Ok now, as I delve back INTO nursing philosophy and theories, I come across, again, the theories of Jean Watson that have been hailed as the greatest thing since polyurethane IV bags - The Caring Theory of Nursing.
Personally, I have never been a fan of Watson, only because I feel that she OVERemphasized the caring aspect, and, in my opinion, dumbified nursing - hence, the ad campaign in the late 80's "If Caring Were Enough, Anyone Could Be a Nurse." Watson threw a fit when she saw this.
As nursing evolves to a more technically challenging field, requiring more acute assessment skills, and as the
"How Women Know" movement which has shaped nursing education for the last decade or so has become archaic, wondering what your thoughts are on if someone can be a nurse and NOT subscribe to the caring theory. Can one be a competent nurse and NOT care about her patients any more deeply than simply getting the job done?
Watson's theory goes a bit deeper than simply "caring" - more so than "caring" about any other job. But "caring" as far as honestly caring about the patient as you would your mom or dad.
Do you think someone CAN be an effective nurse WITHOUT having so much an emphasis on loving her patients?
I have called you "Dr. llg" out of regard for your title.
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OK. I just had a suspicion that you were being sarcastic. Apparently I was wrong on that score, so ... please forgive me for making an issue of it. I didn't want people to think of me as someone who "made" people use my title. I'm a first-name kind of person.
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NurseMark25 further wrote:
I can see why nurses pursue other advanced degrees than the NP and the CRNA.
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Thank for acknowledging that we are not all useless idiots. :-)
Later in your most recent post, you commented on how important it is for nurses to stick together. I agree wholeheartedly. But we all need to remember that "sticking together" goes both ways. Not only do you deserve support from me, but the rest of us should also be able to expect you to support us.
As we all try in our own way to get through this difficult time of the nursing shortage -- which is partly due to the bad decisions made by previous generations, but which is also due to factors beyond their control -- we need to stick together. That includes not attacking everyone who disagrees with you or who has chosen a different way to serve the patients and the profession. I am not responsible for the fact that some administrator treated you badly at some time. I've been treated badly myself on more than one occasion, but I don't blame you for it -- and I don't blame every other administrator I meet for it.
Some of my opinions may surprise you -- because you never bothered to find them out before attacking me and my education. We actually agree about many things. For example:
1. I, too, think Jean Watson goes a bit too far sometimes. When I was at the Univ. of Colorado, I was not in the group that focused on caring theory. I was the one who was the computer lab assistant who helped the other students with their statistics courses and quantitative research projects. The "caring group" was a little too "touchy-feeling" and "new age" for my taste. However, I am sufficiently open-minded to recognize that some of their work is very valuable.
2. I have been a member of a collective bargaining unit and would be so again if the situation called for it. I prefer to work for institutions who treat their staff reasonably enough to not require one, but I understand that sometimes it is necessary to strike. I did work for a hospital once that abused its nurses. I left and hope to never work for such a place again.
3. I do not believe that advanced degrees are the be all and end all. I also value practical experience. As I said in a previous post, how we learn from practical experience is a favorite topic of mine. Some people with advanced degrees are jerks and some people without the formal education, but with lots of experience are also jerks. Either route, there is no guarantee. Neither formal education nor experience can guarantee that a person will fulfill all your hopes for them. People can surprise you for the good or for the worse.
4. I am NOT a big fan of requiring a BSN for entry into practice. While I think there is value in getting a Bachelor's Degree, it is neither necessary nor practical to require it of everybody.
5. You wrote: " The point about caring for another person as a human being is valid. Caring for a complete stranger as you would your mother or father is both dangerous and invalid."
I agree. However, I must again point out that Jean Watson never said that you should care for a complete stranger as you would your mother or father. Anyone who attributes that sentiment to her is, in my opinion, misrepresenting her work. The people who specialize in caring theory describe different types and different levels of caring.
6. You wrote: " I still carry most of my views because nursing is dependent on medicine, therefore, it is still a limited profession."
