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]

For the record, I agree ... and I teach a theory course. I think most people teach theory horribly and cling to out-dated notions about theory and its place in our profession.

I value theory immensely and know that we have to continue our development of nursing theory. But that development needs to be done without being overly afraid of theory developed from within other disciplines. We need to position ourselves as equal partners in the scholarly world -- working WITH the scholars of other disciplines, not working in opposition to them.

I think our profession got so hung up in trying to define what is UNIQUE to nursing (which is an important task for us) .... that some people can't think of OTHER scholarly issues that ALSO need to be accomplished that involved scholarship and theory development.

We act as if we have an inferiority complex. I think that inferiority complex is part of the reason we are so weak in the theory area ... but I also think we are weak in that area because so few nurses are willing to embrace the theoretical work that needs to be done to improve our theory. Not many nurses like it, so the work doesn't get done ... which leads to bad theory ... and poor theory teachers ... which causes students to hate it ... which results if few people willing to do the work that needs to be done ... etc. etc. etc.

I agree with some of what you say. I think we have gone about it from an inferiority perspective, that we've tried to use theory to shore up that inferiority. I think that was bound to fail, in that regard.

I disagree that the problem is so few nurses willing to embrace theory or the theoretical framework necessary to improve it. Theory should be about praxis. Praxis is how well the theoretical translates to the practical - how well our theory actually translates to the trenches.

So, I think you have it backwards. The problem with theory isn't that it's not embraced by the masses. The problem is that it isn't embraceable by the masses. The masses of nurses do not need to adapt to theory. Theory needs to adapt to the masses of nurses.

Theory is a product. You have to sell a product (as you say, teach it better). Yes. But, it also has to have some inherent value on its own. It has to actually have meat to go with the sizzle. I don't think theory does. That's not to say that there is no value for anyone. Clearly, theory is valuable for some. However, for much of theory, there seems to be no inherent value that many nurses cannot also find elsewhere in their overall spiritual warehouse of knowledge.

Each of us have our own religions or our own spiritual values that we bring to our jobs. Not only do we not NEED nursing theory for this task, that theory could not possibly address the spiritual framework of all or even most nurses. I know, I know - it's not necessary to be all things to all people; it's a buffet. However. A buffet is not the same thing as 'core knowledge'. Core knowledge is just that - core, foundational. If you argue that theory was never meant to be core knowledge, then you are arguing that it is 'optional'. In THAT case, there is no place for concern that the masses of nurses haven't taken out an option on theory. It can't be both ways.

So, theory gets dismissed by the masses of nurses not because there isn't some value to it. No. It gets dismissed because the value that it has is duplicative. I bring my OWN spirituality to my job. I neither need - NOR WANT - the spiritual framework of a liberal elite to be pushed on me. I do just fine with my own spirituality.

It's about praxis. It's not that theory hasn't been taught well enough. It's that theory offers nothing of practical value to most nurses. That is well established. Most practicing, in-the-trenches nurses can't name three theorists or comprehensively describe one theory. If you want theory to matter to the masses, then that theory has to be relevant to the masses. Currently, that just isn't the case.

There is an utter lack of praxis in nursing. THAT is what is wrong with theory.

Theory should depart its eastern religion sophistry and bend more towards our science. THAT I could readily embrace. We've over-embraced the 'angels' of our nature. It's time to look more towards our professional practice.

~faith,

Timothy.

[ZASHAGALKA, RN]

To me, my nursing school education caused me increasing apprehension about working as a nurse. If this touchy-feely stuff being taught was what nursing was really about, I was in deep trouble. If our language was really the pseudo-sophistication of care plans and 'metaparadigmatic' theory, then I was over my head.

I had been sold on the solid 'science' of nursing. This stuff wasn't it. I only survived nursing school because I knew the 2 rules of college: 1. The instructor is always right, and 2. If you want to pass, see rule #1. That saved me. It allowed me to answer back on exams stuff that I thought was truly preposterous.

I felt like nursing's 'core' knowledge and language was either an outright lie, or an inside joke that I didn't get.

