Studying nursing theory, came across Jean Watson

[algebra_demystified]

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.

[dudette10, MSN, RN]

I have been following this discussion, and it has been wonderful to read! Thanks to all the thoughtful contributors.

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.

Yes, yes, and YES. Many people--including me--have a difficult time translating theory (thoughts) into action. And, as someone else pointed out, that is where evidenced-based practice comes in. If the relation between the two goes unnoticed by practitioners, so be it. It still works.

Example:

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 can't help but think that "demonstrating caring" can also be called "distraction," which is a proven technique for pain management. It's maybe not what Watson had in mind, but it works.

In reality, saying that this person's or that person's theories are bunk would only worry me if someone was a nurse researcher. Most patient care nurses are too busy to do all the work necessary to make the connections between theory and interventions. They certainly don't have the resources to test them for true evidenced-based practice. That's the contribution to nursing that nurse researchers spend their careers making.

[elkpark]

But does one specific proposal by a theorist (Uncle Siggy or anyone else) that doesn't sound valid to you on first hearing mean that the entire body of that person's work is "crap"?

Yes.

Okay -- then I guess, by your own criteria, that since I've already disagreed with one thing you've said here, I'm now justified in disregarding anything else you ever say on this board as worthless and wrong. :) But I still think that's a v. short-sighted and narrowminded way to approach the world.

Let's say I told you I wanted a steak. The two of us get in the car, and I describe a NY Strip I want as we drive to the store. At the store, I go to the frozen section and get a box that says Frozen Macaroni and Cheese, say to you Here's the steak... wouldn't that be a little weird? I go and pay for it, take it home, open the box, and (this is the part that blows your mind) slide out a NY Strip, just like I wanted.

Now, imagine that I didn't shake the box to see whether it seemed like a steak might be in there. I didn't sniff the box, I didn't weigh the box, submerge it in water to check its displacement, use any kind of electrical conductivity test to see whether it conducted electricity like a steak would.

I just grabbed the box and tossed it in the cart.

While I did end up with the steak, I wasn't CORRECT. I was LUCKY.

Not necessarily -- not if, over time, you had bought many boxes of Frozen Macaroni and Cheese and had observed that each one of them contained a steak rather than the mac and cheese ...

[llg, PhD, RN]

In reality, saying that this person's or that person's theories are bunk would only worry me if someone was a nurse researcher. Most patient care nurses are too busy to do all the work necessary to make the connections between theory and interventions. They certainly don't have the resources to test them for true evidenced-based practice. That's the contribution to nursing that nurse researchers spend their careers making.

Good point ... and I am OK with that. But as one of the people in an "in between role," who tries to bridge the gap between the academic world and the practice world ... it really bothers me when some people in either world completely reject everything in the other, refusing to see that the other world has a valid point and something of value to contribute to nursing profession. Such a narrow vision of the world hurts our profession and the society we serve.

[metal_m0nk, BSN, RN]

Good point ... and I am OK with that. But as one of the people in an "in between role," who tries to bridge the gap between the academic world and the practice world ... it really bothers me when some people in either world completely reject everything in the other, refusing to see that the other world has a valid point and something of value to contribute to nursing profession. Such a narrow vision of the world hurts our profession and the society we serve.

What the practice world is really saying to you is, "Deliver the message in a form that we can use." They are charging you (the middleman) with making a decision about what has use and meaning, developing it, and bringing it out of your mind and into the world's hands. That is the purpose of advanced education, in my opinion.

Philosophizing for its own sake and being bothered that the practice world doesn't appreciate the abstract (probably because the raw practicality of their lives doesn't entirely warrant philosophizing for its own sake) only serves to widen the gap.

Being able to set aside pretension (or not really having any at all) is what separates theorists from innovators.

Resist the urge to intellectually separate yourself from the population you serve (nurses). It isn't all that different up there...people are still people with or without doctorates.

[jjjoy, LPN]

The absence of "medicine", specifically, disturbs me. I don't think it was deliberate, but while we're not practicing "medicine" in the MD sense of the word, make no mistake - this is still medicine.

It's medicine within a different scope of practice, but it's still medicine.

Medicine, like nursing, is an interdisciplinary field. Medical practice and medical research involves pharmacology, physiology, etc.

I do find the lines between "medicine" and "nursing" to be rather vague. When nurses formally diagnose medical conditions and prescribe treatments, such as in advanced practice, then their role IS overlapping that of physician. And the question arises if nurses are practicing medicine or nursing at that point. If we say that that IS nursing practice, then we it would seem that we have to toss out the "not-medicine" definitions of nursing.

