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Connection Between Theory and Advanced Clinical Practice: NR 501 Week 4
While this course focuses on nursing theory, some nurses believe that theory plays no role in clinical practice. What are your thoughts on this? Is there a place for nursing theory in clinical practice? How would you apply nursing theory to improve or assess clinical practice quality? Include an example that demonstrates your point of view. Remember to include a scholarly reference!
Theoretical Foundations of Advanced Clinical Practice SAMPLE INTRODUCTION
I am a firm believer in the importance of theories in daily nursing practice and future nursing development. According to Ahtisham and Jacoline (2015), theoretical research is routinely applied as systematic evidence for critical thinking and decision making,
Connection Between Theory and Advanced Clinical Practice NR 501 Week 4
enhancing a nurse’s professional control. Good patient quality care is characterized by characteristics of optimal and excellent care, as approved by patients, and should be based on nursing theory, which serves as the foundation of clinical practice. In order to provide a broad interpretation of the major concepts in nursing, grand nursing theories are identified by nonspecific and abstract concepts. When deciding to develop a grand nursing theory, it is critical to consider all four nursing paradigms: health, person, environment, and nursing. The original nursing theories that established a foundation and structure for nursing practice were known as grand nursing theories.
SAMPLE RESPONSE
A…, what interesting examples of the application of Henderson’s needs theory.
Henderson did not set out to create a nursing theory (Virginia Henderson, address to Sigma Theta Tau, about 1984). She was trying to describe nursing and set up a framework for nursing education.
One very important statement you made reminded us that nursing is a very thoughtful profession. While some theories (such as the grand theories) become so ingrained in our sense of what nursing is that we proceed with our daily caring without a conscious thought of application. It becomes who we are as nurses. Yet when we encounter a problem, we “activate” those theories that are within and also look for others that may be of heap. Well said A!
The theory of nursing, as we will refer to it, contains both the medical and nursing scientific information that has been transmitted to the trainee, mostly in nursing school, and the rules of thumb that have been acquired primarily via on-the-job training and experience.
Medical scientific knowledge is a very self-explanatory term.
Such information is based mostly on chemistry and biology, and it predicts, among other things, changes in chemical concentrations and biological events that will occur as a result of certain invasive actions.
If you notice the following phenomenon, you should take the following action, according to standard rules of thumb.
These are solid nursing practice standards that have evolved over time and are based on experience, but they often apply to circumstances that are too complex to be analyzed in purely scientific terms.
The real on-the-job behavior of experienced nurses regarded experts by their colleagues and managers is referred to as nursing practice.
Is this expert coping behavior the product of theory implementation?
Is what is taught through experience more than just a more polished and delicate theory?
If that’s the case, what is it?
What causes it to happen?
How can it be rewarded and encouraged?
These are the topics that will be discussed in this book.
In a nutshell, we will demonstrate that, while practice without theory cannot yield fully trained behavior in complicated coping domains like nursing, theory without practice has a much lower chance of success.
In brief, as a nursing graduate builds skill, theory and practice interact in a mutually helpful bootstrapping process.
Full skill can only be realized if both are nurtured and valued.
Since our Western way of being human was first articulated in ancient Greece, the relationship between theory and practice, as well as between reason and intuition, has been a source of worry for our society.
And, despite the fact that it is rarely mentioned, the ostensibly Greek science of medicine played a key part in the early stages of cultural self-determination.
Nursing, it turns out, has a twin element that gives it a unique place in our knowledge of what Western man has become 2,000 years later in our modern world.
Nursing has the responsibility of implementing medical theory, exposing both the power and limits of this and any other theory now that medicine has become a theoretical science.
Furthermore, nursing as a caring profession goes beyond theory and demonstrates that when human meaning is at stake, a level of intuition that can never be represented by logical theory is required.
As a result, nursing practice demonstrates what 2,000 years of Western thought has sought to deny: that theory is based on practice, and reason necessitates intuition.
To grasp the complex relationship between theory and practice, as well as reason and intuition in nursing practice, we must go back to Hippocrates’ attempt to transform medicine from folk wisdom to a scientific art of healing.
