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]

Most of us simply cannot throw our whole being and all of our emotional investment into our patients - you need to save those resources for the rest of your life.

I did some of my graduate work at UCHSC and actually took a class from Jean Watson and worked with some of her teaching & research assistants. I agree with what you said above.

However, what I find frustrating is the number of nurses (including many faculty members) who don't understand the nature of nursing theory or its proper place in nursing. Most nurses that I have encountered have such a simplistic view of nursing theory (and nursing theories) that they handle it badly and ruin it. I have come to believe that this is one realm of nursing in which it is true that "a little knowledge is a dangerous thing."

For example: some people think that in order for a theory to be "good" or "right," it must be able to be applied directly to every given nursing situation. If they can think of a situation for which the theory is not well suited, then it must be a bad theory. That's not true. A theory might help a nurse gain valuable insight into certain types of situations and therefore be a great asset to nursing -- and yet not be very useful in another situation.

In the quote above, KPrice pointed out (correctly, I believe) that we can't give "all" of ourselves to our patients ... and we are not going to "care" about them all in the same way. I don't believe Jean Watson ever said that we should do those things. Anyone who is teaching that Watson's caring theory "says" we need to give all to our patients and/or that we care about everyone in the same way is teaching the theory wrong. In fact, that was a significant topic of discussion in the class I took with Dr. Watson. We talked about how we don't "care" for everyone in the same way and may not even "like" our patients.

I'm not a specialist in caring theory by any stretch of the imagination. But I know enough to know that people who do engage in theorizing about the nature of caring are, for the most part, realistic enough to know that we will feel differently about our families, friends, etc. than we do about the relative strangers who come to us for "nursing care." Their work is an attempt to understand what "nursing care" IS and what it IS NOT and to help nursing sort out the complex issues we face as we interact with our patients and provide them with "care" -- whatever "care" is.

Similar things can be said about most of the major theoretical and philosophical work in any discipline. Each line of inquiry takes a look at one aspect of the profession and tries to understand it throughly. It is hoped that a greater understanding will help people solve problems -- but sometimes, the application of a theory to a concrete situation is more complicated than many people realize.

It reminds me of my 3-year-old nephew making a gingerbread man last year. When told to ue the "Lifesaver" candies for buttons, he took the whole package still in the wrapper and slapped in on his gingerbread man. His 7-year-old sister knew enough to take the candies out of the wrapper and use them to make a row of buttons down the center of the body. He tried to use the Lifesavers, but just didn't have the sophistication to use them properly. (though, I admit, my whole family enjoyed his crazy gingerbread man the most!)

Sorry, I rambled.

llg

[SmilingBluEyes]

I guess, the bottom line is, there is and always should be, room for many "theories" and "theorists" in nursing.....that attempting to describe the essense of nursing is not really possible---or captured---by any ONE theory or person. Heck, we can't even agree if it's an art or a science, or BOTH.

[ZASHAGALKA, RN]

It reminds me of my 3-year-old nephew making a gingerbread man last year. When told to ue the "Lifesaver" candies for buttons, he took the whole package still in the wrapper and slapped in on his gingerbread man. His 7-year-old sister knew enough to take the candies out of the wrapper and use them to make a row of buttons down the center of the body. He tried to use the Lifesavers, but just didn't have the sophistication to use them properly. (though, I admit, my whole family enjoyed his crazy gingerbread man the most!)

llg

I don't have any problems w/ nurses trying to define what THEY believe nursing to be. And to some extent, it MIGHT even be helpful. I have a problem with them trying to define it for ME and pushing it on ME. I'm quite capable of finding and testing my own 'theories' for what nursing is, as I practice it.

These theorists, in an attempt to resolve their own feelings of desperate impotence, have DEFINED nursing by silly standards that have no basis in actual practice. I'm neither that desperate nor that impotent to feel like I have to have my own 'base of theory' before I'm a professional. Especially if that base of theory has no real relationship to my day to day job.

