Nursing Theory???

Roland · Nov 19, 2002

I am saying is that much of nursing theory amounts to little more than a pile of self serving theoretical poop! Your reply reminds me of the story about the guy who goes to his doctor complaining that his pain medication isn't helping his arthritis. His doctor replies that perhaps he should consider a wheelchair because that's the pain medication he always prescribes. You are suggesting that because we find fault in what almost any critically thinking, intelligent person would recognize as religion in the guise of science, that WE are the ones with the problem. Your reply reminds me of the old Soviet Union where it was common to label those who felt communism/socialism was repressive and Evil as being mentally ill rather than admitting that their might be a problem with the system.

I like Peeps, am a student nurse, and find myself horrified at the lack of simple LOGIC associated with much of this theory stuff. It's not JUST about good science. Rather, it is about the unbiased pursuit of simple, unabashed TRUTH. However, rather than LEAVING the profession I for one am going to strive to CHANGE the profession (at least the illogical theory part). Perhaps, I will fail but it will be lots of fun trying, and what's more I have a feeling that I and others will find many allies along the way, (and perhaps more than a few detractors). The only thing I love more than the thought of making decent pay at a steady job with benefits, is having the assurance of a good fight! This sounds like a battle which could last for decades. Let the games begin.

Q. · Nov 19, 2002

Roland (and Peeps for that matter)

Not all the theories that are "fluff" are nursing theories per se. A lot are borrowed concepts from other disciplines, so it's not just nursing that is guilty of this. In fact, take a look at some medical philosophies; you'd be amazed at what you'll find!

A lot of the problem with the theory-practice gap I think is simply because, by nature, theory and philosophies are more abstract than concrete nursing functions. Even Heidegger, a philosopher, criticized most philosophical thinking by basically stating it was not applicable to real life - BUT - that it can be with both calculative thinking and meditative thinking. Calculative thinking is more concrete, meditative more abstract. Heidegger's claim was that for meditative thinking to be useful, it needed to be rooted in calculative thinking. Meaning, they both work together.

So. What's this mean? Basically, to eliminate this type of thinking from nursing, and dismissing it as "fluff" might not be in our best interests as a profession. To quote the author Anne Bishop when discussing a philosophy of nursing, she states: "When practice is reduced to applied science or technology, humans are theoretically designated as objects, which denies their humanity by reducing them to things entirely determined by natural forces." We all know this is not true. Humans are determined by much more than natural law. This is what make nursing different than medicine.

I agree that some theories and philosophies of nursing should be worked from the ground up, but not in all cases. Theories are what makes nurses have a practice versus simply, a technique. Practice is theory and applied science together; technique is simply applied science.

Peeps Mcarthur · Nov 19, 2002

Roland,

I think the reason therapeutic touch won't get anywhere is because nursing is not capable with blending thier ideas into medical practice. For any modality to get recognition and real research some doctors somewhere will have to promote it.

Now about that accupuncture. I was thinking that accupressure could be used in a similar fashion. Accupressure could be an independent action during physical assessment. It seems that there would be a learned skill involved, and maybe it would'nt be precise enough to mimic the therapeutic effects of accupuncture, but maybe have some short-term benefit.

I think your Theoretical Poop theory is valid. I wouldn't offer an hypothesis until I understood what they are trying to communicate, that would be irresponsible(they might try that before writting one........uhmm?). I don't know much about theory because I don't know how to apply it in its entirety, so I have no way to test it.

I believe that's why nursing theory is written that way. To make it inaccessible to the medical community, and those that think in the medical model.

Kate,

You made some thoughtful observations. I think the decision could have been made before I had invested about $900 in books, most of them nursing related or texts, and most importantly 2 academic years to get to this point. If I had recieved complete disclosure of the curicculum basis such as, psych, psychosocial, and almost nothing medical, I would have made a decision agaist it. There's an RN-MSN option at a university here. If I can make it to the associates level with a 3.2 GPA I will get into the program. My main concern is getting to the "front lines" in a capacity that allows me to diagnose, prescribe, and have my own practice. That's what I want, and given my predicament, that's where I need to focus.

