Nursing theory-Do you use it at work?

[grdstdnt]

As a new grad student, I'm hearing lots about nursing theory, and how nurses should be utilizing theory in their practice.

What nursing theory/theorist do you or your facility follow?

[llg, PhD, RN]

Theory is simply the structure that people give to their ideas. Everyone uses theory as they go through the day whether they put a label on those ideas or not. Every interaction we have with patients is based on some conceptualization of what nursing is, what needs the patient has, etc. Those conceptualizations are theories.

Every research project has some theory at its foundation whether or not the researcher specified that theory or not. The researcher had ideas about what to study and how to organize the knowledge known about the phenomena involved in the project. Those are theories.

As philosophers have said, all of our experiences, observations, opinions, perceptions, etc. are "theory-laden." What we notice is partly determined by our preconceived notions about what is and is not possible and what is important enough to notice. Those preconceived notions are theories.

The famous nurse theorists that Timothy always rails against are just part of the whole field of nursing theory. They are the ones who have published their ideas and upon which much academic work is based. Their work has influenced much of the science upon which our care is based.

I don't know exactly why Timothy is so against the study or use of theory in nursing -- but he always joins any thread about theory on this board and bashes it whenever the word is mentioned.

But those of you who are beginning your studies of nursing theory, I hope you can approach it with an open mind. Many of us have found that studying the academic foundation of nursing practice very enriching as it has helped us to see and think about our discipline in new and different ways.

[ZASHAGALKA, RN]

I don't know exactly why Timothy is so against the study or use of theory in nursing -- but he always joins any thread about theory on this board and bashes it whenever the word is mentioned.

I'd be happy to tell you EXACTLY what I have against it. It holds us back, as nurses.

Instead of directly interfacing with our peers, and speaking in a common language, we have chosen this meaningless babble to call a language of our own. We speak in pig-latin and think we're so cool.

In the meantime, our peers ignore us. Why shouldn't they ignore us, as we make no sense?

Don't you find it insulting, just a little, that the only information a doctor wants to know from our charting is the vital signs and I&Os our techs can do? Why should they look at any other part of our charting? We've disguised it in care plans and assorted crap. We're so cool, we're irrelevant.

Theory is more of the same. It's pseudo-language with shifting meanings to metaphysically explain whatever the authors mean, at this minute. Of course, we all use it, whether we call it that, or not. Excuse me, but that's bunk.

By staking out the core of nursing knowledge with bunk, we have dismissed ourselves from any true definition of profession. We just go about our business, stuffing our unread documentation in the corner of the charts because nobody else understands it anyway.

Nursing has lots of potential. WE are there, hour after hour. WE have the skills to assess and intervene. WE have the numbers in healthcare. We have lots of power.

And we frit away that power by vesting it in useless 'metaparadigms'.

I'm tired of pretending to be so cool. I'd rather be relevant. I'm not against theory. I'm against the drivel the Ivory Tower passes off as theory. I'm against it because it holds nursing back. We deserve much more than the tower has seen fit to deliver. It the Tower were just spouting hot air, that would be one thing. I could blissfully ignore that. Instead, it is sucking all the oxygen of nursing professionalism out of the room.

If the tower wishes me to respect its drivel, it can start by being relevant. Until then, it deserves my contempt. Just as it deserves to be completely ignored by the wide base of bedside nurses. Rightly so.

Look, I'm not trying to hijack the thread, but the OP asked if regular nurses use this stuff. The answer is, rarely. I think it is on point to discuss why, or, why not.

~faith,

Timothy.

[llg, PhD, RN]

Timothy,

You always get into a big rant whenever anyone mentions the word "theory," but you never propose a real alternative.

OK, you hate the academic establishment. We got that. Now, show us what you have to offer as an alternative. Show us your version of a practical theory. As long as you just "hate" and "bash" and "tear down," you don't move the discussion forward. Help us move forward by suggesting an alternative. Until you do, there is really not more to be talked about.

[ZASHAGALKA, RN]

Timothy,

You always get into a big rant whenever anyone mentions the word "theory," but you never propose a real alternative.

OK, you hate the academic establishment. We got that. Now, show us what you have to offer as an alternative. Show us your version of a practical theory. As long as you just "hate" and "bash" and "tear down," you don't move the discussion forward. Help us move forward by suggesting an alternative. Until you do, there is really not more to be talked about.

I've mentioned several alternatives over the years, in many threads in which you have participated.

Here's a few:

1. Leave the pseudo-language eastern religious philosophy out of theory. Most nurses bring their OWN spirituality to their jobs and it isn't necessary to develop a paradigm for such things. More to the point, nurses will likely ignore any attempt to do so. The result is a base of knowledge that isn't foundational to the masses of nurses. The tower has found a way to make themselves, and nursing by extension, irrelevant. If you can't place your theory inside the box of 'evidence based practice', leave it at home.

