Nursing Theory??? - page 6

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  1. by   Peeps Mcarthur
    by roland

    We have seen many "alternative" therapies such as acupuncture gain greater acceptence in this manner. However, it has only been AFTER their efficacy has been scientifically proved and explained.
    Gate-Control theory?

    That was actualy in one of our studyguides, as were about 10 drugs. They called anti-anxiety meds Anxiolytics :chuckle

    There were also resp drugs.
    All of that was ignored on the test. These subjects are not important enough to test? I'll bet if I asked about alpha and delta fibers I would get the "crinkled brow" look.:imbar

    I guess you could sum it up by saying that I'm dissapointed with the curicculum. I expected to be challenged by science, instead I'm being presented social work. I assumed that nurses would learn some medical background, instead I find they fear it in a way. I use a palmpilot device with medical programs to teach me the science behind labs and meds because I can't get the information from my social curicculum or my instructor that wants people to stay after clinical next week to learn about some wacky method of taking away pain that involves nothing more than putting your hand on them and drawing it out or something goofy like that. My clinical instructor is a good well-meaning person, but this is just the kind of thing that turns me off to "holistic" in the extreme.

    And then I think "is it weird, or is it me?" my classmates got interested and started talking about it. Thank God nobody asked me what I thought, I felt awkward enough already.

    I'm just very dissapointed.
  2. by   kmchugh
    "Gate-Control theory?

    That was actualy in one of our studyguides, as were about 10 drugs. They called anti-anxiety meds Anxiolytics"

    Actually, anxiolytics is the correct term. I giggle a bit at gate control theory, primarily because its kind of been left behind in pain management. Its a good starting place, but we are learning there is a lot more to it than that.

    "I guess you could sum it up by saying that I'm dissapointed with the curicculum. I expected to be challenged by science, instead I'm being presented social work." "...or my instructor that wants people to stay after clinical next week to learn about some wacky method of taking away pain that involves nothing more than putting your hand on them and drawing it out or something goofy like that."

    You are not alone in your disappointment of the loss of hard science in many nursing programs. I have seen several programs drop hard science requirements in order to shoe horn other, shall we say, less cut and dried course requirements. The therapy your instructor is suggesting sounds a lot like "Therapeutic Touch." Its an interesting therapy, because it is neither "therapeutic" nor does it involve "touch." Its another of those nursing derived therapies that adequately demonstrates how fuzzy minded some nursing "scientists" are. All too often, many otherwise intelligent nurses put their brains in park for something like this. Why? Not sure, but I think it is a doe eyed (and addlebrained) reaction to a "nursing intervention" that doesn't need those nasty old MD's. We'll show em! I would recommend you go, watch the TT demonstration. Think critically about what you are seeing. Does it make sense, in light of what you know about anatomy, physiology, and pathophysiology? Proponents will sing the praises of the "therapy," and will point to mounds of "evidence" that support the technique. The most often cited, strongest evidence was a study done with burn patients. I can't remember the author currently, but if you are interested, I'll go back to my master's research class notes. I did a paper on this study, and it was so full of holes you could have used it as a fruit strainer. Bottom line: no more efficacious than sitting and talking with the patient. However, talking with the patient is actually much more productive, because you will learn things about your patient that may direct other therapies. And you won't get nearly so tired waving your hands about as if you were trying to fly.

    "And then I think "is it weird, or is it me?" my classmates got interested and started talking about it."

    Rest assured, it is weird, it is unscientific. As an added bonus, if you look into the roots of it, TT is more faith based than anything else. It ain't you, Peeps.

    Kevin McHugh
    Last edit by kmchugh on Nov 18, '02
  3. by   Q.
    Originally posted by Peeps Mcarthur
    And then I think "is it weird, or is it me?" my classmates got interested and started talking about it. Thank God nobody asked me what I thought, I felt awkward enough already.

    I'm just very dissapointed.
    Peeps, if you haven't already, go back a few pages on this thread and read the link I provided (Nursing Theory Humbug). Another poster a couple of threads ago gave me this link and it is very interesting. In fact, you should read it and then share it with your instructors. :imbar
  4. by   WashYaHands
    I'd just like to say that as touchy feely as my previous posts may sound, I am in no way discounting hard science knowledge in nursing. I wanted to give some concrete examples of how psychosocial assessment is used in patient care, balanced with medical science. This may not be your strong point in nursing and that's perfectly okay, as we each have different styles. I agree with Kevin in that you watch and listen to what is presented in class and make your own determination in terms of what you deem worthy for your nursing practice.

