Is nursing theory actually used by working nurses?

[BCRNA]

In school I was always told how important nursing theory is in guiding nursing practice and improving care. Both in undergraduate and graduate school my teachers ridiculed PAs for not having a theory that guides their practice. Are there any nurses that actually use a nursing theory in practice? Are there any nurses that can name one nursing theorist and explain the theory? I have also found that the teachers in my theory classes have very elitist attitudes when it comes to the theories. I have encountered one hospital that prides itself on basing its nursing care on one particular theorist. No nurse I have worked with in the last 10 years basis there care on a theorist, they can't name a single one. How can theory be what drives our practice, when it is never used. And my teachers have even admitted that some are too complicated for many entry level nurses to truly understand.

At first I just told myself I am not experience enough or know enough about nursing to understand it. I have been a nurse for almost ten years and now realize that its not just me not grasping its importance, its just not important. My opinion now is that nursing theory was created to justify nursing as an academic discipline in a time when no one believed nursing belonged in a university. Then it was used to justify doctoral level nursing. I think nursing theory could be used to guide nursing, but it just isn't being used in actual practice. I know many nurses are going to read this and consider it heresy, but just ask the nurses you work with about the theorist they know and how they use them, my bet is that very few could even name a theory. Seems to me that only PhD nurses use theory for their research, but it fails completely when it comes to actually guiding practice. Just wondering what everyone else's opinion was on the topic, I have asked graduate faculty about theory in practice and usually get very negative feedback with derogatory comments about nurses in practice not being the academic elite, that it takes experts in nursing theory to understand the nuances of it. There again, if it is to complicated for practicing nurses to understand, can it really be guiding there practice?

[shaas, ASN, RN]

Hi, GHGoonette. :)

My assertion really does not differ much from yours. That is why it is stated that caring should remain an undercurrent trait for both physicians and nurses. It's a human decency issue, and may not be a teachable trait at all. It is an implicit requirement that needs not be stated as it does not need further campagining for it. I believe that the public is well aware of the caring nature of this profession and so do the prospective nurses who enter the field. Who in their right mind enter this profession if they are not ready to do often times the "dirty and thankless" job?

As I am reading posts written by many experienced nurses, it is not just the society that is evolving but the field of nursing as well. The demands on nurses evolve and change, and bedside nursing is not exempt from it, it seems. Yet, it has been indicated by many that there is a stagnant impression on nurses as a collective, both by the public and the physicians and other health professionals, and it is not always a positive picture, treatment, or a fitting adjective for nurses' hard work.

My post is not quite about whether nurses should be genuinely caring individuals or not. Neither of us can define with absolute certainty what constitutes a truly caring nurse. Only the recipient, the patient, can be the judge. Even then, it is subject to the patients' perceived notions.

Nursing theories are great, as long as they are empirically based as they are purported and supposed to be. But, it is not necessarily the right tool to elevate the status of nurses as profession. That recognition comes from other medical professionals and the public. It really has no bearing even if all nurses are gung-ho about these nursing theories and find relevance in their daily practice because the recognition we aspire to attain to elevate our professional status invariably needs to come from others.

We already know that nurses do and know far more than what is being recognized by others. I don't think that nurses lack the awareness of social and psychological needs of the patients, or the cultural awareness, irrespective of where they decide to practice. Nurses have been drilled if not already equipped with them from their prior life experiences. Those who do not get it may not get it. Ever. This degree of caring and cultural and social sensitivity are deeply interdependent and intertwined, I think. A notion that a caring individual can be culturally unaware seems fallacious to me. A caring indvidual is more likely to learn these cultural and social variables of the patient to provide better care. But, then, again it is my subjective assumption and a wish.

The questions I bore in mind when I wrote the long-winded piece are:

1) Would focusing on nursing theories or the discipline of psychology (following their research method) elevate the status of nursing as a whole?

2) Why do some patients demand "I want to talk to the doctor"?

3) Why do some physicians not prefer to confer with nurses who provide direct care but reserve discussing them with their medical 'colleagues'?

4) What is lacking in an average nursing curriculum to be recognized as a rigorous academic program?

4) Does nursing really differ much and should be disparately considered from the whole picture of medical care provided for the patient?

5) What is the reason for overused slogans such as "caring" and "critical thinking"?

I know, I make the readers and myself tired. But, some nights I cannot stop my internal dialogue and I post my thoughts. :)

[Preeps]

Well it helped to a certain extent but no I don't go in every day and think about Florence and her exact ways.

I do consider the person, their environment and what's happening to it, and the type of care I intend to/provide. I think that's what most theories covered, the rest were useless to me and it honestly took up loads of hours writing them when I would have preferred more clinical practice times and skill development. I do believe certain theories are important to know and understand but my nursing program spent too much time on theory and not enough time on what to do!

I graduated with: having put in one female catheter, doing two IM injections, and probably 3 subcutaneous, minimal IV medication practice you can forget about IV starts (Just did my first couple last month!). I did two suctions on a trache patient, no ostomy care, minimal feeding tubes BUT I could tell you every theorist that ever touched nursing. We had 3 theory courses in the program, where it went into deep details about the history and theories involving nursing. Give me a break....we don't NEED all this just show me how to put in a catheter!