2. Get rid of care plans and other devices that relegate our charting to irrelevancy. Say what we mean, in a language our peers can understand.

For example, a new thing is this SBAR, how to communicate clearly and concisely with docs. Now, I have no problem with this. It's telling, however, that the 'body of nursing knowledge' is so cryptic, we need a method to translate it. Instead of developing a translation tool, why don't we just learn the language of our allied peers, and speak it routinely?

3. Chart in the progress notes. Why should our notes be kept in places where they can be conveniently ignored? But, you just try it. The docs would have a fit. How DARE nurses presume to think they have equal standing, "go back to your little care plans and let the docs be in charge". THAT is what the tower should be addressing, instead of focusing on how to make us even MORE irrelevant.

Look, my job is about skill and technique. I can deal with the spirituality I bring to the table. I don't need someone to tell me how to care. Our core of knowledge should focus on our science. The problem that I have with taking up all the space for theory with spirituality is that the tower simply cannot do a better job of that, in my life and for my interactions with patients, than I can accomplish myself.

I understand that you are frustrated that I take chip shots at theory. You've made that clear in the past. However, I CAN conceptualize life savers on a gingerbread man. So can the average bedside nurse. You can pass this off that I'm just some disaffected nurse. In actuality, I'm exceptional at what I do, and highly invested in nursing. I'm very passionate about it, which is why my posting on the topic could be viewed as intense. I want what is best for my profession and hiding ourselves behind cryptic language isn't it.

I'm not alone. More bedside nurses despise this stuff than embrace it. Look at this thread so far. No offense, but so far, the major supporters of theory are an educator, and a manager. This stuff just doesn't resonate at the bedside.

Rather than blaming it on me and other bedside nurses for not having better alternatives, maybe the tower should actually reach out TO the bedside. That is certainly NOT being done today. There is an utter lack of praxis in nursing. You admit it, you just blame it on bad teachers and disaffected students. It's OUR fault there is no praxis in nursing. I not so humbly disagree. The cause is bad theory. More to the point, the cause is irrelevant theory.

I am proud to be a nurse. I want to be relevant, and effective. I rail against the Ivory Tower because, from MY perspective, they hold nursing back. Theory is one big reason why. As a whole, it's neither relevant, nor effective. This is easy to establish; just ask bedside nurses what THEY think about theory. Most couldn't tell you anything about it. I rest my case.

~faith,

Timothy.

[experiencedrn]

llg,

I think it has nothing to do with articulation of the information. It has to do with by in. If the nurse is one that buys into the whole nursing theory way of being then that is all well and good. There are many who do not. Many PhD prepared nurses that dispute theory base. I think it is a personell decission and it depends on how you look at the work you are doing. Is it theroy based being Watson, ect or is theroy based being God.

[llg, PhD, RN]

Here's a few:

1. Leave the pseudo-language eastern religious philosophy out of theory.

2. Get rid of care plans and other devices that relegate our charting to irrelevancy. Say what we mean, in a language our peers can understand.

3. Chart in the progress notes.

I'm not alone. More bedside nurses despise this stuff than embrace it. Look at this thread so far. No offense, but so far, the major supporters of theory are an educator, and a manager. This stuff just doesn't resonate at the bedside.

Rather than blaming it on me and other bedside nurses for not having better alternatives, maybe the tower should actually reach out TO the bedside.

~faith,

Timothy.

I agree with all of your main points expressed above. But the answer isn't to continually bash anything and everything academic in nature. The answer lies in rolling up our sleaves and participating in the study and development of the theory needed to guide our practice. Only by joining the discussion (where it counts and not just here on allnurses) will those of us with a more practical perspective get our voices heard.

Also ... The use of care plans, where we chart, etc. has little if anything to do with real nursing theory. Please don't confuse the two. Those decisions are made by people who work in hospitals and play politics with the other disciplines. Those decisions are NOT made by theorists.

Also ... Of course it is people like educators, managers, etc. who use theory more than the bedside staff. That's only natural. The role of the staff nurse has not been designed with theory in mind. The staff nurse role has evolved to serve the need for certain tasks to be completed -- mostly during a period of our history (past and current) in which nursing theory is still in its infancy. Unlike nurses in leadership positions, staff nurses rarely develop projects that require an organizing framework. The provision of an organizing framework is what theory is best suited for and staff nurses don't do that type of work. So, it is to be expected that those people in jobs that need to have organizing frameworks would be most likely to find the theories more helpful.

