I *do* recognize the need for nursing theory - page 16

but I am a bit appalled by the theory and research classes requird for my NP program while we covered the entire cardiovascular system in 1.2 hours of Patho. Why is that ?????????????????? We have... Read More

  1. by   byrd262
    Hello all,
    This is a really interesting thread. Forgive me if this was already discussed (I didn't read all the pages), but is there theory in traditional medicine (MD)? If yes, how is it different? I haven't started my nursing program yet, so I haven't taken theory yet.
  2. by   BlackAdonis
    Nursing theory is essential to our practice. It goes hand in hand with research and professional developement. Without it we are minimalizing ourseleves to a bunch of glorified butt wipers...
  3. by   Kelly_the_Great
    Welcome to all the new readers!

    This thread orignated some time ago and I have slept (many times) since our initial discussions...

    However, unless my memory serves me wrong ~ no one was advocating that theory be thrown out altogether, rather the point of contention was the emphasis, which is placed upon it.

    Does theory guide practice? No doubt, of course it does. However, when the body of knowledge related to the application of nursing science is so vast and there are so many varying theories;
    the general consensus amongst most of the posters on this thread was that there could be a greater degree of equilibrium between the two (theory & practice) within our schools of learning.

    P.S. This thread has been hands down my favorite on All Nurses!
  4. by   bookwormom
    Quote from byrd262
    Hello all,
    This is a really interesting thread. Forgive me if this was already discussed (I didn't read all the pages), but is there theory in traditional medicine (MD)? If yes, how is it different? I haven't started my nursing program yet, so I haven't taken theory yet.
    I believe the older theories in medicine are allopathy and osteopathy. Both of these have a sort of theoretical framework. Less prominent theories of medicine would be homeopathy, naturopathy and chiropractic. I think you could also say that "holistic medicine" incorporates another theoretical approach. I apologize for not explaining these theories in any more detail. (Maybe someone with a better background in medical theory could add to this?) I think that other health care disciplines also have theoretical bases. For example, I remember being surprised at the theory emphasis in an occupational therapy text.
  5. by   chupacabra
    we are not glorified butt wipers if we question the validity and coherence of "nursing theory" or "nursing science" as a legitimate discipline. More appropriately, there are aspects to nursing theory that are difficult, such as, the grand theories of nursing. Why devote a class to them? In fact, they are ethical theories; that is, they describe approaches to dealing with patients while in the role of the nurse. As ethical theories, they are difficult to operationalize into scientific propositions. If we could start by agreeing to this fact, then much of the content of "nursing knowledge" would be more logical and accessible. However, nursing theory is generally ascribed the notion of science (which it isn't) and we proceed to spend much time running around in circles. An ideal curriculum would put grand theories of nursing and relate them to ethical theories. Mid range theory could be integrated with care of the the patients they deal with (kolcaba's sp? comfort theory with a discussion of pain). The whole issue of nursing diagnosis either needs to be tossed or significantly revised. The nursing process would be much more simple and accessible to students if we could make medical diagnosis when appropriate (sorry D. Orem) such as the case when a pt is hypertensive. My contention is that any junior nursing student can make this diagnosis although she likely can do little to treat it unlike someone with more training. However, in nursing school, instead of following a logical course of reason and diagnosis htn, we instead call it altered hemodynamics which is a meaningless term that obscures not only the condition but also any learning that may have been possible for the poor student. To go back to the original complaint, if we are clear about what nursing theory and science really are, we will be professionals with integrity shaped by ethical discussion with the thinkers of nursing (who need to be reinterpreted for our modern situation.) and not glorified butt wipers (besides, how is butt wiping glorified anything?)

    el chupacabra
  6. by   Josh L.Ac.
    The two classes that I am in to start my master's degree are Graduate Research and Advanced Nursing Theory.

    Yeah.



    I will readily admit that my Nursing Theory class is not as bad as I thought it would be. The Theoretical Nursing 4th Ed text by Meleis is a fairly decent read, although in the first few chapters I can definitely see a major point of contention that might contribute to the schism:


    Do we need nursing theory? If we [as APN's] use theories from other fields like medicine, does that devalue nursing?


    Now I understand the need to separate ourselves from other health care fields by developing and utilizing our own theory, but is it an effective use of curriculum time to focus on the nuances of nursing theory as opposed to spending more time in the clinic or taking cadaver anatomy [or taking more therapeutics classes that pertain to our focus area]?


    It almost seems like the desire to push nursing theory (instead of borrowing from other fields) is resulting in the exclusion of knowledge from other fields.




    [returns to reading about nursing ethics...]
  7. by   dhigbee
    I spent way too much time on theory and research in my master's degree. I wanted more time with pathophys, biochemistry, disease management, cardiology, and so on. Now the DNP programs (which are supposed to be practice doctorates!) are more of the same. Theory and research, leadership and management. I won't be getting a DNP unless they truly morph into practice doctorates.

