What's eating me-theories and professionalism

[pedsrnjc]

There are 6-100 different nursing theories, my classmates think this is a good thing.

No wonder it's hard for nurses to be viewed as "professionals" when we can't even agree on a theory on which to base our practice.

Yeah, I'm trying to do homework again for my BSN and the question is:

"The nursing profession should have only one nursing theory, rather than several, to guide nursing education, practice, and research." Do you agree or disagree with this statement?

Every single classmate disagrees with this statement in the assigned discussion board, I agree. What's really eating me up is that in my personal nursing practice I see nurses using several different nursing theories to guide their practice which makes every nurse off doing their own thing.

For example:

A resident is found on the floor and is not injured.

The nurse using Henderson's Complementary-Supplementary model sees this as "illness-potential for lack of independance" The Henderson nurse will put alarms on this resident and require that whenever this resident gets up, staff will assist with mobility to prevent a broken hip which would remove independance.

The King's Theory of Goal Attainment nurse sees this as illness because the Henderson nurse put on alarms and is requiring the resident to have stand-by assistance with mobility, hence impeding the resident's social roles by slowing the resident who just wants to get to church on time because she plays the piano.

Meanwhile the Leininger's Cultural Care Theory nurse, talks to the resident and discovers that the resident laid down on the floor because the hard, cold surface felt good on her sore back and she has to play piano later, therefore, the resident is not ill at all because of the fall but because of uncontrolled pain.

Each of these three nurses send a note to the doctor all stating different things.

NURSES GET ON THE SAME PAGE! We look stupid to other professionals because we look at our patients with different filters and come up with different conclusions, so it looks like nobody knows what's going on!

Ugh!

Creasia, J & Parker, B. (2007) Conceptual Foundations the Bridge to Professional Nursing Practice. (4th edition). St. Louis. Mosby Elsevier.

[psychonaut]

But what are they meant for? And if they're irrelevant to day to day nursing, why do I have to learn about them, I'd rather have a large dose of TNCC;). But really, what are they for?

They are meant to provide a justification for the nursing PhD. The PhD is required to contribute to their field of knowledge, a field of knowledge requires theoretical underpinnings, thus you have the nursing theory.

The examples you quote exemplify cases in which theory is constraining the perception of a situation. In other words, "when all you have is a hammer, all you see are nails." Ideally, theory should *arise* from the observation, not straitjacket it. Alas, nursing theories in general bear a much closer resemblance to philosophy than they do to scientific theory.

You have to learn about them because the gatekeepers to your educational credentials created them, and making you go through the motions is how they keep the system running.

[themoreyouknow]

I am also in school for my BSN and find the use of "theories" abhorrent. I work as a nurse and am back in school for my BSN. No one - not one nurse - has every mentioned theory. It's a requirement for the BSN program that (for me) has helped me understand that there are many different ways to look at a situation and many different ways to approach the situation. Patients ARE complex. They have physical as well as emotional issues. Some theories address the physical and state that emotional needs can not be met without meeting the physical needs first (like Maslow's hierarchy of needs triangle - not a theory) while other say that we should have "Caring moments" with the patient and that will encourage them to heal. All are right in some respect because humans are multi-faceted.

Watson, I'm sure, makes much dinero (big bucks) for her "theory". Selling bowls, books, etc. To me.. a theory is something someone wrote down while *watching* nurses work. I don't have time to watch people work. I'm too busy doing the actual working! :) I have often wondered how many years these theorists actually worked on the floor before they started writing.

Just make it through school, and you'll probably never, never hear a peep about nursing theory on the job again! :)

~Sherri

[Flying ICU RN]

No wonder it's hard for nurses to be viewed as "professionals" when we can't even agree on a theory on which to base our practice.

I will state this every time I see this statement.

"Professionalism", Is a "State of mind," and individual behavior.

I have known Janitors to be quite professional.

[llg, PhD, RN]

I hear you, but maybe it's a personality thing, or maybe I'm at too low of a level of thinking to work on my BSN, but I want information I can use, tonight when I go into work.

I'm pretty sure I use several pieces of several different theories, but I like Henderson's the best because it's practical and fairly simple on the surface. I really want to learn stuff I can use immediatiely. There's probably a DSM Dx for what I'm going through and it will be a miracle if I pass.

