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?

[llg, PhD, RN]

I really enjoyed your most recent posts, SuzyK, Glad2beHere, and rncountry. Together, we seemed to have found some substantial areas of agreement. (I think I agree with everything the 3 of you said.) Now, if we could just figure out what to do about it!

I had to smile at rncountry's ending to her post in which she talked about the need for a theory upon which to base her ideal cirriculum. If you'll recall from an earlier post of mine, that was how and why Jean Watson developed her theory of caring in the first place! ... and the ND (nursing doctorate) program at UCHSC (her school) based on her caring theory includes a lot more clinical hours than any BSN program I have ever encountered.

So, I guess that brings the discussion back almost to where it started. Upon what theoretical basis should nursing schools be basing their cirricula? Should everybody use the same one?

llg

[Q.]

Originally posted by llg

So, I guess that brings the discussion back almost to where it started. Upon what theoretical basis should nursing schools be basing their cirricula? Should everybody use the same one?

llg

We just had a similar discussion in class, about having a curricula that teaches multiple world-views instead of one, and allow the students exposure to all and then decide on what best fits them.

I tend to agree with this; afterall, I go to school to get educated about as much as I can. To leave out some information and in that same breath skew my thoughts by only including some of it doesn't seem right.

[llg, PhD, RN]

Originally posted by Susy K

We just had a similar discussion in class, about having a curricula that teaches multiple world-views instead of one, and allow the students exposure to all and then decide on what best fits them.

I tend to agree with this; afterall, I go to school to get educated about as much as I can. To leave out some information and in that same breath skew my thoughts by only including some of it doesn't seem right.

I feel the same way that you do. It's when people get too dogmatic about a particular viewpoint or theory that many of the problems begin. The use of one theory only is simply to limiting and restrictive.

However, I think we probably could and should try as a profession to find some common basis of agreement on a few fundamental issues. Without some sense of cohesive identify, it's hard for us to stick together as a group -- or to work together for common goals The challenge is to identify those commonly held beliefs, to articulate them in such a way as to promote cohesion, and then to use them to help build our knowledge base and our professional standards. ... and to do so without overly restricting ourselves and/or future generations.

llg

[WashYaHands]

We just had a similar discussion in class, about having a curricula that teaches multiple world-views instead of one, and allow the students exposure to all and then decide on what best fits them.

I agree that this is the best approach to theory and nursing education, which is why in some Master's programs you're required to write your own personal philosophy of nursing in order to clarify for your self which theories best fit into your personal ways of practice and world view. I would find it difficult to have someone present a theory to me and tell me this is how I have to practice nursing. I'd rather examine my own thoughts/beliefs and find a theory that is compatible with my own.

Linda

[Glad2behere]

Great! llg, Suzy, WashYaHands, rncountry, I really like what is being done here.

WashYaHands made a culimating point in her post...that I really like and was not aware even existed. Having a quick overview of all theories, and having a student write a paper on their own professional image of what they wish to be and what they aspire to contribute to nursing from that foundation. Somehow make it a standard of initiation into nursing. Summon a conference of all Nursing school deans so that a uniform policy is constructed so that Nusing Process is the core of our profession...how you get there is flexible. But together we all start here at this particular point and advance somewhat at the same rate. This would allow for more specificity and differentiation in practice much sooner, yet ally us together.

[llg, PhD, RN]

Originally posted by Glad2behere

Having a quick overview of all theories, and having a student write a paper on their own professional image of what they wish to be and what they aspire to contribute to nursing from that foundation. {snip, snip} Somehow make it a standard of initiation into nursing. Summon a conference of all Nursing school deans so that a uniform policy is constructed so that Nusing Process is the core of our profession...how you get there is flexible..

I, too, like the idea of having all students envision how they plan to contribute. It might get more people thinking about contributing rather than just using.

However, the problem comes in getting all nursing Deans (or all nursing "anythings" for that matter) to agree on any single approach. There will always be some disagreement. Just look at what's happened with "caring theory." A lot of people agreed that nurses provide a unique kind of holistic caring -- different from the generic caring that other people do -- and that "caring" should be the central concept around which to organize a curriculum. But yet, that agreement has not been sufficient to convince the majority of nurses participating in this thread to go along with it.

Who gets to decide what that central concept or core should be? You have proposed the nursing process, but a lot of people would disagree with that because it is simply a re-statement of a basic problem-solving process that is not unique to nursing. Let's face it, Every profession uses a version of the same problem-solving process. People assess and diagnose situations, plan to do something, do it, and then evaluate whether or not what they did worked or not -- whether the activity is nusing, medicine, plumbing, or garbage collecting. So the "nursing process" in and of itself can not be used to distinguish nursing from any other profession. Besides, I doubt that there are many schools out there that don't already teach the nursing process in one form or another -- they just don't see it as the thing that defines nursing and distinguishes from other disciplines.

