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INTRODUCTION TO NURSING

THEORY :ITS HISTORY AND


SIGNIFICANCE
Prof. Maria Susan Z. Maglaqui
HISTORICAL eRAS OF NURSING SEARCH FOR
SPECIALIZED KNOWLEDGE
• Curriculum era (1900-1940) -
• Major Question :What curriculum content shouls a student
nurses study to be nurses?
• Emphasis Courses included in nursing Program
• Outcomes :Standardized Curricula for Diploma Program
• Emerging Goal:Develop specialized knowledge and higher
Education
HISTORICAL eRAS OF NURSING SEARCH FOR
SPECIALIZED KNOWLEDGE
• Research Era :(1950-1970)
• Major Questions :What is the focus to NUrsing Research

• Empasis:Role of NUrses and What to research

• Outcomes:Problem Studies and Studies of Nurses

• Emerging goals :Isolated Studies do not yield unified knowledge


HISTORICAL eRAS OF NURSING SEARCH FOR
SPECIALIZED KNOWLEDGE

• Graduate Education (1950-1970's


• Major Questions :What knowledge is needed for the practice of
nursing ?
• Emphasis:Carving out in advance role and basis for nursing practice
• Outcomes:NMurses have important role in Health care
• Emerging Goals:Focus graduate education on knowledge
development
HISTORICAL ERAS OF NURSING SEARCH FOR
SPECIALIZED KNOWLEDGE

• Theory Era (1980-1990's)


• Major Questions :How do these framework guide this research and
practice?
• Emphasis:There are many ways to think about nursing .
• Outcomes:NUrsing theoretical work shift the focus to the patient
• Emergein Goals:Theories guide nursing research and practice.
HISTORICAL eRAS OF NURSING SEARCH FOR
SPECIALIZED KNOWLEDGE
• Theory utilization Era :21th Century
• Major Questions :What new theories are needed to produce evidence
for qyuazlity care ?
• Emphasis:NUrsing theory Guide Research ,practice ,education and
administration
• Outcomes:MIddle Range theory maybe from quantitaive and
Qualitative approaches
• Emerging Goals:Nursing framework produce knowledge evidence for
quality care.
Significance of Nursing theory
• At the beginning of the 20th century nursing was not recognized as an
academic discipline or a profession but the accomplishments of the
past century led to recognition of nursing .
• Discipline - is a specific to academiaand refers to branch of education
, a department of learning or a domain of knowledge .
• Profession refers to a specialized field of practice founded on a
theoretical structure of the science or knowledge of that discipline
and accompaniying practice abilities.
 Significance for the discipline
Last half of the 2oth century realized the goal of nursing practice was realized
university Baccalaureate program proliferated
Masters of NUrsing program were developed
Standardized curriculum was realized through Accreditation
NUrsing leaders offered their perspectives on the development of nursing science
Addressed significant disciplinary questions about wheter nursing is basic or applied science
Nursing doctoral programs open to generate nursing practice
1970's Journal of Nursing Research had been published in 1977
Batey (1977 )called attention of nursing conceptual frameworkin the Research nursing design
for the production of science
Facett presented her double helix metaphor now a classic publication clarifiying the
interdependent relationshipof theory and research.
NUrsing scholars like Hendewrson ,NIghtingale,Orlando,Peplau,& Weindenbach were for
theoretical nature of their earlier writings.
Orlando's Research theory )(1961-1972)an easrly nationaly funded research project that was
deisng to study nursing practice./
Significance for the Discipline
• 1978 Theorist were brought together at the Nursing EducatorNUrsing theory Conference in Neew York city .They
discussed nature of nursing science and and the nature of knowledge needed for the discipline and the pro fession.
• Donaldson and Crowley (1977) presented the keynote addressed at the Western Commission of Higher education in
nUrsing Conference they discussed the nature of nursing science and the nature of knowledge as for the discipline and
the profession.
• Current development of Doctor of Nursing Practice (DNP)programs not to be confused with NUrsing Research
Philosophy Doctorates (Phd) is apropos to their point.
• NUrsing conceptual frame work began to be used to organize curricula in nursing programs and were recognized as
models that address the values and concepts of nursing
• The creative conceptualizationof nursing metaparadigm (person ,environment ,health & nursing )and a structure of
knowledge clarified the related nature of collected works of major nursing theorists as a conceptual frameworks and
paradigms of nUrsing (Fawcett,1984)
• Each nursing conceptual model was classified on the basis of set of analysisi and criteria (Fawcett 1984,199)
• NUrsing process was used & is useful in practice but the primary focus is the patient or human being .
• The study of Paradigms is what maily prepares the student membershipin the scientific community with which he will later
practice.
• Masters and Doctor of Nursing Practice (DNP) students apply and test theoretical knowledge in NUrsing practice.
• Doctoral (PHD)students studying to become nurse scientists mdevelop nursing theory ,test theory ,and contrinute nursing
science in theory based & generating research nstudies (Grace et al 016)
Significance for the Profession
• Theory is essential for the existence of nursing as an academic disicpline & is Cvital to
practice of professional nursing (McCrae 2012)
• BIXLER IN 1959 publisehd a set of criteria for a profession tailored to nursing in the
American Journal of Nursing
• These criteria have historical Value for enhancing our understanding on the
developmental path that nurse leaders followed .
• Ex. Knowledeg based that is well defined,organized and specific to the discipline was
formalized durignt he last half of of the oth century.
• Theories and Research are vitasl to the discipline and the profession
• The last decade of the 20th century in anticipation of the new millenium ,ideas were
targeted toward morving nursing forward Fitpatrick (1983)presented a historical
chronicle of the 20th century achievements that has led to the professional status in
nursing
• The continued recognition of nursing theory
Criteria for the Development of the Professional Status of Nursing

