Nursing Theoretical Works represents

The most comprehensive ideas

And systematic knowledge about nursing;
Therefore theory is vital to both
The discipline and the profession.

Discipline is specific to academia and a branch of education, a

department of learning or field of knowledge.
Profession refers to specialized field of practice, which is founded
upon the theoretical structure of the science or knowledge of that
discipline and the accompanying practice abilities.

Significance of theory for nursing as a discipline

1. University baccalaureate programs proliferated, masters

programs in nursing were developed, and the curricula began to be
standardized through the accreditation process.
2. Attention to the importance of nursing conceptualizations for
the research process and the role of a conceptual framework in the
purpose and design of research production of science and nursing
theoretical works also began to publish.
3. Works began to be recognize for their theoretical nature, such
as Henderson, Nightingale and etc.
4. KEYNOTE ADDRESS, New nursing doctoral programs were
beginning to open and they reopened the discussion of the nature
of nursing science. This becomes the first classic reference for
nursing as discipline and for distinguishing between the discipline
and profession.
5. Fawcett’s conceptualization of metaparadigm of nursing and
unifying conceptual-theoretical structure of knowledge recognize
works of major nursing theorist as conceptual framework and
paradigms of nursing.
6. MAJOR SIGNIFICANCE IS;THE DISCIPLINE IS DEPENDENT
UPON THEORY
6.1. Theoretical works have taken nursing to a higher level.
6.2. The emphasis has shifted from a focus on knowledge about
how nurses function, which concentrated on the nursing process,
to focus on what nurses know and how they use knowledge to
guide their thinking and decision making while concentrating on
the patient.

Significance of theory for nursing as a profession

Clearly, nursing is recognize as a profession today.

1. Bixler and Bixler published a set of criteria tailored to nursing
in the American Journal of Nursing in 1959. They stated that a
profession:
a. Utilizes in its practice a well-defined and well-organized body
of specialized knowledge that is on the intellectual level of the
higher learning.
b. Constantly enlarges the body of knowledge it uses and
improves its techniques of education and service by the use of the
scientific method.
c. Entrusts the education of its practitioners to institution of
higher education.
d. Applies its body of knowledge in practical services that are
vital to human and social welfare.
e. Functions autonomously in the formulation of professional
policy and in the control of professional activity thereby.
f. Attracts individuals of intellectual and personal qualities who
exalt service above personal gain and who recognizes their chosen
occupation as a life work.
g. Strives to compensate its practitioners by providing freedom
of action, opportunity for continuous professional growth and
economic security.
These criteria have historical value because they provide an
understanding of the developmental path the nursing followed.
2. Nursing theory is a useful tool for reasoning, critical thinking,
and decision making in nursing practice.
3. Nursing theoretical works provide a perspective of the
patient.
4. Nursing theory provides more direction for nursing practice.
5. The conceptual models of nursing are comprehensive and the
reader to the specifics of the practice.
6. Middle range theories contain the specifics of nursing
practice.

NURSING THEORETICAL WORKS;

Philosophies
· Florence Nightingale: Patient-Environment Interaction
· Ernestine Wiedenbach: Art of Nursing
· Virginia Henderson: The 14 Basic Human Needs
· Faye Glenn Abdella: The 21 Nursing Problems
· Lydia E. Hall: Care, Core and Cure Theory
Conceptual Models and Grand Theories
· Dorothea E. Orem: Self-care Deficit Theory
· Myra Estrin Levine: Wrote the “Introduction to Clinical
Nursing”
· Martha Rogers: Key Concepts of Science of Unitary Human
Being, and Principles of Hemodynamic
· Dorothy E. Johnson: Behavioral System Model
· Sister Callista Roy: Adaptation Model
· Betty Neuman: Neumans System Model
· Imogene King: Goal Attainment Theory
Theories and Middle-Range Nursing Theories
· Hildegard E. Peplau: Interpersonal Relation in Nursing
· Ida Jean Orlando: Dynamic-Nurse Relationship
· Joyce Travelbee: Human to Human Relationship and ETC

INTRODUCTION

Nursing theory is the term given to the body of knowledge that is

used to support nursing practice.

