/about praxis

Praxis (πρᾶξιςis the word used by the ancient Greeks for practical reasoning leading to wise action, and is driven by phronesis, the moral disposition to act truly and rightly. In modern times, this moral or ethical component is usually translated as a commitment towards a particular end. As Karl Marx proclaimed: "the philosophers have only interpreted the world in various ways; the point is to change it". Praxis has since taken on many meanings in education, research and the practice disciplines, but usually involves a reflexive cycle in which learning and understanding from practice is fed back into practice in  order to achieve a particular end. In the words of the educationalist and political activist Paulo Freire, praxis is "reflection and action upon the world in order to transform it". Whereas practice is usually set up in opposition to theory, praxis can be regarded as the coming together of practice, reflection, education and research in an integrated whole. 

/about gary rolfe

Gary Rolfe is Emeritus Professor of Nursing at Swansea University, associate professor of innovation and development with Abertawe Bro Morgannwg health board in west Wales, visiting professor in practice innovation at Trinity College Dublin and visiting professor in practice development at Canterbury Christ Church University in Kent. Gary has published ten books and more than one hundred journal papers on subjects including reflective practice, practice innovation, action research, philosophy of nursing, education and scholarship. He receives regular invitations to speak at conferences and has facilitated workshops and seminars across the world. 
We often think and talk about practice as though we all share the same understanding of what the term means. Indeed, we usually use the term to refer to the sum total of what nurses and other health care professionals do as they go about their daily business. However, if we wish to improve, innovate or develop practice, it would be helpful to think more carefully about it in a more considered way.   
   I first made the distinction between the nurse technician and the nurse practitioner in my book Closing the Theory-Practice Gap in 1996, and it has remained the focus of my work for the past 20 years. The nurse technician follows what Donald Schön referred to as the model of technical rationality, where action is based on technical knowledge from research. In recent years this approach has come to be known as Evidence-Based Practice (EBP), with the gold standard research methodology for generating evidence for practice being the randomised controlled trial.
   Technical rationality demands two separate and distinct groups: technologists who usually work in universities and who generate evidence by conducting research; and technicians who apply the findings of research in what Schön referred to as the ‘swampy lowlands’ of practice. The relationship between these groups is hierarchical and one-way. Technologists communicate with technicians by publishing the findings of their research in academic journals, but there is little scope for technicians to respond if they discover that those findings do not translate easily into practice. Technologists therefore operate more or less independently of technicians and the value of their work is judged primarily by the extent to which it is cited and discussed by other technologists. Technicians, on the other hand, depend on technologists to provide them with research-based evidence and guidelines for practice.
   In contrast to the nurse technician, the nurse practitioner does not rely primarily on external knowledge and theory supplied by researchers and academics, but pays far more attention to the internal body of knowledge that arises out of practice itself. In fact, we might go further and suggest that the very idea of practice is defined by the extent to which its knowledge base is generated by practitioners themselves through contemplation and critical examination of their own actions. Practitioners are therefore autonomous theorists and researchers of their own practice and the technical rational hierarchy of evidence is turned on its head. 
   This expanded view of practice suggests a new paradigm for nursing and health care praxis with its own philosophy and methods for generating, evaluating, applying, and transmitting knowledge and theory, and which seeks to integrate them into an organic whole.
The process of thinking critically about our own practice is usually referred to in nursing and the health care disciplines as reflection or reflection-on-action, which has been defined as the retrospective contemplation of practice in order to learn from it. Reflection-on-action, as its name suggests, usually happens at a distance from practice and offers the practitioner an opportunity to recollect, analyse and process prior experiences in order to develop new practice knowledge. Reflection-on-action can happen informally and spontaneously or it can be planned and structured, often by using a reflective framework. It can occur through introspection, by keeping a reflective journal, or through clinical supervision. Wherever, whenever and however it is done, reflection-on-action is the primary means by which the practitioner builds her own unique body of experiential knowledge and theory on which to make informed clinical decisions.
   Reflection-on-action is a useful and valuable tool for the practitioner, but it is essentially a theory of learning rather than a theory of practice. Reflective practice, as opposed to reflective learning, can be traced back to the work of John Dewey in the early years of the twentieth century, and more recently to Donald Schön and his book The Reflective Practitioner. For Schön, the challenge for practitioners is that practice is hardly ever straightforward; the everyday problems encountered in professional settings can rarely be anticipated in advance and often cannot be resolved through the application of generalisable findings from research. The nurse technician who is dependant on technological theory and scientific evidence will struggle to respond to the unique one-off situations facing her as she goes about her day to day work, since her textbook theories will rarely match the messy realities which she regularly encounters. What the nurse requires in these situations is a more experimental approach to practice based on her own experiential knowledge, which she can further develop and test in practice through a process referred to by Schön as on-the-spot experimenting or reflection-in-action.
