I *do* recognize the need for nursing theory - page 5

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   ZASHAGALKA
    Quote from krisssy
    I, also, was a teacher-for 25 years. I was highly respected, teacher of the year, a mentor etc. etc. etc. I never used educational theory. Honestly, I don't even remember what it is. My teaching was based on evidence to back up practice. At the beginning, I learned by watching other teachers who I thought were good at their job and by reading everything that made good sense to me.. Eventually, by trial and error, I learned to be great in my field. I learned by EXPERIENCE and observation of the good and bad teaching skills around me. I learned by observing the children. I learned by doing, reading, listening and observing everything around me. I learned by years and years of very hard work bringing suitcases full of books home each night. I learned by trial and error and trying new things and ways. When something worked, I continued to use it. If it didn't work, that was the end of it. Toward the end of my career, they came out with Educational Standards and constant meetings to discuss them. No one used these standards, and half the teachers didn't even understand them. What the new teachers wanted to know from me was, "How do you do what you do so well?" "Show me, teach me, talk to me, help me, share with me, observe me, let me observe you etc. I spent hours after school showing new teachers how to teach. We talked, and they listened , and they observed, and they learned well. The theories and the standards were words that meant nothing to any of us EXCEPT the people on the committees wasting their time writing about theory and standards that everyone ignored, because they were boring and not practrical at all.

    As far as nursing, I am just starting my NP in Psych program this winter. My first course is Theory. I am enjoying listening to what everyone here has to say about nursing theory. I will let you know what I think when the course starts. Please keep sharing your thoughts. I am really looking forward to taking the course so I can share my own opinions! Right now, I agree with this poster, "Evidence to back up practice seems the way to go for me as of now! At least that is what worked when I was teaching. Krisssy
    And this is essentially how every good nurse become a good nurse: by individual observaton and incorporation of what works.

    Now, if nursing leaders want to examine and expound about what works and pass along those pearls of wisdom, that would be a wonderful base of knowledge to instill into our students.

    With the world looking to medicine to back up its practice with evidence, this would be an appropriate path for our researchers and leaders to follow.

    As of now, bedside nurses can only really start to 'get it' when they chuck the theory garbage to the curb and realize that it is what it is: just a horrible, insensitive, inside joke. You can't really laugh, you can really only just be embarrassed. And then move on.

    ~faith,
    Timothy.
  2. by   grannynurse FNP student
    Quote from 1Tulip
    For the record, I have a PhD in one of the biological sciences and have done research for 14 years with a break of 3 years to teach Pharm and Pathophys on the graduate level. I hope to start a job as a bedside per diem nurse on a neuro unit this month. I have an application in for a tenure track position in a SON and, if hired, would need up to date clinical skills.

    None of which makes my opinion on Nsg. Theory any better than anyone elses'. I'm not sure I understand GrannyNurses' objection to my/our doubts about Nsg Theorists. I think she is suggesting that the anti-Theorist rhetoric is maybe anti-intellectual or anti-nursing scholarship. (She can correct me if I'm wrong.)

    It is, indeed, my strong feeling that the bedside (broadly defined) is the well from which we must draw our definitions of nursing. That context and none other. If it were shown that working nurses object to, do not use, feel frustrated and intimidated by discussion of nsg. theory, then it's time to ask why we are expending a huge (HUGE!!!) amount of academic capital preserving it.

    Somewhere, somehow, that discussion must take place.
    I find that some of those who object to nursing theory are generally anti-nursing scholarship. By this I mean, they are generally not supportive of nursing research that is esoteric in nature, to them. And by that, they appear to demand that all nursing theory and practice be founded in the practical application only. Theory, regardless of the field of study, is an attempt to formulate and explain the phenomenon. The objective of it is formulation of generalizations to explain relationships in a given field of study. It primary use in practice is to provide insight regarding nursing practice (you can substitute any profession) and to guide practice. Theory is meant to identify the focus, means, and goals of practice. The use of it helps to enhance communication, increasing autonomy and goals of practice. Scholarship, for many, beyond the basics, is difficult to understand. Some want theory distilled to the lowest common denominator. They either refuse to recognize or really fail to understand, that new theories are responsible for the development of lanuage to explain their theories. Rather then attempt to understand, they dismiss nursing theory as pointless and irrelant to their practice. I wonder what Florence Nightengale would have to say?