Washyahands,llg,

I think that the idea of introducing theory as those theories become useable to the new student is a good idea. Showing how those theories apply and showing proof in the body of formal research outlines, is the antidote for this problem. Now my question is do they have proof? .

Perhapse an intervention is also needed:

If you looked just at the prerequisites of Anatomy(2 semesters), College level math(for me 3 semesters), chemistry, microbiology, one could assume that the courses must have some medical themes. A student (like me) should be screened for intolerance of the curicculum before it becomes inoperable. I think if someone would have given me a sample curicculum and made me test on it a few months prior, I would have at least looked at another program or two. There should also be counsulting during the first semester to confirm with the student thier level of understanding that this is not just a beggining class, but rather, the basis for all of it.

SuzyK,

Keep that in mind when you are developing and managing your first program. I think you will find on inspection of statistics that you could find a correlation between a curicculum's philosophy, and test scores/drop rates for male students. I think male students are more likely to gravitate towards ICU, ER, (although I haven't seen any stats), where critical thinking in a medical way is more appropriate. If nursing wants to attract more males to the profession, that has to be remedied.

Now I really.....REALLY have to study...........well, maybe I'll just take a look-see at that email...BUT then I really will get started on that psych paper

WashYaHands · Nov 19, 2002

Showing how those theories apply and showing proof in the body of formal research outlines, is the antidote for this problem. Now my question is do they have proof? .

Yes, there are research studies that test the statements and assumptions/hypothesis of theories. If you were to go to CINAHL and enter a nursing theorist name in the search field, you will find numerous research studies published. The studies are used to determine the validity of the theory's hypothesis. Research studies that specifically test theory statements constitute the evidence that determines whether the theory is adequate or must be refined, and the study findings either support, refute, or explain the relevant aspects of that particular theory.

On the other hand, research can be used to develop theory. Research that is used to develop theories helps to create a body of knowledge that best characterizes and supports what nurses do.

Linda

Dr. Kate, BSN, RN · Nov 19, 2002

Just an idle recollection that something Roland said triggered: in the dark ages when I went through nursng school (AA) Logic was a required class. It was a pretty universal requirement on the BSN level but not the AA. It's a pity the requirement has gone the way of all things. It is one way of teaching the young that just because they find something illogical doesn't mean it is when subjected to formal rules of logic.

Research in the hard or soft sciences doesn't prove anything. Rather it seeks to explain a set of observations. You want proof, look to the lower levels of mathematics. Even the highest levels of mathematics are not provable in the stirctest sense of the word.

We like to believe that science is far separated from belief (or religion) but in truth they are two sides of the same coin. Each sets forth an explanation of reality. They just start with different premises.

Peeps I am concerned though that you are not going to find what you are looking for in nursing. You say you want to get out there on the front lines with your own practice where you can diagnose and prescribe. Sounds a lot more like medicine than nursing to me. NPs do those things but they are also nurses. And, whether it is politically correct to say this or not, non-nurses tend to look at NPs as not quite doctors, people who couldn't make it in med school; NPs are good but not as good as a doctor; if you're really sick you'll want a real doctor. (This is not my opinion of NPs, but my take on what I have heard people say of them.) It takes a lot of work for an NP to change that perception, and part of what contributes to the change is the unique quality of holistic caring that nursing contributes to the medical expertise of a NP. Call it touchy-feely, but the facilitating the client's response and adaptation to physical and psychosocial changes is the purvue of nursing as I understand it.

Maybe it's time to bring back required viewing of "Mrs. Reynolds Needs a Nurse."

llg, PhD, RN · Nov 19, 2002

I, too, took a course in logic as a freshman in college. It was one of my favorite courses. It wasn't required: I just took it for fun -- as part of the 2 years of liberal arts education that was required for my BSN program.

