1970-1980’s (Newman, Parse, Watson, Rogers) iv. Development of the metaparadigm per Fawcett
v. Development of paradigms
1. Simultaneity and Totality
2. Particulate-Deterministic, Interactive -Integrative, Unitary Transformative
III. Discuss knowledge development in nursing (10 points)
a. Carper’s Ways of Knowing
b. Emancipatory Knowing
c. Ways of unknowing
d. Role of research
e. Role of the socio political environment
IV. Application/Synthesis for Advanced Practice (10 points)
Describe how the new advanced knowledge, in the course to date has informed and influenced your own perspective on nursing:
i. Philosophic
a. What philosophy is most congruent with your own personal philosophy and why?
ii. Paradigm of Nursing
a. Discuss the congruence between your nursing philosophy and your nursing paradigm
b. Describe which ways of knowing are most integral and important to your theory, philosophy and paradigm of practice
c. Identify research questions you might ask based on your philosophy and paradigm of nursing. Explain why you might be interested in this discovery.
V. Summary (5 points)
Abstract
This research embraces a dissuasion on nursing philosophy. Areas of interest pertained to its foundation; emergence into theory and science; positivism /empiricism; historicism hermeneutics/Interpretative and critical Social Theory and feminism were discussed fully. Comparative world views were exposed concerning these issues and conclusion tendered in relation to results observed.
Introduction
Nursing Philosophy has its firm foundation in the work of Florence Nightingale (1820 -1910), who is considered the lady with the Lamp or in more precise terms the Lady with the Light. The following exposition offers a brief historical background to nursing philosophy and some salient developments of the disciple into a science through theoretical adaptations.
- Philosophic Foundation
The relationship between Philosophy, Science and Theory
Manuel Velasquez (2014) from Santa Clara University advances that philosophy is an investigation into problems. Specifically, these problems are related to articulation of language, interpretation of values, meaning of reality; purpose of human existence; acquisition and interpretation of knowledge; understanding reasoning and how the human mind functions (Velasquez, 2014). The difference between philosophy and other disciplines is that in studying philosophy the emphasis is on its critical approach towards interpreting/understanding the given phenomenon. Also, philosophy differs in the way logical thinking is applied in exploring events, which concern philosophers. Importantly, philosophy is not considered a science and it has no theoretical basis (Velasquez, 2014).
Science emerged from the Latin language and is interpreted to mean knowledge. As an investigative process science is responsible for organizing knowledge. Essentially, science takes one aspect of knowledge and through scientific investigation builds on that specific segment in creating more knowledge. Modern science is firmly concerned with pursuance of knowledge. This is acheived through scientific methods of research involving creation of hypothesis testing techniques. These techniques involve the use of variable and scientists adopting a relevant methodology to investigate the knowledge being tested (Grant, 2007).
Arguments have been that philosophy cannot be considered science because there is no evidence to prove the knowledge obtain as valid. Therefore, scientists criticize philosophy because philosophers base their assumptions on logic whereas scientists have tested the knowledge they advance using scientific tools including data analysis techniques. In this regard scientists contend that philosophy consist merely assumptions, which have not been proven. However, over the ages scientists have taken the knowledge philosophers assumed and tested their thinking though modern scientific methods. As such, philosophers respond with the notion that science is philosophy proven. In reality science has no knowledge of its own (Grant, 2007).
Theory is defined as contemplative abstract thinking, similar to philosophy, but while philosophy uses thinking to produce knowledge theory attempts to explain how knowledge works. In relation to science theories are tested when scientific methodologies are adapted to validate knowledge. Consequently, the relationship between/among philosophy, science and knowledge is knowledge acquisition, testing and explanations of how knowledge is utilized in the real world (Grant, 2007).