It hit me in my next to last semester. This was a game. It was a game that all the students were playing - out of necessity to pass. In reality, the instructors were naked emperors and non-academic true believers were few and far between. The nurses that I saw in clinicals - they had stopped playing long ago because their careers were no longer bound to the game. I began to understand that lots of the stuff they teach in nursing school was outright indoctrination that could be safely tossed on the curb.

As a result, I became a better nurse. I was fundamentally relieved. I COULD be a nurse without buying all the tripe being taught in school. It was nothing less than an epiphany that saved my nursing career before it started.

It made me a great nurse. Ignoring nursing theory allowed me the confidence to pursue my own spirituality and apply it to nursing. To that extent, I'm in comfortable territory. That comfort zone frees me to expand upon my science and, as a result, provide the best combination of both science and spirituality.

I'm no angel. I don't try to be, nor would I want to be. Instead, I am scientifically educated with a high level of experience to manage critically complex equipment and titrated medications in an environment of constant monitoring and re-evaluation. I do bring compassion and caring to the table, but I do so on my own terms. I'm very good at it. After my ADN, when I pursued my bach degree, I chose biology - a scientific underpinning for my nursing career that I did not believe I could get with a BSN.

By making theory a 'buffet', nursing made it optional. It's no surprise to me that the vast majority of nurses opt out. I would. I did.

I know that there are some that read this post and are appalled about what I have written. I know that there are some that strongly disagree with me. Here's the thing. I stipulate that the majority of practicing nurses agree with me and a large number of students will read this post with a nodding sigh of relief. It's a game. Play it and pass. THEN, you can be the best nurse YOU can be. You don't need that stuff to do so.

I offer proof for students. As you encounter practicing nurses in your clinicals, routinely ask them 2 questions. 1. What do you think about care plans? 2. Can you name three nursing theorists? The answers you receive will be very instructional. The chief downfall to theory in nursing is that students must be exposed to practicing nurses and it becomes evident over time that there is a disconnect between school and reality in nursing.

The reason for that disconnect is that there just isn't any praxis to nursing. Theoretical nursing and actual nursing practice are two very different things. That's not the fault of practicing nurses. If theory is to be embraced, it must be relevant. It's not. No improvement in its teaching can make it something that it isn't.

~faith,

Timothy, RN, CCRN, BA-Biology.

[llg, PhD, RN]

Timothy,

I am not feeling very well. So, I am not going to linger in this thread very much and get into a big debate. But I am encouraged that we seem to be coming closer together in our long-standing discussion.

We both agree that many theories are not very good. We both agree that the focus of theory should be praxis. We both agree that not many nurses like theory.

It seems that now, we are simply looking at the same circular process from different sides of the circle. From one perspective: Nursing theories are bad, which causes nurses to turn away from them. From the other perspective: The fact that so many nurses turn away from theory results in our profession's failure to develop better theories.

I suggest that we are not really disagreeing here -- but seeing the same circular process from different sides of that circle. If I could draw a circular diagram in this software to illustrate my point, I would. But I think you can see what I mean without it.

[ZASHAGALKA, RN]

Timothy,

I am not feeling very well. So, I am not going to linger in this thread very much and get into a big debate. But I am encouraged that we seem to be coming closer together in our long-standing discussion.

We both agree that many theories are not very good. We both agree that the focus of theory should be praxis. We both agree that not many nurses like theory.

It seems that now, we are simply looking at the same circular process from different sides of the circle. From one perspective: Nursing theories are bad, which causes nurses to turn away from them. From the other perspective: The fact that so many nurses turn away from theory results in our profession's failure to develop better theories.

I suggest that we are not really disagreeing here -- but seeing the same circular process from different sides of that circle. If I could draw a circular diagram in this software to illustrate my point, I would. But I think you can see what I mean without it.

I hope you feel better. I think you are correct. I would be happy to engage in theory if theory was something I could sink my teeth into. In its current form, it isn't.

I wish that weren't the case. I want to see my profession be all it can be.