    I also agree with Susy about your instructor addressing your concerns and interests. Keep asking the questions. Hopefully, the semester will end, you'll have another instructor whose mindset is more closely aligned with yours and you'll get a balanced education.

    The holistic stuff can be wierd, no doubt. I have a few friends who are majoring in holistic nursing at the master's level and they can be a bit extreme. I have, however, learned from them when they explain things to me from their perspective. This doesn't mean that I fall for everything hook, line and sinker. All things in moderation is my stance on that.

    Anyway, don't be discouraged with one class. If science is your strong point, then you will excell in the hard science courses. The other stuff you may just have to endure temporarily.

  5. by   llg
    I have just finished reading all the previous posts in this thread for the first time and want to say that I appreciate them as they have stimulated my thinking on a subject near and dear to my heart. Here are a few thoughts that I had while reading the posts. I haven't thought them all through, but I wanted to share them any way.

    1. Perhaps beginner-level nursing students aren't ready to deal with much of the theoretical aspects of nursing. The purpose of nursing theory is not only teaching, but includes the guidance of research, the stimulation of thinking, the political diffentiation of the nursing profession, etc. Such theories are not meant to be particularly practical to the bedside nurse and perhaps beginner-level students should be exposed to them in a different way.

    2. We don't teach nursing students about the philosophy and history of science. Many nurses, therefore, don't think of theories in an evolutionary sense. They think of them as static, right or wrong, written in stone, etc. To practice/think in the realm of theory, one needs to understand theory as speculation and be prepared to work in a world that is not static. I don't think most undergraduates are ready for that. They need concrete guidance -- not theorizing and philosophizing. Of course, there are exceptions, and if you are one of them, please don't be offended.

    3. Unfortunately, many nursing faculty are woefully unprepared to deal with the issues we are discussing in this thread. Many have a very limited understanding of theory themselves. How do we address that as a profession?

    Just a few thoughts,
  6. by   WashYaHands
    I agree with point 1. My thinking on this is that beginning nursing theory curriculum should present those theories that are more concrete, understandable and practical. On another thread recently Susy presented Orlando's Nursing Process theory. It's relatively understandable and compatible with beginning nursing education curriculum, yet, this theorist was never studied in my undergrad program. Instead, as a beginning nursing student I was exposed to Martha Rogers (among others), and I have to admit to hearing a "swoosh" sound going right over my head while in class. It was too abstract and I needed more concreteness.

    In most other areas of basic nursing education the curriculum is structured from the ground up. However, it seems that theory education is taught from the top to bottom. Perhaps we should begin with the basics and expand from there. Teach the lesser known practical theories first so students can grasp the overall concept, demonstrate the theory-practice relationship and then add the research piece to complete the triangle.

  7. by   Roland
    and gate theory. Gate theory appears to be part of the answer. That is to say that accupuncture appears to activate higher brain centers which release endorphins that in turn bind with opiate receptors on the afferent pain fiber terminal. This binding seems to suppress the release of substance P, thereby blocking further transmission of the pain signal. This is the "gate theory" part of acupuncture, however it is not the whole story with regard to its action.

    Many physiologists are moving towards an acupuncture endorphin hypothesis as the primary mechanism of acupunture's action. With this hypothesis acupuncture needles activate specific afferent nerve fibers that send impulses ultimately to three centers within the CNS (spinal cord, mid-brain, and hypothalamus/anterior pituitary center, and maybe Limbic as well). These centers block pain transmission via endorphin, enkephalin, and dynorphin release. In addition, certain neurotransmitters such as serotonin and norepinephrine as well as cortisol are also released some of these act by direct action within the CNS extranious to any GATING blockage of substance P.

    After many years of being spurned by the US medical community, acupuncture started gaining respectability after a 1997 report issued by an expert panel convened by the National Institutes of Health. This report summarized the findings of numerous scientific studies that accupuncture is effective as an adjunct or alternative to conventional therapy for many kinds of CHRONIC pain (this would be the pain type most closely assoicated with the unmyelinated "slow C" fibers rather than sharp pain which is often correlated with so called A-delta fibers). Currently, there are over three thousand physicians in the U.S who are licensed acupuncture practitioners (and probably many more who practice the method who are not accredited in the method).

