Can Someone Be a Nurse Without Jean Watson?? - page 12

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... Read More

  1. by   Q.
    Originally posted by llg
    Have you read the chapter on Kristen Swanson yet? In her work, she has built on Watson's early work on caring and is developing intervention strategies based directly on her (Swanson's) theory of caring. Her work is a demonstration of how Watson's early work can be put to practical use.

    I haven't read it in it's entirity, but I did skim it so far and did see that Watson was a major influence in her work. I also saw that Watson was her thesis chairperson.

    I think you answered my question, though you weren't quite sure what I was asking. I think caring is a phenomenon worthy of study, but I feel that it is overemphasized in most nursing curriculums.
  2. by   llg
    Originally posted by Susy K

    I think you answered my question, though you weren't quite sure what I was asking. I think caring is a phenomenon worthy of study, but I feel that it is overemphasized in most nursing curriculums.
    From what some people in this discussion are saying about its use in their programs, I would agree with you. I tend to be very eclectic in my use of theory. I have never been a person who "follows one guru" only. I like to cast my net far and wide, picking and choosing those things I find thought-provoking and/or useful in some other way. I think the caring theorists have opened up some valuable lines of inquiry that have many practical uses in every-day practice. However, I would never say that a particular theory was the be-all and end-all of everything.

  3. by   rncountry
    While I understand that Watson's theory is not inclusive to simply caring for a patient, what I was trying to get across is that the idea of caring is overemphasized in the curriculum as Suzy pointed out. To me that has led directly to the idea that nurses will do nearly anything and take nearly anything to reach that ideal goal of always being there for the patient regardless of what happens to them or their home life. The research on the specifics of mandatory overtime, patient to staff ratios has been belatedly done. I didn't say they hadn't been done at all, but it seems to me that it wasn't until there were some horrid problems that it occured to someone that we couldn't just say hey this is harming patient care, without specific research to back it up. It was a reactive way of looking at nursing and the practice of nursing rather than a proactive way of advancing the importance of what nurses do. And I find that to be very frustrating. So now we are in a hole, and it is going to take a long time to dig out and get things back on track.
    By overemphasizing the caring ideal we have done ourselves and our profession a great disservice, and by extension a disservice to our patients. While it may be important to look at caring as a theory or an issue, it is also important to look at other concrete areas of study, and personally I don't think that has been done well.
  4. by   Q.
    And to agree with Helen (rncountry), it seems that the caring aspect is what people think of as a nurse. Which is why some people are just horrified that a nurse may strike, or walk-out, or leave bedside nursing, even if for the long run it is better for the patient. My very own mother still can't come to grips with the fact that I am not "taking care of little babies anymore." (notice the word care in there! Hee!)

    My one professor said, in reference to the burgeoning caring theories, that we as profession finally weren't "ashamed" to admit we care. Perhaps that is true, but historically I have seen nursing be nothing really BUT caring.
  5. by   Q.
    Ok now, maybe this is a bit off track, but I am going through Swanson's autobiography here and note these things which I find somewhat disturbing:

    In September 1982 I had no intention of studying caring; my goal was to study what is was like for women to miscarry.
    Dr. Jean Watson was Kristen Swanson's dissertation chairperson, as I had noted earlier. Then....

    She immediately struck a deal that included the need for me to examine the meaning of caring in the context of miscarriage. In truth, I said "yes" because, having been a student at that point for 20 of my 29 years, I readily recognized the difference between a negotiable and a nonnegotiable request.
    Having read that, THIS portion of Raskin's article comes to mind:
    Any serious intellectual challenge to the basic ideas was treated as troublemaking.
    Maybe I am wet behind the ears here when it comes to graduate study, but why on earth would a chairperson direct a student's dissertation in the direction to support her own work?

    This is why Watson doesn't sit very well with me. I feel like she studied caring, fine, but continues to proliferate her caring theories into new literature by directing students with it!
  6. by   Stargazer
    WHOA. Does anyone else find this completely unethical?
  7. by   llg
    Originally posted by Susy K
    And to agree with Helen (rncountry), it seems that the caring aspect is what people think of as a nurse. Which is why some people are just horrified that a nurse may strike, or walk-out, or leave bedside nursing, even if for the long run it is better for the patient. My very own mother still can't come to grips with the fact that I am not "taking care of little babies anymore." (notice the word care in there! Hee!)

    My one professor said, in reference to the burgeoning caring theories, that we as profession finally weren't "ashamed" to admit we care. Perhaps that is true, but historically I have seen nursing be nothing really BUT caring.

