Is nursing theory actually used by working nurses?

Nurses Professionalism

Published

In school I was always told how important nursing theory is in guiding nursing practice and improving care. Both in undergraduate and graduate school my teachers ridiculed PAs for not having a theory that guides their practice. Are there any nurses that actually use a nursing theory in practice? Are there any nurses that can name one nursing theorist and explain the theory? I have also found that the teachers in my theory classes have very elitist attitudes when it comes to the theories. I have encountered one hospital that prides itself on basing its nursing care on one particular theorist. No nurse I have worked with in the last 10 years basis there care on a theorist, they can't name a single one. How can theory be what drives our practice, when it is never used. And my teachers have even admitted that some are too complicated for many entry level nurses to truly understand.

At first I just told myself I am not experience enough or know enough about nursing to understand it. I have been a nurse for almost ten years and now realize that its not just me not grasping its importance, its just not important. My opinion now is that nursing theory was created to justify nursing as an academic discipline in a time when no one believed nursing belonged in a university. Then it was used to justify doctoral level nursing. I think nursing theory could be used to guide nursing, but it just isn't being used in actual practice. I know many nurses are going to read this and consider it heresy, but just ask the nurses you work with about the theorist they know and how they use them, my bet is that very few could even name a theory. Seems to me that only PhD nurses use theory for their research, but it fails completely when it comes to actually guiding practice. Just wondering what everyone else's opinion was on the topic, I have asked graduate faculty about theory in practice and usually get very negative feedback with derogatory comments about nurses in practice not being the academic elite, that it takes experts in nursing theory to understand the nuances of it. There again, if it is to complicated for practicing nurses to understand, can it really be guiding there practice?

I studied Roy's Adaptation Model of Nursing. For those unfamiliar with this theorist, it uses a 6 step nursing process.

The nurse assesses first the behaviors and second the stimuli affecting those behaviors. In a third step the nurse makes a statement or nursing diagnosis of the person's adaptive state and fourth, sets goals to promote adaptation. Fifth, nursing interventions are aimed at managing the stimuli to promote adaptation. The last step in the nursing process is evaluation. By manipulating the stimuli and not the patient, the nurse enhances the interaction of the person with their environment, thereby promoting health.

Really, when you think about it, it isn't that complicated. We may not actually be writing this stuff down or analyzing it to death but at some level, subconsciously, we use this with every patient to some degree. So the answer to your question: is nursing theory actually used by working nurses? Most definitely.

"How exactly can they be using a theory in there practice they don't even know?"

I'm assuming this is in reference to my last post. What I'm saying is this: Whatever we do is based upon some philosophic basis, some theory. However we live is based upon some philosophy base. We're not necessarily aware of the philosophical base. It may be received knowledge, i.e. following in the footsteps of your parents or just going along with the current culture. Every nurse is following some kind of theory or base in whatever they do. It may not be recognized "nursing theory," but it is some kind of foundation, whether they are consciously aware of it or not. One guide might be this: You do something. You know it's right. You're challenged by someone who says you didn't do the right thing. You know it's right. Can you explain why you did what you did? Can you defend your action, basing it upon sound theory, evidence, practice, philosophy? If you can, you have a handle on the theory under which you're working. I you can't, you need to ask yourself why you did what you did the way you did it, and how that fits into your belief system.

Specializes in Critical Care.

I find Jean Watson's theories to be useful since if you read her work backwards you can summon your medieval Viking warrior spirit from a previous life, mine is named Torvitt.

Torvitt comes in very handy as a scribe for me while at work, even though the charting he does for me is in Old Norse.

Specializes in FNP.
I disagree w/ the majority, as usual. I do think nsg theory is important and I do rely on it to inform my pracrtice, especially Rogers and Watson. Also, speaking only for myself, i am not part of a medical team any more than I am a part of the occupational therapy or dietary team. I am a nurse on the health care team. I don't practice medicine in any way, shape or form.. . /quote]

Hmm. Interesting. I consider myself a part of the healthcare team for my patients inclusive of doctors, nutritionists, physical therapists, OT, and more!

On my floor we work in conjunction with all the above providers to give our patients the best care, and I consider it imperative to the best possible outcome

Exactly.

Specializes in Critical Care.
I disagree w/ the majority, as usual. I do think nsg theory is important and I do rely on it to inform my pracrtice, especially Rogers and Watson. Also, speaking only for myself, i am not part of a medical team any more than I am a part of the occupational therapy or dietary team. I am a nurse on the health care team. I don't practice medicine in any way, shape or form. I do use NANDA, but only b/c it is a required part of our shift charting.

