March 21, 2008, 4:24 pm

It’s Not the Eye Alone That Gives You Sight

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This explains everything!

I could never understand why some people run to the ED for every little thing.

Now I know!

They are running from a flying pink bloated virus that causes a variety of symptoms.

The guy in the front has a kidney stone so he’s running the fastest.

The woman has abdominal pain and the young girl behind her thinks she has an STD and that 0430 on a Sunday morning is the perfect time to check it out!

The stud muffin on the right has a groin injury from soccer and the guy on the left has urinary retention.

But, the man on the golf cart thinks he should be seen first and he’ll run ‘em all down to make it to triage, only to find out that an infected toenail does not place him at the front of the pack.

Of course, they are actually running to their cars, from which they will not be able to extricate themselves without assistance of three ED staff members.

Which begs the eternal question: how do these people get into the car if they can’t get out of the car?

******************************

Ah…..it is not only Good Friday, but it is also my spring break! No assignments. No responsibilities. No housework (take that, Hubby!).

Time to sit here at Seattle’s Best with a 20 oz. non-fat, caramel latte with whip and a hot asagio cheese sourdough pretzel. Time to actually blog. Ahhhhhhhhhh………

******************************

Speaking of school, I’ve got enough for 9 units next semester. I want to do twelve, so I have three weeks to find another 1000 dollars. I’ve checked the couch cushions and under the seats of my car, the crumb-laden bottom of my purse and the “change box” that holds all our spare change. Now I just need $998.50. Do I rock, or what?

My class this semester is “Theoretical Foundations of Nursing Practice” and I am loving every minute of it. My original nursing classes (thirty years ago) were based on the Roy Adaptation Model, and I find it fascinating to look at the amount of research that has been done on nursing theory. Some wonderful theories have been put forth, and I learn more and more each day as I apply them to my various nursing eperiences.

Yeah, I’m a nerd.

*****

I’m so nerdy I want to discuss nursing theory with my colleagues. So, I ask a newly graduated BSN what theory her program was based on. She can’t tell me. I ask what she thought of Jean Watson’s Theory of Human Caring. She couldn’t remember what it was about.

Um…okay.

So I asked one of my colleagues who works as a clinical instructor for the same program what nursing theory (or theories) the program was based on. She had no idea.

Um…okay.

WTF (pardon the language) was going on here??

I sure as heck knew who Sr. Callista Roy was when I was going through my original nursing program and I can still discuss the Adaptation Model thirty years later.

*****

Now, I’m not trying to say I’m a brainiac. I’m not. In fact, the 1970s saw an explosion in nursing theory, yet I was exposed to only one of them. So, while I knew my theory of practice, I could not begin to discuss any others until now.

Why?

For the simple reason, and I have to thank my professor at the University of Wisconsin, Green Bay BSN/LINC program (Dr. Sylvia Kubsch) for this insight: entry level nursing programs much teach with an eye toward the NCLEX exam. My program, as we are all registered nurses, does not.

*****

Why would this matter?

Well, think back to your nursing program. Would “overload” be the right word? Were you so intent on learning the skills and how to actually function as a nurse that any “theory” you might learn got pushed to the wayside while you were educated on how to “be” a nurse?

How are you supposed to understand and delve into nursing theory with no practical experience from which to draw an understanding?

You can’t.

Now, when I read about a theory, I have an educated opinion on its merits because I can see it through the eyes of thirty years of practice. Of course, I don’t believe it takes that long to develop enough expertise to appreciate nursing theory, but it requires some time.

You have to understand nursing theory to know why, although we work IN the medical model in hospitals and clinics, we are not OF the medical model. To be able to stand up to a physician/pharmacist/physical therapist/psychologist with with an educational background that commands respect.

Can you see where I’m heading here?

Now, before we all get our feathers fluffed up to defend our nursing education, please remember that I am an ADN graduate and have proudly practiced as an RN, ADN for three decades.

