Nursing Theory: Did we throw the baby out with the bathwater?

llg, PhD, RN · Jan 27, 2011

Great OP. I agree with you totally. Sure, there were/are problems with the major nursing theories -- but that's to be expected. We are a young academic discipline and our "young" attempts at theory development, application, and evaluation are bound to be a little clumsy. But I think it is a big mistake to let the pendulum swing too far away from theory-based practice.

We need to find that healthy balance that incorporates theories, but doesn't turn individual theories into "major religions" that aren't allowed to be questioned. If we can find that balance, we can continue to help our theory evolve over time to become increasingly valuable to our practice and to society in general.

I'm with you, orsman167.

ImThatGuy, BSN, RN · Jan 27, 2011

I do not think you have to base your attendance to a patient around a nursing theory. That seems to be debated on here frequently. What's so wrong with practicing under this "medical model?" It works. It's the purview of the nurse to treat that response rather than the disease itself so when doing so the nurse is acting in his or her respective scope of practice. Why not leave it at that? Evidence based practice, to me, is doing things that make sense scientifically. Prove to me that it's right, and I'll incorporate it if I may lawfully do so. I don't need any theories to suggest how I should "care."

anonymurse · Jan 27, 2011

Benner gives us something like one of those mall maps with the red dot that says "You are here." And it tells us where we came from and where we're going and how we're going to get there. Now, that's useful nursing theory. Nursing theory's proper province is theory about nursing, right? All else are sets of filters that get in the way of being able to see everything about my patient that I'm capable of perceiving.

ImThatGuy, BSN, RN · Jan 27, 2011

Benner gives us something like one of those mall maps with the red dot that says "You are here." And it tells us where we came from and where we're going and how we're going to get there. Now, that's useful nursing theory. Nursing theory's proper province is theory about nursing, right? All else are sets of filters that get in the way of being able to see everything about my patient that I'm capable of perceiving.

Are you serious?

ukstudent · Jan 27, 2011

I am probably going to get slammed for this, but this is my thinking. Nursing lost it's way when it started to hate itself.

Until recently (last 40-50 years) nursing has been a blue collar job and for the majority of nurses practicing today it still is. Most nurses are bedside or patient side (OR, School, Camp nurses etc.), we hold pt's hands, give them baths, rubs their backs, clean up stool. In other words good basic nursing care.

However, there seems to me to be a section of nursing that for wont of a better word despise this. All through school I was told that "everyone should continue with their education and get an advanced degree", that " we don't have to stay bedside nurses."

Advance degrees take you away from basic nursing. My friend is currently in school to become a Nurse Practitioner, probably the advance degree most close to bedside nursing. Everyday during clinical she is told to not be the "nurse", to "know your role". If a pt she is seeing request some water she is NOT to go get it, she is to tell the pt that she will get the pt's nurse.

Like I said at the beginning, nursing lost it's way when it started to hate itself, nursing needs to learn to love itself again. The higher up's need to understand that their is nothing wrong in wanting to actually touch pt's, to stay at the bedside.

danh3190 · Jan 27, 2011

I am probably going to get slammed for this, but this is my thinking. Nursing lost it's way when it started to hate itself.
Until recently (last 40-50 years) nursing has been a blue collar job and for the majority of nurses practicing today it still is. Most nurses are bedside or patient side (OR, School, Camp nurses etc.), we hold pt's hands, give them baths, rubs their backs, clean up stool. In other words good basic nursing care.
However, there seems to me to be a section of nursing that for wont of a better word despise this. All through school I was told that "everyone should continue with their education and get an advanced degree", that " we don't have to stay bedside nurses."
Advance degrees take you away from basic nursing. My friend is currently in school to become a Nurse Practitioner, probably the advance degree most close to bedside nursing. Everyday during clinical she is told to not be the "nurse", to "know your role". If a pt she is seeing request some water she is NOT to go get it, she is to tell the pt that she will get the pt's nurse.
Like I said at the beginning, nursing lost it's way when it started to hate itself, nursing needs to learn to love itself again. The higher up's need to understand that their is nothing wrong in wanting to actually touch pt's, to stay at the bedside.

