And in Ch 9., Practitioner as Theorist: A Nurses Toolkit for theoretical Thinking in Nursing, of the various strategies in the article for thinking theoretically, which one best fits your style of thinking or working?
This week you read Reed and Shearer Ch 8., Creating a Nursing Intervention out of a Passion for Theory and Practice, I ask you this, what are you passionate about in nursing? Is it theory, practice, research, or a combination?
And in Ch 9., Practitioner as Theorist: A Nurses Toolkit for theoretical Thinking in Nursing, of the various strategies in the article for thinking theoretically, which one best fits your style of thinking or working? Does this strategy help you balance “following the rules” with your “personal creativity” in building knowledge?
In this week’s readings, Reed and Shearer (2018) explained and elaborated on creating a nursing intervention out of passion for theory and practice. Personally, I am passionate about practice that is driven by best-practice models and theories – therefore, I would say that I am passionate about practice, theory and research. Nursing practice provides us with first-hand experience and knowledge which we can in-turn use to guide research and theory development to better the nursing profession. Reed and Shearer (2018) furthered this by noting, “Reflection on experiences in clinical and community health practice during PhD study provided a basis for clarifying philosophical worldview, identification and analysis of core concepts for theory development, testing, and refinement” (p124). I think that nursing practice is the core, the most important element. Through practice, we can determine the efficacy and validity of research and theories. In the article by Fawcett, et. al. (2001), it is noted that “Nursing … depends on the scientific knowledge of human behavior in health and in illness, the aesthetic perception of significant human experiences, a personal understanding of the unique individuality of the self and the capacity to make choices within concrete situations involving particular moral judgments”. To me, this means that in order to achieve knowledge generation, there must be collaboration and developments on all fronts including practice, research and theory. I believe that the multimodal approach to intervention development, as depicted by Whittemore and Grey (2002) in Figure 1 is an effective method. In this model, clinical knowledge, scientific knowledge, and knowledge of participant perspective and all linked and essential to intervention development and refinement as well as each other. The arrows show that this is a non-linear process that relies on cooperation and collaboration from each element. Intervention development, just like knowledge generation, is essential for furthering nursing practice. It relies on several elements and collaboration from all involved in research, practice and theory development.
In chapter 9 of Reed and Shearer, we are introduced to several toolkits or strategies to aid in theoretical thinking. I personally align with the Guerrilla theorizing perspective. This model is heavy on practice driven initiatives. The meaning of guerilla, small war, reflects the struggles we as nurses face every day, as well as the “war” we face in need to progress our knowledge and understanding as well as research and theory development. This specifically brings my mind to the struggles and challenges nurses have faced during this pandemic. “This concept…the person–environment process of change, pragmatism and pluralism in knowledge building, and voices of patients and bedside caregivers in nursing theory and practice” (Reed & Shearer, 2018). I like that guerilla theorizing strategies are “unconventional” – allowing for some autonomy and creativity in development on knowledge. Guerilla strategies also account for the needs of the patient, culture of the people involved-nurse and patient, and allows for creativity when applying the strategies to practice. I appreciate the ability to have some autonomy and “creative freedom” in order to best meet the needs of my fellow nurses and patients. For example, when my unit encouraged nurses to develop learning modules to educate fellow staff on new procedures and surgeon preferences – we each had freedom to come up with a knowledgeable presentation of any form and to distribute this knowledge in a way that would aid the rest of the staff. By allowing us creative freedom here, we were all able to make well put together and highly informative presentations that our co-workers actually appreciated, engaged with and learned from.
References:
Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2001). On Nursing Theories and Evidence. Journal of Nursing Scholarship, 33(2).
Reed, P. & Shearer, N. (2018). Nursing Knowledge and Theory Innovation: Advancing the science of practice (2nd edition). Springer Publishing Company. Kindle Edition.
Whittemore, R., & Grey, M. (2002). The systematic development of nursing interventions. (Clinical Scholarship). Journal of Nursing Scholarship, 34(2), 115.
After reading Chapter 8, it made me think of what I am passionate about in nursing. I feel that it is a combination of both theory, research, and practice. Theories and theorizing are embedded in practice (Reed & Shearer, 2018). Nursing has a history of theory development, for me, I include theory in my practice. Practicing nurses are theorists that use strategies for knowledge production in nursing (Reed & Shearer, 2018). For me, I use theory in my practice by taking concepts and purposes designed to guide my practice. I believe that theory and research are related because practice nurses come up with a theory that they could implement and potentially benefit the patient. According to Whittermore & Grey (2002), an essential foundation of intervention development is exploring and understanding the problem. You need research to support the theory, which is why research is important and incorporated into my practice. In addition, theory, inquiry, and evidence are inseparably linked (Fawcett et al., 2004). As mentioned before, theory, research, and practice are all connected
Currently, I work at a hospital and practice nursing full-time. According to Reed & Shearer (2018), theory and practice are fused together in a concept called compassionate action. I am a very compassionate person. I put people above myself every day, even when I am not at work. In my practice, I currently have six patients for my assignment. I have learned how to assess my patients and see which one I need to see first. When I assess my patients, I do my best to not miss anything. In the past week, I had a gut feeling that one of my patients did not look right. When I auscultated his heart, it was irregular. He had no history of cardiac problems. When I did an EKG on him, I found atrial fibrillation and was able to transfer him to a higher acuity floor. Without my prior theory, research, and practice I would have not been able to treat this patient appropriately.