Personally, I think everyone should take a course in logic. I also think everyone needs at least a little introduction to the philosophy of science. So many people misunderstand the process -- misunderstanding the nature of evidence, verification, proof, etc. They think that everything in the "hard sciences" is 100% "proven" and "correct" and everything else is all smoke and mirrors. Any real scientist knows that is not true.

llg

Roland · Nov 19, 2002

quantified. However, I am asserting that to the very best of our ability that we should base our practice as health professionals upon an objective appraisal of reality. Thus, what is good or bad for nurses is simply not relevent in a search for truth. This means that we shouldn't adopt methodoligies or protocals that seek even in part to seperate ourselves from doctors. This may be a very valid goal for optimizing autonomy or increasing salary/working conditions, but it is a lousy way of conducting research. Don't misunderstand, I am very much in favor of aggressive action in terms of PR, political lobbying, litigation and the like to improve working conditions for nurses. It's just that I'm not willing to sacrifice essential truths upon the altar of transitory gain in this pursuit. When individuals wander from the light of rationality even in the pursuit of greater good it can leave them in a position where it is difficult to seperate that which is real from that which is only a manifestation of their desires. This sort of thinking can easily transfer over into society as a whole creating a void of irrationality which is soon filled by the forces of darkness.

I suspect that Peeps like myself understands the crucial differences between doctors and nurses in terms of respect and pay. However, I suspect that the frustration he/she experiences relates to the discontinuity between the expectation of scientific rationality and the reality of quasi-eastern-mysticism present in many nursing programs. It would be like paying your fee to attend Physics class, buying your books, and then showing up only to find John Edwards and Miss. Cleo explaining the finer points of the human aura as it relates to out of body travel!

Q. · Nov 19, 2002

Roland, I really think you are making way too broad of a generalization with regard to theory. Yes, we all know Martha Roger's theory is at the height of what you are referring to as far as "out of body travel" and "space nursing" etc. Her theory is not easily testable, if at all.

However, like Linda suggested, do a CINAHL or EbscoHost lit search and you will find hundreds of nursing research articles that have tested theory, and retested theory, complete with the quantitative, ANOVA type methodologies that you seem to be looking for.

Don't let the ONE or TWO theorists that you have been exposed to in school cloud your critique of nursing theory.

Roland · Nov 20, 2002

my opinion on nursing theory until I have a more complete grasp of the subject. Thanks for the input.

Peeps Mcarthur · Nov 20, 2002

Suzy,

Looked up CINAHL and that's a hoot. There was only one referrence to "psychosocial," so it may be safe to surf sometime:uhoh21: :uhoh3:

Thanks.

Q. · Nov 20, 2002

Peeps: glad you looked at CINAHL. Since you seem to be into critical care, try looking at research articles from Heart and Lung. In fact, a nurse I know published several articles in there; her name is Laura Burke.

Anyway, one last point to make with regards to "non-medical" aspects of care and why they are important. A lot of nursing studies and literature has focused on "being" in the universe and society, and our whole aspect of "person" etc. This has actually been somewhat relevant. There has been a phenomenon known as the Black Monday Syndrome, in which heart attacks have been more likely to occur on Monday mornings between 08 and 09. Job dissatisfaction also has been mentioned as a significant risk factor for heart attacks, as well as anger. All these aspects could be/should be just as important to evaluate as cholesterol levels, smoking and obesity.

So...there just may be some relevance to psychosocial, more than we realize, after all.

(I know, just what you wanted to hear, Peeps).

kmchugh · Nov 20, 2002

I'd like to highlight a couple of things said by Dr Kate, and present an opposing viewpoint.

Originally posted by Dr. Kate

"But, if you really like the hard sciences as applied to health care why not think about medicine or pharmacy or biomendical reseach? Nursing just isn't a hard science."

Sorry, but this is just wrong. Frankly, that there are nurses who believe this frightens me for the patients of those nurses. And, as an added bonus, attitudes such as these could easily lead to the downfall of nursing. Consider: The treatment of patients is becoming ever more technical, ever more based on advanced research. Medicine, pharmacology, and physiology are making advances almost every day. These advances are making a huge difference in the lives of patients. 20 years ago, removing a gall bladder was a major operation, that involved enormous amounts of pain and a minimum week long hospital stay. The patient was levt with a big, disfiguring scar as a result of the surgery. Now, the procedure is done laparoscopically, with three to four small scars left on the abdomen. As a result of these kinds of advances, gall bladder patients often go home without difficulty within a few hours of leaving the operating room.

