Journal of Advanced Nursing, 1993,18, 866-872

The significance of the relationship between

a discipline and its practice
Mary Grossman PhD
Asststani Professor

and Margaret Hooton MSc(A)

Assoaate Professor and Assoaate Director (Practtce), McGtll University, School of Nursing,
Montreal, Quebec, Canada

Accepted for pubkcation 13 October 1992

GROSSMAN M & HOOTON M (1993) Journal of Advanced Nurstng 18,

866-872
The significance of the relationship hetween a discipline and its practice
In this paper, it is argued that the absence of conceptual consensus across the
university and its sectors is largely responsible for the growing gap between the
goals of the disapline and its practice Both discipline and practice are defined,
their symbiotic relationship explored, and speafic strategies proposed, to
enhance the development of the profession In particular, the need for a shared
conceptual framework which would transcend university and service structures
to promote an academic practice is examined in addition to the benefits of
instituting theoretically based daily rounds and journal club in the practice
settmg

DEVELOPING NURSING KNOWLEDGE onentation m the literature has been charactenzed by a

lively debate on the value of conceptual models and the
As members of a profession, teachers, clinicians, usefidness of basic, applied and unique knowledge for
researchers and admmistrators have a responsibibty to nursmg (NicoU 1986) Moreover, findmgs based on the
contnbute m some substantial manner to the development saentific method have maeasmgly served as an important
of nursmg's knowledge base However, m today's world means towards evaluatmg the competmg perspectives
of health care delivery one's ability to contnbute tends on the nature of nursmg The publication of theoretical
to be tempered by the pragmatic reabties of a shnnkmg fi-ameworks, empincal data and the accompanymg cntiques
economy, competition for resources, and the need to mam- have propelled nursmg's growth as a credible and distmct
tam a cohesive stance m relation to the other albed health disaplme
professions Nevertheless, the degree to wbch these As nursmg stndes towards delmeatmg its epistemological
professional responsibibties may be met is largely foundations, the schism between the goals of the disapbne
determmed by one's understandmg of what a disaplme is, and practice of nursmg promises to hinder the fiirther
how It IS defined and how it relates to the practice of development of the profession Evidence for this concem
nursmg emerges when the two perspectives are brought to bear on
In the past decade a rather dramatic shift m what discussions regardmg the dinical relevance of knowledge
constitutes nursmg knowledge has occun-ed There has acquired at university Equally, it is apparent m the per-
been a movement awayfroma focus on procedural knowl- sistent tendency of nurses to define practice procedurally at
edge to the development of metaparadigms and concepts the expense of conceptual knowledge Gones & Brown
deemed essential to the practice of nursing This new 1991)
Corrisponderux DrMarvGrossrmm AssiMmlProfesor.McGinUmvemty ScM Although the SerVlCe Sector haS begun tO ldenhfy
N^, 3506 Umoerafy ^rtet Mmoreal Quaiec,H3A2A7, Canada the benefits assoaated With having a cntical mass of
866

