School essay: outsourcing some brain work

post by Swimmer963 · 2012-04-10T20:14:01.427Z · score: 5 (18 votes) · LW · GW · Legacy · 34 comments

I'm currently writing an essay for one of my classes, 'Theoretical Foundations of Nursing.' I'm about the most 'gong-si' class I've ever taken. (That is a Chinese term for 'shit talking,' which is my boyfriend's favourite term for any field that gets into arguments over definitions, has concepts that don't correspond to any empirical phenomena, is based on ideology, etc.)

The essay involves analyzing a clinical situation (in this case a 55-year-old recently divorced, recently unemployed man, admitted to the psychiatric ward with major depression and suicidal ideation) using a theory (in this case, Roy's Adaptation Model). Done. The next step involves finding criticisms with the model...and despite the fact that I've been complaining about this class and its non-empirical nature all semester, I seem unable to come up with specific criticisms of what this nursing theory is missing. 

Which is what I need your help for, because LessWrong is the best community ever when it comes to specific criticisms. 

Here is a very brief overview of Roy's Adaptation Theory:


Now my question is, what is a specific criticism I can make of this particular theory in general...not "your definitions aren't specific enough" or "the whole field of nursing theory isn't reductionist enough", but something that this kind of theory should have but doesn't. Any ideas?

34 comments

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comment by Morendil · 2012-04-10T20:54:06.950Z · score: 12 (14 votes) · LW · GW

I seem unable to come up with specific criticisms of what this nursing theory is missing

Can you go over the exercises suggested in comments on the "Be specific" post, and see if any of them sounds likely to help, or even merely dislodges new ideas for you?

For instance, along the lines of "Filing a bug report", could you try writing a letter to the Department of Theories Department at Knol-Mart, starting with the line "Dear Sirs, I am hereby returning to you my shipment of Roy's Adaptation Theory (nearly unused) which I found defective in the following ways. First, when I tried turning the Health knob on this Theory..."

For a more specific exercise, try locating the opposites of the definitions given. For instance, given a definition for "health", you should be able to invert the terms to get a definition for "illness".

For another, try comparing the theory with some other model - for instance the "naive" model of whatever-it-is that you would have used if you hadn't ever been exposed to the Roy thing, your "intuition" of these things - does the latter give you some specific conclusions, predictions and angles of attack? If so it's doing at least one thing better. Find out why.

For a third, try listing some things that you absolutely wouldn't expect a sane Theory to lead you to do (say, tell the poor guy to "stop whining and get a job"), and based on the general idea that theories should add up to normality, ask how Roy's Adaptation Theory specifically prohibits you from doing them. (If it doesn't, that's where it's broken.)

comment by Desrtopa · 2012-04-12T00:13:19.887Z · score: 3 (3 votes) · LW · GW

For a third, try listing some things that you absolutely wouldn't expect a sane Theory to lead you to do (say, tell the poor guy to "stop whining and get a job"), and based on the general idea that theories should add up to normality, ask how Roy's Adaptation Theory specifically prohibits you from doing them. (If it doesn't, that's where it's broken.)

This is the second thing that jumped out at me when reading the components of Roy's Adaptation Theory (the first being that the "definitions" completely fail to circumscribe the actual concepts they attempt to define.) Adaptation to an environment does not correspond to our naive notions of good patient treatment, in situations such as a prisoner in a maximum security detention facility, whose growth into a violent top dog who makes the other prisoners his bitches a good Adaptation Theory nurse would be obliged to assist.

It's a common naive view of evolution that it consistently makes organisms better and more advanced according to human notions of advancement (and perhaps this misconception is at the root of Adaptation Theory, if it takes adaptation to one's environment as its mandate.) But according to ordinary human values, environments can impose perverse pressures , so that the results of adapting to them can be quite horrible. If the most face-value interpretation of Adaptation Theory tells you that it's better for a patient growing up in a violent slum to become a high-powered drug dealer who occasionally has people shot and has women all over the slum raising children who don't know their father than for him to get some sort of job or education which gets him out of there, it's probably not a very good theory.

