What is "Nursing Theory/Model"?

[jstuben]

Hello,

I am looking into nursing. I keep hearing about the "Nursing Model" and "Nursing Theory." What is it? How is it different than the "medical model?"

Also, I've heard some nursing students, as well as employed nurses criticize nursing theory and the model. I've never really gotten an answer that I understand.

Can anyone out there explain what the nursing theory/model is, and especially how they specifically use it in their practice.

Thanks!

[Q.]

Nursing theory is a fantasy, plain and simple. Sitting around "theorizing" about where imaginary patients fall on "the health/illness continuum" is more properly called engaging in conjecture.

Really? So the very real patients that nurse and theorist Kristen Swanson ( http://www.son.washington.edu/faculty/faculty_bio.asp?id=103)

interviewed and studied regarding perinatal loss are "imaginary"? Did you even know that her work led to the framework for Resolve Through Sharing, the perinatal loss support program that is designed for the specific needs of patients suffering from perinatal loss? But, according to you, her work was conjecture and in fact, specific programs for things like perinatal loss should not even exist.

There is no more proof that any answer is correct than there is that if you step on a crack you will break your mother's back.

And that is precisely what detractors to Einstein's THEORY of Relativity thought, until it was all BUT proven. His theory was generated in 1920. It took many, many years to "prove." If we had it your way, we would have dismissed his theory upon creation as "conjecture." Where would be today?

In addiiton while nursing set out to separate itself from medicine and develop its own scientific model in order to be recognized as a separate profession, this has not been accomplished. Learning to call simple things like wounds, "alterations in skin integrity", is not a separate scientific body of knowledge or way of looking at the same thing by different disciplines. It requires no specific set of knowledge and is more properly called memorizing jargon. Jargon is not knowledge.

First, no one has renamed the term wound as "alteration in skin integrity." "Alteration in skin intergriy" is a nursing diagnosis that is meant to assist in care planning; you know, the things that nurses do so that patients don't have stage IV decubiti?

I hate to see such closed minds.

[zenman]

Nursing theory is a fantasy, plain and simple. Sitting around "theorizing" about where imaginary patients fall on "the health/illness continuum" is more properly called engaging in conjecture.

And to think I thought this was called "patient assessment." And to also think that I would have to identify where a patient was on the "health to illness continuum" in order to plan their care and do discharge planning just gives me the shivers! :chuckle

[sblanchet]

It is absurd to state that anything as verbose as saying "alteration in skin integrity" constitutes some kind of shorthand . By your own account the phrase can mean anything and so therefore actually means nothing. It would be so much simpler to just describe, in succinct language, whatever characteristics of a person's skin one wishes to discuss. I stand by my contention that memorizing jargon is most definitely not the same thing as acquiring knowledge. Anyone can memorize jargon. It does not require any specific knowledge base. I rather doubt that physicians, scientists, mathematicians or other knowledge based disciplines engage in this sort of nonsense.

[Q.]

It is absurd to state that anything as verbose as saying "alteration in skin integrity" constitutes some kind of shorthand . By your own account the phrase can mean anything and so therefore actually means nothing. It would be so much simpler to just describe, in succinct language, whatever characteristics of a person's skin one wishes to discuss. I stand by my contention that memorizing jargon is most definitely not the same thing as acquiring knowledge. Anyone can memorize jargon. It does not require any specific knowledge base. I rather doubt that physicians, scientists, mathematicians or other knowledge based disciplines engage in this sort of nonsense.

Again, "alteration in skin integrity" is NOT a descriptor for a type of wound. Who ever told you that? It does not replace terms like serosang drainage, or stage I-IV, or any other clinical descriptor.

In real practice, no, one does not typically go around and state in their mind, "well, today my patient is at risk for alteration in skin integrity..." but they DO say (or should) in their minds and to other professionals when care planning that the patient is at high risk for bed sores. Or wounds. Or whatever jargon you want to attach. It's the driving force that leads nurses to make referrals to WOCNs or to get an air mattress or whatever. So again, what really is the practical difference if a nurse writes "alteration in skin integrity" on a care plan or makes a referral to the WOCN for a bed sore? NONE.

