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.

[nursemike, ASN, RN]

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.

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.

I think it's interesting that you link NANDA and nursing diagnoses with nursing theory. One seems to me to be the very epitome of practicality, and the other, well...not so much. But it does seem like a legitimate link, somehow. I have to admit, also, that I've been an eye-roller, at times, when introduced to new evidence-based practice. A particular example that relates a lot to my work was when we were told that restraints don't prevent falls. I had a hard time accepting that. It seemed to me that properly applied restraints have to reduce falls. I've changed my mind on that. For one thing, it's far from normal to see them applied properly, and it's human nature not to check as frequently on patients who are tied down. I'm not saying you can't fight human nature, but there are times in just about any shift when you are occupied with something, or even just tired, and human nature is apt to rear its head and bite you on the butt. Most of all, though, I've come to realize how little else the restrained patient has to do than figure out how to get out of his restraints. And I saw from the start how much worse a fall can be when a restrained patient falls. I've never liked restraints, and now I've got EBP to back up my dislike.

I hated careplans in school. I especially hated trying to make a unique individual patient fit some shopping list of problems, then try to choose from a menu of interventions. It seemed like it was making a huge ordeal of what was actually just common sense. I really struggled with them. They nearly got me bounced out of school. But in the end, I learned a lot from careplanning, and I can even see the value of trying to approach the problem in an organized way.

Similarly, the parts of Watson I've actually read, and Orem, seem at first glance to be making a big fuss over what is just simple, common sense. Rogers, and some of the Watson I've read about, here, do sound like pseudoscience. I may well read further in them at some point--even pseudoscience can prompt useful discussion and thought, as it has here. And while I may never love flowcharts, sometimes putting "common sense" into an organized form can reveal assumptions of common sense that are less than entirely true.

I don't mean to speak for anyone else, but I wonder if others find themselves as I do, a bit torn between the art and science of nursing. In public school and my first attempt at college, I saw myself as very science-oriented. In my work, I've always favored hands-on disciplines. I used geometry and some elementary physics as a carpenter, but they were just tools to accomplish goals that were practical and aesthetic. While it was necessary to build structures that would stand, the interesting part was how they looked and the functions they served.

I find myself feeling similarly about nursing. As another poster stated, early in the thread, there definitely are times when competence trumps caring. And, I think, vice versa. Ultimately, both are indispensible, but in different situations, one or the other may be more engaged. And in a discussion such as this one, it seems like the two sides often pull in opposing directions. Do we really need a series of diagrams to describe caring? The poet in me rebels. Am I really supposed to try to treat a Disturbed Energy Field?

My own religious views are somewhat amorphous, but I've come to value a Taoist approach to living. I don't know nothin' about channeling chi energy, and I don't really want to, but I do believe that we each have an inner nature, and it will find expression whether we fight against it or work with it. In my life, at least, if I give my inner nature free reign, I'll starve to death while posting on allnurses.com, or birdwatching, or playing with my cats. But I can't entirely overrule my inner nature, so I have to find a way to balance it with doing what needs to be done. When I finish this post, I'll do my laundry. And I'll take a pad and pen so I can scribble my hare-brained ideas while the machines are running. And I think that's my take on nursing theories: be who you are, use what you need, and do what needs to be done.

[jbluehorseh]

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.

we have different perspectives about nursing theories all are valid, no one theory has the cornerstone in caring. and you just stated a put down.

[nursel56]

Mike--

Wow-thank you for your post! To me, it's a great example of the value of the theory discussion. I'm absolutely not in favor of a wholesale jettison of all of the newish frameworks, as I mentioned earlier somewhere I think. :) Bouncing ideas off each other causes the participants to think about things in new ways and spurs creativity. I was a bit surprised to learn that Watson's theories were actually intended to be "provocative", and I am intending to become more open minded about all of this, something that requires conscious effort on my part. I have a ton of respect and admiration for the nurses here who spend a great deal of time working with these philosophical subjects, either learning or teaching others, and their patience in the face of some pretty inflammatory objections.

