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Philosophy-Science-Nursing Theory

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-OGrady &
Malloch, 2007, p.425).

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

u ates
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Ho arac ursi
ch out n ion?
ab fess
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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

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 20th 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

Paradigm1Normal ScienceAnomalies
CrisisRevolutionParadigm2

Stages of Nursing Theory


Development

Silent Knowledge
blind obedience to medical authority. Little attempt
to develop theory; growth of hospital training
programs w/ apprenticeship model of learning
Received Knowledge
learning through listening to others. Borrowed
theories and reliance on authority of educators,
sociologists, psychologists, physiologists, and
anthropologists to provide answers to nursing
problems:focus on nursing education in
universities; RN shortage, graduate nursing
education; social, biologic, medical theory

Stages of Nursing Theory


Development

Subjective Knowledge: authority internalized and negative


attitude toward borrowed theories and science; focus on defining
nsg, the nurse. Peplau (1952); philosophers Dickoff, James,
Wiedenback; Nsg on nursing; functional nursing; Abdellah,
Orlando, Henderson reflections on experience

Procedural knowledge: (separate and connected) . Focus on


separate with attention to procedures of research methodology and
statistical procedures for data analysis; little focus on connected
knowledge, ie application of theory in practice. (separate;
connected) focus on separate eg. theory development approaches,
methodology, statistical analysis; less on application

Stages of Nursing Theory


Development
Constructed

Knowledge: integration of
different types of knowledge, building on
previous empirical studies, literature, pt
experiences, etcintegration & building on
previous studies, pt. experience, literature,
etc