Commentary: Conceptualising nursing theory and practice within a local cultural and professional context: a methodological example to inform theory development

There is nothing more satisfying for me than reviewing an academic paper that challenges the professional establishment a little. This paper manages to do that, in my view, in three key ways. Firstly, it caught my attention in terms of challenging the historical context and the Anglo-Saxon influence on contemporary nursing. The paper provides us with a good overall background to the issue, allowing the reader to gain a fuller understanding of the historical development of the profession’s theoretical underpinnings which have been dominated, in the main, by an Anglo-Saxon paradigm which has had global implications. Being an Irish Celt, any Anglo-Saxon challenge usually gets my full attention; however, I feel the authors could have focused their critique much more on the British influence on nursing which still persists in most contemporary global healthcare systems. Many countries continue to base their nurse education and practice on the Nightingale model. This influence is evident in the structure of nursing curricula, the emphasis on clinical training, and the professional ethos that values discipline, order and compassion – all hallmarks of the British nursing tradition and most of which has influenced many Nursing Theorists. Even our most prominent professional organisation, the International Council of Nurses (ICN), founded in 1899 by Ethel Gordon Fenwick, a British nurse, reflects British nursing ideals. The ICN’s mission to advance nursing standards globally echoes the principles established by Nightingale and her successors (International Council of Nurses, 2023).

What I found intriguing in this paper is how it seems to be that American Nursing theory has mostly influenced the Italian nursing profession and not the British colonial models, with nursing concepts like Henderson’s wholly adopted into the Italian nursing curriculum and education system without any adaptation. The authors do a great job highlighting that ‘one size does not fit all’ and that most foreign contributions do not align with the local Italian cultural and professional context. They highlight the American emphasis on individualism, autonomy and one’s health vs the Italian emphasis on family and community health as a perfect example.

Secondly, this paper speaks to the age-old theory–practice gap debate that has followed me for the 36 years I have been in the profession. The authors should be commended for drawing attention again to the fact that one of the key contributors to the theory–practice gap is the traditional separation between academic theory and local clinical education and practice. Although this has been in the spotlight previously (Rolfe, 1998; Corlett 2000), they highlight that nursing students often learn theoretical concepts in the classroom before encountering real-world clinical situations in local contexts or cultures, and this separation creates a disconnect, as students may struggle to apply abstract theory and concepts to practical scenarios. Ironically, the nurse theorist Benner (1984) also brought this very issue to our attention in her work on novice to expert theory, emphasising that clinical competence is developed through experience rather than theoretical instruction alone.

Although the authors highlight the ‘confusion’ and ‘questioning’ of nurses when it comes to adhering to or applying theory in the clinical environment, they could have drawn attention to the impact of not being able to reconcile one’s theoretical training with the demands of clinical practice amongst others. Some commentators have suggested that it contributes majorly to job dissatisfaction and high turnover rates in the profession (Flinkman et al., 2010; Monaghan 2015 ).

Finally, the authors do a sterling job using Fawcett’s metaparadigm (1984) to map four foundational disciplinary concepts (person, environment, health and nursing) into an Italian context without anchoring them to any specific model or theory. Thus, creating an understanding of national (or local) nursing practice which could potentially respond more appropriately to the local, Italian patient population needs whilst also incorporating local socio-cultural aspects—which are often very nuanced. What I really like about this approach is that it is essentially nursing practice and nursing research informing the continued theorisation of nursing and not vice-versa which has tended to be the case in recent times. More practically though, the authors have paved the way for many other countries, heavily influenced with Anglo-Saxon or colonial professional nursing systems, practices and theory, with an example of an inductive reflective method that can be used to map nursing practice and research with disciplinary concepts. This mapping can then guide conceptual/theory development that is context or country specific. I am very much looking forward to seeing other countries and jurisdictions build on this approach and examine their own local cultural needs and that of their patient populations to start building their own nursing concepts and theories. Although the Anglo-Saxon and colonial professional paradigm has served globally to some degree, its dissemination has not always been just about healthcare, it has also been about extending Anglo-Saxon and British cultural and social norms globally. The ‘we know best’ approach has had its day, and this paper certainly challenges us to think about how we develop nursing theory in a very bespoke way moving forward.

Biography

Mark White is the Executive Dean of the Faculty of Nursing & Midwifery in the RCSI University of Medicine & Health Sciences where he has responsibility for overseeing the direction and ongoing development of professional education and research in the faculty. Mark is a member of JRN’s Editorial Board.