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
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 (kmusk@earthlink.net).
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.
67
SIGNIFICANCE OF INDEPENDENT NURSING PRACTICE
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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.
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
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
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