   Reflective practice can therefore be described as a response to unique and messy problems in which the practitioner assesses the presenting situation, constructs theories, explanations and hypotheses, applies them on-the-spot to her practice, and evaluates the effects of her actions. The process is then repeated until the problem is resolved or brought under control. The reflective practitioner is therefore engaged in a series of reflexive cycles of thinking and doing in which knowledge and theory generated from practice is immediately applied back to practice.
Practitioner research, as its name suggests, involves practitioners in a critical and systematic exploration of their own practice. Practitioner researchers might confine their investigations to their own practice or they may look more widely at the organization in which they work; they can be the sole investigator or work in partnership with academic researchers; they can carry out their research as an integral part of their everyday practice or step back and look at their practice more objectively; they can work as individuals or as part of a critical community of practitioner researchers.
   Practitioner research has its roots in a quite separate tradition from other research paradigms in nursing and health care, and can be traced to the split between the social sciences and the human sciences at the end of the nineteenth century.Social science is grounded in Auguste Comte's positivism and Durkheim and Mill's quest to discover social laws based on large scale statistical research. Human science, which is the foundation for practitioner research, has its roots in Wilhelm Dilthey's hermeneutics, which was concerned with understanding and interpreting the experiences of the individual. In other words, social science is the study of people, and human science is the study of persons; social science makes generalisations from a sample to a population, human science explores single cases; social science seeks to explain, whereas human science is concerned with deep understanding (Verstehen); social science is a science of large numbers; human science is a science of the unique.
   Practitioner research combines the reflexivity and commitment to change of praxis with the concern 
of hermeneutics to understand and empathise with the individual. Reflective practice is itself a methodology for practitioner research, but the practitioner researcher can adopt a number of other more formal and structured approaches including action research, reflective case study research, single-case experimentsand auto ethnography.
   Practitioner research has a number of distinct advantages over more technical research paradigms. Firstly, it is grounded in practice and is able to respond immediately to the concerns and problems of practitioners and service users. Secondly, the subjects of the research are the very same people who will benefit from it. Thus, the practitioner researcher is able to acquire a deep and specific understanding of the individuals to whom she is providing care. Thirdly, the findings from practitioner research can be applied immediately and reflexively back into the practice setting. Finally, practitioner research empowers and emancipates the practitioner by giving her control over the generation, evaluation, application and dissemination of her own body of professional knowledge.
Technical rational education has two functions: the first is instruction through the transmission of information, facts and knowledge from master to pupil; the second is training through assisting the pupil to apply those facts and knowledge in a practical setting. Carl Rogers referred to this as the mug and jug theory of teaching, where the master fills up the empty brains of the pupils from his jug of knowledge. However, whilst this model of education might be appropriate for training nurse technicians, Donald Schön has pointed out that "what aspiring practitioners most need to learn, professional schools seem least able to teach". 
   What aspiring practitioners most need to learn is not how to apply theory and research findings to practice but how to reflect in and on action, how to develop and apply clinical reasoning and wise action (praxis), how to critically examine and evaluate their own practice, how to develop a deep hermeneutic understanding of their clients and patients, and how to integrate all of these things into a single seamless whole. And the reason that "professional schools" (which are nowadays mostly located in university departments) seem unable to teach these things is because they are not things which can be learnt in schools and universities. 
   Schools and universities are ideal settings for teaching the science and technology of large numbers, that is, for preparing students for the statistically probable, the generally expected and the usual. They can equip students to work in what Schön called "the high hard ground" where "manageable problems lend themselves to solution through the application of research-based theory and technique". But as he pointed out, and as we all know from our own experience, most practice encounters take place in what he called "the swampy lowland" where "messy, confusing problems defy technical solution". 
   Schön uses the term 'practicum' for any setting designed for the task of learning a practice. In the technical rational university department, the practicum is the classroom and the simulation laboratory, where facts can be learnt and applied to practice more or less unproblematically. Learning takes place, but what the student learns is how to deal with the usual and the expected. She also acquires professional knowing, that is, be able to 'think like a...'. However, this professional knowing is not knowledge the practice of nursing or the practice of health care, but the practice of the practicum. The student learns how to solve the artificial problems and puzzles posed by the simulated setting, but not the messy and confusing problems of the swampy lowlands.
   Learning to think like a practitioner can only happen in practice. Practitioner education, as with practitioner research, involves a partnership between practitioner and academic in which the former plays the major role.


    contact: praxis@garyrolfe.net