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Theory suggests—in fact, demands—that nurses reflect on philosophy and consider how their practice is working (or not working) to achieve holistic ideals. Reed and Rolfe write that use of theory requires reflection and is a precondition for professional practice: Theory is understood as “a purposeful form of abstract thinking essential to a discipline and, by definition, a characteristic of the professional nurse.”7 p. 120 The description of holistic nursing developed by the American Holistic Nurses Association states, “Holistic nursing practice draws on knowledge, theories, expertise, intuition, and creativity.”8 All five elements are necessary for the nurse to function in an ideal way: Nursing knowledge is essential for the understanding of health and disease states and the various regimens required to achieve health. Theories enable one to reflect on practice and to consider carefully all alternatives of care. Expertise is necessary to perform nursing skills and for the ability to make accurate assessments and decisions about care. Intuition is needed to understand the client and to appreciate the subjective experiences of others. Creativity is helpful in solving care problems that seem insurmountable; it provides the nurse with novel ideas and ways of being with clients. Each one of these elements Challenges to the Use of Nursing Theory 113 Five Elements of Holistic Nursing Practice Element Domain Use in Practice Knowledge Cognitive Understanding health and disease states; interpreting regimens of care Theory Cognitive Reflection; considered judgments Expertise Experiential Skilled performance Intuition Affective Subjective knowing Creativity Affective Spontaneity; solving problems or challenges is as important as the others. Knowledge and theory are cognitive tools that help the nurse understand and reflect on practice. Expertise is an experiential tool that comes from practice and a significant number of encounters in nurse–client situations. Intuition and creativity are affective tools that lead the nurse to feel, experience, and follow inner guidance when working with clients. Professional practice requires that nurses use these five elements to achieve the best possible results. A holistic nurse can move back and forth between intuitive knowing and logical reasoning, between a creative approach to care and a standard care protocol, and between a hunch of what to do and a considered direction grounded in the predictions of a theory. All of the elements of practice come only by learning how to use them. Table 5-1 presents a summary of the five elements of holistic nursing practice. Once a nurse adapts a holistic way of thinking, embraces the complexities of the lived experiences of clients, and accepts ways of knowing that include aesthetics, personal and ethical knowledge, and empirical knowledge, that nurse needs a means of assembling the ideas, concepts, thoughts, and feelings that originate from practice in a way that is coherent and personally meaningful. It is through use of theory that the nurse can accomplish this. Theory provides the nurse with a framework from which to understand and make meaning out of complex experiences. Theory also provides guidance in practice—guidance to consider alternate explanations for what is observed and alternate ways of addressing concerns. At a time of emphasis on evidence, quality, safety, and outcomes, theory could not be more important to address the parts of practice—comfort, sense of security, creation, and maintenance of a supportive external environment for the patient—that most influence care outcomes. Further, a nurse who is a lone member of an interdisciplinary team might well benefit from communication theories and leadership theories that help in establishing the perception that nursing knowledge is a valuable contributor to the patient and family experience and care outcome. For the holistic nurse today, ignoring theory is as unacceptable as ignoring evidence. Theory Development Theories develop over time as a theorist defines concepts, suggests relationships between concepts, tests and evaluates the relationships, and modifies the theory based on research findings. When the theorist provides definitions of the concepts and suggests possible relationships, the work is called a conceptual model. Some writers find the distinction between a theory and a conceptual model irrelevant.7 It is important, however, for nurses to understand that theories develop and mature and that they pass through the following stages, each serving increasingly complex purposes: 1. Description. The theory provides definitions of concepts, suggests a way of looking at the world, and provides a framework for describing the phenomena of nursing. 2. Explanation. The theory suggests relationships between and among various concepts and gives the nurse a means of explaining observed events. 3. Prediction. The theory has research findings that establish clear relationships between aspects of nursing, and the nurse is able to predict outcomes. 114 Chapter 5 Nursing Theory in Holistic Nursing Practice Prescription. The theory is well developed and permits a nurse to prescribe nurse or client actions with confidence in the outcomes. Most nursing theories are developed to the stage of description and explanation, and theorists and researchers are currently
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