academically prepared nurses (Feeley & Gerez-Lirette
1992), fraditional hospital and nursmg infrastructures
contmue to remam at odds with the disapbne's abibty to
attam truly academic practice It may be that nursing is at a
crossroads in its professional development For at the heart
of a discipbne's abibty to actualize its professioruil mandate
IS the nature of the symbiotic relationship between the
disaplme and practice
How nursmg is defined
How nursmg is defined relates to one's understandmg
of what a disapbne is and how it influences pradice
Although a collaborative relationship between uruversity
and service sectors is descnbed m the bterature (Andreob
& Tamow 1990), actual examples are rare Nevertheless,
collaboration tends to be defined in terms of shared or
overlappmg organizational structures, similar academic
preparation of nursing leaders in both environments and
shared standards of care Still lackmg m descnptions of
these models is the cntical notion of a conceptual con-
sensus or shared theoretical model bmdmg university and
service sectors which supports the development of a
common knowledge base
In addressing the above issue, it is argued m this paper
that the absence of conceptual consensus across university
and service sedors is largely responsible for the perception
of a growing gap between the goals of the disaplme and its
practice Moreover, as the goals between the disapbne and
its practice diverge, nursmg's abibty to reabze m practice
the full potential of its academic preparation will contmue
to be compromised In order to promote the development
of the disapbne and be relevant as health professionals, this
paper proposes the creation of an academic approach to
practice based on a shared model of nursing knowledge
This model would transcend the physical structures of the
university and its service sectors, having as its joint goal
the ongomg development of cntical thinkers among all
students and professionals of a defined community of
nurses
Accordmgly, this presentation will examine what is
meant by the disapbne of nursmg, what is understood by
practice from the perspective of a disapbne, and how these
two may mteract m very speafic ways to enhance the
development of nursmg
THE DISCIPLINE OF NURSING
The broad aims of a disaplme are to specify its proper place
m society and to define the parameters of knowledge
required for its pract«» (Dcmaldson & Crowley 1978)
Relationship between disaplme and its practice
Therefore, a professional disapbne must expbcate its his-
toncal, social, philosophic and leammg traditions m order
to understand its connectedness to others m the field of
epistemology, and to provide a meanmgful context for its
methods of mquiry and its content areas for pradice
A professional discipline is defined by share value
onentations, soaal revelance and a conceptual structure
(Donaldson & Crowley 1978, Newman et al I99I) The
value onentations of the disaplme are reflected by its
philosophy of science and art The bterature appears to
provide broad agreement, for example, that the disapbne
of nursmg adheres to a humarushc, canng and hobstic
philosophy (Gortner 1983, Hagell 1989, Ray 1990) Its
relevance is based on soaety's perception of nursmg as a
helpmg profession devoted to the health of its cbents
across the bfespan (Gortner 1983) Above all, accordmg to
Donaldson and Crowley (1978), a disaplme is character-
ized by 'a unique perspective, a dishnct way of viewmg all
phenomena which ultimately defines the limits and nature
of its inquiry'
Conceptual structure
This unique vision of a disaplme is exemplified by its
conceptual structures These structures are charactenzed
by substantive and synactical components
Substanttve structures
Substantive structures refer to the paradigms, conceptual
frameworks, concepts and theones that descnbe ideas
about the disciplme's phenomena of mterest These
structures provide mental impressions of the content areas
that relate m a particular way to reflect the disaplme's
perspective The linkages between and among these
identified concepts are created by the assumptions and
propositions of a given framework (Fawcett 1990)
Although these structures may be charactenzed by different
fjomts of emphasis or by the mtroduction of different con-
cepts, such as energy or support, aU must be consistent
with and fit the general metaparadigm of the disaplme
consistmg of health, nursmg, environment, and person or
family (Fawcett 1989)
Therefore, the way m which the concepts of a particular
framework mterrelate not only shapes the four phenomena
of mterest, but govems the questions that are asked from a
dinical, administrative, researdi and teadung perspective
These structures provide a context withm which the disa-
plme may be studied, practised, defended or promoted and
are said to provide a general direction for the art and
saence of the profession With the exception of theory,
however, they exist at a fairly high level of abstraction and
867
M Grossrmm and M Hootan