Perhaps we just all need to learn to be comfortable with the fact that different theories and different ways of looking at something is a natural part of an open process -- a process that allows some indivuality and that allows for the introduction of new ideas. If we all get too much alike, that might make us stagnant.

llg

[Glad2behere]

llg,

Doctor, I agree that forming a consensus of nursing school deans to adopt such a policy would be difficult. However, it has been done before, that is how we became saddled by the nursing theories. I do believe I am correct though, that nursing process is a junction at which most theorists converge. Surely some agreement could be reached on that, and some coordination assimilated in a conference setting, and as a group decide what needs to be done. Sure, allow different factions to participate, have our own little "Constititional Congress". Wouldn't that be something! Isn't this how it should be done?

My reasoning is this, you have stated your concerns about producing stagnation if this were instituted, surely that is no worse than division.

Also, this could be mandatory for nurses at the doctorate level to attend, and them having to represent nurses of their specialty to cast a vote in favor of or against certain issues. The grunt nurses could hold meetings to adopt new resolutions to be presented to the voting congress.

In other words, pattern it after our own political party system.

Talk about increasing professionalism and gaining some respect and having some unity!

The voting congress could have ideas submitted to them from the very bottom of core nursing, leadership and direction could be established. Research projects could be dealt out with some degree of accountability and worth, and money would be easier to raise for research with a united effort.

No stagnation here!

I'm saying make Nursing Rock!!!

[rncountry]

Too much the same definately breeds stagnation, I would say we need a curriculum at the BSN level though that is basicly the same so that all nurses start from the same basic framework. Then it is at the master's level where more education is provided in which the many divergent focus' of nursing can be explored more, I particularly like the idea of writing a personal philosophy. BSN programs ideally, would provide several different theories, and again that could be built on more in a Master's program. I know for myself when I go back to school it is with the thought that I am not going to simply go back for my BSN. I want to go into a program where I can become a CNS. At this time I think I would like to go with a focus on infection control, I recall hearing about a program through APIC. Though I enjoy wound care as well.

I think it is vital to nursing to have many different focus', but I also think if too many focus' at once, it dilutes the core.

This is a bit off the topic, yet isn't. I was watching a program on PBS tonight on the Civil War, very good one I might add. Anyway there was a piece about the Battle of Antietum, and there was a small part in it about Clara Barton, while tending a wounded soldier he was shot and killed, and then this quote, "I had to wring the blood from the bottom of my dress as I went from boy to boy just so I may walk." And it made me think of all the nurses in all the wars that stayed through the battles to tend to wounded and dying soldiers and it made me think that at it's extreme that is what nurses do. It is caring, though I don't think it is something that can be captured in a written way well. It is caring enough about fellow human beings that we seek to ease suffering in some manner. Yet it is not enough the simply care, if the practice is to be effective in easing suffering and pain it must be passed on strong scientific knowledge. Nursing as a profession cannot be one without the other. Call it Art and Science or whatever but it is that simple equation that makes nursing what it is. Perhaps because being able to quantify that elusive quality there will never be a theory in which nursing can ever be fully catagorized, in the strict sense of the word. I do think it is important to be able to have a firm foundation on which nursing practice is based, which in my mind must be more scientific in it's approach than many of the theories out there, but I don't know how much anyone can capture the caring qualities that make one decide to become a nurse, police, firefighters or EMT's. It is there but how does one realistically define it? I don't know that it ever can be. It's a bit like theology in my mind. It exists to provide a framework on which religion is based, yet the actual practice of religion rarely mets it's theortical goals. And some theories may have been relevent given the amount of understanding for their age, yet as people have learned more some theories are obviously wrong. St. Augustine's theory that women are only the carriers of a child, but did not actively contribute to the making of that child. In his time the science of sperm and egg did not exist. The theory that the sun revolved around the earth as the earth was the center of the universe, again something that people's of the dark ages knew nothing about. It took scientists who braved not only ex-communication from the church, but also the real threat of death, to do more investigation and uncover the way the body of both men and women worked and to look into the heavens and understand how they worked. It is always pertainent for any group to continue to question and reason out answers. So to the question who gets to decide, I would say all of us. When I see a theory like Martha Rogers that I feel is invalid, it is up to me to say so and not to only say so, but as to why. If I feel there is too much emphasis on the caring aspect of nursing than I must speak up on that as well. Much like societal norms change because of pressure from within a social group to do so, nursing will do the same. And much like social change, that happens not because the majority all suddenly think at the same thing at the same time, but because a few hardy souls are determined enough to push for those changes and once a majority of people feel it is appropriate then changes happen. Top down change rarely is what actually moves things forward.