Nursing theory is a framework designed to organize knowledge and

explain phenomena in nursing, at a more concrete and specific
level.

A nursing theory is a set of concepts, definitions, relationships, and

assumptions or propositions derived from nursing models or from
other disciplines and project a purposive, systematic view of
phenomena by designing specific inter-relationships among
concepts for the purposes of describing, explaining, predicting, and
/or prescribing.

Each discipline has a unique focus for knowledge development that

directs its inquiry and distinguishes it from other fields of study.
(Smith & Liehr, 2008).

Theory-guided, evidence-based practice is the hallmark of any

professional discipline.
Nursing is a professional discipline (Donaldson & Crowley, 1978).

Almost 90% of all Nursing theories are generated in the last 20

years.

Nursing models are conceptual models, constructed of theories

and concepts

A paradigm is a model that explains the linkages of science,

philosophy, and theory accepted and applied by the discipline.

METAPARADIGMS IN NURSING

Person

Recipient of care, including physical, spiritual, psychological, and

sociocultural components.
Individual, family, or community
Environment

All internal and external conditions, circumstances, and influences

affecting the person
Health

Degree of wellness or illness experienced by the person

Nursing
Actions, characteristics and attributes of person giving care.
COMPONENTS OF A THEORY

DEFINITIONS

Theory

a set of related statements that describes or explains phenomena in

a systematic way.

the doctrine or the principles underlying an art as distinguished

from the practice of that particular art.

a formulated hypothesis or, loosely speaking, any hypothesis or

opinion not based upon actual knowledge.

a provisional statement or set of explanatory propositions that

purports to account for or characterize some phenomenon.

Concept

a mental idea of a phenomenon

Concepts are the building blocks (the primary elements) of a

theory.
Construct

a phenomena that cannot be observed and must be inferred

Constructs are concepts developed or adopted for use in a

particular theory. The key concepts of a given theory are its
constructs.

Proposition

a statement of relationship between concepts

Conceptual model

made up of concepts and propositions

They epresent ways of thinking about a problem or ways of

representing how complex things work the way that they do.

Different Frameworks will emphasize different variables and

outcomes and their interrelatedness.( Bordage, 2009)

Models may draw on a number of theories to help understand a

particular problem in a certain setting or context. They are not
always as specified as theory.

Variables
Variables are the operational forms of constructs. They define the
way a construct is to be measured in a specific situation.

Match variables to constructs when identifying what needs to be

assessed during evaluation of a theory-driven program.

Middle range theory

a testable theory that contains a limited number of variables, and

is limited in scope as well, yet is of sufficient generality to be useful
with a variety of clinical research questions.

NURSING PHILOSOPHIES
Theory

Key Points

Florence Nightingale’s Legacy of caring

Focuses on nursing and the patient environment relationship.

Ernestine Wiedenbach: The helping art of clinical nursing

Helping process meets needs through the art of individualizing

care.
Nurses should identify patients ‘need-for –help’ by:
Observation
Understanding client behaviour
Identifying cause of discomfort
Determining if clients can resolve problems or have a need for help
Virginia Henderson’s Definition of Nursing

Patients require help towards achieving independence.

Derived a definition of nursing
Identified 14 basic human needs on which nursing care is based.
Faye G.Abedellah’s Typology of twenty one Nursing problems

Patient’s problems determine nursing care

Lydia E. Hall :Care, Cure, Core model

Nursing care is person directed towards self love.

Jean Watson’s Philosophy and Science of caring

Caring is a universal, social phenomenon that is only effective

when practiced interpersonally considering humanistic aspects
and caring.
Caring is central to the essence of nursing.
Patricia Benner’s Novice to Expert

Described systematically five stages of skill acquisition in nursing

practice – novice, advanced beginner, competent, proficient and
expert.
CONCEPTUAL MODELS AND GRAND THEORIES
Dorothea E. Orem’s Self care deficit theory in nursing

Self–care maintains wholeness.

