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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? Nursing Theory?

ARGGHHHH. Right?

  • “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

Morality

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 science related?

  • 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 science related?

  • 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 science related?

  • 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? science related?

  • “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 science related?

  • Structure & organization

  • Systematic, purposeful approach

  • Focused practice → coordinated and less fragmented care,

  • Goals & outcomes identifiable and traceable.


Define and differentiate
Define and Differentiate science related?

  • Conceptual models or conceptual frameworks

  • Propositions

  • Theory

  • Assumptions

  • Purpose

  • Indications for use


Stages of nursing theory development
Stages of Nursing Theory Development science related?

  • 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 science related?

  • 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 science related?

  • 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 science related?

  • 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 science related?

  • 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 science related?

    • 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 science related?

    • Attempts to explain how or why concepts related

      • Eg smoking and fetal size

      • Helping and lifespan in a nursing home

  • Statistical correlation research



  • Situation relating theories
    Situation-relating theories isolating 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 isolating 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 isolating theories?

    • 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) isolating theories?The Structure of Scientific Revolutions

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


    Stages of nursing theory development1
    Stages of Nursing Theory Development isolating theories?

    • 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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