Vol. 10 Issue 16
Practice With Meaning
Turning to nursing theorists to guide the profession in changing times
What is the meaning of nursing today? As nurses stand at a crossroad of leadership or followership practice, a consideration of nursing theory may provide the professional foundation necessary for growth, excellence and survival. In today's world of evidence-based nursing and knowledge utilization, few question the centrality of theory to nursing knowledge development and the importance of that process to the ongoing evolution of the discipline.1
Though the centrality of theory may not be questioned, nursing theory integration into daily practice is either forgotten or undervalued. The healthcare environment is changing nurses into task and technology workers as nursing theory is left on the back shelf. It is fair to ask, how many nurses consider the theorists' guidance after they graduate? Maben explains that very few recently qualified nurses encountered senior nursing staff who reinforced theory-driven care.2Revisiting our nursing theorists may provide the guidance necessary for our professional survival.
Assessing Nursing Theories
Eliminating the ignorance of nursing theory begins with familiarization with multiple theories and choosing one that best fits the dynamics of your healthcare system.
Considerations a nursing team may take include: a) relations between structure and function of the theory; b) creation of a visual representation of the theory for better understanding; c) adaptation of the theory by practitioners; d) usefulness in practice, education, research and administration; and e) external components of personal, professional and social values, and significance.3
The key to success is to work collaboratively with all levels of nursing as well as other disciplines such as physicians, social service, case management and clinical pharmacist. Nursing theory is a fundamental guide that can transform a healthcare team into one that focuses on caring relationships that allow for a practicing unified force dedicated to positive patient outcomes. Theory-guided practice can be recognized as an important way to communicate nursing roles, values and knowledge to patients and interdisciplinary colleagues.4
To appreciate nursing theory and understand its benefits, it is necessary to take an overview of sampled theories. Nursing theories for your consideration can include human caring theory by Jean Watson, PhD, RN, AHN-BC, FAAN; caring theory by Anne Boykin, PhD, RN, and Savina O. Schoenhofer, PhD, RN; the human becoming school of thought by Rosemarie Rizzo Parse, PhD, RN, FAAN; self-care deficit nursing theory by Dorothea Orem, MSN, Ed, RN; and the science of unitary human beings by Martha Rogers, MPH, RN.
Caring is the most important aspect of nursing.5Watson's caring model is based on characteristics, caritive processes, which formulate a path in the discipline of nursing that provides guidance to the nurse and the discipline as a whole toward a fundamental focus on caring. According to Watson, caring occurs when the nurse enters into the experience of another person, and another can enter into the nurse's experiences.5
Boykin & Schoenhofer's caring theory takes caring to the direct relationship between the nurse and the nursed. The nursing as caring theory focuses on nursing as a discipline and profession that consists of nurturing people living and growing in caring.6
Parse's theory focuses on the individual's lived experiences and the environment. The human becoming theory emphasizes that nursing is a human science that should stress the process, meaning and value of human experiences.7
Orem's self-care theory guides nurses to assist in meeting deficits whether based only on the cognitive or also on the technical. Orem focused on capabilities or action and self-management.8
Rogers' theory of unitary human beings is filled with ideas and abstract concepts that take the nurse's knowledge beyond situational practice. Rogers challenges nurses to view nursing as understanding and caring for human beings in the wholeness and mutuality of the person-environment process rather than as isolated actions and responses in a limited cause and effect manner.9
Implementation of a nursing theory into a healthcare culture requires strategy, consistency and creativity, and should include the staff. After the processes of choosing the nursing theory that best fits your practice environment, a thorough introduction is in order. Posters describing the chosen theory can be displayed throughout the institution, especially in areas where nurses are most likely to have time to read them, such as break rooms and bathrooms.
The next step is implementing the theory as part of competencies, policies and in every aspect that influences practice, such as continuing education classes. Leaders would be expected to model the chosen theory in the way they manage, teach and deliver patient care. The provision of a study room dedicated to the theorist and the chosen theory also can prove effective. The meaning of nursing will be viewed through your chosen theory.
Theory is nursing's guide that validates our discipline as a profession by giving structure and substance to our practice. Nightingale, the first theorist, guided the discipline to a professional level. What has been gained from Nightingale's legacy is not insured. Nightingale viewed nursing as a profession committed to helping others.5An opportunity to renew nursing's commitment to heal and comfort can be sought through the words of the theorists.
Theory serves to organize disciplinary knowledge, which advances the systematic development of that knowledge as well as provide the means for addressing disciplinary problems, furnish a language with which to frame ideas of interest to the discipline, and unify ideas.1
Taking the nursing theories off the back shelf may be the first step to nursing unity and professional survival. What does nursing mean to you? What will nursing practice mean tomorrow?
References for this article can be accessed at www.advanceweb.com/nurses. Click on Education then References.
Roxana Gonzalez is critical care nurse educator at Saint Michael's Medical Center, Newark, NJ.