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Advances in Nursing Science Vol. 34, No. 1, pp. 67–77

Nursing Theory-Based Independent Nursing Practice A Personal Experience of Closing the Theory-Practice Gap

Kathleen Musker, PhD, RN

The article presents a narrative and exemplar from an independent nursing practice under-

pinned by the theory of health as expanding consciousness. The journey illustrates the impor-

tance 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. Key words: health as expanding consciousness, independent nursing practice, practice methodology, theory-practice gap

IN 1989, Rogers wrote that “individualshave a personal paradigm or meaning per- spective that structures the way in which

they existentially experience, interpret, and

understand their world.”1(p112) Each individ-

ual nurse therefore holds a particular world-

view. 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 iden-

tifying 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 knowl-

edge instills a desire to apply the knowledge

in practice. A felt sense of integrity of the-

ory and practice emerges and promotes a pat-

tern of applying theory in practice, and gain-

Author Affiliation: School of Nursing and Health Studies, Northern Illinois University, DeKalb, Illinois.

The author thanks Dr Paula Kagan for her contribution to this article.

Correspondence: Kathleen Musker, PhD, RN, School of Nursing and Health Studies, Northern Illinois Univer- sity, 1240 Normal, DeKalb, IL (kmusk@earthlink.net).

ing new nursing knowledge that arises from

meaningful practice.

Developing processes for expanding con-

sciousness of worldview or paradigmatic per-

spective and theories that underpin my per-

sonal and professional life is a process that

evolved in my life over many years. Only in

retrospect did I realize that I had been repeat-

edly using specific processes of attention, re-

flection, and articulation in my personal and

professional nursing journey to bring to con-

sciousness 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 inde-

pendent nursing practice (INP).2 With in-

creasing 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 illu-

minate the value of nursing theory to INP

and to explicate this as an evolving personal

process. This will be accomplished by pre-

senting a narrative of my evolving personal

and professional journey regarding my ex-

panding awareness and experience of nurs-

ing theory-practice, nursing roles, education,

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68 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2011

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’s2 HEC theory. Implications regard-

ing the theory-practice gap, emergent from

my personal and professional experience, will

also be noted.

I am presenting my personal journey, sup-

plemented with an exemplar from my current

INP, for 2 primary reasons. The first is to in-

dicate that closing the theory-practice gap is

in part an intuitive process of self-awareness

and can be done independently. The second

reason is to present the process of closing the

theory-practice gap in the context of a non-

conventional nursing setting that is an inde-

pendent private practice. 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 nurs-

ing theory–guided INP that is congruent with

the unitary-transformative nursing paradigm.3

Although this article indicates that it is possi-

ble to close the theory-practice gap indepen-

dently, it took me many years to do so, and

it is my belief that using the processes of at-

tention, reflection, and articulation can acti-

vate 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 be-

liefs, theories, and values because they relate

to practice in any nursing setting.

SIGNIFICANCE OF INDEPENDENT NURSING PRACTICE

My current nursing practice includes nurs-

ing 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 in-

dependent practitioners in health care were

rare after 1900.5 With the advent of medi-

cal 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 sub-

servient to doctors, following the doctor’s or-

ders and carrying out their treatment plans.

This type of nursing practice usually oc-

curred 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 nurs-

ing work in private practices8 or using their

nursing knowledge in other fields such as in

business.9

Independent nursing function was de- fined as “any aspect of nursing practice for

which the nurse alone is responsible, act-

ing 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 num-

bers of hospitals in certain areas because of

consolidation,11 the emphasis on preventive

health care,11 and public interest in holis-

tic 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 inde-

pendent 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 dif-

ficulties and opportunities for nurses in incor-

porating theory into practice as compared to

doing so in conventional health care settings.

