Contributor: Manuel Jesús Aragón Aragón
In this post I try to show the difficulties that I felt when I tried to apply nursing theories to practice in my work and personal reality for the first time. I understand that theories are an excellent resource to improve the quality of our care; for that reason in this blog I try to connect the theoretical and the practical aspects of nursing to create strategies and solutions appropriate to our reality.
When a light impacts on a surface, the light that is reflected, for better or worse will never be the same. This is how I see the transfer of nursing theories to the context of my professional practice. Teachings and information are the “light.” Each person interprets and reflects the situation differently depending on their cultural level, convictions, or circumstances.
I always imagined the world of nursing theories as a confusing spider of historical data, meaningless names, and no practical application whatsoever. Now, even if the doubts are many, I have begun to see the importance of those theories in our profession. I think about that question that our teacher shared; “What would be the theoretical design you would recommend to a colleague to guide their care practice?”. This is a difficult challenge in my context of emergency nursing There are always elements that are lacking, and now with a pandemic .. maybe the choice would be a very empirical theory?
I compare the strenuous work of the spider to the commitment of nurses in connecting theory to practice. The “spider of theories” is a symbolic idea of the possible difficulties that nurses, who are centered on practice, can feel when they first enter the world of theories and try to apply them.
Every spider leg represents a nursing school thought based on Kerouac’s theoretical work. Suzanne Kerouac and team in the 90´s created the book “La pensée infirmière” (Nursing thinking), a very good masterpiece that tries to reflect the evolution of nursing conceptions and put order in different theoretical concepts, paradigms, and different schools
Each of the spider legs shows a diverse number of theories and schools of thought. This diversity is often like a confusing “spider web” we would almost never be able to apply without the presence of a good guide. We only have time to practice without having a holistic vision about our patient, or time to think about legitimate nursing diagnosis – diagnoses perhaps missing in a mechanical choice of interventions in a computer program. In the current nursing practice situations, there is often only time to look at medical diagnoses and resolve situations using techniques learned by tradition and authority in an urgent/emergency context.
The change to fully embrace nursing theories should start with the most basic steps. The first nursing class should address “What it is to be a nurse” in any context. This early learning should be based on nursing theories that exist and that should address new realities that are to come. This enlightened ontological knowledge reveals who we are as nurses, and the complexity of the role of nursing. Perhaps this early introduction to nursing knowledge can contribute to the development of the true potential of nursing as a science and contribute to the epistemological part of the subject, the “How”? I am drawn to Carol Polifroni’s theory of Clinical Power that proposes nursing knowledge as the foundation for nursing practice, which is clinical power
Our challenge is to create and believe in our own power and make a difference in nursing practice. As we do this, we will show that nursing is an important and necessary part of our health system, and that we need more support, staff and resources to develop quality nursing care.
Another part of the solution may consist of more and better education of practitioners. As I have stated above, connecting practitioners with a theoretical world is essential in every context, including emergency care. It is necessary to show that theories are here to help, not complicate nursing practice. . Theories and practical work should not be different worlds. It is necessary to combine the best of both and to integrate theories in practice in ways that are appealing and effective for those who are practicing. I believe that practitioners interested in theories will change the game in the future. At this point in time, nursing theorists can adapt old models to the new times to create new theoretical models that meet the challenges of the 21st century. We also need new theories that address the emerging needs of the future. We need professors who stimulate curiosity about this world of theory. Supervisors are also essential in promoting a nursing theory-centered culture
So I ask myself: “What would be the theoretical design you would recommend to a colleague to substantiate their care practice?” I could give an easy answer, and say… Virginia Henderson´s need theory is a good example for my reality in emergency nursing. Or, Myra Levine´s conservation model is good. But first, practitioners need to have time and resources to avoid being slaves to the demands of practice and have time to think, apply theories and finally act with intention to have theory guide our practice. We (all nurses) need to gain respect and power, and Carol Polifoni´s Model is an inspiration to go there.
Second, professors and supervisors must find a way to inspire curiosity and show that theories are not a complicated spiders of useless data, but a resource of strategies to increase the quality of care. Theories should be present in every step of our learning and be part of our professional skills. Finally, practitioners need to be motivated to learn new visions of practice and abandon a practice based only on biomedical perspectives. Nursing is a scientific discipline in its own right, and we have many resources and theories to create a solid profession that delivers the best quality care to our patients.
About Manuel Jesús Aragón Aragón
I am a nurse. I´m from Spain but currently work in General Emergency in the south of Portugal and I am studying the specialty “Medical-surgical nursing, the person in critical situation” in Portuguese Catholic University (Lisbon).