Guest Editorial: On bed baths and conceptual models of nursing

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What, you may ask, do bed baths and conceptual models of nursing have in common? The answer, which should be disturbing, is that many registered nurses have discarded both in favour of other activities and other frames of reference. Bed baths have been declared a far too simple and unimportant activity for registered nurses. Nursing assistants or multiservice support workers now perform what once was thought to be a ‘sacred’ activity that fostered an intimacy between nurse and patient while, at the same time, allowing the nurse to thoroughly assess the patient, make plans with the patient for other care, and initiate patient teaching and other nursing interventions (Niblett 1997). And what of the fate of conceptual models? Some nurses have declared that conceptual models of nursing are ‘dinosaurs’ that are irrelevant for contemporary research and practice, recommending that books about conceptual models of nursing be relegated to the dusty shelves of library stacks. Increasingly, nurses are turning to the conceptual models of other disciplines as guides for their research and their practice.

If readers consider the discarding of bed baths and conceptual models of nursing as acceptable, I submit that they are contributing to the extinction of the discipline of nursing. Or perhaps the readers who do find these developments to be acceptable do not understand what a discipline is or even agree that nursing should be a discipline. The term ‘discipline’ comes from the Latin disciplina, meaning a branch of instruction or learning. Disciplines are distinguished by the unique way in which their members view and develop certain phenomena. The phenomena, or subject matter, of interest to the members of disciplines encompass conceptual models and theories that are sufficiently ordered that they can be communicated and taught to others. Each discipline claims a distinctive body of knowledge and specifies the ways in which that knowledge is generated, tested, and used.

I have long argued that each abstract and general conceptual model of nursing presents a distinctive perspective of the phenomena of interest to nursing (human beings, environment, health, nursing). In addition, I have explained that each conceptual model of nursing includes guidelines for the generation and testing of more concrete and specific theories, as well as guidelines for their use in nursing education programs, administration of nursing services, and nursing practice (Fawcett 1984). Conceptual models of nursing, then, are the foundation on which claims of disciplinary status for nursing rest. If we were to discard this foundation, we would have no right to expect recognition as fellow professionals by physicians, social workers, therapists and health care administrators. We also would have no right to practice autonomously, which is a long-espoused goal of many members of the nursing profession.

Without the foundation provided by conceptual models of nursing, we are nothing more – or less – than skilled tradespeople. Certainly the members of skilled trades contribute a great deal to society. Who, for example, can do without carpenters and electricians and plumbers? But is being regarded as members of a skilled trade what nurses really want?

I think we really want nursing to be recognized as a distinct discipline, with all its rights and privileges. I think we really want to develop, disseminate, use, and evaluate explicit nursing discipline-specific knowledge. I think we really want to conduct nursing discipline-specific research and to engage in nursing discipline-specific practice, using nursing discipline-specific research and practice methodologies.

How, then, did we get to the point in our evolution where some of us have discarded the foundation of our discipline-specific activities? Have we become enamoured of thinking of ourselves as victims of the physicians and healthcare administrators who we are so fond of accusing of oppressing us by not allowing us to practice autonomously? Anderson (2000) thinks that is the case. She maintained that nursing ‘is a culture that values doing more than thinking. A culture that values or at least tolerates being oppressed’ (p. 53). Viewing ourselves as oppressed may provide an answer to why we have come to the point of discarding our nursing discipline-specific knowledge in favour of developing and using knowledge from other disciplines. But valuing doing more than thinking, which is a characteristic of an oppressed group, does not explain why we have discarded the bed bath (and other so-called ‘basic’ nursing activities).

Could it be that we are in the midst of a period of great ambivalence about the fundamental nature of nursing? Could it be that we just don't know what we want to be and how to be whatever that is? I submit that our ambivalence would be resolved in favour of a clear directive to advance the discipline of nursing if nurse educators, practicing nurses, nurse researchers, nurse reviewers of manuscripts and research grant applications, nursing journal editors, and nursing editors at publishing houses would individually and collectively become enamoured of the idea of being champions of nursing discipline-specific knowledge.

Becoming a champion of nursing discipline-specific knowledge requires a commitment by nurse educators to adopt conceptual models of nursing as the guide for their educational programs. The focus of all nursing courses must be on nursing phenomena and nursing activities. If the educators think that students need exposure to knowledge from other disciplines, then the curriculum can include course work in those disciplines. But nursing courses must present nursing knowledge and the practical activities that derive from that knowledge.

Becoming a champion of nursing discipline-specific knowledge requires a commitment by practicing nurses to perform activities that are specifically associated with conceptual models of nursing. If the knowledge underpinning an activity cannot be traced to a conceptual model of nursing, nurses should not perform that activity. Many of the activities that nurses currently perform are to carry out physicians' orders and cannot be traced to a conceptual model of nursing. I would go so far as to say that those activities therefore should not be performed by nurses. Instead, physicians should assume responsibility for performing the activities they order, and nurses should write orders for nursing activities.

Becoming a champion of nursing discipline-specific knowledge requires a commitment by nurse researchers to adopt conceptual models of nursing as the guide for their programmes of research. If the knowledge underpinning the study of some phenomenon cannot be traced to a conceptual model of nursing, nurses should not conduct the study. Although such a study may be of interest to nurses, the subject matter belongs to another discipline and the members of that discipline therefore should be the ones to conduct the study. When nurses conduct such studies, they contribute to the advancement of the other discipline, not to the discipline of nursing.

Becoming a champion of nursing discipline-specific knowledge requires a commitment by nurse reviewers of manuscripts and research grant applications, nursing journal editors, and nursing editors at publishing houses to require that each manuscript for a journal article or a book, and each application for funded research, should include a fully integrated conceptual model of nursing as the guide for the work. In other words, editors and funding agencies will have to institute policies that mandate a focus on nursing discipline-specific knowledge. Reviewers will have to agree with those policies and provide critiques of the manuscripts and research grant applications that emphasize the extent to which the conceptual model of nursing used by the author is integrated fully into the manuscript or research grant application.

I can only hope that enough nurses will make a commitment to becoming champions of nursing discipline-specific knowledge that our discipline will survive and that we may continue to provide a valued and respected service to human beings. I can only hope that all nurses will embrace both bed baths and conceptual models of nursing. Paraphrasing Isaac Newton (1676/1998), I can only hope that we will stand on the shoulders of the giants of nursing to see further and to build on, not discard, the foundations they laid down for the discipline of nursing.

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