Chapter 9 mentions strategies, that could fit your style of thinking or working. I feel that Peplau and Postpositivism fits best to my style of nursing. This practice is centered on the nurse-patient relationship within a therapeutic environment. Furthermore, this strategy mentioned the cycle of inquiry which can be defined as the start of the nurse-patient relationship (Reed & Shearer, 2018). (Reed & Shearer, 2018). I have only been a nurse for a short period of time, but I create a therapeutic relationship with my patients. Therapeutic relationships benefit the nurse-patient relationship because it builds empathy, respect, and trust. Patients want to feel that you care about them and are doing everything in your practice to make them safe. I do my best in my practice to promote healing and trust. I feel that this strategy helps me balance “following the rules” with my “personal creativity” in building knowledge. According to Fawcett et al., 2001, evidence can be interpreted and critiqued by each person who considers whether a theory can be applied in practice. This relates to Peplau’s theory because it is based on therapeutic relationships, and helps me find a balance between the rules and my creativity.
References
Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2004). On nursing
theories and evidence. Journal of Nursing Scholarship: An Official Publication of
Sigma Theta Tau International Honor Society of Nursing, 33(2), 115–119.
Whittemore, R., & Grey, M. (2002). The systemic development of nursing
interventions. Journal of Nursing Scholarship, 34(2), 115-120. https://search-ebscohost-com.umasslowell.idm.oclc.org/login.aspx?direct=true&db=edsgea&AN=edsgcl.88100438&site=eds-live. Acesso em: 29 out. 2021.
Reed, P. G., Shearer, N. B. (2018) Nursing Knowledge and Theory Innovation: Advancing
the science of practice (2nd edition). Springer Publishing Company
The most gratifying thing about nursing or being a nurse is that we make difference in the lives of others like patients, families, or communities. Thus, practicing as a nurse is a huge social responsibility and I’m passionate about fulfilling this responsibility with my utmost gratitude. I have been practicing nursing for over a decade and my experience reflects to me that theory, practice, and research are reciprocal of each other, and will better serve in combination. The primary purpose of theory in nursing is to improve practice by positively influencing the health and quality of life of patients and nursing theory must be validated in practice, and nursing practice provides a foundation for theory validation and knowledge production (Reed & Shearer, 2018, p. 124). In my experience, I found a gap between what was studied and practiced in school with limited situational care settings and the real-time healthcare practice in hospitals. For an instance, we had practiced step by step peripheral intra-venous access technique in school to access a vein, but that technique did not work well for all patients. With a few failed attempts and reflecting on my experiences, I developed my own techniques based on the type of vein, skin, age, and canula in use. To provide effective, efficient, and holistic patient care, the professional responsibility of nurses is centered on providing high-quality nursing interventions to address important clinical problems and to produce positive health outcomes (Whittemore, R. & Grey, M., 2002). Creating and explicating theory-based nursing interventions is a rigorous process and takes a longer period, and nurses can develop a nursing intervention in clinical practice linking theory and practice, and the results from the use of diverse research methods along with reflection on clinical practice experiences were integrated into the evolving theory, to develop and refine the interventions (Reed & Shearer, 2018, p. 132). The clinical practice experience is a key in refining interventions, and patterns of knowing in nursing: empirics, ethics, personal, and aesthetics define the individual’s practice experience and the quality of information extracted as each pattern of knowing can be considered a type of theory, and the modes of inquiry appropriate to the generation and testing of each type of theory provide diverse sources of data for evidence-based nursing practice (Fawcett et al., 2001).
The strategy that strongly fits me the most is the bricoleur concept of guerrilla theorizing strategy. Guerrilla theorizing strategy describes the perspective of how nurses in practice may engage in theory development and a variety of interactions with patients and their environment that can inform a theory include knowledge produced in context, interpretive, partial, and always under construction (Reed & Shearer, 2018, p.141). The bricoleur concept dictates practitioners “create ideas what is at hand” and “produces a new structure to address a problem” in practice-based theory development. I completely agree with the fact that we nurses develop ideas and knowledge on day-to-day interactions with patients, families, and environments around us in practice, and this practice-based knowledge from the experiences of patients and nurses and can be applied to describe a variety of elements to formulate a theoretical framework for action (Reed & Shearer, 2018, p.141). This strategy unquestionably helps me to balance “following the rule” with my “personal creativity” in building knowledge as it dictates not only knowledge generation from practice-based experiences with patients but also a frame to address the problem.