For years, nay nigh on decades, nursing students have been filling out 'care plans' and diagonoses and working nurses have been filing 'care plans' and diagnoses that are never looked at again after they first put on the chart (except for an occasional mandatory 'update' to pull the wool over JCAHO's eyes). They are, in most circumstances, useless.

I don't need an 'alteration in pain' to understand that evaluating for pain management is part of my job.

But worse, because these 'theories' don't translate to any multidisciplinary contribution; our allied health professionals can make no sense of how we chart, and therefore, dismiss our charting. Very few doctors, pharms, social workers, try to understand the high browed gobbledygook that we've been taught makes us 'professionals' (Yes, I DID read S. Gordon's Nursing Against the Odds )

They don't make us professionals, they downgrade our status in the eyes of our professional peers. If we have our own 'language' that excludes other professionals, than it's the equivalent of not bothering to adopt and use the standard language of your countrymen - it is disempowering.

My professional peers relate to me when I can relate to them on equal terms. It's been my experience that most 'theories' take me further away from that equality than they serve to embrace it.

It's not that I have a problem with putting these theories out there: it's that I have a problem with the concept that I must accept the high browed opinions of ivory towered elitists in order to understand my profession. I not so humbly disagree.

And my opinion doesn't make me a three yr old that can't conceptionalize any more than your opinion makes you a seven yr old that can.

I can conceptionalize quite well. I just choose not to adopt THESE conceptionalizations.

This is why nurses have such a steep learning curve out of school. Until they learn to chuck all the excess baggage of school, they can't properly put into perspective what was actually worthwhile and applicable to real life nursing.

~faith,

Timothy.

(Ok, I'm not a touchy-feely type intent upon being in touch with my liberal tendencies. Fortunately, that's not a job requirement in order to have and wield empathy as a part of my job. But my job is not essentially a touchy-feeling job; my PRIMARY job is being a high tech, high skilled hands on, practically useful clinician. I just don't see how most 'theories' advance that practicality. They pigeon-hole me instead of liberate me.)

[llg, PhD, RN]

And my opinion doesn't make me a three yr old that can't conceptionalize any more than your opinion makes you a seven yr old that can.

OK, Timothy. I never meant to say that you had the conceptualization abilities of a 3-year old. If you read (mis-read) that into my post, I am sorry that I did not make my point more clear.

What I meant by the post was that theory is often best-used as an aid to the mind trying to understand things on a deep level -- and NOT as a practical, "how to" guide to perform a specific nursing task. That is particularly true of the more abstract, philosophical theories.

Unfortunately, many people teaching nursing try to directly apply theories to specific situations in ways for which they were not intended and for which they might be ill-suited. Some schools even go so far as to choose 1 theory and use it as if it were the only theory that mattered. That poor use of the theory is what causes many of the problems for the student and/or the practicing nurse -- not the theory itself.

In the case of Watson's caring theory ... it was not developed with the intent of using it as a blueprint for practice. According to Dr. Watson, it was originally developed as a foundation for organizing a faculty's thoughts on key elements of a curriculum.

Finally, it is appropriate for leaders to try to take nursing in directions that they believe will benefit the profession. That's what leadership is all about. If nurse scholars did not try to shape the future of nursing, they would not be fulfilling their roles as leaders of the discipline. It is perfectly appropriate for you to disagree with some of what an individual has to say -- and to express that disagreement -- but please don't try to deny them the right to speak their minds and to provide the leadership we need to move forward.

The process of putting ideas (including theories) out there to be discussed, critiqued, and tried is an important part of any academic discipline. It is inevitable that none of us will agree with every idea out there in the "intellectual marketplace." Perhaps unfortunately for you, many people have found Dr. Watson's ideas to be stimulating and worth exploring further. It's OK if you don't find them to your personal liking. Find other ideas that suit you better and/or develop your own theories. If you don't like the direction that nursing scholarship is taking, become a nurse scholar yourself and take it in another direction.

