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Nursing Through the Looking Glass:

Linking Nursing Knowledge, Theory and Practice

Mae Geraldine E. Dacer

Silliman University

Begin at the beginning," the King said, very gravely, "and go on till you come to the end: then

stop. Lewis Carroll, Alice in Wonderland

Nursing and global healthcare are in constant evolution at a rapid rate and nursing as a

discipline has been a challenge to anticipate, predict, and guide the adaptation of the profession

to these changes and transformation. This paper will explore and investigate deeper on the

historical roots, currently accepted paradigms and the future direction of the discipline to help

understand and explicate the concept crucial in the adaptation of the profession to the ever

changing universe. Scholarly articles made by the different nursing scientist, scholars and

theorist will be dissected, specifically, these articles include: to the discipline of nursing:

historical roots, current perspectives, future directions by Maureen C. Shaw (1993), knowledge

for the good of the individual and society: linking philosophy, disciplinary goals, theory, and

practice by Mary K. McCurry, Susan M. Hunter Revell and Sr. Callista Roy (2009), the

significance of the relationship between a discipline and its practice by Mary Grossman (1992),

and nursing knowledge: womens knowledge, a social perspective by Elizabeth I. Haggel (1989)

but is not limited to the ones previously stated.

Understanding the different paradigms, looking into the historical roots, and linking

theory and practice will help explore the essential knowledge foundation for the profession and

generate new theories essential the acceptance of the nursing as a science and as a discipline.

Intellectual investigations have been the highlight in the development of nursing as a profession

and as a discipline over the years. The dialogues, arguments, and scholarly debates are still

present up to this time and are widely accepted as a means of advancing nursing. Shaw (1993)

together with other nursing scholars believed that the discipline of nursing is slowly evolving

from the traditional role of women, apprenticeship, humanitarian arms, religious ideals, intuition,

common sense, trial and error, theories, and research as well as the multiple influences of

medicine, technology, politics, war, economics, and feminism. This transition is reflected in the

different arguments presented.

Connecting Discipline and Practice

Shaw (1993) in her paper presented that the latest development in nursing science and

research has made a huge impact in nursing education and clinical practice and most recent ways

of looking into phenomena have led to the re-examination and refinement of the previously

known concept on the different metaparadigms in nursing. Shaw (1993) examined the

development of nursing discipline as a unique body of knowledge from three viewpoints as to its

historical roots, current perspective and the possible future direction of the profession. Shaw

(1993) cited Florence Nightingale (1969) the founder of modern nursing who viewed nursing as

one having a separate organize concept and relevance different from medicine. Henderson

(1965) was also cited who describes nursing as a unique, complex service with an independent

practitioners who are authorities on nursing care. Since the development of modern nursing

numerous theories and conceptual framework emerge as a means to describe the nursing


Shaw (1993) therefor concludes that the goal of nursing theory is to contribute to the

wealth of knowledge required for clinical practice in different settings. Shaw (1993) finally

suggests that as nursing is approaching the 21st century, theory development must consider the

changing needs of the clinical population. The society and consumers should be actively

involved in the creation of theories and new avenues for theory development and research. It is

also emphasized in the paper the importance of client outcomes and evaluation as essential to the

future development of nursing knowledge by applying theories and methodologies develop in

nursing working hand in hand with disciplines.

McCurry, Hunter-Revel, & Roy (2009) article explores a philosophical perspective of

nursings social mandate, discusses disciplinary goals as they relate to the good of the individual

and society, and demonstrate how theory can guide the practice. Knowledge in a discipline is

enhanced when philosophy, disciplinary goals, theory, and practice are linked together. Nursing

to be accepted as a profession must contribute to the good of the society through knowledge-

based practice. The integration of theory to practice is accentuated in the papers as it serves as a

guide to achieve the goal of the nursing discipline which is promoting health and preventing

illness. When nursing goals are directed are directed at a synthesis of the good of the individual

and the society, nursings social and moral mandate may be achieved (McCurry, Hunter-Revel,

& Roy, 2009). Linking philosophy, disciplinary goals, theory and practice is the future of the

nursing future profession with the primary goal of healthcare for all.

Grossman and Hooton (1992) argued that the absence of conceptual consensus across the

university and its sectors is largely responsible for the growing gap between the goals of the

discipline and its practice. They pointed the emphasis that university and practice should have a

symbiotic relationship that is both should have a shared framework that would transcend

university and service structures. A professional discipline is defined by shared value orientation,

social relevance and a conceptual structure (Donaldson & Cowly, 1978). Basing on this

definition of a discipline Grossman and Hooton (1992) suggested since nursing is a diverse

discipline there should be a common consensus to lessen the gap.


