philosophy-science-theory.class.ppt
TRANSCRIPT
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Philosophy-Science-Nursing Theory
NUR 601 Nursing Theory and Role Development
Dr. Helen Hodges
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“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?
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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?
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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
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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
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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?
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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
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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)
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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
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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)
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Ways of knowing
Carper’s patterns of knowing (1978)
– Empirics– Esthetics– Personal knowledge– Ethics
▪Schultz and Meleis (1988):
Clinical, conceptual, empirical
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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
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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).
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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).
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Benefits of theory based practice
Structure & organization
Systematic, purposeful approach
Focused practice → coordinated and less fragmented care,
Goals & outcomes identifiable and traceable.
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Define and Differentiate
Conceptual models or conceptual frameworks
Propositions Theory Assumptions Purpose Indications for use
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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)
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Scope* of Nursing Metatheory
Most abstract Philosophical world
views Philosophy of nursing Critical theory Feminist theory
*Refers to complexity and degree of abstraction
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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
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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
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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
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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
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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
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How do factor-relating theories differ from factor isolating theories?
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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
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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
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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?
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Thomas Kuhn (1970) The Structure of Scientific Revolutions
Paradigm1→Normal Science→Anomalies→Crisis→Revolution→Paradigm2
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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