Philosophy, Science, and Nursing

Overview of Theory in Nursing

NURS 3081: January 15th, 2019
Week 2 Required Readings:
1. Textbook: McEwen & Wills (2019), Chapter 1 & 2

2. Article: Carper (1978)

3. Article: White (1995)

Class Outline:
• Nursing as a Profession, Professional Discipline, and Applied Science
• Science and Philosophical Schools of Thought
• Knowledge Development and Nursing Science
• Ways of Knowing in Nursing
• Research methodology and Nursing Science
• Overview of Theory and Theory Development in Nursing
• Classification of Theories in Nursing
• Nursing’s Metaparadigm
What is a Profession?
• Definition: a learned vocation or occupation that has a status of superiority and
precedence within a division of work (pg. 2)

• Characteristics of a profession:
• Defined & specialized knowledge base, control and authority over training
and education, credentialing system/registration to maintain competence,
altruistic service to society, code of ethics, formal training and higher
education, lengthy socialization to the profession, anatomy.

• Consider: all professions are occupations, but not all occupations are
professions.
McEwen & Wills (2019)
Nursing as a Profession
1. Yes
2. Yes
3. Yes, NANB
4. Yes, serve public
5. Yes
6. Yes, BN
7. Yes, lots of orientation and preceptorship
8. Autonomy: is nursing autonomous? We need orders for medicine

• ASPIRING, EVOLVING PROFESSION

McEwen & Wills (2019)

What is a Discipline?
• Definition of a discipline: a branch of knowledge ordered through the theories
and methods evolving from more than one worldview of the phenomenon of
concern, another one in textbook

• Characteristics of a discipline: a distinct perspective & terminology,

determination of: what phenomena of interest, the context in which the
phenomena are used, what questions to ask, what methods of study are used,
and what evidence is proof

• Classifications of disciplines:
• 1. basic sciences (physics, sociology)/ Humanities (fine arts, philosophy)
• 2. academic (history, math), professional (medicine, law and nursing)
McEwen & Wills (2019)
Nursing as a Discipline
Areas that identify nursing as a distinct discipline are:

1. An identifiable philosophy
2. At least one conceptual framework (perspective) for the delineation of what can be
defined as nursing
3. Acceptable methodological approaches for the pursuit and development of knowledge

McEwen & Wills (2019)

Introduction to Science
Science:
• Concerned with causality (cause and effect)
• Is both a process and a product
• A body of empirically tested knowledge
• A system of gathering and verifying information (process)
• Represents knowledge and is generated by the application of methods to
acquire that knowledge

• A discipline science:
• Focuses on solving problems related to nursing
• Directs answering questions for the discipline
• The science contains the research aspect of the discipline
• A disciplines science is tied to its philosophy
McEwen & Wills (2019)
Classification of Science
• Natural sciences
• Chemistry, physics, biology, geology

• Basic or pure sciences

• Math, chemistry, physics and English (language)

• Human or social sciences

• Psychology, anthropology, economics, history, religion

• Practical or Applied Sciences

• Engineering, pharmacy, medicine, law, architecture
• Draw from other sciences
McEwen & Wills (2019)
Philosophy
• Definition: a study of problems that are ultimate, abstract, and
general…these problems are concerns with the nature of existance,
knowledge, morality, reason and human purpose

• Philosophy seeks to:

• Discover knowledge and truth
• Identify what is valuable

• Philosophy is concerned with:

McEwen & Wills (2019)

Branches of Philosophy
• Metaphysics: study of nature of reality and existence
• Ontology: study of the theory of being
• Cosmology: study of the physical universe
• Epistemology: study of knowledge (ways of knowing)
• Logic: studies of principles and methods of reasoning
• Ethics (axiology): study of values (right and wrong)
• Esthetics: study of appreciation of arts or beautiful things

McEwen & Wills (2019)

Philosophical Schools of Thought
• Received view: empiricism*, positivism*
• What is experienced is what exists: one truth
• Individuals learn by being told or receiving knowledge
• Knowledge is described &verified via scientific methods (experiments)
• Prediction and control: quantitative research
• Dominant worldview of the pure and basic sciences
• Perceived view
• Human science*, phenomenology*, constructivism
• Phenomena are studied and described from lived experiences
• Desire is to understand the actions and meanings of individuals
• What exists depends on what individuals perceive to exist: multiple truths
• Knowledge is subjective and created by individuals: qualitative research
• Dominant worldview of the social/human sciences
McEwen & Wills (2019)
 Postmodernism
• Post structuralism*, post colonialism*
• Rejects the notion of single truth: allows for multiple
meanings of reality and ways of knowing
• Knowledge is viewed as uncertain, contextual and
relative
• Promotes use of multiple research methodologies:
methodological pluralism
McEwen & Wills (2019)
Key Terminology:
• Nursing philosophy = statement of foundational and universal assumptions, beliefs and
principles about the nature of knowledge and thought (epistemology) and the nature of
entities represented in the metaparadigm (nursing practice and human health {ontology})
• Provides perspectives for practice, scholarship and research
• Nursing science = both qualitative and quantitative