I'm guilty of being too imprecise in my writing with regard to NANDA, Jean Watson, and other theories that came to fruition, or at least awareness around the same time, late 70s to early 80s. I have such a clear delineation in my mind about nursing before Watson, (BW) and after, that I mentally lump them together by their common New Age-y sounding language. The predominant line of thought in my mind is, "what have we gained or lost through the process of blending these newer ideas into nursing school curriculums, Mission Statements, and formerly practical and widely accepted records (care plans) in such a relatively short period of time?". It's almost as if the "idea" of nursing having it's own body of academic work superseded it's actual value in the real world. If so, we need to look at whether or not mere enthusiasm for the new, or pride in the fact of it's very existence got ahead of itself, and once adopted, defended with the idea that it's mere existence catapulted nursing professionalism to the levels of medicine, psychology, psychiatry, etc., and disagreements with the specifics is tantamount to nursing heresy.

What I see happening is that NANDA and the theories have been folded so completely into nursing that things that were previously stand-alone and widely accepted BW (shorthand) are seen not to have existed at all. In reality, all of it existed before Watson. Evidence based practice, or "doing what works", the carative nature of nursing, and attention to the "whole person" most certainly existed! Many of the nursing diagnoses do have practical value, but those are usually restatements of time honored nursing interventions, and those that don't nobody understands (as in notorious "disturbed energy field"), so they aren't used.

I don't believe trends are ever spawned in isolation, and it's pretty easy to connect Watson to her contemporaries in related fields of the time. I think she did pioneer a new concept, that being the nurse's unseen attributes having a connection to the patient's unseen attributes to the point of having an effect on the healing process of the patient. Does this mean the nurse is actually required to change his or her spiritual nature for the sake of the patient? Now we're really getting into deep waters. A spiritual, moral, religious quest is the right and privilege of all people. We are taught to provide impartial care to people of all religions, races and backgrounds, which will of necessity require some introspection-- how far that goes is not a subject anyone should be attempting say "case closed" about.

Thank you for thoughtfully replying to my post, especially since it was probably more like stream of consciousness than cogent argument.

[nursemike, ASN, RN]

If anyone had told me in the late 70's early 80's that I would be a nurse someday, I'd have swallowed my tongue. So I don't have a real clear sense of what nursing was BW. If anyone had told me in nursing school that I could be interested in a discussion of nursing theory, I'd have been equally skeptical. Now I'm thinking what a great discussion this would be over beers.

I'm not remotely in a position to brag about my five years as a nurse, or even 12 overall in healthcare. Still, even that experience isn't insignificant, and a lot of my colleagues have been at this for decades. And while I'm a newish nurse, I'm an oldish fart, and it occurs to me that a lot of what rankles about some of this "ivory tower" business is that it's usually handed down as if from on high.

This thread seems like evidence that you don't have to have a Ph.D. to do some serious thinking, and keep it grounded in actual bedside practice.

[nursel56]

. . . . .This thread seems like evidence that you don't have to have a Ph.D. to do some serious thinking, and keep it grounded in actual bedside practice.

Absolutely. And likewise, you don't have to have 25 years as a nurse to provide valuable perspective. I think my child-rearing hiatus from nursing and the mental freedom to pursue other interests has made me a better nurse.

[oncnursemsn]

My mentor was Pat Benner- (novice to expert.) As BSN student- we learned about Sister Callistra Roy- theory of adaption. I wasn't impressed. As nursing faculty had to imbrace Carpenito. Anyone out there too? All of nursing diagnoses were based on her. Acute pain as evidenced by.... So not reality based - what do you think?

[algebra_demystified]

I got my final grade in my nursing theory class. A+. My final paper was on Jean Watson's theory, and I scored a 98% on it.

After reading about Jean Watson, I would recommend that anyone interested in the science of Therapeutic Touch take a look at the following JAMA article.

http://jama.ama-assn.org/cgi/content/full/279/13/1005?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Close+look+at+therapeutic+touch&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

The findings:

Context.— Therapeutic Touch (TT) is a widely used nursing practice rooted in mysticism but alleged to have a scientific basis. Practitioners of TT claim to treat many medical conditions by using their hands to manipulate a "human energy field" perceptible above the patient's skin.

Objective.— To investigate whether TT practitioners can actually perceive a "human energy field."

Design.— Twenty-one practitioners with TT experience for from 1 to 27 years were tested under blinded conditions to determine whether they could correctly identify which of their hands was closest to the investigator's hand. Placement of the investigator's hand was determined by flipping a coin. Fourteen practitioners were tested 10 times each, and 7 practitioners were tested 20 times each.