Here is where are views are a little farther apart. While I agree that nursing is sometimes too dependent on medicine, I believe we are beginning to make advances in that area. And unlike you, I believe that our best chances for becoming more independent of medicine is NOT to try to take over functions that physicians have historically controlled (e.g. medical diagnosis, writing prescriptions, doing minor technical procedures, etc.), but rather, to stake out territory that has been traditionally nursing and to demonstrate that it is valuable, based on sound research, and worth paying for.
While I totally support NP's, CRNA's, etc. I don't believe that their practice will lead nursing as a whole to greater independence from physicians in the forseeable future -- because they will never be equally educated as physicians and the physicians will remain in a position of supervising their practice -- either directly or indirectly. That's not going to change in our lifetimes. If it's independence from physicians you seek, then provide services that physicians can't or don't want to provide -- and to which they can NOT claim greater expertise. That's what those "other" people with advanced degrees who are not NP's and CRNA's are trying to do.
I, too, have appreciated this thread. It has made me think very seriously about a lot of issues.
This has been a great thread. I just overspent my lunch break getting caught up.
What has bothered me from the beginning is the lack of definitions for the words being used. Consistently caring and taking care of have been interchanged, as have caring and care for. Likewise, theory and model have been used interchangeably.
The discussion can be muddied when we are not talking about the same things with one another.
The philosophic underpinings of a profession are every bit as important as the scientific ones, just harder for the "nurse on the unit" to see as relevant to their practice.
In many ways nursing is a hybrid discipline--natural science, social science, applied science, then a little philosophy to try and pull it all together. It doesn't always work quite the way it was envisioned. Thus, you see work/research being done from many different perspectives, with different emphases. In universities, nursing usually gets lumnped in with medicine, dentistry, physical therapy. But, wouldn't it be just as valid intellectually to associate it with the social sciences? My point is the apparent weakness of a field that is interdisciplinary is actually its strength. Nursing is in the wonderful position of studying, experiencing, touching, and, yes, helping people in virtually all aspects of their lives. Nursing cannot be confined to one way of viewing and studying the world or people. By its very nature, nursing deals with people as they experience some of the most meaningful and powerful events of their lives. Birth to death and every point in between, and a few before and after, nurses are there. And, somehow, the basics of what someone needs to know to start journey of being a nurse, is taught in two years.
More later. Someone's going to notice I'm not working.
I agree that philosophy, caring, caring for, models, and framework of our profession have been muddied and distorted and interchanged in this discussion. I also agree that you are right in saying that the combination of disciplines that make nursing so hard to define is also a great strength of that profession.
What we are collectively trying to tell the more elite and leaders of that profession is that we all know it. Since the days of Florence Nightingale and Clara Barton we have models of what we are to do, and we strive continuously to uphold the quality of service and care that our pioneers embraced.
We are also attempting to make the statement that either of these women did not make a statement about what nursing should be by professing and attempting to explain their actions from a theoretical basis. Rather, they are recognized for contributions they made by the results they obtained. I believe Clara Barton was pivotal in recognizing the merit of aseptic technique if my history serves me correctly, and for her efforts in regard to cleanliness to thwart the spread of disease. Not to mention her fund raising and volunteer recruiting efforts, the makeshift hospitals she organized. Her degree of caring needed no adulation, study, or recognition. To her it was what she did for the empathy of mankind....like most nurses today. She did what she did for the results they provided, to save as many casualties of war that she could and relieve as much suffering as she could.
I would wager, and I would really like the higher minds of our profession to ask a simple two piece question. Would Clara Barton or Florence Nightengale be pleased by theories or models to explain their actions or would they deem them silly as time and energy wasted?
Would they, if entering a class of new wet behind the ears nursing students question the resolve of these students in discussing and reteaching the very meaning of their presence? Or would they immediately begin to teach them the skills they will need that will ensure proper care is given?
What if we were all to settle for the nursing process as a basis for instruction as other professions do and move on technically from there....and find something out there as crucial as aseptic technique? Let's forget about the theory. Let's make the assumption that everyone who wants to be a nurse has the desirable traits relative to our profession, maybe a little fine tuning here and there. But, let's also make the assumption that they know nothing about nursing technically or scientifically and forward them to being so precise and knowledgeable that they are admired and trusted...without having to ask.
