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Plain Talk:  Maybe we don’t have a theory-practice gap.  Instead, we may have a gap between the way we think of human nature and the questions we come up with for nursing research.  How we understand human nature will necessarily impact what we choose as nursing research topics.  We have not spent enough time in nursing developing the concept of human nature as it relates to health.

The Details:
Green, Catherine. (2009). A comprehensive theory of the human person from philosophy and nursing. Nursing Philosophy 10(4), 263-274.

Ontology: the study of what exists, what is real.

I applaud this article. Catherine Green notes that our source of knowledge of others is our observance of a person’s intentional actions. Green acknowledges the stances of two philosophers, Wallace and Sokolowski.

Wallace states that personal responsibility for choices is ingrained in our relationships with others and society.

Sokolowski asserts that personal intentionality is made known publicly by one’s actions.

If we blend Wallace and Sokolowski into one statement, it would be this: We have knowledge of other people based on their choices and these choices reflect their intentions. At this point, you might be thinking, “duh”. Keep reading.

Green uses this synthesis to suggest this might help close the theory-practice gap. But I think it’s deeper than that. To me, Green’s article reveals that the problem is not a theory-practice gap so much as it is an ontologic-research gap.

The theory-practice gap is the ‘disconnect’ that some have noted as the mismatch between theory in the classroom and real-life nursing practice. Who thinks about Roy, Orem, Nightingale, Rogers, Henderson, etc. during daily work? Some of these theoretical systems are very complex. But maybe that’s not the REAL problem.

The real problem, I think, more often lies in the ontologic, which I’ve written about before. In nursing practice, we’re not dealing with a theory, we’re working with a person. So our assumptions about the nature of man must be accurate for us to effectively intervene on their behalf. We do this instinctively. The reason theory doesn’t resonate with us may be because the theory reflects dimensions of man, rather than ontology of man. Theory recognizes domains of man as social, physical, mental, and spiritual being. But deeper than that is man’s morality and intentionality, as Wallace and Sokolowski asserted.

Ideally, philosophy informs theory which informs research which informs practice.

Skipping philosophy to focus on theory and then jumping to practice creates some potential problems. Problems like treating theory as if it were the philosophy. A poorly articulated philosophy/ontology will result in a tenuous theory, which down the road finds a disconnect to practice.

Green has it right. The ontologic notions of relationship, revelation of personal intention, and moral responsibility that Green so aptly describes is premised on the belief that nursing theory needs a more ontologically sound foundation. Indeed, an ontologic focus on man’s essential being is necessary if we are to extract pertinent research questions about the essence of man’s well-being. By defining the nature of man more thoroughly, nursing theory is built on a more solid foundation. Following suit, the research is targeted to truly pertinent questions, and practice naturally follows in accordance.

Green’s pragmatic emphasis echoes the work of Doane and Varcoe (2005) who adopted a nursing philosophy of pragmatism, which is a process to “bring knowledge, compassion, and action together to produce practical knowing – to develop knowledge in service of worthwhile human purposes” (p. 115). I assert that such practical knowing is steeped in the ontologic primarily, and in the theoretical secondarily. Green’s work is a step in the right direction.

I’m not saying my opinion is revolutionary or the be-all, end-all. I think we need to get out of the rut of always assuming there is a problem we call the theory-practice gap. Maybe it’s not that at all in some cases. Maybe it’s an ontologic-research gap.

I propose that the next step forward involves exploring this ontologic synthesis of man as a relational and intentional being.

Listen to Sokolowski: “What human nature is capable of being in its actions is shown not primarily by philosophical speculation but by good human agents. Virtuous action in concrete situations is the primary display of the possibilities of action…Virtuous agents acting are the measure of what ought to be done. There is no cognitive substitute for this original display.” (Sokolowski, 1985, p. 149).

References

Doane, G. H. (2009). Toward compassionate action: Pragmatism and the inseparability of theory/practice. In P. G. Reed, Perspectives on Nursing Theory (5th ed., pp. 111-121). Philadelphia: Lippincott, Williams, and Wilkins.

