1. Comment on this statement that is often heard: “I have practiced (or taught) nursing for many years without the need to use theory, so why do I need theory in a practice discipline?”
2. Reflect on this statement: “A scholarly discipline must engage in societal concerns, in dialogues about pressing issues, and in shaping health care reform.” Is nursing a scholarly discipline? Do nurse scholars have the same attributes as other scholars in other disciplines? What would be your assessment of the level of scholarship in nursing?
3. What difference do the levels and types of theory make in advancing nursing knowledge?
429040
ck / Practice ApplicationsNursing Science Quarterly
NSQXXX10.1177/0894318411429040Karni
Practice Applications
Seeing the Forest Through the Trees
Nursing Science Quarterly
25(1) 34–35
© The Author(s) 2012
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0894318411429040
http://nsq.sagepub.com
Paula M. Karnick, RN; PhD1
Abstract
The purpose of this column is to stimulate discussion among nurses regarding the importance of nursing theory-guided
practice.The use of metaphor may shed light on defining nursing by its own terms.The time has come for nursing to recognize
its worth as an autonomous discipline and own its contributions
Keywords
humanbecoming, metaphor, nursing theory-guided practice, Parse
Since Aristotle, metaphor pervades everyday life. Metaphor is
an illustration of speech when a word or phrase literally represents an object or idea used in place of another. Metaphor goes
beyond language, it embraces ideas and action. Metaphor may
create clarity, explicating meaning in situation. Parse (2011)
often uses metaphors in her work, most recently she used a
metaphor with the humanbecoming school of thought (Parse,
1981, 1998) to illuminate leading-following.
The metaphor unable to see the forest through the trees is
one this author uses to give clarity to nursing theory in practice in light of the humanbecoming school of thought (Parse,
1981, 1998). Envisioning nursing as forest, one sees dense,
lush greenery pushing upward in unison. Upon first glance
one does not see a path into the forest but upon closer look,
the forest seems inviting and one may view other dimensions.
Therein lays a multitude of entry points. All the possibilities
reveal themselves as one begins the journey moving with
and connecting with the forest. Each step moves one deeper
into the forest as the forest itself comes alive. First traveling
through an eerie quiescence to the trees and leaves blowing
calmly in the breeze to the sounds revealed from the many
forest creatures, concealing themselves as one comes near,
cautiously moving as one turns and sees the many nuances a
forest holds.
As with the forest, nursing appears cohesive. Nurses have
not addressed age-old issues such as role definition and entry
into practice, yet rely on other disciplines to guide nursing
practice. Some look from afar at the forest and use that vision
to depict how nurses stand together. Connecting with the forest, one is enlightened by the subtleties of the many differences. Journeying deeper into the forest one separates from
the forest enlightened by those differences in the sounds, the
trees, the leaves, noting one is still connected to the forest.
Yet there is a fascination for what lies ahead. This is true
with nursing theory. Theories abound from the many nurse
theorists throughout history. Assumptions, foundations, and
underpinnings are often concealed, yet are waiting to be
revealed. As nurses embrace nursing theory, they are able to
hold all that is nursing in their hands, to glean with their
eyes, and live the practice of nursing. Nurses live their value
priorities. These value priorities are essential to being.
Nursing theories that should unite nurses in the profession
are slowly eroding away on the forest floor; in place of nursing theories are theories borrowed from other disciplines.
This is reminiscent of the past. Nursing faculty discourse
continues to bury the importance of nursing theory to practice. Can this be interrupted as an attempt to rid nursing curriculum of nursing theory? Use of other disciplines’ theories
actually eliminates nursing from nursing practice. For example, does business borrow from nursing theory? No, yet nursing borrows from business, by means of acuity systems
and productivity numbers, to name a few. When applying
business theory to nursing is healthcare enhanced? From the
standpoint of business theory, is the work nurses do seen as
nursing?
As in coming to know the trees in the forest, the abstractness of nursing theory may be intimidating, creating cautious
trepidation as nurses are compelled to shape their knowledge
base. Thus coming to know and understand nursing theory as
the foundation of practice is crucial in keeping the profession
of nursing alive. Instead of looking to other disciplines for
guidance and allowing those disciplines to make decisions for
nursing, nurse leaders must focus on nursing’s unique contribution and service to society.
1
Assistant Professor, Lewis University
Contributing Editor:
Paula M. Karnick, RN, PhD, Assistant Professor, Lewis University,
5023 N. Busse, Chicago, Illinois, 60656
Email: pmkarnick@aol.com
35
Karnick
Are you able to see the forest through the trees? Translating
nursing theory into nursing practice lends itself to this metaphor. Clarifying vital issues in nursing practice is seeing
the forest through the trees. At first glance, the discipline
stands together tightly like the trees in the forest. As with
the forest metaphor, trees connect and separate intricately
shifting with the wind and rain, reflecting the idea of nursing
theory intricately connecting and separating with nursing
practice.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship,
and/or publication of this article.
References
Parse, R. R. (1981). Man-living-health: A theory of nursing. New York:
Wiley.
Parse, R. R. (1998). The human becoming school of thought: A perspective for nurses and other health professionals. Thousand Oaks,
CA: SAGE.
