Studying nursing theory, came across Jean Watson

allnurses Guide · Jun 24, 2010

I agree 100% ... and that will require that scholars and practitioners work together -- with each maintaining an acceptance of the other's perspective. Scholars need to become more conscious of the practical ... and bedside caregivers need to get more scholarly. Hence the need for all nurses to study nursing theory -- at least enough to have a working knowledge of the discipline's major scholarly issues and trends.
That's my mission.

What you are describing is evidenced based practice.

There has been no proof that shoving nursing theory down every nurse's throat year after year so they can never use it again has ever advanced nursing science.

Bedside nurses are becoming more scholarly anytime nurses use evidence to make a new policy or change their practice that is scholarship in action. Traditional nursing theory IMO is what kept nursing stagnant for so many years. In practice it takes 10-15 yrs on average from research to implementation into practice. Nurses need to be more like other medical professions quit worrying about theories that hold no practical value(if you can't implement into a policy that everyone can use and show benefit to the patient or staff then it isn't practical), read journals (not just nursing journals), question new things as to what the rational is behind them, and communicate with your providers about treatment/medication regimens.

just my:twocents:

jjjoy, LPN · Jun 24, 2010

Maybe just toss the whole label "nursing theory" and make a clear distinction between nursing models and the various theories in both the hard and soft sciences that nursing practice draws from and contributes to.

Also, some nursing theories/models seem to be stretched too far as they try to encompass all of the various roles that nurses fill. I think nursing could benefit from clarifying the relationship between bedside nursing and nursing in general, especially with the increasing availability of direct-entry NP programs. Is bedside nursing the *foundation* of all nursing practice or is it a *subset* of nursing? If it's a subset, then maybe foundational nursing education could use some restructuring?

nursemike, ASN, RN · Jun 25, 2010

I have been following this discussion, and it has been wonderful to read! Thanks to all the thoughtful contributors
I can't help but think that "demonstrating caring" can also be called "distraction," which is a proven technique for pain management. It's maybe not what Watson had in mind, but it works.
In reality, saying that this person's or that person's theories are bunk would only worry me if someone was a nurse researcher. Most patient care nurses are too busy to do all the work necessary to make the connections between theory and interventions. They certainly don't have the resources to test them for true evidenced-based practice. That's the contribution to nursing that nurse researchers spend their careers making.

You raise an interesting point. It sounds a little counterintuitive, in a way, that talking about your pain could be a distraction from pain, but talking about anything is going to occupy the CNS.

My sense of the situation was that the caring is what helped, that is, that listening was more a psychological intervention than a neurological one. I know we aren't supposed to go there, but I don't really believe the pt was in as much pain as she thought she was when she was hitting the button every ten minutes. For sure, her vitals were all WNL despite 12/10 reported pain. Still, if I were allowed to rate her pain for her, I'd have probably have given her a solid 8/10. Knee replacements hurt. At one point, she got 4mg morphine, IV, 2 percs, and 1mg ativan all at the same time, and slept for about 1.5 hours. That morphine was ordered q2 prn, by the way. A lot of my patients might not survive her pain regimen. She was definitely opioid tolerant from being on PO meds at home for a long time before getting surgery, but I truly think she was also depressed from being in pain so long. I've seen that in my own Dad. And I've seen that depression lowers ones tolerance to pain. Maybe that's at least part of the reason distraction works--keep your mind busy, and you forget how depressed you are, for a bit.

I don't see how placing crystals around her could have helped. Maybe a placebo effect. Maybe convincing her that her nurse has wigged-out and she'd better stay off the call button awhile. And I don't readily see how to decide whether pulling up a chair and listening helped more as demonstrating caring or as a gate-keeper effect. I guess I can vaguely concieve how you might set up an experiment with a number of patients, but I'm just an ASN bedside nurse. In a sense, every intervention is an experiment. You try something and see if it works. And every intervention is based at least a little in theory. You don't just try things at random. (Okay, a lot is based on experience, too. You try things that have worked--for you or someone else--in the past.)

I'm really liking where Moogie and llg seem to be coming from, here. Be open-minded about why things work, but not so open-minded that your brains fall out. Skepticism is also part of the scientific method. But only part.

Moogie · Jun 26, 2010

What is a "mindbodyspirit" and what am I supposed to do with it?

Alg, I was reminded of your post the other day when I was speaking with an experienced nurse educator. She didn't use the terms "mindbodyspirit" or "holistic" but instead told her students (nursing assistant through ADN) to think of nursing in terms of "head" (cognitive or mind), "hands" (body, kinetic knowledge, and hands-on skills), and "heart" (affect, emotions, spirit).

