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.

[algebra_demystified]

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?

That's not what her theory says, though. Her theory is that to care is to cure. She says that the spiritual component of caring IS the cure, and it is more important than anything else. She says that people exist outside of the medical model and that trying to fix the human body puts all of us in danger, and that it's possible that all of humanity will be exterminated unless nurses stop practicing according to the industrial-clinical-medical model and use the moment of caring to cure the patient.

She says that an electromagnetic field is generated between the nurse and the patient that is bigger than either one, and that it transcends time. It leaps beyond any need for proof.

See her 2005 guest column for further weirdness.

I am appalled that this is discussed seriously in a graduate level course.

I think that maybe the first iteration of her theory was reasonable but as her work developed over time... it just went way off the deep end.

[Hospice Nurse LPN, BSN, RN]

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?

That was the only thing I found useful about it. Now, I have to finish my darned paper on..get this..

"Choose 2 theorist (one must be Watson) and describe their theories. Compare and contrast then explain which theory is more relevant to your personal philosophy."

[wtbcrna, MSN, DNP, CRNA]

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?

If you can't remember to treat your patients as you would want to be treated then you don't need to be a nurse. We don't need to spend millions of dollars reprinting, being tested, and generally annoyed by a nursing theorist that no one utilizes except to aggravate students....just my:twocents:

[SharonH, RN]

The biggest problem that I have with Watson's theory is that it is constantly used to belittle nursing science in general and nursing theory in particular. People hold up her theory as proof positive that there is some sort of ivory tower in nursing that has nothing to do with nursing practice. This is done by people both in nursing and outside of nursing. These folks are generally not kindly disposed to nursing scientists anyway and often believe that nursing should confine itself to discussion of pills and bedpans.

Watson is only one theorist. Look at Roy or Orem or Rogers. There are many others. I personally admire Peplau's theory of the nurse-client relationship. You are free to accept or reject. However it is unfair to use her theory as an example of how nursing theory in general is invalid and therefore has nothing to do with nursing practice.

[llg, PhD, RN]

OK. Here is a couple of examples ... using well-know traditional theorists that are usually taught in most theory classes.

Name that theorist:

1. Nurses maintain the environment (cleanliness, nourishment, light, sound, fresh air, etc.) to provide the optimal environment for the patient to recover. Don't we all do that today? Don't we do that in our practice? (Or at least, shouldn't we?)

2. Nurses step in and help patients provide for their own needs (eg. activities of daily living) when the patient is unable to provide for those needs himself. As the patient recovers, the patient does more and more of those things himself until he reaches the point at which he can take care of himself.

3. Understanding the culture of the patient (particularly related to health care practices, dietary traditions, etc.) is integral to providing high quality patient care. Do we not consider a person's cultural practices as we provide care?

4. Tailoring staff education to coincide with the level of expertise of the learner. If you read the Staff Development literature, you will see her name mentioned often.

Here are the answers:

Theorist #1 is Florence Nightingale. Her theories on nursing not only became the foundation for modern nursing, her use of data established the discipline of epidemiology.

Theorist #2 could be either Virginia Henderson or Dorothea Orem. Both theorists focused on this aspect of nursing in their theories. They made models that elaborated on this particular aspect of nursing.

Theorist #3 is Madeline Leininger. She focused on the role of culture in health care and advocated that nurses learn more about the health cultures of their patients and incorporate that knowledge into their nursing care planning and delivery.

Theorist #4 is Patricia Benner. People use her theory all the time, not only to develop education programs, but also as a basis for clinical ladders.

If you want me to teach more theory online, you'll have to pay me to teach a class.

[Moogie]

The biggest problem that I have with Watson's theory is that it is constantly used to belittle nursing science in general and nursing theory in particular. People hold up her theory as proof positive that there is some sort of ivory tower in nursing that has nothing to do with nursing practice. This is done by people both in nursing and outside of nursing. These folks are generally not kindly disposed to nursing scientists anyway and often believe that nursing should confine itself to discussion of pills and bedpans.

Watson is only one theorist. Look at Roy or Orem or Rogers. There are many others. I personally admire Peplau's theory of the nurse-client relationship. You are free to accept or reject. However it is unfair to use her theory as an example of how nursing theory in general is invalid and therefore has nothing to do with nursing practice.

Your points are well-taken Sharon.

Frankly, I think much of the trouble is with nursing education itself because we do not teach students to think in the abstract. To be sure, much of nursing is task-oriented and based on principles and theories from the hard sciences. But nursing is an art as well as a science, so it behooves us to try to explore what do we mean by "nursing" and examine various theories which may vary in their validity and applicability in real-world nursing situations.

