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 ?

[1Tulip]

I think we're sort of off the rails here. EBP is related to our discussion of nsg theory only in as much as there is an outside social force (third-party payers, governmental agencies, etc.) that is/are demanding hard data validating the effectiveness of specific practices.

Since nsg theory can't predict any outcomes, it can't be used to formulate best practices. So, EBP and Nsg theory are related to each other like chocolate and tennis shoes. Not possible to relate within the same discussion.

I mean Watson and Rogers were bankrupt and bogus long before EBP came along.

[gauge14iv, MSN, APRN, NP]

One poster (or more) has suggested that EBP be the basis for defining nursing rather than theory - that was how we ended up with that factoring in to the discussion.

[ZASHAGALKA, RN]

Grannynurse:balloons:

I just wanted to say that I know that your opinion is outnumbered in this particular thread like 4:1 and I while I don't agree w/ your opinion, I appreciate you sticking in this outnumbered discussion.

I'm not trying to be part of a gang up on you - just, like you, I'm passionate about the topic.

I've discussed it elsewhere on this site (where you were a not quite so outnumbered contributor), and prob will again.

Thanks for sticking in here.

~faith,

Timothy.

[Gennaver, MSN]

Before saying anything, let me admit that I believe nursing theory has been hugely detrimental to our growth as a science and a profession. That is an absolute bias of mine. You are entitled to take what I say with a whole pound of salt if you like.

...

I have my MSN and have taught extensively. I've now got a PhD. I've taught on a faculty that was obsessed with Jean Watson. ....

Whew! It's so refreshing to vent!

Hi Tulip,

Happy to read you vent, glad you did. :) I feel lucky that during my undergrad studies (BA in Sociology with Psychology minor) that my theory professor was so practical. He was also the chair of the department and even though he shared which was of the many sociology theories he favored his taught them in a way were we could see who built off of who and what where the pros and cons each offered. None of them were taught as the one and only.

I am noticing now in my Masters Entry to Nursing program that the nursing profs really don't seem to 'get' theory themselves! I am surprised at this. How they teach -A- theory as if it were some sort of gospel.

Something I noticed too is that the nursing theory profs don't seem to truly realize that all disciplines are based on theory, (sure they give passing mention to it but, seem to have lost their own perspective).

Sociological theory really was a hard class but, gave me an appreciation for Theory moreso than my psych theory classes. I hope to pursue a PhD in nursing, (and possibly in Sociology too, if I can).

I agree that something is either lacking or skewed in the way nursing theory is taught.

Gen

p.s. it is nice to vent

[grannynurse FNP student]

So I could order physical therapy for gastritis and the insurance company would pay for that?

I could order Amoxil as a treatment for an acute MI and I wouldnt be sued? Why not? Because the evidence does not show that Amoxil has any effect on MI.

I could treat a patient using a substance I just happen to believe in for something it is not indicated for (maybe the drug rep told me what a great drug it was) and not expect there to be any ramifications? Drugs and their uses are not based on evidence?

Would I keep my license very long if I chose to practice based on my beliefs instead of the evidence that is covered daily in scientific peer reviewed journals around the world?

What if I don't happen to believe Vioxx harms patients so I tell them to order it from Canada? Patient dies from heart attack due to Vioxx use. I ignored the evidence - who's liable?

You think you practice without evidence? It isn't possible - as a nurse, an NP or even an MD anymore. I will tell you however, that I can practice without theory without fear of being sued or losing my license!

Prescribing medication outside its stated use will generally be covered (if the patient has prescription coverage). If you inform the patient of the reasons for withdrawal of Vioxx, he accepts the risks and obtains the medication from outside the country, he or his family is unlikely to be successful, in a suit. You see, to obtain drugs, in Canada, you need a prescription, one written by a Canadian physician. You can go on line it obtain medications on line but I wouldn't ever advise a patient to do so. And I use to obtain my prescriptions in Canada, after seeing a doc there. You are presenting outrageous situations that rarely ever take place, in real life, in my experience.

And these situations have very little to do with theory, unless you consider the adaptation theory and its impact on a patient's and nurse's role. If you consider this, then the practitioner has adapted to a role that is generally unacceptable by his/her peers. And the patient, who follows such advice is adapting his/her role to either meet a need or to gain the practitioner's approval. A patient who says, no way and changes practitioners, is also adapting his/her role in a more positive manner.

Grannynurse

[grannynurse FNP student]

I think we're sort of off the rails here. EBP is related to our discussion of nsg theory only in as much as there is an outside social force (third-party payers, governmental agencies, etc.) that is/are demanding hard data validating the effectiveness of specific practices.