Three Theories:
Theory of Self-Care
Theory of Self-Care Deficit
Theory of Nursing Systems
Nursing Care:
Wholly compensatory (doing for the patient)
Partly compensatory (helping the patient do for himself or herself)
Supportive- educative (Helping patient to learn self care and
emphasizing on the importance of nurses’ role
Myra Estrin Levine’s: The conservation model

Proposed that the nurses use the principles of conservation of:

Client Energy
Personal integrity
Structural integrity
Social integrity
A conceptual model with three nursing theories –
Conservation
Redundancy
Therapeutic intention
Martha E.Roger’s: Science of unitary human beings

Person and environment are energy fields that evolve

negentropically
Nursing is a basic scientific discipline
Nursing is using knowledge for human betterment.
The unique focus of nursing is on the unitary or irreducible human
being and the environment (both are energy fields) rather than
health and illness
Dorothy E.Johnson’s Behavioural system model

Individuals maintain stability and balance through adjustments

and adaptation to the forces that impinges them.
Individual as a behavioural system is composed of seven
subsystems: the subsystems of attachment, or the affiliative,
dependency, achievement, aggressive, ingestive-eliminative and
sexual.
Disturbances in these causes nursing problems.
Sister Callista: Roy‘s Adaptation model

Stimuli disrupt an adaptive system

The individual is a biopsychosocial adaptive system within an
environment.
The individual and the environment provide three classes of
stimuli-the focal, residual and contextual.
Through two adaptive mechanisms, regulator and cognator, an
individual demonstrates adaptive responses or ineffective
responses requiring nursing interventions
Betty Neuman’s : Health care systems model

Neuman’s model includes intrapersonal, interpersonal and

extrapersonal stressors.
Nursing is concerned with the whole person.
Nursing actions (Primary, Secondary, and Tertiary levels of
prevention) focuses on the variables affecting the client’s response
to stressors.
Imogene King’s Goal attainment theory

Transactions provide a frame of reference toward goal setting.

Major concepts (interaction, perception, communication,
transaction, role, stress, growth and development)
Perceptions, Judgments and actions of the patient and the nurse
lead to reaction, interaction, and transaction (process of nursing).
Nancy Roper, WW.Logan and A.J.Tierney A model for nursing
based on a model of living

Individuality in living.
A conceptual model of nursing from which theory of goal
attainment is derived.
Living is an amalgam of activities of living (ALs).
Most individuals experience significant life events which can affect
ALs causing actual and potential problems.
This affects dependence – independence continuum which is bi-
directional.
Nursing helps to maintain the individuality of person by preventing
potential problems, solving actual problems and helping to cope.
Hildegard E. Peplau: Psychodynamic Nursing Theory

Interpersonal process is maturing force for personality.

Stressed the importance of nurses’ ability to understand own
behaviour to help others identify perceived difficulties.
The four phases of nurse-patient relationships are:
1. Orientation
2. Identification
3. Exploitations
4. Resolution
The six nursing roles are:
1. Stranger
2. Resource person
3. Teacher
4. Leader
5. Surrogate
6. Counselor
Interpersonal process alleviates distress.
Ida Jean Orlando’s Nursing Process Theory

Nurses must stay connected to patients and assure that patients get
what they need, focused on patient’s verbal and non verbal
expressions of need and nurse’s reactions to patient’s behaviour to
alleviate distress.
Elements of nursing situation:
Patient
Nurse reactions
Nursing actions
Joyce Travelbee’s Human To Human Relationship Model

Therapeutic human relationships.

Nursing is accomplished through human to human relationships
that began with the original encounter and then progressed
through stages of emerging identities.
Kathryn E. Barnard’s Parent Child Interaction Model

Growth and development of children and mother–infant

relationships
Individual characteristics of each member influence the parent–
infant system and adaptive behaviour modifies those
characteristics to meet the needs of the system.
Ramona T.Mercer’s :Maternal Role Attainment

A complex theory to explain the factors impacting the development

of maternal role over time.
Katharine Kolcaba’s Theory of comfort

Comfort is desirable holistic outcome of care.

