There is an obvious deficiency in the application of theory in nursing practice. This paper will include a discussion of how nursing practice is affected by the use of nursing theory. I will provide evidence in relation to how theory based practice relates to the core competencies of the Institute of Medicine (IOM) and Quality and Safety Education for Nurses (QSEN) project. I will discuss a journal article that reinforces the gap of nursing theory in nursing practice, and interview colleagues regarding the incorporation of theory in their individual practice.
In conclusion I will express my own view point of why theory has been neglected. Nursing Practice Theory In the 1920’s the American Journal of Nursing published proof that nurses use research in their practice. The discovery of theory as a foundation of nursing practice began in the 1960’s. Research and theory exploded among the nursing profession through case studies (American Nurses Association, 2010). Nurses began documenting their research which allowed other nurses to validate the research and theory by putting the ideas into action.
Theories were developed for two main reasons: to increase education and to improve nursing care. Theory helps nursing provide exceptional care by using research and education while also explaining the phenomenon of nursing. Theory proved to society that nursing was a scholarly profession. However almost 100 years later there is an embarrassing deficit of theory based practice amongst nurses. (Sitzman & Wright Eichelberger, 2011) Further proof that nursing theory is imperative to practice is clear to many organizations.
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The Institute of Medicine (IOM) and Quality and Safety Education for Nurses (QSEN) project identified core competencies to improve health care. These competencies are as follows, safety, patient centered care, informatics, teamwork and collaboration, quality improvement, and evidence based practice. In my opinion I believe all six areas are used on a daily basis in my practice as a nurse. I ensure my patients safety through the use of time out prior to all procedures, fall risk assessment, and frequent rounding.
Safety is also maintained by using technology such as bed alarms to prevent falls and dose mode on intravenous pumps to confirm titration calculations. I also confirm patient’s identification by using the “5 rights” prior to any treatment or medication administration to ensure patient safety. I incorporate patient centered care by planning care around my patients needs. Informatics is incorporated through electronic health records and through the hospital’s intranet. I practice teamwork and collaboration by participating in critical care rounds every night to discuss the plan of care for my patients.
We perform most patient care as a team; we try to never say “that’s not my patient”. We continuously collaborate with our colleagues about our patient’s plan of care and any issues that arise. Quality improvement is one core competency used daily. After any emergent situation we engage in a debriefing procedure. We review what occurred and how it could go better in the future. I research through electronic resources and online databases such as ebsco host and lexicomp to ensure the use of evidence based practice. Research eliminates trial and error and integrates innovative solutions to nurses across the world.
If theory could be applied to all nursing practice the quality of health care would reach a shocking new level. Many articles clearly state that there is a problem integrating nursing theory and practice. The integration of theory and practice was discussed in an article published in the journal of Nursing Philosophy. The article calls on the social responsibility of the nursing profession to link nursing practice with theory, philosophy, and disciplinary goals. “The integration of theory into nursing practice provides a guide to achieving nursing’s disciplinary goals of promoting health and preventing illness across the globe. (McCurry, Hunter Revell, & Roy, 2009, p. 42) The article discusses that it is the nurse’s professional and societal responsibility to utilize research based practice to improve the health of society at a global level. When a society is educated continuously there is a direct improvement on their health. This was proved through many theorists in this article such as Sister Callista Roy, John Stuart Mill, and Amitai Etzioni. I agree with this article in that social transformation must occur amongst nurses.
I also agree that middle range theory is the most practical way to utilize nursing theory as a framework for nursing practice because it is concept specific and not as vague as grand theories. Nurses would be more willing to apply a middle range theory because they can relate to it. Many nurses feel grand theories are too broad and generalized to connect their practice to the theory. By utilizing a middle range theory, it would provide consistency in care and effective guidelines. By combining theory and practice, nursing will be able to promote health and minimize sickness throughout a community or across the world. (McCurry et al. 2009) Speaking with any nurse one could discover there is a knowledge deficit regarding the concepts of nursing theory. I interviewed thirteen nurses that work in various departments in the hospital. Eleven of those nurses looked at me like a deer in headlights. I could not be judgmental against those nurses because I honestly must admit that I am one of them. I decided to write about the two nurses who smiled when I mentioned the forbidden word “theory”. The two I chose both have a bachelor’s degree and both began their nursing practice in the past five years. My first interviewee relates Virginia Henderson to her nursing practice.
