Philosophy-Science-Nursing Theory Nursing Theory and Role Development 5/16/2018 Philosophy-Science-Nursing Theory NUR 601 Nursing Theory and Role Development Dr. Helen Hodges

Nursing Theory and Role Development 5/16/2018 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 Theory and Role Development 5/16/2018 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 Theory and Role Development 5/16/2018 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

Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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? Nursing Theory and Role Development 5/16/2018 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? Nursing Theory and Role Development 5/16/2018 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)

Nursing Theory and Role Development 5/16/2018 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

Nursing Theory and Role Development 5/16/2018 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)

Nursing Theory and Role Development 5/16/2018 Ways of knowing Carper’s patterns of knowing (1978) Empirics Esthetics Personal knowledge Ethics Empirics = observation and measurement, replication, prediction; facts, models, laws, principles, theories Esthetics = art of nursing, creation of meaning; experience, inspiration Personal knowledge = therapeutic use of self; engagement, centering, reflection, empathy, active participation Ethics = moral component, values clarification, advocating, deliberate reasoning, evaluation of what is good. Clinical = personal knowledge…results from using multiple ways of knowing while solving problems during pat care. Conceptual = understood through propositional statements; uses knowledge from nursing and other disciplines Empirical = experimental, historical, or phenomenological resesarch and justifies actions and procedures in practice. ▪Schultz and Meleis (1988): Clinical, conceptual, empirical

Human science knowledge understood in context Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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).

Nursing Theory and Role Development 5/16/2018 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).

Benefits of theory based practice Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 Define and Differentiate Conceptual models or conceptual frameworks Propositions Theory Assumptions Purpose Indications for use

Stages of Nursing Theory Development Nursing Theory and Role Development 5/16/2018 Stages of Nursing Theory Development Silent Knowledge Received Knowledge Subjective Knowledge Procedural Knowledge Constructed Knowledge 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 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 Constructed Knowledge: integration of different types of knowledge, building on previous empirical studies, literature, pt experiences, etc…integration & building on previous studies, pt. experience, literature, etc (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 Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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? Nursing Theory and Role Development 5/16/2018 How do factor-relating theories differ from factor isolating theories?

Situation-relating theories Nursing Theory and Role Development 5/16/2018 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 Nursing Theory and Role Development 5/16/2018 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

Nursing’s Metaparadigm Nursing Theory and Role Development 5/16/2018 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?

Thomas Kuhn (1970) The Structure of Scientific Revolutions Nursing Theory and Role Development 5/16/2018 Thomas Kuhn (1970) The Structure of Scientific Revolutions Paradigm1→Normal Science→Anomalies→Crisis→Revolution→Paradigm2

Nursing Theory and Role Development 5/16/2018

Nursing Theory and Role Development 5/16/2018

Stages of Nursing Theory Development Nursing Theory and Role Development 5/16/2018 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 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 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 Constructed Knowledge: integration of different types of knowledge, building on previous empirical studies, literature, pt experiences, etc…integration & building on previous studies, pt. experience, literature, etc