I *do* recognize the need for nursing theory

Nursing Students Post Graduate

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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 ?

No, I didn't feel disrespected b/c I didn't think you were referring to me.

I just wondered why you attacked their cognitive abilities. That was my question. I wondered this b/c, to me, the posters have had valid arguments and have presented them in an intelligent manner.

Oh well. I suppose it really doesn't matter. I'm just very interested in our intraprofessional interactions and I was just curious.

Since theory is such an emphasized aspect of nursings' core curriculum, I'm sure there will be many others who echo your views relating to the importance of theory.

In the meantime, I'm enjoying the discussion and feel very fortunate to have stumbled upon it! :)

In reply to your question regarding cognitive abilities. Cognitive ability refers to the mental process by which knowledge is acquired. Dismissing an entire body of knowledge because it does not fit into their definition of their nursing practice demonstrates, IMHO, a clear deficit in cognitive ability. Or perhaps ignorance of what a theory is all about. Darwin's theory of evolution is a theory steeped in scientific principles and generally is accepted, except by the far right. However Kant's theories are present in the abstract and are difficult for many to understand and accept.

I would appreciate your sharing with me just which posts you find that are so valid in their argument, against nursing theory and its place and role in our profession. You can e-mail me your reply. Like I have posted, many of the responses against nursing theory tend to rely on its supposed failure to meet scientific theory or their own standard of practice. The one theorists they seem to dislike the most is Jean Watson. How about I. King, Lenienger, Dorothea Orem, Callista Roy. or Betty Neuman, surely one of these theorist's meets ones definition of having insight into clinical nursing. I know that Lenienger and Roy's theory of nursing clearly are related to clinical practice. Wouldn't you agree?

Grannynurse:balloons:

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Humor me and ponder this for a few minutes -

Lets say (just for the sake of this) you were raised in a catholic home, in a catholic community and schooled in a catholic church, in addition you attended a catholic university and worked at catholic institutions. And lets say you are very involved in the catholic church you attend.

How likely would it be that you would readily convert to judaism without a second thought? How indoctrinated would you be in the ways of catholicism? Right down to your view and vision of the world, of people as humans, your relationships with others, your choices in life, your family structure and the friends you chose to surround yourself with...all of these would be influenced to some degree by your catholic religion, would they not?

And how much of that religion would be based on what you THINK you know, as opposed to what you actually are 100% certain of?

So nurses are "brought up" in one theory or another...we think we know certain things about certain theories. We are given a few favorite theories which are handed down in schools based on what that school chooses to teach. Do we take those at face value? Or do we question them?

A nurse in a clinical unit tells a new nurse that there is no need to push an IV med slowly - does that new nurse take that at face value or does she do some further investigating to determine what the best practice might be?

To squelch the questioning of theory is to squelch the stream of clinical inquiry. Nurses can no longer be expected to stand idle while another medical professional kills a patient with a practice that is not evidence based, but yet thats essentially what those who say we should not question theory are asking us to do!

We make it all up really - we just think we know (and theorists think they know) what nursing is. Not everyone agrees upon a given theory, and really, those who know theory tend to pull parts and pieces from various theories and use what works for them. Since none of us agree on one theory, the profession is in eternal divide and conquer mode.

The point is - what we are doing really isn't working for us as a profession. As a whole, we don't embrace and believe in theory. Many (maybe even most I would venture to say) nurses are dissenters where theory is concerned. We aren't a unified body - not even in theory. And since we can't be unified in the beliefs that underly our profession, then theory really needs to examined. To throw ALL of it out would be throwing out some valuable stuff, but to not question it at all is to know only one religion and take heresy for fact.

We question because we can, I don't believe humans were meant to follow anything in blind faith - thats MY belief...

I was born and raised in a Catholic family and attended Catholic schools until the age of 12. I was taught religion, thru my junior and senior high school years by Jesuits, the acknowledged masters of catholic theory and argument. The one thing that they taught me, was to question what I did not understand and not to accept, with blind faith, anything I was taught. I do not consider myself indoctrinated by my faith. I have always questioned articles of my faith and have not blindly accepted it, just as I was taught to do.