    The point is of course that acupuncture serves as a MODEL of the proper way that a "new", alternative therapy should be adopted. It may very well be that "touch" therapy is highly effective, but it hasn't been demonstrated to my knowledge to a level of general acceptence (indeed it would seem that if the modalities of many nursing theory advocates are followed that it might never be so demonstrated remaining forever at the fringes of therapy, a true tragedy if it really works). Indeed, there is SOME evidence that interventions as esoteric as "prayer" might have positive influence on patient outcomes (this is not altogether outside the reach of science there is a principal in physics termed by some as "non locality" and epitomized by the thought experiment with Schrodingers cat, that might provide the scientific modality in part for the effectiveness of prayer. Indeed, certain studies conducted at Princton University seem to indicate that participants can slightly ((but definitively)) influence the output of random number generators). HOWEVER, as much as I personally BELIEVE in prayer (supported by some science) I wouldn't proclaim it's effectiveness without a great deal of additional research. So should it be with ANY intervention that we would perform upon those in our trust.
  8. by   Dr. Kate
    Perhaps one of the hardest things in the world to do is to shift directions in the middle of a program. It takes a lot of courage to admit you may just have made a wrong turn in the career decision process. But, if you determine you are not suited to the career choice you've made, there are reasons for staying as well as for leaving. If finishing the program will give you the wherewithall to go on and pursue the career you really want. it's a good enough reason for staying.
    What I am hearing is not only reluctance to make a switch in career direction but also an insistance on making nursing and the program you're in be, for you, something it isn't and probably can't be. Sometimes you have to let go of the hope it will make sense to you, and just let it be the way it is. The fight isn't worth the grief it engenders.
    As far as making a change, no matter what you do for the next 5 years, you'll still be five years older. Do you really want to be older and more miserable? Wouldn't it be nicer to be older and more content? And, yes, I know making career changes costs money, time, and energy; so does grousing about your situation, it's just less obvious at times.

    One of the most amazing things I heard as a student nurse came from an instructor who had been the dean of a three year diploma program. She said that she could teach anyone the skills of nursing in 6 weeks. Teaching the thinking process was what took years.
    I often think of Bev's words when I hear nursing students and new grads obsessing about the skills. Those are the easy things to learn. Those are the things of procedure manuals. Repetition makes you good at them. But to be able to think like a nurse, there's no procedure manual for that. I know students and new grads, and experienced nurses grab onto skills because they are so easily defined. You either can do something or you can't. Nursing is and always will be a profession of skills. But it is also a profession of thought. When you start to think like a nurse, when assessing patients is not something you are consciously aware of but part of what you do the same way breathing is something you do, you're on the way to being a nurse. When you start to put together the things people say to you with what you observe casually and in formal assessment procedures, you're on the way to becoming a nurse. Teaching nursing from a theory or model of nursing helps to shorten the time it takes someone to start thinking like a nurse. The traditional way of teaching the thinking process is through care planning. Do enough care plans and the way you think really does start to change. It doesn't make doing care plans fun or in any way reflect the care planning process in the "real world."

    Peeps, as you have noted, as a science based field nursing requires comparatively little background in the hard sciences. It doesn't mean you can't enhance yourself by taking more than the required science classes. But, if you really like the hard sciences as applied to health care why not think about medicine or pharmacy or biomendical reseach? Nursing just isn't a hard science.

    Remember: Pain is inevitable but misery is optional.
  9. by   llg
    Hi, Dr. Kate.

    I loved your post.

    Thanks for sharing your wisdom once again.

  10. by   Roland
    I am saying is that much of nursing theory amounts to little more than a pile of self serving theoretical poop! Your reply reminds me of the story about the guy who goes to his doctor complaining that his pain medication isn't helping his arthritis. His doctor replies that perhaps he should consider a wheelchair because that's the pain medication he always prescribes. You are suggesting that because we find fault in what almost any critically thinking, intelligent person would recognize as religion in the guise of science, that WE are the ones with the problem. Your reply reminds me of the old Soviet Union where it was common to label those who felt communism/socialism was repressive and Evil as being mentally ill rather than admitting that their might be a problem with the system.

    I like Peeps, am a student nurse, and find myself horrified at the lack of simple LOGIC associated with much of this theory stuff. It's not JUST about good science. Rather, it is about the unbiased pursuit of simple, unabashed TRUTH. However, rather than LEAVING the profession I for one am going to strive to CHANGE the profession (at least the illogical theory part). Perhaps, I will fail but it will be lots of fun trying, and what's more I have a feeling that I and others will find many allies along the way, (and perhaps more than a few detractors). The only thing I love more than the thought of making decent pay at a steady job with benefits, is having the assurance of a good fight! This sounds like a battle which could last for decades. Let the games begin.
    Last edit by Roland on Nov 19, '02
  11. by   Q.
    Roland (and Peeps for that matter)

    Not all the theories that are "fluff" are nursing theories per se. A lot are borrowed concepts from other disciplines, so it's not just nursing that is guilty of this. In fact, take a look at some medical philosophies; you'd be amazed at what you'll find!

