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nurses interpret the child’s crying as separation anxiety, an expected and predicted toddler behavior according to developmental theory. The theory provides a means of understanding behavior that otherwise might seem random and, therefore, is a framework from which to understand the child’s actions. Thus, “a theory suggests a direction in how to view facts and events.”1, p. 4 In the past, four basic ideas (or concepts) were common to all nursing theories—the concepts of nursing, person, health, and environment. These concepts were thought to compose the core content of the discipline—the “metaparadigm” of nursing. As the discipline has matured, authors in the 1990s and 2000s suggested that the four concepts were too restrictive for development of nursing knowledge,2 and some recommended additions to the four. Full discussion of this debate is outside the scope of this chapter; however, it is important to recognize the belief that other concepts may be equally important to the core of nursing.3 For example, concepts such as caring, healing, energy fields, development, adaptation, consciousness, or nurse–client relationships may be as important to describing and understanding nursing as the concept of health. Challenges to the Use of Nursing Theory Currently, however, there are three developments in nursing that consign nursing theories to a tenuous or vulnerable place. These are (1) omission or lack of emphasis of nursing theory in many nursing curricula, accompanied by a view from some that theory is obsolete; (2) a move toward interdisciplinary and interprofessional practice; and (3) the attention given to quality, safety, and nursing outcomes that has focused more on the “doing” of nursing than the reflection on practice that theory demands. Each of these will be discussed. Omission of Nursing Theory from Curricula In 21st-century practice, the use of nursing theories has very likely declined. A group of nursing educators has raised concerns that nursing theory is no longer taught in many programs and that other content required in curricula (quality, safety, evidence-based practice, research methodologies, and interdisciplinary collaborations) may be taking precedence over nursing theory.4 These authors provide a sound rationale for maintaining nursing theory: that an understanding and ability to reflect on 112 Chapter 5 Nursing Theory in Holistic Nursing Practice 9781284082463_CH05_PASS02.indd 112 25/02/15 6:08 pm the discipline is essential for the development of nursing scholars, that knowledge of one’s own disciplinary approach is a prerequisite for interdisciplinary practice, and that theory assists professionals to learn that there are many ways of developing new knowledge for nursing and of understanding evidence. Nonetheless, omission or lack of emphasis on nursing theory should give pause to holistic nurses everywhere as there has not been a full consideration of what might be lost in the process. Nursing and Interdisciplinary Practice The move in all health care toward truly interprofessional practice leaves those who ascribe to nursing theory without a core group of team members who even understand the use and meaning of theory-based practice. Nursing has been alone in the health professions in regard to its theory development. Nurses have identified (through the writings of theorists such as Jean Watson) that professional practice is reflective practice. Other health professionals have simply not had that perspective and do not have a history of identifying philosophical underpinnings and theoretical frameworks for their healthcare practice. This development leaves many nurses in positions where they could be the lone nurse member of a healthcare team with the ability to express theory-to-practice applications. In addition, many nurses may be working in a health system where their immediate supervisor is a nonnurse health professional, creating predictable communication challenges. Theory in an Era of Safety, Quality, and Evidence With the publication of the Institute of Medicine’s To Err Is Human5 and Health Professions Education, 6 the entire healthcare system in the United States and beyond has appropriately given priority attention to ensuring safe practice, providing control over errors, confirming quality assurance (as defined by enacting clinical practice guidelines based on best evidence and/or professional consensus), and reducing regional variation on practices known to be effective. While there is nothing in this movement that prohibits the use of nursing theory, use of theory is not the priority of this focus. It would seem that theory that addressed interprofessional communication (as a contributing factor to errors), and theory that addressed health professional–patient interactions, might gain more purchase than theory perceived to be one held by nurses only. Nonetheless, the very important focus on quality, safety, prevention of complications, and movement toward care outcomes has trumped any use of theory or reflection, now viewed as of lesser importance. Is There Still a Need for Theory? Nurses committed to holism are kind and compassionate nurses who share a philosophy that emphasizes a balance between self-care and the ability to care for patients using the interconnectedness of body, mind, and spirit.
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