INTRODUCTION TO NURSING THEORY,

HISTORY & PHILOSOPHY OF NURSING

AS A SCIENCE, AND STRUCTURE OF
NURSING KNOWLEDGE
 HISTORY OF NURSING
THEORY
- Dated way back when Florence Nightingale began to assume
the great significance of providing a clean and healthy
environment to achieve recovery of patients and continues up
to present

- She also envisioned nurses as a body of educated women who

organized service and caring for wounded in wartime (Crimean
War) and establishment of Nursing school in London (St.
Thomas Hospital) pioneering activities in nursing practice and
education.

- Nursing evolved through different eras. Profession did not start

as what it seemed to be. It started as a vocational course
offering only skills during their time.
 NURSING AS A SCIENCE

APPRENTICESHIP MODEL

- Nursing practice was based on principles and traditions that

were handed down through practice seen by Florence during her time

- Other references note that this is a practice era dated before

the curriculum era where to be a nurse can have a diploma for only 2
years under vocational.
HISTORICAL ERAS OF NURSING’S SEARCH FOR
SPECIALIZED KNOWLEDGE
 SIGNIFICANCE OF NURSING
THEORY
At the beginning of the 20th century, nursing was not recognized as a n
academic discipline or a profession. The accomplishments of the past
century led to the recognition of nursing in both areas. The terms
discipline and profession are interrelated and some may even use them
interchangeably; however, they are not the same.

It is important to note their differences and specific meaning.

 DISCIPLINE PROFESSION
- Specific to academia and refers to a - Refers to a specialized field of
branch of education, a department of practice founded on the theoretical
learning or a domain of knowledge. structure of the science or knowledge
of the discipline and accompanying
practice abilities.
- Branch of education; theoretical - Knowledge of that discipline and
works leading to higher level of accompanying practice abilities
education and practice.
- Functional focus (WHAT NURSES - Recognition and respect for their
DO) – knowledge focus or what scholarly disciplined contribution to
nurses know and how they use them the health of society.
for thinking and decision making while
taking care of a patient
- Knowledge of persons, health and
environment forms the basis for
nursing as a discipline
- Kuhn – stated, “the study of paradigms is
what mainly prepares the student for
membership in a particular scientific
community with which he/she will practice.
 DEVELOPMENT OF THE
PROFESSIONAL STATUS OF
NURSING
1. Utilizes in its practice a well-defined and well organized body of
specialized knowledge.

1. Constantly enlarges the knowledge it uses and improves its

techniques of education and service through scientific method.

1. Entrusts the education of its practitioners to universities/colleges.

1. Applies knowledge in practical services important to community

welfare.
 DEVELOPMENT OF THE
PROFESSIONAL STATUS OF
NURSING
5. Functions autonomously in developing professional policy.

6. Attracts individuals with intellectual and personal qualities of

intensifying service.

7. Strives to compensate nurses by providing freedom of action,

opportunity for continuous professional growth and economic security.
 HISTORICAL VIEWS OF THE
NATURE OF SCIENCE
Epistemology (episteme – knowledge; logos – study of)
- meaning knowledge, understanding
- concerned with the theory of knowledge in philosophical
inquiry or how knowledge came to be.
- what is real is also considered knowledge
- branch of philosophy concerned with the nature & scope of
knowledge
- it is the study of knowledge & justifies beliefs.
- it questions what knowledge is & how it can be acquired
- this aims to discover the meaning of knowledge & called it the
true beginning of philosophy.
 PHILOSOPHICAL FOUNDATIONS OF
SCIENCE
RATIONALISM
• Priori reasoning – utilizes deductive; cause to effect or general to
particular
• Use of rational senses in ensuring the truthfulness of a phenomenon
• Understand the whole first before you can appreciate the lesser parts
• Regards reasons as the chief source & test of knowledge.
• Any view appealing to reason as a source of knowledge or justification
(theory-then-research approach)
• Criterion of truth is not sensory but intellectual & deductive (general to
specific)
• Ex: lack of social support will lead to hospital readmission, “not all”
 PHILOSOPHICAL FOUNDATIONS OF
SCIENCE
EMPIRICISM
• Way of looking at reality using the five senses.
• An object is real in so fat as seen, felt, smelled, tasted, heard
• A theory which states that knowledge comes only primarily from
sensory experience
• Fundamental part of scientific method (experimentations)
• Knowledge is based on experience; Ex. Physical assessment
• Gather info more and observe facts before finally saying a theory exists
• Reynolds, “research-then-theory strategy”
• It is inductive (specific to general)
• Ex: collect data -> diagnose
 History of Nursing Science
Early 20th century views
• Positivism emerged as the dominant view of modern science.
• Modern logical positivists believed that empirical research and logical
analysis were two approaches that would produce scientific knowledge.
- Philosopher focused on the analysis of theory structure
- Scientists focused on empirical research
- Increasing use of computers which permits the analysis of large
data
 History of Nursing Science
Emergent of science and theory in the late 20th century
• 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.
- Several authors presented analysis challenging the positivist
position, thus offering the basis for a new perspective in science
- Empiricists view phenomena objectively, collect data and
analyze to inductively propose theory.
 History of Nursing Science
Interdependence of theory and research
• In constructing theory, theorists must be knowledgeable about available
empirical findings and able to take these into account, because theory
is concerned with organizing and formalizing available knowledge of a
given phenomenon.
• The theory is subject to revision or maybe abandoned in favor of an
alternative explanation for new information.
 History of Nursing Science
Science as a social enterprise
• “Human beings do science” – Gale. It might be anticipated that social,
economic or political factors may influence scientific enterprise. It
depends on the funds, popularity of certain ideologies.
• Science progresses by the diversity of dialogue within the discipline of
nursing. The creation of a merged paradigm form many paradigms is
debated in relationship to the advancement of nursing.
 Theory of Development Process
Theory
• Usually means “mere guess” or unproved hypothesis
• Literally means “a vision” or “a beholding scene:
• Greek word “theoria”
• Scientifically, theory implies that something has been proven and is
generally accepted as being true. An idea or set of ideas that is
intended to explain facts or events.
• An idea that is suggested or presented as possibly true but that is not
known or proven to be true.
 Theory of Development Process
Theory
• A set of statements that tentatively describe, explain, or predict
relationships among concepts that have been systematically selected &
organized as an abstract representation of some phenomenon (Powers
& Knapp)
• An internally consistent group of relation statements (concepts,
definitions, and propositions) that present a systematic view about a
phenomenon & which is useful for description, explanation, prediction &
control (Bodie & Chitty).
• We apply theory to describe, explain, predict, or prescribe nursing
practice.
 Theory of Development Process
Theory
• Example: Theory of Evolution
 Categories of Theory
Components
Concepts
• Are words or phrases that are used to represent the
phenomenon observed or experienced
• Are the building blocks of theories, “ideas”
• Describe and classify the phenomena
 Categories of Theory
Components
Type Meaning Example
Abstract Independent of a certain time and place CHS

