two Tylenol and another gets no relief from 4mg of morphine. But a lot of the patients I see who aren't responding well have been in chronic pain for years before finally having back surgery. Part of the problem is usually that they've been eating Lortabs on a regular basis and have become opioid tolerant, but I don't think you can discount the possibility that they are also depressed and frustrated from having been in pain so long. I am far from convinced that a disturbed energy field has anything to do with their problem and I wouldn't know what to do about it if I did, but neither do I need a double-blind study or survey of the literature to persuade me that showing empathy and understanding makes a lot of patients feel a little better.

My sense of finding a balance between nursing "theory" and EBP is not that one says 2+2=4 and the other says 2+2+6, so lets just agree that 2+2=5. To me, it means when my patient converts to uncontrolled A-fib, I push metoprolol, but also explain that I'm a little worried about their heart rhythm and this medicine should help get it back to normal, and if it doesn't work we have other things we can do. All of which, actually, falls under the heading of EBP, but I don't think it hurts to have Watson and others remind us that we are treating people, not machines. That might be common sense to you or me, but I swear to God I've seen technically competent nurses who seem to find the human element an annoyance and wish all their patients could be intubated.

21st century nursing doesn't have to be 17th century physics or 3rd century theology.

Specializes in ICU.
Well, I've survived numerous free falls without a parachute, but I've never remotely approached my terminal velocity. And I'm not saying superstrings open the door for all manner of new-age fun. If I go to the hospital with an MI and the nurse wants to reallign my chi, I'm gonna ask for a different nurse. But if I survive the acute phase and have a nurse during my recovery who sees me as a purely mechanistic system for which input x must always result in outcome y, I'm probably going to be giving fairly low Press-Gainey scores.

My real-world experience has been that when a patient is calling out repeatedly for pain meds and reporting no relief after exhausting all available PRNs, just pulling up a chair and listening to them gripe awhile leads to fewer calls and less reported pain. My conjecture is that demonstrating care relieves aspects of pain that are more psychological than physical, and makes the physical part more tolerable. I recognize that there are usually some clear physiological reasons why one patient gets complete relief from two Tylenol and another gets no relief from 4mg of morphine. But a lot of the patients I see who aren't responding well have been in chronic pain for years before finally having back surgery. Part of the problem is usually that they've been eating Lortabs on a regular basis and have become opioid tolerant, but I don't think you can discount the possibility that they are also depressed and frustrated from having been in pain so long. I am far from convinced that a disturbed energy field has anything to do with their problem and I wouldn't know what to do about it if I did, but neither do I need a double-blind study or survey of the literature to persuade me that showing empathy and understanding makes a lot of patients feel a little better.

My sense of finding a balance between nursing "theory" and EBP is not that one says 2+2=4 and the other says 2+2+6, so lets just agree that 2+2=5. To me, it means when my patient converts to uncontrolled A-fib, I push metoprolol, but also explain that I'm a little worried about their heart rhythm and this medicine should help get it back to normal, and if it doesn't work we have other things we can do. All of which, actually, falls under the heading of EBP, but I don't think it hurts to have Watson and others remind us that we are treating people, not machines. That might be common sense to you or me, but I swear to God I've seen technically competent nurses who seem to find the human element an annoyance and wish all their patients could be intubated.

21st century nursing doesn't have to be 17th century physics or 3rd century theology.

Dude, after you railed me for a correct interpretation of physics and likened my understanding to a grammatical error, dwarfed in the massive shadow of your "formal physics education", I kind of stopped caring about anything you have to say.

but I don't think it hurts to have Watson and others remind us that we are treating people, not machines.

We can be reminded that we are treating people and not machines without ever introducing any theory. And certainly that doesn't only apply to nursing care. The practice of caring is central in other fields such as child care. And there are some areas of nursing practice where clinical competence does trump caring (so long as the nurse cares that they practice competently). A nurse can most certainly learn and practice caring without any formal theory of caring. That doesn't mean such theories are useless; they just aren't necessary for competent practice.

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