She promotes her patients to increase their independence. By assisting them in their basic needs while they are critically ill and incorporating self determination and autonomy as the long term goal (C. Audus, personal communication, September 21, 2012). The second nurse I interviewed incorporates the theory of Hildegard Peplau. She integrates Peplau theory in her practice because she believes the foundation of nursing is the relationship between the nurse and patient. She establishes a relationship with her patients based on trust and respect which in turn fosters a comfortable judgment free environment.
With each new patient relationship she takes away what she learned and in turn makes her a better nurse (M. Glennon, personal communication, September 26, 2012). I believe there is a gap between the nurses who have an understanding of nursing theory and the nurses caring for patients at the bedside. “It is important for the profession of nursing to close this gap so that nursing theory is interwoven into nursing practice as intended, rather than continuing the pretense that currently exists”. (Sitzman & Wright Eichelberger, 2011, p. 18) There are many barriers to overcome before this integration can occur.
One main reason nurses do not incorporate theory is because it is very difficult to understand. Some nurses shut down as soon as they hear the word theory because of the complexity and become completely consumed by the tasks of nursing practice. Theorists have added to the barrier between nursing theory and nursing practice by using complicated vocabulary in their literature. If nurses are unable to understand what the theory is they will not be able to apply it to their practice. Nursing theories need to be less vague and should be simplified so the nurse can relate the theory to their practice.
So if professional organizations, media, and nurses all agree that theory would improve healthcare and that it is a necessary aspect of caring for patients, why is it an unsolved problem? In my opinion the reason why theory is not utilized enough in nursing practice is because it is complicated, boring, and unrealistic. If nurses could simplify theory and eliminate the complicated language nurses would not shut down and be so resistant to learning. Nurses need to see how they could apply theory to their practice. I also feel there are too many theorists so nurses just give up because they are overwhelmed.
I know many experienced nurses that have a wealth of knowledge regarding how to perform a skill while lacking the reasoning of why they perform the skill. If theory was simplified and conferences and seminars were easily accessible more nurses would incorporate theory in their practice. Some theories appear farfetched with unachievable outcomes. Some theorists do not consider that resources and time are limited to most clinical nurses. Most theories involve a very intimate relationship between the nurse and patient. Clinical nurses have been consumed with computerized charting so much that they are spending much less time with their patients.
This time constraint makes it difficult to integrate theory and practice. In reality the nursing profession is responsible to integrate theory into our practice. It is our duty to integrate research and theory into our practice. It will not be easy or quick but it must be achieved. I believe the most effective way to integrate theory in practice is to actually lead by example. I believe we need to spark our peers to raise their professional standards and to help prevent stagnation amongst our colleagues.
- American Nurses Association. (2010). Scope of nursing practice, Nursing research and evidence - based practice. In (Ed. ), Scope and standards of practice: nursing (2nd ed. , pp. 15-17).
- Silver Spring, MD: Nursing Books. Masters, K. (2012). Nursing theories: a framework for professional practice. Sudbury, MA: Jones & Bartlett Learning.
- McCurry, M. K. , Hunter Revell, S. M. , & Roy, Sister, C. (2009). Knowledge for the good of the individual and society: linking philosophy, disciplinary goals, theory, and practice.
- Nursing Philosophy, 11(), 42-52. Sitzman, K. L. , & Wright Eichelberger, L. (2011). Understanding the work of nurse theorists: a creative beginning (2nd Ed. ). Sudbury, MA: Jones and Bartlett.
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