It really upset me that I spent thousands of dollars and now I am in debt only to know I felt like **** saying "Oh I never done that before" to almost every small skill by end of fourth year.

Just my opinion.

And YES, I agree with your opinion! I believe nursing is an art and a science but not getting enough clinicial time is IMO one of the biggest failure in nursing programs today. It is truly frightening to be a new nurse and as you said have to repeatedly feel insecure in performing tasks and interventions. I get a trached patient maybe once a year and I can't tell you the fear that courses through my veins. . .. And by the response I get from my co-workers they feel pretty much the same.

[danh3190]

I haven't once thought about Nursing Theories since I passed the exam on them in school. Can't remember which theorist had which theory. Really don't think about NANDA nursing diagnoses either.

I try to understand what's going on inside my patient's body (and sometimes his mind) and decide what I can do to help the situation following the guidance and orders of his physicians.

[linearthinker, DNP, RN]

I disagree w/ the majority, as usual. I do think nsg theory is important and I do rely on it to inform my pracrtice, especially Rogers and Watson. Also, speaking only for myself, i am not part of a medical team any more than I am a part of the occupational therapy or dietary team. I am a nurse on the health care team. I don't practice medicine in any way, shape or form. I do use NANDA, but only b/c it is a required part of our shift charting.

[BCRNA]

I have reviewed the nursing theorists that where mentioned so far in these posts. I can definitely see how they "could" be useful. And the theories are excellent in academic settings to help organize concepts and study philosophy. But I don't fully agree that nurses use the theories without thinking about them. If you studied the theory in depth and used it consistently, then yes it would be very easy to use without really thinking about it. But many of the things we do would be completely the same if nursing theory didn't even exist. Other disciplines could not do their job without their theories, we could. An engineer or psychologist would have to incorporate their theories into practice, they could do it subconciously without much thinking about it. But they could actually state the theories they are using if you asked them. Nurses couldn't, except for a few who do use them. Nursing is a blending of many different disciplines, and I think we tend to overcompensate trying to justify ourselves as a seperate entity.

I do believe that some aspects of the theories are used without us thinking about it, but those aspects we used aren't because we studied the theory. I do agree that the theorists help us conceptualize our approach, but the theories tend to be very complicated and hard to grasp. I was a double major in math in chemistry, the theories I picked up there are very complicated too, but I actually had to use them directly to solve problems. They were useful, and things that I would not/could not use without knowing about them.

[sunnycalifRN]

As far as NANDA's and avoiding all use of medical diagnoses, I must admit that I'm a total failure!! Bad nurse, bad nurse!! But, looking at the list of NANDA's, I believe that I address the same issues constantly; I just don't think in terms of NANDA's.

[Jennerizer, ASN, RN]

I used to think the same way back when I was studying nursing theories...that it was ridiculous to think anyone could follow one particular theory. Looking back, I see that I use a combination....bits and pieces of nursing theory at work. It comes naturally.

What doesn't work is when a hospital tries to force their nuses to follow a particular theory. I have been at hospitals that tried that & seen them drive away quality nurses. I'm at a hospital now that seems to give nurses a lot of leeway & in my unit, our HCAPHS scores are above the hospital's goals. I cannot say the same for our md's....not because they don't do a good job, but because our patients not only seem to prefer to speak about their health concerns with their nurse. They value our opinions and therefore don't seem to concern themselves with the md's opinion too much.

[Preeps]

I disagree w/ the majority, as usual. I do think nsg theory is important and I do rely on it to inform my pracrtice, especially Rogers and Watson. Also, speaking only for myself, i am not part of a medical team any more than I am a part of the occupational therapy or dietary team. I am a nurse on the health care team. I don't practice medicine in any way, shape or form.. . /quote]

Hmm. Interesting. I consider myself a part of the healthcare team for my patients inclusive of doctors, nutritionists, physical therapists, OT, and more!

On my floor we work in conjunction with all the above providers to give our patients the best care, and I consider it imperative to the best possible outcome

[ImThatGuy, BSN, RN]

I know that this is not going to be a popular sentiment, but it is what it is, an unpopular but a legitimate gripe of mine. Please, bear with me.

One salient oddity that I've noticed while taking an introduction to nursing class is the nursing academia's desire to align itself with socialpsych./psychology, which baffles me to no end. If you've majored in any known social science discipline (e.g. sociology, psychology, economics, etc.) and have gotten a degree after writing papers coming out of your orifice, singing the same old tune in different keys, then you know this already; these disciplines' aim and pursuit have been gearing heavily toward integrating scientific empiricism and math to add credibility and garner academic clout. They even added 'science' to their moniker because science really does matter, in every way conceivable.