In fact, I believe there is a place for an ADN (and a diploma grad) in the nursing profession. A very important place.

In my next post, I’ll tell you what that is.

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26 Comments

  • moira
    moira

    March 21, 2008 at 5:04 pm

    I am currently in a BSN program. We do not, as I see it, focus on any one nursing theory. In Fundamentals and Intro to Professional Nursing we reviewed nursing theorists, I can’t remember anything significant.

    I really feel that my program focuses on passing the NCLEX. I think the administration would say that the focus is on theory, I don’t see it.


  • Linda
    Linda

    March 21, 2008 at 5:08 pm

    Hi Kim! I can’t believe the responses you got. I graduated from an ADN program and Dorthea Orem model of self care was the foundation – our instructors brought every nursing task back to that theory. It made learning the art and science of nursing relatable (is that a word?) and accessible. I loved her theory. I also loved your post on the theory of caring and I promptly looked it up :)

    I am also in a BSN completion program. I have 3 quarters to go … and not one nursing theorist has been mentioned!? ALthough we’ve heard A LOT about theories of management and leadership (yuck-o!).

    We do need a new system of nursing education … we can collaborate coast to coast :) I’m way over here in Vermont :)


  • Jen C
    Jen C

    March 21, 2008 at 5:13 pm

    I graduated with my BSN in ’99 from Rutgers. We had each semester some portion of our class work that focused on theory. Our last semester was nothing but theory and we had to choose one and write an extensive paper on how and why we would use it in practice. I had to be the freak and choose Rogers. I was the only who picked her.


  • Julie
    Julie

    March 22, 2008 at 1:33 am

    Great post Kim, I too am fascinated by the wealth of nursing theory out there. During my early days we used Roper, Tierney and Logan which to my mind involved nurses doing their paper work in a different way rather than it actually affecting their practice. Later on when I was learning to be a district nurse we looked at Roy, Orem and others.

    Last year when I was doing my dissertation I moved scarily from nursing theory to philosophical theory more generally and that was fascinating. I love the idea of my world being socially constructed.

    Still though my assertion is: theory thats great, but what does it mean for your practice?


  • Kathleen Weaver
    Kathleen Weaver

    March 22, 2008 at 4:36 am

    Don’t feel bad, the same thing happens in education. They are so busy getting you ready to pass the certification test, that the only learning theory you really learn is that which is tested on.

    It’s not until you get a master’s you really learn the background.


  • shirley parks
    shirley parks

    March 22, 2008 at 10:50 am

    I have been a nurse for 17 years and am now a Family Nurse Practitioner. I too graduated originally from an ADN program and did the BSN, MSN, FNP route. My ADN and BSN program used Orem’s theory of Self-Care and to this day Orem’s theory still guides my practice.


  • Janice
    Janice

    March 22, 2008 at 1:59 pm

    In the late ’70s I studied Crisis Theory in a BSN program. I always thought it was stupid and useless and didn’t relate in any practical way to nursing practice.


  • Disappearingjohn
    Disappearingjohn

    March 22, 2008 at 6:45 pm

    My ADN program had one brief moment where they said, “there’s a lot of nursing theorists out there, and it makes for great reading… but it won’t get you past NCLEX… you’ll study them a lot more if you go on for your BSN…

    My BSN program had one class devoted primarily to theories of nursing (It was Foundations of nursing, but along with the history came a lot of theory)

    As a funny side note, Jean Watson is a common point of argument between my BSN classmates and myself. Our hospital just “adopted” her caring theory as the model for our hospital (as opposed to the “making it up as we go” theory we always used before) Personally, it makes a lot of sense, but if you read her writing, she basically says, she made up a bunch of Latin sounding words to make it more “impressive”… but hey, it got her her own endowed seat at the university, and, as far as theories go, ain’t too confusing…


  • Candy
    Candy

    March 22, 2008 at 10:30 pm

    I stil contend the best model for nurses would be for everyone to go through a diploma/ADN progam (hybridized, of course), take and pass the NCLEX, then go to work. You’d start with a 6-month internship, then begin work immediately on your BSN, which would be provided by your hospital (didactic on-site, public health clinical in a pre-determined area that really NEEDED an RN). This would all, of course, be FREE. That way, every nurse would enter through a technical door, if you will (or an LVN door), then finish in a professional program. You’d be in the BSN completer program for 2 years around the clock and your didactic training would dovetail with your actual job responsibilities. New students would have one day a week where they did school work and GET PAID FOR IT.