If we can't take Adaptation Theory at face value, but instead have to twist it around so as to interpret it as telling us to do what already seems like common sense, then it's definitely not a very good theory.

comment by Swimmer963 · 2012-04-12T02:00:28.064Z · score: 0 (0 votes) · LW · GW

I am so tempted to print your comment out and show it to my teacher...

comment by Swimmer963 · 2012-04-11T03:35:58.624Z · score: 2 (2 votes) · LW · GW

For a more specific exercise, try locating the opposites of the definitions given. For instance, given a definition for "health", you should be able to invert the terms to get a definition for "illness".

This sounds like the easiest and most fruitful of the exercises you offered. I don't really have a 'naive model'–I've never trusted my intuitions particularly, and they're mostly silent on nursing-related stuff, probably because as of yet I have hardly any clinical experience.

For a third, try listing some things that you absolutely wouldn't expect a sane Theory to lead you to do (say, tell the poor guy to "stop whining and get a job"), and based on the general idea that theories should add up to normality, ask how Roy's Adaptation Theory specifically prohibits you from doing them. (If it doesn't, that's where it's broken.)

Sounds very useful, but also exhausting on the brain. I'll see how brain-exhausted I am after studying for my upcoming exams, and how many pages I can get out of the other suggestions. (I may not be genuinely curious enough about this to keep working on it after the essay is handed in.) Thanks, though!

comment by RichardKennaway · 2012-04-11T11:58:04.516Z · score: 11 (13 votes) · LW · GW

I thought nursing theory was something invented just to close the prestige gap with doctors.

The Wikipedia article makes it clear, perhaps unwittingly, that "theory" here does not mean what it means in science. In science, a theory is a coherent set of beliefs about how some phenomenon works that constrains your expectation about what you will observe to some subset of what you might observe. In the humanities and in most of social science, and apparently in nursing, it is the other way round: a theory is a coherent set of beliefs about how some phenomenon works that constrains your actual observations to lie within what the theory says they will be. This is why there are so many theories of the same thing, and no-one seems to care whether any of them are true, or even think that is a sensible question to ask.

But maybe you can't say that to your professor.

comment by [deleted] · 2012-04-11T17:26:51.093Z · score: 5 (7 votes) · LW · GW

In science, a theory is a coherent set of beliefs about how some phenomenon works that constrains your expectation about what you will observe to some subset of what you might observe. In the humanities and in most of social science, and apparently in nursing, it is the other way round: a theory is a coherent set of beliefs about how some phenomenon works that constrains your actual observations to lie within what the theory says they will be. This is why there are so many theories of the same thing, and no-one seems to care whether any of them are true, or even think that is a sensible question to ask.

This is the best formulation of this class of criticisms of the social sciences that I have ever read.

comment by Multiheaded · 2012-04-15T08:50:02.687Z · score: 0 (0 votes) · LW · GW

It doesn't indicate that people who don't participate in fields where expectations are clouded by dogma are any more virtuous, of course. They're simply less likely to get away with it.

comment by [deleted] · 2012-04-15T13:19:10.165Z · score: 0 (0 votes) · LW · GW

I didn't mean to imply they where.

comment by Mark_Eichenlaub · 2012-04-10T20:47:37.307Z · score: 9 (13 votes) · LW · GW

Maybe I don't understand the request entirely, but wouldn't any criticism depend not on the details of the theory, but on how well it works?

The point of a nursing theory is presumably to help nurses do their job. So if you want to know if a nursing theory is good, come up with some metric to measure nurse performance, train some nurses in the theory, and measure their performance compared to a control group.

The theory could be absolutely ridiculous to people looking at it on paper, but that doesn't matter much if it turns out that it helps people be good nurses.

comment by Swimmer963 · 2012-04-11T03:23:45.188Z · score: 3 (3 votes) · LW · GW

Good idea! You gave me the idea to go on the university database and look for studies that have been done using the Roy model (which there have been, almost certainly.) Whether or not they say anything that I would consider valid, I can still cite them in my essay.

comment by Mark_Eichenlaub · 2012-04-12T21:59:13.706Z · score: 1 (1 votes) · LW · GW

Did you find anything useful?

comment by MartinB · 2012-04-12T19:20:41.497Z · score: 0 (0 votes) · LW · GW

This still does not make it a correct theory.

comment by Swimmer963 · 2012-04-13T14:15:59.525Z · score: 1 (1 votes) · LW · GW

There is actually an article I had to summarize for one of our first assignments, that discusses why theories in nursing are not "correct" or "incorrect", but have to be evaluated according to their "social congruence" (does the theory live up to society's expectations of nurses), "social significance" (would society change if nurses stopped existing), and "social utility" (do nurses themselves find the theory useful). (Yes, I just had to reopen my assignment in a Word document so I can check which of those concepts was which, because they're named in a way that makes it impossible to remember.)

comment by Mark_Eichenlaub · 2012-04-12T21:58:53.715Z · score: 0 (0 votes) · LW · GW

Can you describe how else one would test a nursing theory for correctness?