Using language like "alteration in skin integrity" is meant for students to better categorize and conceptualize nursing practice.

[SJSU_Mami]

I notice that many hospitals are starting to include nursing theorists as part of the interview. Some of my classmates have been asked who's theory they base their care on. It was required of us to choose and write about a theorist, and demonstrate how we incorporated the theory into our clinical situations. So we were all prepared to answer if asked. I chose Ramona T. Mercer's Maternal Role Attainment theory. Joyce Travelbee was another popular one. I found that Mercer's theory really helped me in understanding and working with young mothers in the postpartum unit. Nursing diagnoses weren't always my favorite but they helped to teach me what I as a nurse should focus on, factors that I could myself try to resolve or prevent, rather than just the medical diagnosis.

[llg, PhD, RN]

Again, "alteration in skin integrity" is NOT a descriptor for a type of wound. Who ever told you that? It does not replace terms like serosang drainage, or stage I-IV, or any other clinical descriptor.

.

I agree with you totally, Q ... but you probably already know that. The fact that nurses don't know the difference between "nursing theory" and "nursing diagnosis" is just more evidence that these topics are not being learned properly in school. Schools must start doing a better job of teaching these things! To have people going around mis-representing things only makes matters worse.

llg

[llg, PhD, RN]

Rather than thinking it is against the very nature of science, I would say that having a theory provides the context by which something is understood, and how things are determined to be studied. If you read Thomas Kuhn's "The Structure of Scientific Revolutions" you will find that, generally, there is one predominant theory in a particular area of science at a time.

Learning the predominant theory is undergrad work; learning other theories and how to question them is grad work. Nursing science is, perhaps, unique in having a number of theories which are considered to be somewhat on a par with each other. I would maintain, however, that learning one nursing theory is the subject of undergrad education and learning substantially about other theories is grad work.

In short, people need to learn to walk before they can run. Learning one theory is walking; learning substantially about another theory, sufficient to compare and contrast, is running.

JMO

NurseFirst

Interesting post ... thanks for the thoughtful addition to the discussion... but I can't whole-heartedly agree. In the first place, it assumes that there IS a predominant theory in nursing and that is not the case. There are many that are condisered equally as legitimate. Everyone has their personal favorite.

Also, I think you are blurring the line between "nursing theory" and Thomas Khun's use of the "paradigm." While Khun was vague in his use of the term "paradigm," it is generally interpreted to mean "worldview" more than "specific theory." The worldview is at a broader level than a specific theory and a single paradigm might include many different theories covering various aspects of a discipline.

Finally, even undergraduates should learn that within a healthy science, there are many theories ... and that the theories within a discipline are constantly evolving. Even though the school may choose to use one theory to organize its curriculum, students should not be taught that there is only one framework worth considering. They should be at least introduced to the other major theorists and given a chance to understand their discipline at an academic level -- at least at the BSN level. It would only take 1 or 2 good lectures. University students can and should handle that level of sophistication. To ask less of them is to sell them short and to send them out into the world without a basic understanding of their chosen discipline.

llg

[Tweety, BSN, RN]

Nursing theory is a fantasy, plain and simple. Sitting around "theorizing" about where imaginary patients fall on "the health/illness continuum" is more properly called engaging in conjecture. There is no more proof that any answer is correct than there is that if you step on a crack you will break your mother's back. In addiiton while nursing set out to separate itself from medicine and develop its own scientific model in order to be recognized as a separate profession, this has not been accomplished. Learning to call simple things like wounds, "alterations in skin integrity", is not a separate scientific body of knowledge or way of looking at the same thing by different disciplines. It requires no specific set of knowledge and is more properly called memorizing jargon. Jargon is not knowledge.

Nope, jargon is not knowledge.

But when a patient has an alteration in skin integrity, while you follow a medical protocol as dictated by the MD, (such as the type of dressing change, ordering a specialty bed etc.), often you perform activities that are strictly nursing. You recognize the risk, you "diagnose" that it's there or potentially there, you turn and reposition, you perhaps institute a protocol your hospital has for using creams, lotions, duoderms, dressings, etc. that don't require an MD order, but require nursing judgement.