    Yes, I have been drinking too many sasparillas, but wouldn’t it be nice? Generic BSN programs would be phased out, replaced by clinical nurse leader programs, advanced practice programs (DNP and PhD).

    On a brighter note, I was privileged to meet Jean Watson about 4 months ago at a conference (in Reno, of all places) and it was amazing. EVERYONE should know about her theory of human caring, not just nurses.


  • Janice
    Janice

    March 23, 2008 at 7:32 am

    I agree with Candy. I think it’d be such a great idea to be working at the same time as you’re getting your BSN. I often wonder how much more I’d have learned in school if I’d had some experience first. As it is, when you’re in school you’re usually so overwhelmed by the technical stuff that a lot of the higher level stuff just falls by the wayside.
    I’ve never even heard of Jean Watson; she sounds interesting. I have to laugh at her saying she made up Latin sounding words to make it seem more impressive. SO much academic writing is like that. I guess it’s expected but it’s so stupid. Nursing writing used to be like that a LOT and it drove me crazy. It’s so much better now. I still see stuff like references to the “nursing process” though. C’mon the nursing process is just basic problem solving 101. You’d use the same process if you noticed that your shoe was loose. Assess–the shoelace is untied. Plan–I’m going to tie the shoelace. Intervene–tie the lace. Evaluate–my shoe is no longer loose. It’s not at all unique to nursing and I hate it when it’s made to seem like something special. Personally I think things like that just make nurses look dum–as though we have to make up fancy sounding stuff just to seem important. We’re damned important just the way we are.


  • UW Nurse
    UW Nurse

    March 23, 2008 at 4:23 pm

    I am starting the BSN program at the University of Washington this coming fall and have received many comments from nurses I work with now saying that ADN nurses make better, well, nurses, I guess I’ll have to see what comes of me.

    But really the alphabet soup behind our name shouldn’t matter as much as how we practice our nursing skills.


  • Marijke
    Marijke

    March 23, 2008 at 5:56 pm

    Funny that you’d get answers like that. I graduated in the early 80s and I still remember Roy. Not that I haven’t tried hard to forget sometimes!


  • TooOldToBeANurse
    TooOldToBeANurse

    March 23, 2008 at 6:01 pm

    Ah, Sr. Callista Roy. I never thought I would think of her with fondness but here I am 28 years later remembering the HOURS spent with her and the 30-40 page care plans her Adaptation Model required. My roommate and I would sit in the coffee shop checking out other people, wondering how they were adapting to various problems we made up for them. Thanks for the blast from the past.


  • annon
    annon

    March 23, 2008 at 9:05 pm

    Janice, you nailed it. Nursing theory is bunk. Caring blah blah blah. It ain’t about caring. Its about saving lives and curing illness. I give medicines and provide treatments and educate patients. Sure, you’ve got to have a decent bedside manner and give a rat’s ass about your patient but that’s not unique to nursing. Its true of everyone in the healthcare environment.

    Nursing is a highly skilled technical job. We don’t need theory and models. We need skills and instinct and talent.


  • annon
    annon

    March 23, 2008 at 9:06 pm

    Candy’s idea sounds like what the French are doing now.


  • annon
    annon

    March 23, 2008 at 9:12 pm

    To be able to stand up to a physician/pharmacist/physical therapist/psychologist with with an educational background that commands respect.