The direction of nursing scholarship is determined by the people who are willing to invest the effort into being nurse scholars. If you have a real interest in the topic, then that might be a good career path for you to follow.

llg

llg

[Works2xs]

It's unfortunate to hear someone summarily dumping academia as "ivory tower" activity totally divorced from the realm of the practical. Why? Here's a few reasons.

For the student, the study of theory (in any field) has at least two major applications. First, it exposes the student to a wider field of view regarding their particular vocation. If each person enters a field with only their personal opinion of how reality works, you end up with a conglomeration of people all looking at the world through a key hole. Having a narrow view of the field may provide some vision and that vision may broaden with time. However, it doesn't prepare you very well for dealing with the unexpected or the unorthodox. While theory may have little bearing on practical application, it goes a long way to making a person at least aware of the multitude of influences that can have an impact on how they DO apply their skill. If a person's aware that other forces (often competing for time, attention, and resources) are at play, they are that much better prepared for developing their own strategies and contingencies.

A second major factor regarding the applicability of theories is the building of a common basis of communication and understanding. In a field where world-wide schools of thought are thrown together, often under very demanding circumstances, just the ability to have a clue where someone else is coming from exponentially increases their ability to resolve issues and, heaven forbid, build collaborations with their peers. You don't have to agree with a particular theory to understand its underpinning and drivers. How much easier is it for someone to start from a common basis of understanding than it is to start from scratch? You can't begin to resolve issues, find solutions, or develop innovations to existing processes until you have a common understanding of concepts, language, and envirionment.

So, these major concepts build into an overall understanding of the factors and ideals that may have relevance to any single issue affecting an individual situation. The broader the understanding of these factors, the more likely the possibility that the solutions, innovations, and invention of new ideas are to succeed. With a broad knowledge of the "big picture", there's less chance that those ideas will be victimized by reality. In the engineering disciplines, it's referred to as "not reinventing the wheel." Thoretical knowledge empowers the individual to first understand their profession in toto and then to communicate their ideas to the wider audience.

So as the earlier poster suggested, resist the urge to view theory as a cookbook for doing your job. Rather, use it as an artist uses pigments. Having a pallet rich in hues and colors provides the artist with a more powerful range of solutions. The variation and depth of such a range of choices provides an awesome toolbox for the individual to mix their own solutions.

[ZASHAGALKA, RN]

So as the earlier poster suggested, resist the urge to view theory as a cookbook for doing your job. Rather, use it as an artist uses pigments. Having a pallet rich in hues and colors provides the artist with a more powerful range of solutions. The variation and depth of such a range of choices provides an awesome toolbox for the individual to mix their own solutions.

Unfortunately, nursing theorists have chosen to paint in such abstract, that the average nurse looks at their work and thinks 'it's just a bunch of squiggles and paint thrown on a canvas'. It may have specific meaning and boundaries to somebody, somewhere, but it is irrelevent to the nurses actually providing patient care.

Developing our own language and terms etc may have enabled us to communicate better with our nursing peers (ala - 'oh, you hate care plans, too'), but it is a major stumbling block to our ability to be seen on the playing field as equal peers with our other allied professionals. We speak a child's language, hinting at what we mean so we don't dare step into the big respected doctor's world of real diagnosis and prognosis.

You disagree? Nurses are referred to by their first names while every other peer has a title. As someone on this site has said, only pets and children don't have last names. This is our reward. This is where our 'leaders' have taken us. Pardon me if I want off the train. . .

Nursing theory isn't the whole picture so that I can look through more than the keyhole. Nursing theory is the lock on the door that prevents me from opening it up and directly participating w/ my peers.

~faith,

Timothy.

[llg, PhD, RN]

So as the earlier poster suggested, resist the urge to view theory as a cookbook for doing your job. Rather, use it as an artist uses pigments. Having a pallet rich in hues and colors provides the artist with a more powerful range of solutions. The variation and depth of such a range of choices provides an awesome toolbox for the individual to mix their own solutions.