One drawback of INP is not having peers with

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Nursing Theory-Based Independent Nursing Practice 69

whom to discuss concerns and learning new

ways to apply theory in nursing practice.13 In

places such as hospitals, theory may be ad-

dressed explicitly through the choice of a the-

oretical framework adopted by the hospital

or a theoretical framework utilized by a spe-

cific 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 im-

plicit, nurses in these conventional health

care settings have a theoretical structure sup-

porting 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 theo-

ries congruent with their worldview. This is

due to their greater autonomy and possibil-

ity for creativity and innovation.11 Also, in a

private practice setting, the need for and rel-

evance of theory to practice may be more ap-

parent than in other circumstances because of

the one-to-one intensity of focus on the ther-

apeutic partnership, and the sole responsibil-

ity for the embodiment of theory by the nurse

in the partnership. With a lack of other ac-

cessible external guidance and structural sup-

ports, theory provides the primary structure

to guide healing process in an autonomous

situation. While relevant theories may pro-

vide 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 be-

came 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 theoreti-

cal 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 ap-

preciation for and application of HEC nurs-

ing theory in my INP, emerged as recently

as 10 years ago. The value of HEC in nurs-

ing practice has been documented by New-

man 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 un-

derstanding self as a whole,21 evolving car-

ing and closeness,19 releasing old unhealthy

patterns,23 and unfolding meaning.22 There

were no articles found that presented evi-

dence of the value of HEC theory in practice

in INP.

NARRATIVE

My nursing career evolved through ap-

proximately 8 phases. Each phase has been

a unique combination of nursing role, iden-

tity, 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 ac-

cording to predominant focus in my life in re-

lation 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 rec-

ognize these theories as directly applicable to

my nursing practice. My theoretical perspec-

tive then was primarily unconscious and my

nursing education at the time did not encour-

age me to call this perspective to conscious-

ness. As I began my first hospital job on a

medical-surgical unit, I compliantly accepted

the received view, which was the biomedi-

cal 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

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70 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2011

belief in persons as the sum of systems in-

cluding 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 pop-

ulation of a small town, working with a physi-

cian’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 read-

ing 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 tech-

nique called Therapeutic Touch.24 My per-

sonal 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 accom-

plished 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 per-

spective of the power of the individual; the

mind-body 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 sup-

port. More often than not this did not hap-

pen and I began to feel disillusioned with

the dualistic medical model in which the doc-

tor and even nurse were “experts” and privi-

leged 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 sys-

tems theories and I also sought more theo-

retical health care knowledge and methods of

nursing practice congruent with my new be-

liefs. 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 under-

lying 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. The-

ories based on Eastern spiritual philosophy

provided models of the body-mind-universe

as energy systems, which operated according

to specific principles. I also learned counsel-

ing theories that focused on attending to en-

ergy of lived experience25 and used somatic

or body-oriented methods26 to elicit energet-

ically based life patterns that were informa-

tion 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 appre-

ciate and apply theory to my work and in fact

found it necessary to do so in order to or-

ganize my practice and explain my work to

clients, to be able to articulate why I used cer-

tain techniques. I worked as a partner with

clients and knew that I was not just observ-

ing their process but was engaged in a mutual

healing process with them. This work was of-

ten transformative for both of us and felt very

satisfying to me. I valued having theories that

applied to and guided my practice. The 1 as-

pect that was disconcerting was that I felt con-

fused about my professional identity. My work

was based on nonnursing theories and I was

not directly involved with other nurses prac-

ticing as I was. I was unclear about my iden-

tity as a nurse and tried on different titles such

as wellness counselor or healing arts practi-

tioner, to see what fit. I deeply identified my-

self 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,

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Nursing Theory-Based Independent Nursing Practice 71

which led to my next expansion of conscious-

ness.

In the course of my ongoing self-study, I dis-

covered 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 intro-

duced 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 do-

ing and provided a nursing theoretical frame-

work in which to do so. I was already work-

ing with pattern and consciousness because

I used cognitive and somatic methods of pat-

tern recognition (PR) with clients in my prac-

tice. During that time I participated in a con-

ference on nursing and the environment and

for the first time I consciously applied New-

man’s theory in a lecture and manuscript27

that I presented at the conference. The con-

ference shifted my awareness to another level

on my evolving journey as I encountered

doctorally prepared nurses doing original re-

search 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 prac-

tice could be supported by nursing knowl-

edge. It was then that I knew it would be pos-

sible for me to obtain a nursing PhD while fo-

cusing on phenomena in a way that was con-

gruent with my worldview.

