A Nurse Practitioner’s Perspectives on Theory in Practice

Guest Post
Welcome  to Guest Contributor Christine Platt, NP-C*,

PhD Student at the University of Arizona College of Nursing

This week I asked, why does nursing theory matter to me? Can I see it directly affect my practice? As a nurse practitioner I see, on average, 26 patients each clinic day. Nursing theory helps define who I am as a nurse and what my goals are as a professional. It also can be evident in the way I give care at the bedside or even the way I influence health policies and practices of my community.

To begin, let’s look at what nursing is not. When discussing primary care, it is easy to think about making a diagnosis and then prescribing medication or a procedure to fix the disease. While these aspects may play a role in nurse practitioner practice, they don’t encompass the professional advanced practice of nursing. Without theory, the focus of our practice could easily become too narrow or lack the direction to influence and promote well-being. For example, let’s take the act of treating acne in a clinic. Without a disciplinary perspective, a nurse practitioner (NP) could easily look at the papules and pustules and determine an antibiotic, retinoid, hormonal control (such as spironolactone or oral birth control) will decrease the papules. If the acne is recalcitrant or scarring, the NP may decide isotretinoin is the best course of action. Without theory, we treat diseases instead of the patient and our communities.

Now, let’s contrast the same situation using our unique disciplinary perspective in our practice. Looking holistically, the NP notes that the patient won’t look them in the eyes very often, they seem withdrawn, which could be due to the embarrassment that the acne is causing. As the NP listens and learns more about the patient, they realize that the patient is depressed, has recently had suicidal ideation, and the patient’s current living conditions are stressful with a poor diet. Moreover, the acne flares significantly during weather inversions that increase pollution and aggregate the patient’s asthma. Nursing is not simply writing a prescription for isotretinoin.

Nursing has helped define our profession as a wholistic one that considers the person, environment, and nursing care to improve health (Fawcett, 1984). Nursing is further assessing the patient’s safety, linking them to the right mental health provider, improving diet, while simultaneously developing a relationship of trust. It does involve treating the acne, but it is so much more than the ability to write a prescription or plan of care. It involves understanding the patient’s culture, their beliefs, and the barriers to improved care. As more and more nurses are prepared at the PhD and DNP levels, they have a great opportunity to conduct research and implement change in practice. They continue to evolve the discipline from the original metaparadigm concepts toward the development and use of middle range theories, which are more specific to the problems they are investigating to guide their work. With their specialized knowledge, they influence change at community, state, national, and even global levels. The broad influence of theory translating into practice is evident when browsing over any national nursing conference program. With the case of the acne patient, NPs may take their experiences and develop studies with PhD and DNP nurses who focus on research and quality improvement projects. They can present their findings to legislators on asthma, acne, pollution, and poor nutrition, as a means of decreasing all of these in the community. They develop algorithms for treating acne combined with depression or other diseases.

Next time you come into contact with a patient, reflect on your nursing perspective in addition to all the specialized knowledge you have. Then think about how more specific theories could facilitate your practice, or maybe they are already embedded in your practice, ready to be articulated more explicitly, tested, and further refined. One of my favorite nursing theorist noted, “Nursing is not only a professional practice, it is a scientific practice as well (Reed, 2019).” Theory-based practice is essential and should be included in how we provide and deliver care on a daily basis. However, it is also time to consider how our professional practice can influence and improve our theories. If you have had an experience similar to mine, please share in the comments. I am excited to take part in this process and look forward to hearing how other nurse practitioners translate theory into practice and their practice into theory.

References

Fawcett, J. (1984). The Metaparadigm of Nursing: Present Status and Future Refinements. Image: the Journal of Nursing Scholarship, 16(3), 84-87. https://doi.org/10.1111/j.1547-5069.1984.tb01393.x

Reed, G. P. (2019). Intermodernism: A Philosophical Perspective for Development of Scientific Nursing Theory. Advances in Nursing Science, 42(1), 17-27. https://doi.org/10.1097/ANS.0000000000000249

About Christine Platt

Christine Platt, MSN, PHN, FNP-C began her career in nursing as a registered public health nurse and hospital staff nurse in St. Paul, MN. She became a critical care RN working in both cardiac and neuro intensive care units and received her CCRN certification after moving to Utah in 2006. She took on the role of house supervisor before returning to graduate school at Brigham Young University, where she received her MSN degree to become a family nurse practitioner. Currently, she sees patients in dermatology and also volunteers in the evenings to serve the community’s under- or un-insured population. Her family is a licensed foster family, caring for medically fragile children over the last decade. As a second-year PhD student at the University of Arizona, she has two areas of research, which span her clinical practice of dermatology and her passion for helping children with disabilities in the U.S. foster care system.

11 thoughts on “A Nurse Practitioner’s Perspectives on Theory in Practice

  1. This explanation in its entirety needs to be shared and embraced by all NP faculty , and NP curricula transformed by thorough infusion and uptake!

    • This is really indisputable that Nursing care is worth nothing without application of theories. I should attest this through my experience of running a clinic trice a week on Chronic diseased patient particularly Diabetes and Hypertension in Tanzania. I always feel so confident to integrate practice of various theory in my service, not to mention Orem Self care theory on self monitoring of glucose at home, nutrition point of view and the like. Surely, theories stands as rampant is nursing care. I urge nursologist to inculcate its applications and of course, we will come out with great yields than ever.