Nursing theory needs no explaining because when it comes out in the wash there is none....it is a behavior common to mankind, just as love, hope, hatred, faith, envy....we all envy docs....any theories on that?...are profession is partially based on that and no one will argue it is held captive by medicine.
If I am a little strong here I apologize, but I think nurses must resolve this issue, and I also think we have been going the wrong way theoretically.
In response to llg's post about CRNAs and their expertise vis a vis MDAs:
Certified Registered Nurse Anesthetist:
The CRNA is possibly the APN role with the least similiarity in practice scope. The CRNA is the oldest of the APN roles and was the first professional group to supply anesthetic services in the United States (Romaine-Davis, 1997). A CRNA provides direct specialist care to individuals requiring anesthesia. Their educational preparation is generally at the masters level; 97% of CRNA programs in the United States in 1995 were masters programs, the 3% which were not were in the process of converting to a masters program (Romaine-Davis, 1997). The specialist knowledge and clinical skills of a CRNA are equivalent to that of a medical anesthetist; therefore, this is one APN role where it would be unnecessary to refer complex client cases for medical anesthetic care. The CRNA works in hospital operating rooms and clinics or settings wherever anesthetic services are needed and can be safely administered.
A certified registered nurse anesthetist provides direct care to clients in all aspects of anesthesia delivery. The difference between physician anesthetists and nurse anesthetists is in their disciplinary backgrounds; the theoretical knowledge and clinical experience required for individual practice is considered equivalent (Romaine-Davis, 1997). However, I was impressed to read that CRNAs have been the primary anesthetic providers for every war that the United States has been involved in since World War I and that the malpractice insurance premium for CRNAs has decreased annually over the last 3 years due to low claim numbers (Romaine-Davis, 1997). (Other than the CRNA being sued for reusing the same syringe and needles on his patients of the day)
I don't think the answer to advancing the profession of nursing lies in nursing becoming ' less dependent on medicine' or in seeking out/advancing areas which have no vested medical interest. Medicine, nursing and other allied health professions are interrelated and interdependent. Any endeavor that advances the image of nursing and the profession of nursing is good for nursing. Please don't put down NPs or CRNAs contributions to 'professional 'nursing. As for taking on medically designated tasks...as noted above, nurses were administering anasthesia before medicine got involved. NPs provide care within a holistic framework ....that is different from the medical perspective of cure. Furthermore, in the past ...doctors took BPs...now of course, noone thinks twice about this previously 'medical' function.
As nurses we need to understand more about each others roles
and to value each others contributions. I was sad to read NurseMark25's post about his friend who felt that a MDA would provide better anasthetic care than a CRNA...give me a CRNA
should I ever need the services. Even on this BB, I saw a thread with someone asking for advice about lady partsl spotting and everyone(yes, all you guys who posted) says to go see a doctor!!! Hey nurses, remember that your primary care provider could be a nurse practitioner too.
Even on this BB, I saw a thread with someone asking for advice about lady partsl spotting and everyone(yes, all you guys who posted) says to go see a doctor!!! Hey nurses, remember that your primary care provider could be a nurse practitioner too.
I would agree with you on this, and I know you are just using this as an example, but I think some nurses here did that because of fear. A lot of nurses here have been held accountable, in the "real" world, for what they have said here. Some nurses have been disciplined, or worse, terminated.
To me, it all goes back to that nursing, as a profession, is broken.
The caring theories and the energy field theories I think, have no place in nursing anymore. They are archaic. And even in defense of Martha Rogers, perhaps she wrote her theory before there was a better handle of physics concepts. I don't think her theory was too abstract, as she often retorts to critics, but rather, so NOT abstract as she delve into the sciences in trying to explain her ideas.
It was interesting to read llg's comments about how she was educated in a time where caring was not really addressed or spoken of, so when Watson published, it was like "a breath of fresh air." Perhaps it was, but I don't think the caring phenomonon is unique to nursing at all, therfore, it shouldn't be our focus nor should it be a Grand Theory by any means.