My next career phase was to enter a nurs-

ing PhD program. I thought I had the theo-

retical understanding I needed to begin a dis-

sertation on pattern using HEC. I had knowl-

edge of the theory, but I found out that I did

not necessarily have a true understanding of

the theoretical perspective of HEC. It was un-

der the guidance of Dr R. Parse and my in-

troduction to her unitary theory of human

becoming28 that I was propelled into aware-

ness that wholeness from a unitary perspec-

tive 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.” Whole-

ness is viewed as an inherent property of real-

ity; an essential unity from which all phenom-

ena 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 in-

teraction of separate but connected elements.

As my paradigm shifted, I adopted a new un-

derstanding of wholeness from a unitary per-

spective as inherent wholeness. With further

awareness of the unitary-transformative nurs-

ing paradigm, and HEC unitary nursing the-

ory, I began my research, using Newman’s2

HEC praxis method, and wrote my disserta-

tion from this perspective of wholeness. I

gained the clarity that HEC was the nursing

theory most congruent with my INP.

As my understanding of HEC theory deep-

ens, I increase my awareness and embodiment

of the theory in my praxis. This occurs in

the mutual lived experiences with my clients,

and as I reflect on the meaning of these

experiences in my life and work. With this

consciousness and experience of embodying

nursing theory in my INP, I see the evidence

of the value of nursing theory in my practice.

It is the pattern awareness and transformation

that occurs in the mutual process of my prac-

tice methodology. I look forward to sharing

this nursing knowledge with students in my

current additional role of a nurse educator. It

will be of value to students to learn that nurs-

ing theory–based INP is a career option for

them, and that it is of value to them to reflect

on their personal ontology and to identify and

apply nursing theory compatible with that.

CURRENT HEC THEORY-GUIDED PRAXIS METHODOLOGY

For a number of years my INP was under-

pinned by an integrative-interactive systems3

paradigmatic perspective. As I shift to a

unitary-transformative perspective, I revisit

the way in which the theory guides my

practice. According to Newman,2 a new

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72 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2011

theory transcends and includes the old. In

terms of energetic pattern change, previous

theories25,26 of energetic pattern change indi-

cated that it is possible, through attention to

a pattern, to let go of what is no longer neces-

sary, and to keep what is necessary. As I incor-

porate and embody a unitary perspective and

HEC theory in my practice, I can keep what is

still viable and valuable in my praxis method-

ology in the service of client health care pro-

cesses. I reflect on what I learn in my practice,

and I articulate new ideas and theories I de-

velop or learn in mutual partnership. I do this

through documentation of work with clients,

printed materials that I create as I develop my

INP, as well as in dialogue with clients, friends,

and colleagues.

The HEC theoretical principles2 guiding

my unitary PR process are that disease and

nondisease reflect the pattern of the whole

person and are rhythmic fluctuations of the

underlying unitary pattern that is reality, pat-

tern is dynamic and evolving to greater di-

versity, consciousness is coextensive in the

universe and persons are identified by their

patterns of consciousness, and health is ex-

panding consciousness. The experiences of

the nurse in the PR praxis process can lead to

insights that might motivate new theoretical

possibilities and new practice methods that

transcend and include previous ones.

My nursing praxis methodology is derived

from Newman’s2 PR process and a somatic

pattern change process developed by so-

matic psychologist, Keleman26 as indicated in

Table 1. In my HEC guided praxis, Newman’s

PR process transcended and included Kele-

man’s somatic change process. An exemplar

of this praxis methodology specifies my use

of theory in practice that, although occurring

in praxis as a unified process, has been differ-

entiated for clarity in the following exemplar

and tables.

