Can Someone Be a Nurse Without Jean Watson??

[Q.]

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?

[NRSKarenRN, BSN, RN]

Check out your schools library. I am able to do remote access from home computer thru my colleges library to CINAHL for literature searches for FREE.

Also my trusty http://www.google.com meta search engine unearths most of what I post here.

Can also try http://www.dogpile.com Others out there too.

A must read for Masters Program Research:PLUMBING THE DEPTHS: USING THE INVISIBLE WEB

[Glad2behere]

Micro said it all in one sentence.

"The caring side of it....comes from a small % from nursing school, and a large % from experience, and just in who I am...."

Who was first, the chicken or the egg?

Was Clara Barton first or caring first?

Maybe being a male I see this as someone trying to solve a problem or make a problem that just isn't there, to me anyway.

There is no reason to make a big ceremony about it. Write books and sell them and someone gets rich trying to analyze and theorize what an individual has to have to be a caring, compassionate nurse. I wonder how anyone can even think about being a nurse unless they had a predispostion to care to begin with. Those that don't get weeded out. Those that do care too much get burned out.

If nursing wants to make inroads and become more recognized, nursing schools need to come out of the rose garden and teach skills, in depth patho, chemistry, nutrition, pharmacology, statistics, epidemiology, and much better anatomy and physiology.

I am sorry if I offended anyone, but I cannot buy into all that grablebrook. You either have it or you don't.

[NRSKarenRN, BSN, RN]

Swanson, K.M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40, 161-166\

Dr. Kristine Swanson

Professor of Nursing

Chair Womens Health Department

University of Washington

School of Nursing

Seattle, WA.

(Developed and researched Swanson Caring Theory and empirical research on caring - conducted meta-analysis on empirical studies on caring)

[email protected]

Caring: The Essence of Nursing

Zane Robinson Wolf, RN, PhD, FAAN

http://nsweb.nursingspectrum.com/ce/ce281.htm

Look at these sources unearthed with google search only checked top three listings to find these.

[Stargazer]

(O/T: Ooohhh--lots of new search engines to play with. Thanks, NRSKaren!)

[NRSKarenRN, BSN, RN]

"Caring is directed toward the good of patients and occurs during moments of shared vulnerability between nurses and patients, benefiting both and occurring when nurses respond to patients in a caring situation."

From:

Wolf ZR, Giardino ER, Osborne PA, Ambrose MS. Dimensions of nurse caring. Image: J Nurs Scholar. 1994;26(2):107-111

There is a difference...

Caring in performing a job versus

Deeper caring: the use of self via really connecting with another individual - patient or family member during an encounter. This caring moment can be as brief as a few seconds in an established relationship to an hour or more if explaining life-threating/end-stage illness.

It is an Aha! moment that often leads to a sense of fulfullment--sometimes only realized on reflection. It is a way of practicing that lets you have a deeper meaning to life and provides much personal satisfaction. This satisfaction/ sense of fullfulment is what helps you get through the stress of every day living.

Guess that's why I feel so fulfilled as a nurse and remain passionate about nursing.

Just had one of those AHa! moments while checking up on my End-stage hospitalized CHF patient who was hospitalized Monday by my partner who co-manages pt. Talked with her husband again re wife's very advanced illness "she in step-down unit with foley, lots of wires and several IV's (Dopamine and Primacor drips I'm sure like 3 weeks ago).

I had told them a week ago, needed to see living will and mentioned Hospice. On Monday, Sandy viewed living will -- NO CPR or ventilator and further explained Hospice benefit. With pt's BP 70/40, 3 lb wt gain and crackles 1/2 up lungs despite Lasix 120mg BID and Zaroxlyn, hospitalization was needed.

Today, while talking with husband "just an inkling of improvment. Social Worker came and explained about Nursing Home placement (had earlier in year while he had hip replacement done) No, not ever again I told them" Reinforced need for him to tell Doctors of wife's living will and request DNR status--for if in hospital and she stops breathing they will place on machine automatically " Well they have a copy on the old chart" Told him needed to speak with Doc directly and get order on chart and hand copy of will for CURRENT record.

Explained two schools of thought re recurring End-Stage CHF with frequent hospitalizations (won't go to Major City hospital for second opinion)

A. Keep going into hospital with lots of IV sticks, IV meds, machines foley etc or

B. Hospice/ Home care with DNR staus, judicious use of meds to provide maximum COMFORT knowing that death will eventually come at some time.

"I hear what you are saying and thank you for that...just want her to be comfortable...will talk to Docs tomorrow." Very peaceful feeling perceived at the end of that 15 minute conversation this afternoon.

[BrandyBSN]

ok, here I go again... cant keep the trap shut :)

My entire nursing program was based on Jean Watson's Carative Theory, and after having carative factors shoved down my throat and in care plans where we had to "site the specific carative factors utilized during this session" I am so sick of Jean Watson that I could practically puke.

Her theory is nice in a warm-fuzzy-"philisophical" soft of way, but in application it is little more than Common Sense!

The main COmmon Sense that can be pulled from her Theory...

1) respect the patient.

2) treat patient so as to do no harm

3) if something good or bad happens, and there isnt a reason, dont rule out a "celestial intervention".

part of senior testing was to be able to list these 10 carative in order, WORD FOR WORD and explain what each factor meant as a whole. lots of wordy crap.. but that is just my opinion :) I could be wrong.

Brandy :)

[karenelizabeth]

Originally posted by NRSKarenRN

It is an Aha! moment that often leads to a sense of fulfullment--sometimes only realized on reflection. It is a way of practicing that lets you have a deeper meaning to life and provides much personal satisfaction. This satisfaction/ sense of fullfulment is what helps you get through the stress of every day living.

Guess that's why I feel so fulfilled as a nurse and remain passionate about nursing.

