I *do* recognize the need for nursing theory - page 7

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   gauge14iv
    Kelly - what you stated is exactly the way I feel.

    Theory has it's place to make it the be all / end all is not right. I have a saying hanging over my desk that says

    "The space and time for what you want is being occupied by that for which you have settled"

    The nursing profession is occupying a LOT of it's time and energy with theory that has gotten us nothing but laughed at by the masses. We have settled for theory and decided there is nothing else - or at least that's how it appears. We say we want respect from other fields, then we had better examine more closely that which they find laughable and look at what it is we need to be respectable. I dont hear the RT's, lab techs, Docs, PT's, or even psychs talking about theory the way we do! MORE FOCUS ON EVIDENCE I SAY!

    And yes BlueEyes - it *IS* very discouraging - I was so looking forward to the theory class, it wasn't at all what I thought it would or could be.
  2. by   ZASHAGALKA
    Quote from grannynurse FNP student
    Abstraction and 'lack' of scientific evidence is not a reason for dismissing theory.
    Actually, I firmly believe it is sufficient reason for dismissing theory.

    ~faith,
    Timothy.
  3. by   1Tulip
    GrannyNurse Wrote:
    As for the faculty member being fired. It lies with the individual to chose an employer whose theorical bases matchs theirs. One does not chose to work in a program that bases its theorical knowledge on King, when she believes in Watson. And one does not neglect to teach King's theory, substituting Watson's. Sorry, the faculty member was wrong and deserved her termination. She should have researched her program's theortical base before accepting the position.

    Oh my! How absolutely wrong you are. Do you understand what's at stake with academic freedom? The WHOLE point of it is to keep departments from becoming little megaphones for a few prominent members! Academic freedom is supposed to be a guarentee that students are exposed to and have a chance to study in depth contrasting, even opposing concepts. If they are to do that, a faculty must employ people who enthusiastically embrace different points of view.

    Imagine, if you will, the philosophy department chairman saying to a scholar in existentialism... "you can't work here, mister. WE are all CARTESIANS!!!" That would be obscenely wrong.

    To accept your notion of "conceptual loyalty oaths" is to welcome .. in fact, REQUIRE ...persecution of faculty with different ideas.

    No way. I can't believe you meant this the way it sounded.

    As for paradigms, empowerment, metanarrative and holistic...
    Naturally disciplines develop their own vocabulary. But that's not what we're talking about here because these words exist in common usage (as opposed to, for example, kinase, levorotary, carboxyl groups, etc.) What I mean, when I say these are buzz-words is (1) that they are hackneyed and used by people too lazy to stretch their vocabulary and (2) they are inexact and can be used to obscure almost better than they can be used to illuminate.

    But WAIT! There is something worse than using hackneyed buzz-words and pretending they are erudite. And that is making up entirely new words for no apparent reason whatsoever! Watson has dumped her "carative factors" ,for example, and now calls them "clinical caritas processes". Now, I gotta tell you, Oxfords Dictionary of the English Language, Websters, and dictionary.com don't know what caritas is all about. Is it an adjective? Is it a noun? Who knows? Only Watson and her enlightened acolytes.

    If she has a reason for doing this i.e. making up new words or using extremely obscure meanings, I can't figure it out. But, assuming she has a reason, it better be a very, very compelling one. Because the only people who use neologisms are either schizophrenic, or cultic.

    In almost every instance, when I've heard or read a buzz word or neologism by nursing theorists, it either doesn't fit in the context of the sentance, or could have been easily replaced with a word that is more accessible to readers in general, or has a meaning only the user understands.
    Last edit by 1Tulip on Dec 6, '05
  4. by   grannynurse FNP student
    Quote from Kelly_the_Great
    I don't think most of the posters on this thread are claiming all nursing theories (maybe a few that resemble visions of Lucy in the sky with diamonds) are invalid but that there is too much of an emphasis placed upon their importance within our curriculum.