This is just one, relatively insignificant example. The care of the sick is moving ahead at a rapid pace. The idea the "nursing isn't a hard science" is going to lead to nurses being left behind. Nursing schools can continue to teach whatever they want, and can continue to focus less and less on the scientific basis of the treatment of disorder. It's a free country. But, if nursing continues down that path, I can forsee a day when hospitals will tell nurses "we can no longer use you, as your knowledge base has no application to what we are doing." This attitude leads to nurses believing that "I don't have time to know about every drug I give." Every day, three and four times a day, I intentionally give medications that, if no other action is taken, will kill my patients. But, after giving these medications, I intubate the patient, I support the patient's respiration. I monitor the patient, and intervene as necessary to keep the patient stable. Everything I do is based on the hard sciences of physiology, pathophysiology, pharmacology, and biochemistry. Without a firm grasp of these topics, I am a dangerous practitioner. That's true not only for anesthetists, but for ALL nurses.

We must keep much of the psychosocial aspects of nursing, for they are what make us nurses. But, we must learn and stay abreast of the hard sciences involved in patient care as well. Above all, we must do so for the good of our patients. All the psychosocial intervention in the world will be for naught if the patient is dead because we gave a 40 mEq bolus of potassium IV push.

"We like to believe that science is far separated from belief (or religion) but in truth they are two sides of the same coin. Each sets forth an explanation of reality. They just start with different premises."

This is a newer idea that has come out of some "new age" thinking. Essentially, it says that science is just a new religion, no more or less valid than other religions. Again, sorry, but the premise itself is false.

Belief (or religion) bases itself on faith. Articles of faith are above testing, and in fact, in most religions, testing articles of faith can be seen as blasphemous. Facts are accepted as facts based on faith, and nothing else. Belief (or religion) can be classified as humankind's search for "truth."

Science, contrary to popular belief, has nothing to do with the search for "truth." Science concerns itself with the search for "fact." Science accepts (or should accept) no facts on faith. In fact, many of the greatest advances in science have come from the testing of facts accepted on faith. In science, theories are formulated, but are not accepted until they are tested, retested, and retested again.

A great example of what I am saying can be found by looking at the most often cited research piece done on therapeutic touch (TT), the Turner Burn Study, and comparing it to any drug research.

TT is, no matter what anyone says, a faith, rather than science based practice. This is proved by the Turner study. In her study, Turner asked patients before ever beginning her study, whether the patients believed in the potential of TT. All patients answers were scored, and this score was factored into the data, giving the responses of those who believed in TT greater statistical weight than those who did not believe in TT. At the end, Turner measured pain on at least four different scales, at intervals throughout the study. On one pain measurement scale, at ONE interval measurement, TT did moderately better than sham TT for pain relief. There is much more to this, but consider. Essentially, the pain of each patient was measured using four different tools, at three different intervals in the study. 12 measurements per patient. On ONE measurement, TT did slightly better. Based on that result, Turner concluded that TT was a success, and research should proceed on how to best implement TT. That's faith, not science.

On the other hand, look, for example, at what would happen to penicillin were it introduced today. In testing the drug, patients with infections would receive either PCN or a physiologically inert placebo. Neither the researcher nor the patient would know what they were receiving. No questions would be asked about the believability of the therapy. Measurements would be taken as to whether or not infections were cleared up, and if so, were they cleared more rapidly in the patients receiving PCN over those receiving placebo. Results would be tabulated, and conclusions drawn over the entirety of data. Science. Pure and simple. The conclusion of whether or not PCN worked would depend not at all on whether the patient believed in it, the provider believed in it, or the bacteria believed in it. Knowing what we know about PCN, the result is the bacteria is just as dead in the patient who believes in it as the bacteria in the doubtful patient. The hypothesis is formed and tested. Belief plays no role.

No, science and belief are not two sides of the same coin, no matter how the politically correct want to believe it to be so. Testable facts, in the treatment of patients, are always the preferred course, for both physicians and nurses.

Kevin McHugh