Like many other issues of ANS over the years, this issue of the journal resonates with implications for practice. But tragically, the messages seldom reach those who might best benefit directly from these insights. The theoretical insights presented by the authors in this and other issues of ANS are exciting and stimulating for those of us accustomed to reading and thinking about theory, but are often obscure for those who are more accustomed to dealing with the practical and urgent challenges of minute-by-minute nursing care. The current and unrelenting shortage of nurses inspires practical and “fast-fix” responses, leaving in the dust the more complex theoretical explorations that reveal fundamental and underlying insights.
I addressed some of the reasons for the divide between theory and practice, and knowing and doing, in the April, 1988 issue of the journal devoted to the theme “Theory and Practice.” Now, over 15 years later, I believe that the issues that were then before us as a collective discipline remain even more urgent today. In that issue I stated:
As nurses we are particularly vulnerable to an unrelenting sense of disparity between what we know and what we do. We know we would be stronger as a profession if we were unified with each other and with other health care providers, but we are not unified. We know we would be able to provide a high quality of care if we were free to practice nursing as we envision it to be, but we do not and cannot practice in these ways. We know we would better serve society if we focused our practice on health and developed greater knowledge about health, but we practice in an illness care system, not a health care system. 1(pvii)
In that editorial, I called for nurses everywhere to begin to take steps toward bringing theory and practice together in small and simple every-day acts. Admittedly, these small and simple acts are challenging, and not easy. The actions call for courage and a recognition that something needs to change. Reflective practice, whether the practice of nursing care, teaching, or research, means finding ways to continually bring what we know and what we do into line with one another. We do this by talking about what we know with other nurses, and exploring how to do more of what we know. We do this by questioning the meanings of the theoretical words and ideas that we use, and challenging how well these thoughts and ideas fit with what is happening in practice. This kind of thinking and challenging is at the heart of what theory is really all about, for theory is created to represent what is “really” going on in the world in a way that challenges preconceived notions, opening the way for new possibilities. When theory does not serve this purpose, it falls by the wayside.
In the 1988 editorial, I cited the still-relevant work of Bunch. 2 She named one of the paradoxes that sustains the divide between knowing and doing as the “too hard/too easy” paradox. Many nurses believe that unless theory is expressed in esoteric terms it will not be viewed as worthy or scholarly, and will not be taken seriously. Others simply assume that all theory is just “too hard.” On the other hand, some nurses would call for theory to be easy to understand by anyone, comprehensible without expert knowledge or the aid of a professional glossary, and that it should be directly applicable to practice. Both extremes serve to sustain the divide between what we know and what we do. Theory development and comprehension is not simple and easy, but it can be done in a way that is comprehensible and explainable.
It is my hope that as you approach the articles in this issue, you will release “too hard/too easy” preconceived notions, and remain open to the possibilities and the challenges that these authors are proposing. The implications for practice are immense and vital if we are to meet the challenges that face us as we enter the year 2004.
1. Chinn PL. Knowing and doing. Adv Nurs Sci
2. Bunch C. Passionate Politics: Feminist Theory in Action
. New York: St. Martin's Press; 1987.
Thanks to Joanne Banks-Wallace, ANS Advisory Board member, for bringing into focus in a recent e-mail message the issues I am addressing here.