Comment on this statement that is often heard: ‘I have practiced (or taught) nursing for many years without the need to use theory, so why do I need theory in a practice disci
1. Comment on this statement that is often heard: "I have practiced (or taught) nursing for many years without the need to use theory, so why do I need theory in a practice discipline?"
2. Reflect on this statement: "A scholarly discipline must engage in societal concerns, in dialogues about pressing issues, and in shaping health care reform." Is nursing a scholarly discipline? Do nurse scholars have the same attributes as other scholars in other disciplines? What would be your assessment of the level of scholarship in nursing?
3. What difference do the levels and types of theory make in advancing nursing knowledge?
20230827010252forest_through_the_trees.pdf
Nursing Science Quarterly 25(1) 34 –35 © The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318411429040 http://nsq.sagepub.com
Practice Applications
Since Aristotle, metaphor pervades everyday life. Metaphor is an illustration of speech when a word or phrase literally repre- sents an object or idea used in place of another. Metaphor goes beyond language, it embraces ideas and action. Metaphor may create clarity, explicating meaning in situation. Parse (2011) often uses metaphors in her work, most recently she used a metaphor with the humanbecoming school of thought (Parse, 1981, 1998) to illuminate leading-following.
The metaphor unable to see the forest through the trees is one this author uses to give clarity to nursing theory in prac- tice in light of the humanbecoming school of thought (Parse, 1981, 1998). Envisioning nursing as forest, one sees dense, lush greenery pushing upward in unison. Upon first glance one does not see a path into the forest but upon closer look, the forest seems inviting and one may view other dimensions. Therein lays a multitude of entry points. All the possibilities reveal themselves as one begins the journey moving with and connecting with the forest. Each step moves one deeper into the forest as the forest itself comes alive. First traveling through an eerie quiescence to the trees and leaves blowing calmly in the breeze to the sounds revealed from the many forest creatures, concealing themselves as one comes near, cautiously moving as one turns and sees the many nuances a forest holds.
As with the forest, nursing appears cohesive. Nurses have not addressed age-old issues such as role definition and entry into practice, yet rely on other disciplines to guide nursing practice. Some look from afar at the forest and use that vision to depict how nurses stand together. Connecting with the for- est, one is enlightened by the subtleties of the many differ- ences. Journeying deeper into the forest one separates from the forest enlightened by those differences in the sounds, the trees, the leaves, noting one is still connected to the forest. Yet there is a fascination for what lies ahead. This is true with nursing theory. Theories abound from the many nurse
theorists throughout history. Assumptions, foundations, and underpinnings are often concealed, yet are waiting to be revealed. As nurses embrace nursing theory, they are able to hold all that is nursing in their hands, to glean with their eyes, and live the practice of nursing. Nurses live their value priorities. These value priorities are essential to being.
Nursing theories that should unite nurses in the profession are slowly eroding away on the forest floor; in place of nurs- ing theories are theories borrowed from other disciplines. This is reminiscent of the past. Nursing faculty discourse continues to bury the importance of nursing theory to prac- tice. Can this be interrupted as an attempt to rid nursing cur- riculum of nursing theory? Use of other disciplines’ theories actually eliminates nursing from nursing practice. For exam- ple, does business borrow from nursing theory? No, yet nurs- ing borrows from business, by means of acuity systems and productivity numbers, to name a few. When applying business theory to nursing is healthcare enhanced? From the standpoint of business theory, is the work nurses do seen as nursing?
As in coming to know the trees in the forest, the abstract- ness of nursing theory may be intimidating, creating cautious trepidation as nurses are compelled to shape their knowledge base. Thus coming to know and understand nursing theory as the foundation of practice is crucial in keeping the profession of nursing alive. Instead of looking to other disciplines for guidance and allowing those disciplines to make decisions for nursing, nurse leaders must focus on nursing’s unique contri- bution and service to society.
429040 NSQXXX10.1177/0894318411429040Karni ck / Practice ApplicationsNursing Science Quarterly
1Assistant Professor, Lewis University
Contributing Editor: Paula M. Karnick, RN, PhD, Assistant Professor, Lewis University, 5023 N. Busse, Chicago, Illinois, 60656 Email: [email protected]
Seeing the Forest Through the Trees
Paula M. Karnick, RN; PhD1
Abstract The purpose of this column is to stimulate discussion among nurses regarding the importance of nursing theory-guided practice. The use of metaphor may shed light on defining nursing by its own terms. The time has come for nursing to recognize its worth as an autonomous discipline and own its contributions
Keywords humanbecoming, metaphor, nursing theory-guided practice, Parse
Karnick 35
Are you able to see the forest through the trees? Translating nursing theory into nursing practice lends itself to this met- aphor. Clarifying vital issues in nursing practice is seeing the forest through the trees. At first glance, the discipline stands together tightly like the trees in the forest. As with the forest metaphor, trees connect and separate intricately shifting with the wind and rain, reflecting the idea of nursing theory intricately connecting and separating with nursing practice.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
References Parse, R. R. (1981). Man-living-health: A theory of nursing. New York:
Wiley. Parse, R. R. (1998). The human becoming school of thought: A per-
spective for nurses and other health professionals. Thousand Oaks, CA: SAGE.
