Generating Theory from Practice: Nursing as a Discipline - Essay Example

? Generating Theory from Practice: Nursing as Discipline Introduction Nursing has been always considered in the context of human science. The majority of studies and researches are focused on the important role of practice in nursing. A role of theory is often diminished and in case practice and theory are combined, little attention is paid. This research paper is focused on the role of theory and practice in nursing. Moreover, there is an option to estimate the role reflective practice plays in theory generation. A modern nurse is positioned as a knowledge developer and a professional with theoretical knowledge and practical skills. Therefore, a scientific and philosophical paradigm of nursing practice is presented further on, representing previous and modern approaches to nursing practice. The outline of the paper is the following: A. Introduction B. General discussion 1) What is nursing? 2) Scientific paradigms in nursing; 3) Reflective practice in nursing; 4) The role of theory in nursing practice; 5) A correlation between theory and practice in nursing; 6) Reflective practice as experience application; C. Conclusion What is nursing? It has been often claimed that nursing is a practical human science. The meaning of the word “practical” should be better interpreted. Further consideration about “practical” aspect of nursing is correlated with the study conducted by Bishop and Schudder (1990). These scientists underlined that “practical” meaning of nursing implies a constant acquisition of required knowledge by nurses. In spite of the majority of works considering nursing as a practical aspect, a theoretical aspect of nursing is also worth being considered. We tent more to the works by Jean Watson (1985), Newman (1986) and others who correlated nursing with science. Philosophical background of nursing was shaped under the influence of phenomenology and such philosophers as Heidegger, Dilthey and Foucault. In order nursing could be positioned as a scientific field, it is relevant for nurses to enrich their philosophical and intellectual background and develop “various models of thinking” (Munhall 1992, p. 371). Currently, there is a need to develop knowledge among nurses. On the one hand, knowledge should be generated in the process of practicing, but on the other hand knowledge should be viewed as a temporary phenomenon. In the course of time knowledge is being developed under the influence of external factors. Thus, knowledge gaining in practice should be made in dynamics and it requires a personal development and self-perfection of a nurse. Generally, nursing is usually correlated with the field of human science. Nursing practice has been developed under the influence of current scientific tendencies, and is currently being considered as a complex knowledge. Nurses meet complex situations and it is on their behalf to solve these problems. Experts have introduced a new term of “intuition” in nursing. Moreover, nursing knowledge development would be considered on the background of reflective practice. Scientific paradigms in nursing Further on, it is necessary to consider possible paradigms involved in nursing learning. The most widely applied paradigms are the following: “positivist, post-positivist, interpretive and critical theory research paradigms” (Long and Johnson 2000, p. 459). Feminist philosophy is also applied in nursing knowledge development. All these paradigms and approaches are directed on imputation a status of a scientific and professional nature to nursing. With this respect, some writers would argue that it is thus necessary to introduce qualitative researches and terminology of positivist research into this field, because “there is nothing to be gained from the use of alternative terms which, on analysis, often prove to be identical to the traditional terms of reliability and validity” (Long & Johnson 2000, p. 30). For nurses, as well for other researchers, it is necessary to achieve positive research results in case their research strategies are valid. Morse et al (2002) claims that rigor of qualitative research is beyond question and it should be perceived as a pragmatic scientific evidence. Researchers in nursing should support their research findings by their subjective positive attitude to the conclusions they have made etc. Moreover, researchers should be responsible for their contribution in the theoretical aspect of their field of study, in order to facilitate the process of knowledge gaining, explain novices and interpret theoretical postulates. Moreover, in order to approve the relevance of the abovementioned paradigms involvement, it is relevant to refer to the western philosophical tradition. This is required for understanding of basic concepts and principles of nursing. Aristotle considers “natural being as a substance having form and matter” (Wallace, 1996). Thus, Aristotle suggests that both material and immaterial is present in a human being. Furthermore, in accordance with the Aristotelian perspective, nursing is more practical discipline than theoretical. He claims that “practical sciences inquire into the principles and causes of things to achieve knowledge in order to make, as in engineering, or in order to do, as in ethics” (Whelton, 1999). Thus, practical knowledge requires not only inquiry into the depth of reasons of a certain subject, but also a deep inquiry into the measures which have to be taken in order to solve a problem. Practical sciences and fields of activity are developed for the sake of practice. Nevertheless, a