EXEMPLAR

My client was a 14-year-old girl brought

by her mother because of depression. The

client stated that she felt judged by others, fre-

quently embarrassed, and became very self-

critical. She felt disconnected from others and

depressed especially when home. As mutual-

ity was established, we discussed what was

meaningful to her in her life. I also engaged

her in somatic exercises such as having her

stand in a way that she felt grounded and

solidly connected. She did so, but as she fo-

cused deeply on her experience and was gen-

tly challenged to move from this place, she

noticed that she was actually imbalanced and

ungrounded. I silently observed that her en-

ergetic pattern seemed to show imbalance

in the area of her hips and legs—also in-

dicating possible lack of grounding. I then

had the client intensify her pattern by sug-

gesting that she attend to thoughts and feel-

ings when feeling off balance in her body.

On the basis of what the client said about

how she experienced her pattern, I facili-

tated a process in which she “undid” the

pattern through shifting thoughts, behaviors,

and embodied ways of holding and releasing

aspects of the pattern. Again, she attended

to her thoughts and feelings from this place.

As the client experienced her lack of ground-

ing, she began to sense this as a larger pat-

tern in her life. She identified a number of

situations in which these sensations, feelings,

and thoughts emerged. As she went through

these experiences, I remained in authentic

presence with her, also noticing my own pat-

terns in resonance with hers. I asked her to

continue noticing sensations, thoughts, and

feelings, particularly when feeling depressed

and disconnected, until the next session. In

the next session we dialogued about what

she had experienced. I asked her what things

she liked to do that felt connecting for her.

She identified drawing and gardening. I asked

her to do these things at home and to no-

tice what came up for her. We also worked

on gently “undoing” her pattern and reflect-

ing on what she noticed. She asked for ideas

about ways to relax during times of stress and

discomfort and I taught her a few techniques

for this. As she tested different ways of deal-

ing with connection-disconnection, she be-

gan to identify what worked for her, and to

incorporate these new ways of being into her

life. Transformation to a new pattern emerged

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Nursing Theory-Based Independent Nursing Practice 73

Table 1. Pattern Recognition Processes: A Comparisona

Somatic Change HEC Pattern Process Recognition Author’s Praxis (Keleman)26 Process (Newman)2 Process (Musker)

Mutual partnership established

Awareness of nurse as

embodiment of HEC

theory. Nurse aware of

self with client as

aspects of inherent

pattern of wholeness.

Presence, and

resonance with client

pattern

Mutual partnership established Awareness of nurse as embodiment

of HEC theory

Present with client

Identify the problem Client tells their story.

Elicit pattern through narrative

Ask what is meaningful.

Elicit pattern Use various ways such as

narrative of meaning, or

noting behaviorally

embodied pattern

aspects.

Intensify problem pattern to note organization

Guide client in use of body-mind exercises

as client focuses on their health issue, to

get felt sense of pattern and how they

organize the pattern.

Create and mutually reflect on pattern diagram

Intensify pattern Further focus on

embodiment of pattern

using somatic,

energetic, and cognitive

techniques, diagram,

reflection on the

pattern.

Disorganize the pattern As clients increasingly sense how the

pattern is organized, they begin to

perceive the ways they can disorganize

and let go of a pattern that does not work

for them. They are encouraged to practice

letting go to the extent that this is

tolerable for them.

Release what no longer works Somatic and cognitive exercises,

dialogue.

Pause With the release of aspects of pattern

aspects that no longer work, there may be

a sense of loss and discomfort because the

known is released, while there is as yet no

new pattern formed. During the pause

phase, new possibilities may arise to be

tested out by the client.

Silence/presence Insight action potential

emerges. Clients try

new ways of thinking

and acting.

Teach healthy ways to tolerate uncertainty and observe for indications of action potential.

Use silence/presence,

insight.

Offer healing modalities.

(continues)

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74 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2011

Table 1. Pattern Recognition Processes: A Comparisona (Continued)

Somatic Change HEC Pattern Process Recognition Author’s Praxis (Keleman)26 Process (Newman)2 Process (Musker)

Reorganize pattern With trying on new possibilities, eventually

a meaningful new pattern gains clarity

and solidity in the client’s life. The new

pattern may contain elements of the old

pattern that continue to be meaningful.