Nursing theories are evolving and changing. A theorist I followed, in my younger days, is not the same one I follow today. The program I am in, follow's King, whose theory I understand but do not accept whole heartly. Dissention is acceptable when it is based on knowledge and logic. It is not acceptable to dismiss nursing theory by claiming it doesn't follow one's clinical practice. Or to dismiss faculty by saying they remain in their ivory towers far from clinical practice. I have attended three universities and all of my facualty members were actively engaged in some aspect of clinical practice. I often wondered where they found the time to teach, practice and conduct research, until I met my SO. He holds a PhD, actively teaches three days a week at university, does research and helps care for a relative with MS.

What about Sister Callista Roy's theory that a person is an adaptive system, who is in constant interaction with an ever changing environment; and is constantly changing and adapting. In regards to those that believe theory plays no importance in their clinical practice, do they so easily dismiss the changing role of a patient, in his/her attempt to adapt to their changing environment. How about a hospitalized patient, who is an RN, who reacts to a change in her role and function, from a nurse to a patient. And how one helps or does not help this patient deal with the change in her role. Roy's theory is just one of the theorist that I have done research on, along with King and Lenieger. And whose theory has been incorporated into nursing research, into my clinical practice area. How about some comments on her theory or any other one. And comments on clinical research that has been done in support of or non-support.

Granynurse:balloons:

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If I hadn't been so dumbfounded by the verbage at times, theory class would have been a lot more fun if I'd been argumentative about it!!!!!

Funny, the graduate course, in nursing theory, at Sage College and the University of South Florida, encourage distention. We did have to back up our argument with data grounded in our dissension and thory, as well as logic..

Grannynurse:balloons:

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First of all... I would like to compliment everyone on this thread. I have never heard or read a more robust and honest discussion of this topic.

Let me try to respond to GrannyNurse. She has taken the not-so-popular position here and I want to be thoughtful in answer.

She writes...

"I find that some of those who object to nursing theory are generally anti-nursing scholarship. By this I mean they are generally not supportive of nursing research that is esoteric in nature."

I understand the word "esoteric" to mean ... intended for, or understood only by a particular group, as in an esoteric cult. (See dictionary.com) I don't think that's the word she meant because it would be a tautology to say "people don't understand what they aren't intended to understand." I think... correct me if I'm wrong here... that she was saying that some nurses have no patience for ideas that start to get metaphysical in nature. She's right to make that observation and call it for the fault that it is. Many nurses are way into "doing" nursing and not "thinking" (about) nursing.

Let me try to bridge the gulf between those who want room for scholarship into the metaphysics of nursing, and those who object to the anti-scientific aspects of such scholarship.

I would suggest that we make room for very expansive and evolving inquiry into the nature of nursing. BUT don't call it science. Call it what it is... philosophy. And there is nothing wrong with philosophy. It's a good thing and if nursing is more introspective than some professions, so what? I see it as a strength, not a weakness.

Science, as understood by other professions is firmly rooted in empiricism. Scientists would say, in effect, "if you can't measure it, you can't study it." Those that want to base research on metaphysical epistemology (Rogers/Watson) are in a bind. Their research is not comparable to that done elsewhere in the academy. If we nurses want to interact with and be as respected as..physiologists, physicians, pharmacologists, chemists, molecular biologists, or anyone in the hard sciences, we have to give up the pretense that gnostic nursing theory is science.

BUT gnostic-Watsonianism-Rogerianism CAN bridge nursing to other soft-science departments, especially those that are heavy into post-modern scholarship. Political science, Philosophy, Journalism, Education, Psychology (especially in departments that are non-neuropsychometrically oriented), Sociology, Social Work, Women's Studies and so on. That is perfectly OK. We are a very unique discipline and we can relate to almost the whole University community in one way or another.

Here's the rub, however. The empiricists among us (evidence-based, clinically or hard-science oriented scholars) are absolutely shut out of the dialogue. Those running schools of nursing, editing the journals, leading the professional organizations, funding the "research" have defined empiricists OUT of the profession by maintaining that their (gnostic) philosophy is, in fact, synonymous with nursing science.

