Academic “Fluff” or Practical Knowledge? Theory-Guided Nursing Practice
Having taught Nursing Theory, I know that nursing theory has a bad rap with students – undergraduate and graduate! Theory-guided nursing practice is encouraged to underlie clinical practice, but the terminology is confusing and the concepts seem too abstract. Students may think of theory classes as boring and not important to actual nursing practice – therefore, “fluff.”
You can’t really blame them, though. I’d venture to say that most students don’t see their preceptors practicing according to a specific nursing theory, unless the institution subscribes to one. They learn about theory, but then don’t hear another word about it – until comps. And theory may not be linked to other coursework, much less threaded throughout the curriculum.
But I submit that nursing theory is NOT fluff! It is a guide for practice (i.e., theory-guided practice)– it provides a context upon which to base our practice, decisions, and research to build our discipline. Yes, we need to do a better job as faculty to be purposeful about threading and tracking theory throughout the curriculum – it can’t just be one class and done. Faculty need to get better at integrating nursing theory in assignments and subsequent courses.
Additionally, faculty should focus on the real-world application of theory to excellent nursing practice. We need to be practical and help students see how nursing practice and patient outcomes differ when a nursing theory is used versus not. When theory (and evidence) are intentionally linked to nursing practice, nurses will see how what THEY do makes a difference to patients, families, and the organization.
My Struggles with Theory-Guided Nursing Practice
A couple of years after I graduated from nursing school, my hospital introduced Orem’s Self-Care theory as our house-wide nursing theory. This was my first experience with theory-guided nursing practice. As a unit-teacher, I was part of the group whose job it was to help educate the nursing staff about how to use this theory in practice.
But, other than when the hospital adopted Orem, I can’t really say that I ever thought about using a specific nursing theory as a guide for caring for my critical care patients – I didn’t learn this in my first nursing program. My unit (actually 2 units with 4 sections and 41 beds total) was the recovery area and short-term ICU for post-op cardiovascular adult and pediatric patients. Pre-printed careplans with physical and psychosocial nursing diagnoses focused on recovery and preventing the complications of CV surgery. We individualized the careplans to the patient, of course.
I will admit that, while I understood how to classify patients and could teach the logistics of using the new documentation forms based on Orem’s theory, I didn’t completely “get” how to practice Orem with intention in the ICU. It made complete sense to me that self-care theory would work great on the Transplant floor, for example; but I struggled with how self-care theory could work in our fast-paced unit. I could only see that my intubated post-CV surgery patients would be classified as wholly compensatory for most of their stay with us.
Even after extubation, the patients weren’t allowed to do much for themselves (this was before Fast-Tracking). We didn’t have much time with them before they were moved to a step-down unit or to a post-op floor. Eventually, I saw how self-care theory could guide how we worked as “agents” for the patients as they moved through the recovery process.
What My Nursing Programs Taught Me
My RN-BSN program introduced me to nursing theorists, of course. I thought it was cool that so many nurses had “thought up” these different ways of seeing the nursing world! But theoretical terminology (e.g., metaparadigms, ontology vs epistemology) and abstract nature of many theories was confusing. (If you find it confusing too, download my free resource guide with nursing theory and philosophy terms and concepts. Click Here for Your Free Nursing Theory and Philosophy: Terms & Concepts Guide!)
Even after my BSN program, I didn’t suddenly choose to practice according to a nursing theory. I was caring, but I didn’t practice deliberately using Watson’s caritas. We had patients from different countries, but other than respecting their personal values and culture and common-sense interventions like using translators, I didn’t use a specific theory to ensure cultural competence. I could have used Leininger’s Sunrise Model to assess and plan care differently for those patients. The AACN Synergy Model for Patient Care was another theory I learned that I could have used in practice. I regret that I missed opportunities to take my clinical practice to a higher level.
My graduate classes took me to that higher level by helping me see how theory guides research and why it’s important to use theory to guide basic and advanced practice. Master’s- and doctoral-level education invites a different level of understanding in our profession.
I’m not saying that you can’t grasp what it means to be a theory-guided practitioner in your baccalaureate program, but it wasn’t until my graduate courses, where I learned more about the interplay of practice, theory, and research, where my “A-Ha moments” finally occurred! Like one of those “I could have had a V8” moments — theory-guided nursing practice and research finally all made sense!
I like William Cody’s comments to advanced practice nurses to thoughtfully consider “what guides my practice?” “A clear understanding of what guides practice helps the practitioner to pursue useful knowledge more efficiently, to represent one’s disciplinary perspective more articulately, and to communicate more effectively with clients and the multidisciplinary team” (2013, p. 5).
As a clinical expert, you are a nursing leader, and as such, a role model for your staff and colleagues. When you use a theory or conceptual model/framework to guide your nursing actions – to promote health, deliver care, comfort a dying patient, teach a patient, engage with a family, participate in a unit project with staff colleagues, lead a quality improvement initiative, etc. – you are using theory and evidence to be the best nurse that you can be. You have invested in the future of nursing.
Theory-guided nursing practice: USING theory to guide your clinical practice to become a better nurse, promote positive outcomes for your patients, and ultimately move the profession of nursing forward.
Teaching Nursing Theory
It wasn’t until I was asked to teach a graduate nursing theory and philosophy class that I fully appreciated the fact that nursing theory and how to practice theory deliberately needed to be championed. My goal, as a faculty member, is always to teach for application in the real world.
Teaching nursing theory, so that the terms and concepts were not just words to be learned and forgotten but had some context in the real world, was important to me. I wanted the nurses to see why theory-guided nursing practice mattered to how they cared for their patients.
Yes, nursing theory is a requirement for accredited nursing programs. BUT… The major reason for learning philosophy and nursing theory is for you to USE the content in your basic and advanced practice to become a better nurse, promote positive outcomes for your patients, and ultimately move the profession of nursing forward. I doubt any of you would disagree that these are worthy outcomes!
So let’s get out there and be deliberate in our nursing practice!
Be a theory-guided and evidence-based nurse! Practice with a nursing theory and philosophy guiding your beliefs, values, and assumptions and seek out the best evidence to underlie your interventions.
Doesn’t that sound like something you want to do for yourself, your profession, and your clients?
Do you use a specific nursing (or other) theory to guide your clinical practice? Is it something that is mandated house-wide or is this a personal choice? Have you been able to track the outcomes related to your use of theory in practice? Post in the comments and let me know!
I know you want to download my free 8-page resource guide of nursing theory and philosophy terms and concepts.
Cody, W. K. (2013). Values-based practice and evidence-based care: Pursuing fundamental questions in nursing philosophy and theory. In W. K. Cody (Ed.), Philosophical and theoretical perspectives for advanced nursing practice (5th ed., pp. 5-14). Burlington, MA: Jones & Bartlett Learning.