Finally ... Here are a few examples of nursing theory that have become so ingrained into our nursing practice that we no longer think of them as "nursing theory." But there was a time when each was considered a "cutting edge" idea proposed by a nurse theorist. Don't tell me you don't use at least some of these ideas in your practice. You do wash your hands, don't you?

1. Cleanliness in hospitals -- Nightingale

2. Decent working conditions for nurses -- Nightingale

3. Keeping track of disease incidence rates, etc. (the whole field of epidemiology) -- Nightingale

4. The idea that the unique function of the nurse is that we will do whatever the patient would do for himself if only he could. -- Henderson

5. The approach of thinking in terms of "patient problems" that need to be addressed rather than just a list of job tasks -- Henderson

6. The goal of returning the patient to a state in which he can care for himself independently -- Henderson and Orem

7. The identification of those factors that prevent people from complying with health recommendations -- Pender

8. The field of maternal-infant attachment -- Mercer

9. The idea that beginners think differently than experts and therefore have different educational needs -- Benner

etc. etc. etc.

[HM2VikingRN, RN]

as well as Maslows hierarchy of needs

[DutchgirlRN, ASN, RN]

Get rid of care plans and other devices that relegate our charting to irrelevancy. Say what we mean, in a language our peers can understand.

Granted in the hospital setting they are ignored but not true in HH. They are extremely important and useful.

Chart in the progress notes. Why should our notes be kept in places where they can be conveniently ignored? But, you just try it. The docs would have a fit. How DARE nurses presume to think they have equal standing, "go back to your little care plans and let the docs be in charge".

Working in the hospital I have charted in the progress notes and it was appreciated by the physician. Physicans often write an order for specific information to be charted by the nurse in the progress notes. Sticky notes placed on the front of charts get lost as do messages left at the doctors office.

I have found that the vast majority of physicians do respect nurses opinions, it when a nurse tries to diagnosis or treat rather than offer his/her opinion is when a physician is likely to have a fit and rightfully so.

I have never had a physician be so condesending to me as to say "go back to your little care plans and let the docs be in charge" or anything similar to that. If a physician did belittle me in such a manner it would promptly be reported and my nurse manager and CNO do stand beside their nurses not the physicians.

[ZASHAGALKA, RN]

Also ... Of course it is people like educators, managers, etc. who use theory more than the bedside staff. That's only natural. The role of the staff nurse has not been designed with theory in mind. The staff nurse role has evolved to serve the need for certain tasks to be completed -- mostly during a period of our history (past and current) in which nursing theory is still in its infancy. Unlike nurses in leadership positions, staff nurses rarely develop projects that require an organizing framework. The provision of an organizing framework is what theory is best suited for and staff nurses don't do that type of work. So, it is to be expected that those people in jobs that need to have organizing frameworks would be most likely to find the theories more helpful.

It took me awhile to respond to this because:

1. I was working, and

2. I wanted to cool down so that my response would be more constructive.

Your first argument was that bedside nurses don't appreciate theory because it hasn't been taught well enough to them, by instructors enthusiastic enough to relay the concepts in a way in which it might be retained.

I countered that there is no praxis in nursing; that bedside nurses just don't care about theory because there is no practicality to it. All the enthusiasm in the world cannot overcome the impracticality of its application.

Here, in this quoted post, you have changed your argument: bedside nurses don't need theory anyway, because, after all, we are just task-oriented, unlike the 'real' nurses that must discuss theoretical frameworks at their academic conferences.

This comment is very telling: "The role of the staff nurse has not been designed with theory in mind. The staff nurse role has evolved to serve the need for certain tasks to be completed" In other words, nursing theory is for professional nurses, a distinct group from bedside nurses, because bedside nurses are much too task oriented to be able to appreciate the complexity of theory, in any case. I see.

It's just a shame that bedside nurses are holding the tower back, high up there in academia. If only we could just realize how important theory is in the conference room, we'd just rush right out there and validate it in the real world. Or, more to the point, the conference room IS the real world, isn't it?

Let me turn your comment on its head, "Nursing theory has not been designed with the role of staff nurse in mind." THAT is its fundamental problem.

I'll discuss your examples, in detail, later.

~faith,

Timothy.

[ZASHAGALKA, RN]

Finally ... Here are a few examples of nursing theory that have become so ingrained into our nursing practice that we no longer think of them as "nursing theory." But there was a time when each was considered a "cutting edge" idea proposed by a nurse theorist. Don't tell me you don't use at least some of these ideas in your practice. You do wash your hands, don't you?

