A light-hearted look at nursing science, theory and the disciplin of nursing

1. Keeping the science in
nursing
Roger Watson

3. 5/3/2016
© The University of Sheffield / Department of Marketing and Communications
3

5. Nursing science
When we relate nursing AND science:
Are we talking about:
• Science in nursing?
0r
• A science of nursing?

6. A science of nursing
Where has the pursuit of a Science OF Nursing taken us?
• Theories and models
• Proliferation
• Hi-jacked curricula
• Lots of publications
• Little evidence of efficacy

11. Where has it led us…?
Bewildered students
and patients
Ridicule of non-nursing
colleagues

12. The problem with nursing theories…
• …and trying to demonstrate them

15. Science in nursing
Where has the pursuit of Science IN Nursing taken us?
• Imported theories and models
• Proliferation
• Hi-jacked curricula
• Lots of publications
• Little evidence of efficacy

16. Imported theories

22. Closing the theory-practice gap

25. …at all costs!

28. The shortcuts
• Critical thinking
• Evidence-based practice
• Physiology ‘for nurses’
• Sociology ‘for nurses’

29. Science (for nurses)
• How do we know the earth revolves round the sun?
• How do we know space is expanding?
• How do we know the blood circulates in the body?
• How do we know that spontaneous generation does not take
place?
• How do we know that vitamin C prevents scurvy?
• How do we know that staff to patient ratios influence patient
mortality?

30. What counts as evidence?
• The outcome of systematic enquiry

32. © The University of Sheffield / Department of Marketing and Communications
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33. Regression towards the mean
• In statistics, regression toward (or to) the mean is the
phenomenon that if a variable is extreme on its first
measurement, it will tend to be closer to the average on its
second measurement—and if it is extreme on its second
measurement, it will tend to have been closer to the
average on its first.

37. Where do we find evidence?
• Evidence synthesis databases

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© The University of Sheffield / Department of Marketing and Communications
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40. 5/3/20
© The University of Sheffield / Department of Marketing and Communications
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44. Real science in nursing
• RN4CAST

45. 3
422 730 patients aged 50 years or older
who underwent common surgeries in
300 hospitals in nine European
countries.

46. Findings
An increase in a nurses' workload by one patient
increased the likelihood of an inpatient dying within 30
days of admission by 7% (odds ratio 1·068, 95% CI
1·031–1·106), and every 10% increase in
bachelor's degree nurses was associated with a
decrease in this likelihood by 7% (0·929, 0·886–
0·973). These associations imply that patients in
hospitals in which 60% of nurses had bachelor's
degrees and nurses cared for an average of six
patients would have almost 30% lower mortality than
patients in hospitals in which only 30% of nurses had
bachelor's degrees and nurses cared for an average
of eight patients.

47. Findings
An increase in a nurses' workload by one patient
increased the likelihood of an inpatient dying within 30
days of admission by 7% (odds ratio 1·068, 95% CI
1·031–1·106), and every 10% increase in bachelor's
degree nurses was associated with a decrease in this
likelihood by 7% (0·929, 0·886–0·973). These
associations imply that patients in hospitals in which
60% of nurses had bachelor's degrees and nurses
cared for an average of six patients would have
almost 30% lower mortality than patients in hospitals
in which only 30% of nurses had bachelor's degrees
and nurses cared for an average of eight patients.

50. SCIENCE

51. r.watson@hull.ac.uk
0000-0001-8040-7625
@rwatson1955