Nursing Theory

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

Copyright c© 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Independent nursing

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 (

ing new nursing knowledge that arises from

meaningful practice.

professional life

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,

Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.




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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.


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.

Independent nursing

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

however nursing knowledge in other fields such as in


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

certainly 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

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