What a journey you have made over the semester! As you have explored different
underpinnings of nursing – from conceptual to theoretical, from philosophy to knowledge
development – the idea of praxis has hopefully not been far from your thought
organization. From the beginning of this semester, we explored the notion of ‘Framework
for Praxis’.
As you can see from the readings, practice and praxis are different. Praxis is what you
‘think, feel, and do’ (head, heart, and hands). Your praxis is larger than just what you can
do with your hands. As you will read, there are numerous ways and methods to develop a
Framework for Praxis.
The content covered this semester has covered different aspects of the components
necessary to develop a Framework for Praxis. We believe you now have a good foundation
to explore your own framework.
This keynote will differ slightly from the previous content provided in the course. There
are a series of articles/book chapters that will help address the notion of praxis. You will
need to read each of the articles with special attention given to the ‘praxis’ sections of the
articles. It is not necessary for you to master the content of the article that does not pertain
to the praxis content. For instance, one of the articles addresses Participatory Research in
Nursing. We don’t expect you to master the content related to participatory research as a
process. Look instead at what is being said about praxis.
Another note about the readings-they are not inclusive of all the materials available. We
have tried to select articles that look at theory and praxis, philosophy and praxis, research
paradigms and praxis, and clinical practice and praxis. Look at the reference lists of the
articles to determine if there are additional resources that you would like (or need to)
explore to write your Framework for Praxis paper.
The paper assignment requires that you reflect on the discipline of nursing, philosophical
underpinnings, theoretical underpinnings, practice underpinning (specifically, the history
of your advanced practice role), and place it all in context to your practice/population
focus.
Know that you might not ‘get’ the literature the first time through. Know that you might
need to read – spend time in reflection “ask questions” explore the article again, or seek a
different article or literature for more of an explanation. Know that you will be expanding
your capacity to think and make connections. Know that you are capable of doing this!
PRAXIS PAPER 2
Praxis Paper
Praxis- Family Nurse Practitioner (FNP)
Introduction
Praxis in nursing is concerned about thinking, feeling and doing. The practice of nursing
requires the practitioners to use their mind and their education to performing responsibilities that
they have been trained to perform (Seng, 1998). Therefore, they have the duty of integrating the
practice, theory and art, recognize, and put into correct use the value of different knowledge they
have through reflection. The paper seeks to delineate on the ethical, ideological and theoretical
influences that apply in the advanced nursing practice.
Overview of praxis and its benefit to the framework of discipline of nursing
Praxis has been found to be one of important pillar that underpins the construct of
nursing. It is therefore, advocated to be the route that allows nurses to be set free from the
reified bureaucratic structures and regimes of truth (Cathrine & Denise, 2009). It is also
described as the road that will lead nurses to their quest of professionalism and professional
growth in their profession as nurses. The concept of praxis has therefore helped to revive the
framework of nursing and how it is viewed. It has been the cornerstone of ensuring that nurses
gain skills and knowledge to allow them expedite their roles with vigor and professionalism
(Kilpatrick, 2008). Nursing is not about nursing actions but it is an ongoing reflective activity on
the consequences and evaluation of nursing actions that enables refinement of knowledge and
future nursing practices. Therefore, praxis has allowed expansive thinking and reflection about
important aspects that concerns nursing. It has also helped nurses to be informed and to remain
committed on their actions that have enabled them to provide quality services in their capacity as
nurses.
PRAXIS PAPER 3
Overview of advanced practice nursing role
Advanced practice nurse is a nurse that has attained a postgraduate education certification
in nursing. Therefore, such an individual has adequate skills, knowledge and scope of practice in
nursing. Such individual is required to utilize these skills, and competencies in assessment,
planning, implementation, diagnosis and in evaluation of the care that their clients require before
prescription treatment. Nurses practicing at this level may work as a generalist or as a specialist.