Choice point as movement

Identify choices.

Possible transformation

occurs.

Reorganize at higher level

of complexity/diversity.

Support client choices Possible pattern

transformation.

Reorganize at higher level

of complexity/diversity.

Reflection Note pattern change as related to Young’s stages of consciousness

Continue to reflect as

needed.

Nurse self reflection on process

Note pattern change as

related to expansion of

consciousness.

Abbreviation: HEC, health as expanding consciousness. aPurposes of all methods are to facilitate pattern awareness and insight into pattern; and to support clients in the process

of pattern recognition and in their choices regarding their pattern.

as she noticed that she was able to remain

positive when with others even in the face

of their criticism. If feeling disconnected, she

would stand in a grounded position or at-

tend to thoughts and shift to positive self-

thoughts. When at home, if she began feeling

the old pattern of depression emerging, she

was able to notice it without judging herself

for it and choose either to stay with it for a

while to see what meaning it had for her or to

choose other activities to feel grounded and

connected in her life. Eventually she was con-

sistent in her new pattern, feeling more con-

nected to others, noticing improved friend-

ships, and being able to let go of self-judgment

or fear of the judgment of others. She let

me know when she felt that she no longer

needed my support and we spent time re-

flecting on what was meaningful for each of

us during our time together. We then ended

our sessions together. After completing my

time with this client, I reflected on the pro-

cess and noticed the changes I experienced

in my own pattern. I noticed more clarity

in my identity as a nurse, and clarity in my

awareness of being supported by HEC the-

ory as I dealt with a teenager, sensing reso-

nance with her changing pattern. The praxis

process increased nursing knowledge as my

client shared what was meaningful to her,

and as I noticed my own pattern because it

changed with new meanings. This was valida-

tion of Newman’s2 contention that according

to HEC theory, a pattern changes with new

information.

THEORY-PRACTICE ANALYSIS OF EXEMPLAR

This exemplar illustrates the theory guid-

ing the author’s nursing praxis methodol-

ogy in individual client sessions. The au-

thor’s methodology is guided by HEC theory

and incorporates somatic and energetic pat-

tern awareness modalities. Table 2 presents

the phases of the practice methodology, ex-

emplar practice action in each phase, and

HEC theory related to each phase of the

methodology.

IMPLICATIONS FOR BRIDGING THE THEORY-PRACTICE GAP

As a nurse who has a nursing theory–

guided INP as praxis, I reflect on how this

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Nursing Theory-Based Independent Nursing Practice 75

Table 2. Examples of Value of Theory in the Pattern Recognition Praxis Methodology

Partnership Mutuality established with both mother and daughter. Individual sessions

held with daughter.

HEC: Author sat in presence with client, aware mutuality of the process and resonance of patterns reflecting the pattern of the whole.

Identify problem Client presented health concern. HEC: Old pattern no longer working. Client experiencing discomfort,

chaos.

Elicit pattern Asked client what was meaningful to her and attended to the narrative. Also did somatic work in which client able to sense into embodiment of pattern.

HEC: Elicit the evolving pattern of the whole in such a manner that clients can gain a global perspective of themselves.

Intensify pattern Further focus and reflect on client pattern and on how client experienced the pattern: through dialogue, use of somatic, energetic, and cognitive techniques.

HEC: Note pattern characteristics such as contradictions and similarities and share this with client without interpretation.

Disorganize pattern Guide client in techniques to ‘‘undo” pattern. HEC: Support and dialogue regarding client experience during this process.

Pause As client chose to end old pattern, nurse supported client through time of uncertainty, new possibility with grounding awareness activities identified by client and nurse.

HEC: Nurse validates all information as relevant as client tries new pattern possibilities that emerge from insight and action potential

Reorganize pattern Client organized a new pattern--transformation of old pattern. Nurse validated client experience of pattern transformation,

mutually ended work together. HEC: The theory is applied by noting expansion of consciousness as

improved quality and increased diversity of relationships with the

environment.

Reflection Mutual reflection of nurse and client on PR process. Nurse reflection on personal meaning of the process.