Health care needs are needs (physical, psycho spiritual, social and
environmental needs) for comfort, arising from stressful health
care situations that cannot be met by recipients’ traditional
support system.
Comfort measures include those nursing interventions designed to
address the specific comfort needs.
Madeleine Leininger’s Transcultural nursing, culture-care theory

Caring is universal and varies transculturally.

Major concepts include care, caring, culture, cultural values and
cultural variations
Caring serves to ameliorate or improve human conditions and life
base.
Care is the essence and the dominant, distinctive and unifying
feature of nursing
Rosemarie Rizzo Parse’s :Theory of human becoming

Indivisible beings and environment co-create health.

A theory of nursing derived from Roger’s conceptual model.
Clients are open, mutual and in constant interaction with
environment.
The nurse assists the client in interaction with the environment
and co creating health
Nola J.Pender’s :The Health promotion; model

Promoting optimum health supersedes disease prevention.

Identifies cognitive, perceptual factors in clients which are
modified by demographical and biological characteristics,
interpersonal influences, situational and behavioural factors that
help predict in health promoting behaviour
CONCLUSION

The conceptual and theoretical nursing models help to provide

knowledge to improve practice, guide research and curriculum and
identify the goals of nursing practice.

Nursing knowledge is the inclusive total of the philosophies,

theories, research, and practice wisdom of the discipline.As a
professional discipline this knowledge is important for guiding
practice.(Smith & Liehr, 2008).

REFERENCES

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of

nursing. Nursing Outlook, 26, 113–120.

Smith, M. J., & Liehr, P. R. (2008). Middle range theory for

nursing. New York: Springer Publishing.

George B. Julia , Nursing Theories- The base for professional

Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for
Nursing Philadelphia. Lippincott Williams& wilkins.

Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development &

Progress 3rd ed. Philadelphia, Lippincott.

Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care

4th ed. Philadelphia, Lippincott.

Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –

Concepts Process & Practice 3rd ed. London Mosby Year Book.

Tomey AM, Alligood. MR. Nursing theorists and their work. (5th
ed.). Mosby, Philadelphia, 2002

Alligood M.R, Tomey. A.M. Nursing theory utilization and

application. 2nd Ed. Mosby, Philadelphia, 2002.
The Parts of a Nursing Model

All nursing theories or models have several essential parts. In order to be

considered a valid nursing theory, a model must include a method of
assessment to determine a patient's individual needs, and a method of
implementing and measuring appropriate patient care. Most nursing models
can be used to produce a care plan that will document a patient's treatment by
all the healthcare professionals and workers who come into contact with him
or her. The care plan should be flexible, so that it can be changed and
evaluated daily as the patient's needs and abilities change.

The care plans themselves will be shaped by the theories behind the nursing
model. Care plans fall roughly into five categories: metatheories, grand
theories, mid-range theories, min-theories and micro theories, in order from
the range of factors considered.

A Brief History of Nursing Theories

Originally, the role of the nurse was to carry out the orders of a physician.
Nursing theories that arose from this model of patient care were essentially
biomedical and focused on treating diseases rather than patients. These
theories allowed little variation in care based on a patient's individual needs
and abilities. The biomedical theories of nursing assume that all patients with
the same illness have the same problems and require the same care. These
theories do not take into account differences in patient knowledge and
abilities due to socioeconomic, psychological or cultural differences. 

Social models of nursing, by contrast, consider the patient from varying

degrees of holistic viewpoints. They take into account differences among
patients due to culture, economic and social status and other factors. One of
the first nursing theorists, though her work is only considered a body of
'nursing theory" in retrospect, was Florence Nightingale, who published her
thoughts on nursing during the Crimean War in, Notes on Nursing: What it Is
and What it Is Not, in 1859.