I like your analogy to an artist's use of pigments. May I use it sometime?

... and I enjoyed your thoughtful post. I see you are fairly new to allnurses. I look forward to running into you again.

llg

[llg, PhD, RN]

Nurses are referred to by their first names while every other peer has a title. As someone on this site has said, only pets and children don't have last names. This is our reward. This is where our 'leaders' have taken us. Pardon me if I want off the train. . .

~faith,

Timothy.

I'm sorry you have had this experience in nursing. It has not been my experience. I have worked mostly in hospitals in which all staff members go by their first names, not just the nurses. If you are unhappy with the culture in which you work, I don't blame you for wanting to leave -- or for wanting to change it.

As for not being able to relate to the theories to which you have been exposed.... Again, I am sorry that you did not attend schools with teachers able to help you with that aspect of nursing. Did your classmates have similar problems relating to the theoretical content? I am not a big fan of some of what I see happening in nursing schools and I see this failure to convey the appropriate uses of theory as another example of weakness in the system. Many people find theory a useful tool in their practice and it's a shame that you have not been able to take advantage of what it has to offer. I hope that someday, you will be able to use at least some nursing theories to strengthen your understanding of your work.

In the meantime, getting angry at the people whose work you don't personally relate to doesn't really help anything. They will continue to explore the topics that they find most interesting and relevant to THEIR practice of nursing. You need to focus on exploring and improving those aspects of nursing most relevant to YOUR practice. Rather than trying to tear down the work of others, why don't you focus on building something that you (and others) can support?

llg

[ZASHAGALKA, RN]

I'm sorry you have had this experience in nursing. It has not been my experience. I have worked mostly in hospitals in which all staff members go by their first names, not just the nurses. If you are unhappy with the culture in which you work, I don't blame you for wanting to leave -- or for wanting to change it.

As for not being able to relate to the theories to which you have been exposed.... Again, I am sorry that you did not attend schools with teachers able to help you with that aspect of nursing. Did your classmates have similar problems relating to the theoretical content? I am not a big fan of some of what I see happening in nursing schools and I see this failure to convey the appropriate uses of theory as another example of weakness in the system. Many people find theory a useful tool in their practice and it's a shame that you have not been able to take advantage of what it has to offer. I hope that someday, you will be able to use at least some nursing theories to strengthen your understanding of your work.

In the meantime, getting angry at the people whose work you don't personally relate to doesn't really help anything. They will continue to explore the topics that they find most interesting and relevant to THEIR practice of nursing. You need to focus on exploring and improving those aspects of nursing most relevant to YOUR practice. Rather than trying to tear down the work of others, why don't you focus on building something that you (and others) can support?

llg

I'm not angry, maybe a tad passionate. I'm not putting anybody down - just engaging in debate. I completely respect your opinions, even as I disagree with them. Your point of view is valid, as is mine.

All the touchy feely stuff labels us as 'angels' and 'caregivers' as if all we have to contribute is our feelings. It's as if nursing is just an extention of mothering.

That degrades a large body of professionals that excel in nursing because of their extensive training, experience, and expertise. These 'leaders' are hyping the typical feel-good politics of academia. The problem with nursing theory is that it cannot escape the politics that feed it to the point that it can be relevant OUTSIDE of academia.

OUR language must be relevant to the language spoken around us by our other peers if WE are to be relevant. Nursing theory has worked against us in this regard. Most of our co-professionals can only understand the graphics part of our documentation. The care plans and nsg diagnosis is a foreign language. Think about that - the only relevant part of my 'body of knowledge' is the part done by my unlicensed counterparts! The only way to effectively communicate is to shirk how I'm forced to chart and to verbally relay my input in order to bypass the theory structure that binds and mystifies our charting.

