The journey to theoretical thinking has been a progression through self-effacing stops, self- doubt detours, humility delays, collisions with opposing and dominating paradigms, and near misses due to embarking into unfamiliar territory or unpaved terrain. Nursing and nurses are emerging theoretically stronger and far better prepared to embark on a task of theoretical clarifica- tion. The quality of the journey could be enhanced by coaching, mentorship, and sponsorship toward the development of the theoretical insights attached to the scholarly role.
Nurses who learn about theoretical nursing, who are groomed to think conceptually, are not resistant to the use of nursing theory in their practice or to their potential involvement in theory development. Rather, they are asking how they can use theory, and they are looking for those they can emulate in the process. One example of nurses’ interest in theory was several national confer- ences held in the 1980s and 1990s by clinical specialists, in which the topic of theory development and utilization dominated a full half-day of the 2-day conference (e.g., a Clinical Nurse Specialists
CHAPTER 4 From Can’t to Kant: Barriers and Forces Toward Theoretical Thinking 55 Conference in 1983). Many more examples are demonstrated in the increasing numbers of nurses who are members of organizations established for such nurse theorists as Dorothea Orem, Callista Roy, Imogene King, and Martha Rogers (see Chapters 11–13).
Planners of one of these conferences were concerned about the responses of attendants to what might appear as highly abstract ideas not directly related to everyday care issues. The results were astonishing, the evaluations were heartening, and the request came for another session the following year, focusing on how to bring acceptance to theory utilization and development in clin- ical areas (Clinical Nurse Specialists, 1984). In short, nurses were asking for role modeling, role clarification, and role rehearsal—all properties of mentorship.
Mentorship is an intense relationship calling for a high degree of involvement between a novice in a discipline and a person who is knowledgeable and wise in that area. . . . In the process of helping the beginning scholar to fit resources to her needs and capabilities, the mentor provides options, opens up new opportunities, and helps to make corrections. This means that, on cognitive and affective levels, the mentor is involved with the novice as a whole person and feels a sense of responsibility for her. (May et al., 1982, p. 23)
Role modeling, which is teaching by example and emulation, then fosters the learning of these behaviors (Bandura, 1962; Meleis, 1975). Role clarification provides an opportunity to understand the subtle intricacies of the role to be emulated. What does it mean to have a role in the theoretical development of nursing? What cues are needed to perform that role? Role clarification in theory use and development may include spelling out the differences between the various theo- ries, the different strategies in theory development, the different barriers to the use of theory, and some strategies for handling all of these. Mentorship also includes opportunities for role rehearsal.
Use of theory in theoretical patient care studies and use of different strategies in theory develop- ment are examples of staged situations in which to practice behaviors central to the use and devel- opment of theory (May et al., 1982; Meleis and May, 1981).
Time and sociocultural conditions are right for the development of theoretical nursing, which in turn is significant for patient care, and nurses are “going for it.” If, indeed, there is a woman’s way to understand the world, and if there are areas of knowledge that are better understood when seen through the eyes of women and through the use of feminine logic, then nursing is ready on all of these accounts, and nurses are prepared to pursue that knowledge.
Nursing education can provide supportive conditions through programs that focus on schol- arly productivity (Meleis and May, 1981; Meleis, Wilson, and Chater, 1980). Theory and theory development should not be limited to graduate programs. Theoretical thinking should be the modus operandi for conscientious patient care from day one in nursing education. Nursing prac- tice has an equal commitment to provide avenues by which nurses can communicate their findings in theoretical terms and can have the opportunity to translate their hunches into theoretical terms.
Within the appropriate atmosphere, nurses should be able to try using different theories in practice for the purpose of refining and extending them.
Similar supportive environments could be provided by nurse administrators to help in the development of a theoretical culture that allows dialogues, debates, and discussions that go beyond immediate day-to-day problem solving and decision making. Strategies to be used by nurse administrators and educators for the enhancement of theory development include creating a theoretical culture, supporting critical thinking, refocusing dialogues and discussions on concepts, defining nursing territory, exploring ambiguous ideas, allowing uncertainty about phenomena to linger, avoiding premature closure on ideas, facing views of phenomena from different perspec- tives, and providing such resources as library time, observation time, and writing time (Jennings and Meleis, 1988; Meleis and Jennings, 1989; Meleis and Price, 1988).
CONCLUSION
Nurses are now in the land of Kant rather than the land of “Can’t.” Kant maintained that knowl- edge depends on experience and experience on observation, but observations by themselves do
LWBK821_c04_p039-058 07/01/11 6:07 PM Page 55
not form experience or give meaning to experience. Observations have to be organized a priori by the mind to develop into knowledge. In so organizing our observations, we tend to reconstruct reality.
