Say It Ain’t So:  Graduate Students Shade Nursing Theory!

Karen J. Foli, PhD, RN, FAAN

I’d finished grading the last of the master’s-level students’ theory in nursing papers. I’d turned in final grades and then, the message came through: anonymous student course evaluations were ready for my review. I took a long sip of water and put my organic, no preservative, granola bar aside.

Steady, old girl, I said to myself. You have tenure. How bad could they be? I’d done my very best in this hybrid-structured course. The graduate students met on campus about five times throughout the semester and the rest of the “class meetings” were virtual. I liked the hybrid structure as it offered the students a sense of community; yet the online component allowed them to be self-directed as adult learners. I tried to impart a rudimentary foundation of the philosophy of science, and used discourse that included logical positivism, epistemology and ontology. The course content included a deep dive into concept analysis, nursing theorists and the major health behavior theories and – I thought – many applications of nursing theory to practice decisions and interventions. Assignments were student-personalized, asking for them to express their own philosophies of nursing care, present on nursing theorists’ work, and take a stab at concept analysis or critique a published analysis.

Yet, here I sat, wanting to avoid the dreaded student evaluations. No delaying it any longer.  I logged into the student evaluation portal and winced as I read the polarized comments. Many were very complimentary: “Course well organized. Grading was clear with helpful comments given on papers.” A continuation of gratifying comments: “Didn’t think I’d like theory, but I did. Liked the examples. Related it to real life. Dr. Foli’s passion really came through and helped make the class enjoyable.”

Then, one student’s comments made me stop. “Too many readings. I didn’t read most of them. I had to take time away from studying for patho and that’s what a nurse practitioner needs to know.”

Flinging the granola bar into the trash (it tasted like sawdust anyway), I reached for the Little Debbie Valentine cake.

What??? I had practically done summersaults trying to get the practice-to-theory connection in this class. And then I paused to reflect on my audience: students enrolled to become primary care nurse practitioners. Many continued to work at the bedside in highly stressful jobs. They all had personal responsibilities, some of which overwhelmed them (an ill child, a sick mother).

When I spoke to the class at the beginning of the semester, I asked them a question that I didn’t need a public response to: “Are you running from something in your current job or running toward a goal of being a nurse practitioner?” Upon hearing this question, I always looked for the nonverbal responses: heads slightly turned down, eyes glancing sideways. Mouths in grimaces. The ones that seemed to embrace the new career path continued to look directly at me.

So I knew from the beginning of the semester this was a tough audience. These folks were frontline, point-of-service providers who had witnessed and experienced nurse-specific trauma on an ongoing basis. Sadly, for the majority of them, nursing theory meant little.

They were here in this first semester graduate class to learn the facts, just the facts. Or as Chinn and Kramer (2015) describe it: empirical knowledge. As advanced practice nurses, they would be tasked to diagnose, prescribe, recommend a treatment plan, and manage illnesses. They’d also engage with the patients to promote wellness and encourage disease prevention. What did theory have to do with all that?

Well, as I read the students’ comments, I wondered what more I could do to ensure they saw the connection between all the ways of knowing (Chinn & Kramer, 2015), how to apply middle-range theories to their practices, and use theory as an organizing framework to track efforts. I wanted them to see patients as dynamic individuals, not merely as objects that may or may not adhere to a treatment plan.

As I put the Little Debbie wrapper in the trashcan, I felt invigorated (it could have been the sugar rush). They may have thrown some shade at theory, but I pulled out the course syllabus, reviewed it, and made note of how I could continue to refine the course so that every student would see the value of theory in primary care. I did this because it’s so important for our profession. Nursing theory gives us identity, ways to increase nursing science/nursology and patient care practices. As the Year of the Nurse and Midwife, the timing couldn’t be better!

What about you?  If you have suggestions for me on how to strengthen the theory-to-primary care advanced practice connection in a master’s level course, please forward them in the comments below.

Or, better yet, go to Nursology’s Teaching/Learning Strategies (https://nursology.net/resources/teaching-strategies/) and complete the form to submit a strategy to strengthen the link between advanced practitioners’ theory-guided knowledge and nursing practice.

Thanks in advance for your help!

Making Nursing Theory Real!

In March, 2019, Case Western Reserve University, Cleveland, OH hosted the conference: “Nursing Theory: A 50 Year Perspective, Past and Future”.  One theme that emerged from the lively dialogue at the conference was that nursing theory should be introduced and integrated in all pre-licensure programs. At the same time, participants noted that many pre-licensure educators lack knowledge and skills for teaching nursing theory.

Energized by the March theory conference, several nurse educators from Northeast Ohio joined together to offer a workshop on the basics of teaching nursing theory. The workshop, Making it Real: Connecting Nursing Theory to Nursing Education, was co-sponsored by Case Western Reserve University (CWRU), Ursuline College, and Lorain County Community College. There was no registration fee, parking was free, light refreshments were provided, and 2 contact hours of CE were awarded.

Patricia Sharpnack speaking at Nursing Theory: Making It Real

We scheduled the workshop to precede a Northeast Ohio League for Nursing (NEOLN) dinner meeting and program at the same location. The event was publicized through emails to directors of pre-licensure programs and, in the spirit of collaboration, the theory group and NEOLN each publicized the other’s event.

The program was coordinated by Dr. Mary Quinn-Griffin (CWRU). The planners kept the workshop to two hours so participants could see that they did not need extensive,highly theoretical content to begin incorporating theory in their class, lab, or clinical teaching. During the first hour, Drs. Joyce Fitzpatrick and Deborah Lindell (CWRU), and Dr. Patricia Sharpnack (Ursuline College) presented content on the disciplinary perspective, nuts and bolts of theories, core concepts of nursing, and strategies for integrating nursing theory in pre-licensure education. During the second hour, the participants worked in small groups to identify, and report out on, ways they could integrate nursing theory in their teaching.

Participants engaged in a group activity

We were delighted by the response to our workshop! In two days, we filled the 35 seats and had a waiting list! So, we repeated this program in November. Evaluations were highly positive and participants suggested topics for future programs, such as in-depth discussion and application of specific theories. We look forward to Making It Real, Phase II.

Please contact Debbie Lindell for more information about our theory workshop.

How to Teach Nursology: A New Resource on Nursology.net

The nursology.net management team is very pleased to announce a new resource for educators of nursology – Teaching/Learning Strategies. This resource is devoted to explanations of diverse approaches to teaching nursology. The first approach focuses on one way to teach the APPLICATION of nursology conceptual models and theories for practice. This teaching strategy involves teams of students role playing nursologists working within the context of various nursology conceptual models and theories that are applied to a fictional multi-generational, multi-cultural family. (See https://nursology.net/resources/teaching-the-application-of-conceptual-models-and-theories-of-nursology/) Comments about this teaching strategy are welcome.

I am confident that the creativity of all nursologists who each in academic and/or clinical settings will be evident as other approaches to teaching nursology are added to this section of nursology.net. Therefore, the management team invites all educators to use the content guidelines and forms found on the “Teaching/Learning Strategies” page to submit explanations of effective teaching strategies.

I would like to thank Deborah Lindell, a new member of our management team, for her exceptionally fine work developing the content guidelines.