Contributor: Patrícia Sofia Oliveira Fonseca Nunes
“He who loves practice without theory is like the sailor who boards ship without a rudder and compass and never knows where he may cast”. Leonardo da Vinci.
For several years, nursing has been recognized as the backbone of worldwide health systems (1). The World Health Organization has urged all countries to valorize this profession, acknowledging its contribution to improving worldwide health. Despite the recognition of the crucial role of nurses in the promotion, maintenance, and restoration of the health of individuals, communities, and populations, the independent contributions of nurses have been poorly recognized (2), thus resulting in low social visibility and recognition of nursing. The construction of the social image of nursing is influenced by historical, socioeconomic, and cultural aspects, often rooted in empiricism, charity, and vocation, to the detriment of scientific knowledge (3), which weakens, per se, the profession and the status of science long conquered by nursing.
Reversing the trend with the contribution of nursing theories
Historically, the social empowerment of nurses began in the 19th century with the professionalization of Nursing. The knowledge systematization and leadership provided by Florence Nightingale were crucial. Based on her environmentalist theory, she documented the health gains potentialized by the work methodology, thus attributing scientific status and autonomy to nursing practice. As the first nursing theoretician, Nightingale (4) demonstrated that nursing, as a science, is guided by theories that presuppose methodology and scientific evidence. Others have followed in her footsteps in providing theoretical support (5) to nursing, hence contributing to its progression as a science.
A vast amount of work has expanded the scope of nursing theories in recent years, offering scientific support to nurses’ actions, and conferring the science status to the profession, however difficulties in integrating theoretical models in professional practice remains (6). This seems to occur not through a deliberate resistance, but through the absence of recognition (unconsciousness) of the theoretical reasoning of nursing. Such can result in the relativization of nursing theories, both in the conception and provision of care, and in its remission to the academic sphere (6). It is urgent, therefore, to find a “common place” that allows an approximation of the academy to the practice, demystifies the impracticability of using theoretical models in the provision of care, and promotes the appropriation of theoretical references that support the daily professional practice of nurses.
From theory to practice
Nursing as a science presupposes the use of theory, method, and scientific evidence (7), nevertheless, as nurses, we often poorly advocate our interventions and explain the health gains resulting from them precisely because we neglect the theoretical frameworks that structure and give meaning to practice. On a personal note, and in a brief retrospective analysis, I cannot identify a moment in my professional practice where I provided care “a theoretically” (8) without resorting to theory. Still, I recognize my unconsciousness in doing so. Although I resorted to theories such as those of Kolcaba, Meleis, Henderson, Roy or Orem to establish nursing diagnoses, plan interventions and evaluate results while caring for critical patients, I often forgot to acknowledge the theoretical and scientific support inherent to the care provided.
As a staunch defender of evidence-based nursing practice, I often sought to promote research in the intensive care unit where I worked. I would frequently resort to quality indicators, such as the length of stay and delirium monitorization, per example, to justify the presence of family members in the ICU during the COVID19 pandemic. But why didn’t I resort more often to the theoretical references that guide nursing practice whenever other members of the multidisciplinary team, in a recognized way, asked me to perform “my magic”? Why didn’t I reinforce the idea that “it’s not magic, it’s science!”? Although these professionals recognized the unique contribution of nursing in the provision of care, they did not recognize it for what it effectively is: a science! Nursing is a science because nurses plan nursing interventions, according to theoretical nursing references (nursing theories), conceived by scientist nurses (nursing theorist) and supported by evidence. It is a science because it allows the development of therapies that guide nurses’ approaches in their work (7), while providing care and support to their patients.
Aware of not being the only nurse unconsciously neglecting nursing theories in everyday practice, I firmly believe that institutional nursing policies and information tools, that encourage and require daily routine to follow theoretically derived principles, should be adopted. By doing this, patients and civil society will become more confident that nursing is guided by empirical evidence. As this confidence increases, the social standing of the nursing profession will also increase.
In sum, for Nursing to be strengthened, as a profession and as a science, its practice must be rooted in the paradigms of nursing sciences, according to theories and models defining its praxis. Nursing evidence and its outcomes should also be mass disseminated, not only through scientific publications, that divulge nursing knowledge in professional settings, but also by socio-political means.
1 World Health Organization (2008). The world health report 2008: primary health care: now more than ever. World Health Organization.
2 Munro, C. L., & Hope, A. A. (2020). Empowering nurses in 2020, the Year of the Nurse. American Journal of Critical Care, 29(3), 165-167.
3 Avila, L. I., Silveira, R. S. D., Lunardi, V. L., Fernandes, G. F. M., Mancia, J. R., & Silveira, J. T. D. (2013). Implicações da visibilidade da enfermagem no exercício profissional. Revista Gaúcha de Enfermagem, 34, 102-109.
4 Lopes, M. (2012). Florence Nightingale: Algumas reflexões. Enfermagem: De Nightingale aos dias de hoje, 100, 9-18.
5 de Sousa, N., de Abreu, L., Araújo, E., Torres, R., de Freitas, M., & Guedes, M. (2019). Nursing and science: a reflection about its consolidation. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 13(3).
6 Ribeiro, O., Martins, M. M., Tronchin, D., & Silva, J. (2018). Professional nursing practice grounded in the theoretical framework of the discipline: reality or utopia. Revista de Enfermagem Referência, 4(19), 39-48.
7 Costa, M., & Gonçalves, D. C. (2021). O Equilíbrio entre a Arte do Cuidar e a Enfermagem como Ciência: Uma Perspetiva Histórica. Lusiadas Scientific Journal, 2(2), 62-64.
8 Fawcett, J. (2019) The Impossibility of Thinking “Atheoretically”. [Blogpost]. Retrieved from: https://nursology.net/2019/01/22/the-impossibility-of-thinking-atheoretically/
About Dr. Nunes
Intensivist nurse in the Portuguese National Health Service (NHS) since 2004, master in health management since 2012, and Phd in International Health since 2021, I have always been a staunch advocate of nursing, nurses and evidence-based practice nursing, fighting for the social recognition of the nursing profession and its irrefutable contribution to global health. This post was created in the nursing theories curricular unit, that integrates the Master in Nursing Course of the Health Sciences Institute of Universidade Católica Portuguesa (Lisbon), with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).