    I’ve got a two year degree and it was earned through the back door. GED, 1 year technical school LPN then another 9 months for my ADN and I command plenty of respect. Its not education that commands respect. Its knowledge and skill. When the docs know they can trust you to take good care of their patients, maybe to cover their asses when they miss the boat, to work together with them as a team then you can command respect. A bunch of letters after your name isn’t going to do it. What commands respect is knowing what your patient needs and being able to do it for them.


  • CrazyCath
    CrazyCath

    March 24, 2008 at 9:53 am

    Hi. I came over from Nervus Rex and so glad I did. What a post! I totally agree even though I do not understand all of the shorthand for the courses.
    I trained over 20 years ago in UK. I have practiced ever since. The nursing courses went out of the hospitals and into universities and the standard of nurse produced is very different now. Yes they have diplomas or degrees, but they cannot nurse on qualification! We could (and do) throughout our final year and the day we got our results, we were IT and could do it without worry. Oh yeah we were green then, but safe green.
    I know the Roy adaptation model and the Rope logan Tierney – the graduates today have no idea what they are learning because they simply cannot apply it. I agree totally.

    Great post. Thanks.


  • Mother Jones RN
    Mother Jones RN

    March 24, 2008 at 7:25 pm

    Thank you for including us old diploma nurses in your post. There are a lot of snotty nurses who treat us like dirt. I once had a person tell me that she couldn’t belive that I was a diploma nurse because I’m “so darn smart.”

    MJ


  • Randall Sexton
    Randall Sexton

    March 25, 2008 at 12:45 am

    Every profession is theory driven, like it or not!


  • Adrienne Zurub
    Adrienne Zurub

    March 25, 2008 at 9:35 am

    Interesting responses to a great post.

    I admit I cannot name the nursing theory under which I was taught. I was so focused with the classes, tests, and graduating!
    My experiences (as a nurse) have truly informed my practice and me.

    I know I assimilated theories, I just do not know which one’s.

    And no, I have never asked any other nurse what ‘theory’ her/his nursing school was based on. :D


  • AzRN
    AzRN

    March 26, 2008 at 7:52 pm

    I remember Dorthea Orem’s Theory of Self-Care Deficit! 17 years ago I learned it in my ASN program, and then when I went back in 2000 I learned/applied it in my BSN program. I think it makes sense and fits well with our APIE focus in nursing. Yeah, I’m a nerd, too :D


  • RNFaye
    RNFaye

    March 28, 2008 at 1:53 pm

    True while nursing theory does contribute to nursing’s body of knowledge,I think that research and evidence based practice holds stronger weight for professional nursing. I personally liked revisiting nursing theorists with my graduate education. However I really have a difficult time translating the mega-theories into practice, but that could just be me.


  • Braden
    Braden

    March 29, 2008 at 6:55 pm

    The first part of that post was so funny and rang so true that I printed it out and posted it in the breakroom in our ER for everyone to enjoy. Thanks!


  • License Pending
    License Pending

    April 1, 2008 at 12:57 pm

    The ADN program touched in nursing theory in the very first semester and I loved it. The problem is that theory gets edged out over stupid stuff like making sure you don’t flunk clinicals by turning your back on your wound dressing supplies. Seriously. An instructor almost failed me for that.

    The cow.

    Personally I love Orem’s theory of self-care. If only I could get the patients to cop to that theory and stop asking me to open their ketchup packets for them.


  • ayla2004
    ayla2004

    April 5, 2008 at 3:29 pm

    i’m a UK 3rd year student in a diploma nursing programs. We briefly were taught various nursing models but mainly have used Roper, Logan, Tierney but far prefer Orems model. All models have some merit as my Tutors have said to guide novices all give some insight and we may move from needing this guidance. However good nurses and i’ve worked with quite a few don’t need guidance for this insight the already have gained it


  • I Don’t Wanna Study! // Emergiblog
    I Don’t Wanna Study! // Emergiblog

    April 17, 2008 at 5:25 pm

    [...] the next installment of my idea for nursing education, even though someone in the comments of the last post on the topic actually beat me to it (hi, [...]


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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