A theoretical death? The Te Henga Section of the Marxist Nurses' Union mourns the passing of Nursing Theory.
Nursing Theory was ever surrounded by controversy. Some say its birth may be traced to the blood and cannon fire of the Crimea. It seems that for those believing in Virgin Birth, the Blessed St Florence of the Nightingale is the first Nurse Theorist. Other schools, of what we will reluctantly call thought, have that Martha Rogers was the originator. This battle of opinion, one favouring a vaporous autocrat and the other championing a psychotic narcissist, remains as an ongoing controversy. Or, as modern nurse managers would say, a continuing conversation.
The vacuous allied with the meaningless
Whatever the truth, and after a difficult childhood, NT came into its own when it was discovered by Nursing Education. This was a marriage made in heaven and remains a happy if unproductive union. In NT, education found the perfect match. Here was the vacuous in a marvellous alliance with the meaningless.
We may now acknowledge the Golden Age of NT. Everywhere a nurse went, there it was. Nursing Students invested hour after productive hour churning out case studies based on some Adaptation Theory, when they weren't assembling seminars to ponder the deeper mysteries of Faye G. Abdella's "Patient-Centred Approaches" as compared with Ida Jean Orlando's "Dynamic Nurse-Patient Relationship"
Generations of nurses entered wards all over the world ready to provide Holistic Care, clutching their Imogene King and Sister Callista Roy books like bibles to their breasts.
It was during this time that NT reached its apogee. Contesting theories battled it out for the hearts and minds of nursing students [Nursing Educators having been totaLLy won over to a woman without a hint of a fight]. Theories fought for superiority. Their weapons were tedium and verbosity mixed with conceptual complexity, unrelieved by vulgar references to reality.
We may gain a small sense of the heights to which NT reached when, with awe in our hearts and wonder in our minds, we read: Jones has a transcendental, entitative theoory ... as foLLows: "Syntoxic responses trigger messengers that act as tissue tranquilizers creating a passive tolerance ... [as opposed to] ... Catatoxic messengers ..." (1)
There is bewilderment amongst many of us as to how nurses were able to exist without this sort of searing insight.
During this Age of Theoretical Enlightenment, theories seemed to proliferate like consultants around a Ministry of Health Special Project.
Nursing Theory at this time assumed near divine status. Dorothea Orem was venerated by the same worshippers who would later become adherents of the Church of Research-Based Practice and [later] the Cult of the Outcome. Dorothea's Theory remains dear to the hearts of all who revere boring restatements of the obvious.
We, in littLe but proud Aotearoa/New ZeaLand, even produced our own theorist. Students in her classes all had the privilege of studying the Partnership Model. The imposition of the Model on students who had no choice but to study and adopt the modell just goes to show what a dynamic concept a Partnership Model is.
Sadly, in its Later years, NT seemed to be in decline.
Critics pointed to the implicit racism of dear Madeleine Leininger, whose response - part indignation, part digging herself into a deeper - dare we say - darker hole, sort of confirmed the criticism.
Have a look a Nursing Praxis in New Zealand 1994-1997 for an interesting little exchange between some local nurses and Ms Madeleine. Oh, atright then: Vol g, No 1, 1994; Vol 11, No 1, 1996; Vol 11, No 2, 1996; and Vol 12, No 1, 1997.
Other critics suggested, probably unkindly, that NT acted as a sort of smoke screen that gave nurses the illusion of importance and being in control, while either ignoring or dismissing the material conditions that shape our realities. We have Looked but can't find a theory approaching the concepts of safe staffing Levels or decent wages. The idea seemed to be that these were sort of beneath the dignity of "professionals, m'dear" This remains the great legacy that NT has bequeathed to academics and Colleges of Nursing, who are the main beneficiaries of NT's Last Will and Testament.
In its Last years, NT underwent a sad decline characterised by the emergence of neo-liberal loopiness such as Rosemary Rizzo Parse's Theory. Mental Health, already handicapped by the empty mechanism of Hildegard Peplau, was further embarrassed by the neo-fascism of the Tidal Model.
In the end, NT could not live with exposure to the real world and when challenged by real people. It leaves a few bastard children and a crippled collective nursing intellect.
There's plenty of reason to be sad, don't you think?
(1) Stevens, B.L. (1984) Nursing Theory. (2nd Ed.) Boston/Toronto: Little Brown & Company.
Chris Cottingham, RN, BA, MEd, DipSocSci, PGDip (Hlth Sci), is a staff nurse working for a district health board that prefers not to be identified. In his spare time, he writes a bi-monthly column of alternative (sometimes amusing or irreverent but always challenging) musings on our profession.
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|Title Annotation:||(A) MUSING ON NURSING|
|Publication:||Kai Tiaki: Nursing New Zealand|
|Date:||Jul 1, 2009|
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