This thesis investigates the beliefs and perceptions of registered nurses  in relation to the theory practice gap. In order to discover these perceptions and beliefs, this qualitative study used critical ethnography, a framework and process in which the paiticipants share in the journey of discovery which sets out to explore, describe and transform these beliefs and perceptions of theory-practice.

The theory-practice debate has been highlighted in nursing for some time and is interpreted in many ways. This multiple interpretation causes confusion and has an impact on the development of the discipline of nursing.

The participants were six nurse clinicians and six nurse educators from a large metropolitan hospital and a School of Nursing and Midwifery within a tertiary educational institution.

Within the critical framework, the research methods used were interviews, observation, paiticipants' personal logs and triangulation between methods and within methods. Data analysis was through content analysis using themes, patterns, and categories arising from the data. The analysis of data indicated that through reciprocal dialogue, the paiticipants' theory-practice perceptions and beliefs had been transformed. This transformation was being premised on an assumption of the existence of a theory-practice gap to an acceptance of the theory-practice relationship as an integrated concept where nursing praxis is shaped by an ongoing development process.

Empowering strategies and recommendations for the development of nursing praxis include coaching, clinical supervision, mentoring, case management, ongoing education, research, faculty practice, joint appointments and reciprocal advisory groups. These strategies provide opportunities for nurses to come together, and reflect on practice in that by becoming aware of their beliefs and perceptions, they gain the confidence and knowledge to begin transforming conditions of power and control, thereby promoting change which results in praxis and professional autonomy