Nurses may have reconstructed the meaning of theoretical constraints into forces that foster the further development of theoretical nurses. They can use the tools of practice in theory develop- ment, relying on the same abilities they have used for practice, research, teaching, and administer- ing, and translating these skills into theorizing and the use of theory, perhaps thereby becoming convinced that their experiences comprise the appropriate impetus for theory development.
The synthesis between continental rationalism and British empiricism espoused by Kant may be helpful in increasing our knowledge of nursing realities.
Are there ways to influence the cycle of shortage and theoretical thinking?
5. As gender, ethnic, and sociocultural diversity increases in nursing, what might be some implications for scholarship in nursing? Envision and discuss outcomes.
Provide support for your arguments.
6. Discuss the current situation in the use of theoretical nursing. How are theories used? What are the outcomes of use or nonuse of nursing theoretical thinking?
7. In what ways did the discourse of evi- dence-based practice contribute to or hin- der the development of nursing theories?
8. In your view, what are some of the current dominant discourses in nursing? What evidence do you have for this assertion?
In what ways did this dominant discourse influence knowledge development?
REFLECTIVE QUESTIONS
1. Explain the barriers and forces that led to utilizing theoretical thinking in your area of clinical practice (or education, admin- istration, or consultation).
2. Discuss how the changes toward women’s and men’s roles may have influenced nursing knowledge develop- ment. What changes would you like to see in the future that you believe could make an impact on advancing theoretical thinking in nursing? Be specific in iden- tifying changes and influences.
3. Identify and discuss one more constraint and one more force that may have influ- enced the theoretical journey in the dis- cipline.
4. In what ways did the wave of the nursing shortage in the 1980s and in 2000 support or constrain theoretical thinking? Why?
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C H A P T E R 5
On the Way to Theoretical Nursing:
Stages and Milestones
Despite the barriers against theoretical thinking and theorizing identified in the previous chapter, nurses, in caring for human beings in an orderly and organized way, have always been involved in some form of theorizing. Concepts of care, comfort, communication, protection, healing, and health, among others, were used to guide clinical practice before they were labeled as concepts and before they were linked together to form nursing theories. However, between 1950 and 1980, a process of serious labeling and a more systematic communication of concepts and theories occurred. This process continues to enrich the discipline of nursing.
First attempts in theoretical nursing were made by Florence Nightingale in the late 19th and early 20th centuries to describe nursing focus and action in the Crimean War. Nightingale was prompted to articulate her ideas in numerous publications, with different goals. Among these goals were gaining support for a national need for nurses, achieving acceptance for the develop- ment of educational programs for nurses, and exposing the unhealthy environmental conditions that were endured by English soldiers during wars.
Subsequent attempts in theorizing were published by American nurse educators in the mid- 1950s, prompted by the need to justify different educational levels for nurses and the need to develop curricula for each of the educational levels in nursing. To differentiate curricula, and to enhance the quality of education in each curriculum, a few pioneer nurses combined their clinical expertise with forward vision to answer such questions as “What are nursing goals?” and “What ought to be the aims of nursing?” These early theorists were aware that by developing programs that represented a nursing perspective, they would help nursing students—that is, future clini- cians—to focus on nursing phenomena and problems rather than on medical phenomena and problems. Groups were formed in different parts of the United States (and subsequently or simul- taneously in other parts of the world) and committees were formed to discuss the nature of nurs- ing, the nature of nurses’ work, and the unique aspects of nursing. The goals of these early efforts were also focused on differentiating nursing from other health science disciplines. These dia- logues went further to explore the nature of nursing knowledge.
Perhaps the best way to consider the history of nursing theory and to analyze nurses’ current interest in theory in perspective is to consider dominant themes in the different stages of the devel- opment of nursing knowledge (see discussion on Nursing Perspective in Chapter 6). The implicit assumption here is that the themes discussed in the literature are indicative and representative of what members of the discipline were interested in at different times during the process of its development. In addition to delineating these themes, an analysis of the theory-literature provides us with specific milestones that may have helped in the development of theoretical nursing. Both approaches provide insights into how nursing evolved into its current status.
In this chapter, the themes are articulated as stages that have influenced progress in knowl- edge development. Stages are complemented by milestones, which characterize the turning points for moving from one stage to the next. These stages and milestones helped achieve the current level of progress in the discipline.