Just like you.

Take care.

~faith,

Timothy.

[llg, PhD, RN]

I hope you feel better. I think you are correct. I would be happy to engage in theory if theory was something I could sink my teeth into. In its current form, it isn't.

I wish that weren't the case. I want to see my profession be all it can be.

Just like you.

Take care.

~faith,

Timothy.

Thank you. I hope all is well with you and your family.

llg

[ntaffe]

Although theory is not my favorite subject, I realize its importance. Nurses, no matter their specialty, must integrate theoretical thinking in the course of their studies and in practice. This is important because it provides a direction to whatever situation (research, clinical practice, or teaching) the nurse finds herself/himself in. I believe it is important for us as nurses to be aware of our history, the current practice, and where we are heading as a profession. For us to continue to progress in our profession, we must show evidence as to the validity of the care we provide to our patients. According to Afaf Ibrahim Meleis, "Theory has become an integral part of the nursing lexicon in education, administration, and practice. Members of the nursing discipline should understand its role in the development of nursing and in the delivery of quality evidence-based nursing care." (p. 4)

[r0b0tafflicti0n]

It isn't stuff that is readily understandable, embraceable or even useful in many way - and the time and energy we waste on it is just astounding.

I haven't studied a lot of theory that I've found worthwhile (yet); but are you *really* stating that because something isn't readily understandable that it's a waste of time?

Perhaps nursing theory needs to be modernized/radicalized, not dismissed/molded into allopatic medicine.

[Kelly_the_Great]

Although theory is not my favorite subject, I realize its importance. Nurses, no matter their specialty, must integrate theoretical thinking in the course of their studies and in practice. This is important because it provides a direction to whatever situation (research, clinical practice, or teaching) the nurse finds herself/himself in. I believe it is important for us as nurses to be aware of our history, the current practice, and where we are heading as a profession. For us to continue to progress in our profession, we must show evidence as to the validity of the care we provide to our patients. According to Afaf Ibrahim Meleis, "Theory has become an integral part of the nursing lexicon in education, administration, and practice. Members of the nursing discipline should understand its role in the development of nursing and in the delivery of quality evidence-based nursing care." (p. 4)

Your post reminds me of that bar scene in Good Will Hunting when the college student is spouting off his beliefs on the evolution of market economies in the southern colonies...lol I mean we could all quote some passage from one of our books that included nursing theory or was solely dedicated towards its study.

What I continue to wonder is, should it take precedence over practice? How much weight should be granted in our instruction towards it? Are we putting too much emphasis on it, to the point of excluding "scientific" knowledge?

Look at your sentences here:

I believe it is important for us as nurses to be aware of our history, the current practice, and where we are heading as a profession. For us to continue to progress in our profession, we must show evidence as to the validity of the care we provide to our patients.

Are the theories helping our profession progress? Are they bringing us any unity? Are they helping us define nursing so we can control it, teach it, advance it and BILL for it? Or are they splintering us? Do they cause befuddlement amongst the students, at which point they just disengage from even considering advancing the profession, opting instead to just jump through the hoops and then become strictly task-oriented nurses? Do the students who do kind of buy into the indoctrination (upon whichever theory their particular program/instructor happens to espouse) then become overwhelmingly disillusioned when they enter the real world and discover that not only do the majority of their colleagues not know anything at all about theory but could care less? Furthermore, how many of these theories are demonstrably valid? How many of them can you measure with any validity whatsoever? Are they grounded in any "evidence" whatsoever?

I propose its study does nothing at all to advance an autonomous profession and is a colossal waste of time! What other "profession" besides theology spends sooooooooooo much time studying its "theories" . Gosh, at least religions can pick one and set forth a doctrine stating who they are and what they stand for.

[JaimeeG]

Kelly -

Excellent post with very valid comments! I am currently in the first semester of a DNP program, and I am seriously considering dropping out and finding another truly clinical path. This is my fourth theory class, and I am learning nothing new, other than how much I loathe nursing theory.

