Chapter 1- Philosophy, Science, and Nursing

Nursing as a Profession
- Profession is a learned vocation or occupation that has a status of superiority and
precedence within a division of work
- Characteristics of a profession include
1) Defined and specialized knowledge base
2) Control & authority over training and education
3) Credentialing system or registration to ensure competence
4) Altruistic to society
5) Code of ethics
6) Formal training within institutions of higher education
7) Lengthy socialization to the profession
8) Autonomy
- Professionals are responsible and accountable to the public for their work; traditionally
professions have included the clergy, law, and medicine.

Nursing as an Academic Discipline

- Discipline is “ a branch of knowledge ordered through the theories and methods evolving
from more than one worldview of the phenomena of concern”
- It’s a branch of educational instruction or a department of learning or knowledge
- The tradition of the discipline provides the content which includes: ethical, personal,
esthetics, and scientific knowledge.
- Characteristics of a discipline:
1) Distinct perspective and syntax
2) Determination of the phenomena of interest
3) Determination of which the phenomena is viewed
4) Determination of the questions to ask
5) Determination of the methods to study
6) Determination of what evidence is proof
- Research in academic disciplines is both basic and applied.
- The professional disciplines are practical in nature, and their research is more
perspectives and descriptive.

Science and Philosophy

- Science is concerned with causality (cause and effect)
- Philosophy is concerned with the purpose of human life, the nature of being and reality,
and the theory and limits of knowledge. Intuition, introspection, and reasoning are
examples.
- Science is both a process and a product. As a process, its characterized by systematic
inquiries that relies heavily on empirical observations of the natural world. As a product,
it has been defined as empirical knowledge that is grounded and tested in experience
and is the result of investigative efforts.
- Natural sciences: chemistry, physics, biology, physiology, geology, meteorology
- Basic or pure sciences: math, logic, chemistry, physics, english
 - Human or social sciences: psychology, anthropology, sociology, economic, political
sciences, history, and religion
- Practice or applied sciences: architecture, engineering, medicine, pharmacology, law.
- 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”
- Rationalist ( descartes and spinoza) believe that reason is superior to experience as a
source of knowledge. It attempts to determine the nature of the world and reality by
deduction and stress the importance of mathematical procedures.
- Empiricist (Bacon) supports experimentation and scientific methods for solving
problems.
- Kant believed that knowledge is relative and that the mind plays an active role in
knowing.
- Traditionally the branches of philosophy: metaphysics, epistemology, logic, esthetics,
and ethics or anxiology.

Schools of Thought
- Three philosophies of science that dominate ( rationalism, empiricism, and human
science/phenomenology).
- Rationalism and empiricism are often termed received view and human
science/phenomenology and related world views are considered perceived views.

Received View (empiricism, positivism, logical positivism)

- Received view denotes that individuals learn by being told or receiving knowledge.
Empiricism
- Empiricism has its roots in the writings of Francis Bacon, John Locke, and David Hume,
who valued observations, perception of the sense, and experience as a source of
knowledge.
- Empiricism is founded on the belief that what is experienced is what exist, and is
knowledge base requires that these experiences be verified through scientific
methodology.
- Empiricism hold the truth corresponds to observable, reduction, verification, control, and
bias free science. It emphasizes math formulas to explain phenomenon. It strives to
explain nature through testing of hypotheses and development of theories.
Instrumentation, reliability, and validity are stressed.
Positivism
- Supports mechanistic, reductionist principles where the complex can be best understood
in terms of its basic components
- Logical positivist recognized only the logical and empirical bases of science and
stressed that there is no room for metaphysics, understanding, or meaning within the
realm of science.
- Theories are either true or false.

Contemporary Empiricism/Postpositivism
 - Current postpositist accepts the subjective nature of inquiry but still supports rigot and
objective study through quantitative research methods
- Concerned with explanation and prediction of complex phenomena, recognizing
contextual variable.

Perceived View (Human Science, Phenomenology, Constructivism, Historicism)

- The perceived view of science, which may also be referred to as the interpretive view
includes phenomenology, constructivism, and historicism. The interpretive view
recognizes that the perceptions of both the subject being studied and the researcher
tend to be de-emphasize reliance on strict control and experimentation in lab settings.
- Descriptions that are derived from collectively lived experiences, interrelatedness,
human interpretation, and learned reality, as opposed to artificially invented ( lab
setting).
- feminism and critical theory may also be considered to be perceived view. These
philosophical schools of thought recognize the influence of gender, culture, society, and
shared history.
Phenomenology
- Study of phenomena and emphasizes the appearance of ting as opposed to the things
themselves. Understanding is the goal of science with the objective of recognizing the
connection between one's experience, values, and perspective. It maintains that each
individual's experience is unique and there are many interpretations of reality.
- Is open, variable, and relativistic and based on human experience and personal
interpretations.
Constructivist
- Focuses on understanding the actions of and meaning to individuals
- What exist depends on what individuals perceive to exit
- Knowledge is subjective and created by individuals.