1. Utilizes in its Practice a well defined and well organized body of specialized knowledge
that is on the intellectual level of the higher learning
2. constantly enlarges the body of knowledge its uses and imporve its techniquesof
education & service to the used of scientifc education and service thro ugh the nuse of
scientific method .
3. Entrust the educaiton of its practitioners to institutions of higher education
4. applies its body of knowledge in practical services vital to huamn and social welfare
5. functions autonomously in in the formulation of professionalpolicy and therby in the
control of professional activity.
6. attract imndividual with intellectual & personal qualities of exalting service above
personal gain who recognize their chosen occupation as a life work
7. strives to compensate its practitioners by providing freedomof action ,opportunity for
continuous professional growth & economic security.
History of nursing Science
• Philosophy in its broadest sense is wondering and being curious about the big or
fundamental questions that human s has grappled with throughout history .
• Questions about what is real (Ontology)
• What is knowable (epistimology
• Is this just (Ethics)
• Is there an art to caring (Aesthetics) re considered indespensible reflections in nursing
practice(Bruce,Rietze,Lim ,2014)
• Science is a method for describing ,explaining ,and predicting causes or outcomes of
interventions
• Scientific activity has helped to stablish the evidence we use to guide practice in the delivery
of nursing care.
• Bronowski ,1979,Piaget 1970 ,Gale 1979 Desired to understand the unknown and identify
the cause ,the effect ,and the significant difference that an intervention can make to increase
the longetivity of Life
• In 1960 Nursing leaders have strategized scientific discipline which mean identifying nursing
unique knowledge for the care of patients ,families and communities.
Historical view of the nature of Science