Parse, R. R. (2011). Humanbecoming leading-following: The meaning
of holding up the mirror. Nursing Science Quarterly, 24, 169-171.
Nursing theory: Its importance to practice
Colley, Sarah
Nursing Standard (through 2013); Jul 30-Aug 5, 2003; 17, 46; Nursing & Allied Health Premium
pg. 33
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
534471
research-article2014
NSQXXX10.1177/0894318414534471Nursing Science QuarterlyNursing Science QuarterlyKarnick / Practice Applications
Practice Applications
Nursing Science Quarterly
2014, Vol. 27(3) 211–212
© The Author(s) 2014
Reprints and permissions:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0894318414534471
nsq.sagepub.com
What Kind of Nurse Are You?
Paula M. Karnick, RN; PhD1
Abstract
Once again the importance of nursing theory in practice comes to the forefront. By examining one’s personal and professional
beliefs in how one cares for people, it becomes apparent that nursing theory does guide nursing practice. The moral and
ethical judgments one makes before or while caring for a person may reveal that personal bias can detract from the quality
of care.
Keywords
moral and ethical care, nursing, nursing theory
A 54-year old man is admitted to your unit for the third time
in as many months. His admitting diagnosis is alcohol abuse.
Everyone on the unit is familiar with this person. He is
unkempt and verbally abusive to the nurses caring for him.
Another person is admitted to the unit that evening, a 27-year
old young woman with a diagnosis of stage four breast cancer, terminally ill with intractable pain. She has an eightmonth old baby at home and her husband is fraught with
anguish and grief. Do you think each of these people will be
given the same ethical, moral, quality care? Can nurses provide the same standard of care to every person, indiscriminately, every time?
How are nurses prepared academically to provide care
and attend to people in a manner that is fair to every person?
I challenge the readers of this column to ponder whether or
not they meet each individual person’s needs to the best of
their ability.
Nurses are human and have good days and bad days.
Nurses have issues too. What knowledge base do nurses
draw upon to provide care and excellence? Are nurses judgmental of people in their care? Can this judgment affect care?
If so, what does that verdict reveal about the profession, the
nurses, and the quality of care?
I would suggest that nurses examine their personal belief
system. What does nursing mean? What drew you to the profession of nursing? What are your convictions about humankind? Nursing is a profession like no other. The intimate
relationships built between nurses and people, no matter how
brief, should be one of trust and commitment to do the best
for the person. It is a daunting task and arduous to care for
people in challenging circumstances.
The essence of applying theory to practice has the potential to guide nurses to do the best for people every time, all of
the time. The concern is that if nurse educators are not exposing students to nursing theory, what guides their personal
practice? This circular argument is one which is too familiar
to nurses. In the nursing profession important questions are
never fully answered, they merely fade away while some
other diverting questions are introduced to prevent the tangible question from being answered thus distracting us from
our goals.
In reality does not it appear true that other professions
anticipate and expect the passivity of nursing? Do what you
are told. Beware of thinking for yourself; just follow a protocol of patriarchal and administrative practices long ingrained
in the culture of healthcare. It is my belief that in response to
these long-standing practices nurse theorists arrived on the
scene. These strong, resilient, visionary people (mostly
women) refused to settle for the way in which things were
done. With a deep commitment to human beings and the discipline of nursing from Nightingale to the present, nurse
theorists have been the foundational leverage the profession
needs to continue to care for people the right way, the ethical
way, every time. They saw unfairness, suffering, and impracticality in care and spent their lives attempting to serve people, support nurses, and sustain the profession.
Nursing theory informs and guides practice. The basis of
nursing theory resoundingly views people from a moral and
ethical stance. This is the crux of care. It is the core of being
with others in a manner that listens to people’s stories.
Many theorists working under the premise that fair and
equitable care is the basis for the profession were often
criticized by other nurses. Some nurses undervalued and
misunderstood those who embrace nursing theory. Nursing
theory, which should be taken and utilized in practice is
1
Director of the Institute of Nursing Education, Emergency Nurses
Association, Desplaines, IL
Contributing Editor:
Paula M. Karnick, RN, PhD, Director, Institute of Nursing Education,
Emergency Nurses Association, DesPlaines, IL.
Email: pmkarnick@aol.com
212
not valued, especially in the boardroom so it has virtually
been dismissed. It was first dismissed by hospitals and
more recently by universities. This dismissal has left nursing in the hands of administrators and financial officers
whose agenda reveals that profit, not people are the bottom
line.
This is a clarion call for nurses to question themselves.
What do you believe? What is your model of care? Is it to
get the person in and out of the setting? Do nurses attend to
persons in a fair and compassionate manner? How do you
care for persons in your care? When the 54-year old man
with alcoholism comes to your unit for the third time in
three months, what is your reaction? What informs your
practice?
Nursing Science Quarterly 27(3)
Before the diatribe regarding nursing theory in practice
does die, perhaps one should consider how care is given to
patients at every organization, at every interaction, by every
nurse. Is it ethical, moral, and without judgment? Is it theory
based? Is it the kind of care you want to receive? Start here.
Start now.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the authorship and/or publication of this column.
Funding
The author received no financial support for the authorship and/or
publication of this column.
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