      • Katunzi,
        I absolutely love that you incorporate Orem Self Care Theory for your patients as they self-monitor glucose levels and nutrition. You are truly partnering with them to achieve a higher level of health.
        Sincerely,
        Christine Platt

  2. Great post, congratulations!
    Therefore, nurses need NURSING LANGUAGE including nursing diagnoses – to name nursing and make nursing visible. The example shows that the NP addressed nursing diagnoses (even when not naming them). In this example, the patient had either Hopelessness, Social Isolation or Situational Low Self-Esteem. These nursing diagnoses are defined concepts reflecting nursing theory. All nursing diagnoses are also linked with concepts of effective nursing interventions and outcomes (e.g. NIC and NOC).
    Lets go on to make nursing visible!

  3. Thank you for explaining how you integrate nursing theory into practice. I especially appreciate that you presented an overarching theoretical approach (which seemed to incorporate population health in nursing) to your patient without being specific about a theory. There are so many middle range theories that it can seem overwhelming to designate just one. As you describe in your post you approached your patient from multiple areas in nursing and actually treated the patient in a holistic manner. I expect your patient walked away from his visit feeling listened to and as well as grateful for your quality care.

  4. Dorothy,
    Yes, I believe my background as a public health nurse influences the way I think. Population health is so integral to nursology. We care about the health of individuals, and by extension, their communities. I feel they are inseparable. Like a fish and water, they are a part of a complex and flowing system. Thank you for your thoughtful comments.
    Sincerely,
    Christine Platt

  5. Greetings,

    This is a nice post expressing the importance of holistic medicine. I am curious why you associate this specifically with the practice of nursing? As a physician trained in recognizing and acting upon features of patient presentations beyond chief complaint (the reason, after all, that we perform a “history and physical,”) I am curious about a couple things:

    (1) How, in a 26-patient day in a “Western”/modern-medicine Dermatology clinic, do you make time to attend to the full extent of the various underlying conditions with which your patients present? For instance, how personally would you address your acne patient’s depression, domestic safety concerns, financial issues, etc. in the minutes available? Also, how does the structure of the Dermatology clinic in which you work allow you to diagnose and address the primary etiologies of more complex conditions for which patients seek your attention – discoid lupus, stasis dermatitis, calciphylaxis?

    (2) Why, as an intelligent, motivated, well-written individual did you elect to enroll in a brief nurse practitioner program rather than a medical school and residency? Medical training could have increased your understanding of pathophysiology, psychiatry and other fundamental areas of medical practice – just as an Olympic diver invests thousands of hours to improve. Also, I would argue that becoming a physician provides independence of practice, which certainly increases one’s options for the practice of holistic medicine.

    I believe pitfalls and opportunities for holistic medical care reach across all professions – from the nurse’s aide attending to a patient in-home to the cardiothoracic surgeon planning after-care. And I think within each profession, whether Physician Assistant or Physical Therapist, many nowadays espouse the importance of comprehensive patient care – perhaps without trying to glue it so tightly to a specific profession?

    I believe it is past time to expect all medical professions to take a whole-patient approach to care – at whatever level they’ve trained. It takes a lot of people working together to care for our fellow humans, and I believe ultimately comprehensive care gets further by building bridges (rather than silos).

    (P.S.: Maybe if medical school was free, it would encourage many more qualified people to apply?)

    • Floyd, thank you for your comment, but we are not publishing it as it is. If you wish to revise and comment again, please do. But first, nurses do not, and cannot practice medicine, holistic or otherwise. Nurses practice holistic nursing, a form of nursing care that employs a number of self-care approaches that are available to anyone. Your question about “why nursing and not medicine” is quite simple – we see the two disciplines as related, but not the same. The definition of each goes far beyond simply the tasks we do and the time allotted for doing those tasks. The practice of nursing is based on the concepts and approaches reflected in the many nursing theories that you can access on the Nursology.net website.

  6. Thank you for your article. I’m still left with a question though. When I look for information on the difference between the medical model and the nursing model I always see that the nursing model is holistic, implying that the medical model isn’t. Maybe it’s because I work in psychiatry in an academic hospital but when I see the medical team practice I see holistic care. They address every aspect of the patients life. So the holistic answer doesn’t mean much for me. Am I missing something?
    I’m regards to theorists do you just pick one or several theories that are meaningful to you and try to keep them in mind as you provide care? Does the medical model have theorists they subscribe to or is it just one monolithic theory?
    Thank you for your response. This has bothered me for a while and I’ve never found a satisfactory answer.

    • Thank you for this comment, Chris. You ask a very important question. For me, the distinction is in the “definition” of the term “medical model” – which to my knowledge does not refer to a body of theory that describes medicine as a practice. In common understanding, it refers to the application of scientific facts and evidence in rendering pharmaceutical or surgical treatments – plus of course in psychiatry using scientifically tested forms of talk therapy as well. In contrast, the term ‘nursing model” is not commonly used, but generally when ideas of what nursing consists of there is a focus on caring, of being with a person/family/community to assist them to move through whatever health challenge they are experiencing. Nursing demands a more holistic approach, whereas medicine can ‘happen’ in a context that is isolated from the wholeness of the situation. This does not mean that often medicine is practiced holistically, and it does not mean that nursing is always practiced holistically. What it means is that the foundation, the disciplinary focus relative to a holistic approach is quite different for each discipline. Medicine does not have theory in the same sense that we have theory in nursing. And each of the many nursing theories, as diverse as they are in terms of the concept or phenomena of focus, places that focus in the context of some form of “wholeness.”

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