    There are too many theories first of all. Thus, it further leads to division within nursing. The exact thing we don't need!

    Why don't we focus our energies on coming up with a consensual definition of nursing? And find unity within our profession, where the subsets of the system are viewed as even more valuable when considered as part of the whole. I love something I found on the Royal College of Nursing website re. the lack of our ability to define nursing: "If we cannot name it ... we cannot control it, finance it, research it, teach it or put it into public policy." Further, I believe we cannot easily promote it to potential recruits, other professions or to our prospective consumers.

    Doing this and grounding ourselves in EBP instead of all of these hooky-kooky theories would allow us not only stability but growth as a profession.

    What is wrong with defining ourselves in our practice? Lawyers do, so do bankers and doctors - people don't consider them vocational workers. I just don't see th' down side.

    We can still have theory but it doesn't have to define who we are or totally consume our energies when they could be better spent addressing other aspects of our profession. Does this make sense to anyone but me?
    Too many theories and not enough hard evidence to support these too many theories. And just who is suppose to decide which of these theories are worth saving and which should be dropped. You? Me? A floor nurse? And what do we use as criteria and who decised which criteria are acceptable. And what happens to those of us, who do not subscribe to EBP theory.

    I certainly do not consider attorneys, physicians or bankers vocational workers but I do consider the scope of their basic education. All require a BS or BA, as well as a three or four year advanced degree-M.D., J.D. or M.B.A.
    And what do we require--that is a whole other thread.

    Believe it or not, theory is a part of the defining a profession. MBAs have several different economic theories, some of which are generally acceptable and others that are questionable. Does that mean they drop a theory because some MBAs don't agree with its premis? I don't think so. I have heard of only two definitions of nursing and they are quite clear and basically quite simple. Nursing theory, like many other theories, is not steeped in hard science. Does this mean that it is invalid. No, but there are those that believe lacking this nursing theory is not worth much. Their loss.

    Grannynurse
  5. by   Kelly_the_Great
    It all really does bear a resemblance to the thinking/reasoning/tactics of the occult (imo).

    The buzz words, the ambiguity, the "secret knowledge" - only enlighted/illuminated one's can comprehend. I liked Tulip's reference of the gnostics - the mystery religions.

    You know something else the occult will often do? Often they will have their members memorize long, laborious text that really have no meaning at all, that the lower members do not understand at all, that serves no direct, useful purpose at all. It's a way of "draining" the underlings' energies. I mean, look guys, I know this sounds far-fetched yet they are the one's espousing belief in things like "energy fields" and "auras." Do we wish to return our profession to the days of healing women being seen as witches? That might sound beyond belief but it certainly is not, not under the right circumstances (political, cultural or otherwise).

    As gauge14iv mentioned earlier to her sign "The space and time for what you want is being occupied by that for which you have settled," dedicating so much time to these theories, let alone the manner in which we're taught to incorporate these theories into our own belief systems - without question, it's frustrating.