professional in the practical study needs to have scientific knowledge about patient, of health, of technical practical operations and other important factors. At this point it is relevant to talk about transforming of theoretical knowledge into practice. Moreover, integration of practice and theory in nursing is correlated by Imogene King with classical Aristotelian philosophy (Whelton, 1999). Thus, nursing interaction supposes a correct solution of a certain problem and development of the best practices that are the most relevant to the healthcare institutions where they are employed. The universal principles of nursing should be refereed to certain cases and particular interventions would be required in that case: “in order to practice nursing, one’s knowledge of the science of nursing must be completed by practical actions directed towards caring for specific clients or directing them in the pursuit of health” (Whelton, 1999). Therefore, scientific generalizations could be hardly applied in the practical nursing context. Thus, many scientists and researchers may question the relevance of nursing correlation with science. For example, there is no universal goal to be achieved in the result of nursing. Not health should be achieved, but certain healthy state. Positivism chosen as the most appropriate paradigm for nursing can be usually approved in the following terms: the main claim of positivism is the existence of objective reality in spite of the fact whether an individual is aware of it or not. In the modern scientific paradigm the most relevant aspect of positivist philosophy is logical positivism. “The logical positivists brought about an emphasis on induction, verification, and development of laws” (Gortner & Schultz, 1988; Coward, 2007). This philosophical paradigm is relevant for nursing, because sensory experience and observation prevail over metaphysics in these studies. This suggestion can be also supported by the study conducted by Kolb (1991) (cited by Coward, 2007). This scientist has often claimed that learning is a cyclical process where thought and action are interrelated. When an individual reflects in his experience ideas about the world or some other knowledge, he actually correlates macro- and micro-level knowledge. If to consider theory and practice in nursing with respect to this correlation, it is relevant to mention the works by Lindsay (1990) and Gook (1991) (cited by McKenna, 1997). These scientists underline the necessity to set limits for theory and practice gap in nursing. There is no need to appeal for epistemology and trying to find out the only truth in order to appeal for theory or practice only. Moreover, it is evident that knowledge required for nursing includes both cognitive and practical knowledge basis. It is more appropriate to find the best balance between theoretical and practical knowledge and introduce this integrative strategy to nursing practice development. Currently, a great role plays a technical rationality as an integrative component of knowledge gaining. Firstly, technical rationality is of subjective nature. For young practitioners it is relevant to develop their research skills and conduct the researches on their own experience. The best way out for nursing practitioners is to involve a threefold knowledge development: that of a practitioner, a theorist and a researcher. In the modern world with highly-developed technologies, it is relevant to develop knowledge in another context. An overall social communication mediated by computer technologies implies that there is an essential external influence that influences on development of personal knowledge of a practitioner. In this context, “knowledge is viewed as temporary, dynamic and problematic rather than absolute and permanent” (Antrobus, 2008). A humanistic perspective is more relevant in the modern paradigm than a scientific paradigm. A well-developed and extended humanistic arena requires more introspective approaches to human arena. A role of creative potential is very important nowadays. Reflective practice in nursing Therefore, reflection of nursing practice should be also developed with regards to the modern paradigm. Benner (1984) and Schon (1987) have underlined a creative potential of nursing knowledge. In the process of reflection, knowledge gained by nurses is presented as “a dynamic integration and construction of the empirical, clinical and the personal, in the context of the activity of doing nursing” (Meerabeau, 1992). Another researcher Fay (1987) presents learning through reflection as the process of “enlightenment, empowerment and emancipation” (Meerabeau, 1992). Thus, a practitioner should work out his personal strategy in accordance with a certain situation. Thus, being a nursing practitioner implies development of personal qualities compatible with the ability to interpret subjective nature of other people. Nursing practitioners should be able to interpret certain patient’s cases with regards to his closest environment. Moreover, it is relevant to a nursing practitioner to integrate experience gained from clinical practice and correlate it with scientific knowledge about certain client groups. The role of theory in nursing practice Theory application in a certain sphere of human activity is a complicated task. In accordance with some researchers and scientists, theory is directed on explanation of certain events or processes that have to be further identified, explained and solved. In accordance with O’Brien (2000): “theory is about saying clearly what is being done about something so that others can understand