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.

[llg, PhD, RN]

21st century nursing doesn't have to be 17th century physics or 3rd century theology.

I loved your post ... and really loved that last line. It would make a great signature line. I hope you don't mind if I someday make up some version of it for myself.

[carolinapooh, BSN, RN]

Something kind of interesting- One of my classmates went to a Watson Convention for extra credit, and enrolled in a study Watson was doing. Watson invented what is in essence an electronic mood ring. It is a small box with different color lights and electrodes. The electrodes hook to the patient like a pulse-ox and it lights up whatever color you are feeling. Like one color was for anxiety, stress etc.

Oh....my.....GOD......

These are the little things about my profession that I pray daily the general public never, ever gets wind of....

[carolinapooh, BSN, RN]

Those theories, though, are conceptual frameworks, not scientific theories. When it comes to empirical research, I don't see nursing as a separate, unique field. Instead nursing is an interdisciplinary field involving physiology, psychology, pharmacology, sociology, education, etc.

The absence of "medicine", specifically, disturbs me. I don't think it was deliberate, but while we're not practicing "medicine" in the MD sense of the word, make no mistake - this is still medicine.

It's medicine within a different scope of practice, but it's still medicine.

[carolinapooh, BSN, RN]

I've always wondered if she was the inspiration behind the bogus nursing diagnosis 'disturbed energy field.'

I spent three years in nursing school desperately trying to make that diagnosis fit, just because it would've been a hilarious way to point out its ridiculous-ness

I was going to make the EXACT SAME comment.

[carolinapooh, BSN, 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.

I have to say that number four isn't really a theory - it's a basic tenet of adult education that was around long before Benner tagged it to nursing. Actually, it's a basic tenet of education in general. Can't imagine how it got credited to nursing theory.

[nursemike, ASN, RN]

Dude, after you railed me for a correct interpretation of physics and likened my understanding to a grammatical error, dwarfed in the massive shadow of your "formal physics education", I kind of stopped caring about anything you have to say.

Honestly didn't mean it as a rail, and my point about the grammar error analogy was meant to be an admission that I had been unduly pedantic. Probably shouldn't have gotten off on a tangent about physics, either. It's just that I get irritable when the life sciences seem to break their necks to meet a deterministic ideal that has long been outdated in physical sciences and math. As for your original example, I misunderstood you to mean that acceleration due to gravity was proportional to mass as in Aristotle's model, which Galileo did disprove. But you are correct that air resistance does enter into the equation.

[nursemike, ASN, RN]

We can be reminded that we are treating people and not machines without ever introducing any theory. And certainly that doesn't only apply to nursing care. The practice of caring is central in other fields such as child care. And there are some areas of nursing practice where clinical competence does trump caring (so long as the nurse cares that they practice competently). A nurse can most certainly learn and practice caring without any formal theory of caring. That doesn't mean such theories are useless; they just aren't necessary for competent practice.

Well, yeah, if you're going to say it succinctly, I totally agree. It's just, well, my knees ain't what they used to be, so I need to start working on my spurious analogies and hyperbole, so I can be a nursing theorist when I get too old for the bedside.

[nursemike, ASN, RN]

I loved your post ... and really loved that last line. It would make a great signature line. I hope you don't mind if I someday make up some version of it for myself.

Thanks. I like your take on nursing theories and do think some of them do seem to have a baby somewhere in among the bathwater. Discussions such as this one have helped me a lot in developing my personal philosophy of nursing, beginning from a time when I had no idea I even needed a philosophy of nursing. As I alluded above, I can hardly wait to put this philosophy into systematic form and inflict it upon the world, but for the time being I'll just have to pop some ibuprofen from time to time, since my attention is currently divided between my bedside practice and my ongoing research into Japanese Internet Mediaography.

[metal_m0nk, BSN, RN]

Honestly didn't mean it as a rail, and my point about the grammar error analogy was meant to be an admission that I had been unduly pedantic. Probably shouldn't have gotten off on a tangent about physics, either. It's just that I get irritable when the life sciences seem to break their necks to meet a deterministic ideal that has long been outdated in physical sciences and math. As for your original example, I misunderstood you to mean that acceleration due to gravity was proportional to mass as in Aristotle's model, which Galileo did disprove. But you are correct that air resistance does enter into the equation.

It was basically akin to correcting someone's grammar by saying, "You ain't no talk like that, yo." ....All the while claiming to be a scholar of English and lamenting about how generally misunderstood basic concepts of grammar are.

I can accept that it was a misunderstanding, but this comment at least:

Seriously? Air resistance is a very real thing in my world. Where do you live that it isn't?

