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Guest Editorial: On bed baths and conceptual models of nursing

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
2003 Blackwell Publishing Ltd

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 disciplinespecific 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 dont 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
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Guest Editorial

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

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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 disciplinespecific 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.
Jacqueline Fawcett PhD
Professor, College of Nursing
and Health Sciences,
University of Massachusetts,
Boston, USA

References
Anderson C.A. (2000) Undereducated, aging,
and ... a cycle of decline? Nursing Outlook
48, 5354.
Fawcett J. (1984) Analysis and Evaluation of
Conceptual Models of Nursing. FA Davis,
Philadelphia.
Newton I. & (1676/1998) Letter to Robert
Hooke, February 5, 1676. In: The Oxford
Essential Quotations Dictionary (American Edition). Berkley Books, New York.
Niblett V. (1997) A ritual for all reasons.
Registered Nurse Journal 6(5) (10), 13.

2003 Blackwell Publishing Ltd, Journal of Advanced Nursing, 44(3), 229230