Surfacing nursing process: a method for generating nursing theory from practice

Abstract

The process dimension in nursing is far more complex than currently recognized. Lack of knowledge about process in nursing has consequences for professional development and nursing theory. A method for generating theory from systemic observation, description, identification and analysis of nursing practice is presented.

The Relationship of Nursing Theory to Practice and Research within the British Context: Identifying a Way Forward

“…Chenitz and Swanson (1984) exhorted nurses to direct their attention toward building knowledge directly from a systematic study of nursing experience. They asserted that nursing is a professional practice rather than an academic discipline and that the purpose of a practitioner scientist is to study ways to achieve change in various health measures.…”

The development of theory in British nursing: current position and future prospects

“…The failure of nursing theory to explam nursmg action m a way that nurses can understand pomts not to a refractory nursmg professton, but to madequate theory Two groups of reasons are proposed for this theory practice mismatch There are structural reasons, and philosophical reasons The structural reasons can be seen m the transatlantic ongm of all significant models of nursmg save that of Roper et al (1983) There are considerable cultural and professional differences between Amencan and Bntish nurstng, including the pnvate health care system and umversity-based professional education of the Amencans, and the responsibibty to demonstrate that these differences can be transcended and the theones applied to Bntish nursmg rests with those who import them As Miller suggests, the fact that undergraduate student nurses use these models as organizmg frameworks for patient care studies says more for their ingenuity as students than for the appropnateness of the models The philosophical reasons will now be dicussed Two fundamental philosophical onentations to the development of theory m science are descnbed by Harre (1972), each of which generates its own nwthodologies for research The inductive method is exemplified by the work of the philosopher J S Mill, and mvolves a process of reasoning begmnmg with evidence drawn from observation, and passing to the formulation of theory An example of mductively-based work m nursing is that of Jeffry (1979) who observed casualty department staff categorizing patients accordmg to their de^ee of worth or deservingness, and Melia (1982) who used an inductive methodology to examine the construction of the nursmg world by student nurses Methods based upon the philosophy of deduction take as their starting pomt existing theory, often drawn from scientific disciplines other than nursing, and then use it to explain and explore the nursmg world It IS argued that the failure of existmg models of nursmg to reflect the reality of the nursing world and therefore to significantly mfluence nursmg practice ts due both to the structural reasons described above, and m some mstemces to an mappropnate reliance on theory drawn from other sctentific fields Walker (1983) for instance, ates Johnson in her argument that nursmg science is essentially denvative in nature Tundamental to Johnson's position was the idea that nursing saence as applied saence was dependent on other disaplmes for the stuff from which nursing science was then reconstructed While nursing concepts might be called new, they would be realigned or redefined concepts from other disaplmes' So Riehl's model draws upon symbohc interactionist theory, Roy's model draws upon systems theory, and Roger's Unitary Field Model is based on the concept of hohsm which is developed from elements m ancient onental wntmg Chenitz & Swanson (1984) argue agamst this process 'We cannot expect to generate theory speafic to nursmg by testing theones and concepts developed for the puposes of other disapbnes Research guided by Maslow's theory adapted to nursing will feedback to refine, elaborate and correct Maslow's theory'…”

Os clientes e os enfermeiros: construção de uma relação

“…Não, de todo. Entendo tão só, na linha de pensamento de alguns (11,13,31) , que o processo de enfermagem é, em primeira análise, o processo de raciocínio clí-nico do enfermeiro e que as características do mesmo poderão estar relacionadas com o contexto onde aquele desenvolve a sua prática de cuidados. Por esta ordem de ideias, entendo ainda que o mesmo carece de ser investigado, desvendando-se não só as características do processo, mas também as características do diagnóstico propriamente dito.…”

“…Por esta ordem de ideias, entendo ainda que o mesmo carece de ser investigado, desvendando-se não só as características do processo, mas também as características do diagnóstico propriamente dito. É também nesse sentido que outros (31) propuseram um sistema que denominaram como "trazendo à superfície o processo de enfermagem". Este consiste basicamente no desenvolvimento de um trabalho indutivo que permita identificar sistematicamente, descrever e analisar a dimensão processual de enfermagem inerente e enraizada na prática quotidiana.…”