Postmodernism ( Poststructuralism, Postcolonialism)

- Postmodernism rejects the notion of a single truth. It recognizes the value of science and
scientific methods, postmodernism allows for multiple meanings of reality and multiple
ways of knowing and interpreting reality.
- Rather than focusing on a single research methodology, postmodernism promotes the
use of multiple methods for development of scientific understanding and incorporation of
different ways to improve understanding of human nature.
- Postmodernism has been described as a dominant scientific theoretical paradigm in
nursing in the late 20th century. It has helped dislodged the authority of a single
research paradigm in nursing science by emphasizing the blending or integration of
qualitative and quantitative research into a holistic, dynamic model to improve nursing
practice.

Nursing Philosophy
- Refers to the belief system or worldview of the profession and provides perspectives for
practice, scholarship, and research
 - Most would agree then that is nursing is increasingly recognized as the “multiparadigm
discipline”

Nursing Science
- Recognizes the relationships of human responses in health and illness and addresses
biologic, behavioural, social, and cultural domains. The goal is to represent the nature or
nursing to understand it to explain it, and to use it for the benefit of humankind.

Philosophy of Science in Nursing

- Helps to establish the meaning of science through an understanding and examination of
nursing concept, theories, laws, and ais as they relate to nursing practice

Knowledge Development and Nursing Science

- Approaches to knowledge has 3 factors: ontology, epistemology, and methodology.
- Ontology refers to the study of being: what is or what exists
- Epistemology refers to the study of knowledge or ways of knowing
- Methodology is the means of acquiring knowledge.

Epistemology
- Is the study of the theory of knowledge
- Basic types of knowing:
1) Empirics- scientific form; observation, testing, and replication
2) Personal knowledge- knowledge gained through thought alone
3) Intuitive- not guessing but relies on nonconscious patterns and intuition
4) Somatic- knowledge of the body in relation to the physical environment; tasks
5) Metaphysical- aspects of spiritual knowing include magic, mirackles, near death
experiences
6) Esthetics- related to beauty, harmony, and expression, art, values, and creativity
7) moral/ethical- what is right or wrong. Values and social and cultural norms.
Nursing Epistemology
- Defined as the study of the origins of nursing knowledge its structure and methods, the
patterns of knowing of its members and the criteria for validating its knowledge claims.
- Four patterns of knowing for nursing: empirics, esthetics, personal, and ethics.
- Empirical is traditional ideas that can be verified through observation and proved
hypothesis
- Esthetic is sensing the meaning of the moment, it relies on perception and empathy
- Personal incorporates experience, knowing, encountering and actualizing the self within
practice
- Ethics refers to the moral code for nursing and is based on obligation to service and
respect for human life

Other Views of Patterns of Knowledge in Nursing

 1) Clinical knowledge refers to the individual nurses personal knowledge. It results from
using multiple ways of knowing while solving problems during client care provision. It
may also be intuitive and subjective knowing.
2) Conceptual knowledge is abstracted and generalized beyond personal experience.
Concept are drafter and relational statements are formulated.
3) Empirical knowledge results from experimental, historical, or phenomenological research
and is used to justify actions and procedures in practice.

Nursing as a Human Science

- Proposes that the human sciences require concepts, methods, and theories that are
fundamentally different from those in natural sciences. Human sciences study human life
by valuing the lived experiences of persons and seek to understand life
- Scientists hope to create knowledge to provide understanding and interpretation of
phenomena.

Quantitative vs Qualitative
- Quantitative approach has been justified by its success in measuring, analyzing,
replicating, and applying the knowledge gained.
- Phenomenology and other qualitative methods arose because of aspects of human
values, culture, and relationships were unable to be described fully using quantitative
research methods.

Key Points
- Nursing can be considered an aspiring or evolving profession
- Nursing is a professional discipline that draws much of its knowledge base from other
disciplines
- Nursing is an applied science that has been influenced by several philosophical schools
of thought including received view ( empiricism, positivism, logical positivism) the
perceived view (humanism, phenomenology, constructivism) and postmodernism.
- Nursing philosophy refers to the worldviews of the profession and provides perspective
for practice, scholarship, and research. Nursing science is the discipline- specific
knowledge that focuses on the human environment health process. Philosophy of
science in nursing establishes the meaning of science through examination of nursing
concepts, theories, and laws as they relate to nursing practice
- Nursing epistemology (ways of knowing in nursing) has focused on four predominant or
fundamental ways of knowledge: empirical, esthetic, personal, and ethical.