the concepts involved and how they relate to each other” (O’Brien 2000, p. 202). This explanation of theory would be used further on as the basic explanation of the important role of theory. Moreover, O’Brien’s considerations have been mainly focused on a strong correlation between theory and practice. Theory should not be invented but should reflect a reality gained in the process of human experience. Theory should advance nursing practice. A cultural background of theory development usually coincides with theory application. The infrastructures that develop and apply the theories have many features in common. At this point it is appropriate to restore in our memories the concept of decontextualization. The illusive belief that theories can be applied universally is not correct. In the field of nursing practices the interesting processes occurred. Thus, in accordance with Meerabeau (2000) nursing theory defines the essence of this field of study and underlines the importance of organization of nursing curriculum and other issues. The development of nursing theory followed the development of nursing practice. Therefore, we can see initial correlation between theoretical and practical development of nursing practice. Concerning a practical aspect of nursing practice, it is relevant to underline that practice is more than just doing. In accordance with current works, “knowing” is divided into technical, practical and emancipatory and cognitive interests (Long and Johnson, 2000). Nursing practice should be focused on a client’s family background and be developed individually. Practice in nursing is usually assigned to a practical aspect of nursing. A correlation between theory and practice in nursing Dichotomy of theory and practice in nursing has recently exceeded its initial limits and nowadays it is relevant to consider it in a broader context. A gap between theory and practice of nursing is considered in the following terms: “(the gap)…refers to the relationship between nursing theory and nursing practice and not the education-service gap. Much has been written about the knowledge that is required to theorize and that which is required to practice, and in this field too, there exists some support for the existence of the ‘gap’” (McKenna, 1997). There is also a vivid discussion concerning the relevance of theoretical knowledge for nurses. The reasons for practical implementation of gained theoretical knowledge are often questioned. Moreover, it is often claimed that practical skills and knowledge of “how to act” in one or another situation prevail over theoretical knowledge necessary for nursing practice. Manning, Broughton and McConnell (1995) underlines the necessity of multidisciplinary knowledge among nurses, because it would be easier for nurses to determine in what situation practical nursing skills prevail over other required knowledge (cited by McKenna, 1997). The prevalence of practicing skills over theoretical knowledge is often underlined by many researchers and scientists. “A practically oriented nurse” is often discussed in the researches and studies (O’Brien, 2000). “A sense of being” or a special attitude development to any particular situation is very important to every nurse. Still, not only practical experience is of high importance, but also theoretical knowledge otherwise practice would be “not automatic, thoughtless behavior which exists separately from theory and to which theory is applied” (Speedy, 1989; cited by McKenna, 1997). Moreover, not only a theoretical knowledge, but also a personal factor should be implemented in the process of practical nursing. Furthermore, there is a need for nurses to develop their empirical knowledge and tacit experiential stuff. There is a well-known conventional approach, in accordance with which technical or rational knowledge prevails over any other form of knowledge. On the contrary, it may be argued, that in case empirical knowledge is the most important for nurses, practical nurses do not have the highest ranking in the ranks of nursing. Therefore, there is a time to develop the most appropriate strategy of nursing practice development. An integrative approach to nursing practice development should be preferred by nurses. With this regard, it is necessary to work at reasoning development. To make a good clinical judgment, a nurse has to develop “thinking-in-action and reasoning-in-transition” (Long and Johnson, 2000). It means that nurses should be able to develop their knowledge in the process of information gaining at any moment. Thus, knowledge should be developed and obtained from practice. Practical knowledge enrichment should be perfecting tool for nursing practice. An integrative component of nursing practice development is clinical reasoning, i.e. “…the deliberate, organized, and multidimensional intellectual process of analyzing the nature and significance of actual, potential, and perceived relationships and influencing assumptions and variables that have actual, potential, or perceived significance to nursing situation” (Long and Johnson, 2000). There are many forms of reasoning. The most known are the inductive and deductive reasoning processes. In the process of inductive reasoning, a nurse can predict conclude general outcomes. Inductive reasoning is based on scrutinized considerations about certain clinical signs. On the basis of deductive reasoning nurse is focused on generalized knowledge and then applies it to some specific cases. This type of reasoning is more logical and there are more absolutes in this type of thinking. Still, as we have mentioned above, a