[GilaRRT]

Medicine, like nursing, is an interdisciplinary field. Medical practice and medical research involves pharmacology, physiology, etc.

I do find the lines between "medicine" and "nursing" to be rather vague. When nurses formally diagnose medical conditions and prescribe treatments, such as in advanced practice, then their role IS overlapping that of physician. And the question arises if nurses are practicing medicine or nursing at that point. If we say that that IS nursing practice, then we it would seem that we have to toss out the "not-medicine" definitions of nursing.

Exactly, we cannot have it both ways. Either we are practicing medicine or not. The concept of diagnosing and treating people does not change because another provider is doing it, it's medicine IMHO. Yet, we continue to overlook the implications of this concept.

[Moogie]

I can't help but think that "demonstrating caring" can also be called "distraction," which is a proven technique for pain management. It's maybe not what Watson had in mind, but it works.

Keep in mind that distraction as an intervention for pain management came out of the gate control theory, which was very controversial when it was first introduced in the 1960s. This theory came into wider acceptance in the 1970s and has since been refined by the original researchers themselves to encompass pain caused by peripheral causes (e.g., inflammation and neuropathy) which had not been considered in the original theory of how the CNS deals with pain.

However, even the gate theory was considered controversial when it was introduced.

Despite the mention that it was a theory, endless arguments and debates ensued. Poring over the details, arguing over the substrates, all futile and pointless since the theory has stood the test of time and has changed the way we think about pain--the new theory has endured

(Dickinson, 2002, p. 755). In light of this quote, I think it is probable that many well-educated researchers dismissed the gate control theory as "crap", particularly after its introduction and that, while the theory has been supported by a plethora of subsequent research over many years, others have tried to discredit or dismiss it.

I don't have a problem with nurses, entry-level students, or nurses who happen to be students being less than thrilled with the tenets of some of these nursing theories, particularly the very abstract, metaphysical theories that don't seem to be as grounded as some of the others. However, I do feel a bit dismayed at the blanket dismissal of all theory as "crap". It's one thing to be able to critique a theory and realize, after looking at it with an open mind, that it has little relevance to one's practice or personal philosophy of nursing. It's another thing---and seems a bit closed-minded to me---to skim over a few readings and denounce the entire body of a theorist's work as "crap".

Again, it is not a question of whether or not a nurse finds a particular theory useful or useless---my concern is the lack of intellectual curiosity about the various theories, if only from a historical perspective. What was going on at the time that some of these theories came into vogue that influenced those theorists? What was happening in nursing? In our society? In the world? Keeping in mind that Watson's editorial that the OP found to be too metaphysical for his tastes was published in 2005, it likely reflects much of the cultural mindset post 9/11, when people were very afraid and looking to find answers in spirituality.

Watson's work also seemed to take on more of a metaphysical/spiritual approach after the death of her husband in 1998. She suffered a freak accident in 1997 that resulted in the loss of her eye and perhaps her delve into metaphysics was colored by these two huge losses in her life. Not saying that nursing should change because of Watson's personal losses but I am saying that everyone's perspective is dependent on his/her life experiences and perhaps these losses sufficiently changed the direction of Watson's work into one that is not always understood or valued by those who have not gone through similar experiences.

Source: Dickenson, A. H., (2002). Gate control theory stands the test of time. British Journal of Anaesthesia, 88(6) 755-757. Retrieved from http://bja.oxfordjournals.org/cgi/content/full/88/6/755

[llg, PhD, RN]

What the practice world is really saying to you is, "Deliver the message in a form that we can use." They are charging you (the middleman) with making a decision about what has use and meaning, developing it, and bringing it out of your mind and into the world's hands. That is the purpose of advanced education, in my opinion.

Philosophizing for its own sake and being bothered that the practice world doesn't appreciate the abstract (probably because the raw practicality of their lives doesn't entirely warrant philosophizing for its own sake) only serves to widen the gap.

Being able to set aside pretension (or not really having any at all) is what separates theorists from innovators.

Resist the urge to intellectually separate yourself from the population you serve (nurses). It isn't all that different up there...people are still people with or without doctorates.

I agree with you ... and that's what I try to tell the people in academia. But it goes both ways. I would say the same thing to those in practice (with only a few minor revisions.) The people at the bediside need to stop denigrating academic work and those who are doing academic work, as well.

