I wish I'd have known....B4 nursing school

Supercalifragilistic · May 20, 2004

Snake,

I am a new nurse and generally find that my work is much less "art and science" and much more technical skills and tasks to be marked off of a long to-do list. However, I disagree with the following arguments that you used in an effort to debunk the "art and science" idea:

Nursing has no scientific knowledge base to stand on.

Ever heard of "evidence-based nursing"? If you have not, you should definitely look into it!

...infective process or a somatic lesion, although that has been the definition of illness since Virchow defined it in 1858.

(1) I NEVER heard this exclusionary definition of disease before.

(2) I, for one, am glad we do not live by 1858 definitions/standards anymore...

(3) Is diabetes a "lesion" or an "infective process"? As far as I know, it is neither...but I think we'd all agree it is a "disease." (And you use it as an example of disease, if I'm not mistaken.)

I haven't recently seen any change in the definition of diabetes as a disturbance in metabolism of sugar.

See my comment above regarding diabetes.

Art? Art is self expression. It is hopefully fresh, original, and makes an impact on the listener, viewer, or taster. Aesthetics does not have to be beautiful, but it must convey or provoke an emotional response.

And this is why caring IS an art - it requires EXPRESSING oneself in a way that makes an IMPACT, and doing this generally does convey or provoke an emotional response.

Supercalifragilistic · May 20, 2004

Lol, Mandy Patinkin, right?
What was the name of that movie?

The Princess Bride

talaxandra · May 20, 2004

Coming from a hospital-based background, and with my post-grad qualifications in health ethics, most of my contact with nursing theory has been self-directed. Despite my current academic supervisor's strong championing on nursing theory and professionalism, I must confess that I lean more toward Watersnake's position than that of the majority.

One article I found particularly interesting was Jef Raskin's "Humbug: Nursing Theory" (http://www.jefraskin.com/forjef2/jefweb-compiled/published/NursingTheoryForSite.html), and Quakwatch's on-going debate about therapeutic touch (http://www.quackwatch.org/01QuackeryRelatedTopics/tt.html) seems convincing to me.

THis sounds to me like it could be a whole new thread - any takers?

watersnake · May 20, 2004

Snake,
I am a new nurse and generally find that my work is much less "art and science" and much more technical skills and tasks to be marked off of a long to-do list. However, I disagree with the following arguments that you used in an effort to debunk the "art and science" idea:
Ever heard of "evidence-based nursing"? If you have not, you should definitely look into it!
(1) I NEVER heard this exclusionary definition of disease before.
(2) I, for one, am glad we do not live by 1858 definitions/standards anymore...
(3) Is diabetes a "lesion" or an "infective process"? As far as I know, it is neither...but I think we'd all agree it is a "disease." (And you use it as an example of disease, if I'm not mistaken.)
See my comment above regarding diabetes.
And this is why caring IS an art - it requires EXPRESSING oneself in a way that makes an IMPACT, and doing this generally does convey or provoke an emotional response.

Well, to answer you,

#1. look up Rudolph Virchow. His definition stands...although ironically, he was responsible for the death of a high official because he knowingly treated him for the wrong disorder. He was afraid the official would not like hearing the truth.

#2. The quantity Pi has been with us longer than Virchow. I still use it in calculation, how about you? Being old doesn't make it wrong, indeed it often gains validity during repeated use.

#3. Diabetes can be identified as cellular dysfunction on biopsy, necropsy, and responds (hopefully) to a given treatment regimen. That is science. A lesion may be only a single dysfunctioning cell, believe it or not. This has been investigated in cardiac electrophysiology with profit.

My point is, that the DMS (the Bible of Psychiatry) invents "disorders", diagnoses change from pathology to non pathology when the big wheels get together to revise it. Homosexuality was a disorder at one time. Now it is only psychopathology if the person is uncomfortable with it, i.e. 'ego dystonic'. And another tragic example: in the late 1840s, runaway slaves were "treated" by white physicians as 'mentally ill', the diagnosis being termed 'drapetomania' which could be 'cured' by frequent beatings. I agree with you there, I'm certainly glad we don't recognise some of the older diagnostic and treatment methods.

#4. Evidence based? That sounds like emperical treatment, although I will look it up. If it can't be reproduced with the same result using similar method, it's not science. It is opinion. There are 3 sorts of lies: Lies, D*mn lies, and statistics.

#5. Disclaimer....I love playing the devil's advocate. It keeps my mind fresh to hear different ways of seeing things. "Snake does not necessarily agree with all the viewpoints expressed."

Keep your zeal.-----Snake

watersnake · May 20, 2004

Lol, Mandy Patinkin, right?
What was the name of that movie?

I dig that movie sooo much. Ever see 'Kingpin'?

We ought to start a thread on that subject.

How many times in old schlocky 1950s giant insect movies did a doctor say; "I've given her a sedative, she'll sleep now. All we can do is watch and hope."

