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Philosophy-Science-Nursing Theory. NUR 601 Nursing Theory and Role Development Dr. Helen Hodges. Philosophy? Nursing Theory? ARGGHHHH. Right?.

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Philosophy science nursing theory

Philosophy-Science-Nursing Theory

NUR 601 Nursing Theory and Role Development

Dr. Helen Hodges

Philosophy science nursing theory

Philosophy? Nursing Theory?


  • “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).

Nursing as profession academic discipline

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

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

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

What are the concerns of Philosophy

Philosophy studies concepts that structure thought processes, foundations, and presumptions

Nature of existence


Knowledge and reason

Human purpose

From what philosophers is nursing generally drawn?

Upon what philosophers is nursing based

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

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

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 related1

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

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

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

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

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

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

Define and Differentiate

  • Conceptual models or conceptual frameworks

  • Propositions

  • Theory

  • Assumptions

  • Purpose

  • Indications for use

Stages of nursing theory development

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

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

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

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

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

    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

    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

    How do factor-relating theories differ from factor isolating theories?

    Situation relating 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

    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

    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

    Thomas Kuhn (1970)The Structure of Scientific Revolutions

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

    Stages of nursing theory development1

    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

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