I *do* recognize the need for nursing theory

[carachel2]

but I am a bit appalled by the theory and research classes requird for my NP program while we covered the entire cardiovascular system in 1.2 hours of Patho. Why is that ??????????????????

We have Nursing Theory, Research and Research and Theory.

How are other programs compared to this one ?

[Kelly_the_Great]

. And what happens to those of us, who do not subscribe to EBP theory.

I'm thinking they better start subscribing to it if they want to get paid b/c the 3rd party payors as well as the patients are.

Edited to add: And so is (subsribing to) medicine which we all already know is gettin' paid any ol' ways.

[tencat]

Ok, I just want to pause a moment and say that I thoroughly enjoy the debate going on here! Let's keep it going!

[ZASHAGALKA, RN]

And you believe this Ivory Tower attitude is restricted to nursing theory only? It is not. Theory, regardless of who formulates it, is always under attack. And there are always those that defend it and take issue with the attackers. And may even insult them by declaring them intellectually impaired. I have never blindly accepted any theory, either in my MS or MBA programs, and certainly not in my nursing programs. And I have never been made to suffer, academically or in any fashion, for questioning the premises of a program. And I certainly would not remain in a program that forced such thinking on me. And I did ask questions, during my interview for my MSN program regarding the theorist and academic freedom. I was told who they had chosen and that I was free to accept any theorists but need to realize that they based their program on that theory. I understood this to mean that the program bases its education on the theory of one theorist. And that their educational premise is based on that theorists. And that I am free to disagree. However, were I to have completed by educational experience, within the education tract, then I would be required to base my teaching on the Watson Theorical Model. I do not accept her model but I understood it was the model of my program. And as such, I was required to teach based on that model. If I didn't like it, I was free to go to another program. I was willing to make the adjustment.

The fact that there are questions, as far flung as some may, adds only to strengthen a theory.

Grannynurse:balloons:

You keep saying that you've never been penalized for a having a different point of view w/ some of the theorists.

But it's important to note that you're a BELIEVER.

You met the most important hurdle: you have bought into the rationale that these people are the self-important people they believe themselves to be. You're in the IN crowd.

Now go to some of those classes and meekly profess that you AREN'T a believer, and you'll be treated like the heretic you claim isn't just dismissed as uncognizant for not believing.

Theory isn't a science: it's a RELIGION.

I have my own religion, thank you very much.

~faith,

Timothy.

[1Tulip]

GNFNPStudent wrote:

Too many theories and not enough hard evidence to support these too many theories. And just who is suppose to decide which of these theories are worth saving and which should be dropped. You? Me? A floor nurse? And what do we use as criteria and who decised which criteria are acceptable. And what happens to those of us, who do not subscribe to EBP theory.

~~~~~~~~~~~~~~~

I don't understand what you're saying. It sounds like you're saying that once a theory makes it into print or is uttered in a classroom, it can't be evaluated for either its veracity or its utility.

As far as your question... what do we use as criteria...

You're asking the same question I am. If a theory can NOT be tested, it's impact on some system can't be measured, what can we do with it? Or stated another way, what good is it? (BTW: Economic theories are testable. That's why lots of economists have won Nobel Prizes.)

Let me turn the question back to you? What do we do with a theory that cannot be tested, for which criteria for rejecting the null hypothesis don't exist? Why should we expect that such a theory can improve (or have any influence on) what happens in our practice?

Remember, I'm not saying Theories have no value. I'm saying merely that they are not science. Philosophy, yes. Helpful in formulating definitions, yes. But science, no.)

Also, when you suggest that you, I and floor nurses in general aren't necessarily adequate to the task of evaluating theories... aren't you ceding critical analysis to the "masters" who alone are enlightened and worthy to be praised forever and ever, Amen.

This is the sort of thing that makes nursing theory so unpalatable to so many. It's not that its hard or over their heads. I've had to teach really hard material to students, stuff they hate. But they get it. Honest they do. I reject the notion that anti-theorists are intellectually inferior to the true believers.

Oh well...

[grannynurse FNP student]

I'm thinking they better start subscribing to it if they want to get paid b/c the 3rd party payors as well as the patients are.

Edited to add: And so is (subsribing to) medicine which we all already know is gettin' paid any ol' ways.

Now let me see if I understand correctly In order to get paid, I have to subscribe to a theory--EBP-because??????? I am aware of no 3rd party payor that mandates a practitioner follow EBP. However, even if some did, I am free not to accept any of those who carry their policy. And what theory a practitioner subscribes to or does not, is quite irrelvent. Offering of services has little to do with the theoretical bases of the profession offering said service. Theory is offered as an attempt to articulate, in a systematic, coherent and orangized manner, answers to questions in a given discipline. Nursing theory has been an attenpt to describe a given phenomena by explaining the relationship between the phenomena, then predicting the consequences or prescribing nursing care. There are atleast four other definitions of nursing theory that I am aware of. Theory is a means of explaing. Payment for one's services does not have much to do with theory, unless you are the theorist postulating a given theory.

A physicist, with NSA, employes one or more of the theoritical concepts of physics. Do they address the theory as they develop the rocket? Generally no but that does not lessen the theorical bases of physics.

Grannynurse:balloons:

[gauge14iv, MSN, APRN, NP]

Payors are increasingly basing reimbursement on outcome data as well as benchmarking - that is evidence based practice. They make decisions about what procedures and practices to reimburse based on EVIDENCE that they WORK!

As more practices and practice environments become electronically based, you will see more an more benchmarking done. So yes, if you want to get paid, you better be prescribing (if you are an NP) the stuff that is proven to work and is within your scope to prescribe, and referring for reasons that follow guidelines. Payors don't just pull guidelines out of thin air (although sometimes it sure sounds that way), they are based on the available clinical evidence.

You want to perform a massage on your patient? Great! Make sure the patient can pay out of pocket in most cases - why? Many payors don't reimburse for massage. Now does that mean massage is an invalid therapeutic modality? Absolutely not. Do we know it helps people to feel better? Absolutely. But do we have proven studies seeking both to prove and disprove that massage is effective that agree with each other and control for the placebo effect? Not likely....

And therein lies the trouble with theory....

ETA - I used to work as a contractor for insurance companies - I have seen the guidelines, I have seen how they are used and I have seen what they are based on.

[Kelly_the_Great]

Why is the consideration of reimbursement looked down upon as an invalid concern for nurses?

GrannynurseFNP, didn't you say you had an MBA earlier? I'm kind of surprised that you wouldn't be aware of the trends of payors towards reimbursing care which is delivered by EBP standards.

[Kelly_the_Great]

And what theory a practitioner subscribes to or does not, is quite irrelvent. Offering of services has little to do with the theoretical bases of the profession offering said service.

I thought theory was supposed to guide practice?

Nursing theory has been an attenpt to describe a given phenomena by explaining the relationship between the phenomena, then predicting the consequences or prescribing nursing care.

Didn't you say above that it's irrelevant?

I'm just not understanding your explanation. Maybe it's my lack of logical understanding/processing or education. Your argument appears contradictory to me.

[grannynurse FNP student]

Why is the consideration of reimbursement looked down upon as an invalid concern for nurses?

GrannynurseFNP, didn't you say you had an MBA earlier? I'm kind of surprised that you wouldn't be aware of the trends of payors towards reimbursing care which is delivered by EBP standards.

I studied for my MBA from 1974-76. Neither my insurance nor many others demand EBP standards. Most require an op report, special testing and the correct code for billing. And that code does not included EBP standards.

Grannynure:balloons:

[grannynurse FNP student]

I thought theory was supposed to guide practice?

Didn't you say above that it's irrelevant?

I'm just not understanding your explanation. Maybe it's my lack of logical understanding/processing or education. Your argument appears contradictory to me.

Its is suppose to guide practice but it is not necessarily what many nurses do.

Ever read any of the numerous articles, in professional literature that incorporate a theory and its impact on certain types of nursing practice. I believe that nursing practice should follow a nursing theory. However, I am in the minority. I incorporate the transcultural theory into my area of practice because of the types of patients I have worked with. But a large number of practicing nurses cannot name a nursing theorist, who guides their practice. Or was I wrong when I saw that some have posted, to use my term, they don't have time for this type of goggbly goup. And see it as irrelvent to their nursing practice?

Grannynurse:balloons:

[gauge14iv, MSN, APRN, NP]

So I could order physical therapy for gastritis and the insurance company would pay for that?

I could order Amoxil as a treatment for an acute MI and I wouldnt be sued? Why not? Because the evidence does not show that Amoxil has any effect on MI.

I could treat a patient using a substance I just happen to believe in for something it is not indicated for (maybe the drug rep told me what a great drug it was) and not expect there to be any ramifications? Drugs and their uses are not based on evidence?

Would I keep my license very long if I chose to practice based on my beliefs instead of the evidence that is covered daily in scientific peer reviewed journals around the world?

What if I don't happen to believe Vioxx harms patients so I tell them to order it from Canada? Patient dies from heart attack due to Vioxx use. I ignored the evidence - who's liable?

You think you practice without evidence? It isn't possible - as a nurse, an NP or even an MD anymore. I will tell you however, that I can practice without theory without fear of being sued or losing my license!

[gauge14iv, MSN, APRN, NP]

As for placing theory in a research article - we were told we HAD to if we wanted to get published...and if we wanted to meet the requirements for the assignment...

SO we found one that fit and stuck it in there - I rarely find them to be of any real significance!