I disagree wholeheartedly. The gnostic theorists are philosophers, not scientists. The strength of any philosophy is found in how well it responds to critical examination and debate. The Old-Gals that run nursing go to great lengths to avoid exactly that kind of dialogue.

There is nothing wrong in developing a philosophy of nursing and teaching it to students. There is A LOT wrong in formulating a philosophy and then punishing those that refuse to accept it.

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Specializes in ICU, ER, HH, NICU, now FNP.

Tulip - very eloquently stated!

Im not advocating that we throw out nursing thery altogether, but I think we have to be careful that we don't turn it into a blind expectation that all nurses are required follow.

In my experience - a theory class I took was "Believe it or leave it". The instructor SAID she wanted dialogue, but attacked anyone who dared to disagree. That has been my experience with theory. She was the ideal illustration of a theory thumper - one who advocates theory with the enthusiasm of a southern tent preacher on hades hottest day but without being open to question and examination.

I love Artinian & Congers Intersystem Model - it makes great sense to me and I have found it to be very helpful in bedisde practice. The fact that I love it does not make it wholly embraceable by the entire profession however.

I really like the concept of calling this part of the nursing discipline - "Philosphy" - as opposed to theory. Philosphy expects to be queried and dialogued, Theory (or some of those who defend it staunchly) thinks it ought to stand on it's own right - at least in the exposures *I* have had.

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First of all... I would like to compliment everyone on this thread. I have never heard or read a more robust and honest discussion of this topic.

Let me try to respond to GrannyNurse. She has taken the not-so-popular position here and I want to be thoughtful in answer.

She writes...

"I find that some of those who object to nursing theory are generally anti-nursing scholarship. By this I mean they are generally not supportive of nursing research that is esoteric in nature."

I understand the word "esoteric" to mean ... intended for, or understood only by a particular group, as in an esoteric cult. (See dictionary.com) I don't think that's the word she meant because it would be a tautology to say "people don't understand what they aren't intended to understand." I think... correct me if I'm wrong here... that she was saying that some nurses have no patience for ideas that start to get metaphysical in nature. She's right to make that observation and call it for the fault that it is. Many nurses are way into "doing" nursing and not "thinking" (about) nursing.

Let me try to bridge the gulf between those who want room for scholarship into the metaphysics of nursing, and those who object to the anti-scientific aspects of such scholarship.

I would suggest that we make room for very expansive and evolving inquiry into the nature of nursing. BUT don't call it science. Call it what it is... philosophy. And there is nothing wrong with philosophy. It's a good thing and if nursing is more introspective than some professions, so what? I see it as a strength, not a weakness.

Science, as understood by other professions is firmly rooted in empiricism. Scientists would say, in effect, "if you can't measure it, you can't study it." Those that want to base research on metaphysical epistemology (Rogers/Watson) are in a bind. Their research is not comparable to that done elsewhere in the academy. If we nurses want to interact with and be as respected as..physiologists, physicians, pharmacologists, chemists, molecular biologists, or anyone in the hard sciences, we have to give up the pretense that gnostic nursing theory is science.

BUT gnostic-Watsonianism-Rogerianism CAN bridge nursing to other soft-science departments, especially those that are heavy into post-modern scholarship. Political science, Philosophy, Journalism, Education, Psychology (especially in departments that are non-neuropsychometrically oriented), Sociology, Social Work, Women's Studies and so on. That is perfectly OK. We are a very unique discipline and we can relate to almost the whole University community in one way or another.

Here's the rub, however. The empiricists among us (evidence-based, clinically or hard-science oriented scholars) are absolutely shut out of the dialogue. Those running schools of nursing, editing the journals, leading the professional organizations, funding the "research" have defined empiricists OUT of the profession by maintaining that their (gnostic) philosophy is, in fact, synonymous with nursing science.

I disagree wholeheartedly. The gnostic theorists are philosophers, not scientists. The strength of any philosophy is found in how well it responds to critical examination and debate. The Old-Gals that run nursing go to great lengths to avoid exactly that kind of dialogue.

There is nothing wrong in developing a philosophy of nursing and teaching it to students. There is A LOT wrong in formulating a philosophy and then punishing those that refuse to accept it.

