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Philosophy-Science-Nursing Theory

NUR 601 Nursing Theory and Role


Development

Dr. Helen Hodges
Sometimes all that is
possible is to embrace
the mystery, the
unknown, of a situation
and allow it to be
beyond reach or
understanding for a
while (Porter-OGrady &
Malloch, 2007, p.425).

Philosophy? Nursing Theory?
ARGGHHHH. Right?
Nursing as profession & academic
discipline
What differentiates a profession from an occupation?




Defined knowledge base
Power & authority over training & education
Registration
Altruistic service
Code of ethics
Lengthy socialization
Autonomy, and accountable to public

Nursing as a profession & academic
discipline
What distinguishes one
academic discipline from
another?




Structure and tradition, ie delineation
Language
Worldview, ie philosophy
Professional disciplines practical; research is prescriptive and
descriptive
Methods of knowledge development
Is nursing a science?
Science is logical, systematic, & coherent way to
solve problems and answer questions
Pure or basic (aka bench science)
Natural, human, or social
Applied or practical
What are the concerns of Philosophy
Philosophy studies concepts that structure
thought processes, foundations, and
presumptions
Nature of existence
Morality
Knowledge and reason
Human purpose
From what philosophers is nursing generally
drawn?
Upon what philosophers is nursing
based?
Descartes & Spinoza (1600s) rationalists: reason is superior to
experience as a source for knowledge through deduction and
mathematics
Bacon (1600) empiricist: experimentation and scientific method
Kant (1700) knowledge is relative; mind
is active in knowing
What is philosophy of science and
predominant schools of thought?
Received View: rationalism positivism empiricism: Observation,
testing, verification, explain, predict, mathematical, deduction, parts of the
whole. Logical Positivism dominant philosophy of science until 1950s
Perceived View: (aka interpretive view) phenomenology, human science,
experience, context, holism, understanding meaning, patterns; feminism,
critical theory (influence of gender, culture, society, & power)
How are nursing philosophy, science,
and philosophy of science related?
Nursing philosophy: foundational and universal
assumptions, belief system & principles of the
profession; Epistemology (nature of knowledge);
Ontology (nature of existence)





Nursing science: discipline-specific knowledge of
relationships of human responses in health and
illness
How are nursing philosophy, science,
and philosophy of science related?
Philosophy of Science of Nursing establishes
the meaning of science





Scientific knowledge is transformed into nursing
knowledge though contexts of nursing practice
(Reed, 2000/2009, p.100)
Ways of knowing
Carpers patterns of
knowing (1978)
Empirics
Esthetics
Personal knowledge
Ethics




Schultz and Meleis (1988):
Clinical, conceptual, empirical
Human science knowledge understood
in context
Wilhelm Dilthey (1833-1911) concepts,
methods, theories fundamentally different
from natural sciences
Interpretation of phenomena
Embrace subjectivity
Understand the nature of experience
Holistic approach





Early Views on Nursing Theory
Confusing, of no practical value, too theoretical

Confusion over terms: conceptual framework,
conceptual model, and theory

Levels, testing, analysis, one theory or many?



In the early days, theory was expected to be obscure. If
it was clearly understandable, it wasnt considered a very
good theory (Levine, 1995, p11).

So Why Theory? Why Now?
In the 20
th
century the focus of work was on
performing the right processes. In the 21
st

century the focus is on obtaining the right
outcomes (Porter-OGrady & Malloch, 2007, p. 4).


Benefits of theory based practice
Structure & organization

Systematic, purposeful
approach

Focused practice
coordinated and less
fragmented care,

Goals & outcomes
identifiable and traceable.



Define and Differentiate
Conceptual models or
conceptual frameworks
Propositions
Theory
Assumptions
Purpose
Indications for use




Stages of Nursing Theory
Development
Silent Knowledge
Received Knowledge
Subjective Knowledge
Procedural Knowledge
Constructed Knowledge




(Note: From Kidd & Morrison, 1988 who adapted language from seminal
work of Belenky, Clinchy, Goldberger, & Tarules Womens Ways of
Knowing from the early 80s. The 80s were an active period of womens
studies and research about differences between men and womens ways
of being in the world)


Scope* of Nursing Metatheory
Most abstract
Philosophical world
views
Philosophy of nursing
Critical theory
Feminist theory
*Refers to complexity and degree of abstraction
Scope* of Nursing Grand Theories




Complex and broad, as
well as abstract
Non specific
Not immediately applicable
or testable without further
definitions
Eg. Orem, Roy, Rogers





Scope* of Middle Range Nursing
Theories

Middle Range theories

Less abstract
Focus on a particular
phenomenon
Eg social support, quality of
life, hope, anxiety; death and
dying
Scope* of Practice Nursing Theories




Specific directions for practice
Specific phenomenon with
specific population or field of
practice
Eg theory of departure in
college students;
Eg Death and Bereavement
in Teens
Fewest concepts
Prescribe or guide practice
Factor-isolating theories
Descriptive, names concepts and dimensions
Tested by descriptive research
Describes what is
May include models that illustrate an
experience, culture, or process
Factor-relating theories
Attempts to explain how or why concepts
related
Eg smoking and fetal size
Helping and lifespan in a nursing home
Statistical correlation research

How do factor-relating theories differ
from factor isolating theories?
Situation-relating theories
Predictive of future outcomes. If this, then
that
Eg smoking and fetal size
Helping and lifespan in a nursing home
Cause and effect, empirical testing

Situation-producing theories
Prescriptive for future outcomes and defined goals.
Smoking cessation and improved birth weight
Cocaine abuse and fetal addiction

Prescribe directed interventions and
consequences of interventions

Propositions call for change among specific
patient groups and conditions


Nursings Metaparadigm
Paradigm: A boundary structure which consists of items
or phenomena for investigation for a given disciplinary
perspective (Kim, 2009/1989, p.43).




A Metaparadigm is a gestalt or total world view within a
discipline the broadest consensus within the discipline of
the general parameters (Hardy, 2009/1978, (cited in Reed & Shearer, p.531)
What are the main concepts in Nursing's metaparadigm?
Thomas Kuhn (1970)
The Structure of Scientific Revolutions


Paradigm
1
Normal ScienceAnomaliesCrisisRevolutionParadigm
2


Stages of Nursing Theory
Development
Silent Knowledge
growth of hospital training programs w/ apprenticeship model of
learning
Received Knowledge
focus on nursing education in universities; RN shortage, graduate
nursing education; social, biologic, medical theory
Subjective Knowledge
Peplau (1952); philosophers Dickoff, James, Wiedenback; Nsg
on nursing; functional nursing; Abdellah, Orlando, Henderson
reflections on experience
Procedural Knowledge
(separate; connected) focus on separate eg. theory development
approaches, methodology, statistical analysis; less on application
Constructed Knowledge
integration & building on previous studies, pt. experience,
literature, etc