As I understand it, a nursing theory says, "If the nurse follows procedure A, the reaction in the patient will be X. If the nurse doesn't follow procedure A, the reaction in the patient will be Y."

If the theory is accurate in those predictions, it's a correct theory, even if it sounds crazy. To tell whether it's a correct theory, we have to test it. That's what I was driving at.

comment by MartinB · 2012-04-13T06:25:09.674Z · score: 0 (0 votes) · LW · GW

I don't think I have to answer that to point out the flaw. If all nursing theories considered are wrong than one of those can easily still be the one that produces the best results despite no correlation with what nursing actually is about. A flaw I would expect to see more often is a nursing theory that has new age elements that are not linked to reality, makes the user feel helpful and good and leads possibly to a good care of patients. But that sounds like rating the more effective bedtime story or the more effective motivational mission statement. The term "nursing theory" implies that it is a theory about how nursing should be done, not what thoughts the nurse should have while doing it.

comment by Swimmer963 · 2012-04-13T14:18:40.343Z · score: 1 (1 votes) · LW · GW

There are actually some nursing theories–specifically those under the model of Transformation, which is apparently 1975-onwards–which are completely New Agey and waaay more useless than Roy's theory. Roger's theory of "Unitary Human Beings" defines humans as "indivisible energy fields defined by their patterns" and health as "a manifestation of constant and mutual exchange processes between the energy fields of the person and the environment." Not only is that vague, it's not even comprehensible to me.

comment by saturn · 2012-04-10T23:51:37.570Z · score: 6 (6 votes) · LW · GW

The most glaring problem I see with this theory is that it would allow a potted spider plant to be considered a 'person', and Patrick Bateman to be considered 'healthy'.

comment by Swimmer963 · 2012-04-11T03:36:45.170Z · score: 4 (4 votes) · LW · GW

Yes. That's my biggest complaint about all the things we're learning in our theory class–it seems like every nursing theory has definitions that are more inspirational and pretty-sounding than specific. But I don't know if my teachers would consider that a valid consideration.

comment by Incorrect · 2012-04-12T19:38:52.509Z · score: 0 (0 votes) · LW · GW

It's telling nurses to teach potted spider plants as people. How is that not a valid consideration?

comment by buybuydandavis · 2012-04-11T06:03:04.611Z · score: 3 (3 votes) · LW · GW

Ugh. What verbal diarrhea. This is why I hated some classes with a white hot intensity. You're supposed to stuff things into gibberish. What fun.

I'd note that despite having that tedious definition for health, and having it come first, it is not referred to again in any definition, goal, or step, and so is apparently superfluous to the rest of the theory, and in particular, the nurse's goal.

One "step" is setting a goal, which I thought we had already set with "The nurse's goal is..."

This is probably unfair to Roy, since it's just your brief overview.

Looking at the "diagnosis" list, it includes some immediate observables and other huge inferences. Distinguishing between observables and inferences seems important to me.

comment by Swimmer963 · 2012-04-13T14:20:19.054Z · score: 2 (2 votes) · LW · GW

Try this gibberish (Roger's Theory of Unitary Human Beings): humans are defined as "indivisible energy fields defined by their patterns" and health is defined as "a manifestation of constant and mutual exchange processes between the energy fields of the person and the environment." Just a moment while my brain melts down trying to translate that into English...

comment by TheOtherDave · 2012-04-13T14:28:02.007Z · score: 0 (0 votes) · LW · GW

(shrug) We're made of stuff, and for our purposes we care more about how that stuff interacts with itself and its environment than about, say, whether it's the same stuff we were made out of yesterday. I'd quibble with "indivisible," but otherwise I'd agree as far as it goes. I agree with you completely about it being useless, though. (Well, useless for purposes of understanding anything.)

comment by Swimmer963 · 2012-04-13T14:36:55.453Z · score: 0 (2 votes) · LW · GW

Ya. I don't do well with abstract definitions.

comment by buybuydandavis · 2012-04-13T18:24:31.407Z · score: 1 (1 votes) · LW · GW

No no no. Recognizing this stuff as BS is about the best anyone can do. These aren't well defined abstractions, they're ritual incantations. Discomfort with them, to the point of revulsion, is a sign of a healthy mind.