I do not understand what you mean by punishing those that refuse to acceot it. I have never been punished, by faculty, when I disagreed with the theorist who is the chosen one, of the program. I and all the other students have been encourage to question the theory of the program. I and some of my fellow students did not agree with I. King's theory and she was the one teaching the class.

Grannynurse:balloons:

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Specializes in Critical Care.
In reply to your question regarding cognitive abilities. Cognitive ability refers to the mental process by which knowledge is acquired. Dismissing an entire body of knowledge because it does not fit into their definition of their nursing practice demonstrates, IMHO, a clear deficit in cognitive ability. Or perhaps ignorance of what a theory is all about. Darwin's theory of evolution is a theory steeped in scientific principles and generally is accepted, except by the far right. However Kant's theories are present in the abstract and are difficult for many to understand and accept.

I would appreciate your sharing with me just which posts you find that are so valid in their argument, against nursing theory and its place and role in our profession. You can e-mail me your reply. Like I have posted, many of the responses against nursing theory tend to rely on its supposed failure to meet scientific theory or their own standard of practice. The one theorists they seem to dislike the most is Jean Watson. How about I. King, Lenienger, Dorothea Orem, Callista Roy. or Betty Neuman, surely one of these theorist's meets ones definition of having insight into clinical nursing. I know that Lenienger and Roy's theory of nursing clearly are related to clinical practice. Wouldn't you agree?

Grannynurse:balloons:

In truth, if If I thought that theory just didn't apply to me, I'd have no opinion of it, positive or negative.

If I thought that theory was cognitive instead of pseudo-cognitive, I'd give it another look.

If I thought a single or unified base of knowledge could describe the spiritual contributions that go into the making of the individual nurse, I'd embrace it.

But none of these things are true.

In truth, theory does apply to me, whether I like it or not. It applies to me because it undermines my professionalism.

It isn't cognitive: it only pretends to be. The problem is that the politics of academia limit the practical usefulness of what an academic can say and be well-received by THAT community. And the process of the necessity to choose an "academic" point of view tends to have the result of making such observations mutually exclusive to reality. Hence the ivory tower.

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. The fact that I have no real interest in unrebutted gobeldygook being the standard of my practice doesn't make me any more 'uncognizant' than it makes the gobeldygook cognizant.

And why is it unrebutted? Because any attempt to do so is rebuffed as not cognizant. True scientists place their framework of the value of their contribution in the aggressive reproof of their work - not the fiefdom protection of their assumptions, truthful or not.

In truth, it is impossible to qualify a standard equation that describes the spiritual contributions of even a fraction of nurses. We are all individuals and bring our own individual spirituality to the job. It would be more wise to develop spiritual standards, like we have with the impetus to bring cultural considerations into our base of knowledge.

I don't oppose discovering our own language. But not to the exclusion of the common language of our peers. It makes us appear as children, speaking in pig-latin to distinguish ourselves from the group. We're so cool.

When a significant chunk of our paperwork and proposed practice is not only considered useless by our other health care professionals, but also by our own nursing peers, then how have we increased our value and understanding?

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.

If this is our language, my vote is to either adopt a serious, professionally motivated language that is evidence based and has common interfaces with our peers, or to, at a minimum, stop pretending that pig-latin makes us 'unique'.

The major problem with our 'theory' is that it starts with the assumption that we must be so different from our other healthcare professionals that they cannot relate to us. We've spent too much time defining how we are different, and not enough time defining how we are complimentary.

This is why it is only nurses that cry about 'multidisciplinary' approach. The other healthcare professions don't need to beg for a place at the table, they carve it out for themselves. We don't.

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.

The more we choose to describe ourselves as 'angels', the less we are viewed as applied science professionals and allied peers. Caring and spiritual models have their place, but not at the head of the table. I make no apologies for advocating that the science aspect of our profession deserves the head seat.

I’m not disdainful of the current ‘theorists’ because they don't apply to my practice; I’m opposed because they hold back my professionalism. Shame on them.

~faith,

Timothy.

(Note: a few of these paragraphs were originally posted by me in the 'Can you be a nurse without Jean Watson?' thread.)