    Dana
  8. by   llg
    Quote from Josh L.Ac.
    It almost seems like the desire to push nursing theory (instead of borrowing from other fields) is resulting in the exclusion of knowledge from other fields.

    [returns to reading about nursing ethics...]
    For the record, I agree ... and I teach a theory course. I think most people teach theory horribly and cling to out-dated notions about theory and its place in our profession.

    I value theory immensely and know that we have to continue our development of nursing theory. But that development needs to be done without being overly afraid of theory developed from within other disciplines. We need to position ourselves as equal partners in the scholarly world -- working WITH the scholars of other disciplines, not working in opposition to them.

    I think our profession got so hung up in trying to define what is UNIQUE to nursing (which is an important task for us) .... that some people can't think of OTHER scholarly issues that ALSO need to be accomplished that involved scholarship and theory development.

    We act as if we have an inferiority complex. I think that inferiority complex is part of the reason we are so weak in the theory area ... but I also think we are weak in that area because so few nurses are willing to embrace the theoretical work that needs to be done to improve our theory. Not many nurses like it, so the work doesn't get done ... which leads to bad theory ... and poor theory teachers ... which causes students to hate it ... which results if few people willing to do the work that needs to be done ... etc. etc. etc.
  9. by   allaboutthefamily
    The last four paragraphs of the sidebar are simply.....

    http://jef.raskincenter.org/publishe...ryForSite.html
  10. by   ZASHAGALKA
    Quote from llg
    For the record, I agree ... and I teach a theory course. I think most people teach theory horribly and cling to out-dated notions about theory and its place in our profession.

    I value theory immensely and know that we have to continue our development of nursing theory. But that development needs to be done without being overly afraid of theory developed from within other disciplines. We need to position ourselves as equal partners in the scholarly world -- working WITH the scholars of other disciplines, not working in opposition to them.

    I think our profession got so hung up in trying to define what is UNIQUE to nursing (which is an important task for us) .... that some people can't think of OTHER scholarly issues that ALSO need to be accomplished that involved scholarship and theory development.

    We act as if we have an inferiority complex. I think that inferiority complex is part of the reason we are so weak in the theory area ... but I also think we are weak in that area because so few nurses are willing to embrace the theoretical work that needs to be done to improve our theory. Not many nurses like it, so the work doesn't get done ... which leads to bad theory ... and poor theory teachers ... which causes students to hate it ... which results if few people willing to do the work that needs to be done ... etc. etc. etc.
    I agree with some of what you say. I think we have gone about it from an inferiority perspective, that we've tried to use theory to shore up that inferiority. I think that was bound to fail, in that regard.

    I disagree that the problem is so few nurses willing to embrace theory or the theoretical framework necessary to improve it. Theory should be about praxis. Praxis is how well the theoretical translates to the practical - how well our theory actually translates to the trenches.

    So, I think you have it backwards. The problem with theory isn't that it's not embraced by the masses. The problem is that it isn't embraceable by the masses. The masses of nurses do not need to adapt to theory. Theory needs to adapt to the masses of nurses.

    Theory is a product. You have to sell a product (as you say, teach it better). Yes. But, it also has to have some inherent value on its own. It has to actually have meat to go with the sizzle. I don't think theory does. That's not to say that there is no value for anyone. Clearly, theory is valuable for some. However, for much of theory, there seems to be no inherent value that many nurses cannot also find elsewhere in their overall spiritual warehouse of knowledge.

    Each of us have our own religions or our own spiritual values that we bring to our jobs. Not only do we not NEED nursing theory for this task, that theory could not possibly address the spiritual framework of all or even most nurses. I know, I know - it's not necessary to be all things to all people; it's a buffet. However. A buffet is not the same thing as 'core knowledge'. Core knowledge is just that - core, foundational. If you argue that theory was never meant to be core knowledge, then you are arguing that it is 'optional'. In THAT case, there is no place for concern that the masses of nurses haven't taken out an option on theory. It can't be both ways.

    So, theory gets dismissed by the masses of nurses not because there isn't some value to it. No. It gets dismissed because the value that it has is duplicative. I bring my OWN spirituality to my job. I neither need - NOR WANT - the spiritual framework of a liberal elite to be pushed on me. I do just fine with my own spirituality.

    It's about praxis. It's not that theory hasn't been taught well enough. It's that theory offers nothing of practical value to most nurses. That is well established. Most practicing, in-the-trenches nurses can't name three theorists or comprehensively describe one theory. If you want theory to matter to the masses, then that theory has to be relevant to the masses. Currently, that just isn't the case.

    There is an utter lack of praxis in nursing. THAT is what is wrong with theory.

