Nursing theory and practice in patient care delivery

¶ … Utility of the Knowledge of Nursing Theory in Patient Care

When people describe nursing theories and theoretical concepts, they frequently try to separate the theory from the practice of nursing. However, this is a critical mistake. Theory and practice are inseparable. While there are many established nursing theories, it is important to look at the origins of those theories. They developed, not in an isolated academic setting, but because they reflected the issues that were presented to nurses in the field and reflect how those nurses dealt with questions and concerns that frequently arise in the context of nursing practice. As a result, it is important to keep in mind that theory and practice are not distinct from one another. On the contrary, theory should be viewed as a type of practice because theories involve: asking certain questions, questioning the status quo, seeking the most plausible or meaningful answers, and building a logical structure for those answers (Goodson, 2010, p.78). In other words, nurses who are confronted with particular patient issues or illnesses are relying, not only on nursing theory, but also on other medical theories to practice with those patients.

Moreover, disregarding theory can be time consuming and inefficient for the patient. While nurses are able to observe patients and develop their own theories, the individual knowledge of a particular nurse cannot compare to the collective knowledge of nursing as a profession. Therefore, relying on individual experience rather than on the collective body of nursing knowledge and theory would result in a nurse practicing at a disadvantage, which would result in lower quality of patient care. An ill patient comes to a nurse with medical questions. "Scientific theories- when they have already been proposed and tested- provide clean, decluttered explanations to answer these questions" (Goodson, 2010, p.77). This makes nursing theory a critical part of the practice of nursing.

The Effectiveness of Contemporary Nursing Theories

One of the most fascinating components of contemporary nursing theories is that they are not all equally applicable to all healthcare scenarios. Instead, some of them are tailored to the specific area of nursing in question and do not contribute anything meaningful to other healthcare scenarios. This is not a weakness of those theories, because many of them acknowledge their limitations and are clearly about being tailored to a specific scenario. Instead, what that reveals is the complexity and breadth of the modern nursing profession. However, after briefly reviewing the contemporary nursing theories covered in the textbook, I was struck by the efficacy and universal applicability of feminist nursing theory. Although there are two approaches to feminist nursing theory, I found both of them to be applicable in my healthcare setting and have determined that both should shape my practice, probably more than they have to this point in time.

Care-focused feminists, generally, support the idea that care can be more feminine it has been traditionally. The American medical model has emphasized a masculine approach to medicine that has taken the nurturing aspect away from healthcare providers. Care-focused feminists look at traditionally feminine forms of providing care and suggest that they are at least as good, if not better than, masculine approaches. In practice, this would translate as treating patients as individuals, nurturing them, and finding out about their larger concerns not simply their health issues. Perhaps even more important than care-focused feminist theory is power-focused feminist theory. "Women everywhere, to some extent or another, have less power, authority, and autonomy than men do" (Tang, 2010, p.166). This power differential can have important health consequences, so knowledge of this theory must play a role in practice.

The Application of Theories to Clinical Settings

I do not believe that theories need to be further operationalized and simplified so as to make them more usable and applicable to clinical settings. To explain my answer, one needs to consider that nursing is more than simply a skill set of activities. It may be important to operationalize some of those skills. For example, consider giving an immunization. The nurse needs to be aware of patient age and size, any particular sensitivities, patient health concerns, and also the specific instructions for the administration of a particular vaccine. However, much of what a nurse does is not so easily quantified. Instead, many times a nurse's activities will be guided and directed by interactions with a particular patient. Theory can guide how a nurse approaches that patient, but operationalizing those interactions would actually deprive the patient of the genuine human interaction that seems to provide much of the benefit of having a nurse as a healthcare professional.

Furthermore, operationalization and simplification assume a static healthcare environment. Going back to the immunization example, rigorous testing is done to ensure that vaccines are being given in the safest and most effective manner, and then the way to administer those vaccines is operationalized for practice. However, much of nursing is less static than that. "Nursing knowledge development and practice must be in a constant state of evolvement so that nurses will be equipped to fulfill the ever-changing societal needs" (Butts, 2010, p.90). Operationalizing and simplifying theories for use in practice strips the nurse of the ability to exercise his or her professional judgment in regards to individual patients. In my opinion, doing so then stifles the ability of the individual nurse, and the profession as a whole, to evolve in response to changing societal needs, as manifested by the individual patients being treated by each nurse.