are not meant to be directly observed or tested (Fawcett PRACTICE IN RELATION TO THE
1989) What conceptual structures provide is a nursmg DISCIPLINE
perspective They shape the selection of content areas Havmg descnbed the key elements of a disapbne, this
which become the dontain of our practice section focuses on the responsibilities and expectations
of practice The practice component of a professional
Syntactical structures
disaplme consists of the researchers, educators and prac-
Syntactical structures are the methodologies for mquiry titioners who utilize the disapbne's knowledge base for
that fit with the disapbne's epistemological perspective learrung, investigative inqumes, assessment and inter-
Given that knowledge may be revealed m different ways, ventions (Donaldson & Crowley 1978) Although it is the
syntactical structures refer to the disapbne's accepted disapbne that establishes the epistemoiogical domain
modalities for testmg and evaluating its phenomena These for practice, it is the pradihoner who is accountable for
modabties have important impbcahon for the development utilizing and developing this knowledge base
of knowledge Until the nursing disapbne began to
Despite the intended symbiotic nature of the relationship
explore its own philosophic hentage, for example, it
between a disaplme and its practice, a discrepancy exists m
accepted the logical positivishc approach as the only vabd
nursing with regard to what the disapbne represents and
method for acquinng knowledge This deductive onen-
practice reflects It is most apparent with the realization
tation has prevailed despite nursmg's contention that it
that the knowledge base of practice has tended to remam
values subjective as well as objective data and is con-
impbat (Kemp 1990) One explanation for this may relate
cemed about hobstic rather than particulanshc aspects
to the divergent goals established by university and
of care (Hagell 1989) The obvious lack of fit between a
service sectors Whereas the disapline-onented univer-
methodology based on measurable, empincal parts and
sity IS charadenzed by the development of theoretical
nursing content that is lrreduable in its holistic and highly
knowledge, practice-onented service tends to emphasize
subjective onentations has necessitated the identification
technical expertise and symptomologic assessments
of other ways of knowmg
Whereas the pnmary purpose of the university is leammg,
These ways of knowmg seem to be more suited to the the concem of service tends more toward nurse perform-
nature of the content the disapbne seeks to understand ance (operationalized by tasks, procedures and comfort
(Carper 1978) They stiU mdude the empmcs, but recog- measures on behalf of the dient) Where the university's
nize the contnbuhons from ethics, aesthetics or the art of pnmary interest bes with the student, the service sector
nursmg, and personal knowmg or mtuition However, in understandably focuses on the patient's welfare
contrast to the world of empmcs, those of ethics, personal
What these distinctions represent is a rather different
knowmg and the art of nursmg stnve to look beyond
onentation m values and bebefs about the nature of
labels, categones and behaviours to perceive the essence m
knowledge, leaming and nursing m the two sectors despite
the situation For these latter three ways of knowmg, the
collaborative efforts to share ideas and concems What it
whole rather than the particulars of the situation are the
suggests IS that different ways of knowmg may be valued
focus of mquiry
without havmg cnticaUy exammed their potential impact
In order to tap this holistic perspective, qualitative upon the development of the disapbne This thesis is
researdi, and m particular, phenomenology have emerged explored m greater depth by companng and contrasting
as formal methodologies for explonng the personal mten- the way m which practice has been perceived by service
hons, thoughts, feelmgs and desires of hobstic man (Ray and university sedors
1990) To date, there have been few senous attempts to
identify methods of mquiry that could explore these
unitary concepts at a more informal, dinical level of Service
practice In the service sedor, practice tends to be shaped by
In summary, the two pnnapal ways m which a disaplme syntactic rather than substantive structures In partiailar,
may govem practice is via its substantive and syntactical the nursing process, as a methodological approach to
structures Whereas the substantive structures provide the practice, has been problematic for the development of the
theoretical onentation for practice, syntactical structures disaplme As a posihvistic strategy for solvmg problems,
provide the methodologies for inquiry Both are required m the nursing process has been treated, mistakenly, as a
order to promote the development of the profession How defining attnbute of the profession rather than as a
practKe, m him, may influence these two structures is the methodological ^proadi which must be bnked to a con-
subject of the followmg section ceptual framework m order to yidd meaningful ckucal

