E ditorial
Nursing models redundant in practice S
omething very exciting appears to be happening in nursing in the U K. Well, some will regard it as excit ing, others will greet it with horror, scorn and derision. I believe we are starting to explore the real essence of nursing, the intuitive rather than the empirical. Over the past 20 years, nurse theorists, largely from North America, have valiantly struggled with the em pirical, i.e. have tried to define nursing and create grand frameworks, models and theories in an attempt to move the profession forward. The gains have been considerable. Not only has a huge body of knowledge developed, but there has also been a thorough and stimulating exploration of our profes sion. However, with the exception of a few, the theorists seem to have missed the mark. For example, Orem, Neuman and Roy may well be very interesting, but do they capture the real essence of nursing? I think not. I find little more than some fancy language camouflaging the traditional medical and reductionist views of nursing. They still divide people into a series of systems and the only real difference be tween ‘traditional’ and ‘model-based’ nursing is the labels we attach to them. Instead of the reductionist lo comotive, gastrointestinal and respiratory systems of old, we now speak of ‘mobility’, ,‘eating and drinking’ and ‘breathing’. Instead of disease, we talk of ‘intrapersonal’ or ‘extrapersonal stressors’. These models have produced only ‘technical knowledge’ (Silva and Rothbart, 1984). Can this be counted as progress? In one sense it can, and this stage in the development of a nursing science certainly needs to be valued. The exploration of the model or theory base is an essential step in the journey towards discovering the true essence of nursing. However, has the almost wholesale rejection of nursing models and theory occurred because practis ing nurses recognize, intuitively, that they do not cap ture this essence? The second part of the journey has begun with the emphasis of nursing study moving away from the previ ously predominant empirical natural science definitions in favour of much more abstract explorations of the hu man science process. There is the growing realization, perhaps initially prompted by Carper (1978), that nurs ing comprises much more than just empirical knowledge and is beginning to value the aesthetic, the art and the process of nursing. We are starting to value the more abstract, tacit and personal areas of knowledge. As examples of this we need only consider the move away from disease-orientated nursing textbooks (that took up all the space on my bookshelves during my training), towards those that explore real nursing and real nursing knowledge, e.g. Robinson and Vaughan (1992) and Mor rison and Burnard (1991); the move from writing case studies towards keeping reflective journals; Philip Darbyshire’s ‘storytelling’; the exploration of concepts such as ‘caring’ (Bottorff, 1991); and the move towards British Journal of Nursing, !992,Vol l,N o5
valuing feminist ways of knowing (Belenky et al, 1986) that are much more applicable to the nursing culture. As stated earlier, such developments will horrify some, particularly those in the medical and natural science communities who continue to cling to the em pirical and insist on empirical testing, sometimes even of abstract ideas, e.g. Robinson (1992). An idea that is fatally flawed as an abstract idea per se need not, indeed cannot, be tested. It is essential to place less emphasis on empirical testing as a justification for our actions and to start acknowledging the value of intuition, which is, after all, the most compelling criterion of truth (Polanyi, 1958; Sarter, 1988). It is necessary to start discovering the true essence of nursing without entirely forgetting our empirical in heritance. Let us follow our intuition, pay less attention to our earlier follies, place greater value on practical ex periences and move on to explore the human sciences and nursing concepts that include ‘presencing’, ‘being with’, ‘caring’ and ‘loving’. Perhaps only then can we discover the real essence of nursing and have a positive impact on improving the quality of patient care. W
branas Biley Lecturer in Nursing School o f Nursing Studies University o f Wales College o f Medicine Heath Park Cardiff CF4 4XN Belenky MC, Clinchy BM, Goldberger NR, Tarule JM (1986) Women's Ways of knowing: The Development oj Self, Voice ana Mind. Basic Books, New York Bottorff JL (1991) Nursing: A practical science of caring. Adv Nurs S a 14(1): 26-39 Carper BA (1978) Fundamental patterns of knowing in nursing. Adv Nurs Set 1(1): 13-23 . Morrison P, Burnard P (1991) Caring and Communicating: The Inter personal Relationship in Nursing. Macmillan, Basingstoke Polanyi M (1958) Personal Knowledge. Routledge and Regan Paul, London . Robinson JJ (1992) Problems with paradigms in a caring profession. / Adv Nurs 17: 632-8 Robinson K, Vaughan B (1992) Knowledge for Nursing Practice. Butterworth Heinemann, Oxford Sarter B (1988) The Stream of Becoming: A Study of Martha Roger's Theory. National League for Nursing, New York Silva M, Rothbart D (1984) An analysis of changing trends in philos ophies of sciences on nursing theory development and testing. Adv Nurs Sci 6: 1-13
Correspondence If you have any comments on this or any other article in the journal, please write to:
Managing Editor British Journal of Nursing Croxted Mews 288 Croxted Road London SE24 9DA
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 203.002.032.208 on October 18, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
