Transcript Philosophy-Science

Philosophy-Science-Nursing Theory
NUR 601 Nursing Theory and Role
Development
Dr. Helen Hodges
Philosophy? Nursing Theory?
ARGGHHHH. Right?
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“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
What differentiates a profession from an occupation?
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▪ Defined knowledge base
▪ Power & authority over training & education
▪ Registration
▪ Altruistic service
▪ Code of ethics
▪ Lengthy socialization
▪ Autonomy, and accountable to public
▪
Nursing as a profession & academic
discipline
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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 (1600’s) …rationalists: ‘reason is superior to
experience as a source for knowledge’ … through deduction and
mathematics
۩ Bacon (1600) …empiricist: experimentation and scientific method
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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 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?
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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?
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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
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Carper’s patterns of
knowing (1978)
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Empirics
Esthetics
Personal knowledge
Ethics
▪Schultz and Meleis (1988):
Clinical, conceptual, empirical
Human science knowledge understood
in context
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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
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Confusing, of no practical value, ‘too theoretical’
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Confusion over terms: conceptual framework,
conceptual model, and theory
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Levels, testing, analysis, one theory or many?
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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?
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“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
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Structure & organization
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Systematic, purposeful
approach
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Focused practice →
coordinated and less
fragmented care,
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Goals & outcomes
identifiable and traceable.
Define and Differentiate
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Conceptual models or
conceptual frameworks
Propositions
Theory
Assumptions
Purpose
Indications for use
Stages of Nursing Theory
Development
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Silent Knowledge
Received Knowledge
Subjective Knowledge
Procedural Knowledge
Constructed Knowledge
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(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
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Most abstract
Philosophical world
views
Philosophy of nursing
Critical theory
Feminist theory
*Refers to complexity and degree of abstraction
Scope* of Nursing Grand Theories
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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
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Middle Range theories
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Less abstract
Focus on a particular
phenomenon
Eg social support, quality of
life, hope, anxiety; death and
dying
Scope* of Practice Nursing Theories
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Specific directions for practice
Specific phenomenon with
specific population or field of
practice
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Eg theory of departure in
college students;
Eg Death and Bereavement
in Teens
Fewest concepts
Prescribe or guide practice
Factor-isolating theories
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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
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Attempts to explain how or why concepts
related
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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
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Predictive of future outcomes. If this, then
that…
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Eg smoking and fetal size
Helping and lifespan in a nursing home
Cause and effect, empirical testing
Situation-producing theories
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Prescriptive for future outcomes and defined goals.
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Smoking cessation and improved birth weight
Cocaine abuse and fetal addiction
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Prescribe directed interventions and
consequences of interventions
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Propositions call for change among specific
patient groups and conditions
Nursing’s Metaparadigm
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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
Paradigm1→Normal Science→Anomalies→Crisis→Revolution→Paradigm2
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Stages of Nursing Theory
Development
Silent Knowledge
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Received Knowledge
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… Peplau (1952); philosophers Dickoff, James, Wiedenback; Nsg
on nursing; functional nursing; Abdellah, Orlando, Henderson
reflections on experience
Procedural Knowledge
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…focus on nursing education in universities; RN shortage, graduate
nursing education; social, biologic, medical theory
Subjective Knowledge
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… growth of hospital training programs w/ apprenticeship model of
learning
…(separate; connected) focus on separate eg. theory development
approaches, methodology, statistical analysis; less on application
Constructed Knowledge
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…integration & building on previous studies, pt. experience,
literature, etc