Discuss : Theory-practice Gap

Discuss : Theory-practice Gap

Key Words: Holism, nursing theory, pain

management, caring, relationship-centered

care, theory-practice gap, nursing practice,

holistic theory, client-centered care


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.


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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