    When I was a young nurse, I took two classes taught by Jean Watson. Her explanation of her theory was somewhat difficult for me to grasp but I struggle through it. I also later took a class taught by Imogene King. Her theory of goal attainment was more palatable to my taste, although I really follow Leininger's Transcultural Theory. Formulating a theory is not a task for the faint of heart. It is a difficult task and it is one that our profession needs to embrace, instead of dismissing it as something unnecessary to our practice. If that happens, then nursing will no longer be a prossion, just a technical job. And despite what many appear to believe, nursing theory does take its bases from bedside nursing.

    Grannynurse
  3. by   Kelly_the_Great
    Quote from grannynurse FNP student
    If all one can do is articulate the negative and their own failure to understand, even attempt to understand, they are clearly lacking in cognitive abilities.
    Why would you say they are lacking in their cognitive abilities?

    The statements of dissent I have seen thus far, have been presented in a manner that is indicative of persons who posses above standard/superior intellect (imo).

    Of course, as I stated earlier, I'm not at all as educated and for that matter as intellectual as many (maybe even all) of the posters on this thread but I can appreciate and recognize intellegent discourse when I see it. And am really enjoying this discussion.

    I hope the thread can continue in a spirit sharing wisdom versus challenging others' knowledge and intellect if there is disagreement.
  4. by   grannynurse FNP student
    Quote from Kelly_the_Great
    Why would you say they are lacking in their cognitive abilities?

    The statements of dissent I have seen thus far, have been presented in a manner that is indicative of persons who posses above standard/superior intellect (imo).

    Of course, as I stated earlier, I'm not at all as educated and for that matter as intellectual as many (maybe even all) of the posters on this thread but I can appreciate and recognize intellegent discourse when I see it. And am really enjoying this discussion.

    I hope the thread can continue in a spirit sharing wisdom versus challenging others' knowledge and intellect if there is disagreement.
    I am sorry if you feel disrespect. However, I stand by what I have posted. Many of those who dismiss nursing theory and say it has no place in nursing, demonstrate their own inabilities to comprehend the abstractness of theory. And I have attempted to maintain an theorical discussion, with the result being only one poster responding in kind. All others have either posted a reference to an individual who has no base for his criticism, or have dismissed theory with out an adequate explanation, other then to claim it doesn't relate to THEIR clinical practice.

    Grannynurse
  5. by   Kelly_the_Great
    Quote from grannynurse FNP student
    I am sorry if you feel disrespect. However, I stand by what I have posted. Many of those who dismiss nursing theory and say it has no place in nursing, demonstrate their own inabilities to comprehend the abstractness of theory. And I have attempted to maintain an theorical discussion, with the result being only one poster responding in kind. All others have either posted a reference to an individual who has no base for his criticism, or have dismissed theory with out an adequate explanation, other then to claim it doesn't relate to THEIR clinical practice.

    Grannynurse
    No, I didn't feel disrespected b/c I didn't think you were referring to me.

    I just wondered why you attacked their cognitive abilities. That was my question. I wondered this b/c, to me, the posters have had valid arguments and have presented them in an intelligent manner.

    Oh well. I suppose it really doesn't matter. I'm just very interested in our intraprofessional interactions and I was just curious.

    Since theory is such an emphasized aspect of nursings' core curriculum, I'm sure there will be many others who echo your views relating to the importance of theory.

    In the meantime, I'm enjoying the discussion and feel very fortunate to have stumbled upon it!
  6. by   gauge14iv
    Humor me and ponder this for a few minutes -

    Lets say (just for the sake of this) you were raised in a catholic home, in a catholic community and schooled in a catholic church, in addition you attended a catholic university and worked at catholic institutions. And lets say you are very involved in the catholic church you attend.

    How likely would it be that you would readily convert to judaism without a second thought? How indoctrinated would you be in the ways of catholicism? Right down to your view and vision of the world, of people as humans, your relationships with others, your choices in life, your family structure and the friends you chose to surround yourself with...all of these would be influenced to some degree by your catholic religion, would they not?

    And how much of that religion would be based on what you THINK you know, as opposed to what you actually are 100% certain of?

    So nurses are "brought up" in one theory or another...we think we know certain things about certain theories. We are given a few favorite theories which are handed down in schools based on what that school chooses to teach. Do we take those at face value? Or do we question them?

    A nurse in a clinical unit tells a new nurse that there is no need to push an IV med slowly - does that new nurse take that at face value or does she do some further investigating to determine what the best practice might be?

    To squelch the questioning of theory is to squelch the stream of clinical inquiry. Nurses can no longer be expected to stand idle while another medical professional kills a patient with a practice that is not evidence based, but yet thats essentially what those who say we should not question theory are asking us to do!