Nursing models redundant in practice S
omething very exciting appears to be happening in nursing in the U K. Well, some will regard it as excit ing, others will greet it with horror, scorn and derision. I believe we are starting to explore the real essence of nursing, the intuitive rather than the empirical. Over the past 20 years, nurse theorists, largely from North America, have valiantly struggled with the em pirical, i.e. have tried to define nursing and create grand frameworks, models and theories in an attempt to move the profession forward. The gains have been considerable. Not only has a huge body of knowledge developed, but there has also been a thorough and stimulating exploration of our profes sion. However, with the exception of a few, the theorists seem to have missed the mark. For example, Orem, Neuman and Roy may well be very interesting, but do they capture the real essence of nursing? I think not. I find little more than some fancy language camouflaging the traditional medical and reductionist views of nursing. They still divide people into a series of systems and the only real difference be tween ‘traditional’ and ‘model-based’ nursing is the labels we attach to them. Instead of the reductionist lo comotive, gastrointestinal and respiratory systems of old, we now speak of ‘mobility’, ,‘eating and drinking’ and ‘breathing’. Instead of disease, we talk of ‘intrapersonal’ or ‘extrapersonal stressors’. These models have produced only ‘technical knowledge’ (Silva and Rothbart, 1984). Can this be counted as progress? In one sense it can, and this stage in the development of a nursing science certainly needs to be valued. The exploration of the model or theory base is an essential step in the journey towards discovering the true essence of nursing. However, has the almost wholesale rejection of nursing models and theory occurred because practis ing nurses recognize, intuitively, that they do not cap ture this essence? The second part of the journey has begun with the emphasis of nursing study moving away from the previ ously predominant empirical natural science definitions in favour of much more abstract explorations of the hu man science process. There is the growing realization, perhaps initially prompted by Carper (1978), that nurs ing comprises much more than just empirical knowledge and is beginning to value the aesthetic, the art and the process of nursing. We are starting to value the more abstract, tacit and personal areas of knowledge. As examples of this we need only consider the move away from disease-orientated nursing textbooks (that took up all the space on my bookshelves during my training), towards those that explore real nursing and real nursing knowledge, e.g. Robinson and Vaughan (1992) and Mor rison and Burnard (1991); the move from writing case studies towards keeping reflective journals; Philip Darbyshire’s ‘storytelling’; the exploration of concepts such as ‘caring’ (Bottorff, 1991); and the move towards British Journal of Nursing, !992,Vol l,N o5
valuing feminist ways of knowing (Belenky et al, 1986) that are much more applicable to the nursing culture. As stated earlier, such developments will horrify some, particularly those in the medical and natural science communities who continue to cling to the em pirical and insist on empirical testing, sometimes even of abstract ideas, e.g. Robinson (1992). An idea that is fatally flawed as an abstract idea per se need not, indeed cannot, be tested. It is essential to place less emphasis on empirical testing as a justification for our actions and to start acknowledging the value of intuition, which is, after all, the most compelling criterion of truth (Polanyi, 1958; Sarter, 1988). It is necessary to start discovering the true essence of nursing without entirely forgetting our empirical in heritance. Let us follow our intuition, pay less attention to our earlier follies, place greater value on practical ex periences and move on to explore the human sciences and nursing concepts that include ‘presencing’, ‘being with’, ‘caring’ and ‘loving’. Perhaps only then can we discover the real essence of nursing and have a positive impact on improving the quality of patient care. W
branas Biley Lecturer in Nursing School o f Nursing Studies University o f Wales College o f Medicine Heath Park Cardiff CF4 4XN Belenky MC, Clinchy BM, Goldberger NR, Tarule JM (1986) Women's Ways of knowing: The Development oj Self, Voice ana Mind. Basic Books, New York Bottorff JL (1991) Nursing: A practical science of caring. Adv Nurs S a 14(1): 26-39 Carper BA (1978) Fundamental patterns of knowing in nursing. Adv Nurs Set 1(1): 13-23 . Morrison P, Burnard P (1991) Caring and Communicating: The Inter personal Relationship in Nursing. Macmillan, Basingstoke Polanyi M (1958) Personal Knowledge. Routledge and Regan Paul, London . Robinson JJ (1992) Problems with paradigms in a caring profession. / Adv Nurs 17: 632-8 Robinson K, Vaughan B (1992) Knowledge for Nursing Practice. Butterworth Heinemann, Oxford Sarter B (1988) The Stream of Becoming: A Study of Martha Roger's Theory. National League for Nursing, New York Silva M, Rothbart D (1984) An analysis of changing trends in philos ophies of sciences on nursing theory development and testing. Adv Nurs Sci 6: 1-13
Correspondence If you have any comments on this or any other article in the journal, please write to:
Managing Editor British Journal of Nursing Croxted Mews 288 Croxted Road London SE24 9DA
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 203.002.032.208 on October 18, 2017. Use for licensed purposes only. No other uses without permission. All rights reserved.