Nicely said.

NottaSpringChik, BSN, RN · Jan 27, 2011

I am probably going to get slammed for this, but this is my thinking. Nursing lost it's way when it started to hate itself.
Until recently (last 40-50 years) nursing has been a blue collar job and for the majority of nurses practicing today it still is. Most nurses are bedside or patient side (OR, School, Camp nurses etc.), we hold pt's hands, give them baths, rubs their backs, clean up stool. In other words good basic nursing care.
However, there seems to me to be a section of nursing that for wont of a better word despise this. All through school I was told that "everyone should continue with their education and get an advanced degree", that " we don't have to stay bedside nurses."
Advance degrees take you away from basic nursing. My friend is currently in school to become a Nurse Practitioner, probably the advance degree most close to bedside nursing. Everyday during clinical she is told to not be the "nurse", to "know your role". If a pt she is seeing request some water she is NOT to go get it, she is to tell the pt that she will get the pt's nurse.
Like I said at the beginning, nursing lost it's way when it started to hate itself, nursing needs to learn to love itself again. The higher up's need to understand that their is nothing wrong in wanting to actually touch pt's, to stay at the bedside.

I love what you said here. We should not run from the bedside or be ashamed of the human contact in our jobs as nurses. I still see this as a privilege and part of the intimacy and trust our patients give to us.

eriksoln, BSN, RN · Jan 27, 2011

hi fellow nurses. i'm a clinical nurse educator (cne) in mental health in a major australian hospital in melbourne. for many years now i have felt frustrated by what seems to me to be a loss of direction for nurses. i completed my degree course in new zealand around the year 2000 and was taught about several different nursing theories/models (the terms seem to be faily interchangeable for the most part...)surprise. bs is interchaneable with bs peplau was the most significant for the mental health nurses (of course), but there were orem's self-care deficit, there was callista roy, jean watson, newman, neuman, leininger, erikson - so the list goes on.
there's a lot of talk about evidence based practice, these days. but i'm wondering, how do we instil the value of this in our nursing colleagues,we don't. when it comes to nursing theory, there is nothing to "instill". can't instill something you don't have. may as well be trying to convince people water is not wet. especially the beginner practitioners, if we don't give them somewhere to ground their practice? maybe i'm getting it wrong, but it seems to me if you're not basing (aka grounding) your practice in a nursing model, then you're practising medical model, by default!
i'm wondering how others feel? is it just me that feels this loss? do we need to bring some sense of ownership of our nursing practice back?can't really bring back something you've never had. autonomy and the lack thereof is one of many reasons nursing is not a profession. the lack of a "unique body of knowledge being the most prominent reason. if not, how do we regain and retain our professionalism and sense of who we are and what we do as nurses, if we can't articulate this in some form of framework or structure?ask the other skilled trades how they do it. bricklayers, electricians, painters, landscapers etc. why has it disappeared?because it never existed what have we replaced it with (if anything) and is this working?
please share your thoughts and feelings on this subject. sometimes i feel like a lost voice in the wilderness and wonder if there's some giant factor that i'm completely missing...???
james

take a gander at "time to call a duck a duck".

eriksoln, BSN, RN · Jan 27, 2011

Great OP. I agree with you totally. Sure, there were/are problems with the major nursing theories -- but that's to be expected. We are a young academic discipline and our "young" attempts at theory development, application, and evaluation are bound to be a little clumsy. But I think it is a big mistake to let the pendulum swing too far away from theory-based practice.
We need to find that healthy balance that incorporates theories, but doesn't turn individual theories into "major religions" that aren't allowed to be questioned. If we can find that balance, we can continue to help our theory evolve over time to become increasingly valuable to our practice and to society in general.
I'm with you, orsman167.

You say tomato, I say tomoto.

You call it a young and clumsy attempt at theory.

