Philosophy-Science-Nursing Theory

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Philosophy-Science-Nursing Theory

• NUR 601 Nursing Theory and Role Development
• Dr. Helen Hodges

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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).

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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 Knowl
edge and reason Human purpose
From what philosophers is nursing generally
drawn?
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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
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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 1950s
? 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

• Carpers 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
  wasnt 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-OGrady 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, 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)

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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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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?
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Thomas Kuhn (1970) The Structure of Scientific
Revolutions
Paradigm1?Normal Science?Anomalies?Crisis?Revoluti
on?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