    Theory should depart its eastern religion sophistry and bend more towards our science. THAT I could readily embrace. We've over-embraced the 'angels' of our nature. It's time to look more towards our professional practice.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Apr 6, '08
  11. by   ZASHAGALKA
    To me, my nursing school education caused me increasing apprehension about working as a nurse. If this touchy-feely stuff being taught was what nursing was really about, I was in deep trouble. If our language was really the pseudo-sophistication of care plans and 'metaparadigmatic' theory, then I was over my head.

    I had been sold on the solid 'science' of nursing. This stuff wasn't it. I only survived nursing school because I knew the 2 rules of college: 1. The instructor is always right, and 2. If you want to pass, see rule #1. That saved me. It allowed me to answer back on exams stuff that I thought was truly preposterous.

    I felt like nursing's 'core' knowledge and language was either an outright lie, or an inside joke that I didn't get.

    It hit me in my next to last semester. This was a game. It was a game that all the students were playing - out of necessity to pass. In reality, the instructors were naked emperors and non-academic true believers were few and far between. The nurses that I saw in clinicals - they had stopped playing long ago because their careers were no longer bound to the game. I began to understand that lots of the stuff they teach in nursing school was outright indoctrination that could be safely tossed on the curb.

    As a result, I became a better nurse. I was fundamentally relieved. I COULD be a nurse without buying all the tripe being taught in school. It was nothing less than an epiphany that saved my nursing career before it started.

    It made me a great nurse. Ignoring nursing theory allowed me the confidence to pursue my own spirituality and apply it to nursing. To that extent, I'm in comfortable territory. That comfort zone frees me to expand upon my science and, as a result, provide the best combination of both science and spirituality.

    I'm no angel. I don't try to be, nor would I want to be. Instead, I am scientifically educated with a high level of experience to manage critically complex equipment and titrated medications in an environment of constant monitoring and re-evaluation. I do bring compassion and caring to the table, but I do so on my own terms. I'm very good at it. After my ADN, when I pursued my bach degree, I chose biology - a scientific underpinning for my nursing career that I did not believe I could get with a BSN.

    By making theory a 'buffet', nursing made it optional. It's no surprise to me that the vast majority of nurses opt out. I would. I did.

    I know that there are some that read this post and are appalled about what I have written. I know that there are some that strongly disagree with me. Here's the thing. I stipulate that the majority of practicing nurses agree with me and a large number of students will read this post with a nodding sigh of relief. It's a game. Play it and pass. THEN, you can be the best nurse YOU can be. You don't need that stuff to do so.

    I offer proof for students. As you encounter practicing nurses in your clinicals, routinely ask them 2 questions. 1. What do you think about care plans? 2. Can you name three nursing theorists? The answers you receive will be very instructional. The chief downfall to theory in nursing is that students must be exposed to practicing nurses and it becomes evident over time that there is a disconnect between school and reality in nursing.

    The reason for that disconnect is that there just isn't any praxis to nursing. Theoretical nursing and actual nursing practice are two very different things. That's not the fault of practicing nurses. If theory is to be embraced, it must be relevant. It's not. No improvement in its teaching can make it something that it isn't.

    ~faith,
    Timothy, RN, CCRN, BA-Biology.
    Last edit by ZASHAGALKA on Apr 6, '08
  12. by   llg
    Timothy,

    I am not feeling very well. So, I am not going to linger in this thread very much and get into a big debate. But I am encouraged that we seem to be coming closer together in our long-standing discussion.

    We both agree that many theories are not very good. We both agree that the focus of theory should be praxis. We both agree that not many nurses like theory.

    It seems that now, we are simply looking at the same circular process from different sides of the circle. From one perspective: Nursing theories are bad, which causes nurses to turn away from them. From the other perspective: The fact that so many nurses turn away from theory results in our profession's failure to develop better theories.

    I suggest that we are not really disagreeing here -- but seeing the same circular process from different sides of that circle. If I could draw a circular diagram in this software to illustrate my point, I would. But I think you can see what I mean without it.
  13. by   ZASHAGALKA
    Quote from llg
    Timothy,

    I am not feeling very well. So, I am not going to linger in this thread very much and get into a big debate. But I am encouraged that we seem to be coming closer together in our long-standing discussion.

    We both agree that many theories are not very good. We both agree that the focus of theory should be praxis. We both agree that not many nurses like theory.

    It seems that now, we are simply looking at the same circular process from different sides of the circle. From one perspective: Nursing theories are bad, which causes nurses to turn away from them. From the other perspective: The fact that so many nurses turn away from theory results in our profession's failure to develop better theories.

    I suggest that we are not really disagreeing here -- but seeing the same circular process from different sides of that circle. If I could draw a circular diagram in this software to illustrate my point, I would. But I think you can see what I mean without it.
    I hope you feel better. I think you are correct. I would be happy to engage in theory if theory was something I could sink my teeth into. In its current form, it isn't.

    I wish that weren't the case. I want to see my profession be all it can be.

    Just like you.

    Take care.

    ~faith,
    Timothy.

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