As others have stated, we are one of a very few professions who has chosen to become mired down in theory. I NEVER use nursing theory in my daily practice as an NP, much to the dismay of my current theory professor. When I am with a patient and have a problem to solve, I have never scratched my head and thought to myself, "Hmmm...what would Orem/Rogers/Roy/Watson/(insert theorist of your choice) do in this situation?"

Although the powers-that-be in nursing academia would like to convince us otherwise, we CAN be a legitimate and respected profession without years of nursing theory crammed down our throats. We CAN provide good patient care without years of nursing theory classes. Nursing theory, in my opinion, has done nothing to advance our profession; instead, I feel that it has been a serious detriment. I know of many nurses who stopped their education at the Associate's or Bachelor's level because they so dreaded the thought of more theory. Very sad....

In the early postings of this thread, someone commented that in their NP program they had a few hours of cardiology instruction but an entire semester on theory. That was something I questioned when I looked at the curriculum of my NP program as well. We had ONE class in adult health in which we went over cardio AND respiratory. Our neuro talk consisted of a neuro NP (who does only sleep medicine) came in and talked about MS and migraines. But, I did have an entire semester of theory and research. Yes, we must make sure we have the classes important to patient care!

I believe my rant is over for now. I have built-up issues because I am trying to do discussion posts in my class without saying the things I have said above!!!

Jaimee

[thbos]

Hi All,

I’m not a nurse, or even in the clinical health care field, but I stumbled upon the concept of nursing theories and out of curiosity to learn more read this thread. Thanks to all those who have been contributing your thoughts, I feel like I’ve learned a great deal regarding the relevance of nursing theory. I hope you don’t mind, but I’d like to present my opinion as someone outside of the nursing field. After all, the main topic of this post, how to best train students, is fundamental to every field.

The first thing I noticed in the back and forth of these posts is a lack of opinion by those without a conflict of interest. Many posters on this thread seem to have no appreciation of the importance of bias and conflict of interest. A nurse who has studied nursing theory, taught it, or applied it to their work, has an inherent bias regarding it. A student taking a nursing class and having trouble with the material is also in a conflict of interest when judging it. Certainly those who’s careers are based on it have a conflict of interest when attempting to judge its value.

My point is, nursing theory needs an external audit by unbiased non-nurses. It is purely self-serving to believe that the only people capable of truly understanding and judging the value of nursing theories are the ones that study and teach it. For instance, a child can be taught the importance of calculus without having to actually understand the language of math. An educated adult can figure out the importance (or lack thereof) of nursing theory without devoting their lives to it first.

So let’s imagine a group of educated professionals tasked with making recommendations for future nursing curriculums (for the sake of argument lets assemble a small panel of scientist, lawyers, and other community leaders). The Panel would spend a few months interviewing nursing professors, students, and working nurses along with their medical colleagues and patients. Do you think that the panel, after studying current curricula, desired curricula, and professional duties, would recommend more or less nursing theory be taught? My guess is that nursing theory for the most part would be removed from the curriculum and replaced with classes focused on practical skills.

PS- I did notice that one person attempted to support their side of the argument by arguing that Florence Nightingale would agree with them? Conjuring up the current opinions of the long-time deceased is a very strange way to support any argument. I think it should always be avoided. Who knows what the dead are thinking?

[Mission]

My point is, nursing theory needs an external audit by unbiased non-nurses.

Future of nursing report: http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Do you think that the panel, after studying current curricula, desired curricula, and professional duties, would recommend more or less nursing theory be taught? My guess is that nursing theory for the most part would be removed from the curriculum and replaced with classes focused on practical skills.

I think your guess is probably wrong. Nursing is a science (and an art) and you can't teach science with theory. I think, like many other health sciences, the push is towards teaching interdisciplinary theories and methods. At least that is what my school had done.

[Mission]

I think your guess is probably wrong. Nursing is a science (and an art) and you can't teach science with theory. I think, like many other health sciences, the push is towards teaching interdisciplinary theories and methods. At least that is what my school had done.

That should say you can't teach without theory.