Snake

Q. · May 20, 2004

One article I found particularly interesting was Jef Raskin's "Humbug: Nursing Theory" (http://www.jefraskin.com/forjef2/jefweb-compiled/published/NursingTheoryForSite.html), and Quakwatch's on-going debate about therapeutic touch (http://www.quackwatch.org/01QuackeryRelatedTopics/tt.html) seems convincing to me.
THis sounds to me like it could be a whole new thread - any takers?

I'd definitely be up for a whole new thread.

I also read Jeff Raskin's article and I personally think it's a must-read for every nurse.

susanna · May 20, 2004

#3. Diabetes can be identified as cellular dysfunction on biopsy, necropsy, and responds (hopefully) to a given treatment regimen. That is science. A lesion may be only a single dysfunctioning cell, believe it or not. This has been investigated in cardiac electrophysiology with profit.
Keep your zeal.-----Snake

Cool, no wonder I never understood the phrase, "Where is the lesion?" when electroneurodiagnostic personnel were talking. I always assumed they were talking about an injury.

GracefulRN · May 20, 2004

I'd definitely be up for a whole new thread.
I also read Jeff Raskin's article and I personally think it's a must-read for every nurse.

I vote for a new thread too. Very interesting article by Raskin, definately, thought provoking

Supercalifragilistic · May 20, 2004

Snake,

RE: Virchow

I will have to look him up! I know the name, and I think we covered him in my nursing pre-reqs. I just don't remember ever hearing that his was THE ultimate definition of disease and the one we still use as a "litmus test" for defining disease today.

RE: "Being old doesn't make it wrong, indeed it often gains validity during repeated use."

I agree with you here and did not mean to imply otherwise. Rather - like you said in talking about runaway slaves - just meant I'm glad we don't still use ALL 19th century definitions and standards anymore!

RE: Diabetes & lesions

Interesting! Didn't know single dysfunctioning cells could be called "lesions."

RE: mental health & the DMS

I think the issue here is really that we still have a long way to go in understanding psych issues. There's still a lot of research to be done, and we are certainly far from having "all the answers," hence some of the "confusion" and reworking of definitions.

Personally, I am really intrigued by psych - especially how it overlaps with philosophy, religion, and social mores. I forget who it is here on Allnurses.com, but someone has a signature line that says something like, "when you talk to God, they call it prayer; when God talks to you, they call it schizophrenia." Who's to say, since we don't really know the causes of these things (yet)?

But just because we don't have the answers yet doesn't mean it's not science. You're right, whether it's "science" has to do with the method/process for determining the answers. So I'm sure some of the reworked definitions are unscientific, but I'm sure others are scientific and change based on new & developing information that must be considered.

Will have to check out that link posted by Susy K.

RE: evidence-based nursing

Probably true that much of it is empirical right now. Again, another area with a long way to go; I think the push for this is relatively new. But there are plenty of studies (regarding nursing practice) that have been done and are being reproduced...time will tell whether or not they hold the same results!

RE: general skepticism and playing the devil's advocate

I am right there with you on this one! Firm believer in the saying, "Question Authority!" Makes you a better citizen/nurse/person when you take the info and analyze for yourself whether it is legitimate.

Supercalifragilistic · May 20, 2004

Sorry to the OP - didn't mean to hijack the thread with such lengthy posts.

What I wish I'd known/realized before nursing school: That I'm much more interested in nursing theory and health information/education as a career than in bedside nursing as a career!

susanna · May 20, 2004

Personally, I am really intrigued by psych - especially how it overlaps with philosophy, religion, and social mores. I forget who it is here on Allnurses.com, but someone has a signature line that says something like, "when you talk to God, they call it prayer; when God talks to you, they call it schizophrenia." Who's to say, since we don't really know the causes of these things (yet)?
RE: general skepticism and playing the devil's advocate
I am right there with you on this one! Firm believer in the saying, "Question Authority!" Makes you a better citizen/nurse/person when you take the info and analyze for yourself whether it is legitimate.

You should definately read some Thomas Szasz(sp?) then because thats where the quote came from. The first book I read by him I think was called, "The myth of mental illness" or "The dangers of mental illness" or something like that. He doesn't use tact. Szasz rocks!

Supercalifragilistic · May 20, 2004

Yep, it's "Szasz" - I remember reading about him too and putting him on my "to-read" list.

Speaking of reading, just read the Raskin article. Geez - when I said I was interested in "nursing theory" I sure wasn't referring to the same "nursing theory" he was talking about through most of the article!

Maybe I should have said "nursing research" since what I was referring to was not an overarching "theory of nursing" but rather, investigatons into theories of best practices in nursing care. That's how the term "nursing theory" was used in my nursing school...it wasn't used to refer to a single, all-encompassing theory of nursing. Can you imagine trying to come up with such a theory??? Yikes!!!