Should have been your first clue as to where I was coming from. You made an assumption (and an insinuation) that because I didn't major in physics at any point in my academic career, then I must not know what I'm talking about. You were right about one thing, I never did major in physics. But my reading comprehension is spot on most of the time and I know when someone's blowing smoke up my orifice.

Cheers!:redbeathe

[algebra_demystified]

But does one specific proposal by a theorist (Uncle Siggy or anyone else) that doesn't sound valid to you on first hearing mean that the entire body of that person's work is "crap"?

Yes.

I think that a lot of the problem with people finding nursing theory so distasteful and useless is that they don't get much exposure to it. They get a few "sound bites" in an Intro to Nursing Theory course, think that they don't make much sense, and decide that means all nursing theory is useless gibberish.

BTW, a few years ago, I was privileged to be able to attend a presentation by an international neuropsychiatric authority (the man who did most of the research on trauma that originally established PTSD as a diagnosis) -- the focus of his presentation (one of several I was able to attend -- the major teaching hospital at which I worked brought him in for a week-long "residency") was how the PET brain scan results in his current research supported the validity of Freud's theories, that Uncle Siggy was way ahead of his time in many ways and we were just now getting to the point where we have the technology to be able to verify how right he was (of course, a lot of us knew that all along ... :)).

Let's say I told you I wanted a steak. The two of us get in the car, and I describe a NY Strip I want as we drive to the store. At the store, I go to the frozen section and get a box that says Frozen Macaroni and Cheese, say to you Here's the steak... wouldn't that be a little weird? I go and pay for it, take it home, open the box, and (this is the part that blows your mind) slide out a NY Strip, just like I wanted.

Now, imagine that I didn't shake the box to see whether it seemed like a steak might be in there. I didn't sniff the box, I didn't weigh the box, submerge it in water to check its displacement, use any kind of electrical conductivity test to see whether it conducted electricity like a steak would.

I just grabbed the box and tossed it in the cart.

While I did end up with the steak, I wasn't CORRECT. I was LUCKY.

Freud didn't have the proof at the time he wrote the theory.

The reason I dismiss theories with massive and obvious flaws is that I have better things to do with my time. I could study the medications I pass at the hospital and have a better understanding of the side effects and why they might happen. I could study body language. There is some fascinating stuff out there about the the construction of malls, casinos, and outdoor shopping centers. How far apart you have to put garbage cans so people are less likely by a certain percentage to drop their garbage on the ground. I work in psych, so this information is useful to me.

I could read biographies, case histories, I could study chemistry or physiology. Why would I want to waste my time trying to figure out which parts of a broken theory might apply some day to something?

Check out this theory.

[llg, PhD, RN]

I have to say that number four isn't really a theory - it's a basic tenet of adult education that was around long before Benner tagged it to nursing. Actually, it's a basic tenet of education in general. Can't imagine how it got credited to nursing theory.

You're right in a way. It was a bad example. I was trying to think of ones that everyone knew and could relate to. The actual "novice to expert model" is the original work of Hubert and Stuart Dreyfus, and Benner's dissertation just validated it's applicability to nursing situations (and expanded it by adding the "advanced beginner" stage I think.) But her work has gone beyond that basic model since then and she is still a theorist. It's not a theory OF nursing: it is a theory IN nursing that has been expanded by a nurse and adapted for use in nursing. ... But no one ever said that all nursing theories have to be theories OF nursing.

My point was that people use that theory all the time. My post was made in response to people who said that no one ever used any theories in practice. While Benner did not totally originate that theoretical model, her work on it within nursing has made it most associated with her. And the point that I was trying to make that real people do actually use the work of some of the nursing theorists in every-day practice is illustrated by the example.

[metal_m0nk, BSN, RN]

Let's say I told you I wanted a steak. The two of us get in the car, and I describe a NY Strip I want as we drive to the store. At the store, I go to the frozen section and get a box that says Frozen Macaroni and Cheese, say to you Here's the steak... wouldn't that be a little weird? I go and pay for it, take it home, open the box, and (this is the part that blows your mind) slide out a NY Strip, just like I wanted.

Now, imagine that I didn't shake the box to see whether it seemed like a steak might be in there. I didn't sniff the box, I didn't weigh the box, submerge it in water to check its displacement, use any kind of electrical conductivity test to see whether it conducted electricity like a steak would.

I just grabbed the box and tossed it in the cart.

While I did end up with the steak, I wasn't CORRECT. I was LUCKY.

Need......MORE......kudos....

I love analogies.

Edit: I hate that I feel like I have to do this, but I probably should.

Yes, I understand that the analogy totally ignores the portion of our little discussion that addresses how ideas once thought irrational evolve when someone picks them up and expands them. I just love analogies. Especially elaborate ones.

Carry on.