The "jargon" is an attempt to describe what you are doing above. Whether or not it's important to you or the profession is definately debatable and you're entitled to your opinion.

[sblanchet]

When did I ever say that only wounds are called alterations in skin integrity? I used that as an example. I am well aware, as pointed out by another writer, that the term can apply to any number of things and as such has no particular meaning in and of itself. Understanding that certain patients are at risk for "alterations in skin integrity" is no different than understanding that they are at risk for skin breakdown, which is the way such things used to be taught. Changing words or phrases and simply, arbitrarily,assigning certain phrases as "accepted" for use, as I said before, represents no advancement in anything and most certainly does not designate nursing as a profession with its own scientific body of knowledge. It is simply the adoption of a jargon to describe things nurses and others have known for years.

[sblanchet]

Finally, one last thought about this discussion about so-called nursing "theory". What ever was the point of changing the description of a certain sound in the lungs from "rales" to today's accepted word, "crackles"? It is all nonsense. The sound is the same. The significance of this sound in a patient's lungs has not changed at all. Changing the name of something does not represent any advancement in knowledge for nursing or any other discipline. The concept has been around for ages. If nursing wants true recognition as a profession it should get away from such silly exercises in renaming things that are already known.

[NurseFirst]

interesting post ... thanks for the thoughtful addition to the discussion... but i can't whole-heartedly agree. in the first place, it assumes that there is a predominant theory in nursing and that is not the case. there are many that are condisered equally as legitimate. everyone has their personal favorite.

also, i think you are blurring the line between "nursing theory" and thomas khun's use of the "paradigm." while khun was vague in his use of the term "paradigm," it is generally interpreted to mean "worldview" more than "specific theory." the worldview is at a broader level than a specific theory and a single paradigm might include many different theories covering various aspects of a discipline.

finally, even undergraduates should learn that within a healthy science, there are many theories ... and that the theories within a discipline are constantly evolving. even though the school may choose to use one theory to organize its curriculum, students should not be taught that there is only one framework worth considering. they should be at least introduced to the other major theorists and given a chance to understand their discipline at an academic level -- at least at the bsn level. it would only take 1 or 2 good lectures. university students can and should handle that level of sophistication. to ask less of them is to sell them short and to send them out into the world without a basic understanding of their chosen discipline.

llg

thanks !!! :blush: (we need a blushing smilie, not just the imbar one...)

i did say:

nursing science is, perhaps, unique in having a number of theories which are considered to be somewhat on a par with each other.

now it has been a long, long time since i read kuhn. it's one of the first books i remember reading that really had a profound impact on my thinking--and has remained so over decades. i could be mistaken, but i could have sworn he mentioned scientific theories, like newtonian mechanics vs. quantum mechanics--but, like i said, it's been a long time. i think, subsequently, that paradigm has become known as a different worldview, such as in the phrase "shifting paradigms".

you are probably right about undergrad; change it to associate-level education compared with upper class (i.e., jr., sr.), or bachelor's, education.

nursefirst

[NurseFirst]

Finally, one last thought about this discussion about so-called nursing "theory". What ever was the point of changing the description of a certain sound in the lungs from "rales" to today's accepted word, "crackles"? It is all nonsense. The sound is the same. The significance of this sound in a patient's lungs has not changed at all. Changing the name of something does not represent any advancement in knowledge for nursing or any other discipline. The concept has been around for ages. If nursing wants true recognition as a profession it should get away from such silly exercises in renaming things that are already known.

Well, I have always been rather fond of the word "rales" -- especially since it is correctly spelled with the a with the little hat on top, and said with a sort of french accent. :) But if you think medicine hasn't changed words, or made up complex sounding words for simple concepts ... whoo boy!!! Are you in for a surprise. Let's see, what was the one a recent instructor discussed with me -- ah yes -- something being a "lesion" (and described) vs. a rash. Abrasion is just a scrape, right? Coryza -- a cold; cyanosis -- turning blue; diaphoretic -- sweating.

May I recommend a nice course in psycholinguistics to you? :)

Oh, and btw, congratulations on successfully hijacking this thread.

NurseFirst