    Like ZASHAGALKA mentioned earlier, I'm not sure if it's not dumbing us down. In today's world, I think it's much more important if a nurse knows how to obtain and access the current evidence that represents the best care for her/his patient at any given time than if they memorized a bunch of theories. Our minds are needing to evolve past rote memorization.
  6. by   grannynurse FNP student
    Quote from tencat
    I agree with you there that theory should be there to guide practice, but if the theory has been proven to be irrelevant or not useful to practice, why continue hanging on to it? Theory should be fluent and able to be amended or changed to be useful to guide a profession. The problem I see is that some of those in the Ivory Towers are positive that their way is right, and any questioning of theory is seen as an attack by those that are not as 'enlightened' as they are, or not as 'intellectually capable'. Thus theory becomes stagnant and loses its credibility because it is not allowed to be scrutinized by anyone who is less than 'worthy'. And to be 'worthy' a person must totally accept that theory is the end all and be all of a profession. Blindly clinging to theory does not make one smarter than or superior to everyone else. Without the question "does it enhance practice?" theory becomes nothing more than dogma.
    And you believe this Ivory Tower attitude is restricted to nursing theory only? It is not. Theory, regardless of who formulates it, is always under attack. And there are always those that defend it and take issue with the attackers. And may even insult them by declaring them intellectually impaired. I have never blindly accepted any theory, either in my MS or MBA programs, and certainly not in my nursing programs. And I have never been made to suffer, academically or in any fashion, for questioning the premises of a program. And I certainly would not remain in a program that forced such thinking on me. And I did ask questions, during my interview for my MSN program regarding the theorist and academic freedom. I was told who they had chosen and that I was free to accept any theorists but need to realize that they based their program on that theory. I understood this to mean that the program bases its education on the theory of one theorist. And that their educational premise is based on that theorists. And that I am free to disagree. However, were I to have completed by educational experience, within the education tract, then I would be required to base my teaching on the Watson Theorical Model. I do not accept her model but I understood it was the model of my program. And as such, I was required to teach based on that model. If I didn't like it, I was free to go to another program. I was willing to make the adjustment.

    The fact that there are questions, as far flung as some may, adds only to strengthen a theory.

    Grannynurse
  7. by   Kelly_the_Great
    Quote from grannynurse FNP student
    . And what happens to those of us, who do not subscribe to EBP theory.
    I'm thinking they better start subscribing to it if they want to get paid b/c the 3rd party payors as well as the patients are.

    Edited to add: And so is (subsribing to) medicine which we all already know is gettin' paid any ol' ways.
    Last edit by Kelly_the_Great on Dec 6, '05
  8. by   tencat
    Ok, I just want to pause a moment and say that I thoroughly enjoy the debate going on here! Let's keep it going!
  9. by   ZASHAGALKA
    Quote from grannynurse FNP student
    And you believe this Ivory Tower attitude is restricted to nursing theory only? It is not. Theory, regardless of who formulates it, is always under attack. And there are always those that defend it and take issue with the attackers. And may even insult them by declaring them intellectually impaired. I have never blindly accepted any theory, either in my MS or MBA programs, and certainly not in my nursing programs. And I have never been made to suffer, academically or in any fashion, for questioning the premises of a program. And I certainly would not remain in a program that forced such thinking on me. And I did ask questions, during my interview for my MSN program regarding the theorist and academic freedom. I was told who they had chosen and that I was free to accept any theorists but need to realize that they based their program on that theory. I understood this to mean that the program bases its education on the theory of one theorist. And that their educational premise is based on that theorists. And that I am free to disagree. However, were I to have completed by educational experience, within the education tract, then I would be required to base my teaching on the Watson Theorical Model. I do not accept her model but I understood it was the model of my program. And as such, I was required to teach based on that model. If I didn't like it, I was free to go to another program. I was willing to make the adjustment.

    The fact that there are questions, as far flung as some may, adds only to strengthen a theory.

    Grannynurse
    You keep saying that you've never been penalized for a having a different point of view w/ some of the theorists.

    But it's important to note that you're a BELIEVER.

    You met the most important hurdle: you have bought into the rationale that these people are the self-important people they believe themselves to be. You're in the IN crowd.

    Now go to some of those classes and meekly profess that you AREN'T a believer, and you'll be treated like the heretic you claim isn't just dismissed as uncognizant for not believing.

    Theory isn't a science: it's a RELIGION.

    I have my own religion, thank you very much.

    ~faith,
    Timothy.
  10. by   1Tulip
    GNFNPStudent wrote:

    Too many theories and not enough hard evidence to support these too many theories. And just who is suppose to decide which of these theories are worth saving and which should be dropped. You? Me? A floor nurse? And what do we use as criteria and who decised which criteria are acceptable. And what happens to those of us, who do not subscribe to EBP theory.
    ~~~~~~~~~~~~~~~
    I don't understand what you're saying. It sounds like you're saying that once a theory makes it into print or is uttered in a classroom, it can't be evaluated for either its veracity or its utility.

