Duke University Philosophy of Nursing Science Essay

Objectives
Following completion of this chapter, the reader will be able to:
1.
Describe characteristics of a science, a profession, and an academic
discipline.
2.
Explain why it is important for nursing to be recognized as a science, a
profession, and an academic discipline and what is necessary for those
distinctions.
3.
Discuss various worldviews related to scientific and philosophical schools
of thought of interest to nurses.
4.
Describe the process of knowledge development in nursing science.
5.
Differentiate among the multiple “ways of knowing” in nursing and give
examples of each.
Nursing as a Profession vs.
Occupation
 Characteristics of a profession include:
1.
Defined and specialized knowledge base.
2.
Control and authority over training and education.
3.
Credentialing system or registration to ensure competence.
4.
Altruistic service to society.
5.
A code of ethics.
6.
Formal training within institutions of higher education.
7.
Lengthy socialization to the profession.
8.
Autonomy
Nursing as a Profession
Nursing as an Academic
Discipline
“A discipline is a branch of educational
instruction or a department of learning or
knowledge.”
Nurses as an Academic
Discipline
 Characteristics of discipline includes:
1) A distinct perspective and syntax.
Determination of:
2) What phenomena are of interest 3) the context in
which the phenomena are viewed 4) what questions to
ask 5) what methods of study are used and 5) what
evidence is proof.
Ways to Classify Disciplines
 Basic Sciences vs. Humanities
 Academic Disciplines vs. Professional Disciplines
“How is nursing classified??”
Areas that Identify Nursing as a
Distinct Discipline
 1) An identifiable philosophy.
 2) At least one conceptual framework
(perspective) for delineation of what can be
defined as nursing.
 3) Acceptable methodologic approaches for
the pursuit and development of knowledge.
Nursing Knowledge
 Draws from many disciplines:
– In the past, nursing relied heavily on physiology,
sociology, psychology, and medicine to provide
academic standing and to inform practice.
– In recent decades, nursing has been seeking
what is unique to nursing and developing those aspects
into the academic discipline.
Introduction to Science and
Philosophy
 Science and philosophy shares the common
goal of increasing knowledge.
 The science of any discipline is tied to its
philosophy, which provides the basis for
understanding and developing theories for
science.
Overview of Science
 Science is concerned with causality.
 The scientific approach to understanding
reality is characterized by observation,
verifiability, and experience; hypothesis
testing and experimentation.
Characteristics of Science
1. Science must show a certain coherence.
2. Science is concerned with definite fields of knowledge.
3. Science is preferably expressed in universal statements.
4. The statements of science must be true or probably true.
5. The statements of science must be logically ordered.
6. Science must explain its investigations and arguments.
Overview of Philosophy
 Philosophy has been defined as “a study of problems
that are ultimate, abstract, and general.”
 These problems are concerned with the nature of
existence, knowledge, morality, reason, and human
purpose.
 Philosophy tries to discover knowledge and truth and
attempts to identify what is valuable and important.
Philosophers
 Rene Descartes (1596-1650) – rationalist
 Francis Bacon (1561-1626)- empiricist
 Immanuel Kant (1724-1804)-
 Thomas Kuhn (1922-1996)
Francis Bacon (1561-1626)Empiricist
 Known as “Father of
Empiricism”. He
believed in empirical
scientific methods.
 He supported
experimentation and
scientific methods for
solving problems.
Rene Descartes (1596-1650)
Rationalist
 Believes that reason is
superior to experience as a
source of knowledge.
 Rationalist attempts to
determine the nature of the
world and reality by
deduction and stress
importance of mathematical
procedures.
Immanuel Kant- German
(1724-1804)
 His work set the foundation
for many later developments
in philosophy.
 He believes knowledge is
relative and that the mind
plays an active role in
knowing.
 The mind shapes and
structures all experiences
including physical ones.
Thomas Kuhn
(1922-1996)
 Most influential philosopher
of science in the 20th
century.
 “There is no single truth.”
 Believes knowledge is true
if it withstands tests of
utility and reason.
 Focus is on lived experience,
learned reality, human
interpretation less on
experiments in laboratory
settings.
Period of Modern Science
 3 Philosophies of Science (paradigms/worldviews)
1. Received View: empiricism, positivism
2. Perceived View: constructivism/phenomenology
3. Postmodernism: Began around 1960s, feminist
philosophies, absence of strict control over
methodology and interpretation of research.
Nursing and Empiricism
 Early nurse scientists embraced the importance of
objectivity, control, fact, and measurement of smaller
parts.
 Based on this influence, acceptable methods for
knowledge generation in nursing have stressed
traditional, orthodox, and preferably experimental
methods.
Nursing and Postmodernism
 Emerged as a dominant scientific theoretical
paradigm in nursing in the late 1990s.
 This view supports the blending or integration
of qualitative and quantitative research into
a holistic, dynamic model to improve nursing
practice!
Knowledge Development
and Nursing Science
 Epistemology is the study of the theory of
knowledge.
 What do we know?
 What is the extent of our knowledge?
 How do we decide whether we know?
 What are the criteria of knowledge?
Ways of Knowing
Table 1-4 pg.14
 Empirics
 Personal knowledge
 Metaphysical
(spiritual
knowledge)
 Intuitive knowledge
 Esthetics
 Somatic knowledge
 Moral or ethical
knowledge
Research Methodology and
Nursing Science
Practice Science
Human Science
 Nursing requires research
that is applied and clinical
that generates and tests
theories related to health of
human beings within their
environments as well as the
actions and processes used
by nurses in practice.
 This approach study human
life by valuing the lived
experience of persons and
seek to understand life in its
matrix of patterns of
meaning and values.
Qualitative vs Quantitative
Methodology Debate
Quantitative
Qualitative
 – developed from positivistic
worldview
 -a method to study human
phenomena that is grounded
in social science.
 – utilizes: measuring,
analyzing, replicating, and
applying the knowledge
gained.
 Arose because aspects of
human values, culture, and
relationships were unable to
be described using only
quantitative methods.
The Future of Nursing
 The Institute of Medicine (IOM, 2011)
recommendations directed toward the
nursing profession.
1. Nurses should be able to practice to the
full extent of their education.
2. IOM promotes “seamless academic
progression”
3. Nurses should be full partners with
physicians and other health
professionals.
OVERVIEW OF THEORY
IN NURSING
CH. 2
(MCEWEN & MILLS)
Objectives