    We make it all up really - we just think we know (and theorists think they know) what nursing is. Not everyone agrees upon a given theory, and really, those who know theory tend to pull parts and pieces from various theories and use what works for them. Since none of us agree on one theory, the profession is in eternal divide and conquer mode.

    The point is - what we are doing really isn't working for us as a profession. As a whole, we don't embrace and believe in theory. Many (maybe even most I would venture to say) nurses are dissenters where theory is concerned. We aren't a unified body - not even in theory. And since we can't be unified in the beliefs that underly our profession, then theory really needs to examined. To throw ALL of it out would be throwing out some valuable stuff, but to not question it at all is to know only one religion and take heresy for fact.

    We question because we can, I don't believe humans were meant to follow anything in blind faith - thats MY belief...
  7. by   krisssy
    Quote from gauge14iv
    Humor me and ponder this for a few minutes -

    Lets say (just for the sake of this) you were raised in a catholic home, in a catholic community and schooled in a catholic church, in addition you attended a catholic university and worked at catholic institutions. And lets say you are very involved in the catholic church you attend.

    How likely would it be that you would readily convert to judaism without a second thought? How indoctrinated would you be in the ways of catholicism? Right down to your view and vision of the world, of people as humans, your relationships with others, your choices in life, your family structure and the friends you chose to surround yourself with...all of these would be influenced to some degree by your catholic religion, would they not?

    And how much of that religion would be based on what you THINK you know, as opposed to what you actually are 100% certain of?

    So nurses are "brought up" in one theory or another...we think we know certain things about certain theories. We are given a few favorite theories which are handed down in schools based on what that school chooses to teach. Do we take those at face value? Or do we question them?

    A nurse in a clinical unit tells a new nurse that there is no need to push an IV med slowly - does that new nurse take that at face value or does she do some further investigating to determine what the best practice might be?

    To squelch the questioning of theory is to squelch the stream of clinical inquiry. Nurses can no longer be expected to stand idle while another medical professional kills a patient with a practice that is not evidence based, but yet thats essentially what those who say we should not question theory are asking us to do!

    We make it all up really - we just think we know (and theorists think they know) what nursing is. Not everyone agrees upon a given theory, and really, those who know theory tend to pull parts and pieces from various theories and use what works for them. Since none of us agree on one theory, the profession is in eternal divide and conquer mode.

    The point is - what we are doing really isn't working for us as a profession. As a whole, we don't embrace and believe in theory. Many (maybe even most I would venture to say) nurses are dissenters where theory is concerned. We aren't a unified body - not even in theory. And since we can't be unified in the beliefs that underly our profession, then theory really needs to examined. To throw ALL of it out would be throwing out some valuable stuff, but to not question it at all is to know only one religion and take heresy for fact.

    We question because we can, I don't believe humans were meant to follow anything in blind faith - thats MY belief...
    Great post Gauge14iv, I recently took a refresher course. If I followed everything I saw and was told with "blind faith", I would have bathed a patient with MRSA without gloves, left meds on the patient's nightstand while she was in the bathroom, not put a gown on AND ENTERED A ROOM WHERE THE PT. WAS IN ISOLATION -AMONG OTHER THINGS. When a nurse being precepted is told something that she or he thinks is wrong, it MUST of course be questioned. I am taking a graduate theory course in Jan. After this discussion, I am truly lookng forward to taking it, and I intend to read, and decide what I personally believe in. Thank you again for a very intersting and terrific post. Krisssy
  8. by   gauge14iv
    If I hadn't been so dumbfounded by the verbage at times, theory class would have been a lot more fun if I'd been argumentative about it!!!!!
  9. by   grannynurse FNP student
    Quote from Kelly_the_Great
    No, I didn't feel disrespected b/c I didn't think you were referring to me.

    I just wondered why you attacked their cognitive abilities. That was my question. I wondered this b/c, to me, the posters have had valid arguments and have presented them in an intelligent manner.

    Oh well. I suppose it really doesn't matter. I'm just very interested in our intraprofessional interactions and I was just curious.

    Since theory is such an emphasized aspect of nursings' core curriculum, I'm sure there will be many others who echo your views relating to the importance of theory.