• Basic questions ,must be considered to formalize the science of


nursing Like what is science ,knowledge ?The answer to this questions
has influenced with philosophy.
• Two Competing Philosophical perspectives use in science
• Rationalism & Empirism .They are a type of Epistimology that is a
theory of knowledge for understanding how to uncover the answer
to a question .
• Gale (1979)labeled this alternatives epistimologies as centrally
concerned with the power of reason and the power of sensory
experience
Rationalism
• The Rationalist epistimology (scope of knowledge )emphasizes the importance of a priori
reasoning as the appropriate method for advancing knowledge .
• Priori Reasoning uses deductive logicby reasoning from the cause to an effect or from
generalization to a particular instance
• The rationalist view is most clearly evident in the work of Eisntein ,the theoretical
physicist who made extensive use of mathematical equations in developing his theories.
• He offered an imaginative framework which is directed researchin numerous
areas.(Calver 1979)
• 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
• Reynolds view as the continuous interplay between theory construction (Invention )and
testing with empirical research progresses,the theory becomes more precise and
completeas the description of nature and therfore more useful for the goals of science
Empiricism
• Empirist view is based on the scientific knowledge can be derived from sensory experience
• Ex. seeing feeling hearing facts .
• Francis Bacon received credit for popularizing the basis for tghe empiricist approach to
inquiry
• He believed that scientific truth was discovered through generalizing observed facts in the
natural world
• Inductive methodis based on the idea that the collectionof facts precedes attempts to
formulate generalizations or as Reynolds (1971)called it Research the theory strategy .
• Example is formulating differential diagnosis tha requires collecting the facts and then
devising a list of possible theories to exsplain the facts
• 1950 Skinner asserted that advances in science of psychology could be expected if scientists
would focus on the colleciton of empirical data
• His approach to research were 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
• The difficulty of inductive mode of inquiry
Early 20the Century views of Science & Theory
• Philisophers focused on the analysis of theory Structure
• Scientists focused on empirical Research(Brown 1977)
• Positivism Term used by Comte ,emerged as trhye dominat view of modern science (gale 1979)
• (Brown 1977)Two approaches that produce that produce Scientific Kbowledge
1. Empirical Research -Deductive
2. Logical analysis -Inductive
3. Logical Empiricm offers a more lenient view of Logical positivism and argued that theoretical
proposition (affirm or deny something) and must be tested through observation and
experimentation (Brown `1977)
4. This perspective is rooted in the idea that Empirical facts exist independently of theories and
offer the only basis for objectivity in Science
5. Increasing use of computer s permit the analysis of large data sets that contributed to the
acceptance of the positivist approach to modern science(Snelbecker 1974)
6. 1950 the Literature began to reflect an increasing challenge to the positivist view. therby ushering
new view in science
Emergent views of Science and theory in the
Later 2oth Century
• Foucult 197 published his analysis of the Epistimology (Knowledge )of
human sciences from the 17th to 19th centuries
• HIs major thesis stated that Emperical knowldge was arranged in
different patterns at a given time &in given culture & that human
were emerging as the objects of study
• In 1977 ,Brown argued for an intellectual revolution in philosophy
that emphasized the history of science was replacing formal logic as
the major analytical tool inj the philosophy of science
• one philosophy is that science was a process of continuouslybuilding
research rather than a product of findings.
Emergent views of Science and theory in the Later
2oth Century
• Empirists view phenomena objectively collect data and analyze it to
inductively propose theory (brown 1977)
• This is based upon objective truth existing in the world waiting to be
discovered
• Brown observation are concept laden an observation is influenced by the
values & ideas in the mind of observer:
• Eg. An elderly patient has been ninm trauma and appears to be crying
.The nurse observes upon admission marks on her body & believed has
been abused .The orthopedist have seen in the Xray that the pt has
fractured femur & the crying is due to pain .No surgery is required only
closed reduction.The chaplain observes the elderly is crying and needs
spiritual support.Its observation is concepts laden.
• Brown Maintain a presupposed theoretical framework influences
perceptions Theorie are not a single determining factor of the scientist
perception
Emergent views of Science and theory in the Later 2oth Century
• Brown Identified the following three views of the relationship between observation
& theories
1. Scientists are merely observers of occurence in the emperical world.Observable
data are objective truth waiting to be discovered.
2. Theories structure what the scientist percieves in the empirical world.
3. Presupposed theories & observable data in teract in the process of scientific
investigation(Brown 1977)
4. The following disitnct Minitheories have directed Research effort s in this Area
1. The data driven or botton up theory meanscognitve expectation are used to select
input process incoming information from the environment
1. .Conceptually driven or top down theory (Nortman 1976)asserts that incoming
data are percieved as unlabeled input and anal;yzed a raw data with increasing
level of complexity until all datas are classified.
2. Brown 1977 view of the transaction s between theory & empirical
