I *do* recognize the need for nursing theory

[carachel2]

but I am a bit appalled by the theory and research classes requird for my NP program while we covered the entire cardiovascular system in 1.2 hours of Patho. Why is that ??????????????????

We have Nursing Theory, Research and Research and Theory.

How are other programs compared to this one ?

[ZASHAGALKA, RN]

But we are not discussing theories IMPACT on nursing - we are discussing it's use as THE basis for nursing. That distinction is necessary to this discussion.

Whether you love theory or hate theory, there is no denying it's impact on the profession. Whether that impact is viewed as positive or negative depends on our own experiences.

I personally believe there is not sufficient evidence to continue the expectation that theory should be at THE ROOT of nursing - I do not deny that it does have influence on practice, and I can agree that it can be used to guide practice. I object however to it being THE DEFINITION of nursing itself.

What needs to be used as the basis for nursing is science, validated and proven science. We are no longer expected to just place wet cloths on peoples foreheads as the major nursing intervention we are independantly allowed to perform. Today's nurse is expected to thoroughly understand pharmacology, pathophysiology, biology AS WELL AS psychology, spirituality and sociology. That doesn't leave theory OUT - it just reduces it's importance to a place that allows us to move the smoke screen aside and examine it on a level that allows us to ask - as a profession - if it should BE THE FOUNDATION.

I wouldn't have as big a problem w/ theory if I didn't feel it wasn't pushing aside a more fundamental aspect of nursing that SHOULD BE OUR BASE OF KNOWLEDGE. And that aspect of nursing is the applied science of nursing that interfaces w/ our peers so that we are integral professionals to the process of providing, (here it comes) holistic, science driven care.

It's not that I hate theory. It's that I hate not having what theory has systematically pushed aside: a professional base of knowledge.

And grannynurse: EBP isn't the newest NURSING thing. It's a process to standardize a 120 yr trend in medicine - the process of not doing things because that's the way we always did, but critically examining the things we do in order to provide evidence that they work. Nurses will continue to be part of those protocols, but the protocols themselves are nationwide, and even worldwide - and transcends all aspects of medicine.

~faith,

Timothy.

[1Tulip]

You know... I might be wrong, but I think we're sort of reaching some conclusions here. Bookwormom's post on how her thoughts about the human condition influenced her view of nursing and nursing theory are, I think, quite telling. This is what philosophy is for. Even the most pragmatic and technophilic people on this thread have a way of thinking about nurisng. They specifically rank order human needs. I think it was Timothy saying in effect that you can't pray with a person who can't breathe. (Don't want to put words in anyone's mouth so correct me if I'm wrong.) So... none of us are without a guiding philosophy of care. And if we took the time we could either (1) plow through the tomes to find the established theorist with whom we have most in common or (2) take the time to publish our own "theories". (Now there's a scarey thought.)

GrannyNurseFNP is stalwartly defending existing theorists, but... it seems to me... mainly as a philosophy for guiding, not so much practices themselves, but how we think about practice in general. Again, a proper use of a philosophy.

Those who suggest EBP as philosphy are on weak ground. It's a tool for measuring results. It doesn't necessarily help us design altogether new and innovative practices. Those breakthroughs come from scientists and laboratories and clinical studies (or ground floor anecdotal data that can arise from the bedside). But then we apply a systematic approach to measure whether the practices work or not. That's when EBP becomes our guide.

Nurse academics have done more damage to the cause of nursing theory than any other party could have. They've tried to impose it on students rather than persuading them. They've used language badly in explaining it. They have overstated its value by pretending its a science. They've misrepresented it as an entree into a unique body of knowledge (when in fact its been derived from other disciplines.) BUT having said all that, the quest for an articulate philosophy of nursing is a very important exercise.