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Specializes in home & public health, med-surg, hospice.

Okay, as I've stated before, I'm only in my undergraduate studies. However, I have taken an introductory nursing theory course and have also had a philosophy class, both of which I enjoyed. In addition, I have had a nursing research class, which promoted EBP. Also, in my school of nursing they heavily emphasize EBP in all of our clinical courses. For example, all of our comparative analysis must be backed up by EBP. So, I think I have a small understanding of the issues at hand.

I understand this forum is dedicated to issues R/T graduate studies, therefore, if my lack of knowledge is a detriment to this discussion, please let me know and I will refrain from comment (with no offense taken :) ). However, I have been a practicing vocational nurse for 12 years and do plan on furthering my education after I have attained my Bachelor's degree.

Okay, here's what I found when I looked up the term theory on http://www.dictionary.com (italics mine):

1.) A set of statements or principles devised to explain a group of facts or phenomena, especially one that has been repeatedly tested or is widely accepted and can be used to make predictions about natural phenomena. LOL…One, how many does nursing have? Are they repeatable or testable? Are they widely accepted? Are they actually being “used” by most practicing nurses?

2.) The branch of a science or art consisting of its explanatory statements, accepted principles, and methods of analysis, as opposed to practice. Ex.: The proficient nurse who had never studied theory.

3.) A set of theorems that constitute a systematic view of a branch of mathematics.

4.) Abstract reasoning; speculation: ex. - a decision based on experience rather than theory.

5.) A belief or principle that guides action or assists comprehension or judgment. Again, are most practicing nurses using these theories to guide their individual practice?

6.) An assumption based on limited information or knowledge; a conjecture. I know what I’ve been told about assuming in nursing. Often these “theories” are not being presented as exactly what they are – assumptions. Rather they are offered as “the gospel” in a zealous fashion. Am I wrong?

I think the frustration that I’m seeing voiced here is that there is so much importance being placed upon nursing theory within our educational programs when yet there is a solid scientific base to draw from which is ever expanding and not being granted its deserved significance. It's like looking at a periodic table and saying, lithium has more weight than say, gold. I remember the term from my philosophy class that kind of reasoning is called, it's called "willed ignorance."

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Okay, as I've stated before, I'm only in my undergraduate studies. However, I have taken an introductory nursing theory course and have also had a philosophy class, both of which I enjoyed. In addition, I have had a nursing research class, which promoted EBP. Also, in my school of nursing they heavily emphasize EBP in all of our clinical courses. For example, all of our comparative analysis must be backed up by EBP. So, I think I have a small understanding of the issues at hand.

I understand this forum is dedicated to issues R/T graduate studies, therefore, if my lack of knowledge is a detriment to this discussion, please let me know and I will refrain from comment (with no offense taken J). However, I have been a practicing vocational nurse for 12 years and do plan on furthering my education after I have attained my Bachelor's degree.

Okay, here's what I found when I looked up the term theory on http://www.dictionary.com (italics mine):

1.) A set of statements or principles devised to explain a group of facts or phenomena, especially one that has been repeatedly tested or is widely accepted and can be used to make predictions about natural phenomena. LOL...One, how many does nursing have? Are they repeatable or testable? Are they widely accepted? Are they actually being "used" by most practicing nurses?

2.) The branch of a science or art consisting of its explanatory statements, accepted principles, and methods of analysis, as opposed to practice. Ex.: The proficient nurse who had never studied theory.

3.) A set of theorems that constitute a systematic view of a branch of mathematics.

4.) Abstract reasoning; speculation: ex. - a decision based on experience rather than theory.

5.) A belief or principle that guides action or assists comprehension or judgment. Again, are most practicing nurses using these theories to guide their individual practice?

6.) An assumption based on limited information or knowledge; a conjecture. I know what I've been told about assuming in nursing. Often these "theories" are not being presented as exactly what they are - assumptions. Rather they are offered as "the gospel" in a zealous fashion. Am I wrong?

I think the frustration that I'm seeing voiced here is that there is so much importance being placed upon nursing theory within our educational programs when yet there is a solid scientific base to draw from which is ever expanding and not being granted its deserved significance. It's like looking at a periodic table and saying, lithium has more atomic mass than say, gold. I remember the term from my philosophy class that kind of reasoning is called, it's called "willed ignorance."

