More Questions

Some scholars have observed that there is a plethora of nursing theories—mostly theories that are considered middle-range. More recently, this author was exposed to the notion that advanced practice nurses might consider using a variety of nursing theories to underpin their practice depending on what diseases the persons they are working with are experiencing. Then, an illogical thought surfaced: Maybe if middle-range theories continue to proliferate, there might be a theory for every patient some day!

Then veracity took hold. First of all, the discipline and/or profession or professional discipline of nursing has not yet come to any consensus on one worldview, much less one conceptual-theoretical-empirical (C-T-E) system of nursing knowledge to close the theory-research-practice gap (Fawcett & DeSanto-Madeya, 2013). Second, a healthcare organization would generally shy away from encouraging the use of many different nursing theories in one institution. It would be a logistical nightmare especially when it came to documentation, much less how one was to be with persons served by nursing. Moreover, according to Fawcett and DeSanto-Madeya, most conceptual nursing models and nursing theories are broad enough to accommodate all participants. Lastly, nurses have a difficult enough time pondering how nursing theories underpin their practice, let alone struggling to become proficient in several or many. This author was gratified to see that Fawcett and DeSanto-Madeya concur and recommend “that just one conceptual model or theory be selected for initial use on all nursing units of a healthcare institution” (p. 36). The nurse executives of the world are grateful. (Note: This does not really address what one does if one is working in an organization that selects a nursing theory from a different perspective than one’s own … and that is for discussion on another day.)

Regarding the notion that there are too many nursing theories, one could consider this conundrum from a different perspective. If nursing wants to be considered as a stand-alone science, should not nursing applaud nurses who continue their education to the doctoral level or the nurses who have enough interest in phenomena and participants’ experiences with a phenomenon to make it their life’s work? From another entirely different perspective, one could question, Is the proliferation of middle-range theories the nature of normal science as defined by Kuhn and where the discipline of nursing currently is in its own scientific revolution? This author has no answers today; rather this author is just providing food for thought.

Other questions that surfaced in reading Fawcett and DeSanto-Madeya’s (2013) book Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories, the book that is reviewed here this quarter, are as follows: What would Kuhn (1996) say about nursing’s competing paradigms? Does the professional nurse at the bedside consider theory as the basis of evidence-based nursing practice? Has anyone created a pocket guide reference on the various nursing theory textbooks and their differences and similarities or on which author calls which nursing body of work a conceptual model as opposed to a grand theory or a middle-range theory? Another question that surfaced for this author was as follows: Will nursing ever have a doctorate entry level to professional nursing, or how can the global community with its current model of bundled payments meet the expense of fee-for-nursing-service? Lastly, is there an emerging nursing worldview that could encompass all the current worldviews in nursing?

On that note, there are two reviewers for Fawcett and DeSanto-Madeya’s (2013) thought-provoking text Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories: Drs. Thomas Blodgett and Michelle Block. Let us see what they have to say.