    As far as your question... what do we use as criteria...

    You're asking the same question I am. If a theory can NOT be tested, it's impact on some system can't be measured, what can we do with it? Or stated another way, what good is it? (BTW: Economic theories are testable. That's why lots of economists have won Nobel Prizes.)

    Let me turn the question back to you? What do we do with a theory that cannot be tested, for which criteria for rejecting the null hypothesis don't exist? Why should we expect that such a theory can improve (or have any influence on) what happens in our practice?

    Remember, I'm not saying Theories have no value. I'm saying merely that they are not science. Philosophy, yes. Helpful in formulating definitions, yes. But science, no.)

    Also, when you suggest that you, I and floor nurses in general aren't necessarily adequate to the task of evaluating theories... aren't you ceding critical analysis to the "masters" who alone are enlightened and worthy to be praised forever and ever, Amen.

    This is the sort of thing that makes nursing theory so unpalatable to so many. It's not that its hard or over their heads. I've had to teach really hard material to students, stuff they hate. But they get it. Honest they do. I reject the notion that anti-theorists are intellectually inferior to the true believers.

    Oh well...
  11. by   grannynurse FNP student
    Quote from Kelly_the_Great
    I'm thinking they better start subscribing to it if they want to get paid b/c the 3rd party payors as well as the patients are.

    Edited to add: And so is (subsribing to) medicine which we all already know is gettin' paid any ol' ways.
    Now let me see if I understand correctly In order to get paid, I have to subscribe to a theory--EBP-because??????? I am aware of no 3rd party payor that mandates a practitioner follow EBP. However, even if some did, I am free not to accept any of those who carry their policy. And what theory a practitioner subscribes to or does not, is quite irrelvent. Offering of services has little to do with the theoretical bases of the profession offering said service. Theory is offered as an attempt to articulate, in a systematic, coherent and orangized manner, answers to questions in a given discipline. Nursing theory has been an attenpt to describe a given phenomena by explaining the relationship between the phenomena, then predicting the consequences or prescribing nursing care. There are atleast four other definitions of nursing theory that I am aware of. Theory is a means of explaing. Payment for one's services does not have much to do with theory, unless you are the theorist postulating a given theory.

    A physicist, with NSA, employes one or more of the theoritical concepts of physics. Do they address the theory as they develop the rocket? Generally no but that does not lessen the theorical bases of physics.

    Grannynurse
  12. by   gauge14iv
    Payors are increasingly basing reimbursement on outcome data as well as benchmarking - that is evidence based practice. They make decisions about what procedures and practices to reimburse based on EVIDENCE that they WORK!

    As more practices and practice environments become electronically based, you will see more an more benchmarking done. So yes, if you want to get paid, you better be prescribing (if you are an NP) the stuff that is proven to work and is within your scope to prescribe, and referring for reasons that follow guidelines. Payors don't just pull guidelines out of thin air (although sometimes it sure sounds that way), they are based on the available clinical evidence.

    You want to perform a massage on your patient? Great! Make sure the patient can pay out of pocket in most cases - why? Many payors don't reimburse for massage. Now does that mean massage is an invalid therapeutic modality? Absolutely not. Do we know it helps people to feel better? Absolutely. But do we have proven studies seeking both to prove and disprove that massage is effective that agree with each other and control for the placebo effect? Not likely....

    And therein lies the trouble with theory....

    ETA - I used to work as a contractor for insurance companies - I have seen the guidelines, I have seen how they are used and I have seen what they are based on.
    Last edit by gauge14iv on Dec 6, '05
  13. by   Kelly_the_Great
    Why is the consideration of reimbursement looked down upon as an invalid concern for nurses?

    GrannynurseFNP, didn't you say you had an MBA earlier? I'm kind of surprised that you wouldn't be aware of the trends of payors towards reimbursing care which is delivered by EBP standards.
    Last edit by Kelly_the_Great on Dec 6, '05

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