inquiry for the discipline, provide the basis for
nursing education and often the framework to or-
ganize nursing curricula.
NURSING IS A PROFESSIONAL PRACTICE
Closely aligned with attributes of nursing as a dis-
cipline previously described is consideration of
nursing as a professional practice. Professional
practice includes clinical scholarship and processes
of nursing persons, groups, and populations who
need the special human service that is nursing. The
major reason for structuring and advancing nurs-
ing knowledge is for the sake of nursing practice.
The major reason for structuring and ad-
vancing nursing knowledge is for the sake
of nursing practice.The primary purpose of nursing theories is to fur-
ther the development and understanding of nurs-
ing practice. Theory-based research is needed in
order to explain and predict nursing outcomes es-
sential to the delivery of nursing care that is both
humane and cost-effective (Gioiella, 1996). Because
nursing theory exists to improve practice, the test of
nursing theory is a test of its usefulness in profes-
sional practice (Fitzpatrick, 1997; Colley, 2003).
The work of nursing theory is moving from acade-
mia into the realm of nursing practice. Chapters in
the remaining sections of this book highlight use of
nursing theories in nursing practice.
Nursing practice is both the source of and goal
for nursing theory. From the viewpoint of practice,
Gray and Forsstrom (1991) suggest that through
use of theory, nurses find different ways of looking
at and assessing phenomena, have rationale for
their practice, and have criteria for evaluating out-
comes. Recent studies reported in the literature af-
firm the importance of use of nursing theory to
guide practice (Baker, 1997; Olson & Hanchett,
1997; Barrett, 1998; O’Neill & Kenny, 1998;
Whitener, Cox, & Maglich, 1998). Further, these
studies illustrate that nursing theory can stimulate
creative thinking, facilitate communication, and
clarify purposes and relationships of practice. The
practicing nurse has an ethical responsibility to use
the discipline’s theoretical knowledge base, just as it
is the nurse scholar’s ethical responsibility to de-
velop the knowledge base specific to nursing prac-
tice (Cody, 1997, 2003).
Integral to both the professional practice of
nursing and nursing theory is the use of empirical
indicators. These are developed to meet demands
of clinical decision making in the context of rapidly
changing needs for nursing and the knowledge re-
quired for the nursing practice. These indicators in-
clude procedures, tools, and instruments to
determine the impact of nursing practice and are
essential to research and management of outcomes
of practice (Jennings & Staggers, 1998). Resulting
data form the basis for improving quality of nurs-
ing care and influencing health-care policy.
Empirical indicators, grounded carefully in nursing
concepts, provide clear demonstration of the utility
of nursing theory in practice, research, administra-
tion, and other nursing endeavors (Hart & Foster,
1998; Allison & McLaughlin-Renpenning, 1999).
Fawcett (2000) has placed empirical indicators in
the hierarchy of nursing knowledge and relates
them to nursing theory when they are an out-
growth of particular aspects of nursing theories.
Meeting the challenges of systems of care deliv-
ery and interdisciplinary work demands practice
from a theoretical perspective. Nursing’s discipli-
nary focus is essential within an interdisciplinary
environment (Allison & McLaughlin-Renpenning,
1999). Nursing actions reflect nursing concepts and
thought. Careful, reflective, and critical thinking is
the hallmark of expert nursing, and nursing theo-
ries should undergird these processes. Appreciation
and use of nursing theory offer opportunity for
successful collaboration with related disciplines
and practices, and provide definition for nursing’s
overall contribution to health care. Nurses must
know what they are doing, why they are doing what
they are doing, what may be the range of outcomes
of nursing, and indicators for measuring nursing’s
impact. These nursing theoretical frameworks serve
in powerful ways as guides for articulating, report-
ing, and recording nursing thought and action.
One of the assertions referred to most often in
the nursing theory literature is that theory is given
birth in nursing practice and, following examina-
tion and refinement through research, must be re-
turned to practice (Dickoff, James, & Wiedenbach,
1968). Within nursing as a practice discipline, nurs-
ing theory is stimulated by questions and curiosi-
ties arising from nursing practice. Development of
nursing knowledge is a result of theory-based nurs-
ing inquiry. The circle continues as data, conclu-
sions, and recommendations of nursing research
are evaluated and developed for use in practice.10 SECTION I Perspectives on Nursing Theory