    I don't really disagree with you about the need to study the limits of one's obligations to patients.

    What I find really interesting is your last sentence about having seen nursing be nothing BUT caring. When Watson first proposed her caring theory, it was quite revolutionary for its time. When I got my basic education (in the 1970's) caring was never mentioned. The emphasis was on the "hard" sciences -- biology, chemistry, physiology, etc. Anything related to the "softer" side of nursing was considered less respectable and not worthy of serious scholarship. Watson was a leader in trying to bring the more spiritual aspects of nursing "out of the closet" and into the mainstream of academic discourse.

    This may be a somewhat of a generational issue. Nurses educated to believe that any emotional attachment to the patient was "unprofessional" and nurses were not supposed to have feelings or to have any personal relationship with their patients found Watson's work (and others) to be inspirational -- a refreshing wind of change that helped them overcome the burnout they suffered by having to bury any emotions they may have about their work. It was now OK to talk about the connections between nurses and their patients in ways that had been previously denied. As with any revolution, sometimes the "first generation" of nurses who experienced life before the change can sometimes become zealots that go a little overboard.

    You "younger generation" nurses -- regardless of your chronilogical age -- who were educated after the change never experienced the straightjacket of not having those caring relationships denied. You "assume" that caring exists and know that your profession acknowledges it openly. Therefore, you don't perceive a need to make it such a big deal.

    Hmmmmm..... I hadn't looked at it that way before.

  8. by   llg
    Originally posted by Susy K
    Ok now, maybe this is a bit off track, but I am going through Swanson's autobiography here and note these things which I find somewhat disturbing:

    Maybe I am wet behind the ears here when it comes to graduate study, but why on earth would a chairperson direct a student's dissertation in the direction to support her own work?
    It is considered totally ethical and is standard practice in most disciplines. That's why Dr. Swanson stated it so openly in the chapter she wrote. It's not a "dirty secret" or anything.

    The match-up between a doctoral student and her dissertation chair (and all the other members of the committee as well) is a process of negotion whereby the student and potential committee members interview each other to find out if they have enough interests in common to make the big investment of their time worthwhile. No faculty member "in demand" as an committee member (either because they are expert, prominent, or popular with students) has the extra time available to serve on the committe of a student whose research interests do not match well with their own. Time is a valuable commodity. So if you, as a student, are going to ask a busy person to donate some of their precious time to serve as your advisor, you had better be prepared to make it worth their while. The more popular the professor, the more requests they receive to serve on committees. If they can't say "yes" to all of them, they will pick only those that interest them most.

    This is not usually considered a bad thing because it ensures that the faculty members who are advising the student are truly interested in the field being studied by the student. It also makes it possible for a "research program" to be established by senior researchers. A research program is a series of studies all related to a central theme or based on a common foundation. Research can be such a long, involved process that a single researcher may accomplish only a few major studies over the course of a lifetime. By establishing a team of people all studying the same thing, more work can get done more efficiently.

    In the hard sciences, senior researchers/professors set up their own labs. They hire lab assistants, professional technicians, etc. and then recruit graduate students to do their research in them -- all related to the work of the senior researcher. The work is moved forward much more quickly and effectively because they all help each other. That's the way "big science" as they call it, happens. Little, independent researchers struggle to get funding and to get noticed because they don't have the resources that the large, well-funded labs have. If you want to be successful as a researcher, the smart move is to develop a team of people to work with.

    Just look at the advertisements for senior level researchers and faculty members in the scholarly nursing journals. They all require "an established research program and a history of extra-mural funding." If you are serious about your academic career, you need to get your ideas out there, get other people furthering your work, collect colleagues to work with on projects of mutual interest, etc. You have little time left over to "donate" to a student whose interests do not match well with yours.

    From the student's perspective, it's an advantage to have a good match with your committee members -- and to have a topic that excites them. That way, you will be sure to receive maximal benefit from their expertise. Kristen Swanson obviously WANTED to work with Jean Watson badly enough that she was willing to base her dissertation on Watson's theory. She wasn't forced to work with Dr. Watson. She CHOSE to -- after fully exploring and understanding what Dr. Watson expected from the relationship they were entering into together. That's the way it should be -- and that's why she discussed it so openly in her chapter.