Nightingale's beliefs about nursing have influenced the shape of the profession
for well over 150 years. She was the first to view the nurse as more than a
servant carrying out the orders of a physician, but rather as a caregiver in her
own right, who could manipulate the environment and situation to influence
the patient's well-being. Since then, there have been many models of nursing
proposed and accepted by various communities and types of nursing. The
most familiar names in nursing theory include Madeleine Leininger, who
brought concerns of recognizing cultural needs into nursing care, and
Hildegard Peplau, who introduced the idea of nursing roles and the nurse-
client relationship as major influences in quality of nursing care.

Using Nursing Theory in the Real World

As a student nurse, you will be expected to learn about and be able to describe
various bodies of work and knowledge about nursing and nursing theories.
Some programs may require you to develop and articulate your own nursing
theory to help you formulate nursing care and nursing plans, and differentiate
yourself as a nursing professional. In the real world, however, you will often
find that different fields of nursing subscribe to specific theories of nursing. 

While there is a great deal of semantic debate about whether the abundance of
"nursing theory" is beneficial to the profession or splits it needlessly, there is
no doubt that the study of nursing theory can help you understand nursing as
a profession from multiple viewpoints, and can afford you the capability to
begin to formulate your own concept of what it means to be a nurse, and how
your actions fit into a full plan to best care for your patients

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2. History and philosophy of science

CHAPTER 2
History and philosophy of science
Sonya R. Hardin

“Why should nurses be interested in the history and philosophy of science? The history and philosophy of science
is important as a foundation for exploring whether scientific results are actually truth. As nurses our practice should
be based upon truth and we need the ability to interpret the results of science. Nursing science provides us with
knowledge to describe, explain and predict outcomes. The legitimacy of any profession is built on its ability to
generate and apply theory.”
(McCrae, 2011, p. 222)
Modern science was established over 400 years ago as an intellectual activity to formalize given phenomena of interest in an attempt
to describe, explain, predict, or control states of affairs in nature. Scientific activity has persisted because it has improved quality of
life and has satisfied human needs for creative work, a sense of order, and the desire to understand the unknown ( Bronowski,
1979; Gale, 1979; Piaget, 1970). The development of nursing science has evolved since the 1960s as a pursuit to be understood as a
scientific discipline. Being a scientific discipline means identifying nursing’s unique contribution to the care of patients, families,
and communities. It means that nurses can conduct clinical and basic nursing research to establish the scientific base for the care of
individuals across the life span. For example, research revealed gaps between the pain management needs of patients and the
information communicated by patients and clinicians during office visits. Although many older adults have painful but not readily
visible conditions (e.g., symptomatic osteoarthritis), little research has examined how the style or format of a health care
practitioner’s questions influence the quality and amount of diagnostic information obtained from older adults. A recent study
tested the theory that a certain type of question would elicit the most response. The theory was confirmed when findings supported
that the open-ended questions prompted patients to provide a larger amount of diagnostically useful pain information than did the
closed-ended questions (McDonald, Shea, Rose, & Fedo, 2009). While this study is one example of nursing science, advance practice
nurses should be familiar with the long history of the science of nursing.
Previous author: Sue Marquis Bishop.

Historical views of the nature of science

To formalize the science of nursing, basic questions must be considered, such as: What is science, knowledge, and truth? What
methods produce scientific knowledge? These are philosophical questions. The term epistemology is concerned with the theory of
knowledge in philosophical inquiry. The particular philosophical perspective selected to answer these questions will influence how
scientists perform scientific activities, how they interpret outcomes, and even what they regard as science and knowledge (Brown,
1977). Although philosophy has been documented as an activity for 3000 years, formal science is a relatively new human pursuit
(Brown, 1977; Foucault, 1973). Scientific activity has only recently become the object of investigation.
Two competing philosophical foundations of science, rationalism and empiricism, have evolved in the era of modern science
with several variations. Gale (1979) labeled these alternative epistemologies as centrally concerned with the power of reason and the
power of sensory experience. Gale noted similarity in the divergent views of science in the time of the classical Greeks. For example,
Aristotle believed that advances in biological science would develop through systematic observation of objects and events in the
natural world, whereas Pythagoras believed that knowledge of the natural world would develop from mathematical reasoning
(Brown, 1977; Gale, 1979).
Nursing science has been characterized by two branching philosophies of knowledge as the discipline developed. Various terms
are utilized to describe these two stances: empiricist and interpretive, mechanistic and holistic,
quantitative and qualitative, and deductive and inductive forms of science. Understanding the nature of these philosophical stances
facilitates appreciation for what each form contributes to nursing knowledge.