And seriously, anyone who is in graduate school or is contemplating graduate school had better get used to examining even the most abstract nursing theories. A grasp of theory is going to be be required, to a greater or lesser degree, in all subsequent nursing courses as well as in writing a thesis or even a grad school project. As the level of education increases, so does the degree of abstraction. Most graduate students are asked to examine various nursing theories, apply them to case studies and clinical scenarios, and articulate how well their own philosophies of nursing may be congruent or incongruent with certain theories. I think that anyone who *hates* nursing theory and finds it all to be a waste is going to have a tough time with many graduate programs because of the level of abstract thinking that is required. Even if a theory seems useless or impractical, a student still needs to understand that theory in order to articulate why it may be less than useful in his/her practice.

In all honesty, I think that students and nurses who have strong, visceral objections to a certain theorist need to be aware that many schools do base their curricular philosophies on the works of some of these theorists. Watson's theory of caring is used in many, many schools and it would be tenuous indeed to end up attending a school (or working in an institution) that followed her ideas if one thought they were irrelevant.

[Moogie]

That was the only thing I found useful about it. Now, I have to finish my darned paper on..get this..

"Choose 2 theorist (one must be Watson) and describe their theories. Compare and contrast then explain which theory is more relevant to your personal philosophy."

That sounds like a very typical assignment in a BSN or master's level nursing theory class. I take that back. The grad course would be twenty-page plus papers on one nursing theory and comparing it to one's own personal philosophy.

BTW, could the OP please tell us which of Watson's writings seemed so offensive? Watson has written prolifically and I have several of her books, some of which focus on caring and only a couple that delve into the metaphysical aspects of nursing. I didn't think there was anything too outrageous in her books but maybe you're read something different. (Or maybe I am more freaky than I thought I was...sometimes it would be helpful if nurses could read minds! ) Much of what is being attributed to Watson seems to be more in line with the theories of Martha Rogers, who wrote quite extensively about energy fields and the like.

[Moogie]

That's not what her theory says, though. Her theory is that to care is to cure. She says that the spiritual component of caring IS the cure, and it is more important than anything else. She says that people exist outside of the medical model and that trying to fix the human body puts all of us in danger, and that it's possible that all of humanity will be exterminated unless nurses stop practicing according to the industrial-clinical-medical model and use the moment of caring to cure the patient.

She says that an electromagnetic field is generated between the nurse and the patient that is bigger than either one, and that it transcends time. It leaps beyond any need for proof.

See her 2005 guest column for further weirdness.

I am appalled that this is discussed seriously in a graduate level course.

I think that maybe the first iteration of her theory was reasonable but as her work developed over time... it just went way off the deep end.

I would like to read that article at some point. In which journal did it appear? It doesn't sound like her earlier work so I am very curious to read it.

Thanks!

[wtbcrna, MSN, DNP, CRNA]

Your points are well-taken Sharon.

And seriously, anyone who is in graduate school or is contemplating graduate school had better get used to examining even the most abstract nursing theories. A grasp of theory is going to be be required, to a greater or lesser degree, in all subsequent nursing courses as well as in writing a thesis or even a grad school project. As the level of education increases, so does the degree of abstraction. Most graduate students are asked to examine various nursing theories, apply them to case studies and clinical scenarios, and articulate how well their own philosophies of nursing may be congruent or incongruent with certain theories. I think that anyone who *hates* nursing theory and finds it all to be a waste is going to have a tough time with many graduate programs because of the level of abstract thinking that is required. Even if a theory seems useless or impractical, a student still needs to understand that theory in order to articulate why it may be less than useful in his/her practice.

In all honesty, I think that students and nurses who have strong, visceral objections to a certain theorist need to be aware that many schools do base their curricular philosophies on the works of some of these theorists. Watson's theory of caring is used in many, many schools and it would be tenuous indeed to end up attending a school (or working in an institution) that followed her ideas if one thought they were irrelevant.

I would venture say the vast majority of nursing schools are moving away from nursing theory and moving towards evidenced based practice. I have 20hrs towards my FNP from two different nursing schools and my MSN in nurse anesthesia from another graduate nursing program. None of them based their curriculum on any nursing theorist. We did the bare minimum in nursing theory in each program, and spent the rest of the time on evidenced based practice. We had one of the most intensive research oriented nurse anesthesia/MSN programs in the country where the majority of students ended up publishing in peer reviewed journals, and all MSN students were required to at least submit their research for publication in a peer reviewed journal. At no time did any of my classmates for my nurse anesthesia class base any of their research on nursing theory.