  9. by   NurseMark25

    I have called you "Dr. llg" out of regard for your title. You have a doctorate, you deserve to be called "doctor". But I shall refer to you as simply "llg" if you so please. I have heard many good points once again. Thank you for being patient with me. I can see now where the CNS role is valuable, but the hospital in which I now work does not employ CNS's . I can see why nurses pursue other advanced degrees than the NP and the CRNA. I guess it does advance the profession. BUT, I'll bet you money that the biggest way nurses can advance the profession is by sticking together, forming unions everywhere, and stop taking crap from management. The advanced degrees alone will not do this. Nurses do not get listened to as much as they should because they are too complacent and not willing to take chances on strikes or put their needs first. As far as theory, I still say Jean Watson took it too far. 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 still carry most of my views because nursing is dependent on medicine, therefore, it is still a limited profession. Almost every job a nurse has involves some interaction with a physician, in a dependent way. Until nurses get out from under the stigma of being the physician's lackey, I still argue, to the death, that this is a limited profession. The public still does not know what nurses do. Many members of the public do not know what NP's do. For goodness sake, my own best friend wrote about why the average medical consumer should beware of CRNA's stating that their services are not as good as an anesthesiologist for a class in computer school! That's frightening! Perhaps we should spend more of our time and effort educating the public and each other than trying to get advanced degrees to make people listen.

    Just my two cents. Thank you for the interesting conversation.

  10. by   Glad2behere
    Ok llg,

    I graduated from nursing school in 1977. I had so much caring dumped on me that it made me reach for the emesis tray...even now. My mother graduated from nursing school in 1950. She still has the Florence Nightengale touch. Anything can be rationalized.

    The message here is that nursing is a caring profession with very much commonality with other professions, who also have in the same vein of commonality an attachment to mankind, and the same commonality generally accepted among many other species.
    That is not so hard is it?

    What seems to be missing here is a very basic concept of where nurses fit into society, and there are a lot of nurses who feel differently. Our goal or mission I thought was to care for the sick, and prevent sickness in the healthy. We are discussing a BEHAVIOR here and trying every which way to rationalize basing an entire profession on it.