Perhaps, multiple theories are vital to nursing and I'm just lazy so I'd prefer one. IDK

OK. I see your problem. You are only focusing on the tasks of nursing work -- and not on the thinking and knowledge behind the tasks. The purpose of a theory is not to change the process of doing a physical task (such as starting an IV), it is to promote the development of critical thinking so that the nurse can better deal with the whole situation surrounding the task. Different theories provide you with different "lenses" through which to view the situation. Each theory that might be used "illuminates" different aspects of the situation and suggests things that might be done regarding those different aspects.

Let's take a specific scenario as an example: Your patient is nauseated, in pain, needs a bunch of diagnostic tests to figure out what is wrong.

1. Nightingale: If you look through the lens of her theory, you see that you need to manage the environment to promote this patient's comfort, safety, etc. You consider things like the lighting, sounds, smells that make him/her more nauseated, etc. Cleanliness would also be critical. If you were not familiar with Nightingale's work, you might not notice the things in the environment that could need improvement. Nightingale also emphasized the importance of basing nursing care on scientific evidence: so you would be comparing your patient's needs and care to the scientific literature, best practices, etc.

2. Henderson: You would be doing whatever the patient could not do for himself/herself. And you would have a list of possible patient problems that you could use to guide your assessments and care.

3. Watson: You would be particularly attuned to the need for this patient to feel cared for and would be paying lots of attention to what this whole experience meant the patient. You would be sensitive to the needs of his/her "mind" and "spirit" as you cared for the needs of his/her physical body.

4. Leinginger: You would be particularly sensitive to any cultural needs that this patient may have.

5. Roy: You would noticing how this patient was adapting to this new situation.

etc. etc. etc. Each theory views the patient from a different angle -- and being well-versed in a variety of theories gives you a lot of different ways to view the patient. Combining them all gives you the most complete view of the patient and/or the situation. That's why it is important to be familiar with a variety of theories. It helps your view of the patient/situation be more complete and "rich." An expert nurse sees the whole picture -- not just the technical skills -- and can incorporate a variety of theories into practice, making his/her practice much more comprehensive and "deep."

Another reason why we need theories is to provide a structure for our teaching, research, and knowledge. When we deal with the knowledge of our profession (rather than just the performance of physical tasks), we need to organize that information in some way. Theories are necessary for that organization. As you advance your education (now at the BSN level), you are learning to deal with the underlying knowledge of the nursing profession (the academic discipline of nursing) rather than just learning how to do the tasks. And as you focus on the knowledge base (and not just on the tasks), you need to learn the various organizational structures that have been used to organize that knowledge. That's a big part of what higher education is about.

No, the theory usually doens't change the way you change the dressing, start the IV, etc. Those are technical procedures that anyone can be trained to do in a short vocational program. As you enter the world of higher education, the subject matter becomes less about those technical procedures and more about the organization and development of the knowledge that undergirds the physical practice of nursing. It's more intellectual and less physical. That's what higher education is all about -- the intellectual side of it.

Don't get me wrong: the correct performance of the physical tasks is important. I'm just saying that those tasks are only 1 aspect of nursing. They are not the "whole thing." There is also the academic, intellectual side required for the development and organization of nursing knowledge. That's important, too.

I hope that helps a bit.

[SaltyNurse]

Thanks guys, please tell me more, I think I'm not understanding these concepts.

I also agree about the full assessment statements, I was just trying to think of an example of theories in action, but I have unfortunately seen nurses do crazy things like put alarms on a resident who crawled onto the floor to ease her back pain.

I really do see many nurses with opposing viewpoints that affect their clinical decisions.

You will not be able to rigidly apply "nursing theory" to practical situations. Different theorists can give some insight into various aspects of practical situations. And even without knowing a thing about "nursing theory" different nurses have different opinions on priorities and ways to approach problems.

Here's my nursing theory.... "When you're in my hospital, under my care, you obey my rules because my sweet buttocks are on the line when you step over my safety boundaries."

Here's the practical application.... If you insist you want to lie down on the freaknasty floor- fine. Use your call button and ask so I can assist you with sanitizing the floor, putting down a sheet, and easing you safely to the floor so you don't hurt yourself as you are actualizing your autonomy and then sue my sweet buttocks. If you don't comply with the house rules, I'll absolutely use the bed alarm, and any other means necessary. If you don't like it, go find some other facility that prioritizes actualizing your autonomy as more important than the cost of fracured hips, subdural hematomas, mechanical ventilation, ARDS, etc.

Call me crazy, but when you start discussing "nursing theories" as they translate to practice, please follow those practices through to their logical conclusions.