• Philosophy of science in nursing =

McEwen & Wills (2019)

Ways of Knowing in Nursing
• Epistemology & Nursing Epistemology

• Fundamental patterns of nursing knowledge (Carper 1978)

Carper (1978); McEwen & Wills (2019)

Ways of Knowing in Nursing:
Empirics

Carper (1978); McEwen & Wills (2019)

Ways of Knowing in Nursing:
Esthetics

Carper (1978); McEwen & Wills (2019)

Ways of Knowing in Nursing:
Personal Knowledge

Carper (1978); McEwen & Wills (2019)

Ways of Knowing in Nursing:
Ethics

Carper (1978); McEwen & Wills (2019)

McEwen & Wills (2019)
Research Methodology & Nursing Science
• The Great Debate….

• Quantitative methods

• Qualitative methods

• Methodological pluralism

McEwen & Wills (2019)

Overview of Theory

McEwen & Wills (2019)

Why is theory important in nursing?

McEwen & Wills (2019)

How are theories used in nursing practice?

McEwen & Wills (2019)

Theory Development in Nursing:
Six Stages:
1. Silent knowledge
2. Received knowledge
3. Subjective knowledge
4. Procedural knowledge
5. Constructed knowledge
6. Integrated knowledge

McEwen & Wills (2019)

1. Silent Knowledge (1870’s-1940’s)

McEwen & Wills (2019)

2. Received Knowledge (1945-1960)

McEwen & Wills (2019)

3. Subjective Knowledge (1960-1970)

McEwen & Wills (2019)

4. Procedural Knowledge (1970-1985)

McEwen & Wills (2019)

5. Constructed Knowledge (1985-2010+)

McEwen & Wills (2019)

6. Integrated Knowledge (2010-???)

McEwen & Wills (2019)

Methods of Theory Classification

There are 2 ways of classifying theories in nursing:

1. Range/Scope

1. Purpose

McEwen & Wills (2019)

Classification of Theory by Scope

McEwen & Wills (2019)

Metatheory
• Theory about a theory

• Focused on broad issues

• Philosophical issues

• Methodological issues

McEwen & Wills (2019)

 Grand Theories
• Most complex theories

• Attempt to explain broad areas within a discipline

• Characteristics:

McEwen & Wills (2019)

Middle-Range Theories
• More circumscribed than grand theories
• Contain a limited number of concepts that are operationally defined
• Focus on a limited aspect of reality
• Propositions may be tested through research
• Middle-range theories may be:
• a description of a particular phenomenon
• an explanation of the relationship between phenomena
• prediction of the effects of one phenomenon or another
McEwen & Wills (2019)
Practice Theories
• AKA: microtheories; prescriptive theories; and situation-specific theories

• Least complex  contain fewest concepts

• Refer to specific, easily defined phenomena

• Limited to specific populations or fields of practice

• Often use knowledge from other disciplines

McEwen & Wills (2019)
Classification of Theory by Purpose

• Descriptive

• Explanatory

• Predictive

• Prescriptive

McEwen & Wills (2019)

Issues in Theory Development in Nursing

• Borrowed versus unique theory in nursing

• Nursing Metaparadigm

McEwen & Wills (2019)

Metaparadigm
• Metaparadigm—the most global perspective of a discipline
• The primary phenomena that are of interest to a discipline
• Explains how the discipline deals with phenomena in a unique manner
• Characteristics of a metaparadigm:

McEwen & Wills (2019)

Nursing’s Metaparadigm
• Person

• Health

• Environment

• Nursing

McEwen & Wills (2019)

Nursing’s Metaparadigm Concepts:
Person

McEwen & Wills (2019)

Nursing’s Metaparadigm Concepts:
Health

McEwen & Wills (2019)

Nursing’s Metaparadigm Concepts:
Environment

McEwen & Wills (2019)

Nursing’s Metaparadigm Concepts:
Nursing

McEwen & Wills (2019)

Relationships Among Metaparadigm Concepts
• Person and health

• Person and environment

• Health and nursing

• Person, environment, and health

Donaldson & Crowley (1978); Gortner, (1980)

Caring as a Central Construct in Nursing

McEwen & Wills (2019)