Studying nursing theory, came across Jean Watson

Hospice Nurse LPN, BSN, RN · Jun 20, 2010

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.

LOL! It's funny you would mention this as I just read some of her work for a paper I'm doing. I'm having a hard time taking any of this seriously. About the only thing I've read so far is her caring theory. So glad I'm not the only one.

llg, PhD, RN · Jun 20, 2010

When you really get into taking care of patients, all that is crap. We don't tell our alzheimers patient 87 times a day her mother is dead... as she is 80 years old herself, only to have her grieve for hours on the death of her mom... we learn through experience that the theory is crap. QUOTE]
Telling that patient that her mother is dead is NOT a proper use of theory. It is the mis-use of theory. That's one of the big problems with nursing theory ... many people don't like studying theory and therefore don't learn it well. They then apply it badly and give it bad name.
It's a vicious cycle. People don't enjoy it, so they have a negative attitude about it. They learn it badly and then don't know how to use it properly ... which creates bad results ... which gives people a negative impression about it ... which means they don't approach it with a postive attitude ... which prevents them from learning and using it properly in the future.
What's even worse is that few undergraduate instructors have studied theory in any sort of in-depth way. So, they teach it badly. That poor teaching only magnifies the problems.

allnurses Guide · Jun 20, 2010

I can honestly say that I don't use any kind of nursing theory in my practice. I treat my patients the way I would want myself or my family treated, and I use evidenced based practice. Nursing theory is outdated. It has little if any use in everyday practice and IMO only alienates nurses from communicating effectively with other healthcare professionals whom base their practices in science/evidenced based practice.

llg, PhD, RN · Jun 20, 2010

I can honestly say that I don't use any kind of nursing theory in my practice. I treat my patients the way I would want myself or my family treated, and I use evidenced based practice. Nursing theory is outdated. It has little if any use in everyday practice and IMO only alienates nurses from communicating effectively with other healthcare professionals whom base their practices in science/evidenced based practice.

You say you think nursing theory is "outdated." Are you talking about nursing theories from the 1960's and 1970's or are you talking about nursing theory developed within the last few years? Have you looked at the theoretical foundations of the research studies that produce the "evidence" that you say you base your everyday practice upon?

Most nurses (including many nursing instructors teaching theory) have not studied nursing theory since they went to school, which may have been many years ago. Most practicing nurses have not kept up with the latest developments in theory or with the ways nursing theories are used as foundations for the "evidence-based practice" guidelines that most nurses are using as a basis for their practice today. If you scratch the surface of most of those "evidence-based guidelines," you'll find research projects that were based on nursing theories.

HealthShepherd · Jun 20, 2010

Llg, would you mind giving us an example of how you've put nursing theory into practice? My experience of studying nursing theory was completely unpleasant and useless, probably for the reasons you've described above, but I'd like to keep an open mind to the possibility that it can be relevant.

We certainly use scientific theories in nursing practice (such as the germ theory, as you mentioned), but I don't see any connection between scientific theories and nursing theories. Scientific theories are about things that are concrete (i.e. the pathogenic bacteria exist - or not, but probably do exist) and can be tested against observations. To me, nursing theories seemed like putting abstract words together in different orders and rendering unsubstantiated opinions on which order you like more.

allnurses Guide · Jun 20, 2010

You say you think nursing theory is "outdated." Are you talking about nursing theories from the 1960's and 1970's or are you talking about nursing theory developed within the last few years? Have you looked at the theoretical foundations of the research studies that produce the "evidence" that you say you base your everyday practice upon?
Most nurses (including many nursing instructors teaching theory) have not studied nursing theory since they went to school, which may have been many years ago. Most practicing nurses have not kept up with the latest developments in theory or with the ways nursing theories are used as foundations for the "evidence-based practice" guidelines that most nurses are using as a basis for their practice today. If you scratch the surface of most of those "evidence-based guidelines," you'll find research projects that were based on nursing theories.

Nursing theory has no part of my practice. My practice (anesthesia) is based on scientific theory and geared towards the medical model. I have not seen or heard of a nursing theory that would cover what I do. I still see no point in nursing theory, but if you can find some nursing theory that covers what I do I would be willing to look at it.

GilaRRT · Jun 20, 2010

I have a couple of problems with Watson's caring theory.

First, at it's core, it's nothing new. I have read a bunch of mumbo jumbo about this and that, but essentially, I gather it comes down to treating the psychological aspect of patient care with due respect and consideration. I go it, we need to look after psychological well being. Why these theorists need to push a simple thing too far is well beyond my pea brain's ability to properly appreciate?

Next, some of the peripheral topics such as life forces and spiritual fields have no credible basis IMHO. I call them peripheral because they really do little in the way of defining what I think is the core concept, psychological well being. This stuff is pseudo-science. I was not aware that a new force carrying Boson that carries the life and spiritual forces was discovered or even theoretically identified? What do we call it, the Spirit Boson? Let's place it on the standard model next to the photon. Perhaps the large hadron collider has been spewing out rather interesting results? I doubt it.