Hagell (1989) in her paper questions the direction in which the profession is moving. The

feminist perspective is used in critiquing basic assumptions about science, scientific method, and

scientific knowledge. This uses sociological and feminist theory to support the idea that nursing

as a discipline has a distinct knowledge base which is not grounded in empirico-analytic science

and its methodology but which stems from the lived experiences of nurses as women and as

nurses involved in caring relationships with their clients. Hagell (1989) cited sociologist

Holtzner (1968) who further explored the relationship of social framework and knowledge. He

describes knowledge as the mapping of experienced reality by the observer of the phenomenon.

The notion that all knowledge originates in an observer makes it necessary to specify the

observers position and point of view as a reference.

Hagell (1989) concluded that nursing knowledge is based in part on their situation as a

woman in a patriarchal society and in part as a woman involved in a specific gender defined

occupation which is given little value in the society. The author also concluded based on this

assumption that nursing knowledge is different from scientific knowledge and therefore not

given the scientific knowledge status. This idea suggests that nursing science is not a mature

science since the characteristics of a mature science (Kuhn, 1970) is made by the perceptive of a

male. The ambivalence that has characterized the relationship between nursing and feminism

should exist no more. Nursing can embrace the movement because of equality benefits

individuals, society, and, thus, the recipients of nurses care. We no longer need to hang back,

fearful that feminism will drive more talented students away from nursing and into other

professions. We can use our considerable creative skills to design ways to invite men into

nursing and to develop programs that make full use of all of the societys talented members who

desire to enter nursing (Sullivan, 2002).


Lauden (1984) as cited by McCurry, Hunter-Revel, & Roy (2009) explains that

knowledge is based on the theories made in the discipline, while problems constitute the

question, thoeries constitute the answer. Meleis (1987) as cited by Shaw (1993) defined theory as

a powerful, dynamic, yet focused source of professional autonomy and clinical challenge and

that the development of nursing knowledge is evolving in an unconventional way. Although

doing things in a conventional way would mean the acceptance of nursing in the scientific

community this also sparks debates. Shaw (1993) cited Hardy (1978) who advocated of having a

completing theory and adapting a specific paradigm in order to bring unity in the profession.

McCurry, Hunter-Revel, & Roy (2009) qouted Grace (2002, p.67) who stated that practicing

according to a well-established theoritical framework generally results in more consistent and

better care than practice without guides. Grossman and Hooton (1992) also emphasized the

importance of having a conceptual consensus that would bridge the gap between university and

service unit but having a conceptual consensus would limit the growth of nursing as a

professional discipline.

Then again, contemporary authors proposed diversity and plurality in nursing philosophy,

science and practice. In the unconventional perspective, not only is adaptation of a specific

standpoint is unlikely in a profession that understands multidimensional, complex human

behavior, but theoretical consensus is quite unlikely in a discipline that values the role of

perceptions, uniqueness and individuality in health and illness (Shaw, 1993). These different

views towards nursing knowledge fuel healthy differences among nursing scholars and theorist

that helps in the continuous improvement of the profession. The unique synthesis of the art of

caring and the empiricism of science is what distinguishes nursing from other health profession.


Nursing is in a constant evolution. Continued research and quest for knowledge is the

hallmark of the profession and it should not stop. Cody (1995) anticipated that there will be

changes in the nursing perspective in the coming years. Feasibly according to Cody there will be

emerging knowledge that will abolish the reductionist, natural science model of nursing. He

views that in time there will be a middle ground in the nursing profession.

The ability to analyze, reason, and evaluate is important in the modern health service to

provide care based on the best available evidence (Holt & Clarke, 2000). Hence, there is a need to

let future nurses think on their own, examine assumptions presented, and provide reasoned

arguments to support ideas and judgement.

Holt and Clarke (2000) suggested the introduction of philosophy to the nursing curriculum

as a way to address the needs of the students to develop skills in critical analysis, evaluate

published literature and how nursing theory can be relevant to practice. This will now bridge the

gap between universities and practice sectors. They also point out that nursing practice should be

an association of theoretical knowledge and philosophy. This can be applied in case studies, related

learning experiences, clinical exposures, and research among others.

Therefore, nursing knowledge needs to consider and reflect on the uniqueness of nursing

and welcome pluralism in its practice. The inference that the scientific field in isolation is

extremely limiting and restrictive to thoroughly explore, describe and predict the nature of nursing

and its practice, leads to nurses needing to explore knowledge from a combined art and science

standpoint: inextricably linked in such a way that the whole is more than the sum of the two (Rose

& Parker, 1994).



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