Since nsg theory can't predict any outcomes, it can't be used to formulate best practices. So, EBP and Nsg theory are related to each other like chocolate and tennis shoes. Not possible to relate within the same discussion.

I mean Watson and Rogers were bankrupt and bogus long before EBP came along.

And Orem or Roy or Travelbee or Lenienger? Are they all bankrupted and bogus as well. While I do not agree with the theories of Watson or King, I see their place and role in the formulation of nursing theory.

Grannynurse

[ZASHAGALKA, RN]

This might be a surprise considering all my rants on the topic . . .

But I'm not AGAINST theory - I'm not even totally against some of theory being taught.

I'm against the pedastool they are placed upon.

As long as they are the prime focus, nursing suffers.

If I could chuck them all so we could start over and get our priorities right, I would.

They may have their place, but they are currently so OUT OF PLACE that my disdain is absolute.

~faith,

Timothy.

[Gennaver, MSN]

I happen to agree with the others on this post and not your sentiment. You say that to sustain ourselves as a profession we need to examine what makes us nurses...what other profession does this?? ...K

Hi there,

I thought all 'disciplines' did this, (not professions, all 'jobs' can be a profession right?)

While I was working towards a BS in Biology, (changed it though, left it as an associates), we had basic theory for a semester which all we talked about was, "what makes science a discipline?" When I switched to Sociology and Psychology I experienced the same thing, "what makes us a discipline." When I took a cross-listed class for Law, Gender Studies and Sociology I had the triple whammis of "What makes law a discipline, what makes feminist studies a discipline" and so on.

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.

Gen

Gen

[Kelly_the_Great]

Well, and some have referred to EBP as theory. I believe even Grannynurse gave credence to it as a theory. She said, "And what happens to those of us, who do not subscribe to EBP theory."

That's one reason why I incorporated it into my discussion. Very likely, I misinterpreted this from its meant context. But here again, this is where the language is so ambiguous, coming across as incoherent and for lack of a better way to put it, double-talk.

I mean, I am a nurse, although granted the exclusive ANA (which is supposed to facilitate unity within nursing) does not recognize vocational nurses as worthy of membership, even in some auxiliary form, to encourage the eventual attainment of professional standards - yet I digress. Still we are there right along side you, performing many of the same tasks, particularly those of interacting with the patients in education of disease process/medication/procedures. And as an undergraduate student I have been exposed to the theorist, granted not at the in-depth level you all have. Yet, I have been required to incorporate theory into a couple of the papers I have been assigned. In addition, I have had to incorporate EBP in R/T my reasoning of the nursing interventions I have chosen and in my comparative analysis of the actual care my patients are receiving. This is being done to help facilitate critical thinking skills.

I'm just not understanding, if theory is meant to guide practice then why is it irrelevant to our interventions? And why is so much time dedicated to it within our core curriculum versus making this a more specialized branch to be explored in-depth at the practioners choice?

Again, I'm saying I'm not understanding the reasoning. If I'm not, how in the world can we possibly think other professions who have not been indoctrinated with these theories, let alone the patients we are providing care to, are supposed to understand our rationale for doing what we do? For that matter, how are they supposed to understand the reasoning for our very existence as a profession?

I think I'm going to bow out of the discussion for a while because it obviously is beyond my comprehension level at this point. I've asked a couple of questions, if anyone would like to respond to them perhaps I can gain understanding. However, I'm kind of thinking, indeed nursing theory as it presently exists, might be as some have suggested more closely R/T philosophy - which is not in and of itself a "bad" thing. However, I'm beginning to think the answers to nursing theory questions are like philosophical queries that have no answers - if a tree falls in the forest and no one is there does it make a sound, what's the sound of one hand clapping?

[ZASHAGALKA, RN]

Well, and some have referred to EBP as theory. I believe even Grannynurse gave credence to it as a theory. She said, "And what happens to those of us, who do not subscribe to EBP theory."

That's one reason why I incorporated it into my discussion. Very likely, I misinterpreted this from its meant context. But here again, this is where the language is so ambiguous, coming across as incoherent and for lack of a better way to put it, double-talk.

I mean, I am a nurse, although granted the exclusive ANA (which is supposed to facilitate unity within nursing) does not recognize vocational nurses as worthy of membership, even in some auxiliary form, to encourage the eventual attainment of professional standards - yet I digress. Still we are there right along side you, performing many of the same tasks, particularly those of interacting with the patients in education of disease process/medication/procedures. And as an undergraduate student I have been exposed to the theorist, granted not at the in-depth level you all have. Yet, I have been required to incorporate theory into a couple of the papers I have been assigned. In addition, I have had to incorporate EBP in R/T my reasoning of the nursing interventions I have chosen and in my comparative analysis of the actual care my patients are receiving. This is being done to help facilitate critical thinking skills.