All joking aside, people are free to believe in this stuff (I am a religious person, so clearly a little bit of hypocrisy exists); however, when we incorporate pseudo-science into our theories of health care delivery, it harms the validity of our profession. A profession that is already under attack by some due to the perceived lack of "hard" science education in the various nursing curricula.

CrufflerJJ, BSN, RN, EMT-P · Jun 20, 2010

I do not worship nurse theory, nor focus on it as to my day-to-day practice in the ICU. Nurse theory was only briefly (THANKFULLY!) covered in my accelerated BSN program.

That being said, I believe that Jean Watson's "to care is to cure" is valuable. That is probably the SOLE nursing theorist perspective that I recall/honor from my accel-BSN program.

From the perspective of a (newbie) bedside ICU nurse, you can be the best technical nurse in the world. If, however, you fail to provide sensitive, caring attention to both the patient AND the patient's family, you are doing a disservice to both.

Emotional or technical care, in and of itself, may not "cure." Providing purely technical care, without the human touch, may leave both the patient and his/her family feeling somewhat unfulfilled. My family doctor takes the time to see ME. Not just my medical issue at hand, but ME. This is an important factor for both nurses and docs, in my not-so-humble opinion.

Multicollinearity, BSN, RN · Jun 20, 2010

I wonder if it has occurred to some here that when they give their opinions about what nursing is or is not - even when attacking theorists - that they are talking "in" nursing theories and sometimes introducing their own theories.

Of course we give attention to the formal theorists' most "wacky" theories, but truly, every profession has theories underlying the framework of the profession. Research rests on frameworks of theories.

I do believe nursing needs to do a better job with theory, though. For example, I think too many "meh" theories have been introduced just so some student can produce a dissertation, or so a professor can attend conferences, and publish, while the theory itself is lacking. Also, teaching of theory seems to be lacking. I've learned more about nursing theories' merits and usefulness on allnurses than I did in any university class.

metal_m0nk, BSN, RN · Jun 20, 2010

The whole scientific process (by which that evidence you value is produce) is by definition the development and testing of theories. A scientists develops a theory, proposes hypotheses based on that theory, and then conducts experiments to test those hypotheses -- thereby supporting the theory or finding weakness/errors in it. That's what science is. Didn't you learn that in high school?

It doesn't just stop there. In the scientific community, if an experimental design cannot be replicated with similar results, then the validity of the original is questioned. Peer review of experimental findings is an important part, not only of maintaining the integrity of knowledge, but also of the expansion of ideas.

Most of the evidence used in "evidence-based practice" comes from scientific inquiry and/or the rational evaluation of data -- organized into a theoretical framework of some kind. For example, we wash our hands because we have a theory that if we remove the bugs on our hands, we will reduce the spread of certain diseases. That theory has been supported by research studies: so, we incorporate that theory into our set of beliefs. But that basic germ theory, is still a theory. So, I think we can agree that not all theory is bad. There are good theories out there.

First, as with many English words, the word "theory" is noun with multiple meanings. Scientists are often annoyed with the prolific use of the term to describe an idea, opinion, or set of personal beliefs irrespective of empirical evidence or hypothesis testing - which is what this "theory" is.

Watson's theories are nowhere near germ theory on an evolutionary scale of science. They should not even be placed in the same category. Like germ theory, gravitational theory is "only a theory", but the mechanism behind gravitational pull can be taken for granted in a specifically defined set of circumstances because the theory has been predicting gravitational events for over 350 years. A rock dropped from 5 feet above the Earth's surface will fall to the ground with a speed proportional to its mass now, just the same as it did 350, 500, or 1500 years ago. Watson's theories have NOT earned that tenure.

Without empirical evidence to support her theories, they are not going to be taken seriously by any science professional and shouldn't. Neither should they be put into practice until there is evidence to support them, methods and standards for action, and some speculation as to the long-term implications of action...especially in the case of any practice that deals specifically with people's lives.

Besides, there is a reason why "unmeasurable electromagnetic fields" aren't being widely studied. It is because they are neither observable, nor measureable. You can't scientifically approach the existence of phenomena that cannot be observed or measured. What she proposes fits most aptly and firmly in the category of pseudoscience. I'd be curious to know if Jean Watson has ever been able to even secure any funding to test her ideas. Whether or not someone is willing to put down some cold, hard cash to facilitate the exploration of her ideas says a lot about their scientific integrity.

Multicollinearity, BSN, RN · Jun 20, 2010

What if Watson's theory is useful just for reminding us to be caring when we sometimes become engrossed in the technical aspects of our jobs? What if it's that simple?

metal_m0nk, BSN, RN · Jun 20, 2010

What if Watson's theory is useful just for reminding us to be caring when we sometimes become engrossed in the technical aspects of our jobs? What if it's that simple?

I would hope that the majority of people have plenty of reminders in their lives and experiences that would drive them to be caring in their treatment of patients. I know I do. I don't have to subscribe to anyone's half cracked philosophy to meet that end.