Studying nursing theory, came across Jean Watson

[algebra_demystified]

I haven't read much of her work, but what I've seen so far looks like the ravings of a schizophrenic. It looks like she rejects the medical model completely and believes in telepathy and mind reading over distances, and unmeasurable electromagnetic fields that are created when nurses care about their patients.

What is a "mindbodyspirit" and what am I supposed to do with it? Does she even believe in germ theory?

I'm having a hard time believing that this is taken seriously in graduate level classes.

[wtbcrna, MSN, DNP, CRNA]

I don't think that everyone is equally in touch with the spiritual self and that aspect of nursing. It also takes time to develop. Hard science needs to come first. It is like Maslow's hierarchy in that you have to meet the lower needs first before you can get to the higher needs including those where holistic nursing comes into play. I think it is good to learn about it and keep what you will from it. She makes a lot of good points. In time you begin to see people in a different light, at least I have. There is so much more to people than just pain and symptoms. Much of what we experience is beyond the physical. It is hard to explain in words- people like her can put it into words, not me.

Having nursing theories is essential to the view of nursing as a unique body of knowledge. You do not have to accept every aspect of every theory- that is why they are theories. Theory separates us as a profession from just being automatons or even technicians who simply follow Dr. orders. Nurses have so much more to give then just that.

Therapeutic use of the self is much more than giving a pill. You may never know how much you can impact your patients in other ways if you don't look beyond basic nursing functions. I know this because it was an experience with a wonderful nurse who helped me through a trauma that made me want to be a nurse. I don't remember the ones who gave me pills and shots and IV's. But I remember her- the one who sat on the side of my bed and opened herself to me and held me as I cried. She truly cared about my suffering and that made all the difference.

Nursing theories are not unique bodies of knowledge. Nursing theories are most often just adaptations of other theories from other social scientists. The majority of nursing theories have only been developed in the last few decades, and Florence Nightingale wasn't trying to develop any theory. Nightingale wasn't known as developing any nursing theory initially. It wasn't until decades after her death that someone called it a nursing theory, and most of what people would call her theory is nothing more than Christian teachings adapted to nursing. You don't need nursing theory to know to treat people with caring and compassion.

The oldest nursing speciality in the US is nurse anesthesia. Have you ever seen any great nurse anesthesia theorists. Nurses existed long before nursing theory and will exist long after we finally give up the ghost on nursing theory.

Nurses exist to care for patients. That is what we do. We are not defined by some theory we are defined by the quality care we give.

No one needs any nursing theory to know to treat others as you would want to be treated.

IMO teaching nursing theory just stands in the way of what nurses should spend more time being taught, and that is more science, pharmacology, and how to apply evidenced based practice to their own practices to improve patient care. If you still need a formal class to tell how to treat patients stick with your Ethics class and the basic principles of Beneficence and nonmaleficence.

[Wishinonastar, BSN]

I did not say nursing theories are a unique body of knowledge, I said nursing is. The art and science of nursing includes all of nursing, even nurse anesthetists. That is a specialty area, but still a type of nursing. You don't need theories of specialties, only of nursing.

[nursemike, ASN, RN]

I agree. Unfortunately, many nursing schools provide minimal opportunity to master technical nursing skills and yet try to get students to apply nursing theory to a practice that they haven't had any chance to develop. Isn't that putting the cart before the horse?

I can't argue with your observation. In fact, it seems to me that in my first year of practice, I was so caught up in those practical skills that I had precious little opportunity to do much critical thinking. I was task-oriented because my tasks took all the attention I had to give. But I've never thought critical thinking was a waste of time.

In another thread, I tossed out a term, "critical feeling." It isn't one I've heard before, although I won't be surprised if someone has done doctoral dissertations on it. It is something I plan to think more about, because I'm not entirely sure what I meant by it. I think I'm starting with the idea that empathy and intuition are important (bear in mind, I'm a guy, so these are kind of radical ideas for me!).

Trying to include "spirit" in a theory is problematic. The idea that people have spirits seems unproveable almost by definition. My own feeling, for what it's worth, is that my cats have souls, and that that is important. I am skeptical that that belief is of much practical relevence to my nursing, beyond maybe the basic assumption that people are worthy of my care.

One difficulty with venturing into spiritual matters as part of a nursing theory is that I don't think anyone wants to seem dismissive of other belief systems. Some of my co-workers--smart, capable nurses--reject Darwin's theory of evolution by natural selection because it contradicts their belief in the Christian Bible as literal truth. I don't agree with them, but in another sense their beliefs are no less valid than mine, or a Moslem's, or a Buddhist's, or a Wiccan's. At least as much to the point, many of my patients have beliefs that differ from mine, and part of my duty is to accommodate those beliefs as best I can. To some extent, though, I think the intent to respect various beliefs becomes an attempt to incorporate all of them into a theory. I think, or feel, or believe that when science attempts to explain religious matters, it goes as far off track as some religious attempts to explain science.

