Is nursing theory actually used by working nurses?

  1. 4 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?
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  3. Visit  BCRNA} profile page

    About BCRNA

    Joined Dec '10; Posts: 254; Likes: 144.

    44 Comments so far...

  4. Visit  netglow} profile page
    28
    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.
    prettymica, anon456, skisgirl276, and 25 others like this.
  5. Visit  ImThatGuy} profile page
    10
    Quote from onaclearday
    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.
    Kudos x infinity!

    That's the way I see it.

    It seems that nursing tries way too hard to justify its role in healthcare and define its nature. Powerful lobbying. The DNP. Theories out the rectum. You're a nurse. People know that. The patient needs to be driving your practice and not some stupid theory. Geez, I took criminology (read: criminal theory) back when I was in college and was in law enforcement for a good while (still am), but do you honestly think I applied any of those theories when taking crackheads and wife beaters off the streets? Heck no! I just became attuned to the situation, much like a nurse does to patients, and did the job.



    And the theory PAs follow is cure the dang patient. What's wrong in that?
  6. Visit  NYLady} profile page
    10
    Nursing theory is important to nursing practice in the same way Philosophy is important to living. We all know that in life not everyone studies Philosophy but, whether they know it or not, everyone lives by a philosophy. Studying a little philosophy can help us know more about how we live and, sometimes, to live better. Studying a little nursing theory can help us know more about our practice and, sometimes, to practice better.
    elkpark, NurseKatie08, lindarn, and 7 others like this.
  7. Visit  tablefor9} profile page
    9
    I've been a nurse for 15 years, and I don't think about "nursing theory" unless a question like this comes up. Jeez...who among us runs around thinking about NANDA and theory???

    However, it does drive my practice, because I buy into Henderson and Watson in as much as they fall in with my own philosophy: Encourage independence and autonomy, promote wellness.

    Or, as my mother's theory would say, "Those that can, should. Is your arm broken?"
    tewdles, lindarn, BCRNA, and 6 others like this.
  8. Visit  Miller86} profile page
    5
    Well it helped to a certain extent but no I don't go in every day and think about Florence and her exact ways.

    I do consider the person, their environment and what's happening to it, and the type of care I intend to/provide. I think that's what most theories covered, the rest were useless to me and it honestly took up loads of hours writing them when I would have preferred more clinical practice times and skill development. I do believe certain theories are important to know and understand but my nursing program spent too much time on theory and not enough time on what to do!

    I graduated with: having put in one female catheter, doing two IM injections, and probably 3 subcutaneous, minimal IV medication practice you can forget about IV starts (Just did my first couple last month!). I did two suctions on a trache patient, no ostomy care, minimal feeding tubes BUT I could tell you every theorist that ever touched nursing. We had 3 theory courses in the program, where it went into deep details about the history and theories involving nursing. Give me a break....we don't NEED all this just show me how to put in a catheter!
    It really upset me that I spent thousands of dollars and now I am in debt only to know I felt like **** saying "Oh I never done that before" to almost every small skill by end of fourth year.

    Besides, theories are just a bunch of people's opinions that were validated by another's opinion. I could just make up a theory now and maybe it will be practiced 50 years from now. So just take what you can from it and the rest you will likely never remember it.
    Just my opinion.
    AmericanRN, annister, lindarn, and 2 others like this.
  9. Visit  NRSKarenRN} profile page
    5
    our health system chose betty neuman's system model in 1990's for their care philosophy.

    luckily, my bsn program in 1979 was based on this theory.... still influences me today with every homecare referral i obtain and process....along with thousands of careplans i've hand written in 25+ yrs as homecare rn--- computerized since 2002!

    her archives are now housed at my alma mater: neumann university
    http://www.neumann.edu/academics/und...sing/model.asp
    Last edit by NRSKarenRN on Dec 24, '10
    elkpark, VickyRN, NurseKatie08, and 2 others like this.
  10. Visit  GHGoonette} profile page
    7
    Depends on what you're referring to; I just finished a refresher course in circulating and recovery room practice, and when my fellow students were struggling with the learning material, I pointed out to them that these are things we do every day, without even thinking about it.

    I think a lot of the nursing theory is like that, we do it habitually; we just don't make the connection and say, "right, what does my nursing theory say about this?"
    pers, tewdles, annister, and 4 others like this.
  11. Visit  cjcsoon2brn} profile page
    6
    I think that while many non-academic practicing nurses are not able to recite the names of theorists and their associated theories by memory they are in fact using certain theories in practice (depending upon the area of nursing). Nursing is becoming increasingly more evidence-based practice because our practice is being guided by theory and has been proven with research. I think that the drive from academics to emphasize nursing theory is to elevate nursing so that nursing can be respected as a both a profession and a healthcare dicipline (among the ranks of medicine, physical/occupational therapy, pharmacy etc.)
    elkpark, pers, NRSKarenRN, and 3 others like this.
  12. Visit  Mona77} profile page
    1
    The only thing I remember about Florence is that she was "the lady with lamp" during the Krim War, changing nursing professionalism.
    Before my final exams I was able to explain a lot of nursing theories, but now
    when practising nursing I try to work with compassion - this leads automatically to evidence-based nursing and lifelong learning.
    During my nursing education we had to state a reason why we are caring a particular way, that's probably why I catch myself reasoning with Orem and Peplau.
    Orem is omnipresent in Germany, don't ask me why...
    lindarn likes this.
  13. Visit  shaas} profile page
    8
    I know that this is not going to be a popular sentiment, but it is what it is, an unpopular but a legitimate gripe of mine. Please, bear with me.

