Nursing theory - conceptual spaces: Where's my T-shirt?

Tripp-Reimer's 1996 paper The Dimensional Structure of Nursing Interventions has been sitting in my dsw - 'do something with' - pile for ages. Now reading Gardenfors I came across multidimensional scaling and realised that Tripp-Reimer et al. have also been there done that. They have been wearing the T-shirt for well over a decade.

Their paper begins with the evolution of nursing’s substantive structures and the emergence through the late 1960s to the early 1980s of a plethora of conceptual models (including - but not mentioned Hodges’ model). According to Tripp-Reimer these models while clearly possessed of nursing credentials, they were not always produced as combined research and practice tools. They argue that this failure may have contributed to the rise of the metaparadigm of nursing, with the effect that:

‘At best, the metaparadigm myth provided a rationale and mechanism for the discipline to displace (transcend) the conceptual models.’ p.11.

Ah! So that would account for why Hodges' model (and other global conceptual frameworks) have languished in the lay-bye!

‘Currently, nursing conceptual models have limited utility beyond their historical importance. That utility is derived from the structures they can provide for nursing education programs. Analogously, they also provide a framework that is useful for beginning nurses, assisting them in cognitively framing a clinical situation. These models provide a map, stimulating the new nurse in a clinically familiar space.’ p.15.

The paper goes on to contrast the way these models are used a-consciously by experts. I would suggest that there is a problem in nursing theory; or if not so severe as to be deemed a 'problem' then a tension at least. Educationalists (theorists) will rightly justify the case for nursing to be defined and boundaries set; otherwise, curricula will not support delivery of the desired learning experience, would lack focus and integrity in terms of evaluation of content and professional credibility. Socio-politically professional groups need a sense of (group) identity. The intention to develop models – theories in order to delineate nursing and establish professional identity is, however, at odds with the practice objectives of holistic and (interdisciplinary) integrated health and social care. Nurses need conceptual models and spaces that extend - from the outset - beyond the clinical situation.

It is the unfamiliar spaces (patient, carer, community... occupied) that we must seek or at least be able to account for in assessment, planning, interventions, evaluation (research) and information governance. Clinical situations should certainly be familiar within the bounds (latitude) of the curricula and including the match between what is taught and practical experience (practicum).

Health and social care, education and policy are constantly changing. Amid the rapid pace of T-shirt slogan turnover tools such as Hodges’ model retain their relevance for experts and beginners alike.

Tripp-Reimer, T., Woodworth, G., McCloskey, J.C., Bulechek, G. (1996). The dimensional structure of nursing interventions. Nursing Research; 45(1):pp.10-17.

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