    In the meantime, I'm enjoying the discussion and feel very fortunate to have stumbled upon it!
    In reply to your question regarding cognitive abilities. Cognitive ability refers to the mental process by which knowledge is acquired. Dismissing an entire body of knowledge because it does not fit into their definition of their nursing practice demonstrates, IMHO, a clear deficit in cognitive ability. Or perhaps ignorance of what a theory is all about. Darwin's theory of evolution is a theory steeped in scientific principles and generally is accepted, except by the far right. However Kant's theories are present in the abstract and are difficult for many to understand and accept.

    I would appreciate your sharing with me just which posts you find that are so valid in their argument, against nursing theory and its place and role in our profession. You can e-mail me your reply. Like I have posted, many of the responses against nursing theory tend to rely on its supposed failure to meet scientific theory or their own standard of practice. The one theorists they seem to dislike the most is Jean Watson. How about I. King, Lenienger, Dorothea Orem, Callista Roy. or Betty Neuman, surely one of these theorist's meets ones definition of having insight into clinical nursing. I know that Lenienger and Roy's theory of nursing clearly are related to clinical practice. Wouldn't you agree?

    Grannynurse
  10. by   grannynurse FNP student
    Quote from gauge14iv
    Humor me and ponder this for a few minutes -

    Lets say (just for the sake of this) you were raised in a catholic home, in a catholic community and schooled in a catholic church, in addition you attended a catholic university and worked at catholic institutions. And lets say you are very involved in the catholic church you attend.

    How likely would it be that you would readily convert to judaism without a second thought? How indoctrinated would you be in the ways of catholicism? Right down to your view and vision of the world, of people as humans, your relationships with others, your choices in life, your family structure and the friends you chose to surround yourself with...all of these would be influenced to some degree by your catholic religion, would they not?

    And how much of that religion would be based on what you THINK you know, as opposed to what you actually are 100% certain of?

    So nurses are "brought up" in one theory or another...we think we know certain things about certain theories. We are given a few favorite theories which are handed down in schools based on what that school chooses to teach. Do we take those at face value? Or do we question them?

    A nurse in a clinical unit tells a new nurse that there is no need to push an IV med slowly - does that new nurse take that at face value or does she do some further investigating to determine what the best practice might be?

    To squelch the questioning of theory is to squelch the stream of clinical inquiry. Nurses can no longer be expected to stand idle while another medical professional kills a patient with a practice that is not evidence based, but yet thats essentially what those who say we should not question theory are asking us to do!

    We make it all up really - we just think we know (and theorists think they know) what nursing is. Not everyone agrees upon a given theory, and really, those who know theory tend to pull parts and pieces from various theories and use what works for them. Since none of us agree on one theory, the profession is in eternal divide and conquer mode.

    The point is - what we are doing really isn't working for us as a profession. As a whole, we don't embrace and believe in theory. Many (maybe even most I would venture to say) nurses are dissenters where theory is concerned. We aren't a unified body - not even in theory. And since we can't be unified in the beliefs that underly our profession, then theory really needs to examined. To throw ALL of it out would be throwing out some valuable stuff, but to not question it at all is to know only one religion and take heresy for fact.

    We question because we can, I don't believe humans were meant to follow anything in blind faith - thats MY belief...
    I was born and raised in a Catholic family and attended Catholic schools until the age of 12. I was taught religion, thru my junior and senior high school years by Jesuits, the acknowledged masters of catholic theory and argument. The one thing that they taught me, was to question what I did not understand and not to accept, with blind faith, anything I was taught. I do not consider myself indoctrinated by my faith. I have always questioned articles of my faith and have not blindly accepted it, just as I was taught to do.

    Nursing theories are evolving and changing. A theorist I followed, in my younger days, is not the same one I follow today. The program I am in, follow's King, whose theory I understand but do not accept whole heartly. Dissention is acceptable when it is based on knowledge and logic. It is not acceptable to dismiss nursing theory by claiming it doesn't follow one's clinical practice. Or to dismiss faculty by saying they remain in their ivory towers far from clinical practice. I have attended three universities and all of my facualty members were actively engaged in some aspect of clinical practice. I often wondered where they found the time to teach, practice and conduct research, until I met my SO. He holds a PhD, actively teaches three days a week at university, does research and helps care for a relative with MS.

    What about Sister Callista Roy's theory that a person is an adaptive system, who is in constant interaction with an ever changing environment; and is constantly changing and adapting. In regards to those that believe theory plays no importance in their clinical practice, do they so easily dismiss the changing role of a patient, in his/her attempt to adapt to their changing environment. How about a hospitalized patient, who is an RN, who reacts to a change in her role and function, from a nurse to a patient. And how one helps or does not help this patient deal with the change in her role. Roy's theory is just one of the theorist that I have done research on, along with King and Lenieger. And whose theory has been incorporated into nursing research, into my clinical practice area. How about some comments on her theory or any other one. And comments on clinical research that has been done in support of or non-support.