Still, we are inherently dealing with philosophical and/or religious concepts. It's a value judgement that health is good. We're routinely faced with the question whether more life is better. I can formulate a view of my realtionship with my cats that is rigidly reductionist, that what I perceive as love is merely the pleasure principle.

In my mind, and in my heart, that worldview leads to an inevitable conclusion that love, and life itself, have no meaning. So I try to function as a scientist, but operate within a framework of beliefs I know are unscientific. And I don't really see a workable alternative.

Granted, there are still plenty of moments where what I want most out of life is to get a working IV site.

[wtbcrna, MSN, DNP, CRNA]

I did not say nursing theories are a unique body of knowledge, I said nursing is. The art and science of nursing includes all of nursing, even nurse anesthetists. That is a specialty area, but still a type of nursing. You don't need theories of specialties, only of nursing.

Okay, my bad. Can you tell me what exactly is the unique body of knowledge that belongs to nursing, because I have yet to find the unique body of knowledge that belongs or even has been soley created by nursing.

[jbluehorseh]

The are many different conceptual models, from Benner to Watson, from Porifice to Rogers. They all have there pro and cons mostly it is how you the nurse see these models. To me some of these theories are too "sappy" or corny from a male prospective. I feel many of these theories were written from female point of view. Not that if is a bad thing, but males express them selves differently then females. Nursing theories are just a frame work to which to guide you. I think too many nurses schools take these theories as absolutes or too concretely. I can remember discussing in nursing school therapeutic conversations using Roy, I felt that the instructors wanted the student to talk to the patient in a "over caring , ferment matter" which in talking to a male patient may not respond well to that type of mannerism verse engaging the patient directly. Where talking to a female patient it might work very well. Nevertheless, men do not talk this manner and it is very awkward for men and we should not have talk like a woman to show that we do care. While I understand, most of the concepts it is very clear it was written form a female point of view. Now that more and more men are entering nursing, these concept and views are not adjusting with the times.

The pro and con lie with us, each nursing theory appeals to the individual nurse because it agrees with their principles, morality or ideology. There is not one theory that can be applied to all patients or for that matter any one community. With this in mind a nurse might apply different concepts from many theorist to achieve his or her goals, one might use Watson's holistic approach coupled with Orem' self-care.

[Moogie]

Trying to include "spirit" in a theory is problematic. The idea that people have spirits seems unproveable almost by definition. My own feeling, for what it's worth, is that my cats have souls, and that that is important. I am skeptical that that belief is of much practical relevence to my nursing, beyond maybe the basic assumption that people are worthy of my care.

One difficulty with venturing into spiritual matters as part of a nursing theory is that I don't think anyone wants to seem dismissive of other belief systems. Some of my co-workers--smart, capable nurses--reject Darwin's theory of evolution by natural selection because it contradicts their belief in the Christian Bible as literal truth. I don't agree with them, but in another sense their beliefs are no less valid than mine, or a Moslem's, or a Buddhist's, or a Wiccan's. At least as much to the point, many of my patients have beliefs that differ from mine, and part of my duty is to accommodate those beliefs as best I can. To some extent, though, I think the intent to respect various beliefs becomes an attempt to incorporate all of them into a theory. I think, or feel, or believe that when science attempts to explain religious matters, it goes as far off track as some religious attempts to explain science.

Still, we are inherently dealing with philosophical and/or religious concepts. It's a value judgement that health is good. We're routinely faced with the question whether more life is better. I can formulate a view of my realtionship with my cats that is rigidly reductionist, that what I perceive as love is merely the pleasure principle.

In my mind, and in my heart, that worldview leads to an inevitable conclusion that love, and life itself, have no meaning. So I try to function as a scientist, but operate within a framework of beliefs I know are unscientific. And I don't really see a workable alternative.

Granted, there are still plenty of moments where what I want most out of life is to get a working IV site.

A dozen kudos to this post, particularly the paragraphs that are bolded. I think you have beautifully described the art and science of nursing.

I see some of Watson's metaphysical writings as her striving to explain how the art of nursing is linked to human spirituality. She writes about the validity of many faith traditions, particularly in her book Postmodern Nursing. Although many nurses are uncomfortable with spirituality, we need to recognize that many of the people we see in clinical settings are having some sort of spiritual struggle---often with end of life issues but sometimes with wondering why something bad happened to them. I also believe deeply that nurses need to have some sort of understanding of their own spiritual beliefs---even if they feel they have no belief whatsoever---simply to help them to cope with the issues we see in the patients and families for whom we care.