Simultaneously, Socrates, born in 469 BC, 9 years after Hippocrates, was attempting to comprehend this new intellectual achievement, of which medicine was only one example.
Around 400 BC, physics, astronomy, and geometry had separated themselves from ordinary, practical measurement and counting, and philosophers wondered what made these new studies so unique.
The answer was that these new disciplines were based on theory, as proposed by Socrates and improved by philosophical tradition.
There are five fundamental properties of theory.
Socrates was the one who identified the first three.
(1) Discretion.
A theory should ideally not be reliant on intuition and interpretation, but rather be set out in such a way that any rational being may comprehend it.
(2) The concept of universality
Theorems should be valid in all places and at all times.
(3) Abstraction is a term used to describe a state of being detached from reality.
A theory should not necessitate the use of specific examples.
Socrates presupposes these requirements in the Euthyphro, when he assumes that moral behavior must be based on abstract, universal principles, and thus asks the prophet Euthyphro to justify his behavior by providing an explicit, universal, and abstract definition of piety, scorning Euthyphro’s appeal to examples and his own special intuition.
Descartes (1641/1960) and Kant (1963) added two more conditions to the Socratic account of theory:
(4) Reliability.
A theory must be expressed in terms of isolated elements such as features, factors, attributes, data points, cues, and so on, which we now refer to as features, factors, attributes, data points, cues, and so on—isolable elements that have nothing to do with human interests, traditions, institutions, and so on.
(5) Consistency.
A theory should be a new whole in which decontextualized pieces are linked by rules or laws.
The theorist must remove his object of knowledge from the everyday, perceptual, social reality in order to see the universal relations between the explicit and abstract elements—in this case, the ideas—as expressed by Plato in the cave myth.
The elements, stripped of all context, form their own system—all of Plato’s ideas are arranged around the concept of the Good.
Plato observed that, whereas ordinary understanding is implicit, tangible, local, holistic, and partial, theories are explicit, abstract, universal, and encompass a wide variety of parts structured into a new comprehensive whole.
What do these new theoretical disciplines have to do with everyday practice, was another issue.
Medicine was the most popular example given in response to this question.
Hippocrates claimed to have a theory that taught physicians what to do, unlike physics, astronomy, and geometry, which were all abstract.
Socrates praised Hippocrates for this reason, and the new medicine was held up as a model of knowledge for philosophers to study.
“A philosophical physician resembles a god,” Hippocrates responded to the praise.
Socrates’ inquiry became, “How is a theory-based craft such as medicine different from skills based on rules of thumb such as stonecutting and cooking?”
His response arose from two observations, both of which have important implications for our modern lives.
Both were accurate medical observations, but Socrates, like any good philosopher, overgeneralized them.
He noticed that doctors claimed to be able to explain why they did what they did, and that their explanations were founded on principles that could be seen to rationally follow the behavior in question.
In Gorgias (Plato, 1937), Socrates generalizes these observations, claiming that every craft must contain “principles of action and reason” (p. 501a).
Socrates ruled out all forms of intuitive knowledge that do not appear to be based on any principles at all because he said that a craft or techne must be based on a theory that can be articulated by the practitioners.
Unlike medicine, cooking, for example, is “unable to provide any account of the nature of the methods it employs” (Plato, 1937, p. 465a).
It “never considers or calculates anything” and “goes right to its conclusion” (p. 465a).
Socrates believes that such intuitive talents are not crafts at all, and that professionals in these fields possess only a knack rather than understanding.
This is true for intuitive professionals ranging from basketball players to chess masters to brilliant musicians, who are all unable to express rational principles based on a theory to explain what they do.
Socrates believed that these kind of experts were little more than cunning crowd pleasers who relied on hunches and lucky guesses.
Only experts, such as doctors, possessed solid, dependable knowledge because they could explain why they did what they did.
Cooks have a flair for making food taste nice, according to Plato, but only doctors know what is good for you and why.
But this bothered Socrates, because skillful statesmen, heroes, and religious prophets did not claim to be working on principles like doctors, and hence appeared to be on par with cooks.
