Nursing Theory Practice Gap Essay
Nursing Theory Practice Gap Essay
Assignment Content
| SIGNIFICANCE OF INDEPENDENT NURSING PRACTICE |
| My current nursing practice includes nursing education, inpatient acute psychiatric clinical practice, and a private INP. Much has been written about theory as applied to practice in the more traditional health care settings,4 but little has been written about independent practice as a setting in which nurses apply nursing theory. |
| Nursing as a healing art was independently practiced in various forms and cultures for eons, but in Western society women as independent practitioners in health care were rare after 1900.5 With the advent of medical science and the dominance of medicine as a predominantly male profession in the late 1800s,5,6 the role of women in health care as nurses came to be viewed as subservient to doctors, following the doctor’s orders and carrying out their treatment plans. This type of nursing practice usually occurred in hospital settings where nurses worked as teams. As nurses moved into public-community health care settings, they gained a measure of independence.6 With the advances of the feminist movement in the 1960s and 70s, nurses began to seek ways to practice independently,7 either doing nursing work in private practices 8 or using their nursing knowledge in other fields such as in business.9 |
| Independent nursing function was defined as “any aspect of nursing practice for which the nurse alone is responsible, acting on his or her own initiative and without instructions from any other discipline.”10(p1) There are new opportunities emerging for nurses to enter independent practice due to social trends such as decreasing numbers of hospitals in certain areas because of consolidation,11 the emphasis on preventive health care,11 and public interest in holistic modalities.12 Independent nurse practices form “a small but important part of the health care system and provide the public with a greater degree of choice regarding health care delivery.”13(p237) Nurses seek to enter independent practice for a variety of reasons such as freedom to focus on chosen areas of health, including holistic health, that are important to the practitioner,12,14,15 flexibility and control in management of the practice,14 creativity in nursing practice,16 and autonomy.17 |
| Independent nursing practice presents difficulties and opportunities for nurses in incorporating theory into practice as compared to doing so in conventional health care settings. One drawback of INP is not having peers with whom to discuss concerns and learning new ways to apply theory in nursing practice.13 In places such as hospitals, theory may be addressed explicitly through the choice of a theoretical framework adopted by the hospital or a theoretical framework utilized by a specific unit. In many cases, nursing practice in large health care settings has been based on tradition or implicit theory and this has been found to contribute to the theory-practice gap.13 Whether the theory is explicit or implicit, nurses in these conventional health care settings have a theoretical structure supporting their nursing practice and they have opportunities to share practice ideas with peers. |
| In terms of opportunities for nurses in INP to close the theory-practice gap, nurses are in a situation to immediately apply chosen theories congruent with their worldview. This is due to their greater autonomy and possibility for creativity and innovation.11 Also, in a private practice setting, the need for and relevance of theory to practice may be more apparent than in other circumstances because of the one-to-one intensity of focus on the therapeutic partnership, and the sole responsibility for the embodiment of theory by the nurse in the partnership. With a lack of other accessible external guidance and structural supports, theory provides the primary structure to guide healing process in an autonomous situation. While relevant theories may provide a needed supporting structure, nursing theory provides the most relevant guiding structure for all nursing practice, including INP.18 |
| In my life, conscious awareness of my worldview and theoretical framework did not occur during my nursing education, and it became a personal career struggle and quest to clarify my beliefs and theories about reality and nursing. The conscious articulation of my evolving worldview and congruent theoretical underpinnings regarding my health care work with others did not come until 15 years into my 36 year career as a nurse. My shift in awareness from a systems perspective to the unitary-transformative paradigm,3 and my appreciation for and application of HEC nursing theory in my INP, emerged as recently as 10 years ago. The value of HEC in nursing practice has been documented by Newman scholars related to praxis in conventional health care settings such as hospitals,19-21 community/home health,19,22 and an assisted living facility.23 The value of HEC theory to practice in these settings was identified by nurses and clients as empowerment,20,21 understanding self as a whole,21 evolving caring and closeness,19 releasing old unhealthy patterns,23 and unfolding meaning.22 There were no articles found that presented evidence of the value of HEC theory in practice in INP. |