Main Outcome Measure.— Practitioners of TT were asked to state whether the investigator's unseen hand hovered above their right hand or their left hand. To show the validity of TT theory, the practitioners should have been able to locate the investigator's hand 100% of the time. A score of 50% would be expected through chance alone.

Results.— Practitioners of TT identified the correct hand in only 123 (44%) of 280 trials, which is close to what would be expected for random chance. There was no significant correlation between the practitioner's score and length of experience (r=0.23). The statistical power of this experiment was sufficient to conclude that if TT practitioners could reliably detect a human energy field, the study would have demonstrated this.

Conclusions.— Twenty-one experienced TT practitioners were unable to detect the investigator's "energy field." Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.

---------------------------------------------------------------------

Bottom line -- Mysticism is not something that should be part of nursing. If we want to be respected as professionals, we should choose something far away from shamanism and faith healing, and closer to science.

[wtbcrna, MSN, DNP, CRNA]

I got my final grade in my nursing theory class. A+. My final paper was on Jean Watson's theory, and I scored a 98% on it.

After reading about Jean Watson, I would recommend that anyone interested in the science of Therapeutic Touch take a look at the following JAMA article.

http://jama.ama-assn.org/cgi/content/full/279/13/1005?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Close+look+at+therapeutic+touch&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

The findings:

Context.-- Therapeutic Touch (TT) is a widely used nursing practice rooted in mysticism but alleged to have a scientific basis. Practitioners of TT claim to treat many medical conditions by using their hands to manipulate a "human energy field" perceptible above the patient's skin.

Objective.-- To investigate whether TT practitioners can actually perceive a "human energy field."

Design.-- Twenty-one practitioners with TT experience for from 1 to 27 years were tested under blinded conditions to determine whether they could correctly identify which of their hands was closest to the investigator's hand. Placement of the investigator's hand was determined by flipping a coin. Fourteen practitioners were tested 10 times each, and 7 practitioners were tested 20 times each.

Main Outcome Measure.-- Practitioners of TT were asked to state whether the investigator's unseen hand hovered above their right hand or their left hand. To show the validity of TT theory, the practitioners should have been able to locate the investigator's hand 100% of the time. A score of 50% would be expected through chance alone.

Results.-- Practitioners of TT identified the correct hand in only 123 (44%) of 280 trials, which is close to what would be expected for random chance. There was no significant correlation between the practitioner's score and length of experience (r=0.23). The statistical power of this experiment was sufficient to conclude that if TT practitioners could reliably detect a human energy field, the study would have demonstrated this.

Conclusions.-- Twenty-one experienced TT practitioners were unable to detect the investigator's "energy field." Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.

---------------------------------------------------------------------

Bottom line -- Mysticism is not something that should be part of nursing. If we want to be respected as professionals, we should choose something far away from shamanism and faith healing, and closer to science.

E

Congratulations on your 98%!

Nice article.

I think I will stick with EBP.

[algebra_demystified]

E

Congratulations on your 98%!

Nice article.

I think I will stick with EBP.

I sourced a block quote incorrectly, or it would have been 100%.

So near, yet so far away.

If any of the Watsonites are interested, I will be more than happy to share my paper out.

Evidence based practice for me.

[wtbcrna, MSN, DNP, CRNA]

I sourced a block quote incorrectly, or it would have been 100%.

So near, yet so far away.

If any of the Watsonites are interested, I will be more than happy to share my paper out.

Evidence based practice for me.

I like AMA style a lot better than APA. Some peer review journals want one some want the other. I am glad though that American Assoc. of Nurse Anesthetists uses AMA. Although, in my Master's program we had to write papers in AMA and APA style.

[metal_m0nk, BSN, RN]

Bottom line -- Mysticism is not something that should be part of nursing. If we want to be respected as professionals, we should choose something far away from shamanism and faith healing, and closer to science.

I completely agree.

[HamsterRN, ADN, RN]

A profession's theory should define that profession as being distinct from others. While caring is central to nursing, it is also central to any "service" profession such as social work, medicine, teaching, even many lawyers go into that profession out of a pure desire to show caring for others.

Watson's theory is not inaccurate, but it is woefully incomplete. As a noetic scientist, Watson brings a unique view to defining the profession of nursing from which we can pull out some useful wisdom. At the same time, we need to be careful about using theories that fail to capture the overall mainstream purposes of nursing.

As a profession that seeks respect from society, I think we need to be careful about presenting pseudo-scientist as the face of nursing.