Concrete More specific time or place Nursing, Pharmacy

Discrete They may or may not belong to a particular category or Patients, nurses,
class or phenomena environment
Continuous - Concepts – classifications of dimensions or gradations Pain, health – illness
of a phenomenon across a continuum continuum
- Degrees or levels in a given continuum
Theoretical Establish meaning Dictionary meaning
Definitions
Operational How these concepts are used or will be used within the Provide measurement
Definitions context of the phenomenon
 10 Phases of Concept Building
Process
1. Write a meaningful practice story.
2. Name the central phenomenon in the practice story.
3. Identify a theoretical lens for viewing the phenomenon.
4. Link the phenomenon to existing literature,
5. Gather a story from someone who has lived the phenomenon.
6. Reconstruct the shared story and create a mini-saga that captures its
message
7. Identify the core qualities of the phenomenon
8. Use the core qualities to create a phenomenon
9. Create a model of the phenomenon
10. Write a mini synthesis that integrates the phenomenon with a
population to suggest research direction
1. Relational statements
- statements in a theory may state definitions or relations among
concepts

2. Theoretical statements
- relate concepts to one another; permit analysis

3. Operational statements
- relate concepts to measurements
 Linkages and Ordering
Linkages of theoretical statements Provide rationale of why theoretical
statements are linked; add
plausibility

Linkages of operational statements Provide rationale for how

measurement variables are linked;
permit testability

Organization of concepts and Eliminates overlap (tautology)

definitions into primitive and derived
terms

Organization of statements and Eliminates inconsistency

linkages into premises and derived
hypotheses and equations
 Scientific Law vs Theory
SCIENTIFIC LAW THEORY
• A statement of fact that aims to explain, in • More complex & dynamic; maybe replaced
brief and simple terms, an action or set of • Explains an entire group
actions • Can be changed or improved without
• Generally accepted to be true and universal changing the overall truth
and can of occasionally be expressed in • Developed from the scientific method
terms of a single mathematical equation • ACCEPTED AS TRUE & PROVEN
• SIMPLE, TRUE, UNIVERSAL, & ABSOLUTE
• Governs a single action, foundations for all
science
• Statement based on repeated experimental
observations that describes some aspects of
the universe
• Always applies under the same conditions,
and implies that there is a causal relationship
involving its elements
Hypothesis
• An educated guess based upon observation
• Can be supported or proven false by experimentation or continued
observation
• An idea or theory that is not proven but leads to further study or
discussion
• An assumption made for the sake of argument
• HAS NOT BEEN PROVEN
• Ex. Watching excessive amounts of TV reduces a person’s ability to
concentrate; smoking leads to lung cancer
Contemporary Issues in Nursing Theory
Development
• Theoretical Boundaries and Levels to Advance Nursing Science
- proposed framework now used without reference to the author for
the development of nursing science

• Nursing Theory, Practice, and Research

- theory-testing research may lead one nursing theory to fall aside
as a new theory is developed that explains nursing phenomena more
adequately; must continue to advance the discipline.
End