And, I want to support GrannyNurse in her reluctance to totally buy into EBP. I worry that EBP is based upon a practice called meta-analysis, the pooling of data from many studies, all of which are limited in one way or another and rarely comparable. I am not ready to buy their statistical methods whole-heartedly. However, it's a worthy effort and until we have something better to hang our hats on, it gets my vote.

This has been a fine thread.

[grannynurse FNP student]

You know... I might be wrong, but I think we're sort of reaching some conclusions here. Bookwormom's post on how her thoughts about the human condition influenced her view of nursing and nursing theory are, I think, quite telling. This is what philosophy is for. Even the most pragmatic and technophilic people on this thread have a way of thinking about nurisng. They specifically rank order human needs. I think it was Timothy saying in effect that you can't pray with a person who can't breathe. (Don't want to put words in anyone's mouth so correct me if I'm wrong.) So... none of us are without a guiding philosophy of care. And if we took the time we could either (1) plow through the tomes to find the established theorist with whom we have most in common or (2) take the time to publish our own "theories". (Now there's a scarey thought.)

GrannyNurseFNP is stalwartly defending existing theorists, but... it seems to me... mainly as a philosophy for guiding, not so much practices themselves, but how we think about practice in general. Again, a proper use of a philosophy.

Those who suggest EBP as philosphy are on weak ground. It's a tool for measuring results. It doesn't necessarily help us design altogether new and innovative practices. Those breakthroughs come from scientists and laboratories and clinical studies (or ground floor anecdotal data that can arise from the bedside). But then we apply a systematic approach to measure whether the practices work or not. That's when EBP becomes our guide.

Nurse academics have done more damage to the cause of nursing theory than any other party could have. They've tried to impose it on students rather than persuading them. They've used language badly in explaining it. They have overstated its value by pretending its a science. They've misrepresented it as an entree into a unique body of knowledge (when in fact its been derived from other disciplines.) BUT having said all that, the quest for an articulate philosophy of nursing is a very important exercise.

And, I want to support GrannyNurse in her reluctance to totally buy into EBP. I worry that EBP is based upon a practice called meta-analysis, the pooling of data from many studies, all of which are limited in one way or another and rarely comparable. I am not ready to buy their statistical methods whole-heartedly. However, it's a worthy effort and until we have something better to hang our hats on, it gets my vote.

This has been a fine thread.

Thank you. I agree with much of your posts. And I accept that many nurses have a problem with theory and theorists. However, I am not willing to write off all theorists and substitute EBP. Now, if you want to discuss the bases for testing a theory, I'm ready, willing and able. According to my professors and others there are three approaches to testing and they are linked to one another.

Testing verifies theories through critical reasoning.

Testing verifies through a description of personal experiences.

Testing verifies through the application of nursing practice.

Testing through a description of personal experiences cause a problem for me, in as much as it relies on the use of experience. What is your preception of theorical testing. Or if you wish, chose a theorist and defend or oppose her theory.

Grannynurse:balloons:

[gauge14iv, MSN, APRN, NP]

Or if you wish, chose a theorist and defend or oppose her theory.

But...that wasn't the point of this thread - there are plenty of others for that :)

As for theoretic testing, I agree that more needs to be done, however, I still don't think theory should outweigh science. As we are told from the beginning - nursing is both an art and a science. The art may have needed to outweigh science in the past, but the time has come to examine that and question it.

[Kelly_the_Great]

And, I want to support GrannyNurse in her reluctance to totally buy into EBP. I worry that EBP is based upon a practice called meta-analysis, the pooling of data from many studies, all of which are limited in one way or another and rarely comparable. I am not ready to buy their statistical methods whole-heartedly. However, it's a worthy effort and until we have something better to hang our hats on, it gets my vote.

This has been a fine thread.

This is a concern of mine as well, 1Tulip, in regards to the meta-analysis of evidence.

Something I have thought of is, what if there's something out there that can really benefit a patient (maybe even save lives) yet there's not enough "data" to support the evidence? Then we're back to performing the traditional tasks (versus doing what's best practice) b/c it's the only "proven" method.

