The concept of praxis, also known as the practical discourse in philosophy, has been expressed in different ways in different eras. However, the linkages from one era to another and from one paradigm to another are not well explicated in the nursing literature. Difficulties with translations of 'praxis' into 'practice' and the connotations of the word 'practical' in the English language and in nursing have influenced extrapolation of the linkages. More recently, further blurring of the linkages occurred from the popular association of praxis within the emancipatory paradigm. Integral to the concept of praxis, since the time of Aristotle, is the notion of phronesis: a process of moral reasoning enacted to establish the 'good' of a particular situation, often referred to as practical wisdom.
The purposes of this paper are threefold. First, this paper will state the meaning of praxis and demonstrate a number of linkages and shifts in the evolution of praxis. Second, this will enhance understanding of the multiple expressions of praxis in contemporary nursing. And lastly, this paper will discuss the implication of praxiological knowledge in the field of nursing. Also, increased appreciation of the concept of praxis provides an important vehicle for the advancement of nursing as a moral endeavor and the nurse as moral agent.
The definition of praxis is very simple yet it encompasses a deep attributions. Praxis means translating an idea into action or to put theory into practice. Praxis also means a performance of an action. There are many authors who had tried to discuss the meaning of praxis. Freire (1972) defines praxis as the process of reflection that enables us to understand the world in which we practice. This in turn allows us to make sense of ourselves, what we experience and how we act. Action and reflection must go hand in hand even in the temporal sense. Freire (1972) insists that praxis cannot be divided into a prior stage of reflection and a subsequent stage of action. Action and reflection must take place at the same time. It is believed that when this two come together they become creative. This was done by endorsing reflections that has been carried in a struggle to create a new social order, in many ways representing a new unity of theory and praxis. In addition, praxis is described as the center of human activity and believed it to be an important component for those working within the critical theory paradigm (Habermas, 1972). In addition, praxis is the act of reflectively constructing or reconstructing the social world (Grundy, 1987). Within these parameters the discourse of different fields like political, social or philosophical would be the medium through which praxis could be worked towards and achieved.
The notion of conceiving praxis as a theory and practice embedded within an intimate relationship at first glance appears somewhat glib and limited (Warelow, 1997). Although praxis is characterized by certain fundamental types of relation between person, their actions and the world, praxis can be also be viewed as the link between reflection or theorizing and action or practice per se. Practice is often depicted as the act of doing something but it is usually contrasted to theory which means the abstract of ideas about something or a phenomenon. These theories then may be applied to the problems of putting it into practice.
In praxis there can be no prior knowledge of the right means by which individual realize the end in particular situation. Hence, praxis is not merely action based on reflection. It is an action which embodies certain qualities and meaning. These may include a commitment to human well being and search for the truth and respect from other individuals. It is the action of people who are free against any oppression and those who are able to act for themselves. Furthermore, it is undeniable that praxis is risky because it requires people to make a wise and prudent practical judgment about how to act in a certain situation. The word and action, action and reflection, theory and practice are all facets of the same idea (Taylor, 1993). This action (praxis) is not simply the doing of something, what had been described by Freire as activism and Aristotle as poiesis (about acting upon or about merely working with objects). Praxis therefore is creative, other-seeking and dialogic.
It is a widely held believed that nursing science is developed predominantly through a combination of theory, research and practice. Each component enjoys periods of popularity, which is often dictated by the prevailing ethos of the time. Which elements have the most influence on how heath care is delivered is determined in part by the way it complements the other realms of health care. How these components collectively assist nursing practice does not attract overwhelming consensus and continues to be one of the major issues debated by clinicians, academics, researchers, politicians and administrators.
The use of the term praxis in nursing ranges from the liberal and radical sense of such concept. Liberal apolitical notions of praxis are confined to the ideas of reflection on an individual’s practice and consideration of the dialectic relationship between reflection and practice and praxis in a radical sense encompasses reflection on the world and action towards emancipatory purpose.
Since nursing are attached to many theoretical concepts that are put into practice. The idea of reflexive examination of oneself and one’s relationship with wider nursing community follows typology in which praxis is suggested as a means of confirming the humanity and uniqueness of the nurse in relation to others. Jobs in the caring profession such as nurses are only done well when they are performed out of a sense of vocation, that is, unconditional desire to help other people (Sayers, 1991). Praxis in the fields of nursing through the use of reflection on practice enables different transformations and changes to the nursing world. Praxis remakes the conditions of informed action and constantly reviews action (practice) and the knowledge (theory) which informs it (Cox et. al, 1991).
