Assignment Content 1. Fundamentals of Nursing Models, Theories, and Practice discusses the theory-practice gap in detail in many chapters. As you have read throughout the course, there is ongoing discussion about the connection between theory and practice, and the application in day-to-day nursing activities. This assignment is designed to illustrate that although there may be a gap, other factors play an important role in decision-making, and each aspect of theory, research, and practice experience are integral to well-rounded patient care. Access Fundamentals of Nursing Models, Theories, and Practice, and review Figure 1.4 Correlation: education, science and practice, by clicking the Theory–Practice Gap Readings Link directly below this assignment entry. Think of a scenario in which theory, research, and practice interact to create good patient outcomes. Create a visual representation of the theory-practice relationship or gap by replacing the text in the Theory-Practice Gap Diagram Template. o o o o Write a minimum of 525- to 700-word narrative explanation of your visual representation following the diagram. Describe the chosen theory, research, and practice guideline or standard. Explain the relationship between the three, and discuss the role each plays in quality patient care in the scenario. Explain any gaps, such as a lack of research, no practice standard, or no usable theory. Determine the best course of action for making decisions in the absence of one aspect. Include documentation of the practice guideline or standard, as well as your corresponding research, evidence, or literature example. Cite your research and practice guidelines in-text and on the references page at the end of the template. Nursing Theory-Based Independent Nursing Practice: A Personal Experience of Closing the Theory-Practice Gap Musker, Kathleen PhD, RN Author Information Author Affiliation:School of Nursing and Health Studies, Northern Illinois University, DeKalb, Illinois. Correspondence: Kathleen Musker, PhD, RN, School of Nursing and Health Studies, Northern Illinois University, 1240 Normal, DeKalb, IL (kmusk@earthlink.net). The author thanks Dr Paula Kagan for her contribution to this article. Abstract The article presents a narrative and exemplar from an independent nursing practice underpinned by the theory of health as expanding consciousness. NSG University of Phoenix Nursing Theory Practice Gap Essay

The journey illustrates the importance of developing personal and professional awareness of theories that are congruent with one’s worldview. This enhances meaning in nursing practice and contributes to closing the theory-practice gap. The benefits of independent nursing practice to closing the gap are also discussed. IN 1989, Rogers wrote that “individuals have a personal paradigm or meaning perspective that structures the way in which they existentially experience, interpret, and understand their world.”1(p112) Each individual nurse therefore holds a particular worldview. According to their worldview, they are likely to have theories congruent with the paradigm, by which they account for how things work in the world. It is the contention of this writer that, as a nurse, becoming aware of one’s worldview contributes to identifying theories, particularly nursing theories, that are congruent with her or his worldview and therefore are recognized by the nurse as meaningful to her or his nursing practice. In my experience, having meaningful knowledge instills a desire to apply the knowledge in practice. A felt sense of integrity of theory and practice emerges and promotes a pattern of applying theory in practice, and gaining new nursing knowledge that arises from meaningful practice. Developing processes for expanding consciousness of worldview or paradigmatic perspective and theories that underpin my personal and professional life is a process that evolved in my life over many years. Only in retrospect did I realize that I had been repeatedly using specific processes of attention, reflection, and articulation in my personal and professional nursing journey to bring to consciousness my beliefs and the theories that support them. This occurred while I spiraled through phases of theory and practice toward my current unitary worldview and health as expanding consciousness (HEC)-based independent nursing practice (INP).2 With increasing autonomy in my nursing practice, I became more and more aware of the value of theory to guide my practice, which led to my experience of closing the theory-practice gap. It is the purpose of this article to illuminate the value of nursing theory to INP and to explicate this as an evolving personal process. This will be accomplished by presenting a narrative of my evolving personal and professional journey regarding my expanding awareness and experience of nursing theory-practice, nursing roles, education, employment, identity, and worldview. My nursing practice as evidence of the value of theory to practice will be further detailed through a description, exemplar, and analysis of my current INP methodology as guided by Newman’s 2 HEC theory. Implications regarding the theory-practice gap, emergent from my personal and professional experience, will also be noted. I am presenting my personal journey, supplemented with an exemplar from my current INP, for 2 primary reasons. The first is to indicate that closing the theory-practice gap is in part an intuitive process of selfawareness and can be done independently. The second reason is to present the process of closing the theorypractice gap in the context of a nonconventional nursing setting that is an independent private practice. NSG University of Phoenix Nursing Theory Practice Gap Essay

It is important that nurses are aware of nursing practice options through which they can practice in ways that are congruent with their personal paradigms, and this article presents an example of a nursing theory-guided INP that is congruent with the unitary-transformative nursing paradigm.3 Although this article indicates that it is possible to close the theory-practice gap independently, it took me many years to do so, and it is my belief that using the processes of attention, reflection, and articulation can activate awareness and close the gap in a more timely manner. As nurses are being held more and more accountable for theory in practice, time may be of the essence in expanding self-awareness of personal and professional beliefs, theories, and values because they relate to practice in any nursing setting. Back to Top 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.NSG University of Phoenix Nursing Theory Practice Gap Essay

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. Back to Top NARRATIVE My nursing career evolved through approximately 8 phases. Each phase has been a unique combination of nursing role, identity, worldview, and theoretical underpinning. The phases were BSN student, hospital nurse, rural clinic nurse, urban home health nurse, MA student, independent holistic practice nurse, PhD student, and nurse educator/INP. The last 4 phases began to overlap, but for the purposes of this article, they are addressed according to predominant focus in my life in relation to theory-guided practice. As an undergraduate nursing student right out of high school in the 70s, I had 1 nursing theory class in my senior year. I learned the theories as abstract concepts and did not recognize these theories as directly applicable to my nursing practice. My theoretical perspective then was primarily unconscious and my nursing education at the time did not encourage me to call this perspective to consciousness.NSG University of Phoenix Nursing Theory Practice Gap Essay