868

data (H^ell 1989) Where knowledge m the dinical field
has been deemed to guide practice, it has tended to be
procedurally rather than conceptually grounded A con-
ceptual perspective would draw the practitioner's attention
toward the disaplme's substantive base, thereby shaping
the development and the use of nursing knowledge
0ones & Brown 1991) Thus, the lack of a nursmg theoreti-
cal framework to guide practice m conjunction with an
empmast methodology have contnbuted to a narrow
understandmg of nursing's dinical mandate
This bmited vision of nursing pradice has been reflected
by the value placed on patient outcomes at the expense of
careful analysis of the patient and his or her clmical and
family context Analysis, for the most part, has been
implied rather than expbatly undertaken, partly due to an
assumption that graduate nurses utibze well-developed
faculties of reason in order to deduce outcomes In
addition, the analytical phase has been hindered by
nursing's own uncertainty about the actual content
that reflects dinical practice By focusing on signs and
symptoms which refled the patient's status, this ambiguity
IS 'resolved'
Therefore, without a conceptual hebnsman, mstitutional
values have tended to shape the model of nursmg practice
Traditionally, these hospital-based norms have upheld,
reinforced and supported the medical approach to care Far
from rejectmg the administrative stance, nursmg m the
service sector has embraced this particular 'saentific'
approach to practice as a means toward legitimizmg and
defining nursmg's contnbutions m the world of service
Given a contmued emphasis on a particulanstic approach,
practice has failed to mcorporate the professional expec-
tations of its disapbne In particular, it has not captured the
disaplme's broad, more hobstic perspective For example,
there is mountmg concem that practice mostly consists of
identifying currently observed behaviours and symptoms
The use of care plans 'on what to do', the development of
manuals on 'how to do it' and the use of workshops to
assimilate 'ttie finished produd of someone else's con-
clusions' Oones & Brown 1991) serve as testimony to a
behaviounshc, problem-solvmg onentation toward know-
ing in nursmg practice (Posner 1992) This redudionistic
approach cannot accommodate the disapbne's wider
theoretical scope, which mdudes the personal thoughts,
feelmgs and beliefs of families It aiso encompasses their
health behaviours, relationships and copmg pattems m
addition to the illness and symptomotogy Qones & Brown
1991)
A logical contention, given a narrow scope of practice,
IS that this nursmg knowledge will necessanly remam
impbat As a consequence, nursmg's traditional adherence
Relationship bettoeen disaplme and its practice
to form as substance and structure as content has exposed
professional practice to the same accusations of irrele-
vance that are popularly hurled in the diredion of the ivory
tower where theory is thought to reside unruffled by the
expectations of the real world
University
In contrast, the uruversity tends to define practice m terms
of concqjts and theoretical frameworks, reveabng a cogm-
tive onentation toward understanding the cbentele to be
served that tends to stress cntical thinking over technical
behaviours Cntical thinkmg is the process of linkmg
observed particulars and subjective impressions to a
substantiated and well-debneated knowledge base for the
purpose of generatmg and debatmg the ments of several
hypotheses It is charadenzed by highly developed facul-
ties of reason, an abibty to accommodate and assimilate
cognitively dissonant pieces of information, and an abibty
to think divergently (Posner 1992) Thus, a cntical thinker
may mterpret data from several perspectives, amvmg as
dosely as possible at the 'truth' through dialedical activity
(Popper 1962)
This type of reflective analysis depends on the con-
tinuous development and utilization of cognitive
operations and schemata These mtemal processes serve as
the mental structures for acquinng the concepts that form
the basis for mterpretatmg events, thoughts, feebngs and
expenences (Posner 1992) Through a process of cntical
thinkmg the concepts that underlie a nursmg framework are
continuously refmed, modified, broadened and eluadated
The process and the content interrelate m a conhnuous
dialogue that promotes the development of the disaplme
by validating its underlying conceptual structures
Accordmg to Resmck & Klopfer (1989), a cognitive
persp>ective 'assumes that concepts are contmuaUy at work
m contexts of reasonmg and problem-solving there is
no choice to be made between a content emphasis and a
thinkmg-sblls emphasis' Content, thinkmg and skills are
mtegral to the development and utilization of knowledge
through an on-gomg process of reflection and analysis
By embedding this cognitive approach to practice
within a theoretical context and without allymg it to one
way of knowmg, the university offers a broad perspective
on the disaplme which can accommodate several ways of
knowing m nursing With the emphasis on the process
of analysis rather than outcome, the meanmg of events,
feelings, behaviours and situations may be fully explored
from different viewpomts These multifaceted perspectives
enhance the possibibties for developmg a broad, hobstic
domain of practice
869
M Grosatum and M Hooton