To effect a measurable change for Nursing to gain greater respect and legitimacy as a challenging academic discipline is to integrate more science; some schools are already headed that way. The prospective nurses already enter the field of nursing because they want to help others. And, that sort of personality trait will not be affected whether there is more theory added or not. Furthermore, go ahead and examine the curriculum of advanced nursing degrees, be it FNP or CRNA. They all end up taking the undergrad science core classes that are requisite to pre-medical or pre-pharmacy programs. Why do you think that is the case?

Nurses are, indeed, a part of the medical team. Nurses are not there merely to be caring and fluffy, solely. For me, medication errors and not knowing the pathophysiological pathways bear more serious implications for deleterious patient care than not possessing excellent bedside manners. Being a caring human being is not a negligible requisite, but the "caring" slogan has been abused to ad nauseum in nursing. I want to be a competent, clinically sound nurse who aid in the healing and coping process for the patients. In the mean time, I want to impart an impression of a nurse who is a knowledgeable professional and not be perceived as someone who posses surface-skimming knowledge about human health and pathology. Caring should remain an undercurrent trait of human decency for both the physicians and nurses, not a central theme that drives our discipline away from what should be added to achieving psychological well-being for the patients.

There is nothing wrong with nurses being medically knowledgeable and being able to think "like a physician" or a logical clinician. We already have those nurses around us. As nurses advance, they end up purchasing more medical references than nursing theory books. I sympathize that the nursing as a burgeoning academic discipline would like to align itself with something. I understand the assertion of the importance of nursing theories, but the academic discipline of psychology already exists and nursing should really take no shame in adding more science to its currently word-heavy curriculum.

I have encountered and read so much on this forum how the nurses want their profession to be considered truly professional and, thus, be respected accordingly. Unfortunately, being more caring through acquainting more theories is not going to get nurses there. We already have tremendously caring nursing workforce. It's been established. And, I don't think that it would be churning out new theoretical paradigms every decade that will set nursing atop or apart. In my limited thought, it would actually be the rigorous curriculum that does not mimic social sciences but add depths to our existing nursing science curriculum, which reflect what nurses actually do and face on the floor as nurses. Evidence-based means scientifically-based through exercising empiricism. Theories are the mere outcome of these empirical experiments that are subject to scrutiny and to continued revisions based on more empirical data.

Lastly, an added bonus to heavier science curriculum would be reduced utterances of this darned "critical thinking" that I hear so much in nursing; as a pre-med/pharm student for two years, never once a professor uttered that phrase because it implicitly comes with the territory. Science does indeed makes you think in a systematic fashion. It continues to prove to be an invaluable training tool for all nurses who pursue and advance their nursing careers.

P.S.: I am sorry that this turned out to be a long-winded novelette. However, I really wanted to share my perspective while I am still somewhat of an outsider/public element looking in.

Good post. I agree wholeheartedly. There isn't a single element of this thread that I wouldn't stand up at a lectern and tout.

As I said in a previous post nursing is trying too heard to identify the nature of its profession and achieve recognition by others, yet the manner this is transpiring is shallow and silly. Deeper grounding in sciences, scientific studies (not evidence based practice), statistics, and diagnostic training are the processes that will help achieve better patient outcomes. Anyone can care, but like this poster said, caring does not need to be a central theme. It should merely be a background process.

I'm so appreciative that my nursing program never adopted a singular nursing theory and thus aligns itself with no theorists. Fortunately, aslo I recall only about four theories, none of which I can tell you anything about, were covered in a 20-30 minute period. Honestly, I don't want to remember them either.

[Wishinonastar, BSN]

I am sure that the theory I learned influences my work, but I do not think about it. Who has time? I am too busy thinking about meds, infection, right choices, symptoms, how to get my work done without working TOOO much overtime, how to avoid getting sued, yelled at or fired, and when the heck is payday???

[Cul2]

Theory or philosophy underpins everything we do. We are either aware of these foundational values behind what we do or we're not. I think it's best to be aware of them. It seems, though, that it's best if we're not only aware of them, but that they also become so embedded in what we do that we don't think about them all the time. What does this "theory" represent? Why we do what we do the way we do it. How we treat people. How we view the human condition, wellness and illness. What it means to be human. There's a philosophical basis behind everything we do regardless of whether we are aware of it or not.

[BCRNA]

How exactly can they be using a theory in there practice they don't even know? Their personal philosophy may be very similar to a certain theorists, but if they don't know that theorist at all then they are using their own philosophy, not a nursing theory. I am just trying to understand others rationale, please don't think I am criticizing, I just think it'd time nurses evaluate nursing theory, and actually use it. My main point I am trying to make in this discussion I guess is that we need to actually use our theorists in actual practice. If the theory is too complicated for a new grad to use, then it needs to be re-examined. If you "have" to be a PhD to really understand a particular theory, then it does not drive actual clinical practice, though I could see how it could guide research and "upper level" nurses. I think a truly good theory would be,after a little study, a very valuable tool that can be used. It just seems to me that most of our theorists are unused tools. Making them wasted. Maybe if in our theory classes we focused more on how the theories can be applied in daily use. That would be a more practical approach as opposed to the panda nursing diagnosis that aren't even used, at least not in any institution I have worked. I actually forgot all about those until they were mentioned on this site.