Here is a definition of nursing theory:

GRAND THEORIES: these are systemic constructions of the nature, mission and goals of nursing and nursing care.

MIDRANGE THEORIES: are less abstract, address specific phenomena and reflect nursing practice.

SITUATION_SPECIFIC: focusing on specific phenomena reflecting clinical practice and a limited to specific populations or a area of practice.

I have not experienced a theory as being gospel and to take issue, am judged wrong. Perhaps my experience was more informed as it was taught by an individual who held her PhD and was not an instructor. Abstraction and 'lack' of scientific evidence is not a reason for dismissing theory. There are areas of study, grounded in theory, that has not been validated by 'scientific' research. One is the area of theraputic touch, a field that is dismissed as new age fluff. But there are studies, conducted under the rules of valid research that demonstrate the effectiveness of TT, but which cannot be proven by concrete data. Can TT be proven simply by applying the rules of scientific study or can it be dismiised because we have no conrete base to apply. Or can it be accepted merely on the bases of a patient's reported experience and small physical changes that can be measured.

And how about the theory of adaptation. We accept changes in our environment and our animals, as an adaptation to changes in their surroundings. Why can we not accept it in nursing? Do not patients adapt to their illness, their role? We may not like their adaptations and may negatively label the individual, but is he not using a model of adaptation? Think about it. Think about it in relation to your practice.

Grannynurse:balloons:

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One other thing. While one can accept the very generalized definition of theory, most areas accept a definition more in line with their field of study. A theory of physics is difficult for most to understand. Does that make it invalid?

GRANNYNURSE

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One other thing. While one can accept the very generalized definition of theory, most areas accept a definition more in line with their field of study. A theory of physics is difficult for most to understand. Does that make it invalid?

GRANNYNURSE

Although I don't really understand a lot of this (never taking a theory course), because of this discussion, I cannot wait to take my first graduate theory course next month. If I learn something that I can use for myself and in my practice, I will surely use it. I cannot be against something I have not really studied. Thank you all for everything you have written. I plan on going back and reading and studying everyone's responses. If anything, you have all really gotten me interested in learning and theory and deciding how it can or cannot help me in my practice. This is an amazingly interesting thread! Krisssy

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Kelly the Great gets her say because (1) it's well reasoned and (2) as an undergraduate she has to deal with Nsg. Theory in her curriculum and (3) AllNurses is a completely egalitarian place.

OK... GrannyNurseFNP asked the question:

"I do not understand what you mean by punishing those that refuse to acceot it." "It" being Nsg. Theory.

What I mean is being threatened with an F in an upper division graduate course in my MSN program. More than threatened. First assignment got a big fat F. I had to do two things in order to pass. First, I had to force the prof to narrowly define what she meant on each assignment. I did this by submitting an outline for each essay and asking her to initial the outline if it did indeed conform to the requirements of the assignment. (She had a very lax mental discipline. Her assignments were very plastic, could be understood in any number of ways. She could not write a declarative sentance. Hense she would summarily fail any essay she didn't like by saying it "did not follow the assignment." So I removed that issue in advance by forcing her to acknowledge that my proposed paper fit within the parameters of the assignment. She would not be able to say after the fact that I hadn't understood her assignment.)

Second, I started using her vocabulary: paradigm, empower, carative, whollistic, metanarrative...what ever buzz word I could pick up from her. I DO NOT write that way. I HATE using that kind of verbiage. But I had no choice.

Another example: A junior faculty member (not me... someone I heard about) refused to make her students' papers and practica conform to the Nsg. Theory favored by that school. She said she didn't agree with that theory (there being a universe of competing theories) and she was fired. Proving that there is no such thing as academic freedom in that School of Nursing.

My experiences are not unique. I think quite a few of the respondents on this thread have encountered theory fascism.

I'm pleased that GrannyNurse has had more positive experiences in her academic career. It makes me believe that there are some nurse- philosopher-theorist-academics who actually welcome dialogue. That's a good thing. Maybe it's a trend that could spread.

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