Jones, E. Marion

English

Massey Research Online

Copyright is owned by the Author of the thesis.  Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only.  The thesis may not be reproduced elsewhere without the permission of the Author.  -50-Massey University Library Thesis Copyright Form ~ ., ,it:>·rs 1 ~~ .- Vl"Crx., s. 0 , .-c> eJ , tt Title of thesis:_~~~0 ~ 1~tev% 1'/u~;::,' '~€.p+ions a.Ylo\ D · ,e·p i,P-~vv\ '\ v-ae.ki<.t.e_. 1) (a) I give perinission 'for my thesis to be made available to readers in Massey University Library under conditions determined by the Librarian. (2) (a) I agree that n1y thesis, or a copy, may be sent to another institution under conditions determined by the Librarian. (b) 3) (a) I agree that my thesis may be copied for Library use. ~ ~~~~~~:De _c:9-pictlfQvI:11i,§ry--usd-0r Signed Date The copyright of this thesis belongs to the author. Readers must sign their name in the space below to show that they recognise this. They are asked to add their permanent address. NAME AND ADDRESS DATE 16 SHAPING NURSING P s - Some Registered Nurses' Perceptions and Beliefs of Theory Practice A thesis presented in partial fulfilment of the requirements for the degree Master of Educational Administration at Massey University E. Marion Jones 1993 ii ABSTRACT This thesis investigates the beliefs and perceptions of registered nurses in relation to the theory practice gap. In order to discover these perceptions and beliefs, this qualitative study used critical ethnography, a framework and process in which the paiticipants share in the journey of discovery which sets out to explore, describe and transform these beliefs and perceptions of theory-practice. The theory-practice debate has been highlighted in nursing for some time and is interpreted in many ways. This multiple interpretation causes confusion and has an in1pact on the development of the discipline of nursing. The participants were six nurse clinicians and six nurse educators from a large metropolitan hospital and a School of Nursing and Midwifery within a tertiary educational institution. Within the critical framework, the research methods used were interviews, observation, paiticipants' personal logs and triangulation between methods and within methods. Data analysis was through content analysis using themes, patterns, and categories arising from the data. The analysis of data indicated that through reciprocal dialogue, the paiticipants' theory-practice perceptions and beliefs had been transformed. This transformation was being premised on an assumption of the existence of a theory-practice gap to an acceptance of the the01y-practice relationship as an integrated concept where nursing praxis 1s shaped by an ongoing development process. Empowering strategies and recommendations for the development of nursing praxis include coaching, clinical supervision, mentoring, case management, ongoing education, research, faculty practice, joint appointments and reciprocal advisory groups. These strategies provide opportunities for nurses to come together, and reflect on practice in that by becoming aware of their beliefs and perceptions, they gain the confidence and knowledge to begin transforming conditions of power and control, thereby promoting change which results in praxis and professional autonomy. iii Acknowledgments This thesis is a reflection of not only the commitment, tenacity and professional belief of myself, but also of the many people who supported, assisted and challenged me throughout. A special acknowledgment goes to my husband, Glen whose support, devotion and love encouraged me on the road of Masters study. An immense void is in my life without him but his inspiration, challenge and love has motivated me to continue and I dedicate this thesis to him. My children's and family support has been invaluable as well as a comer to hide at Kath and Johns. I wish to particularly thank the participants who chose to come on this journey of discovery with me and shared their perceptions and beliefs with me. Each of them has enriched me personally and professionally. I would like to thank Dr Wayne Edwards for his support, encouragement, and scholarliness that helped on this journey. Dr Judith Clare for her professional guidance, support, and resources that challenged me to think and question on this journey. Diane Nicholson for her patience, cheerful personality, friendship and superb typing skills that made this thesis a bound reality. My colleagues and friends who offered their advice, critique, and support along with patience as the journey became too difficult to continue, with a special thank you to Jane and Maureen for your critique. Table of Contents Abstract Acknowledgments List of Contents List of Figures and Tables Chapter One - Introduction Background to the ·Study Statement of Research Question Nature of the Study Organisation of the Thesis Chapter Two - Setting the Scene Ways of Knowing Page Number 11 111 IV vu 1 4 4 5 7 Theory and Practice Development - what is it 9 Nursing's History of Theory and Knowledge Development 10 Culture ofNursing 12 Conclusion 14 Chapter Three - Theoretical Framework Introduction 15 Ways of Knowing 18 Emancipatory Knowledge 21 Hegemony 21 Power and Control 22 Ideology Critique 23 Limitations of Critical Social Theory 24 Ethnography as a basis for Critical Ethnography 25 Critical Ethnography 26 Conclusion 27 J.V V Chapter Four - The Process - Methodology Introduction 28 Context of the Study 28 Negotiating Entry and Access to the Field 29 Contacting the Participants 30 Data Collection 32 Ethical Issues 32 Data Collection Methods 33 Interviews 34 Observations 35 Journal Writing 37 Issues of Reliability and Validity 38 The Researcher's Role with Reflection 43 Data Analysis Process 45 Conclusion 51 Chapter Five - The Discovery - Perceptions and Beliefs Shaping Practice Introduction 52 Ideal versus Reality 55 Culture of Nursing 64 The Developmental Process 68 Professional Judgement 76 Conclusion 81 Chapter Six - The Discovery - The Influences that affect the Perceptions and Beliefs that Shape Nursing Practice Introduction 82 Image of Self and Nursing 83 Valuing in Theory-Practice 88 Language affects interpretation 95 Power in Theory-Practice 99 Horizontal Violence 105 Shaping Practice 107 Conclusion 110 Chapter Seven - The Reality or Myth of Theory-Practice Gap Introduction Ill 112 Culture of Nursing in Context Effect of Personal Knowledge on Theory-Practice I 16 Effect of Ideology on Theory-Practice 119 Effect of Power on Theory-Practice 121 Issues that affect Professional Judgement 124 Conclusion 127 Chapter Eight - Shaping Nursing Practice Postscript Appendices Bibliography Introduction 129 Shaping Nursing Praxis - A Hegemonic or