The advanced practice-nursing role that I will be practicing is that of Family nurse
practitioner (FNP). FNP developed because of the higher and increasing demand for specialists
that would help to provided clinical services to families in different settings (Oiler, 1993). The
demand for these services was high prompting the need for specialist nurses to be trained to
execute these duties. FNP usually assume the role of health care providers in different settings
such as rural and remote clinics, joint practice with physicians, neighborhood health centers,
private practitioners and outpatient departments (Frederickson 2003). This capacity pervades all
aspects of FNP and it influences how relationships are established between patients and their
families in their work setting. As FNP, the focus is on the primary care settings and it involves
screening and promotion of health and disease preventions across the span. As an FNP I will also
handle issues relating to acute care and not deal with critical conditions, therefore, I am
optimistic that in future this role will impact positively to the life’s and health of people.
Patients will benefit from education on prevention healthcare that they will receive. This
is because of the extensive training and education programs that are provided to patients and
people on how to live healthy lifestyles. The rate of child mortality an women cases of stillbirth
will also be reduced drastically. The future is going to be bright and the overall health of patients
is also going to be improved. Nurses of this stature have advanced skills and knowledge owning
PRAXIS PAPER 4
to their extensive trainings and continued search of knowledge and skills through continuous
research and studies. Therefore, these competencies will promote health living and foster good
health.
Core competencies and skills for an FNP
An FNP should have the ability to carry out physical examination, have the ability to
assess, evaluate, screen and conduct diagnostic tests. Strong communication skills are also
required to express and relate well with the patients (Fitzpatric & Emerson, 2011). FNP should
have interest and ability and have the ability to work as a team as well as independent, have
knowledge on acute and chronic conditions and excellent judgment ability when making
prescriptions and referral.
Ideological influences
The art of nursing is aimed at providing patient care that requires personal instinct and
insight that is gained through practice and experience. The ideological influences or philosophy
as FNP is always to ensure that actions or decisions taken promote human good. The skilful
connection that are carried out by the mind, body , feelings and hands and words and body
languages should be aimed at provide better care and ensuring that the goals of nursing are
achieved. Therefore, the values, and competent that are vivacity to personal and professional
linkage will always be upheld to ensure that patients are well attended to and get the best of the
healthcare services. It is not only skills and knowledge that an individual need to have to be an
FNP, rather a coherent structure of work need to be integrated in guiding values and actions that
are in consistent with the social mission of professionals, community awareness, and knowledge
construction guided by the quest to promote and enhance human health. Therefore, the
philosophical framework is to always yearn to promote human health by using the skills and
PRAXIS PAPER 5
knowledge acquired in the training. In so doing, the community, family members and all
stakeholders will be useful in ensuring that this is achieved. Therefore, opening up
communication and creating positive relationships will be part of the philosophies that will
ensure that the objective is achieved.
Theoretical influences
The system theory proposed by Ludwig von Bertalanffy best fits my nursing practice as
FNP. The theory was proposed in 1950 and it aspires to serve as framework between human
beings and environment. Health facility is considered as an organization or rather an open
system, which is part of the larger supra-system of the society. Therefore, it is considered as an
integrated system that ensures information sharing between systems within the environment.
Therefore, changes in the system are likely to affect the operations of the other subsystems,
therefore, management process can be considered as series of integrated factors that interact
within an organization environment. Therefore, such a system is essential in assessing the
changes that are needed in the healthcare organization. As FNP, this theory is applicable as it is
going to help me to analyze the various trends in nursing that will help me to provide appropriate
services to the patients (Ziegler 2005). The theory is also important in enhancing understanding
of the functioning of the organization such as culture that are fundamental in enhancing the
work of a nurse.
Ethical influences
Ethics refers to issues pertaining to what is wrong or right. Heath practitioners are
obliged to always uphold to ethics when providing their services to the patients. They are
required to make rational decisions, which foster good health. According to Fry, Veatch and
Taylor (2010), the ability to identify ethical and other value issues in nursing care and
PRAXIS PAPER 6
understanding or other moral authority is the foundation of understanding some of the ethical
dilemmas that many nurses find themselves in. There are various principles of ethics that are
applicable in FNP. This includes considering the value of life, justice or fairness, goodness or
rightness, individual freedom and truth telling or honest (Burnard, Chapman & Smallman, 2004).
