Portal de Periódicos da CAPES

Editorial: Valuing the knowledge of nursing: naming it and making it visible

2016; Wiley; Volume: 25; Issue: 13-14 Linguagem: Inglês

10.1111/jocn.13332

1365-2702

Dickon Weir‐Hughes,

Health Sciences Research and Education

Whatever happened to the knowledge of our discipline? Miss Florence Nightingale is often credited as the first nursing theorist. She wrote, particularly, about environment theory or, the impact (both negative and positive) of an environment on human beings and of the knowledge she generated about environmental impact on care in places like Scutari during the Crimean war. This knowledge became the underpinnings of ‘modern’ nursing theory, particularly in relation to hospital design. The 1960s and 1970s, in particular, saw an emergence of a range of other theories and models mainly generated by an amazing group of American nurse academics. Margaret Newman, Martha Rogers and Sister Calista Roy were especially important to me. For others, it might have been Hildegarde Peplau or Dorothea Orem. But therein lies the beauty of nursing theory. It is complex, overlapping, can create confusion, and to the reflective nurse, an internal debate. It is a smorgasbord of knowledge on which you can draw. For me, that has been the excitement of theory. As a young staff nurse in a highly complex neurosurgical unit in London, UK, I encountered a confusing constellation of human responses to assaults (both literal and metaphorical) on individual's neurological systems. In the now almost forgotten years before the introduction of the car seat belt law in UK, we saw some of the most war-like injuries, ever seen in peacetime, and these almost on a daily basis. It was impossible to piece the human needs of these complex patients together in a meaningful way, with anything other than a task list. So with the challenges that I saw before me as a young staff nurse in neurosurgery, I felt an incredible sense of relief when I turned to the literature and found the wise and explanatory words of those insightful and reflective academic nurses who helped me to piece together the manifestly variable (yet privileged) challenges of clinical nursing. I enjoyed the fact that Newman's Health and Expanding Consciousness theory (Newman 1986) would help me to understand and meet the demands of one situation and Orem's Self Care theory (Orem 1991) would help me in another. By the same token, I took exception to the ‘we-do-King's-model; on-this-unit’ approach that I later found in my leadership practice. I struggled with the linear, singular and dogmatic approach to the use of nursing theories (as I did with the theories that were awkwardly converted into nursing assessment tools) in favour of choosing theory neutral assessment tools that were still strongly grounded in evidence-based nursing practice, such as Gordon's Functional Health Patterns (Gordon 1994). As the years have gone by I have tended to think more broadly about nursing theory, now favouring an approach where theory includes those traditional theories but also, for example, Corner's evidence-based model of nurse-led breathlessness clinics in cancer care (Corner & O'Driscoll 1999) and the plethora of middle range theory that has emerged from volunteer nurse scientists and that now forms NANDA International's Nursing Diagnoses definitions and classifications. This work defines the clinical, front line knowledge of our discipline and if used properly, can enable nurses to consistently describe, communicate, research and teach the phenomena of concern to nurses. We know that this focus on nursing knowledge makes a clinical difference to nurse-sensitive outcomes (Muller-Staub et al. 2007) so why, now, is so much of this work so studiously ignored? Why do we see the knowledge of our discipline being neutralised? Our failure to articulate the knowledge of our discipline and to value that knowledge seems to permeate the knowledge and attitudes of others too. How often, for example, do we come across nursing assistants who genuinely believe that they ‘do everything a Registered Nurse can “do” apart from giving drugs’. I do not blame them for thinking that nursing is a series of tasks when, we, their role models, fail to articulate that professional nursing is also about what goes on in our heads and not just what we do with our hands. In the UK, we have seen firsthand the implications of nursing losing its way, and as professional nurses we must step up and take responsibility. Do we really believe that professional nursing is simply about being a ‘trained’ doer with a knowledge base cobbled together from the work of other disciplines? This approach is often sold as a move towards multi-disciplinary care and education. Linked to this is a drive towards multi-disciplinary education that has seen the removal of the word ‘nursing’ from the titles of all sorts of nursing courses, including some graduate and undergraduate degrees, and even vocational courses. Although often defended on the basis that naming a course as a nursing course might reduce the potential appeal of the course to non-nurses, it has had the effect of diminishing nursing and the knowledge associated with nursing. There are considerable implications of making nursing invisible in this way. I would argue that one can only be an effective member of a multi-disciplinary team with a thorough understanding of one's own role and a strong underpinning knowledge of the evidence and theory of one's own discipline. Furthermore, we have now ended up with an almost unintelligible array of meaningless job titles (such as ‘advanced clinical practitioner’) that seem almost designed to confuse patients and carers. But it is more than this – perhaps a form of cultural cringe – a feeling that nurses do not want to be called nurses any more. While the aim may be ostensibly be to make courses more inclusive, and attractive to a wider range of potential students, it has the effect of removing the pride in our profession and diminishing our professional cultural identity. There is nothing more devaluing and disabling than removing the name of one's profession. The tendency towards this seems to be peculiar to (some institutions) in the UK, as many other countries still appear to value the distinct knowledge base of nursing sufficiently to enable it to be named in course and degree titles. As a profession, we must resist moves to make nursing invisible in courses and programmes. It is so important that all nursing courses, including advanced degrees in nursing, have a strong and identifiable thread of nursing knowledge. Nurses bring a unique quality and a distinct knowledge base to healthcare. If, as nurses, we don't value the knowledge of nursing, and articulate that knowledge and the difference it makes to safe and high quality patient care we cannot expect anyone else to. It is not acceptable that nurses who are seeking further their education to become more advanced practitioners are offered courses that make their profession invisible, and become morphed into neutrally educated generic workers. My greatest fear is that it is almost too late to turn the tide but it is crucial that, as a profession, we begin to address this sorry state of affairs.