I'm just not understanding, if theory is meant to guide practice then why is it irrelevant to our interventions? And why is so much time dedicated to it within our core curriculum versus making this a more specialized branch to be explored in-depth at the practioners choice?

Again, I'm saying I'm not understanding the reasoning. If I'm not, how in the world can we possibly think other professions who have not been indoctrinated with these theories, let alone the patients we are providing care to, are supposed to understand our rationale for doing what we do? For that matter, how are they supposed to understand the reasoning for our very existence as a profession?

I think I'm going to bow out of the discussion for a while because it obviously is beyond my comprehension level at this point. I've asked a couple of questions, if anyone would like to respond to them perhaps I can gain understanding. However, I'm kind of thinking, indeed nursing theory as it presently exists, might be as some have suggested more closely R/T philosophy - which is not in and of itself a "bad" thing. However, I'm beginning to think the answers to nursing theory questions are like philosophical queries that have no answers - if a tree falls in the forest and no one is there does it make a sound, what's the sound of one hand clapping?

Don't bow out, you are acquiting yourself nicely and your input is relevant.

I'm an ADN-RN and I'll tell you a secret: the ANA might let me in, but they don't like me any more than you. Which is why I'd NEVER join. When you write off 80% (60% ADN/Diploma RNs plus LVNs/LPNs) of nursing, you can talk about unity until the cows come home - you don't really mean it. What you mean is - unity for the ones of us that, in our opinion, matter.

That is why that whole debate of minimum standards UNDERMINES nursing instead of pushing it towards a professional improvement. If the only way to advance nursing is to poison the very soil of its membership, then how on earth can you expect the desired outcome to take root? You need look no further than N. Dakota's repeal of BSN-only to see that it's just not a possible solution at this time.

But in the meantime, it still tears apart any semblance of 'unity'. An ANA that actually tried to represent all nurses could be a powerful entity. But that is clearly very unimportant to the ANA. So in the name of professionalism, we've effectively divided and conquered ourselves - and undermined our professionalism for lack of unity.

Keep posting.

~faith,

Timothy.

[gauge14iv, MSN, APRN, NP]

Prescribing medication outside its stated use will generally be covered (if the patient has prescription coverage). If you inform the patient of the reasons for withdrawal of Vioxx, he accepts the risks and obtains the medication from outside the country, he or his family is unlikely to be successful, in a suit. You see, to obtain drugs, in Canada, you need a prescription, one written by a Canadian physician. You can go on line it obtain medications on line but I wouldn't ever advise a patient to do so. And I use to obtain my prescriptions in Canada, after seeing a doc there. You are presenting outrageous situations that rarely ever take place, in real life, in my experience.

And these situations have very little to do with theory, unless you consider the adaptation theory and its impact on a patient's and nurse's role. If you consider this, then the practitioner has adapted to a role that is generally unacceptable by his/her peers. And the patient, who follows such advice is adapting his/her role to either meet a need or to gain the practitioner's approval. A patient who says, no way and changes practitioners, is also adapting his/her role in a more positive manner.

Grannynurse

But you said you don't believe in EBP!

[Kelly_the_Great]

Yes, ZASHAGALKA, I mean I realize ANA membership is off the topic of this thread and I don't want to do/say anything that would lead to its disintegration.

However, I do believe that it R/T theory vs. practice and the facilitation of unity within nursing.

I've said b4, why do we not apply the scientific nursing process to ourselves to further our profession? For instance, what's the best way to ensure patient goal attainment? As for as I know, the best way is to involve the patient in decision making within their plan of care, as an active, participating member! Nursing process works, why do we disregard it as it (does and can) R/T ourselves [profession of nursing]?

For all of Watson's talk of a "world view of unity and connectedness of All," I'm not seeing that it's being applied to nursing itself and how we interact with one another to achieve unity.

Here's an experiential story. My mother was a Diploma nurse and DON of a HH agency for over 20 years. She had a phenomenal record of holding on to her employees, some had been with her 15 and 20 + years. You know how she was able to do this? Believe me the employees didn't stay b/c it was such a great place to work, no health ins., no retirement benefits and the owner was a drunk & part time substance abuser. It was b/c she cared about her fellow workers as much as she cared about her patients. Guess what? She'd never even heard of Watson. She was too busy actually assisting in delivery, surgery and other various forms of patient care in her education than to get all the good theory classes. Was she a worse nurse for it? I don't know, ask her employees and the different ppl she interacted with in the community - including physicians what they thought of her (standing room only at her funeral), better yet, go ask her patients.

Now, I truly am duckin' out for a while b/c I have become completely enthralled w/ this thread and am neglecting some of my ADL b/c of it...LOL