I'm obviously doing OK cos I'm still pashionate about my job after 8 years and I get warn fuzzy feelings re my patients and their parents and I never knew she existed until to day.

I'm back in Uni for a year in 4 days so it'll be interesting to see if she has made it accross the atlantic yet

Karen

[WashYaHands]

My view of the whole nursing theory subject is that since we are all unique individuals with our own personal style of nursing, we may not fall under one specific theoretical way of doing things. Using the analogy of an empty house that is for sale. Theory is like that house, it is a frame, a shell, a blueprint that appeals to the buyer. But, what goes into that house and how that house is decorated is how the buyer of the home personalizes it. In other words, we may buy into a theory because it sounds logical and applicable to us, but when we apply the theory to practice, we add our personal touches and own it for ourselves. Suzy may look at the house and say, "Ick, I don't like it, it's not me", whereas I may look at the house and think, "I like it, it's perfect, it suits me fine." It's all relative. Some theories you can relate to, others you can't. Doesn't mean one is better or useless. What I get from Watson's theory of Human Caring and Human Science is that as nurses we experience caring moments, those "ah ha! Moments" in which we connect with a patient and that patient connects with us...there is a transpersonal phenomenon where the patient learns from us and the nurse learns from the patient. Watson seeks to define those moments and place value on these moments as a part of the patients and nurses healing process. Nurses may know that these moments exist, but we may not associate them as being part of theoretical understanding because not all of us are familiar with every nursing theory published. I've read Jean Watson's book and I agree with most of her philosophy. She saw this phenomenon called caring, and wanted to explore it, define it and include it in what we term, "the art of nursing".

Linda

[Q.]

Brandy,

I hear your common sense thing; but I think one of the reasons nursing fumbles as a profession is that we can't define it, really. I mean, most people identify a nurse as what she DOES, as in psychomotor skills, and it's hard to put into words all the OTHER things that nurses do.

I also just learned about Carter's Patterns of Knowing. Back in '78 she attempted to delineate nursing by describing 4 patterns: 1. Ethics - knowing what is right/wrong 2. Personal Knowing - about yourself and what you know 2. Empirics - the science background we have and 4. Asthetics - the art of putting that all together in practice. I think it's a good start but needs to be expanded.

Most of these theories/philosophies were written as spin offs of Nightengale, and while her story is amazing, it's archaic now. Nightengale truly believed in nursing for WOMEN ONLY, and as such, we are where we are today because we never really let that go. When "Women's Way of Knowing" was published in the 80's, it totally shifted nursing philosophy and curricula and it is still that way today. How do we expect to attract men, for example, if curricula is based on WWofK???

So Brandy, while I agree with your common sense, we can't use that as a basis for our profession. We need to figure out what makes a nurse a nurse, why and if it's different from medicine, and why it's more than just caring about something.

[NRSKarenRN, BSN, RN]

My alma nater, Neumann College used Betty Neuman's : Neuman Systems Model in 1981-82 as the theoretical basis of it's program. Nursing Theory's were just creaping into nursing programs then. Wrote many a paper too till I had my fill. Those lines of defence and concentric rings of primary, secondary and tertiary interventions almost strangled me in my sleep .

Neuman's System Theory:

http://www.lemmus.demon.co.uk/neumodel.htm

"The person, with a core of basic structures, is seen as being in constant, dynamic interaction with the environment. Around the basic core structures are lines of defence and resistance (shown diagrammatically as concentric circles, with the lines of resistance nearer to the core.

The model looks at the impact of stressors on health and addresses stress and the reduction of stress (in the form of stressors). A stressor is ANY environmental force which can potentially affect the stability of the system: they may be

intrapersonal - occur within person, eg emotions and feelings

interpersonal - occur between individuals, eg role expectations

extrapersonal - occur outside the individual, eg job or finance pressures,

and can occur at any time, in any number or combination.

The person has a certain 'degree of rection' to any given stressor at any given time. The nature of the reaction depends in part on the strength of the lines of resistance and defence.

By means of primary, secondary and tertiary interventions, the person (or the nurse) attempts to restore or maintain the stability of the system."

Reflecting back on my twenty years of practice, I can see how much this theory had unconsciously shaped my nursing practice and lead me to love home health nursing. Combine Betty and Jean and that sums up my practice today...with a little bit of Imogene King and Dorothy Rogers' Energy fields.

I've been lucky to share many personal experiences with my patients/clients (cherrish my two years in hospice) and with these shared experinces have grown tremendously in knowledge, skills and wisdom.

WashYaHands quote:

"My view of the whole nursing theory subject is that since we are all unique individuals with our own personal style of nursing, we may not fall under one specific theoretical way of doing things."

Stated it better than I did and loved your example!

[WashYaHands]

Karen,

Even though I believe in "theoretical ecclecticism". I'm using the Neuman Systems Model as the basis for my oral comp questions. I've been studying that model like a madwoman :)

Linda

[Glad2behere]

NRSKarenRN,

The care you provided to the CHF patient is, in my opinion, excellent. It is similar to what I am accustomed to, working on a burn unit, conversing with family, and getting the point across that their 2 sons involved in a house fire have at best 20 days to live. Helping them through the denial, anger, and acceptance, and finally proposing organ donation. Then going to the bedside while the sons are still coherent, and explaining to these two sons one by one their true situation, and asking if they would need a minister or priest. Yes, definitely an involvement connection there, particularly if one is at all spiritual in nature.

I just think these things are innate to humans that provide nursing, agreed, some of it is a learned skill as was said earlier about adding one's personal touches.

And I also agree that job satisfaction from a technical point of view is not the whole issue, though it does add to it because competence, I think adds confidence. When we are confident I think we are better positioned to do our role as a nurse...and that is to care. It's what we do.