Dynamic Processs Theory-Practice - how is it seen? Ways of Thinking The01y-Practice Place of Reflection in Nursing Practice Strategies and Recommendations for Nursing 129 130 131 136 Practice 13 7 Further Research 139 Implications and Limitations of this Study 140 Assessment of the Trustworthiness of this study 141 Concluding Statement 142 - Transforming Practice 1. Area Health Board Ethics Committee approval 2. Participant Information Sheet 3. Participant Consent Form 4. Examples of data 5. Examples of data analysis vi Figures 1 2 3 4 5 Tables 1 2 List of Figures and Tables Data Collection and Analysis Process Data Analysis Process Shaping Nursing Praxis Ways of Thinking Theory-Practice (hegemonic model) Ways of Thinking Theory-Practice ( dynamic model) Naturalistic Inquiry/Positivist Paradigm Summary of Strategies with which to establish trustworthiness vii Page Number 46 47 112 132 137 41 50 CHAPTER 1 INTRODUCTION The aim of this thesis is to discover and describe nurse clinicians' and nurse educators' perceptions and beliefs of the link between theory and practice. By this means, it will be possible to address the question, "Does a theory-practice gap exist within nursing?" This question seeks to clarify whether such a gap is a reality, or a myth. The answers to this question will help to explain how nursing practice is shaped. This chapter outlines the background of the thesis, and provides a statement of the research questions and an outline of the organisation of the thesis. Background to the study The theory-practice debate has been an issue in nursing for some time and many authors have discussed it (Miller 1985; Moccia 1992; Chinn 1991; Schon 1983; Speedy 1989). Confusion exists in defining and explaining the concept of the01y-practice. It has been perceived that education ideals are often different from practice ideals both in teaching and nursing contexts (Clare 1991: 19). It is crucial to determine whether the identification of a theory-practice gap is in fact intended to refer to an education practice gap. New Zealand nursing has been dominated by imported ideas largely from North America and the United Kingdom. This study is the first of its kind in New Zealand and takes into consideration the context in which nursing practice occurs for New Zealand nurses. Have nurses been too preoccupied with the theory-practice gap to see past it or within it? The opportunity to explore these trends is timely in today's dynamic health environment. There are many nurses in the profession who question the emphasis on theory when the practice of nursing is active, skill and practice based. Doubts are reflected in such statements as - 'There is a theory-practice gap and nursing does not need to pursue a theory base to the degree it does'. The question is asked 'What does theory mean' when used in this way. Nurse educators are often labelled as those who are full of the jargon of academia, while nurse clinicians are seen to use a more reality based language. Miller ( 1985: 417) emphasises that these two groups of nurses have differing perceptions of patients and of 2 nursing and do value different kinds of nursing knowledge. Meleis (1985:43) made the point that in the minds of practitioners, theorists who were associated with the ivory towers of educational institutions were castigated for being far removed from practice. The literature portrays nurses as perceiving the the01y-practice gap as an important issue for research and nurses seek its resolution for the very survival of nursing as we know it today (Lewis 1988; Miller 1985; Stevens 1990; Meleis 1985; Benner 1989). This study aims to discover whether this is reality or myth and will enable participants to reflect on their perceptions of theory and practice and the reasons for their particular theo1y-practice understanding and reality. Coeling and Wilcox (1988) view understanding of the cmTent work group culture as an essential step in bringing about change. Myths, beliefs and rituals are important issues to identify in the theory-practice gap. Killman (1987:93) makes the point that the gap between the outdated culture and what is needed for dynamic complexity gradually develops into a culture rut - where it becomes a habitual way of behaving without asking any questions: He goes on to say that human fear, insecurity, over- sensitivity, dependence and paranoia seem to take over unless a concerted effort of establishing an adaptive culture is undertaken. Miller (1985:417) points out that, in the course of time, many unexamined and unproven beliefs and assumptions are incorporated into an integrated and consistent personal attitude towards life and reality which underlie nurses' central and shared purposes. It therefore seems to be very important to identify the 'what is' and 'what ought to be' aspects of nurses' practice and to endeavour to reconcile the differences. The actual beliefs about what practice includes are explored in this study and help in discovering the realities of any the01y-practice gap which might exist. With the changes in the Health Care System in New Zealand which have occurred over the last five years and the National government's proposal for 1993, there is a real possibility that socio-political forces will further undermine the nursing profession. At no other time have nurses reached such a cross road of decision making. The unravelling of what nurses really think of theory-practice and nursing knowledge will assist the researcher to uncover the assumptions and myths inherent in nursing. This could help put nursing as a profession on a pathway of collegiality and unity so crucial for the survival of nursing into the 21st century. Clare (1991:21) emphasises this point: I believe that we must seize opportunities that the education and social legislation has given us and work together towards uniting and strengthening the professional value of nursing. 