In contrast to the behaviounst/empinast approach, the constitutes more material than is possible to integrate fully,
university instills a toleraiKe for ambiguity by recogruzmg owmg to the tremendous subjed matter that must be
several possible explanations for a client's behaviour, covered m a relatively short time Given that the concepts
concem, event or difficulty Qones & Brown 1991) These mtroduced at uruversity generally reflect the scope but not
mterpretations constitute the essential steppmg stones the depth of content debneated by a speafic framework
towards the creation as well as the utilization of new refmement and consobdation of this knowledge can only
knowledge on behalf of the disaplme Given the two be promoted through empincal testmg m a settmg guided
visions of practice outbned above, it becomes evident that by the same framework Accordmg to Bruner (1960), an
m order to respect the symbiotic nature of the relationship mdividual leams with repeated exposures to the same
between a disaplme and its practice nursing must practice concept(s) presented m different forms and at higher levels
accordmg to conceptual onentations delineated by the of abstraction accordmg to his or her abibhes This repeti-
disaplme tive process serves not only to mtegrate and mtemabze
knowledge but to make key linkages sabent m the mmd of
DISCIPLINE AND PRACTICE: HOW THEY the leamer/practitioner It is this sabence of pattems,
MAY INTERCONNECT linkages and observations that, meaningfully mterpreted,
leads to expbat knowledge (Simonton 1980)
The previous sections show that a disapbne provides a
The path towards discovery, therefore, is possible m
uruque perspective on speafied content areas for practice,
settmgs where the imiversity and service sectors share the
whereas pradice provides the disaplme with possibibties
same vision of nursmg Under the aegis of a shared concep-
to generate, dissemmate and utibze its knowledge base
tual framework the cntical bnk between a disapbne's
Given the symbiotic relationship between the disapbne
knowledge base and its utibzation and development
and its practice, certam actions could be taken m order to
through practice may be fully reabzed Given that the
move the goals of the uruversity and service towards
university has had a head start m operationalizmg concep-
greater convergence tual onentations through its programme cumculum, how
One essential act would be to establish an educational then does a service or practice setting aeate an approach to
programme whose content and methods would transcend practice which will promote and support the contmued
uruversity and service sectors for the pnmary purpose of development of these conceptual underpmrungs of the
promohng the goals of the disapbne Key elements of this disapIine?
programme would mdude a shared conceptual frame-
work, an emphasis on acquinng and utilizing cogruhvely
onented learmng strategies, and the employment of key Cognitively oriented leamii^ strategies
educationabsts, or custodians of the disapbne
Two service-based learrxmg strategies that promote a
cognitive onentation to practice are proposed They are
Shared conceptual framework weekly journal club and daily rounds Both activities are
Accordmg to Huckabay (1991), a conceptual framework onented toward the ongomg development of three key
'serves as a means for ldentifymg, labebng and dassifymg aspeds of cntical thinkmg an mquinng attitude, the active
phenomena important to the disapbne of nursmg' use of knowledge and cogrutive faculties of reasonmg and
Although the academic cumculum of the university tends analysis (Miller & Malcobn 1990, Watson & Glaser 1964)
to be organized accordmg to a conceptual model, the Although journal dub and daily roimds would appear to
service sector has been slower to adopt a conceptual frame- cultivate the four leammg competencies of concrete
woric as the basis for pradice (Kemp 19W) However, expenence, reflective observation, abstract conceptualiza-
adoptmg the same conceptual mockl m a uruversity and tion and active experimentation outbned by Kolb's (1984)
hospital network would create academic coherence withm leammg theory, the goals of both activities are direded
a leammg-teshng system Conceptual unity across towards developing and refining skills of abstract concep-
settmgs provides an opportunity to gam depth as well tuabzation and refledive observation — the hallmark of
as breadth of knowledge (Huckabay 1991) thus streng- academic practice A bnef descnption of how journal dub
thening the theoretical urulerpinrungs of the disapbne. The and daily rounds may be operationabzed follows
following c4>servations of students and nurses in university
and service sectors further eluadates this pomt Journal club
At uruversity, the student is exposed to an overview of llie pnnapal objective of journal dub is to provide nurses
the disapbne's substantive and syntactical domains wbdi and students with an opportunity to develop depth of