    I say WRONG! Think about this if you would, from a common sense approach. I think in spite of the huge financial and emotional rewards attached to nursing, varying persons of all disciplines still have an inherent desire to help others. Since this behavior (caring) is common to so many and so many professions, are we not better off to abandon these philosophies and leave them to the psychologists and psychiatrists where they better fit society? And let's get on to our business of making people well again and how they became ill in the first place.
  11. by   rncountry
    llg, with all due respect the explanation you offered on the relationship between student and teacher at the PhD level does not sound like what happened between Swanson and Watson. Swanson may very well have wanted to work with Watson, but yet it sounds as if a heavy hand was used in terms of what the thesis would be ultimately. Perhaps it would have been better to have supported the student and then directed her where her initial interest would have been better served instead of offering what a student felt was a nonnegotiable deal.
    You know llg, neither of my older children will even consider nursing as a profession for themselves. My oldest is a Freshman at Western Michigan University and his major is journalism, my 15 year old daughter intends on going into photography at this point. I believe she is quite serious as she bought her own Cannon camera a couple years ago that she saved for herself for over $600. She buys her own film, pays to have it developed. Both of these children picked what they did because both want to freelance, they both want to take routes that allow them more freedom to call their own shots. And that is the direct result of watching me consistantly work overtime and sometimes pull my hair out when I feel I have not been able to meet the needs of a patient, not because I am a poor nurse, but because I didn't have either the time or the resources. The youngest at six wants to be a shark scientist. More power to him! At the same time I take great pride in knowing my children care deeply about their fellow people. This year my older both went on Mission trips with our church. My oldest boy went to WV to help build houses in the Appalation mountains. My daughter went to TN and assisted in helping children learn to read, and to volunteer time in a nursing home. They do the walk for hunger every year, a variety of things through the year to help their fellow human beings. My youngest participates in endeavors that are appropriate for his age. I guess what I am trying to say is that my children are wonderful, caring people, yet there is no consideration to follow me in my career choice. And that is based strictly on them growing up and watching me struggle with so many unrealistic expectations of how much I can consistantly give to my patients. I realize that each child is going to do what fits them, yet I can't help but be sad that they feel the way they do. My oldest child has actually pushed several times for me to leave the profession, it angers him greatly for some of the things that have happened. The first time I was mandated and my youngest was about 9-10 weeks old, still breast feeding and when I flat refused to stay my job was threatened and I was written up for unprofessional behavior. The job I walked out of at 1 in the afternoon because my dad in TN was dying and I was told no I could not have time off to go take care of my dad because a state inspection was due any time. I am grateful I decided to be "unprofessional" and walk out because it was the last time I saw my dad alive. He died three weeks after I came back to Michigan because I had to get my kids back into school. The job I was fired from because I reported abuse to the state the facility tried mighty hard to cover up.
    In school we were taught that regardless of how a patient behaved we needed to be caring and understanding because they were in pain, they were dealing with loss of control issues etc... we were told that professional nurses did not join unions, they were for blue collar workers not professionals. We were indoctinated with the idea that regardless of our own needs the patient must always come first, and by extension that meant doing whatever it was that management felt was necessary for that to occur. Obviously I am paraphrasing, but that was always the underlying message. I have the personality though in which I do not do this well. But I resent that this is the way in which I was instructed, and in which my fellow students were instructed. I graduated from nursing school in 1991, just in time to watch healthcare evolve into what we have now. I recall when hospitals were shifting to 12 hour shifts because it saved on benefits. I came out into a job market in which there was supposedly a nursing shortage, within two years there was supposedly a glut of nurses and lay offs and hiring freezes were common. I ended up in LTC because when I divorced and my children were still small I needed to leave midnights and work days, something that was flat not available in the area hospitals, including the one I worked in so I couldn't even transfer to another area. I have steadily watched the increasing patient load, the sicker patients to be taken care of in shorter time frames. The elimination of nurse educators in various fields. And for the life of me I cannot understand why while this was happening theorists were working on theoritical frameworks that had little to do with what nurses actually provide. When I hear other nurses bemoan the inability of the public to truly understand what it is that nurses are there to provide it makes me angry to think that there are academic nurses out there that I and the public should be able to look to provide a realistic framework in which what nurses do, the reality of nursing and it's vital importance to healthcare in general and what nursing provides on a more intimate level to sick loved ones, who are not providing that, while pushing theories on caring.
    It is obvious that you are a well educated person, and I applaud your ideas of marrying academia to reality. That is what I think is missing so very badly in my profession. Every profession needs it's thinkers, that said I believe they need to provide something back to their profession that has real value and meaning to the nurse and the patient. Not to mention basing their theories on something that not only can nurses in general relate to but that the public in general can relate to.
    In many ways I feel that I have watched the barn burn down while the people who are supposed to be the leaders in my profession stood around and roasted marshmallows over it. I know that is harsh and it is not in any way directed at you. I am making a general statement on my feelings. When my dad was in Baptist Memorial hospital in Memphis his nurse was carrying 14 patients in a surgical oncology floor. His most basic care was provided by his family, not a nurse or a PCA. I found all of his nurses to be caring individuals as well as competant in what they were doing. I also found that they were as overwhelmed and frustrated in their inability to provide basic care, let alone education or anything else, as they possibly could have been. No theory on caring, auras or even patient spirituality will help that situation. Only concrete research will. And not only that teaching theory that has little to do with the reality of what the bedside nurse and their patients are experiencing, will not assist more advanced degreed nurses participate in that concrete research, because their focus and energies are pushed elsewhere. While I don't deny theory is needed, what I am trying to get across is that there should be more focus on theory that has relevence to the actual hands on practice of nursing, and therefore patient care and it's outcomes.
  12. by   JWRN
    To NurseMark25
    glad you see the value of CNS's. I am a CNS in critical care, and I have perscriptive authority with my State BNE. The CNS role is valuable and more hospitals should start using them. I think I am a good CNS in the hospital I work, I try to make things happen when staff come to me with problems, etc, though my main role is staff orientation and education. I am not above taking patients and I often take patients in the ICU/CCU or Tele, I am not above cleaning up poop or helping a patient to the restroom or chair. There are good and bad in every profession, I am sorry that the CNS you mentioned in your previous post was not a good one. I am in Doctoral program not because I want people to listen to me, but because it is a goal I set for myself. People ask me what I am going to do with it when I get it? Sometimes I just want to scream "DO I HAVE TO DO ANYTING WITH IT, CAN'T I JUST HAVE IT FOR MYSELF BECAUSE I LIKE TO LEARN IS THAT A FREAKING CRIME?"
    Having advanced degrees does not make one a better bedside nurse. It has opened doors for me that would not have been opened had I not had my Masters degree. Having advanced degrees can open doors for you and there are many opportunities out there for nurses who are willing to dig little and do a little research.

    Well just my two cents
  13. by   llg
    To JWRN:

    My reasons for going back to school for a doctorate were pretty much the way you described yours. I had been a CNS for 10 years and had simply reached a point at which I wanted to learn more. After finishing my dissertation -- and flirting with the idea of an academic career briefly -- I returned to being a CNS. Bringing what I learned into the practice setting and bridging the gap between academia and practice is what interests me most.

    Good luck with your studies,