1. Describe theory classifications, components and
its use for practice, education and research in
nursing.
2. Define theoretical terms.
3. We will discuss the different types of theories,
including grand, middle-range, practice and
borrowed theories in planning to meet the needs
of individuals, families, and populations.
Yuk!
Not applicable.
Waste of time.
Too abstract.
No practical value.
Too theoretical.
Confusing.
What comes to your mind
when you hear the words
“Nursing Theory”???
Definition of Theory
“At a basic level, theory has been described as
a systematic explanation of an event in which
constructs and concepts are identified and
relationships are proposed and predictions
made” (Streubert & Carpenter, 2011).
What is the importance of
Theory in Nursing?
Why Theory is Important to Nursing
Theory offers structure and organization to nursing
knowledge and provides a systematic means of
collecting data to describe, explain, and predict nursing
practice.
2. Use of theory also promotes rational and systematic
practice by challenging and validating intuition.
3. Theories define and clarify nursing and the purpose of
nursing practice to distinguish it from other caring
professions by setting professional boundaries.
4. Finally, use of a theory in nursing leads to coordinated
and less fragmented care.
1.
Terminology of Theory
Table 2-1









Assumptions
Borrowed or shared
theory
Concepts
Construct
Empirical indicator
Epistemology
Hypotheses
Knowledge
Laws









Metaparadigm
Middle Range Theory
Model
Ontology
Paradigm
Phenomena
Philosophy
Taxonomy
Worldview
Theory Development in Nursing
Historical Overview:
-Florence Nightingale
-1st modern nursing theorist
“to nurse” meant having
charge of the personal health
of someone.
-1859 she proposed basic
premise for nursing practice
which was published in 1859.

Stages of Theory Development
in Nursing (Table 2-2 pg.29)
1.
2.
3.
4.
5.
6.
Silent knowledge.
Received knowledge.
Subjective knowledge.
Procedural knowledge.
Constructed knowledge.
Integrated knowledge.
Table 2-3: Significant Events in Theory
Development in Nursing
1859 Nightingale publishes
1920 Columbia University: Doctorate in Education
for nursing
Classifications of Theories in Nursing
Metatheory
 Grand theories
 Middle range theories
 Practice theories

Metatheory
Refers to a theory about theory.
 In nursing, metatheory focuses on broad issues.
 Walker and Avant (2011) presented an overview of
historical trends in nursing metatheory.
-1960s discussion involved nursing as an
academic discipline and the relationship to basic
sciences.
-Recent issues relate to the philosophy of
nursing and address what levels of theory
development are needed for nursing practice,
research and education

Grand Theories




Are the most complex and broadest in scope.
Attempt to explain broad areas within a discipline
and may include a lot of other theories.
They are nonspecific and are made of abstract
concepts that operational definitions.
The majority of the nursing conceptual frameworks
are considered to be grand theories.
Middle Range Theories

Lies between the grand nursing models and more
concrete ideas related to practice.

They are specific and includes a limited number of
concepts and a limited parts of the real world.

These theories are made of mostly concrete
concepts that can be operationally defined and
relatively concrete propositions that may be
tested.
Practice Theories

Also called situation-specific theories, prescriptive
theories, or microtheories and are the LEAST
complex.

More specific than middle range theories and
produce specific directions for practice.

Contain few concepts and refer to specific, easily
defined phenomena.
Purpose Theories

Descriptive (Factor-Isolating) Theories

Explanatory (Factor-Relating) Theories

Predictive (Situation-Relating) Theories

Prescriptive (Situation-Producing) Theories
General Systems Theory
Ludwig von Bertalanffy

Proposed in 1936

Founder and principle
author of GST

“ GST is a general
science of
wholeness….”
GST Basic Principles




A system is a complex of interacting elements and
they are open to, and interact with their
environments.
They can acquire qualitatively new properties
through emergence, thus they are in continual
evolution.
A system is greater than than the sum of its parts.
Examples: health care system, a family system,
body systems, information systems, etc.
Summary



Theory offers structure and organization to nursing
knowledge and provides a systematic means of
collecting data to describe , explain and predict
nursing practice.
Nursing “borrows” or “shares” theories and
concepts from other disciplines to guide theory
development, research and practice.
The concepts of nursing, person, environment, and
health are widely accepted as the dominant
phenomena in nursing.
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