Chapter 2- Overview of Theory in Nursing

The Importance of Theory in Nursing
 - Believed that the use of theory offers structure and organization to nursing knowledge
and provides a systematic means of collecting data to describe, explain, and predict
nursing practice.
- Use of theory also promotes rational and systematic practice by challenging and
validating intuition.
- Nursing has influenced nursing practice are described by Fawcett:
a) Identify certain standards for nursing practice
b) Identify settings in which nursing practice should occur
c) Identify distinctive nursing processes and technologies
d) Direct the delivery of nursing services
e) Serve as the basis for clinical information systems such as admissions, orders,
care plans, and discharge summary
f) Guide the development of client classification systems
g) Direct quality assurance programs.

Historical Overview
- Most nursing scholars credit Florence with being the first modern nursing theorist
- She postulated that “ to nurse” meant having charge of the personal health of someone
- According to Florence, formal training for nurses was necessary to “teach not only what
is is to be done but how to do it”. She was the first to advocate the teaching of symptoms
and what they indicate.
- She taught the importance of rationale for actions and stressed the significance of
trained powers of observations and reflection.

Stages of Theory Development in Nursing

Silent Knowledge Stage
- Is blind obedience to medical authority
- The first training schools for nurses was in New England in 1872 and that instructions be
provided by medical staff and resident physicians.
- Nurses depended on physician's’ diagnosis and orders.
- Nursing education meant acquisition of technical skills and that knowledge of theory was
unnecessary and might actually handicap the nurse

Received Knowledge Stage

- Learning through listening to others
- Not until after WWII when changes were made in nursing
- Severe nursing shortage during this time
- The first Nursing Research was published in 1950.
- 1956, the health amendments act authorized funds for financial aid to promote graduate
education for full time study to prepare nurses for administration, supervision, and
teaching.
Subjective Knowledge Stage
- Authority was internalized to foster a new sense of self
 - Until the 1950s nursing practice was principally derived from social, biologic, and
medical theories.
- Peplau described the interpersonal process between nurse and the client. This started a
revolution in nursing and independent frameworks were emerging.
- During the 1960s the development of nursing theory was heavily influenced by 3
philosophers: James Dickoff, Patricia James, and Ernestine Wiedenbach. They
attempted to define what nursing is, describe the social purposes nursing serves, explain
how nurses function to realize these purposes, and identify parameter and variable that
influence illness and health.
Procedural Knowledge Stage
- Includes both separate and connected knowledge
- By the 1970s the nursing profession viewed itself as a scientific discipline evolving
toward a theoretically based practice focusing on the client.
- Many nursing theorist published their beliefs and ideas about nursing and some
developed conceptual model.
- Common elements of nursing were identified: the individual recipient of care (client), the
context of nurse-client interactions (environment), and health.
- Books were written for nurses on how to critique, develop, and apply nursing theories.
Constructed Knowledge Stage
- Combination of different types of knowledge (intuition, reason, and self knowledge)
- During the late 1980s scholars began to concentrate on theories that provide meaningful
foundation for nursing practice.
- The 1990s into the early 21st century saw an increasing emphasis on philosophy and
philosophy of science and nursing.
- Attention shifted from grand theories to middle range theories as well as application of
theory in research and practice
- Evidence based research**
Integrated Knowledge Stage
- Assimilation and application of “evidence” from nursing and other health care disciplines
- Blends and uses a variety of processes to achieve a given research aim as opposed to
adherence to strict accepted methodologies.
- In the current state of knowledge development considerable focus in nursing science
has been on integration of knowledge into practice largely with increased attention on
EBP and translational research.

Scope of Theory
- The scope of theory includes its level of specificity and the correctness of its concepts
and propositions
- Metatheory, philosophy, or worldview to describe the philosophical basis of discipline
- Grand theory or macro theory to describe the comprehensive conceptual frameworks
- Middle range theory to describe frameworks that are relatively more focused than grand
theories
- Situation specific or micro theory to describe those smallest in scope.
Metatheory
- Refers to a theory about theory.
- Focuses on broad issues such as the processes of generating knowledge and theory
development and it is a forum for debate
- Recent metaphorical 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
- They attempt to explain areas within a discipline and may incorporate numerous other
others
- They are nonspecific and are composed of relatively abstract concepts that lack
operational definitions
- Are developed through thoughtful and insightful appraisal of existing ideas as opposed
to empirical research

Middle Range Theories

- Lies between grand and more circumscribed concrete ideas.
- Are specific and encompass a limited number of concepts and a limited aspect of the
real world. They are composed of relatively concrete concepts that can be operationally
defined and relatively concrete propositions that may be empirically tested
- They can be a description of a particular phenomena, an explanation of the relationship
between phenomena, or a prediction of the effects of one phenomena or another.