3 Some of the issues that appear to impact on the very essence of nursing are the historical roots of the "Nightingale ethos" (Chinn and Kramer 1991) and the "handmaiden" concept perpetuated by the biomedical model of health. Nightingale in the 1850's was determined to raise the profile of nursing and developed the model for nurse training schools (Kozier, Erb and Blais 1992). Throughout history, Nightingale's influence on the development of nursing has been evident along with the impact of war and colonisation. Her strong insistence on the hierarchical relationships with nursing superiors and doctors was designed to legitimate nursing as a good profession for women (Street 1992:5). Political, economic, technological and consumer demands are all factors that influence contemporary nursing practice. Kozier et al (1992:25) emphasise that "the history of nursing is intertwined with the history of women." Approximately 90% of the world's nurses are women. As Watson (1981:19) points out professional socialisation involves changes in attitudes, skills, knowledge and values and reinforces this view in a definition of professional socialisation: the process whereby the values and norms of the profession are internalised into ones own behaviour and concept of self; it is the process whereby the knowledge, skills, and attitude characteristic of a profession are acquired Professional nursing today in a dynamic socio political environment, requires development of critical values, a strong commitment to autonomy and education, and a belief in the individual's worth and dignity. The transition from the traditional apprentice style, task-orientated positivist model to the professional student-based holistic interpretivist model has been difficult for many nurses. Nursing is still viewed as subordinate and secondary to the medical profession (M01Tow 1988). Roberts (1983:26) believes nurses have internalised the values of physicians to such an extent that they can be said to be marginal. Some writers believe that the medical profession has used the myth that 'nurses are born' to keep nurses as second class citizens (Lovell 1981; Roberts 1983). Nursing is struggling to find its professional identity and many nurses, who have 4 low self esteem, and low professional self concept, still seek support from doctors to represent or support them rather than deal with the issue themselves (Rodgers 1981; Strasen 1992). This has an impact on the development of nursing knowledge, theoiy-practice relationships and the development of collegiality and unity within the nursing profession. A clear professional purpose is inter-related to professional identity and coherence of purpose contiibutes to a collective identity when nurses agree on the general practice domain (Chinn and Kramer 1991:24). Statement of Research Question In order to address the more general question, "Does a theoiy-practice gap exist within nursing", two questions were constructed. The following questions will form the basis of this qualitative research study which uses critical ethnography as a framework for investigation. 1. What are nurse clinicians and nurse educators perceptions and beliefs of the link between theoiy and practice in nursing? 2. How do their beliefs and perceptions shape their practice? Nature of the Study In this thesis, critical ethnography was used as a framework for understanding the beliefs and perceptions of the theoiy-practice gap of registered nurses. A group of nurses were involved in reciprocal dialogue that encouraged reflection, action and transformation. In order to gain this perspective, interviewing and observational study were used to make sense out of the nurses' world at first hand. Ethnography, as a research method, allowed the researcher to get close to the participants who were involved in the theoiy-practice Journey of discove1y', to see the variety of situations they met, to watch their way of life in practice, to listen to what was said and to ask questions that might shed light on the issues under discussion. As a result of this process, this ethnographic study facilitates the development of conceptual frameworks that can help us understand and interpret behaviour and situations across a wide range of social situations (Boyle 1991 :277). In order to justify the addition of the term 'critical' to ethnography, the research needed to involve critique and transformation of oppressive and inequitable conditions which might affect the participants along with the historical relations of power, and authority being recognised as an integral part not just as background to the study (Simon & Dippo 1986). 5 Critical ethnography enabled the researcher to view the study as a journey of discovery, with the participants emphasising the imp01tance of dialogue and sharing, insights, knowledge and experience. As part of this reciprocal relationship with the participants, the researcher attempted to become part of the registered nurses' world both in clinical practice and educational settings and to discover with them, the issues underlying their beliefs and perceptions of the theo1y-practice gap and the ways in which these may shape their practice. In order to discover and describe the beliefs and perceptions of the participants in this study, dominant themes were identified and analysed from the data, with possible directions being identified for the future. Organisation of the Thesis This thesis is organised into 8 chapters. Chapter 1 provides a brief overview of the underlying reasons for the research and outlines the research questions and framework of critical ethnography. Chapter 2 in setting the scene provides the reader with a picture of the assumptions underlying the theory-practice debate, the impact of being a majority culture of women and th~ struggle for professional identify which is affected by the bureaucratic structures, power and the social context within which nursing knowledge is practiced. Chapter 3 provides the reader with an outline of the theoretical framework of critical social theory, critical ethnography and its suitability as a model for this thesis. Chapter 4 describes the methods used to explore the proposed questions and includes data collection methods, ethical issues, triangulation and issues of reliability and validity. The issues and problems encountered in this journey of discovery are illuminated through the researcher reflecting on her role. Chapter 5 and 6 summarise under themes the data obtained and shares with the reader some participant realities of the theory-practice debate. Chapter 7 involves the discussion of the data with justification from the literature and the participants. It gives the reader the opportunity to experience some of the insights and reflections of the researcher through 6 theoretical interpretations and critical analysis. Chapter 8 links the preceding six chapters and gives the reader a conclusion that explores not only the findings but also the areas of limitation, the impact of the research upon nursing along with further research opportunities. 

Shaping nursing praxis : some registered nurses' perceptions and beliefs of theory practice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Educational Administration at Massey University

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Shaping nursing praxis : some registered nurses' perceptions and beliefs of theory practice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Educational Administration at Massey University

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