[llg, PhD, RN]

To Glad2BeHere: I'm sorry if my last post seemed a bit "contentious." After I sent it, I regreted my tone a little. I didn't intend to really disagree with what you had written: I was trying to say that the issues would not be solved so easily.

It is my impression that the overwhelming majority of nursing schools already teach the nursing process -- and it hasn't led to that ideal world we are talking about. As it is only a generic problem-solving process, the nursing process does not at all address the "content" of what it is that the nurse is supposed to assess, the types of problems or needs the nurse is supposed to address, and the types of interventions the nurse is supposed to plan, do, and evaluate.

In other words, nursing "bought into" the nursing process years ago -- but it is in the next step, the step of eludidating the substance that the divergence remains. And that's the realm that is addressed by theory.

Also, as for the leaders getting together, having conferences, etc. that already happens and has been happening for years. Believe me, leading academics have their own conferences and meetings they attend at which they discuss these issues. Again, it has been done for years but has not lead to the unity we have been discussing.

Finally, there are already broad nursing organizations that have addressed these issues for years. There is the ANA, the NLN, and groups for everybody. They have been around for years, and yet, there is still no unity.

I appreciate your input. This discussion has moved my own thinking forward on these issues and again, I aplogize if I seemed a bit too contentious earlier. And please, please, don't keep referring to me as "Doctor." It's not that I take offense or that I am ashamed of it. It's just that some people have such a prejudice against nurses with doctoral degrees that I am reluctant to advertise mine in an environment which might not be safe.

llg

[Glad2behere]

llg,

First, I apologize.

I realize that the ANA and NLN have been doing this for years with some degree of effectiveness, but also lacking a lot as far as a uniform policy or governing body. State Boards do the governing and interpretation of nurse practice acts and their enforcement.

My message is a little different. I am proposing a mandatory membership upon certification as a nurse, and create a heirarchy similar to party politics. This would allow a channel of ideas to flow primarily from the bottom to the top. Have the caucuses and the whole nine yards, and elect one speaker for us all with a set term. I worked as a precinct chairman for several years and I am excited how much we could benefit from such a system. Anyone aware of party politics understands how a party platform is adopted..from the bottom up. I understand the NLN and ANA have done a lot, but they are similar to the League of Nations. Very good but no teeth. All these organizations only reflect isolated views of nursing and thus are unable to speak for us all, albeit because of their limited membership.

Upon issue of license, a nurse would have to send in a fee and initiate membership. Attend a minimum number of meetings on a county or city level to offer, discuss, and vote on ideas. The results of the meetings rehashed again at the state level, then the national level. At the state level delegates are elected to voice and vote to the national level. To me it would be unbelievable what an organization of this caliber could achieve.

Research in any discipline could continue and actually be fostered by the organization, or discouraged by it. I am not saying at all that theories would have no place. I am only saying that at the point of nursing process that is at least one point we could all agree to the extent to make such a body possible.

This body would be able to articulate philosophical statements, espouse research, and put us on a leadership track and inherently have some clout from any point of view.

I disagree that it would be impossible. I think a need has to be demonstrated and the concept sold to nurses. Do I think it would work? Without a doubt.

[Jonty, RN]

Originally posted by OBNURSEHEATHER

Since I have never even heard of her, I would have to say yes.

Heather

Absolutely brilliant summation Heather..I would have been horrified to think that after 39 years practice I wasn't caring because I hadn't heard/read of Jean Watson!!

[llg, PhD, RN]

Originally posted by Glad2behere

llg,

My message is a little different. I am proposing a mandatory membership upon certification as a nurse, and create a heirarchy similar to party politics. This would allow a channel of ideas to flow primarily from the bottom to the top.

Ahhh... Now I see your point more clearly. As you well know, it would still not be easy. A lot of people would reject the idea of a MANDATORY membership &/or participation -- for the same reasons we don't have mandatory voting in the USA. People cherish their right to sit on the sidelines and criticize those who are actively trying to do something!

I think that all we can realistically do is to give people the opportunity to participate -- and then respect their choice to either do so or not. Unfortunately, a lot of nurses prefer to not participate in discussions of nursing academic issues -- and even more choose not to become very knowledgeable about them. That's why a thread like this one has been is a bit unusual.

llg