They're giving you all these definitions. Is there anything you're supposed to do with them, besides chant them back on a test?

comment by Rain · 2012-04-17T18:10:56.764Z · score: 1 (1 votes) · LW · GW

I engage my fiction / roleplaying modules to deal with it. "Okay, we're in a magical world where auras are real, people are energy patterns, and magic powers can heal them but only through technological interventions. How will my Level 2 Nurse character deal with Condition C? Let's see what I have in my inventory..."

comment by Swimmer963 · 2012-04-20T03:45:16.523Z · score: 0 (0 votes) · LW · GW

I just had a momentary fantasy about someone designing a video game like that as a teaching device for nursing school... Would be epic and I would never forget anything I learned.

comment by buybuydandavis · 2012-04-17T21:02:59.986Z · score: 0 (0 votes) · LW · GW

I was thinking a similar thing, only it was visualizing the IRS web site as if it were Quirrell humming.

comment by Normal_Anomaly · 2012-04-11T00:07:26.654Z · score: 3 (3 votes) · LW · GW

The definition given for "health" is only tangentially related to biological functioning, which sounds to me like the primary domain of a nurse.

comment by Swimmer963 · 2012-04-11T03:25:53.305Z · score: 2 (2 votes) · LW · GW

It's 'in character' for the schooling I've done so far...most of our theory classes seem to be trying to convince us that biological function isn't our only concern/responsibility. So I could complain about that it in my essay, but my teacher might not agree with me on that particular complaint.

comment by David_Gerard · 2012-04-11T11:22:42.117Z · score: 4 (4 votes) · LW · GW

Aha, you're faced with actually having to guess the teacher's password.

comment by aelephant · 2012-04-10T23:18:49.688Z · score: 3 (3 votes) · LW · GW

Are you familiar with SOAP notes? The S and O are Subjective and Objective. One thing I don't see from your description is a separation or clarification about what is subjective and what is objective. For example, the patient's "self-concept mode" which I'm reading refers to "level of anxiety, involvement in self-care, relationship with family and friends and general outlook" sounds like it is all subjective (if we are simply talking asking the patient, "What is your level of anxiety?" and so forth). I think it is important to clearly distinguish what is subjective and objective, which seems to be lacking (at least from your description).

comment by Swimmer963 · 2012-04-11T03:27:25.685Z · score: 1 (1 votes) · LW · GW

"self-concept mode" which I'm reading refers to "level of anxiety, involvement in self-care, relationship with family and friends and general outlook."

Did you google that? If so I'm very impressed!

We covered the SOAP concept in another class, and we've come back to it, but none of the notes on Roy's theory mention it. So good point–I can double check and if I still don't find any reference, I can put that as 'something that's missing.'

comment by Incorrect · 2012-04-12T19:29:40.444Z · score: 0 (0 votes) · LW · GW

Defines a 'person' as an 'adaptive system with coping processes.'

You could point out that this definition gives personhood to animals and a few electronic systems/computer programs.

Most of these seem like fancy ways of saying simple things.

comment by AstraSequi · 2012-04-11T03:33:43.968Z · score: 0 (0 votes) · LW · GW

I think that you can derive a strong argument from "your definitions aren't specific enough," if the theory allows for more than one interpretation (which should arise as a result of nonspecific definitions being used). The "specific" criticism could come from looking at your answer for the first part of the essay, suggesting an analysis that is sufficiently different from yours that they differ in key points, and then supporting this alternative analysis using the theory as well. Or, as an alternative way of phrasing question - is there one clear answer to the first part, or does the theory allow for multiple courses of action with non-trivial differences?

So although the original problem arose from the definitions, the actual criticism would be along the lines of "the theory is not specific/developed enough to prescribe a unique course of action in all circumstances."