    A lot of the problem with the theory-practice gap I think is simply because, by nature, theory and philosophies are more abstract than concrete nursing functions. Even Heidegger, a philosopher, criticized most philosophical thinking by basically stating it was not applicable to real life - BUT - that it can be with both calculative thinking and meditative thinking. Calculative thinking is more concrete, meditative more abstract. Heidegger's claim was that for meditative thinking to be useful, it needed to be rooted in calculative thinking. Meaning, they both work together.

    So. What's this mean? Basically, to eliminate this type of thinking from nursing, and dismissing it as "fluff" might not be in our best interests as a profession. To quote the author Anne Bishop when discussing a philosophy of nursing, she states: "When practice is reduced to applied science or technology, humans are theoretically designated as objects, which denies their humanity by reducing them to things entirely determined by natural forces." We all know this is not true. Humans are determined by much more than natural law. This is what make nursing different than medicine.

    I agree that some theories and philosophies of nursing should be worked from the ground up, but not in all cases. Theories are what makes nurses have a practice versus simply, a technique. Practice is theory and applied science together; technique is simply applied science.
  12. by   Peeps Mcarthur

    I think the reason therapeutic touch won't get anywhere is because nursing is not capable with blending thier ideas into medical practice. For any modality to get recognition and real research some doctors somewhere will have to promote it.

    Now about that accupuncture. I was thinking that accupressure could be used in a similar fashion. Accupressure could be an independent action during physical assessment. It seems that there would be a learned skill involved, and maybe it would'nt be precise enough to mimic the therapeutic effects of accupuncture, but maybe have some short-term benefit.

    I think your Theoretical Poop theory is valid. I wouldn't offer an hypothesis until I understood what they are trying to communicate, that would be irresponsible(they might try that before writting one........uhmm?). I don't know much about theory because I don't know how to apply it in its entirety, so I have no way to test it.

    I believe that's why nursing theory is written that way. To make it inaccessible to the medical community, and those that think in the medical model.

    You made some thoughtful observations. I think the decision could have been made before I had invested about $900 in books, most of them nursing related or texts, and most importantly 2 academic years to get to this point. If I had recieved complete disclosure of the curicculum basis such as, psych, psychosocial, and almost nothing medical, I would have made a decision agaist it. There's an RN-MSN option at a university here. If I can make it to the associates level with a 3.2 GPA I will get into the program. My main concern is getting to the "front lines" in a capacity that allows me to diagnose, prescribe, and have my own practice. That's what I want, and given my predicament, that's where I need to focus.

    I think that the idea of introducing theory as those theories become useable to the new student is a good idea. Showing how those theories apply and showing proof in the body of formal research outlines, is the antidote for this problem. Now my question is do they have proof? .

    Perhapse an intervention is also needed:
    If you looked just at the prerequisites of Anatomy(2 semesters), College level math(for me 3 semesters), chemistry, microbiology, one could assume that the courses must have some medical themes. A student (like me) should be screened for intolerance of the curicculum before it becomes inoperable. I think if someone would have given me a sample curicculum and made me test on it a few months prior, I would have at least looked at another program or two. There should also be counsulting during the first semester to confirm with the student thier level of understanding that this is not just a beggining class, but rather, the basis for all of it.

    Keep that in mind when you are developing and managing your first program. I think you will find on inspection of statistics that you could find a correlation between a curicculum's philosophy, and test scores/drop rates for male students. I think male students are more likely to gravitate towards ICU, ER, (although I haven't seen any stats), where critical thinking in a medical way is more appropriate. If nursing wants to attract more males to the profession, that has to be remedied.

    Now I really.....REALLY have to study...........well, maybe I'll just take a look-see at that email...BUT then I really will get started on that psych paper

  13. by   WashYaHands
    Showing how those theories apply and showing proof in the body of formal research outlines, is the antidote for this problem. Now my question is do they have proof? .
    Yes, there are research studies that test the statements and assumptions/hypothesis of theories. If you were to go to CINAHL and enter a nursing theorist name in the search field, you will find numerous research studies published. The studies are used to determine the validity of the theory's hypothesis. Research studies that specifically test theory statements constitute the evidence that determines whether the theory is adequate or must be refined, and the study findings either support, refute, or explain the relevant aspects of that particular theory.

    On the other hand, research can be used to develop theory. Research that is used to develop theories helps to create a body of knowledge that best characterizes and supports what nurses do.