1. Cleanliness in hospitals -- Nightingale

2. Decent working conditions for nurses -- Nightingale

3. Keeping track of disease incidence rates, etc. (the whole field of epidemiology) -- Nightingale

4. The idea that the unique function of the nurse is that we will do whatever the patient would do for himself if only he could. -- Henderson

5. The approach of thinking in terms of "patient problems" that need to be addressed rather than just a list of job tasks -- Henderson

6. The goal of returning the patient to a state in which he can care for himself independently -- Henderson and Orem

7. The identification of those factors that prevent people from complying with health recommendations -- Pender

8. The field of maternal-infant attachment -- Mercer

9. The idea that beginners think differently than experts and therefore have different educational needs -- Benner

etc. etc. etc.

I stated that nursing theory should embrace evidence based practices instead of feel good eastern religious philosophy. Many of your examples are just that: evidence based practices. Of COURSE I wouldn't disagree with those, as it is the 'conceptual framework' on which theory SHOULD be based.

1. Don't I wash my hands is a nice touch in your post. I guess, if not for FN, I wouldn't be washing my hands at work, today. Semmelweis had nothing to do with this concept, right? I made a point that, in my opinion, much of nursing theory is duplicative, if applicable at all, making its study very optional. This is the case here. It's academically arrogant to suggest that the germ theory of disease comes as a RESULT of nursing theory.

2. FN and decent working conditions? Surely, you jest: FN went to the Crimea with 38 nurses to treat over 17,000 wounded. What kind of nurse to patient ratios would 39:17,500 be? It’s a good thing the California ratio law didn’t apply to Florence in the Crimea otherwise, this would be a classic discussion of the failures of nursing management. And Florence was that manager. Now, add to that a chronic lack of basic supplies and a stern management philosophy to ‘buck up’ and you are describing many unhealthy nursing environments today. The only thing needed to complete this picture of Florence, as manager, is an utter disdain for the nurses under her authority: “My doctrines have taken no hold among women. Not one of my Crimean following learnt anything from me - or gave herself for one moment after she came home to carry out the lessons of that war or of those hospitals.”– Florence.

I submit that FN is a proto-typical version of TODAY'S nursing administrator, and that ain't a complement.

3. Epidemiology: evidence based practice, something FN actually SHOULD get credit for her work in improving hospital care. I'm ALL FOR theory based on evidence.

4. I completely disagree with Henderson. I'm sorry, but don't dismiss me as a missing arm. My job involves so much more. No, I DON'T just do what a pt would do, if they could. I bring a high level of science and skill to the table that enables me to act in protective ways to restore health in my patients, ways in which that patient couldn't do, if they could. They couldn't because there is a level of skill and science involved.

I do not take kindly to having my experience and knowledge dismissed as 'task oriented' skills. I never have. I reject Henderson, as do my bedside peers.

5. This is Henderson's way of addressing her demeaning task-oriented bedside concept. I'm not impressed. You dismissed the bedside as task oriented, so why would a theory that claims that being a nurse is so much more resonate? After all, the bedside is not a role designed to use such theories. Right? Those WERE your words.

6. I guess restoring a pt to baseline was something beyond the level of understanding of most bedside nurses, until some theorist pointed it out. I'm sorry, but this is like astrology. If you're going to be so vague that any situation fits what you say, then I submit that you are correct, and a sage. I do NOT submit that I will live my life waiting with bated breath for what the next astrologist, or nursing theorist, has to say.

7. See answer for 6. No-brainers aren't novel because some theorist generalizes about it.

8. I'll defer as maternal child health isn't my strong suit and I don't know enough about this particular idea, except to say, did we really need a nursing theorist to understand the importance of infant/mother bonding? Really?

9. Oh, I'm glad there is a NURSING theorist for this. Quick - have we told all the other professions, in the world, that it takes a nurse to understand that experience is a grounding factor to knowledge!

Theory has its place, but that place is in science. Much more often than not, theory is irreproducible pseudo-language, eastern religious, feel good, feminist garbage. If we want to take our rightful place at the table, we should get past the victim politics that dominates the tower, and stand up for our place.

Unfortunately, that would require praxis: a practical application of theory to the bedside. And THAT would require respect FOR the bedside.

~faith,

Timothy.

[llg, PhD, RN]

You're reading things into my post that aren't there, Timothy, there is no reason for me to even try to communicate with you anymore.

Saying that I have contempt for staff nurses, etc. is totally out of line.

You owe me an apolgoy. ... and I won't "play" with you anymore until I get it.

[Tweety, BSN, RN]

Timothy, I hate to say that it did stand out in your post the Ivory Tower has contempt for the nurse, which I don't understand. The theorists are attempting to explain what we do. In my studies I've never noticed contempt.

However, it is loud and clear in your posts is your contempt for the Ivory Tower.