[Wishinonastar, BSN]

Okay, my bad. Can you tell me what exactly is the unique body of knowledge that belongs to nursing, because I have yet to find the unique body of knowledge that belongs or even has been soley created by nursing.

All disciplines grow out of knowledge as knowledge develops. In the beginning there was the mother who cared for her children. As illness developed there was the medicine man, but someone had to do the hands on care of applying the poultice or giving the mixture every two hours. A caring person-probably based on what a mother does for her children- stepped up to the plate. The medicine man did his thing, the caregiver did his or hers. The caregiver based his or her next moves on the responses of the patient. And so on. And nursing was born. It is an old profession of caring for others not out of obligation, but as a calling. In time, knowledge of medicine and of nursing grew to become what they are today.

We all share knowledge, but a nurse bases his or her actions on human responses to illness and uses scientific knowledge to assess, plan, implement and evaluate care. No other profession has our exact skills, though we share some common knowledge with all health care professions. Any nursing textbook will provide you with what makes us unique. Do you think doctors know nursing skills? They do not. Neither do physical therapists or psychologists or any other helping profession. We all share the same knowledge of biology, chemistry, anatomy and physiology, pharmacology, and any other science you want to toss in. But nursing skills are nursing's realm, diagnosing and prescribing belong to medicine. Untangling the psyche belongs to the psychologists, and a rehab plan of treatment belongs to the PT. No one can take our place, and we can't take theirs.

I sense some negativity from your responses toward nursing. If you work in anesthesia it could be that physicians have made you feel insecure about your profession. That is a shame because the world would be a dark place indeed without nurses.

[jjjoy, LPN]

All disciplines grow out of knowledge as knowledge develops. In the beginning there was the mother who cared for her children. As illness developed there was the medicine man, but someone had to do the hands on care of applying the poultice or giving the mixture every two hours. A caring person-probably based on what a mother does for her children- stepped up to the plate. The medicine man did his thing, the caregiver did his or hers. The caregiver based his or her next moves on the responses of the patient. And so on. And nursing was born.

So the nurse/caregiver learns from the medicine man and starts to 'diagnose' conditions and 'prescribe' treatments and doesn't call the medicine man for every illness, is that practicing medicine or nursing? I'm not being facetious. I think what was described can be a useful conceptualization of differentiating medicine from nursing, but since nurse DO do more than provide comfort care and 'follow dr's orders', it would seem many nursing functions spill over into "medicine" and not "pure" nursing.

[algebra_demystified]

Okay, my bad. Can you tell me what exactly is the unique body of knowledge that belongs to nursing, because I have yet to find the unique body of knowledge that belongs or even has been soley created by nursing.

See, that's the $64K question.

I find it hard to believe that nurses even WANT to be respected for this body of knowledge. This is the best we can do? I would much rather be respected for being thoroughly competent and knowledgeable about how to manage ventilator settings, how to perform assessments correctly, how to use the top 20 hospital beds, show that I chart thoroughly, that kind of thing.

It's a shame that nurses want to be recognized for a specific body of knowledge and they choose spiritualism.

I would rather demonstrate that I can perform an assessment in the most common five languages in the country. English, Spanish, and whatever comes next.

That would be something worthy of respect.

[wtbcrna, MSN, DNP, CRNA]

All disciplines grow out of knowledge as knowledge develops. In the beginning there was the mother who cared for her children. As illness developed there was the medicine man, but someone had to do the hands on care of applying the poultice or giving the mixture every two hours. A caring person-probably based on what a mother does for her children- stepped up to the plate. The medicine man did his thing, the caregiver did his or hers. The caregiver based his or her next moves on the responses of the patient. And so on. And nursing was born. It is an old profession of caring for others not out of obligation, but as a calling. In time, knowledge of medicine and of nursing grew to become what they are today.

We all share knowledge, but a nurse bases his or her actions on human responses to illness and uses scientific knowledge to assess, plan, implement and evaluate care. No other profession has our exact skills, though we share some common knowledge with all health care professions. Any nursing textbook will provide you with what makes us unique. Do you think doctors know nursing skills? They do not. Neither do physical therapists or psychologists or any other helping profession. We all share the same knowledge of biology, chemistry, anatomy and physiology, pharmacology, and any other science you want to toss in. But nursing skills are nursing's realm, diagnosing and prescribing belong to medicine. Untangling the psyche belongs to the psychologists, and a rehab plan of treatment belongs to the PT. No one can take our place, and we can't take theirs.