Thus, praxis in this sense touches ethical perspectives suggesting that nursing praxis is guided by a moral rule of conduct, encouraging them to act truly and justly in which praxis entails theory and practice in a dialectical and complementary relationship. For most nurses the caring relationship, where the nurse seeks to bring about 'healing’, is where the art and science of nursing is found. Benner (1989) says that this relationship intricately binds the act of caring with an understanding of the needs of people as they experience illness. It has been pointed out that the skills needed to understand the lived experience of the illness are extensive and require detailed observations and attentiveness. This is caring enriched by education and experience. For Benner, theory arises out of, and is therefore grounded in, the experience of caring for patients. Consequently, nurses will often experience conflict between the contexts in which society chooses to view illness, and the experiences that both nurses and patients have of working together to ease suffering.
Conceiving nursing as a form of praxis is articulated by many authors. Nursing theory guides practice provides guidance for research and answers questions gathered from practice and (Meleis & Price, 1988). Lutijens and Horon (1992) talk of theory, research and practice as being a cyclical process that defines nursing science with practice serving as the catalyst. Despite the interrelatedness of these elements, Fawcett (1978) warns that theory development and research are excursions into the trivial when presented in isolation. However, nursing developed essentially as a profession of 'doing' despite nursing education moving into a university setting and adopting a scientific framework. Many nursing authors have promulgated this dilemma by accepting nursing as purely a scientific enterprise, incorporating reductionism, causality and measurable quantity rather than quality. The theory-practice nexus in praxis illustrated that nursing often just fit in with accepted ways and subscribe to the accepted ideology and discourse (Melia, 1987). Nursing in this sense would be practiced on the basis of tried and tested routines handed down from the days of their formulation. Here, theory can be asserted to be driving practice using formal models to educate nurses.
On the other hand, there are some who says that in nursing praxis, theory and practice are mutually constitutive with neither being pre-eminent with the only fixed element being some altruistic disposition to act truly and justly (Carr & Kemmis, 1986). This was extended by Freire (1972) by saying that praxis is the action and reflection of people upon their world in order to transform it. In addition, the Habermasian perspective that describes praxis as the center of human activity (Habermas, 1972) and points out that it becomes an important ingredient for those working within critical theory paradigm such as nurses.
Moreover, emancipation empowers self and others by making values live through ones action, which bring s about continual transformation as actions are altered and modified by experience and reflection (Lumby, 1991). The clear notion for nursing with the apprehension in mind is the liberation of nursing praxis or nursing knowledge and practices from constraint, domination, false consciousness and distorted ideology. The emergence of nursing praxis in its own right rests upon developing stronger links between many facets of nursing praxis per se.
In nursing there exists also the so called discursive praxis. Discursive praxis describes the verbal and documented reflective techniques in respect of both theory and practice (Warelow, 1997). This description allows the enhancement of greater comprehension of personal beliefs (theories) and practices and would enable nurses to learn from experience (Sims, 1991). This also allows nursing to be viewed as a more theoretico-practical process. Described as praxis, this permits nurses to practice from a more practico-theoretical with praxis driving theory (Benner, 1984). This enables nurses to move into the realms of expert nursing practice and experienced wisdom working in harmony. This practice then can be documented, reflected upon and used as a powerful discursive medium, knowledge based and teaching tool. If nurses can capture these thoughts practice and patient care will be the benefactors of both theory and practice. In this sense, discursive praxis is perceived in driving theory and subsequently authenticates the discipline of nursing using praxis as a foundation.
Praxis in the field of nursing also includes two different levels; the macro-praxis and the micro-praxis. Macro-praxis includes works that are being done for purposes of affecting a population or society. This may include researches, advocacies, program development, teaching and dissemination tasks. While, micro-praxis are those works that go between client and the nurse for purposes of understanding an individual problem and affecting an individual’s health.
Praxis from the point of view of some has its own implications. Praxis is an awkward word. And grabbing hold of it is difficult because it sounds so much like “practice” and “practical.” All these words are of course related. But conflating them misses the richer sense of praxis. Hence, it is important to extrapolate the implication of praxis in nursing. In the above discussion praxis is perceived as reflective practices, as this is a core element in the theoretical approach. Freire (1990) defines praxis as the process of reflection that enables us to understand the world in which we practice. This in turn allows us to make sense of ourselves, what we experience and how we act. Carr (1996) believes the process of reflection is central to the evolution of nursing knowledge. However, many articles appear to stop short and merely discuss the process of reflection in praxis. Boud, Keogh and Walker (1985) offer a definition stating that reflection, in the context of learning, is a generic term for those intellectual and affective activities in which individuals explore their experiences in order to lead to new understanding and appreciation. No authors explain the radical reflection proposed by Wilson (1995), but one might assume this means a vigorous form of contemplation.
