SCI晨读：护理理论教学还有价值吗？

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Introduction

Have you ever been on a ladder and felt like you were losing your footing? Or have you experienced your home's foundation settling or shifting only to find later that significant damage has occurred? These questions inform an intentional examination of the critical need to integrate theory as a thread within nursing education and determine its current position within the profession. In the quest to expand our existing body of knowledge, many believe nursing theory and its development are essential to preserving nursing as a unique science, distinct from the basic sciences from which it is collectively composed. Nursing curricula lay the groundwork for the discipline's philosophy, structure, knowledge, and practice. Thus, a curriculum that includes theories and theoretical thinking is also foundational to the continued advancement of our profession. Yet, current trends suggest a decline in the inclusion of nursing theory within curricula (Yancey, 2015). Are we witnessing nursing's theoretical foundation crumbling before our eyes because we have not created a blueprint to preserve it? While drafting this Editorial, we experienced firsthand significant difficulty retrieving current literature focused on the importance of infusing theory into nursing education. This experience stimulated the question, “Is there still value in teaching nursing theory?” This Editorial explores the significance of integrating theory into nursing education, the benefit of exposing students to it early in and throughout the curriculum, and the costs of failing to prepare students for their role as nurse theorists.

The American Association of Colleges of Nursing ([AACN]; 2021) recently revised the Essentials for Professional Nursing Education to better equip graduates to meet the increased demands of our current practice environment. One critical goal is to narrow the gap between nursing research, education, and practice. This revised framework acknowledges the significance of incorporating theory into nursing program curricula by suggesting that nursing practice should be shaped by a perspective grounded in its science. Furthermore, this science-based perspective is needed to collaborate with other health care professionals (AACN, 2021). Thus, AACN recommends that a theoretical perspective guide the academic preparation of students, which the organization addresses in the framework's first domain entitled, “Knowledge for Nursing Practice.” Although the directing framework does not explicitly state that curricula should be nursing theory-based, it explicitly indicates that the application of theory and research-based knowledge be derived “… from nursing, the arts, humanities, and other sciences” (AACN, 2021, p. 27).

As nurse educators, our ultimate goal is to direct students on their journeys toward knowledge acquisition, development, discernment, and implementation. In working toward this goal, students must be equipped with a fundamental understanding of nursing, its practice, and the occurrences of components essential to carry out both its art and science. Students must be introduced to nursing theory early and consistently throughout their formal educational instruction to achieve this goal. If you agree with this perspective, should we not expect nursing curricula to be grounded in nursing theory and begin the work of creating this reality? Deliberately framing nursing curricula within a nursing theoretical lens significantly increases the value in teaching and facilitates embracing theory as fundamental. Engaging in theory as foundational to nursing prepares students to implement it in their clinical practice, leadership roles, and future research endeavors as they advance in the profession.

Unfortunately, in today's academic environment, emphasis is often placed on increasing clinical and skills-focused content within curricula that will prepare students to effectively practice within the ever-changing health care environment while meeting the increasingly complex needs of patients. In adhering to such trends, faculty may minimize or remove content from curricula concentrated on the philosophical underpinnings and theoretical frameworks that guide the practice of nursing in an effort not to overwhelm students (Yancey, 2015). Unfortunately, this action devalues nursing theory. More importantly, minimizing or excluding nursing theory content from curricula does not equip students with the cognitive skills necessary to recognize theoretical and scientific aspects of their practice unique to nursing. In essence, eliminating nursing theory content from curricula is counterintuitive to meeting our goal of preparing students to provide care that meets the needs of complex patients. Further, without a clear theoretical foundation, students will be unable to synthesize factors that patients present with from a unique nursing perspective. Recognizing these factors through the lens of nursing is critical to expanding the science for the discipline.

Nursing program curricula, both undergraduate and graduate, will often begin with introductory courses that pose the question to students, “What is nursing?” Although this is an important question to help propel students during their nursing journey, we argue that this question cannot be effectively addressed without adequately preparing students with some theoretical context. Nursing theory and theory development have long since been identified as the “building blocks” that differentiate nursing from a task-oriented job to a distinguished profession (Walker & Avant, 2019). Consequently, it is essential that nursing programs curricula, at the very least, begin with a preview of theory to serve as the foundation upon which students' knowledge is gained and fostered. Establishing students' foundation in theory early in their education helps create the framework for approaching their developing practice and contributions to the profession. Rather than arbitrarily posing the question to students, “What is nursing,” perhaps we should use this question to help them recognize their role as emerging nurse theorists. Early exposure to theory establishes a strong foundation in nursing science. It prevents the profession from building onto a house settling into the ground without a solid foundation to support the shifting landscape of health care.

