New Thoughts on the Supposed Theory-Practice Gap

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.

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