870

knowledge m content areas denved from a nursmg frame-
work. This fonnat faalitates one's abibty to stay current m
a speafic area It also helps to identify gaps m the bterature
which may lead to the formulation of research questions
In order to promote dialectical thinkmg and a spint of
collegial inquiry, members present research findmgs on a
topic related to the theoretical framework In the discussion
that follows, members may offer clmical data or other
relevant matenal which may substantiate or challenge
aspects of the presentation The combination of facts,
theones, dimcal impressions and assumptions emergmg
from these discussions constitute the essential requisites
for the development of reflective and abstract thinkers
(Miller & Malcokn 1990) Whereas journal dub pnmanly
IS directed by relevant research related to content areas
delmeated by the framework, daily rounds are directed
by patient and family as interpreted by the nursmg
framework
Daily rounds
Instituting daily patient rounds is based on the premise that
there is always somethmg to be leaned m a practice pro-
fession and that leammg is enhanced when it is current and
related directly to the dinical situation (McCaugherty
1991) Leammg withm groups offers an mvaluable oppor-
turuty to generate multiple hunches based of the different
msights of nurses whose mvolvement with the cbent may
vary These competing mterpretations serve as the basis
for dialectical discussions consistent with the cognitive
pnnaples of accommodation and assimilation
The process of companng and contrasting empincal and
theoretical data provides an opporturuty for hypothesizing
and makmg aeative or mtuihve leaps mto less travelled
temtory, based on what is known The capaaty to 'see'
beyond empuical reabties serves as a source of mspiration
for the development of new knowledge of a disapbne
(Posner 1992) Thus daily rounds offer the diruaan a
hands-on opporturuty to formulate hypotheses and obtam
meanmgful feedback from colleagues
However, the extent to which journal dub or rounds
may facilitate the mtegration of theory and pradice as
govemed by a conceptual framework will depend on
several factors These mdude whether rounds are legiti-
mized as an institutional expectation for practice and
whether schedules and extraneous tasks are re-organized
to accommodate the educatiorud pnonties of the disapbne
Moreover, the distmct leaming styles of staff and students
must be recognized and difiFerences valued
There wdl always be a need to accommodate the relative
strengths and weaknesses of team members What is un-
portant is that a dynamic, pro-active learning opportunity
Relationship between discipline and its practice
IS provided to make nursmg knowledge expbat The
alternative is to fall back on traditional strategies that
depend on the passive acquisition of information (such as
grand rounds, didactic teachmg and the use of manuals)
This IS unacceptable to a disapbne that has made great
theoretical stndes m the past decade and must contmue
to do so, by ensunng that theoretical gams and resezirch
fmdmgs fr)rm the basis for dirucal practice Our abibty to
remam socially relevant as a profession will depend on the
realization that the goals of disapbne and practice are one
and the same
Educational custodians of the disdpline
Given a conceptual frcimework reflectmg a vision of our
disaplme and appropnate strategies to mtegrate its theory
with practice, who then will guide our profession? Who are
the custodians of the disaplme? At the university, this
position IS held by the teacher In the service sector, the
identity of the custodian has vaned
Accordmg to Huckabay (1991), an educator's responsi-
bility IS to organize the content of the disaplme m such
a way that leaming opportunities may be selected to
promote the growth and development of staff Therefore,
the teacher must know the strengths and weaknesses of
her/his students and staff He or she must be extremely
knowledgeable about the depth and breadth of the concep-
tual framework, able to identify its limitations while havmg
the expertise to interpret from the model's perspective the
full range of dient and family concems
Above all, this teacher needs to be a nsk taker, someone
who understands how hypotheses are generated and the
true sigruficance they hold for the disaplme In fact, m a
world of infinite possibilities, the skills and knowledge base
of teachers from the university and service sectors should
be virtually indistinguishable Only then can students and
staff move back and forth between university and service
sectors and expenence a professional world based on
knowledge, mquiry and social relevance This expertise
exists m the nursing community, exempbfied by those head
nurses and dinician teachers with master's preparation who
understand the importance of conceptual models and the
nature of this knowledge to the development of a truly
acadenuc practice — the hallmark of a profession
CONCLUSION
The relationship between a disaplme and its pradice has
been explored m this paper One mtent was to highlight
the need for a common conceptual framework that would
871
M Grossman and M Hooton
bmd the prc^essional goals of tiie uruversity and service
sectors The other was to propose speafic leammg
strategies to strengthen the development of the disaplme
m the practice settmg
In order to remam soaaUyrelevant,a disapbne rebes on
pradice to speafy areas of needed growth and change In
contrast, practice looks to its disapbne for dinical and
academic directions In order to realize oi^'s professional
potential fully, it has been argued m this paper that the
symbiotic nature of the relationship between a disapbne
and practice be acknowledged and promoted m order to
further the development of nursmg
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