As previously mentioned, AACN (2021), in the revised Essentials for Professional Nursing Education, recognizes that a theoretical perspective grounded in nursing science is necessary for individuals practicing within an interdisciplinary health care environment. This sentiment is one that Rosemary Ellis also shared in 1969. In her article, The Practitioner as Theorist, she argued that for nurses, a theory is an organizational structure composed of concepts for the purpose of practice (Ellis, 1969). If we are preparing students to provide care for diverse patients experiencing complex medical conditions, then they must also be prepared to alter that care to meet each patient's individual needs. This alteration of care involves nurses' ability to translate theory into practice. Translating theory into practice expands upon the “building blocks” that serve as the foundation upon which we practice and helps to solidify further nurses' role in generating new knowledge and improving health care. Because providing health care is not a practice that is “one size fits all” and involves a compilation of skills developed from various areas, it is paramount that nurses recognize the unique contributions they bring to the interdisciplinary team.

Finally, equipping nurses to develop proficiency in their ability to address the complexity of patients involves embracing their role as a theorist. Most nurses, often without recognizing it, use theory to guide their practice (Ellis, 1969). Continued exposure to nursing theory throughout curricula helps students readily identify the practical use of theory in their clinical decisions and the interventions they deliver. While tailoring care for individual patients, nurses often modify theory by putting the patient's presentation into context to address their specific needs. This knowledge-generating action involves nurses expanding upon existing theory (Ellis, 1969). As educators, we must teach students that the practice of nurses requires acting as “expanders” of theory and prepare them to be comfortable with this component of their role.

Teaching students to embrace the role of nurse theorists by expanding upon the frameworks that guide their practice yields two significant outcomes. First, it prepares students to climb the ladder of nursing education without losing their footing. By stabilizing their theoretical ladders with substantial exposure to nursing theory, we educators prepare nurses to advance knowledge throughout their nursing careers. Second, by reinforcing the foundation of students' education to one grounded in nursing theory, the nursing profession will thrive from contributions made through the continued development of theory generated from practice. Developing theory strengthens the commitment to enhancing nursing as a profession and discipline instead of focusing on tasks and skills. Therefore, in addressing the question, “Is there still value in teaching nursing theory?” the answer is not just “absolutely.” Theory's influence on the advancement of the profession is “priceless.”

Melody Norris Waller, PhD, MSN, RN

mwaller@uthsc.edu

Assistant Professor

College of Nursing, University of Tennessee

Health Science Center

Mona Newsome Wicks, PhD, RN, FAAN

Assistant Editor

全文翻译（仅供参考）

您是否曾经在梯子上感觉自己正在失去立足点？或者您是否经历过房屋的地基沉降或移动，后来才发现发生了重大损坏？这些问题告知有意检查将理论作为护理教育中的主线并确定其在专业中的当前位置的关键需求。在寻求扩展我们现有的知识体系的过程中，许多人认为护理理论及其发展对于保持护理作为一门独特的科学至关重要，区别于构成它的基础科学。护理课程为该学科的哲学、结构、知识和实践奠定了基础。因此，包含理论和理论思维的课程也是我们专业持续发展的基础。然而，目前的趋势表明，在课程中纳入护理理论的程度有所下降（扬西，2015 年）。我们是否正在目睹护理的理论基础在我们眼前崩溃，因为我们没有制定蓝图来保护它？在起草本社论时，我们在检索当前关注将理论注入护理教育的重要性的文献时遇到了第一手的重大困难。这次经历引发了一个问题：“教授护理理论还有价值吗？” 这篇社论探讨了将理论融入护理教育的重要性、在课程早期和整个课程中让学生接触它的好处，以及未能让学生为他们作为护士理论家的角色做好准备的成本。

美国护理学院协会 ( [AACN]; 2021 ) 最近修订了专业护理教育的要点，以更好地装备毕业生，以满足我们当前实践环境日益增长的需求。一个关键目标是缩小护理研究、教育和实践之间的差距。这个修订后的框架承认将理论纳入护理课程的重要性，建议护理实践应该以科学为基础的观点来塑造。此外，与其他医疗保健专业人员合作需要这种基于科学的观点（AACN，2021）。因此，AACN 建议以理论视角指导学生的学术准备，该组织在框架的第一个领域“护理实践知识”中解决了这一问题。虽然指导框架没有明确规定课程应该以护理理论为基础，但它明确指出理论和研究性知识的应用“......来自护理、艺术、人文和其他科学”（AACN，2021，第 27 页）。