Therefore, the appropriate theory that best benefits my practice as a nurse is deontological
theory. This theory is best exemplified by the concept that state that ‘the means should justice
the end’. Therefore, in the service delivery any actions that are taken should be able to manifest a
moral weight (Burnard, Chapman & Smallman, 2004). In the service delivery, all acts or
actions that tend to cause harm on other people should not be welcome as this will be going
against the moral standards or obligations. Immanuel Kant proposed this theory, 1724-1804 and
it is the biggest rival of utilitarianism. No human being should be treated as a means to an end.
Applying this theory, a nurse has a moral obligation to always endeavor to do right regardless of
the consequences. By so doing, the nurse will avoid various conflicts that may arise between him
and the patients or other stakeholders.
Utilization of Framework of Praxis
In the care of patients, process that facilitates and enhances continuous improvement is
important especially in an environment that experiences changes in patient care that focuses on
patient and on evidence that aims at providing high quality health. For such initiative to succeed,
it requires commitment and involvement of all stakeholders in order to change the practice. Two
conceptual frameworks which include; promoting action on research implementation in health
service model and appraisal of guidelines for research and evaluation can be combined with the
system theory, ideologies and ethical influences or help in developing of praxis that can enhance
the practice of nursing (Zaccagnini & white, 2011). These models function on three factors that
PRAXIS PAPER 7
include the nature of evidence, means of facilitating change and the context of the desired
change.
The framework also requires application of system theory to ensure that the nurses relate
well with other stakeholders. Therefore, communication is essential in provision of health care to
the patients. In communication, feedback is essential in translating theories into practice. Sources
of evidence are also important in ensuring that quality healthcare is provided. Therefore, the
FNP should be able to engage in continuous researches, refer from patient situations to provide
nursing interventions that result in a quality healthcare.
Conclusion
Even though FNP are considered as nurses that assume and handle manual nursing task
by focusing on information dissemination and basic support to the physicians, they provide in-
depth skills and knowledge to the overall health care system. Nevertheless, appreciating the fact
that healthcare industry and nursing are growing and developing, hence efforts should be
channeled on integrating theory into practice. Various sources of evidence such as researchers
and studies should also be relied upon in acquiring additional skills that would help nurses to
improve on their quality of healthcare.
PRAXIS PAPER 8
References
Burnard, P., Chapman, C., & Smallman, S. (2004). Professional and Ethical Issues in Nursing,
Elsevier Health Sciences.
Cathrine, F., & Denise, M. (2009). Chapter 4 praxis: Essential nursing construct. Retrieved from:
http://www.irma-international.org/viewtitle/48921/
Ethical theories. Retrieved from: http://courses.cs.vt.edu/cs3604/lib/Ethics/notes.html
Fitzpatrick, J., & Emerson, E. (2011). 201 Careers in Nursing, Springer Publishing Company.
Frederickson, K. (2003). Opportunities in Nursing Careers, McGraw-Hill Professional.
Fry, S., Veatch, R., & Taylor, C. (2010). Case Studies in Nursing Ethics, Jones & Bartlett
Learning.
Kilpatrick, K. (2008). “Praxis and the role development of acute care nurse practitioner”,
Nursing Inquiries, vol. 15, no. 2, pp. 116 – 126. The Doctor of Nursing Practice
Essentials: A New Model for Advanced Practice, Jones & Bartlett Publishers.
Zaccagnini, M and White, K W 2011,
Oiler, B. (1993). Toward a nursing practice research method, Adv Nur Sci., 16(2):9-25.
Seng, J. (1998). Praxis as a conceptual framework for participatory research in nursing, ANS Adv
Nursing science, 20(4):37-48.
Ziegler, S. (2005). Theory-Directed Nursing Practice, Springer Publishing Company.