There is very little "philosphizing for its own sake" going on in academia. If someone doesn't see the applicability of a certain piece of scholarship, that doesn't mean it doesn't exist. It takes time and considerable effort to translate some scholarship into practical applications. And everyone in the profession needs to "make room" for that activity to happen. We need practicing bedside nurses (and middlemen like me) to "try out" new ideas and experiment with them in practice settings -- as part of the process of refining those ideas. They don't get born as "ready for practice" ... they become "ready for practice" only through refinement at the point of application. Which means ... that the people in practice have to be willing to work with them before they are totally refined.

Both sides need to accommodate some of the other. Scholars must accommodate the concrete realities of practice ... and people in practice need to accommodate some of the abstraction of developing theory. It's a 2-way street.

It's just as wrong for people at the bedside to make negative assumptions about scholarly work they don't relate to as it is wrong for scholars to make negative assumptions about bedside caregivers whose work they don't relate. We've got to get over this ..."It's not my cup of tea, therefore it is crap" mentality that pervades most discussions of these issues.

[metal_m0nk, BSN, RN]

I agree with you ... and that's what I try to tell the people in academia. But it goes both ways. I would say the same thing to those in practice (with only a few minor revisions.) The people at the bediside need to stop denigrating academic work and those who are doing academic work, as well.

There is very little "philosphizing for its own sake" going on in academia. If someone doesn't see the applicability of a certain piece of scholarship, that doesn't mean it doesn't exist. It takes time and considerable effort to translate some scholarship into practical applications. And everyone in the profession needs to "make room" for that activity to happen. We need practicing bedside nurses (and middlemen like me) to "try out" new ideas and experiment with them in practice settings -- as part of the process of refining those ideas. They don't get born as "ready for practice" ... they become "ready for practice" only through refinement at the point of application. Which means ... that the people in practice have to be willing to work with them before they are totally refined.

Both sides need to accommodate some of the other. Scholars must accommodate the concrete realities of practice ... and people in practice need to accommodate some of the abstraction of developing theory. It's a 2-way street.

It's just as wrong for people at the bedside to make negative assumptions about scholarly work they don't relate to as it is wrong for scholars to make negative assumptions about bedside caregivers whose work they don't relate. We've got to get over this ..."It's not my cup of tea, therefore it is crap" mentality that pervades most discussions of these issues.

Why let the opinions of a few stop progress? Unmistakable utility will surpass any need for approval. The task is to take theory and make it unmistakably useful.

[carolinapooh, BSN, RN]

You're right in a way. It was a bad example. I was trying to think of ones that everyone knew and could relate to. The actual "novice to expert model" is the original work of Hubert and Stuart Dreyfus, and Benner's dissertation just validated it's applicability to nursing situations (and expanded it by adding the "advanced beginner" stage I think.) But her work has gone beyond that basic model since then and she is still a theorist. It's not a theory OF nursing: it is a theory IN nursing that has been expanded by a nurse and adapted for use in nursing. ... But no one ever said that all nursing theories have to be theories OF nursing.

My point was that people use that theory all the time. My post was made in response to people who said that no one ever used any theories in practice. While Benner did not totally originate that theoretical model, her work on it within nursing has made it most associated with her. And the point that I was trying to make that real people do actually use the work of some of the nursing theorists in every-day practice is illustrated by the example.

No worries. You are completely correct.

Thank you for not being one of the folks who takes offense at every little thing. :redpinkhe

What I really liked about your post is that you at least pointed out CREDIBLE nursing theories and tenets. Some of this stuff gets a bit too spacey for me sometimes.

[llg, PhD, RN]

Why let the opinions of a few stop progress? Unmistakable utility will surpass any need for approval. The task is to take theory and make it unmistakably useful.

I agree 100% ... and that will require that scholars and practitioners work together -- with each maintaining an acceptance of the other's perspective. Scholars need to become more conscious of the practical ... and bedside caregivers need to get more scholarly. Hence the need for all nurses to study nursing theory -- at least enough to have a working knowledge of the discipline's major scholarly issues and trends. ... And scholars need to maintain contact with the world of practice, forming parterships with people in practice, etc. to help move their work closer to being "practice ready."

That's my mission.

[llg, PhD, RN]

With only a few exceptions, I think this thread has been the best one we have had that discussed these issues. I think we have clarified our thoughts and made much more progress towards finding common ground than previous attempts. Thank you, everyone who has managed to participate in a constructive way.