Practice Theories
- Called situation specific theories, prescriptive theories or microtheories and are the least
complex.
- Are more specific than middle range theories and produce specific directions for practice
- They contain the fewest concepts and refer to specific easily defined phenomena.
- They are narrow in scope, explain a small aspect of reality and are intended to be
prescriptive.
- Examples are practice theories developed and used by nurses are theories of
postpartum depression, infant bonding, and oncology pain management.

Type or Purpose of Theory

- Defined theories as intellectual inventions designed to describe explain, predict, or
prescribe phenomena. They described four kinds of theory
1) Factor isolating theories (descriptive)
2) Factor- relating theories (explanatory)
3) Situation-relating theories ( predictive, promoting, or inhibiting)
4) Situation-producing theories

Factor Isolating Theories (descriptive)

- Those that describe, observe, and name concepts, properties, and dimensions
 - Identifies and describes the major concept of phenomena but doesn’t explain how or
why the concepts are related
- The purpose is to provide observation and meaning regarding the phenomena. Its
generated and tested by descriptive research techniques including concept analysis,
case studies, and lit review.
Factor Relating Theories (Explanatory)
- Those that relate concepts to one another, describe the interrelationships among
concepts or propositions, and specify the associations or relationships among some
concepts
- They attempt to tell how or why the concepts are related and may deal with cause and
effect and correlations or rules that regulate interactions.
Situation Relating Theories (Predictive)
- Are achieved when the conditions under which concepts are related are stated and the
relational statements are able to describe future outcomes consistently.
- Relatively difficult to find in nursing literature.
Situation Producing Theories
- Prescribed activities necessary to reach defined goals.
- They address nursing therapeutics and consequences of interventions
- Include propositions that call for change and predict consequences or interventions
- They should describe the prescription, the consequences, the type of client, and the
condition
- Among the most difficult to identify in nursing literature.

Borrowed vs Unique Theory in Nursing

- The main premise held by those opposed to borrowed theory is that only theories
grounded in nursing should guide action
- Although one might borrow theory and apply it to the realm of nursing action it is
transformed into nursing theory because it addresses phenomena within the area of
nursing practice. They believe that borrowing requires returning and that the theory is
not in essence nursing if concepts are borrowed.
- Proponents of using borrowed theory feel that knowledge is not the private domain of
one discipline and the use of knowledge generated by an discipline is not borrowed but
shared. Shared theory does not lessen nursing but enhances it.
- In reality all nursing theories incorporate concepts and theories shared with other
disciplines to guide theory development, research, and practice. However, simply
adopting concepts or theories from other disciplines does not convert them into nursing
concepts or theories.

Nurses’ Metaparadigm
- Refers “globally to the subject matter of greatest interest to member of a discipline”
- The purpose or function of the metaparadigm is to summarize the intellectual and social
missions of the discipline and place boundaries on the subject matter of the discipline
 - A number or nursing scholars identified a growing consensus that the dominant
phenomena within the science of nursing revolved around the concepts of person,
health, environment, and nursing.
- Person refers to a being composed of physical, intellectual, biochemical, and
psychosocial needs. Most nursing models organize data about the individual person as a
focus of the nurses attention, although some nursing theorist have expanded to include
family and community.
- Health is the ability to function independently, successful adaptation to life's stressors,
unity of mind body and soul
- Environment refers to the external elements that after the person; internal and external
conditions that influence the organism; significant others with whom the person interacts.
- Nursing is a science, an art, and a practice discipline and involves caring furthermore,
nursing practice facilitates, supports, and assists individuals, families, communities, and
societies to enhance maintain and recover health and to reduce and ameliorate the
effects of illness.

Caring as a Central Construct in the Discipline of Nursing

- It has been proposed that nursing be defined as the study of caring in the human health
experience
- Thorne and Colleagues cited three major areas of contention in the debate about caring
in nursing.
1) The first is the diverse views on the nature of caring
2) A major issues in the caring debate concerns the use of caring terminology to
conceptualize and specialized role.
3) The implications for the future development of the profession that nursing should
espouse caring as its unique mandate.
- Furthermore, caring is not uniquely a nursing phenomena, and caring behaviours may
not be generalizable across national and cultural boundaries.