practical aspect of nursing prevails over theoretical aspect. Reflective practice as experience application In this context, inductive reasoning would be the most preferential for the nurses. “Reflective practice” is developed in the process of practical consciousness development. The reflective practice generates knowledge required for nursing practice from personal practical experience of a nurse. Basically, the main goal of reflective practice is the discipline promoting tool. Nursing should be considered as a professional discipline, because knowledge it generates promotes and develops the discipline. Still, a concept of reflective practice in nursing remains completely unresolved. Nevertheless, reflective practice is only a part of the discipline of nursing. In accordance with Antrobus (2008) reflective practice implies “the throwing back of thoughts and memories, in cognitive acts such as thinking, contemplation, meditation and any other form of attentive consideration, in order to make sense of them, and to make contextually appropriate changes if they are required” (Antrobus 2008, p. 34). Moreover, the meaning of this concept should be extended and be perceived as a means of personal experience correlation with the external world, the self and work. The most important goal of reflection is the development of knowledge relevant to the discipline. Moreover, reflection allows a nurse being distracted from generally accepted rules and traditions. A subjective nature of reflection has also been widely discussed and it has been claimed by Antrobus (2008) that in case of a personal reflection occurrence, many issues would be projected into the external world or would serve as a reflection of a collection experience. From the ideal perspective, personal reflection would serve for creation of a “meaningful whole”. Therefore, the most important consideration about reflection practice concerns knowledge development. With respect to knowledge development, it is relevant to know that there is “reflection-in-action” and “reflection-on-action”. Concerning my personal experience, I would like to note that I would prefer the first type of reflection. Firstly, it implies that it is important to be conscious in the process of doing. Therefore, we have come to the conclusion that it is relevant to correlate theory in nursing with practice. In this case, a synchronous perfection of nursing practices would occur. Unlike pure sciences, nursing practice is focused on a severe prescription of necessary actions that should be taken by practitioners. This paradigm is irrelevant for nursing practicing, for sure. There is no exact direction between theory and practice in nursing practice. Unlike social workers, who claim that foreign theory cannot be dominant in practice development, nurses are more tolerant to theoretical knowledge application. There is a direct correlation between knowledge and practice in nursing. It is also relevant to consider the limits of the important role theory or practice plays in nursing practice. Kolb’s learning cycle implies that it is more relevant to draw parallels between thoughts and practice than between theory and practice. In this context, reflection means “research”. On my own experience, I would like to underline that in the process of research performance personal skills are developed and influence on nursing practice development. In accordance with the scientific paradigm of previous years, the effective nursing practice occurs in the process when a nurse is able to develop knowledge, influence on a person’s development and nursing theory and practice development. Thus, it is relevant to note that perfection of nursing practice depends on involvement of artistry of practice and refer more to holistic approach in their practice. Nevertheless, an important role of reflective practice is also marked as an integrative part of a successful nursing practice. Conclusion Therefore, considerations about integration of theory and practice in nursing are worth being considered in the modern scientific paradigm. This approach would underline nursing as a professional scientific field of human activity. There is an urgent need for medicine to develop a new epistemological basis and reconceptualize it in the field of medicine and in the scientific paradigm in general. Moreover, an inductive basis of knowledge gaining is also important for nurses. Thus, on the basis of the practical experience and professional skills gained during reflective practice, nurses can enrich theory applied in the process of their practice. A nurse should enrich her knowledge and be focused on the self-perfection. In this case, a nurse would develop medical skills appropriate for any patient. The major trigger for further learning is the personal development of a nurse as a “knower”. Therefore, it is relevant to develop a dualistic approach to knowledge gaining and knowledge application: on the one hand it is relevant to be focused on the personal knowledge gained during practice, but on the other hand, it is necessary to support knowledge by theoretical background. Works cited 1. Antrobus, S. (2008). Developing the nurse as a knowledge worker in health-learning the artistry of practice. Journal of Advanced Nursing, 25 (4), 829-835. 2. Coward, D. C. (2007). Critical multiplism: a research Strategy for Nursing Science. Journal of Nursing Scholarship, 22 (3), 163-167. 3. Long T. & Johnson M. (2000) Rigour, reliability and validity research. Clinical Effectiveness in Nursing 4(1), 30–37. 4. McKenna, H., 1997. 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