Socrates set out to see if such experts were acting on the basis of theories or not.
By eliciting norms or principles from professionals in these fields, he wanted to demonstrate that morality and statesmanship were actually crafts.
Socrates, for example, assumes that Euthyphro, a religious prophet, is an expert at recognizing piety in his dialogue Euthyphro (Plato, 1937), and thus asks Euthyphro for his piety recognizing rule: “I want to know what is characteristic of piety…to use as a standard whereby to judge your actions and those of other men” (p. 6e3–6).
He’s looking for a principle that will anchor piety in theory and therefore make it knowable.
Euthyphro responds to this requirement in the same way that any expert would.
He gives Socrates instances from his field of expertise—in this case, mythical historical scenarios in which men and gods did actions that everyone considers devout.
In Laches (Plato, 1937), Socrates poses the identical question to Laches, apparently a courage expert: “What is that common attribute, which is the same in all circumstances, and which is termed courage?”
(p. 191e), but no rules are given.
This led Socrates to the famous conclusion that, because prophets and heroes could not enunciate the consistent, context-free principles that supply the rationale for their actions in the same way that doctors could explain their prescriptions, all of their abilities were only talents.
Even doctors couldn’t come up with a fully developed and tested medical theory when they were just getting started.
So, since no one passed his knowledge test, Socrates grudgingly concluded that no one understood anything at all—not a promising start for Western philosophy.
This is where Plato stepped in to help Socrates.
Plato claimed that specialists operated on principles they didn’t understand.
He maintained that experts had mastered the ideas involved in a previous life, at least in areas involving non-empirical knowledge such as morals and mathematics, but had forgotten them.
The philosopher’s function was to assist moral and mathematical specialists in remembering the principles on which they were acting.
These concepts would serve as a foundation for the expertise.
Knowledge must be “fastened by cause-and-effect reasoning,” which is accomplished through “recollection” (Meno Plato, 1937, p. 98a).
Aristotle believed something fundamental had been left out of Plato’s medical model of knowledge a generation after Plato.
Rather of recognizing the ability to give explanations for their actions—like doctors do—as a test of expertise, Aristotle regards an experienced artisan as having an immediate, unreasoned, intuitive response.
“Art (techne) does not deliberate,” Aristotle writes in his book Physics.
(Chapter 8 of Physics Book II, p. 200b)
Furthermore, even if there were universal rules based on a theory, Aristotle was clear that intuitive insight was required to recognize how the principles applied in each circumstance.
“It is not easy to find a formula by which we may define how far and up to what point a man may go wrong before he incurs blame,” he says, citing Plato’s belief that ethics must be based on universal laws (Aristotle, 1952, Physics Book, Ch. 8 199b).
“However, this problem of definition is inherent in every object of perception: such degree questions are bound up with the conditions of the individual situation, where our only criterion is perception,” he continues (p. 199b).
Of course, the same could be said for medication.
The two areas where theory intersects with the concrete issue, diagnosis and therapy, would necessitate intuition and experience.
Aristotle was absolutely correct.
Expert diagnostic methods, such as the computer programs MYCIN and INTERNIST, which are based on principles but lack intuition and judgment, outperform nonexperts but fall short of capturing the competence of specialists.
The Journal of the American Medical Association published a systematic review of MYCIN (Yu et al., 1979).
MYCIN was given data from 10 real-life meningitis cases and asked to suggest medication.
A panel of eight infectious disease specialists who have written clinical papers on the therapy of meningitis reviewed its prescriptions.
70% of MYCIN’s recommended therapy were deemed acceptable by these specialists (Yu et a1.).
The evidence for INTERNIST-1 is significantly more comprehensive.
“The systematic examination of the model’s performance is essentially unprecedented in the world of medical applications of artificial intelligence,” according to The New England Journal of Medicine, which released an evaluation of the program (Miller, Harry, Pople, & Myers, 1982).
“The experienced clinician is considerably superior to INTERNIST-1 in terms of considering the relative severity and independence of the various signs of disease, as well as understanding the temporal progression of the disease process,” the evaluators concluded (p. 476).
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