If you want to be an APN you should be able to understand the medical model, utilize evidenced practice, and have firm grasp advanced science as it relates to patient care.

[wtbcrna, MSN, DNP, CRNA]

OK. Here is a couple of examples ... using well-know traditional theorists that are usually taught in most theory classes.

Name that theorist:

1. Nurses maintain the environment (cleanliness, nourishment, light, sound, fresh air, etc.) to provide the optimal environment for the patient to recover. Don't we all do that today? Don't we do that in our practice? (Or at least, shouldn't we?)

2. Nurses step in and help patients provide for their own needs (eg. activities of daily living) when the patient is unable to provide for those needs himself. As the patient recovers, the patient does more and more of those things himself until he reaches the point at which he can take care of himself.

3. Understanding the culture of the patient (particularly related to health care practices, dietary traditions, etc.) is integral to providing high quality patient care. Do we not consider a person's cultural practices as we provide care?

4. Tailoring staff education to coincide with the level of expertise of the learner. If you read the Staff Development literature, you will see her name mentioned often.

Here are the answers:

Theorist #1 is Florence Nightingale. Her theories on nursing not only became the foundation for modern nursing, her use of data established the discipline of epidemiology.

Theorist #2 could be either Virginia Henderson or Dorothea Orem. Both theorists focused on this aspect of nursing in their theories. They made models that elaborated on this particular aspect of nursing.

Theorist #3 is Madeline Leininger. She focused on the role of culture in health care and advocated that nurses learn more about the health cultures of their patients and incorporate that knowledge into their nursing care planning and delivery.

Theorist #4 is Patricia Benner. People use her theory all the time, not only to develop education programs, but also as a basis for clinical ladders.

If you want me to teach more theory online, you'll have to pay me to teach a class.

1. I would say that Florence Nightingale's theory comes from the bible "cleanliness is next to Godliness", and she just adapted it to meet patient care at the time. Re: Cleanliness is next to Godliness Since one of the things Florence was noted for was her strong religious background I don't see this as great cognitive leap. We know through evidenced based practice that all these things that Florence advocated work. There are a lot more of her teachings that retarded nursing growth and made females subservient to males in the hospital for many decades to come.

2. & 3. Both I believe are just modifications of different social theories adapted to nursing. Absolutely nothing wrong with that if it works use it.

4. Again I don't this is anything original just adaptation of educational theory.

I think most of these nursing theories were either proven techniques (2-4) or based on religious doctrine that were adapted to nursing. These are a lot different than Watson or some of the others we were forced to study as undergraduates.

[Moogie]

I would venture say the vast majority of nursing schools are moving away from nursing theory and moving towards evidenced based practice. I have 20hrs towards my FNP from two different nursing schools and my MSN in nurse anesthesia from another graduate nursing program. None of them based their curriculum on any nursing theorist. We did the bare minimum in nursing theory in each program, and spent the rest of the time on evidenced based practice. We had one of the most intensive research oriented nurse anesthesia/MSN programs in the country where the majority of students ended up publishing in peer reviewed journals, and all MSN students were required to at least submit their research for publication in a peer reviewed journal. At no time did any of my classmates for my nurse anesthesia class base any of their research on nursing theory.

If you want to be an APN you should be able to understand the medical model, utilize evidenced practice, and have firm grasp advanced science as it relates to patient care.

The grad program I attend requires that the thesis or grad project has to have a theoretical foundation of some kind. I have a middle range theory in mind. This is for the APN students (NP, CNS, CRNA) as well as the nurse educator students. I agree with you about evidence based practice---which is stressed in my school as well---and having a firm grasp of advanced science. I respectfully disagree with you about the medical model for advanced practice nursing because APNs should be studying advanced nursing and not trying to be junior doctors, but that's another day, another discussion.

[llg, PhD, RN]

In all honesty, I think that students and nurses who have strong, visceral objections to a certain theorist need to be aware that many schools do base their curricular philosophies on the works of some of these theorists. Watson's theory of caring is used in many, many schools and it would be tenuous indeed to end up attending a school (or working in an institution) that followed her ideas if one thought they were irrelevant.

Good point. Also, Magnet hospitals are required to use a Professional Practice Model and have that model integrated within their practice. Those models articulate theories. If someone has a problem practicing nursing from a theoretical perspective or has a significant problem with a particular theoretical perspective ... then you might want to avoid working for a hospital that uses that theoretical perspective.

Learning to incorporate theoretive perspectives into our work is increasingly becoming an expectation of 21st century nursing. In other words, "It's not just for academics anymore."