Theory-practice gap in nursing through to a fully-formed model of praxis, the coming together of practice, research and theory as an integrated whole is just a part of praxis nursing. The theme that runs throughout is the celebration of reflexivity, the idea that everything we do as practitioners influences and is influenced by everything else. This might seem rather obvious, but the application of the scientific paradigm to nursing has sought to minimize the effects of reflexivity in research, education and nursing practice.
It has referred to this denial of reflexivity as ‘technical rationality’. The world of technical rationality is a well-organized and carefully controlled environment in which research findings always translate into best practice, in which the knowledge required in order to practice can be neatly packaged into a syllabus, and in which theorists always know best because their ivory towers afford them a better view of the swampy lowland of practice. Each advocates a form of reflexivity, whether it is the interrelationship between researcher and nurse, between nurse and educationalist, or between these different aspects within each individual practitioner. Nursing praxis, the arising of theory and practice in a single person and in a single action, demands that an individual must act reflexively. Similarly, although this stands alone and complete in itself there is a constant reflexive interweaving and cross-referencing between the must come together with regards to praxis in the field of nursing.
In the world where changes are happening day by day, many people would be familiar with the idea that there is an emerging trend toward what has been described as praxis in the field of nursing. In this matter there is a need to have a curriculum based on praxis that would enable nurses to work with theory and practice harmoniously. This is not only occurring in nursing education, but is a general trend away from product, or even process oriented curricula, toward praxis oriented curricula. It has been widely discussed in nursing literature as a practice oriented approach to curriculum; however it is totally congruent with praxis as it encourages the learner to move toward the skills of reflection, action and transformation that underpin praxis. A model for nursing praxis must be presented for the future use. It must be indicated in this model, key elements are experience in context, lifelong learning ability and a curriculum that frames these toward the development of the critically reflective practitioner so often considered the goal of nursing programs. Many authors have argued that clinical experience is important because it gives the student or the nurses the opportunity to bridge the so call theory- practice gap. In a the new curriculum approach which is a very famous issues in nursing, theory and practice have a symbiotic relationship Note that one examines practice to generate theory and returns to practice to test out theory. Practice and theory are not dichotimised, they are mutually interdependent through the praxis oriented elements of reflection and enquiry, testing out and reflection and revision.
Although praxis is one of the most important issues to be considered in nursing, there exist also some issues important to nursing. It is very significant that as part of collaborating praxis in nursing it will also include the philosophy of technology as a focus of inquiry emerging within nursing scholarship and research. Philosophy of technology and nursing is fundamental to discipline development and has a role in enhancing health care. It is argued that nurses must further their responsibility and interest in critiquing current and future health care systems through philosophical inquiry into the experience, meaning and implications of technology. This locates nurses as important contributors to the use and integration of health care technology and identifies nursing as a discipline that can provide specific insights into the health experience(s) of individuals, cultures and societies. Nurses are encouraged to undertake further examination of epistemological, ontological and ethical challenges to arise from technology as a focus of philosophical inquiry. The advancement of philosophy of technology and nursing will make a profound contribution to inquiry into the experience of technology, the needs of humanity and the development of appropriate health care.
Aside from technological issues that will be very important for the future of nursing traditional values, such as advocacy for individual patients/clients, holistic client care, and meeting the healthcare needs of individuals and populations, are at stake in managed care arenas that are ostensibly concerned with both cost containment and quality as new arrangements for the financing and delivery of health care also evolve. This is also an important issue that will be very significant for the future of nursing. Nurses, both individually and collectively, and the profession are struggling with new issues and questions in all areas of clinical practice, the use of praxis in nursing, administration, education, and research, in order to meet the differing goals of health care in a managed care world is valuable.
In conclusion, Praxis is our common ground; it unifies our roles, and purpose of existence. Hence annotation must be attributed to praxis in which nursing have been used. Through praxis, nurses have been able to put theory into practice with the consideration of the consequences that might happen if they do not practice their profession accurately and effectively. Also, praxis enables nurses to use reflection and action at the same time which helps them become a true professional since. Nursing's contributions to care have been significant and enduring. Nursing has always provided the caring part of the healing process and has had as a major focus maintaining and promoting health. Furthermore, issues with regards to nursing must be able to be given priority and focus because it is the only way that nurses will know what lies for them in the future.
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