Nursing theory and practice: who guides who?

I am no expert when it comes to nursing theory, but I do know a thing or two about it. For instance, I know that it is very complex, and that not a lot of nurses know or understand a great deal of it. I find that a bit disheartening because our practice should be "guided by theory", right? Perhaps the problem is that there are extremely diverse fields of nursing theories, found at many levels of complexity and practicality. Modern nursing theory is said by many to have evolved from the works of Florence Nightengale in the late 19th century. Since that time, there have been a multitude of nursing theorists who have thrown their proverbial hat in the ring. There are so many types of nursing theories out there, that they have been categorized into "grand theories", "middle range theories", and even "practice theories". It's no wonder nursing students have a hard time understanding nursing theory, and why professional nurses, for the most part, couldn't name many theorists...let alone a theory that "guides their pactice."

So what are we to do about that? How can we be professionals, "grounded in theory" and "based in science" if our practicing membership...our frontline representatives...do not understand the very essence that is their "profession?" I suppose that is a complex question in and of itself. So what about this: why can't practice guide theory? Perhaps it can be argued that it does, in many ways. Evidence-based practice (EBP),I think, is fairly close to this...even though the practice is still "guided" by something. Taking all of the evidence we have on a particular practice issue, such as family presence during resuscitation or palliative care efforts, helps to formulate how and why we should practice in a particular way. But could it also guide theory development too? What about Elizabeth Kubler-Ross' work with the stages of grief? Now, she wasn't a nursing theorist, but her work is most definitely found in nursing practice. It can be, perhaps, known by what is referred to as a "borrowed theory": non-nursing theory that has been adapted for use within the profession.

We incorporate so many "bits and pieces" of so many different theories into our practice, that perhaps we do it without even realizing it. I think that unless you work in a particular area of nursing, where one particular theory almost entirely supports your practice, it is difficult to pick just one and stick with it. As nurses we must adapt to our ever-changing environment. We must be able to learn-unlearn-relearn many times over, as our practice is constantly changing...yet our theories rarely do. Now some of you will recall that there is a nursing theorist who spoke about "adaptation": Sister Callista Roy. I'm not going to discuss any particular theorists here, just making observation.

So maybe you are mot familiar with any one particular theory, or maybe you combine many theories into your practice...either way your practice is guided by something. Maybe your practice will guide you to develop a new theory in nursing, or perhaps improve upon an existing one. I think where many nurses lose interest in nursing theory is when they begin discussing some of the grand theorists, such as Martha Rogers (not picking on anyone in particular). Rogers' theory is very abstract and difficult to follow, yet she touches on some very key adpects related to complexity, which is a big topic of today. She was truly ahead of her time, when compared with theorists contemporary to her day. But at what point do these theorists say, "I think I'm going to make up a nursing theory today, I have nothing better to do today..." my guess is probably never. I would imagine that their theories were formed out of experience and practice. So, who guides who?

I think that in the end, it will be up to us as individual nurses to identify with a particular theory or theorist. Maybe it's time we start looking at a theory that helps circumscribe our own professionalism and interpersonal relations (beyond the work of Peplau). What about achieving professional growth? Or one about nursing as a unique culture, and the many ways we tend to interact with one another (good and bad), and what we can do to improve. Do any one of us have the answer? I doubt it. Many times, the best things to happen are not from the "inventors", but the "innovators"- the ones that improve what was discovered by others. And, again, that's the beauty of complexity science: we can never predict the effect one thing has on another.

So, who guides who: nursing practice or nursing theory??? Are patients in a continuum of wellness or illness? I think we could argue either point.... But I will leave you with this: do your homework- find out about nursing theory, EBP, and complexity science. Find out what your profession has to say about your practice style, and more importantly, what it needs to say about it.

We need to be more aware of the "forces" that fuel our practices, and the practices that can lead to better, more effective theory.

Thank you.

Steve