作为护士教育者，我们的最终目标是引导学生踏上知识获取、发展、洞察力和实施的旅程。在朝着这个目标努力的过程中，学生必须具备对护理、护理实践以及开展艺术和科学必不可少的组成部分的基本了解。学生必须在整个正规教育教学中尽早并始终如一地向他们介绍护理理论，以实现这一目标。如果你同意这个观点，我们不应该期望护理课程以护理理论为基础并开始创造这个现实的工作吗？在护理理论镜头中精心设计护理课程会显着提高教学价值，并有助于将理论作为基础。

不幸的是，在当今的学术环境中，重点通常放在课程中增加以临床和技能为重点的内容上，这将使学生准备好在不断变化的医疗保健环境中有效实践，同时满足患者日益复杂的需求。为了遵循这种趋势，教师可能会尽量减少或删除课程中的内容，这些内容集中在指导护理实践的哲学基础和理论框架上，以免让学生不知所措（Yancey，2015 年））。不幸的是，这一行动贬低了护理理论。更重要的是，从课程中减少或排除护理理论内容并不能使学生具备必要的认知技能，以识别护理特有的实践的理论和科学方面。从本质上讲，从课程中删除护理理论内容违背我们的目标，即让学生准备好提供满足复杂患者需求的护理。此外，如果没有清晰的理论基础，学生将无法从独特的护理角度综合患者呈现的因素。从护理的角度认识这些因素对于扩展该学科的科学至关重要。

本科和研究生的护理课程通常从介绍性课程开始，向学生提出“什么是护理？”的问题。虽然这是一个重要的问题，可以帮助推动学生的护理之旅，但我们认为，如果没有让学生充分准备一些理论背景，就无法有效地解决这个问题。护理理论和理论发展早已被确定为区分护理从以任务为导向的工作到杰出职业的“基石”（Walker & Avant，2019 年））。因此，护理课程的课程至少必须从理论预览开始，以此作为学生获得和培养知识的基础。在学生接受教育的早期建立理论基础有助于为他们的发展实践和对专业的贡献创建框架。与其武断地向学生提出“什么是护理”的问题，也许我们应该用这个问题来帮助他们认识到自己作为新兴护士理论家的角色。早期接触理论为护理科学奠定了坚实的基础。它可以防止该行业在没有坚实基础的情况下建造一座落入地下的房屋，以支持不断变化的医疗保健格局。

如前所述，AACN（2021 年）在修订后的专业护理教育要点中认识到，基于护理科学的理论视角对于在跨学科医疗保健环境中实践的个人来说是必要的。这种情绪是一种迷迭香埃利斯也于1969年共同在她的文章中，实践者作为理论家，她认为，护士，理论是实践的目的（的概念组成的组织结构埃利斯，1969年）。如果我们让学生为遇到复杂医疗状况的不同患者提供护理做好准备，那么他们还必须准备改变这种护理以满足每位患者的个性化需求。这种护理的改变涉及护士将理论转化为实践的能力。将理论转化为实践扩展了作为我们实践基础的“积木”，并有助于进一步巩固护士在产生新知识和改善医疗保健方面的作用。由于提供医疗保健不是一种“一刀切”的做法，并且涉及从各个领域开发的技能的汇编，因此护士认识到他们为跨学科团队带来的独特贡献至关重要。

最后，让护士能够熟练地处理患者的复杂性，包括接受他们作为理论家的角色。大多数护士，往往没有意识到这一点，用理论来指导他们的实践（埃利斯，1969）。在整个课程中持续接触护理理论有助于学生轻松确定理论在他们的临床决策和他们提供的干预措施中的实际应用。在为个别患者量身定制护理时，护士经常通过将患者的陈述置于上下文中来修改理论以满足他们的特定需求。这种知识生成行动涉及护士扩展现有理论（埃利斯，1969）。作为教育工作者，我们必须教导学生护士的实践需要充当理论的“扩展者”，并让他们做好准备以适应其角色的这一组成部分。

通过扩展指导他们实践的框架来教学生接受护士理论家的角色会产生两个重要的结果。首先，它让学生准备好在不失足的情况下攀登护理教育的阶梯。通过大量接触护理理论来稳定他们的理论阶梯，我们教育工作者为护士在整个护理职业生涯中提高知识做好准备。其次，通过将学生教育的基础强化为以护理理论为基础，护理专业将因实践产生的理论的持续发展所做出的贡献而蓬勃发展。发展理论加强了将护理提升为专业和学科的承诺，而不是专注于任务和技能。因此，在回答这个问题时，“教授护理理论还有价值吗？” 答案不仅仅是“绝对”。理论对职业发展的影响是“无价的”。

Melody Norris Waller，博士，MSN，注册护士

mwaller@uthsc。教育

助理教授

田纳西大学护理学院

健康科学中心

Mona Newsome Wicks，博士，注册护士，FAAN

助理编辑

原文链接：

https://doi.org/10.3928/01484834-20211007-02