    One salient oddity that I've noticed while taking an introduction to nursing class is the nursing academia's desire to align itself with socialpsych./psychology, which baffles me to no end. If you've majored in any known social science discipline (e.g. sociology, psychology, economics, etc.) and have gotten a degree after writing papers coming out of your arse, singing the same old tune in different keys, then you know this already; these disciplines' aim and pursuit have been gearing heavily toward integrating scientific empiricism and math to add credibility and garner academic clout. They even added 'science' to their moniker because science really does matter, in every way conceivable.

    To effect a measurable change for Nursing to gain greater respect and legitimacy as a challenging academic discipline is to integrate more science; some schools are already headed that way. The prospective nurses already enter the field of nursing because they want to help others. And, that sort of personality trait will not be affected whether there is more theory added or not. Furthermore, go ahead and examine the curriculum of advanced nursing degrees, be it FNP or CRNA. They all end up taking the undergrad science core classes that are requisite to pre-medical or pre-pharmacy programs. Why do you think that is the case?

    Nurses are, indeed, a part of the medical team. Nurses are not there merely to be caring and fluffy, solely. For me, medication errors and not knowing the pathophysiological pathways bear more serious implications for deleterious patient care than not possessing excellent bedside manners. Being a caring human being is not a negligible requisite, but the "caring" slogan has been abused to ad nauseum in nursing. I want to be a competent, clinically sound nurse who aid in the healing and coping process for the patients. In the mean time, I want to impart an impression of a nurse who is a knowledgeable professional and not be perceived as someone who posses surface-skimming knowledge about human health and pathology. Caring should remain an undercurrent trait of human decency for both the physicians and nurses, not a central theme that drives our discipline away from what should be added to achieving psychological well-being for the patients.

    There is nothing wrong with nurses being medically knowledgeable and being able to think "like a physician" or a logical clinician. We already have those nurses around us. As nurses advance, they end up purchasing more medical references than nursing theory books. I sympathize that the nursing as a burgeoning academic discipline would like to align itself with something. I understand the assertion of the importance of nursing theories, but the academic discipline of psychology already exists and nursing should really take no shame in adding more science to its currently word-heavy curriculum.

    I have encountered and read so much on this forum how the nurses want their profession to be considered truly professional and, thus, be respected accordingly. Unfortunately, being more caring through acquainting more theories is not going to get nurses there. We already have tremendously caring nursing workforce. It's been established. And, I don't think that it would be churning out new theoretical paradigms every decade that will set nursing atop or apart. In my limited thought, it would actually be the rigorous curriculum that does not mimic social sciences but add depths to our existing nursing science curriculum, which reflect what nurses actually do and face on the floor as nurses. Evidence-based means scientifically-based through exercising empiricism. Theories are the mere outcome of these empirical experiments that are subject to scrutiny and to continued revisions based on more empirical data.

    Lastly, an added bonus to heavier science curriculum would be reduced utterances of this darned "critical thinking" that I hear so much in nursing; as a pre-med/pharm student for two years, never once a professor uttered that phrase because it implicitly comes with the territory. Science does indeed makes you think in a systematic fashion. It continues to prove to be an invaluable training tool for all nurses who pursue and advance their nursing careers.

    P.S.: I am sorry that this turned out to be a long-winded novelette. However, I really wanted to share my perspective while I am still somewhat of an outsider/public element looking in.
    Last edit by shaas on Dec 24, '10
  14. Visit  GHGoonette} profile page
    2
    Quote from shaas
    I know that this is not going to be a popular sentiment, but it is what it is, an unpopular but a legitimate gripe of mine. Please, bear with me.

    One salient oddity that I've noticed while taking an introduction to nursing class is the nursing academia's desire to align itself with socialpsych./psychology, which baffles me to no end. If you've majored in any known social science discipline (e.g. sociology, psychology, economics, etc.) and have gotten a degree after writing papers coming out of your arse, singing the same old tune in different keys, then you know this already; these discipline's aim is geared heavily toward integrating scientific empiricism and math to add credibility and garner academic clout. They even added 'science' to their moniker because science really does matter, in every way conceivable.

    To effect a measurable change for Nursing to gain greater respect and legitimacy as a challenging academic discipline is to integrate more science; some schools are already headed that way. The prospective nurses already enter the field of nursing because they want to help others. And, that sort of personality trait will not be affected whether there is more theory added or not. Furthermore, go ahead and examine the curriculum of advanced nursing degrees, be it FNP or CRNA. They all end up taking the undergrad science core classes that are requisite to pre-medical or pre-pharmacy programs. Why do you think that is the case?

