Philosophy-Science-Nursing Theory

1. Philosophy-Science-Nursing Theory NUR 601 Nursing Theory and Role Development Dr. Helen Hodges

2. 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).

3. 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?

4. 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

5. 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

6. 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?

7. 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

8. 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)

9. 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

10. 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)

11. Ways of knowing • Carper’s patterns of knowing (1978) • Empirics • Esthetics • Personal knowledge • Ethics ▪Schultz and Meleis (1988): Clinical, conceptual, empirical

12. 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

13. 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).

14. 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).

15. Benefits of theory based practice • Structure & organization • Systematic, purposeful approach • Focused practice → coordinated and less fragmented care, • Goals & outcomes identifiable and traceable.

16. Define and Differentiate • Conceptual models or conceptual frameworks • Propositions • Theory • Assumptions • Purpose • Indications for use

17. 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)

18. Scope* of Nursing Metatheory • Most abstract • Philosophical world views • Philosophy of nursing • Critical theory • Feminist theory *Refers to complexity and degree of abstraction

19. 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

20. 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

21. 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

22. 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

23. 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

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

25. 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

26. 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

27. 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?

28. Thomas Kuhn (1970)The Structure of Scientific Revolutions Paradigm1→Normal Science→Anomalies→Crisis→Revolution→Paradigm2

31. 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