Understanding the Practical Application of Nursing Theory

As I began my education in nursing, nearly 20 years ago, I reflect on my transition from a student to my current role. Throughout my undergraduate education I often became confused and perplexed when my instructors discussed nursing theory, and to be quite honest; I became bored. I didn’t understand at that time how theory applied to my role as a nurse in the clinical setting. Scholars have defined theory in multiple ways but the definition that I relate to the most is that, theory “is a creative and rigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena (McEwen, Wills, 2014). This definition acknowledges that we develop global ideas (theories) based on the events that we observe in practice. Now,

I started nursing on the cusp of the transition from wearing all white and reciting “yes, doctor” to wearing scrub or lab coats and having collegial conversations with providers and making recommendations to providers to improve patient outcomes. I ask myself, “when did this happen”? Maybe, it wasn’t so much a cultural shift in nursing but maybe it was my own understanding of the role a nurse plays in patient care. Or, maybe it was both. Either way, this shift has played an instrumental role in my perception of nursing and my own career development. Nursing theory has been around since the time of Florence Nightingale but in recent years it has played an integral role in the way nursing is perceived. Nursing theories allow nursing to be purposeful by stating not only the focus of practice but specific goals and outcomes (McEwen, Wills, 2014). Gone are the days of completing tasks and orders but instead using theory to guide our plan of care. In my own practice theory has helped guide the role of the nurses in the ambulatory

Working in a neurosurgical practice we care for patients that have chronic pain, as well as acute pain due to structural issues. The gate control theory proposes that there are psychological components to pain as well as physiologic (McEwen, Wills, 2014). This theory can be applied on a daily basis with both operative and non-operative patients. Patients in the post-operative setting can have pain attributed to surgical intervention. But, why do patients, which have had the same procedure, experience pain at varying levels? Some patients may have anxiety related to the procedure or may have socio-economic burdens that contribute to fear, anxiety and helplessness when they discharge home. The nurse triaging these calls regarding pain must acknowledge the structural and psychological factors contributing to the pain and provide interventions to address both. Reviewing prescriptive pain options as well as discussing relaxation techniques may help a patient that has underlying anxiety in addition to physiologic pain. Many of our non-operative/chronic pain patients come to our clinic look for a surgical “fix” but often times there is not a structural issue that we can attribute to their pain. Prior to patients being seen they complete an assessment tool that quantifies their depression, anxiety and sleep habits. We use this tool to help determine a holistic care plan. Often times,