Green, C. (2009). A comprehensive theory of the human person from philosophy and nursing. Nursing Philosophy , 10 (4), 263-274.

Sokolowski, R. (1985). Moral Action: A Phenomenological Study. Bloomington IN: Indiana University Press.
Portions of this post were selected from my letter to the editor of Nursing Philosophy, publish date pending.

(This was an impromptu writing to fulfill a short assignment on metaphors for nursing theory.)

I’m sitting at my computer, gazing at my 10 year old arthritic black and tan female German Shepherd, Jala, who is sleeping three feet from me with her muzzle cradled on her right paw. A distant child’s voice from outdoors sparks her from slumber. Ears upright, a turn of the head, a quick glance towards me, and she lazily rolls onto her side. It’s only a child. No worry.

For ten years she has exercised faithful vigilance over the theoretical unknowns. New interpretive contexts fall somewhere between Jala’s creative independence and learned boundaries. Like letting babies crawl on her. Or assuming a sentry position outside doors of dreaming toddlers. Or testing new relationship constructs by “telling” me the cat need to go out. Or experimenting with new applications: Will she be allowed to take Vail’s place in bed while he is out of town?

We have not yet discovered any interpersonal environment to which she cannot adapt. Her concepts have stood the test of time. As an interdisciplinarian with Kuhnian tendencies, this 4-legged, 90 lb. holistic framework must perpetually assess the neighborhood for new evidence that might invoke a paradigm shift. The research continues to support Jala’s fundamental assumption that a healthy and safe environment is the criterion of community wellness.

Nursing theory is such a dog!

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Every discipline has its philosophical foundation, and nursing is no different. Philosophy attempts to answer the questions of what nursing is, why it exists, and what ethics and values underpin these beliefs. Inherent in any nursing philosophy is how man is conceptualized. If you are new to nursing philosophy, this is where I would recommend you begin in identifying your own philosophy of nursing.

Nursing philosophy, like any other discipline-specific philosophy, is what directs and drives research and knowledge development to advance the discipline. Philosophy, then, articulates the core beliefs of a discipline and defines the boundaries of what we want to know about our discipline.

Your personal nursing philosophy is not your treatise on why you want to be a nurse. It is not a statement about what nurses do in context of health and illness. If that is where you’re at right now, you need to drop down a level, because what nursing “looks like” must be undergirded by why it should look like that (whatever “that” is). You are trying to explain to someone else why nursing exists. Go deeper than the superficiality of “nursing helps people maintain health” or “nurses alleviate suffering”. Incessantly ask yourself “why”. Get past the superficial.

Philosophy is formed from intuitions and beliefs about the way life should be and why you think it should be that way. You should consider the following questions when you write your personal nursing philosophy:

1. What is the purpose of man’s life? Why do you believe what you believe?

2. Why do people value health? How does health relate to man’s purpose?

3. How does illness interfere with our purpose in life? Or does it?

4. How do you define health? How is that related to your idea of man’s purpose in life?

5. What do you believe about the community of man? What are our social obligations to our fellow man? Why?

6. Is “health” a right? Or is it an ideal? Is medical care a right? Or is it an ideal?

7. By now you should have an idea about what ethical values you think should be held by nurses. Again, this is related to your concept of humanity and our purpose in life.

8. If you get stuck anywhere along the way, keep asking yourself “Why do I believe this?” and you’ll eventually get there, though it can be mind-boggling at times. You’ll find that your answers always revolve around values and morals and purpose. That’s why it’s important to know what you believe and why. Keep asking these questions of yourself.

By working through these questions you will arrive at how nursing fits into your philosophy of man, because your philosophy will reflect what you believe about yourself, and it should also lead you to why you chose nursing as a profession.

Philosophy can be intimidating, but it is just a fancy term for your beliefs and your justification of those beliefs. Good luck! Email me with your questions. I’d also love to read your philosophy! pamelafruechting@gmail.com

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