Discussion: Theory-practice Gap
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Key Words: Holism, nursing theory, pain
management, caring, relationship-centered
care, theory-practice gap, nursing practice,
holistic theory, client-centered care
Introduction
The use of theory to guide practice
has been advocated for decades, but the
translation of theory into practice has been
difficult for clinicians. Poor understanding
of theory and its purpose inhibits the nurse’s
ability to apply theoretical constructs in
practice, thus reducing practice to a task-
oriented enterprise rooted largely in habit.
Dossey’s (2008) theory of integral nursing
has recently emerged as a new holistic
theory that provides opportunities for
clinicians to invest in a worldview that
embraces the caring behaviors central to
the delivery of nursing care and encourages
nurses to design care that is relationship
centered and focused on healing. This
theory holds promise for application in
many care situations, though the client
experience of acute pain presents itself
as a uniquely universal opportunity to
demonstrate the prospective value of the
theory’s application.
It is widely known that pain is one of the
most common symptoms experienced by all
clients and that knowledge about effective
pain-relieving strategies is important
and essential in guiding practice. Despite
numerous advances in pain management,
pain continues to be insufficiently managed.
Inadequate understanding and use of theory
to guide pain management practice may
obscure nurses’ ability to rely on theoretical
knowledge as a basis for pain management
care. Insufficient knowledge about the
theory of integral nursing precludes
effective application of its theoretical
concepts in clinical practice, thereby
inhibiting nurses’ ability to improve pain
management practice while also inhibiting
clients’ ability to participate in the co-
creation of personalized interventions to
relieve pain. Failure of the nurse to engage
in holistic care, to capture the client’s
perspective in the design and delivery of
care, and to create a sacred space for
carrying out the holistic caring process
thwarts achievement of the mutually sought
after goal of healing. By embracing the
broader and deeper view of care offered by
the theory of integral nursing, the nurse and
client collaborate in the development of
trusting relationships as they intentionally
strive to improve client outcomes and
ultimately enhance client, nurse, and
provider satisfaction with care.
Background
Pain management has remained enigmatic
for clients and healthcare professionals for
decades. When caring for clients, pain is the
most common symptom for which nurses
need to intervene, yet it continues to be one
for which they may be least prepared to
successfully mediate (Lui, So, & Fong,
2008; Montes-Sandoval, 1999; Wilson,
2007). Pain is a multidimensional,
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