observation:Theory determines what observationsare worth making & how they
are to be understand & observation provides challenges to accepted theoretical
structures .
Relationship between Research and Theory
• The relationship between research and theory can be discerned through the definitions of their
functions.
• The impetus for research is the search for theory or theory development.
• Research relies on theory and theory relies on research. This is a dialectic or transactional process
such that initial theory is based on research, then research is conducted to test the theory and the
theory is amended based on the research findings.
• These steps are repeated over and over such that theory is never considered absolute and believed
always able to be further refined through the research process.
• Modern Scientific Method has created a clear relationship between theory and research…
• Data gathering. This is the process of sifting through existing data and trying to find a pattern.
• Hypothesis (theory formation). The scientist then proposes a new relationship in Nature; the more
testable it is, the better.
• Experiment. At this point, scientists go back to research again, trying to devise experiments that
either confirm the theory or disprove it.
• Refinement. If the hypothesis fails, then the scientist may try to adjust the hypothesis, using
feedback gained through the Experiment phase.
• Scientific Method, there is a continuous feedback loop involving both Theory (hypothesis forming)
and Research (data gathering and experiment).
Relationship between theory and research – reciprocal
or interrelated
• A.Theory is developed from observations – arises from research
• B.Theory is a source of scientific inquiry-generates new research hypotheses
• C.Using theory in research proposals
a.Testing a theory-researcher analyzes a theory and develops hypotheses. The
hypotheses are then tested empirically.
b.Sometimes researchers will test 2 theories at the same time to compare them.
This is called theoretical triangulation.
c.Fitting a Problem to a Theory-All researchers try to add to the general body of
nursing knowledge.
One way to assure the generalizability and usefulness of findings is to fit the
project into a conceptual context. Generally nurse researchers will try to find an
appropriate theoretical model for their research.
Three Key Areas for Any given Theory
1. Agreement on the bounderies of the theory,that is the phenomenon it
addressesand the phenomena it excludes (criterion of coherence)
2. Agreement on the logic used in constructing the theory to further
understand ing from a similar perspective ((criterion of coherence)
3. Agreement that the theory fits the data collected and analyzed through
research (criterion of correspondence)
In social & Behavioral science such as nursing there is challenge to the
assumptions undelying accepted methods of experemental design
,measurement ,and statistical analysis that empahsize the the search for
universal law and the use of procedures for random assignment of subjects
across contexts
Misler (1979) argued that in studying human behavior researcher should
develop methods and procedures that are dependent on context for meaning
rather tha eliminate context by searching the laws that hold across context .
Interdependence of theory and Research
• Phenomenology describes how we experience the objects of the external world and
provides an explanation of hiow we construct objects of experience
• In Phenomenology the researcher post that all objects exist because people
percieve and construct them as such
• Ex. Attempt to understand a patient through listening to his or her lived
experience and appreciate each individual holistically .
• Consensus based upon the postpositivist and interpretative philosophies
(Ford ,-Giboe,Campbell & Berman1995)
Postpositivism focuses on discovering patternsthat may describe,explain &
predict phenomena.
It rejectsthe older ,traditional positivist views of an ultimate objective
knowledge that is observable only throughsenses Ford ,-Giboe (1995)
• Interpretative paradigm tends to promote understanding by
addresing the meaning s of the participants social interaction that
emphasize the situation context and multiple cognitive constructions
individual s create from everydxay experiences.
• Critical Paradigm for knowledge devlopment in nursing has been
describe as emergent ,postmodern paradigm.It focused on the
interaction between social ,political ,economic , gender and cultural
factors and the experiences of health and illness
• The Philosophy has been developed as
1. Caring -involves the wholeness of the patient's situation which
implies that nursing care requires interpretation ,understanding and
hermeneutic experience
-It involves knowledge ,skills,patient trust and the ability to manage
all elements simultaneously in the context of care (Adams 2016)
2. Wholism is another philosophy in understanding patient(Hennesy 2011)
Wholistic nursing views the biophysical ,psychological and sociological
systems aqs related but separate thus the whole is equal to the sum of
the parts.
Holistic nursing recognizes the multiple subsystem are in continuous
interaction and that mind relationship do exist(Aghebati et ,al 2015)
. Naturalism has a metaphysical component taht implies that the naqtural
world exists.There is no non natural or supra natural realm.
Natural worl is open because it depends on what method the inquiry
requires.
Knowledge & belief are gained by one's senses guided by reason and by
various method of science
Science as an Enterprise
• The process of scientific enquiry maybe viewed as human enterprise
(Mishler 1979)
• Scientific enterprise may be influence by social ,politicaland economic
factors (Brown 1977).
• Ex. Popularuity of certain ideologies influences how phenomena are
viewed and which problem that are selected for study (Hudson 1977)