    Granynurse
  11. by   grannynurse FNP student
    Quote from gauge14iv
    If I hadn't been so dumbfounded by the verbage at times, theory class would have been a lot more fun if I'd been argumentative about it!!!!!
    Funny, the graduate course, in nursing theory, at Sage College and the University of South Florida, encourage distention. We did have to back up our argument with data grounded in our dissension and thory, as well as logic..

    Grannynurse
  12. by   1Tulip
    First of all... I would like to compliment everyone on this thread. I have never heard or read a more robust and honest discussion of this topic.

    Let me try to respond to GrannyNurse. She has taken the not-so-popular position here and I want to be thoughtful in answer.
    She writes...
    "I find that some of those who object to nursing theory are generally anti-nursing scholarship. By this I mean they are generally not supportive of nursing research that is esoteric in nature."

    I understand the word "esoteric" to mean ... intended for, or understood only by a particular group, as in an esoteric cult. (See dictionary.com) I don't think that's the word she meant because it would be a tautology to say "people don't understand what they aren't intended to understand." I think... correct me if I'm wrong here... that she was saying that some nurses have no patience for ideas that start to get metaphysical in nature. She's right to make that observation and call it for the fault that it is. Many nurses are way into "doing" nursing and not "thinking" (about) nursing.

    Let me try to bridge the gulf between those who want room for scholarship into the metaphysics of nursing, and those who object to the anti-scientific aspects of such scholarship.

    I would suggest that we make room for very expansive and evolving inquiry into the nature of nursing. BUT don't call it science. Call it what it is... philosophy. And there is nothing wrong with philosophy. It's a good thing and if nursing is more introspective than some professions, so what? I see it as a strength, not a weakness.

    Science, as understood by other professions is firmly rooted in empiricism. Scientists would say, in effect, "if you can't measure it, you can't study it." Those that want to base research on metaphysical epistemology (Rogers/Watson) are in a bind. Their research is not comparable to that done elsewhere in the academy. If we nurses want to interact with and be as respected as..physiologists, physicians, pharmacologists, chemists, molecular biologists, or anyone in the hard sciences, we have to give up the pretense that gnostic nursing theory is science.

    BUT gnostic-Watsonianism-Rogerianism CAN bridge nursing to other soft-science departments, especially those that are heavy into post-modern scholarship. Political science, Philosophy, Journalism, Education, Psychology (especially in departments that are non-neuropsychometrically oriented), Sociology, Social Work, Women's Studies and so on. That is perfectly OK. We are a very unique discipline and we can relate to almost the whole University community in one way or another.

    Here's the rub, however. The empiricists among us (evidence-based, clinically or hard-science oriented scholars) are absolutely shut out of the dialogue. Those running schools of nursing, editing the journals, leading the professional organizations, funding the "research" have defined empiricists OUT of the profession by maintaining that their (gnostic) philosophy is, in fact, synonymous with nursing science.

    I disagree wholeheartedly. The gnostic theorists are philosophers, not scientists. The strength of any philosophy is found in how well it responds to critical examination and debate. The Old-Gals that run nursing go to great lengths to avoid exactly that kind of dialogue.

    There is nothing wrong in developing a philosophy of nursing and teaching it to students. There is A LOT wrong in formulating a philosophy and then punishing those that refuse to accept it.
  13. by   gauge14iv
    Tulip - very eloquently stated!

    Im not advocating that we throw out nursing thery altogether, but I think we have to be careful that we don't turn it into a blind expectation that all nurses are required follow.

    In my experience - a theory class I took was "Believe it or leave it". The instructor SAID she wanted dialogue, but attacked anyone who dared to disagree. That has been my experience with theory. She was the ideal illustration of a theory thumper - one who advocates theory with the enthusiasm of a southern tent preacher on hades hottest day but without being open to question and examination.

    I love Artinian & Congers Intersystem Model - it makes great sense to me and I have found it to be very helpful in bedisde practice. The fact that I love it does not make it wholly embraceable by the entire profession however.

    I really like the concept of calling this part of the nursing discipline - "Philosphy" - as opposed to theory. Philosphy expects to be queried and dialogued, Theory (or some of those who defend it staunchly) thinks it ought to stand on it's own right - at least in the exposures *I* have had.

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