As I began my first hospital job on a medical-surgical unit, I compliantly accepted the received view, which was the biomedical model of health care. I was experiencing reality shock in my first full-time job in the “real world” and was focused on learning a new job. I was guided by the experienced nurses who mentored me, and by my personal belief in persons as the sum of systems including emotional and spiritual systems. I was young and adventurous and left this job to pursue life and work in Alaska. Eventually I found employment in Alaska in a rural health clinic providing nursing care to the local population of a small town, working with a physician’s assistant who functioned as the local doctor for the region. Again, my practice was not guided consciously by theory, but I was beginning to expand my worldview by reading books that challenged my linear view of reality as objects interacting in predictable ways. I resonated with many of the ideas about a nonlinear unpredictable universe, and the effect of the observer on the observed. I learned about an energy-based nursing technique called Therapeutic Touch.24 My personal view began shifting to a system’s view of wholeness as greater than the sum of parts. I had high hopes for what could be accomplished in terms of nursing care as I began my next job as a visiting nurse in the inner city of Chicago. With my new theoretical perspective of the power of the individual; the mindbody connection, and the nurse-client relationship as a partnership, I believed that the people I worked with would feel freer to make healthy choices with my nursing support. More often than not this did not happen and I began to feel disillusioned with the dualistic medical model in which the doctor and even nurse were “experts” and privileged in the health care system as opposed to the patient who often behaved as a victim of both the illness and the health care system. As my discomfort with my nursing practice increased, I began to reflect on and question my own theories about what health was, and what my role was as a nurse. I explored the idea of INP when I found the book On Their Own9 written by Chicago nurses, and when I attended a lecture by Kinlein,8 who spoke about her INP. I was not yet prepared to enter independent practice as a nurse, but the idea of it continued to intrigue me. Meanwhile, I continued my self-study of holistic and systems theories and I also sought more theoretical health care knowledge and methods of nursing practice congruent with my new beliefs. This led to my next venture, which was to return to school in California for a master’s degree in holistic health. The program I entered drastically shifted my ideas because I learned about theories of consciousness and energy patterns as underlying reality. The educational philosophy of the program was primarily experiential and it was a challenge for me to first experience lessons and then to learn the theory. Theories based on Eastern spiritual philosophy provided models of the body-mind-universe as energy systems, which operated according to specific principles.NSG University of Phoenix Nursing Theory Practice Gap Essay

I also learned counseling theories that focused on attending to energy of lived experience 25 and used somatic or body-oriented methods 26 to elicit energetically based life patterns that were information about a person’s health, including my own. With this new knowledge, I returned to Chicago and decided to begin a part-time private practice based on the theories I had learned in the program. In my private practice I was able to appreciate and apply theory to my work and in fact found it necessary to do so in order to organize my practice and explain my work to clients, to be able to articulate why I used certain techniques. I worked as a partner with clients and knew that I was not just observing their process but was engaged in a mutual healing process with them. This work was often transformative for both of us and felt very satisfying to me. I valued having theories that applied to and guided my practice. The 1 aspect that was disconcerting was that I felt confused about my professional identity. My work was based on nonnursing theories and I was not directly involved with other nurses practicing as I was. I was unclear about my identity as a nurse and tried on different titles such as wellness counselor or healing arts practitioner, to see what fit. I deeply identified myself as a nurse but could not see how this could mesh with the society’s view of a nurse, nor did I have a nursing theoretical framework to guide my work. My personal explorations continued through reading and workshops, which led to my next expansion of consciousness. In the course of my ongoing self-study, I discovered the work of Margaret Newman and her theory of HEC.2 Not only did I resonate with her theoretical assumptions, but in my master’s degree program, I had been introduced to many of the authors and works she cited as background sources for her theory. I felt an immediate connection with HEC as if the theory validated the work I was doing and provided a nursing theoretical framework in which to do so. I was already working with pattern and consciousness because I used cognitive and somatic methods of pattern recognition (PR) with clients in my practice. During that time I participated in a conference on nursing and the environment and for the first time I consciously applied Newman’s theory in a lecture and manuscript 27 that I presented at the conference. The conference shifted my awareness to another level on my evolving journey as I encountered doctorally prepared nurses doing original research from a holistic perspective. This was congruent with my beliefs and with HEC. For the first time I felt that there might be a place for me in the discipline of nursing as a nurse with a holistic perspective, and that my practice could be supported by nursing knowledge. It was then that I knew it would be possible for me to obtain a nursing PhD while focusing on phenomena in a way that was congruent with my worldview. My next career phase was to enter a nursing PhD program. I thought I had the theoretical understanding I needed to begin a dissertation on pattern using HEC. I had knowledge of the theory, but I found out that I did not necessarily have a true understanding of the theoretical perspective of HEC. It was under the guidance of Dr R. Parse and my introduction to her unitary theory of human becoming 28 that I was propelled into awareness that wholeness from a unitary perspective was very different from the systems view I held. Rather than my view of wholeness as greater than the sum of the parts, the unitary view posits that there are no “parts.” Wholeness is viewed as an inherent property of reality; an essential unity from which all phenomena manifests.2,26 It took me a while to grasp this and then to realize that this perspective underpinned HEC. As Maslow suggested, “if all you have is a hammer, everything looks like a nail.”29(p15) Until this shift in consciousness occurred, my hammer was systems theory and wholeness looked like an indivisible interaction of separate but connected elements. As my paradigm shifted, I adopted a new understanding of wholeness from a unitary perspective as inherent wholeness. With further awareness of the …