I can certainly understand about and agree with not 'diagnosing over the internet' and the legal issues around that.
What I have issue with is: that nurses recommended seeing the doctor only ....rather than recommending that the person see her primary care provider( who could be a doctor, NP or PA).
If we as nurses see things only in terms of medicine.....
Hmmm...a little off track from the topic thread...but I think it highlights the commonalities within this thread....people making assumptions without knowing more facts...about Jean Watson, CNSs, NPs and CRNAs...
Please accept my appology if I offended you with my comments about NP's and CRNA's. I never meant to criticize the level of their practice in any way. I have been treated by Nurse Practitioners many times in the past and would not hesitate to be treated by a CRNA.
What I was trying to do with my earlier post was respond to NurseMark25's earlier comments suggesting that nurses whose Master's Degrees were in other areas of nursing (and any nurse with a doctorate) had wasted their time getting those degrees. He seemed to think that NP's and CRNA's were the only legitimate paths "upward" in the field of nusing -- that the rest of us were all full of s***, so to speak. Finally, he had lamented the fact that, in his view, nursing is too dependent on medicine.
In my response to him, I was trying to say that those of us with graduate degrees who are NOT NP's or CRNA's are trying to establish fields of expertise outside the realm of physician interest and control. Further, I was trying to suggest that such a focus had more chances of being "independent" than the NP and CRNA paths. That's all. I had no intention of insulting the level of expertise or level of care provided by NP's and CRNA's.
To me, it all goes back to that nursing, as a profession, is broken. The caring theories and the energy field theories I think, have no place in nursing anymore. They are archaic.
It was interesting to read llg's comments about how she was educated in a time where caring was not really addressed or spoken of, so when Watson published, it was like "a breath of fresh air." Perhaps it was, but I don't think the caring phenomonon is unique to nursing at all, therfore, it shouldn't be our focus nor should it be a Grand Theory by any means.
Perhaps this discussion is reaching a point of resolution many (if not most) of us can live with. Perhaps it is best to think of caring theory as NEITHER the "be all and end all" of nursing NOR the "abomination" that some people seem to think it is. Perhaps it is time to accept it simply as another school of thought within a stage of the nursing discipline's evolution.
Perhaps we can take from caring theory that which is good (e.g. certain methodological considerations) and move forward with the next stage of development -- a stage which hopefully will not be simply a reactionary rejection of all that came immediately before. I hope the next stage will build on everything that has come before -- including both caring theory and many other perspectives -- and adding new insights.
What has bothered me from the beginning is the lack of definitions for the words being used. Consistently caring and taking care of have been interchanged, as have caring and care for. Likewise, theory and model have been used interchangeably.
The discussion can be muddied when we are not talking about the same things with one another.
The philosophic underpinings of a profession are every bit as important as the scientific ones, just harder for the "nurse on the unit" to see as relevant to their practice.
Hi, Dr. Kate,
I loved your post and welcome to the discussion. Thank you for pointing out that terms such as "caring" and "caring theory" are being thrown around very loosely here. Many of the participants have never really studied caring theory in depth and others are basing their comments on experiences they have had with teachers who have used caring theory as a blueprint for courses and/or a prescription for practice.
Having spent 5 years during the 1990's on the fringes of Jean Watson's International Center for Human Caring, I find it very interesting (and somewhat distressing) to see how their work has been interpreted -- and sometimes misinterpreted -- in an effort to use it.
What I have issue with is: that nurses recommended seeing the doctor only ....rather than recommending that the person see her primary care provider( who could be a doctor, NP or PA).
If we as nurses see things only in terms of medicine.....
I understand what you were saying now. I myself was guilty of thinking "medicine" and not even recognizing your whole point - that primary providers don't necessarily have to BE physicians.
Hallelujah! Someone else sees the light like I do, or at least sees it somewhat like I do. Thank you for your post. All good posts indeed. I like what the CRNA group has become and what they will become.... I think that nursing has headed in the right direction with your group.
I myself was guilty of thinking "medicine" and not even recognizing your whole point - that primary providers don't necessarily have to BE physicians.
llg, PhD, RN
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