Rationalism
Rationalist epistemology (scope of knowledge) emphasizes the importance of a priori reasoning as the appropriate method for
advancing knowledge. A priori reasoning utilizes deductive logic by reasoning from the cause to an effect or from a generalization
to a particular instance. An example in nursing is to reason that a lack of social support (cause) will result in hospital readmission
(effect). This causal reasoning is a theory until disproven. The traditional approach proceeds by explaining hospitalization with a
systematic explanation (theory) of a given phenomenon (Gale, 1979). This conceptual system is analyzed by addressing the logical
structure of the theory and the logical reasoning involved in its development. Theoretical assertions derived by deductive reasoning
are then subjected to experimental testing to corroborate the theory. Reynolds (1971) labeled this approach the theory-then-research
strategy. If the research findings fail to correspond with the theoretical assertions, additional research is conducted or modifications
are made in the theory and further tests are devised; otherwise, the theory is discarded in favor of an alternative explanation ( Gale,
1979; Zetterberg, 1966). Popper (1962) argued that science would evolve more rapidly through the process of conjectures and
refutations by devising research in an attempt to refute new ideas. For example, his point is simple; you can never prove that all
individuals without social support have frequent rehospitalizations since there might be one individual that presents with no
rehospitalization. A single person with no social support that does not have a readmission disproves the theory that all individuals
with a lack of social support have hospital readmissions. From Popper’s perspective, “research consists of generating general
hypotheses and then attempting to refute them” (Lipton, 2005, p. 1263). So the hypothesis that a lack of social support results in
hospital readmission is the phenomena of interest to be refuted.
The rationalist view is most clearly evident in the work of Einstein, the theoretical physicist, who made extensive use of
mathematical equations in developing his theories. The theories Einstein constructed offered an imaginative framework, which has
directed research in numerous areas (Calder, 1979). As Reynolds (1971) noted, if someone believes that science is a process of
inventing descriptions of phenomena, the appropriate strategy for theory construction is the theory-then-research strategy. In
Reynolds’ view, “as the continuous interplay between theory construction (invention) and testing with empirical research
progresses, the theory becomes more precise and complete as a description of nature and, therefore, more useful for the goals of
science” (Reynolds, 1971, p. 145).

Empiricism
The empiricist view is based on the central idea that scientific knowledge can be derived only from sensory experience (i.e., seeing,
feeling, hearing facts). Francis Bacon (Gale, 1979) received credit for popularizing the basis for the empiricist approach to inquiry.
Bacon believed that scientific truth was discovered through generalizing observed facts in the natural world. This approach, called
the inductive method, is based on the idea that the collection of facts precedes attempts to formulate generalizations, or
as Reynolds (1971) called it, the research-then-theory strategy. One of the best examples to demonstrate this form of logic in
nursing has to do with formulating differential diagnoses. Formulating a differential diagnosis requires collecting the facts and then
devising a list of possible theories to explain the facts.
The strict empiricist view is reflected in the work of the behaviorist Skinner. In a 1950 paper, Skinner asserted that advances in
the science of psychology could be expected if scientists would focus on the collection of empirical data. He cautioned against
drawing premature inferences and proposed a moratorium on theory building until further facts were collected. Skinner’s (1950)
approach to theory construction was clearly inductive. His view of science and the popularity of behaviorism have been credited
with influencing psychology’s shift in emphasis from the building of theories to the gathering of facts between the 1950s and 1970s
(Snelbecker, 1974). The difficulty with the inductive mode of inquiry is that the world presents an infinite number of possible
observations, and, therefore, the scientist must bring ideas to his or her experiences to decide what to observe and what to exclude
(Steiner, 1977).
In summary, deductive inquiry uses the theory-then-research approach, and inductive inquiry uses the research-then-theory
approach. Both approaches are utilized in the field of nursing.