HEC: “Whatever transforms you transforms your practice.”2( p116)

Abbreviations: HEC, health as expanding consciousness; PR, pattern recognition.

process developed for me and I see the im-

plications for other nurses in independent

practice. In considering the experiences and

thoughts presented in the narrative and exem-

plar as they might relate to other nurses, it is

important to note that nurses must come to

their own understanding of what is meaning-

ful for them in their practice and what theo-

ries are congruent with their basic beliefs and

values. Although I framed my process of clos-

ing the theory-practice gap from the perspec-

tive of HEC, I believe that the processes of at-

tention, reflection, and articulation in relation

to theory and practice can be used from any

perspective.

Johns posed the question, “. . .whilst reflec-

tion is espoused as empowering, are nurses

empowered enough to utilize reflection to

become self-determining?”30(p241) In review-

ing my personal journey and my current

praxis, I realized that each phase of my ca-

reer journey to independent practice was a

pattern spiral of theory, practice, attention,

reflection, articulation, theory. Initially my

worldview and theory were unconscious,

based on received personal and professional

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76 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2011

theories and then increasingly conscious and

based on self-study and further education.

This was an empowering, self-determining

process and my own personal PR process.

Newman2 contended that the process of PR

is emancipatory. Each phase of my theory-

practice journey was evidence of this as I ex-

panded my consciousness of my worldview

and of a congruent nursing theory to guide

my nursing practice. My practice became in-

creasingly autonomous because I freed my-

self from old beliefs about what nursing and

my nursing practice had to be. I believe that

nurses can be empowered enough to be-

come self-determining in closing the theory-

practice gap.

CONCLUSION

Knowledge of personal and professional

paradigmatic perspectives and congruent the-

ories can lead to meaningful nursing practice.

Such knowledge can be brought to awareness

through a process of self-guided searching,

and through techniques such as attention, re-

flection, and articulation. Independent nurs-

ing practice offers an opportunity to close the

theory-practice gap by offering the autonomy,

and possibilities for creativity, in which to ap-

ply such knowledge. What shifted my per-

ception and experience of the theory-practice

gap were the processes of attention, reflec-

tion, and articulation in relation to theory

and practice. As indicated in the explication

of my journey, when ways of practicing no

longer worked for me, I attended to my dis-

comfort. This was also an evolving process,

initially very difficult, but easier as I learned

in my master’s program that it is a principle

of expanding consciousness to pay attention

to any experience, particularly ones that are

uncomfortable. As I allowed myself to dwell

with discomfort and uncertainty, I reflected

on the meaning of what was occurring and

this led to insights as to further areas of study.

The new theoretical perspectives and specific

theories that I learned in various phases of

my transforming praxis, transcended, and in-

cluded aspects of previous theories that I had

embodied. I then articulated new ideas and

theories I developed or learned. I did this

through dialogue with friends and colleagues.

I also articulated the theories in printed mate-

rials that I created as I developed my INP, as

well as in dialogue with clients.

My current praxis is one in which theory is

both a guide and an embodiment and concurs

with Newman2 that the content is the prac-

tice. As such, the theory-practice gap in my

independent nurse practice remains closed

to the extent that I continue to attend to

it and reflect on it. It is important to note

that the closure is not a static condition of a

static place or gap, but rather both condition

and place are aspects of a whole, living, dy-

namic, evolving process. From this perspec-

tive, theory-practice as praxis is unpredictable

and endlessly creative.

The personal perspective presented here

of the value of theory to INP and closing

the theory-practice gap has implications for

other nurses. My intent is that illumination

of my personal journey culminating both in

my establishment of an INP and in closing

the theory-practice gap in this practice may

encourage other nurses in independent prac-

tice. It is possible that if a nurse in indepen-

dent practice experiences the discomfort of

a theory-practice gap and chooses to address

it independently, then they know that they

are not alone and that the processes of at-

tention to feelings, especially of discomfort

regarding nursing practice, reflection on old

and new ideas about practice, and articulation

of meaningful perspectives may offer ways to

approach the theory-practice gap.

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