    Nurses are, indeed, a part of the medical team. Nurses are not there merely to be caring and fluffy, solely. For me, medication errors and not knowing the pathophysiological pathways bear more serious implications for deleterious patient care than not possessing excellent bedside manners. Being a caring human being is not a negligible requisite, but the "caring" slogan has been abused to ad nauseum in nursing. I want to be a competent, clinically sound nurse who aid in the healing and coping process for the patients. In the mean time, I want to impart an impression of a nurse who is a knowledgeable professional and does not possess surface-skimming knowledge about human health and disease states. Caring should remain an undercurrent trait of human decency for both the physicians and nurses, not a central theme that drives our discipline away from what should be added to achieving psychological well-being for the patients.

    There is nothing wrong with nurses being medically knowledgeable and being able to think "like a physician" or a logical clinician. We already have those nurses around us. As nurses advance, they end up purchasing more medical references than nursing theory books. I sympathize that the nursing as a burgeoning academic discipline would like to align itself with something. I understand the assertion of the importance of nursing theories, but the academic discipline of psychology already exists and nursing should really take no shame in adding more science to its currently word-heavy curriculum.

    I read so much on this forum how the nurses want their profession to be considered truly professional and, thus, be respected accordingly. Unfortunately, being more caring is not going to get nurses there. We already have tremendously caring nursing workforce. It's been established. And, I don't think that it would be churning out new theoretical paradigms every decade that will set nursing atop or apart. In my limited thought, it would actually be the rigorous curriculum that does not mimic social sciences but add depths to our existing nursing science curriculum, which reflect what nurses actually do and face on the floor as nurses.
    You mention specifically psychology and sociology, but there is one aspect which is very important for any bedside nurse to know, and that is the psychological effect of illness and hospitalization on any person. Judging by your post, your appear to have already studied these subjects "ad nauseam", so you already know what I am referring to.

    You must also bear in mind that not every nurse will elect to work in a first world country, and a good grounding in social and cultural usage may very well come in handy for those who practice in rural communities.

    Caring should be a trait of both physicians and nurses, as you say; in fact it would be great if such a quality could be imparted to the entire human race. But I do not think that simply drumming the concept into students' heads is going to make them better caregivers; they either have it or they don't..... And if they don't, they probably won't remain at the bedside.
    NRSKarenRN and dishes like this.
  15. Visit  shaas} profile page
    1
    Hi, GHGoonette.

    My assertion really does not differ much from yours. That is why it is stated that caring should remain an undercurrent trait for both physicians and nurses. It's a human decency issue, and may not be a teachable trait at all. It is an implicit requirement that needs not be stated as it does not need further campagining for it. I believe that the public is well aware of the caring nature of this profession and so do the prospective nurses who enter the field. Who in their right mind enter this profession if they are not ready to do often times the "dirty and thankless" job?

    As I am reading posts written by many experienced nurses, it is not just the society that is evolving but the field of nursing as well. The demands on nurses evolve and change, and bedside nursing is not exempt from it, it seems. Yet, it has been indicated by many that there is a stagnant impression on nurses as a collective, both by the public and the physicians and other health professionals, and it is not always a positive picture, treatment, or a fitting adjective for nurses' hard work.

    My post is not quite about whether nurses should be genuinely caring individuals or not. Neither of us can define with absolute certainty what constitutes a truly caring nurse. Only the recipient, the patient, can be the judge. Even then, it is subject to the patients' perceived notions.

    Nursing theories are great, as long as they are empirically based as they are purported and supposed to be. But, it is not necessarily the right tool to elevate the status of nurses as profession. That recognition comes from other medical professionals and the public. It really has no bearing even if all nurses are gung-ho about these nursing theories and find relevance in their daily practice because the recognition we aspire to attain to elevate our professional status invariably needs to come from others.

    We already know that nurses do and know far more than what is being recognized by others. I don't think that nurses lack the awareness of social and psychological needs of the patients, or the cultural awareness, irrespective of where they decide to practice. Nurses have been drilled if not already equipped with them from their prior life experiences. Those who do not get it may not get it. Ever. This degree of caring and cultural and social sensitivity are deeply interdependent and intertwined, I think. A notion that a caring individual can be culturally unaware seems fallacious to me. A caring indvidual is more likely to learn these cultural and social variables of the patient to provide better care. But, then, again it is my subjective assumption and a wish.

    The questions I bore in mind when I wrote the long-winded piece are:

    1) Would focusing on nursing theories or the discipline of psychology (following their research method) elevate the status of nursing as a whole?
    2) Why do some patients demand "I want to talk to the doctor"?
    3) Why do some physicians not prefer to confer with nurses who provide direct care but reserve discussing them with their medical 'colleagues'?
    4) What is lacking in an average nursing curriculum to be recognized as a rigorous academic program?
    4) Does nursing really differ much and should be disparately considered from the whole picture of medical care provided for the patient?
    5) What is the reason for overused slogans such as "caring" and "critical thinking"?

    I know, I make the readers and myself tired. But, some nights I cannot stop my internal dialogue and I post my thoughts.
    Last edit by shaas on Dec 24, '10
    GHGoonette likes this.


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