"Medicine" is commonly defined as the science and art of healing. I don't why we are so determined to deny that this is what we do. I agree that NANDA is pointless, but mainly because it's a good example of nursing trying to deny to what it really is. No wonder the public, and even nurses, have such a hard time understanding what we do.

Yes, that makes perfect sense, I agree completely with philosophy guiding our actions.

Truthfully, I cannot think of any specific nursing theories off the top of my head. The most important thing I had to use in nursing was my organizational skills, and physical energy. Now that I think about it, my ability to perform nursing can be broken down into the amount of skills that I had to master. Assessment, documentation, admin. medications, admin. treatments, starting an IV, etc. Much of my knowledge after school was based on experience. I agree a lot of nursing education is dogmatic. Needs to be more relevant.

I know that I just don't give a rat's behind about nursing theory, or nursing diagnosis.

I am part of a team that practices medicine. My role/scope is that of a nurse, within this team.

Screw NANDA, give me straight up clinical pathways devised by my team to follow.

I agree with onaclearday, theories that are based on caring, evidence based practice and health promotion are not unique to the discipline of nursing, all health care professionals base their practice on these ideologies. Academics need to stop emphasizing the uniqueness of nursing theories, instead academics should teach interprofessional theories because in the real world it isn't the work of one profession that provides the best outcome for the patient, it is the work of the team.

dishes

Never found myself using any of it--except maybe in my mind Maslow's hierarchy of needs. My patient doesn't give a rat's a** about me teaching her how eat properly once home to help her wound heal when she has been NPO for 3 days and has 9/10 pain and has not crapped in 6 days! LOL so I guess when I think about Maslow's theory it makes sense why she can't listen to a word I have to say until her basic needs are met. As far using the actual nursing process.........um nope I don't think I have used any of that crap. Maybe if I worked in peds I might find helpful the theories more for developmental stages.

Specializes in Geriatrics, Transplant, Education.

I didn't understand how I could possibly be using theory as a working nurse until this semester. I just started a MSN in Nursing Education program, and grumbled at the thought of taking a theory class. It wasn't until I got into depth studying Neuman & Johnson that I "got it". There is a lot of literature out there about the application of specific theories to practice. I challenge you nay-sayers to check it out :D

Specializes in Psychiatric and Mental Health Nursing.

Many times the students in my psych clinicals ask this same question. I have been a RN for over 28 years full time and have been teaching since 2004. I think the problem with trying to describe the ideals are the "nurse-isms". It can be confusing to decipher what is being said.

First of all, we are not part of the "medical" profession. We are the Nursing Profession. How do we differ? Look at the definition: "the diagnosis and treatment of actual and potential HUMAN RESPONSES to illness/disease" We do not focus on the medical diagnosis, we look at how our patient (individual, family, community) is responding to the illness/disease/disorder (whatever!). Of course we do need to be knowledgable about the diagnosis so we know what to assess for. We do not "cure", in fact we do "care". We help the patient acheive their highest level of functioning (who's theory is that), by taking caritive measures (who is that?), etc. Do we always know the formal names to our behaviors, not necessarily.

It is the same regarding the nursing process/nursing care plan. Many times the students will say "The nurse said they never do care plans". Really? The nursing process is the basic framework of nursing (ADPIE). These phases are also the exact parts of the nursing care plan. What I respond is: in practice while I may no longer write a nursing care plan (yes, we used to have an area for this in the MR) I do use the nursing process. I collect subjective and objective data re: my patient, I analyze the significance and determine what I think is going on for the patient, I discuss with the patient how we will address the problem, select appropriate actions to help meet the goal and take a look to see if it works. Isn't that a care plan? The nursing process? When I document, I address each step of the nursing process as well-regardless of the format used (PIE, DAR, narrative, etc)

For those who don't care for NANDA, it is those impairments that are typically used in the multidisciplinary treatment plans (Potential for violence, alterations in sensory perceptions, alterations in thought process, etc). If my patient is schizophrenic, you bet I care about the presence of hallucinations or delusions (those are the symptoms (responses) I assess for based on the medical dx). If they are present, I want to decrease/eliminate them. I medicate, I engage in a 1:1 to provide support and diversions,and check back to see if it worked. The person that spoke about Maslow is correct in that application of a theory-basic needs need to be met before progress can be made. Different levels of care happen at different phases of the patient's illness, theory addresses this as well. Sometimes you have to slow down and really take a look at what you're doing and why. You may surprise yourself! Embrace nursing, it's a great profession.

My NY 2 cents.....

Looking at how the patient is responding to illness/ disease/disorder is not unique to nursing, the interprofessional team look at the patient from this point of view.

dishes

+ Add a Comment