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Barriers to Nursing Theory Development

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A Nurse Contemplates Hegel's Ethics Nurses are considered doers, not thinkers. There have been many barriers to the development of theory in nursing, but no factor as significant as that one. The entire enterprise of nursing theory development, in fact, has been called into question. Theory demands detached thinking and questioning, as well as the leisure time to commit to such work. There is nothing in the day-to-day practice of nursing that is conducive to the theoretical realm.

2. The Profession
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Afaf Ibrahim Meleis, dean of the University of Pennsylvania School of Nursing, has written substantially on these barriers and their causes. The basic reason for the lack of theoretical development and the barriers to nursing theory derive from the profession itself. Most young people come to the nursing profession to be activists, to help and assist people, not to think about metaphysical or ethical issues. In addition, the stress on financial and career advancement in the nursing profession, according to Meleis, has been a significant barrier to thinking philosophically about nursing.

Routine
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Meleis holds that the stress on "doing," especially "routine and repetition," are barriers in themselves to nursing theory. The practice of nursing has been reduced---for better or worse---to the routine of care rather than the manifestation of ethical principles. All of this derives from the basic functional orientation of nursing in general. Not helping matters are the long shifts served by most nurses and especially nursing students. These long shifts and exhaustion also serve as a barrier to theory development.

Training
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Nurse training is another barrier, according to Meleis. In this case, what is stressed is efficiency and saving money, not ethical reflection. For a long time, the basic function of the nurse was to serve as the eyes and ears of the doctors. There was never any real sense of nursing as an autonomous profession, but always as an afterthought to professional care by doctors and specialists.

Rewards
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Lastly, Meleis holds that the reward structure of the nursing professional is a barrier to theory development. Nurses are rewarded and recognized by the sort of work they do, not the thoughts that might occur to them about the work in general. No rewards are given out for questioning the "metaphysical foundations" of nursing, and a patient might become concerned if he overheard such discussions. If any questioning does occur among nurses, if is likely to concern medical science, rather than the theoretical foundations of such science. If medical science is advancing, then theory might no longer have a place. Nursing "theory" might then be reduced to the most efficient application of medical techniques. If this becomes the case, then there is no more theory, but only efficiency and passivity.