References
Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 33(2), 115–119. https://doi.org/10.1111/j.1547-5069.2001.00115.x
Reed, P. G., & Shearer, N. B. (2018). Nursing Knowledge and Theory Innovation: Advancing the Science of Practice (2nd ed.). New York, NY: Springer Publishing Company.
Whittemore, R., & Grey, M. (2002). The systematic development of nursing interventions. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 34(2), 115–120. https://doi.org/10.1111/j.1547-5069.2002.00115.x
When it comes to nursing, I am passionate about the practice. As mentioned in the book, “Nursing practice provides a foundation for knowledge production” (Reed & Shearer, 2018, p. 126). I believe this is true because in practice nurses are able to see what is working and what is not. We’re able to discern if a certain practice is benefiting the patients or if it needs to be studied and refined. I am able to learn more while I am in practice, and that is why find myself more passionate about it. Furthermore, I love being able to interact with patients and provide care. I am a very hands-on type of person and I have been able to develop skills and experience on how to interact with patients through practice. I feel like I am able to make an impact on patients in practice, and I am able to see it with my own eyes. Shearer mentions an instance where she provided emotional support to a mother who had lost her daughter and in doing so she gained knowledge on how to intervene in those situations (Reed & Shearer, 2018). Situations like this are what makes me passionate about practice. Being able to provide emotional support to patients and dealing with different unexpected situations helps us learn things that otherwise we wouldn’t have learned. Additionally, an essential foundation of intervention development is exploring and understanding the problem (Whittermore & Grey, 2002). This means that in order to develop theories or interventions, a problem needs to be explored, and this can only be done through practice. Being present in practice allows practitioners to see first-hand the issues that need to be addressed, and develop theories and strategies to improve them.
From all of the strategies mentioned in chapter 9, the one that best fits my style of thinking and working is Peplau’s Post-positivism. Her strategy focused on the nurse-patient relationship within a therapeutic environment (Reed & Shearer, 2018). This resonated with me because just as practice is my passion, creating therapeutic relationships with patients is the reason behind it. If I am able to connect with them and help them achieve healing, then I feel like I am fulfilling my purpose. Fawcett et. al., (2001) mentions that therapeutic nurse-patient relationships can be achieved when nurses come to know how to be authentic in relationships with patients, and how to express their concern and care for other people (p. 116). This supports Peplau’s post-positivism and the idea that therapeutic relationships with patients are important. Not only that, but it places importance on the nurse’s role on expressing care and concern all while being authentic. I believe Peplau’s theory helps me balance following the rules with my personal creativity in building knowledge. This is because in order to build knowledge I have to interact with patients and build relationships that will allow me to see what is to learn from the specific relationship. I am able to provide care and complete my duties more efficiently if I am able to form that relationship with the patient.
References
Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 33(2), 115–119.
Whittemore, R., & Grey, M. (2002). The systemic development of nursing interventions. Journal of Nursing Scholarship, 34(2), 115-120. https://search-ebscohost-com.umasslowell.idm.oclc.org/login.aspx?direct=true&db=edsgea&AN=edsgcl.88100438&site=eds-live. Acesso em: 29 out. 2021.
Reed, P. G., & Shearer, N. B. (2018). Nursing knowledge and theory innovation: Advancing the science of practice (2nd ed.). New York, NY: Springer Publishing Company, LLC.
Nursing practice and the healing of human beings of all ages is what I am most passionate about however I understand theories as a guide within the dynamic process of developing nursing interventions. Reed & Shearer discuss how practice enhances theory and the role of clinical practice is to “serve as a guide to creating a theory- based intervention” (2018, p. 123). Generation of theory- based interventions is not a straightforward process. Instead, interventions require reflection on past experiences from practice along with how best to utilize research findings. Whittemore & Grey describe variability in perspectives of research as best for development of research, appreciating complicated nursing interventions and exploration of outcomes (2002, p. 115). Utilizing the role of diverse clinical practitioners within multimethod research combines an ideal assortment of practice experience and theoretical perspectives in which offers an ideal environment to develop theory-based intervention.
Peplau’s post positivism theories most closely align with my personal practice and how I view my role as a nurse. Peplau offers nursing interactions as central to knowledge generation. Reed & Shearer describe Peplau’s cycle of inquiry as “a method of knowledge development that shifts between nursing practice and formal research” (2018, p. 138). Nurses utilize honed assessment skills to observe the wellness to illness continuum. Elements of such a continuum become the basis for theoretical inquiry. Theoretical inquiry is then refined and translated into nursing practice to be repeated in a nonlinear fashion. Viewing every nursing interaction as fodder for nursing knowledge allows the nurse to appreciate the value of nurse- patient relationship and the potential for every connection to act as a vessel from which knowledge is developed.
References
Reed, P. G., & Shearer, N. B. C. (2018). Nursing knowledge and theory innovation: advancing
the science of practice (2nd ed.). Springer Publishing Company.
Whittemore, R., & Grey, M. (2002). The systematic development of nursing interventions. (Clinical Scholarship). Journal of Nursing Scholarship, 34(2), 115.
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