Parse, R. R. (2011). Humanbecoming leading-following: The meaning of holding up the mirror. Nursing Science Quarterly, 24, 169-171.
20230827010255what_kind_of_nurse_are_you.pdf
Nursing Science Quarterly 2014, Vol. 27(3) 211 –212 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414534471 nsq.sagepub.com
Practice Applications
A 54-year old man is admitted to your unit for the third time in as many months. His admitting diagnosis is alcohol abuse. Everyone on the unit is familiar with this person. He is unkempt and verbally abusive to the nurses caring for him. Another person is admitted to the unit that evening, a 27-year old young woman with a diagnosis of stage four breast can- cer, terminally ill with intractable pain. She has an eight- month old baby at home and her husband is fraught with anguish and grief. Do you think each of these people will be given the same ethical, moral, quality care? Can nurses pro- vide the same standard of care to every person, indiscrimi- nately, every time?
How are nurses prepared academically to provide care and attend to people in a manner that is fair to every person? I challenge the readers of this column to ponder whether or not they meet each individual person’s needs to the best of their ability.
Nurses are human and have good days and bad days. Nurses have issues too. What knowledge base do nurses draw upon to provide care and excellence? Are nurses judg- mental of people in their care? Can this judgment affect care? If so, what does that verdict reveal about the profession, the nurses, and the quality of care?
I would suggest that nurses examine their personal belief system. What does nursing mean? What drew you to the pro- fession of nursing? What are your convictions about human- kind? Nursing is a profession like no other. The intimate relationships built between nurses and people, no matter how brief, should be one of trust and commitment to do the best for the person. It is a daunting task and arduous to care for people in challenging circumstances.
The essence of applying theory to practice has the poten- tial to guide nurses to do the best for people every time, all of the time. The concern is that if nurse educators are not expos- ing students to nursing theory, what guides their personal practice? This circular argument is one which is too familiar
to nurses. In the nursing profession important questions are never fully answered, they merely fade away while some other diverting questions are introduced to prevent the tan- gible question from being answered thus distracting us from our goals.
In reality does not it appear true that other professions anticipate and expect the passivity of nursing? Do what you are told. Beware of thinking for yourself; just follow a proto- col of patriarchal and administrative practices long ingrained in the culture of healthcare. It is my belief that in response to these long-standing practices nurse theorists arrived on the scene. These strong, resilient, visionary people (mostly women) refused to settle for the way in which things were done. With a deep commitment to human beings and the dis- cipline of nursing from Nightingale to the present, nurse theorists have been the foundational leverage the profession needs to continue to care for people the right way, the ethical way, every time. They saw unfairness, suffering, and imprac- ticality in care and spent their lives attempting to serve peo- ple, support nurses, and sustain the profession.
Nursing theory informs and guides practice. The basis of nursing theory resoundingly views people from a moral and ethical stance. This is the crux of care. It is the core of being with others in a manner that listens to people’s stories.
Many theorists working under the premise that fair and equitable care is the basis for the profession were often criticized by other nurses. Some nurses undervalued and misunderstood those who embrace nursing theory. Nursing theory, which should be taken and utilized in practice is
534471 NSQXXX10.1177/0894318414534471Nursing Science QuarterlyNursing Science QuarterlyKarnick / Practice Applications research-article2014
1Director of the Institute of Nursing Education, Emergency Nurses Association, Desplaines, IL
Contributing Editor: Paula M. Karnick, RN, PhD, Director, Institute of Nursing Education, Emergency Nurses Association, DesPlaines, IL. Email: [email protected]
What Kind of Nurse Are You?
Paula M. Karnick, RN; PhD1
Abstract Once again the importance of nursing theory in practice comes to the forefront. By examining one’s personal and professional beliefs in how one cares for people, it becomes apparent that nursing theory does guide nursing practice. The moral and ethical judgments one makes before or while caring for a person may reveal that personal bias can detract from the quality of care.
Keywords moral and ethical care, nursing, nursing theory
212 Nursing Science Quarterly 27(3)
not valued, especially in the boardroom so it has virtually been dismissed. It was first dismissed by hospitals and more recently by universities. This dismissal has left nurs- ing in the hands of administrators and financial officers whose agenda reveals that profit, not people are the bottom line.
This is a clarion call for nurses to question themselves. What do you believe? What is your model of care? Is it to get the person in and out of the setting? Do nurses attend to persons in a fair and compassionate manner? How do you care for persons in your care? When the 54-year old man with alcoholism comes to your unit for the third time in three months, what is your reaction? What informs your practice?
Before the diatribe regarding nursing theory in practice does die, perhaps one should consider how care is given to patients at every organization, at every interaction, by every nurse. Is it ethical, moral, and without judgment? Is it theory based? Is it the kind of care you want to receive? Start here. Start now.
Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the authorship and/or publication of this column.
Funding The author received no financial support for the authorship and/or publication of this column.
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