I sense some negativity from your responses toward nursing. If you work in anesthesia it could be that physicians have made you feel insecure about your profession. That is a shame because the world would be a dark place indeed without nurses.

This is an old argument about nursing. There is no unique knowledge that belongs to nursing. I agree our duties/actions make us nurses, but it isn't the nursing theory or so called nursing research that define us as nurses. There is only knowledge and research what you do with it is what makes it unique.

I would say I am hardly insecure. I am an independent practitioner of nurse anesthesia in the military. I don't have physician dictating my practice. My education I believe has given me insight that nursing theory is a waste. If you want to study nursing theory that is fine, but it should be an elective class in nursing school not a mandatory class for all nurses. I have yet to meet any nurse that incorporates nursing theory into their practice, but I have met plenty of nurses that aren't taught enough basic science and pharmacology that would let them communicate better with other healthcare providers and provide better care for their patients.

Also, for those that aren't familiar with military nursing we have some of the most educated nurses that you can find outside of academia, and we have enough PhD prepared nurses in the military to rival most university nursing departments . All of our active duty nurses have at least a BSN, and the majority of our nurses have at least one Master's degree by the time they reach Major. All branches of the military are currently trying to build a cadre of DNP nurses as their clinical experts, and at the same time maintain their full scholarships to obtain more PhDs in nursing. This doesn't even count the PhD programs in hard sciences/pharmacology available only to CRNAs that all the military branches offer either. So is the military with one of the largest medical/nursing systems in the US behind the times, because they don't promote nursing theory and have moved to advocating evidenced based practice?

We had nursing before nursing theory existed and we will still have nursing long after nursing theory is nothing more than an antiquated concept.

[Wishinonastar, BSN]

So the nurse/caregiver learns from the medicine man and starts to 'diagnose' conditions and 'prescribe' treatments and doesn't call the medicine man for every illness, is that practicing medicine or nursing? I'm not being facetious. I think what was described can be a useful conceptualization of differentiating medicine from nursing, but since nurse DO do more than provide comfort care and 'follow dr's orders', it would seem many nursing functions spill over into "medicine" and not "pure" nursing.

Who said anything about diagnosing and prescribing? I said that part belongs to physicians. There seem to be a lot of angry nurses on this thread. What would you all have us be? I think we need theory, I think we need research. I think we need to continually strive to think, define and improve nursing. We need to learn from the past and look towards the future. I think we need pride in ourselves as a profession. What we don't need is a bunch of people on this board saying how bad we suck. I am not going to respond or read this thread anymore because the people who put us down do not deserve to be nurses.

[nursel56]

. . . .Therapeutic use of the self is much more than giving a pill. You may never know how much you can impact your patients in other ways if you don't look beyond basic nursing functions. I know this because it was an experience with a wonderful nurse who helped me through a trauma that made me want to be a nurse. I don't remember the ones who gave me pills and shots and IV's. But I remember her- the one who sat on the side of my bed and opened herself to me and held me as I cried. She truly cared about my suffering and that made all the difference.

I went into nursing because of several very caring nurses taking care of my critically ill brother. I am not angry, but it borders on insulting to imply that nursing theory or nursing diagnosis was the thing that caused the nurses to care, and that NANDA discovered "caring" as Columbus "discovered" the New World. There was caring before NANDA, and there was a "world" in North America before Columbus.

Who said anything about diagnosing and prescribing? I said that part belongs to physicians. There seem to be a lot of angry nurses on this thread. What would you all have us be? I think we need theory, I think we need research. I think we need to continually strive to think, define and improve nursing. We need to learn from the past and look towards the future. I think we need pride in ourselves as a profession. What we don't need is a bunch of people on this board saying how bad we suck. I am not going to respond or read this thread anymore because the people who put us down do not deserve to be nurses.

I don't think people are as angry as you perceive. Quite a few commented about the general civility of this thread, and there are many worthwhile and compelling posts on both sides. We are having an exchange of ideas. Sometimes tempers flare a bit, but I am really not hearing people say that "nurses suck".

NANDA is not synonymous with care plan. NANDA is not synonymous with caring. NANDA is not synonymous with professionalism or respect. One of the core tenets of research is dissent. There are theories and countertheories. It appears that some people here want to stifle dissent, a very counter-intuitive proposition which can only lead way out into isolation, as things incubate with no one offering structural feedback.

I'ts quite unfortunate that you end your contribution here by stating those opinions about theory that differ from yours means they don't deserve to be nurses. Academia should never operate by edict.