I call it an epic fail at magic, trying to make something that isn't there appear as though it is.

james2309 · Jan 27, 2011

@ I'mThatGuy - Maybe it's because I work in mental health that I have such a strong reaction to someone saying the medical model works. It doesn't. It is illness focussed. Good mental health care is about knowing how the brain works and that is, by 'accentuating the positive'. You only need to sit in on a doctors interview with a mental health patient and the focus is usually 95% on the negative, deficit leaning, things that are wrong with you. A good mental health clinician needs to learn how to guide, reframe and support someone learning how to view their mental state more postively. In international sports coaching they have been using the philosophy 'what you concentrate on, you get more of...' - with international, wides-spread acceptance. This is no less true for our physical/mental health (placebo-effect?) and becoming increasingly well supported in the research literature. In my opinion it's NOT good enough for nurses to simply accept the medical model and medical model delivery - it's only HALF the picture. If it were, why are we not all trained/training to be doctors? I'm not saying that it's not important, just that it's only half the picture. The Practice Developmental way of looking at Evidence-Based practice is useful here - because more and more it is being acknowledged that there is much more than just the 'research based' evidenced - and that good health clinicians are looking at the 'big picture' stuff and including that in their assessments and treatment interventions. (So maybe I'm agreeing with you, a bit?) BUT I do believe that unless we teach nurses HOW to argue their interventions from a nursing perspective, we are short changing them. I see increasing evidence that junior nurses are NOT comfortable having professional discussions with doctors about their patients.

@ UKstudent: I'm not going to slam you - I hope nobody will, eveyone's entitled to their opinion - which is what's so great about these forums... But I'm not sure where you're looking to see nurses (or nursing) hating themselves (itself) - I certainly don't see it in my area of clinical practice. And to acknowledge that you might be speaking metaphorically, to me the idea that we are advancing the practice of nursing through academia is evidence that we ARE loving ourselves and our practice. Let me put it this way... If you were accused of murder and your freedom and total liberty were in the hands of a legal representative, wouldn't you want the best qualified, most experienced person you could possibly get your hands on (and afford) arguing your case and defending your rights? If you needed heart or brain surgery wouldn't you want the best qualified, most experienced person handling the scalpel? If your car needed major work and it was make or break - you might be up for a new one if you can't fix it - wouldn't you want the best qualified, most experienced mechanic (that you could afford

:->) doing the repairs? I'm going to assume you answered yes to these questions and so my next question is this, why is nursing any different? I don't see my extra learning, my additional qualifications or my drive to improve and enhance my skills as taking me away from basic patient care. I see it more as improving my skills so that I can do the basic care much more easily and include ADVANCED patient care - thus improving the overall health outcomes for the person (people) I'm looking after.

I invite any/all of you to have a closer look at Watson's Carative Factors (for example) and consider how pertinent they are to the argument for the delivery of a nurse-specific process. To me they seem to be so inclusive, so basic and yet so encompassing that they are applicable in almost any nursing setting (with the possible exception of theatre, since theatre nurses don't tend to see quite so many awake patients...) as to make them highly useable as the grounding theory of pretty much any nursing practice. And in case anyone is going to argue the usual line - "existential, phenomenological" factors are words that can be looked up in the dictionary - and are, in fact, highly relevant to pretty much all of us!

Thanks for sharing your thoughts so far! Lecture here endeth...!

GHGoonette, BSN, RN · Jan 27, 2011

Nicely said.

I agree, ukstudent has expressed to a T many of my opinions about the way nursing is going....

I think that, in order to become a nurse, you first need to have some desire to serve your fellow human beings; there are many threads about "nurses who are only in it for the money", and to that you can add status. I have no problem with nurses being paid highly for their services, or the almost-awe with which nurses are viewed, at least in my country; but I do have a problem with nurses who regard basic care as being beneath them, and who regard patients as being nuisances.

Science is an inextricable part of nursing. Without knowledge of disease processes and developments in treatment of disease, the nurse is not equipped to function as the central point of the health care team-the interface between the patient and the other disciplines involved. However, nurses should always remember that their profession is also a humanity.

The bulk of patient care IS basic care. Once nurses forget that simple fact, they are in danger of losing the spirit of nursing. Once the spirit is gone, only the science remains, and the art of nursing is lost.