I am more than some idealized 'care'-giver. I'm an intelligent, experienced, well-trained, integral component of healthcare. Healthcare would grind to a halt without me and my kind. But. It would also grind to a halt if all I had to contribute was emotional nurturing.

I have no intention of leaving nursing: I am outstanding at what I do, and I like it.

The OP's original question was 'Can someone be a nurse without Jean Watson'

My reply is that I am good at what I do, not because of her and her kind, but in spite of her. The day I decided to chuck Jean Watson and her kind to the curb is the day I opened myself to possibility of being a true collaborative professional.

~faith,

Timothy.

[llg, PhD, RN]

I'm not angry, maybe a tad passionate. I'm not putting anybody down - just engaging in debate. I completely respect your opinions, even as I disagree with them. Your point of view is valid, as is mine.

All the touchy feely stuff labels us as 'angels' and 'caregivers' as if all we have to contribute is our feelings. It's as if nursing is just an extention of mothering.

~faith,

Timothy.

Aaahhhh ... now this is what I like about allnurses. Sometimes, we can have a good, positive debate. I agree with almost your entire post. Perhaps I was reading (mis-reading) a little more anger and attacking of the nurse theorists than you really feel. They (and their work) are certainly far from perfect -- but they have done the best they can with what they have to work with and are worthy of respect and compassion.

I am not very "touchy-feely" either and also wish there were more emphasis on the intellectual side of nursing. My "complaint" about the use/teaching of theory is really all about the lack of scientific and philosophical rigor in nursing -- and I think we would agree on that. Many people teaching theory to undergraduates these days have very little education in that field themselves. I think it's a case of the "blind leading the blind" (no offense inteded toward people with vision impairments, of course)

We differ in that I am more tolerant and even more appreciative of what some of those theories/theorists have to offer -- even though I see lots of imperfections. I don't know your age or how long you have been in nursing. I am 50 years old and entered the profession at 18. That's 32 years of dealing with these issues and seeing the evolution of the profession and discipline.

I've also studied a bit of nursing history and understand how it is that we came to have this crazy patchwork of theories. Many of the major theories were developed at a time in our history when there was no such thing as a PhD in nursing. Nurses seeking doctoral-level education had to obtain it within other disciplines -- usually taking some of that other discipline's perspectives and trying to adapt and apply them to nursing situations. They were forced to do that because of their situations. In the process, they earned enough respect from those other disciplines to be granted the privilege of establishing doctoral level programs in nursing (in the 1970's). It was an important milestone for the nursing discipline and deserves to be treated with respect.

Also ... there is the politics and the job requirements of academia. Those pressures also shape the knowledge development of our discipline -- sometimes for the better -- sometimes for the worse. Having spent a little time in academia, I am more sympathetic to those realities (which are just as real as hospital realities) than some people who have not.

Finally, while I am not terribly "touchy-feely," I do believe that the "softer" side of nursing has value. People in distress benefit from caring behaviors and those basic behaviors should be a part of every nurse's reportoire. Such behaviors can and should be studied in a scientific way -- thus the legitimacy of studying caring in a rigorous scientific manner. I also believe that getting the science right etc. is one aspect of caring. When I am sick or injured, I want a professional who "cares enough to get the right diagnosis and treatment." Some of Dr. Watson's students and I had many discussions about this when I was in Colorado. We all agreed on that point: "good science," and "intellectual rigor" are consistent with caring -- not opposite.

So I take what I can from each body of work with the attitude that no one approach has all of the perfect answers. I usually find something of value in each major body of work and/or theory.

Went on too long again ... but thanks for the good discussion.

llg

[Works2xs]

I like your analogy to an artist's use of pigments. May I use it sometime?

... and I enjoyed your thoughtful post. I see you are fairly new to allnurses. I look forward to running into you again.

llg

Wow... many thanks! Feel free to use the analogy anytime. (Unless, of course, there's money involved. Then I want full attribution!! j/k)

[jeepgirl, LPN, NP]

OMG

why does this thread have like, 35 pages?!?!?!