Here's an example, I had a patient with a wound VAC, it's the use of subatmospheric pressure dressings applied to wounds. Anyways, I go to review the "evidence" for it's use and there's hardly anything out there. Sure there's lots and lots out there raving about how great this device is for healing wounds but not many studies comparing results with a control group, etc. Know why? Because the use of the device is so overwhelmingly effective many practitioners come to the conclusion that it is unethical to even have a control group.

Perhaps this is some harkening back to my own dislike of statistical math...lol Ever heard what Twain said about statistics, "There's lies, there's d@mn lies and then, then there's statistics"?

I know I've submitted views here that may seem as though I am anti-theory. I am not, I'm just questioning it's importance and position within our study of nursing, how it is being used to define nursing and it's effect on our profession as a unified body. I am still (and hope always to be actively) learning.

[Kelly_the_Great]

But...that wasn't the point of this thread - there are plenty of others for that :)

As for theoretic testing, I agree that more needs to be done, however, I still don't think theory should outweigh science. As we are told from the beginning - nursing is both an art and a science. The art may have needed to outweigh science in the past, but the time has come to examine that and question it.

Right! The OP said:

I do recognize the need for nursing theory but I am a bit appalled by the theory and research classes requird for my NP program while we covered the entire cardiovascular system in 1.2 hours of Patho.

Why is that ??????????????????

We have Nursing Theory, Research and Research and Theory.

[Gennaver, MSN]

Hi Tulip,

Another field that it seems like nursing freely borrows theory from is quantum physics combined with cognitive neuroscience via the whole concept of higher consciousness and 'enlightenment' as exemplified by various religions, (such as Ba'hai and also possibly Buddhism). Yet, even the combination of quatum physics/neuroscience/cognitive theories can seem way out amongst each disciplines neophytes as it is. To mix them all together and apply them to nursing is clearly not applicable-its too varied.

Good theory should take the most complex issue and explain it concisely and simply not the other way around!

As my own former Sociologic theory professor explained, if it is too difficult to explain then you don't have the basic, simple concept.

Possibly these nursing theorists haven't really created anything but have only synthesised and applied already existing theory from various disciplines. This is of course, with exception to the first and most revolutionary theorists.

Gen

p.s. really dig this thread, too

Apologies to GrannyNurseFNP. I shouldn't post when it's way past my bedtime. The ramifications of nursing theories (the good, the bad, and the ugly) are too important for throw away words like bogus and bankrupt.

Gen raised an excellent point. She wrote

Another thing that irks me in nursing theory is that it seemingly denies the existence of -other- disciplines as a whole and yet tries to permeate itself through those very disciplines themselves as if it is the one and only. Ay ay ay.

I've wondered the same thing.

My understanding was that Nsg. Theory was valuable to our profession because it articulated and defined our unique body of knowledge and realm of practice. When I was being taught Nsg Theory (admittedly 30 years ago) the whole point of it was to set us apart from other professions. In particular it was to make clear we were not physicians' little flunkies. For that reason, as I recollect, theories were designed specifically to avoid aspects of professional roles that were interdependent with medicine, i.e., the pathophysiological aspects of disease. Hense there was very little connection between (some) theories and any of the hard sciences.

But THEN, like Gen... I noticed that theorists are freely borrowing from psychology, sociology, education and so forth to derive their theories. And usually borrowing bits that are not empirically based.

So, we are left with the observation that maybe there is not a unique body of knowledge that is the sole pervue of nursing. Would that be a fair statement?

[grannynurse FNP student]

But...that wasn't the point of this thread - there are plenty of others for that :)

As for theoretic testing, I agree that more needs to be done, however, I still don't think theory should outweigh science. As we are told from the beginning - nursing is both an art and a science. The art may have needed to outweigh science in the past, but the time has come to examine that and question it.

