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-O’Grady & 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

▪

How would you

characterize debates

about nursing as a

profession?

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 (1600’s) …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 1950’s

۩ 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

Carper’s 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 wasn’t considered a very good theory” (Levine, 1995, p11).

So Why Theory? Why Now?

“In the 20th century the focus of work was on performing the right processes. In the 21st century the focus is on obtaining the right outcomes” (Porter-O’Grady & 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, & Tarule’s Women’s Ways of Knowing from the early 80’s. The 80’s were an active period of women’s studies and research about differences between men and women’s 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

Nursing’s 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

Paradigm1→Normal Science→Anomalies→Crisis→Revolution→Paradigm2

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