Early twentieth century views of science and theory

During the first half of this century, philosophersfocused on the analysis of theory structure, whereas scientists focused on empirical
research (Brown, 1977). There was minimal interest in the history of science, the nature of scientific discovery, or the similarities
between the philosophical view of science and the scientific methods (Brown, 1977). Positivism, a term first used by Comte, emerged
as the dominant view of modern science (Gale, 1979). Modern logical positivists believed that empirical research and logical
analysis (deductive and inductive) were two approaches that would produce scientific knowledge (Brown, 1977).
The logical empiricists offered a more lenient view of logical positivism and argued that theoretical propositions (proposition
affirms or denies something) must be tested through observation and experimentation (Brown, 1977). This perspective is rooted in
the idea that empirical facts exist independently of theories and offer the only basis for objectivity in science ( Brown, 1977). In this
view, objective truth exists independently of the researcher, and the task of science is to discover it, which is an inductive method
(Gale, 1979). This view of science is often presented in research method courses as: “The scientist first sets up an experiment;
observes what occurs …. reaches a preliminary hypothesis to describe the occurrence; runs further experiments to test the
hypothesis [and] finally corrects or modifies the hypothesis in light of the results” (Gale, 1979, p. 13).
The increasing use of computers, which permit the analysis of large data sets, may have contributed to the acceptance of the
positivist approach to modern science (Snelbecker, 1974). However, in the 1950s, the literature began to reflect an increasing
challenge to the positivist view, thereby ushering in a new view of science in the late twentieth century (Brown, 1977).

Emergent views of science and theory in the late twentieth century

In the latter years of the twentieth century, several authors presented analyses challenging the positivist position, thus offering the
basis for a new perspective of science (Brown, 1977; Foucault, 1973; Hanson, 1958; Kuhn, 1962; Toulmin, 1961). Foucault (1973)
published his analysis of the epistemology (knowledge) of human sciences from the seventeenth to the nineteenth century. His major
thesis stated that empirical knowledge was arranged in different patterns at a given time and in a given culture and that humans
where emerging as objects of study. In The Phenomenology of the Social World, Schutz (1967) argued that scientists seeking to
understand the social world could not cognitively know an external world that is independent of their own life experiences.
Phenomenology, set forth by Edmund Husserl (1859 to 1938) proposed that the objectivism of science could not provide an
adequate apprehension of the world (Husserl 1931, 1970). A phenomenological approach reduces observations or text to the
meanings of phenomena independent of their particular context. This approach focuses on the lived meaning of experiences.
In 1977, Brown argued an intellectual revolution in philosophy that emphasized the history of science was replacing formal logic
as the major analytical tool in the philosophy of science. One of the major perspectives in the new philosophy emphasized science as
a process of continuing research rather than a product focused on findings. In this emergent epistemology, emphasis shifted to
understanding scientific discovery and process as theories change over time.
Empiricists view phenomena objectively, collect data, and analyze it to inductively proposed theory (Brown, 1977). This position
is based upon objective truth existing in the world, waiting to be discovered. Brown (1977) set forth a new epistemology challenging
the empiricist view proposing that theories play a significant role in determining what the scientist observes and how it is
interpreted. The following story illustrates Brown’s premise that observations are concept laden; that is, an observation is influenced
by values and ideas in the mind of the observer:

“An elderly patient has been in a trauma and appears to be crying. The nurse on admission observes that the patient
has marks on her body and believes that she has been abused; the orthopedist has viewed an x-ray and believes
that the crying patient is in pain due to a fractured femur that will not require surgery only a closed reduction; the
chaplain observes the patient crying and believes the patient needs spiritual support. Each observation is concept
laden.”

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