I thought that was a great way to explain the holistic approach. Does that seem more user-friendly and grounded than Watson's abstract "mindbodyspirit" concept?

hearts895, RN BSN · Jun 27, 2010

I just wanted to applaud everyone for such an interesting thread. I'm a new nursing student and I've been interested in Jean Watson and her theory of caring ever since I came across some of her quotes when I was writing an nursing essay. I can see that I agree with her in some ways but she seems pretty "out there" in other ways. I'm looking forward to learning more about nursing theories. Its fascinating to see the intellectual & philosophical side of nursing.

algebra_demystified · Jun 27, 2010

alg, i was reminded of your post the other day when i was speaking with an experienced nurse educator. she didn't use the terms "mindbodyspirit" or "holistic" but instead told her students (nursing assistant through adn) to think of nursing in terms of "head" (cognitive or mind), "hands" (body, kinetic knowledge, and hands-on skills), and "heart" (affect, emotions, spirit).
i thought that was a great way to explain the holistic approach. does that seem more user-friendly and grounded than watson's abstract "mindbodyspirit" concept?

the problem is, watson said "mindbodyspirit" and "mindbodysoul." do you have a link from watson where she restates her concept?

although watson’s work does not deny the importance of empirical factors and the physical, material world of nursing practice, she embraces concepts of mind, consciousness, soul, the sacred, the ancient, and the contemporary yin emergence, holism, energy fields, waves, energy exchange, quantum, holography, transcendence, time and space, healing artistry, evolution, and the transpersonal. watson’s language also speak to more elemental grounds of our being: beauty, truth, goodness, harmony, openings, possibility, beyond, deep understanding, oneness, coming together, nurturance, honoring, authenticity, wide awakeness, human sensitivity, suffering, pain, hope, joy, spiritual, the divine, grace, the mystical, dream work, passion, poetry, metaphor, nature, i-thou, awe, dignity, reverence, ritual, light, the sacred feminine, wonder, compassion, love, blessings, peace. it is here that most practicing nurses find the theory’s truest resonance and hope. watson is an eternal optimist (watson, 1999, 2005), and she writes about the personal as well as the sacred.

alligood, m.r., & toomey, a.m. (2006). nursing theory utilization and application. terre haute, in: mosby. see p 105

and this crap from p 106

this broadened interpretation of science does not negate the significant contributions of objective medical and nursing science but includes and restores subjective experience and values, meaning, quality, and soul-to-human phenomena allowing an integral view of the whole. it does not deny the objective components of science but situates them. as dossey and dossey (1999) have said, watson does not discard science; she honors it, builds on it, and extends it. she asks, if we have the courage to honor all that science is telling us, what would health care look like? what would it feel like to be a...

you know, i'm thinking about embracing and extending science, too. that sounds like fun!

allnurses Guide · Jun 27, 2010

Fascinating thread - just found it and it's almost midnight.

My university planned it's RN to BSN program around Jean Watson. I think one of the initial posters may be attending this university. Jean spoke here - and I attended a luncheon with her. She's very nice but she does have an other-worldly way of speaking that can be hard to follow. Her theories were interlaced into all our subjects and papers.

Our theory teacher was just awful though - llg we needed you!

steph

d'cm · Jun 30, 2010

Jean's work is just further proof of th first law of nursing...." s_ _ _ t runs downhill. "

Wishinonastar, BSN · Jun 30, 2010

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.

jjjoy, LPN · Jun 30, 2010

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 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?

oncnursemsn · Jun 30, 2010

I just found this post and was compelled to read all 11 pages. Have to agree with a few posters- one of the best with few negative/critical posts. I struggled with nursing theory, but Patricia Benner was my instructor (yes, really!) when I went to UCSF. (She's in Boston now...) I loved llq and Moogie's posts. Yes, I think we need to combine theory with EBP. "Mindbodyspirit"? That's what we do as nurses. As posted, I don't just give a pill. I think nursing theory describes, identifies, quantifies what we do as nurses. Thanks to previous posters for fascinating blog!

berrygal · Jun 30, 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.

She takes you beyond the linear world of science into the non linear, unseen areas. We cannot see the subjective aspects of a human being, such as thoughts and feelings, but they exist. There is more of a person in what we can't see than what we can. Watson helps us learn to treat the 'whole' person. It's serves us to keep an open mind. :)