This may be the point of the thread but it appears that some are more interested in trashing nursing theory and nursing theorists

As for the comment that art should not outweigh science, there is a scientific bases to some nursing theory. But in the quest to validate a scientific approach, an old, outdated scientific method is used as a model. By this I mean the use of one approach that espouses reductionism, quantifiability, objectivity and operationalization. For this reason, certain other aspects of nursing theory are judged to be non-scientific and therefore not worthy of study because they cannot be reduced, quantified or objectified. While this may be justified to those who strictly subscribe to the scientific method, it deprives nursing theory of the richness of description and understanding. Not all discplines bow down before the scientific principle. There are those that embrace the art of their discipline. Does that make their theory or ours less? Only if you believe in the scientific method when posulating and study theory.

Grannynurse:balloons:

[grannynurse FNP student]

But...that wasn't the point of this thread - there are plenty of others for that :)

As for theoretic testing, I agree that more needs to be done, however, I still don't think theory should outweigh science. As we are told from the beginning - nursing is both an art and a science. The art may have needed to outweigh science in the past, but the time has come to examine that and question it.

In your opinion. However you are the group that is subscribing to an outdated, limited scientific view. Hard science may be necessary but it is the dreamers who first set the steps towards scientific gain. And the dreamers, for lack of a better word, are the ones, who in any discipline, formulate the theories. And just because something cannot be validated by a scientific method, does not lessen its value to a discipline.

There are times when one just has to accept, without a proven scientific base. I believe in God. Can I prove that God exists? Not really but that does not make the likelyhood of his existence any less. Atleast not for me.

Grannynurse:balloons:

[Kelly_the_Great]

This may be the point of the thread but it appears that some are more interested in trashing nursing theory and nursing theorists

As for the comment that art should not outweigh science, there is a scientific bases to some nursing theory. But in the quest to validate a scientific approach, an old, outdated scientific method is used as a model. By this I mean the use of one approach that espouses reductionism, quantifiability, objectivity and operationalization. For this reason, certain other aspects of nursing theory are judged to be non-scientific and therefore not worthy of study because they cannot be reduced, quantified or objectified. While this may be justified to those who strictly subscribe to the scientific method, it deprives nursing theory of the richness of description and understanding. Not all discplines bow down before the scientific principle. There are those that embrace the art of their discipline. Does that make their theory or ours less? Only if you believe in the scientific method when posulating and study theory.

Grannynurse:balloons:

Are you saying it has to absolute one or the other?

[ZASHAGALKA, RN]

In your opinion. However you are the group that is subscribing to an outdated, limited scientific view. Hard science may be necessary but it is the dreamers who first set the steps towards scientific gain. And the dreamers, for lack of a better word, are the ones, who in any discipline, formulate the theories. And just because something cannot be validated by a scientific method, does not lessen its value to a discipline.

There are times when one just has to accept, without a proven scientific base. I believe in God. Can I prove that God exists? Not really but that does not make the likelyhood of his existence any less. Atleast not for me.

Grannynurse:balloons:

1. I'm all for dreaming - taking the so-called first step. But we don't live in a dream world and until there is enough substance to the dream that it bears some semblance to reality, it shouldn't be preached as reality.

2. I agree w/ your last statements about God and faith. But, nursing is not my religion. And that is the problem w/ theory: it is pushed as faith.

And those that disagree are faithless, uncognizant heathens.

My faith is about believing in the substance of things unseen. It is personal. I bear the responsibility for my successes and failures in that regard.

But when it is preached to me that I must put the lives of my patients in the 'faith' of the theorists mystics, that is a step too far.

Nursing is an art and a science. But it is the science that gives me the expertise to use my art, not the other way around.

~faith,

Timothy.

[gauge14iv, MSN, APRN, NP]

So you are unwilling to subscribe to my belief that a mix of theory and science is necessary and both need to be examined, but I am supposed to subscribe to your belief that theory is the end all? Why is that?