11. Major philosophies that have shaped nursing
- Positivism /empiricism
For example, positivism assumes that knowledge is concrete and any phenomenon can be measured. Therefore, clinical data, which is used to verify diagnoses are measures applicable to philosophies that have shaped nursing practice. Evidence based practice is also another element of positivism and empiricism emerging from philosophy into science through theory formation (Landero et.al, 2014)
Positivism emphasizes knowledge emerging from the observable, whereas empiricism focuses on clarifying knowledge through application of scientific methods. While positivism single hamdely have has moved nursing science from philosophy into a scientific discipline, positivism and empiricism together have paved the way for this triumphant entry. Essentially, these development are aligned to Nightingale's nursing philosophy pertaining to her trascendent publication Notes on Nursing. These notes reflected the abstract thinking concerning environment hygienist. Currently, they are conceptualized as principles of cleanness, space, light, and air. In the absence of theory and scientific testing of abstract thinking, Nightingale recorded the interventions she observed, diminishing infections and death in her peculiar setting. At the time it was a nursing room at Crimea, containing injured soldiers (Landero et.al, 2014).
- Historicism
Historicism embraces multiple philosophical perspectives regarding the development of nursing into a science. One such view relates to the belief that traditionally, for nature to be clearly understood , it must be taken within a context of time and place simultaneously. This philosophy is closely associated with relativism in other disciplines. As such, nursing is linked to historical ideologies through development of theoretical perspectives, by assessing the use of variables. This assumption coincides with the culture paradigm of the individual patient (Velasquez, 2014).
- Hermeneutics/Interpretative
The initial use of hermeneutics/interpretative pertained to deciphering of scripture and its meaning. Hence, the applications are strongly related to the abstract thinking contained in philosophical expositions. The applications of hermeneutics/interpretative paradigms to nursing practice involves interpreting texts or evidence, since in the beginning there were no theories/ hypotheses to prove or dispute knowledge. Interpretations focused on producing more knowledge as well as clarifying what already existed being practiced in nursing science (Velasquez, 2014).
- Critical Social Theory and feminism
An unspoken philosophy, which pervaded nursing practice for centuries pertained to the feminists ideology that nursing was only executed by women since Florence nightingale is a woman. In those days women were not even supposed to work, much more enter a professional practice. However, it can be said that she was the first feminists who advocated for women in the work force as nurses training them to practice the philosophy she espoused (Green, 2012).
As such, critical social theory in relation to feminism and nursing practice, argues for addressing patients from a perspective of gender. Ancient societies marginalized women as being inferior to men. Male chauvinism ruled the world. While there are still elements within modern professional culture, social theory has helped to eradicate many misconceptions of women in the society. Social theory applied empirical evidence in proving that there are no significant social differences regarding the capabilities of men and women. Discrepancies were socially constructed (Green, 2012).
c. Compare and Contrast the worldviews that inform nursing science
i. Reaction
Michele Sloma (2014) commented on the ‘Impact of Nursing Models in a Professional Environment: Linking Spiritual End-of-Life Care to Nursing Theory.’ This nursing theorist was reacting to the world’s perspective of hospice intervention (care for the dying), which is a relatively modern feature in nursing science. Originally, nursing was approached from the paradigm of enhancing quality of life. The prevailing world view has extended the arm of nursing towards enhancing the quality of death, which is a paradox to philosophies espoused by early thinkers such as Florence Nightingale (Sloma, 2014)
Sloma (2014) argued that spiritual facilitation is important to end of life. This is the technique whereby a nurse offers spiritual support in resolution of end-of-life (EOL) issues. Nursing conceptual models are applied to the process. These models promote positive client/ family interactions during the end life stages, which are often festered with grief, resentment and remorse. Nurses are trained to adopt strategies that help the dying person cope with death itself while family members are comforted as they experience the imminent lost. Critics of nursing philosophy argue that nurses are forced to play the role of religious scientists when they realty ought to be caring for the body Sloma (2014) advanced (Sloma, 2014).
However, she further contends that with regards to nursing science, the proposed spiritual facilitation approach towards end of life care; the interventions executed, nursing education and conceptual models applied are all consistent with evolution in the science as it pertains to holistic care. Essentially, it is taking into Account of physical, social and spiritual elements of the human being. They are intricately related to the nursing process. The theorists was profound in pronouncing her claim for end of life intervention in nursing science (Sloma, 2014).
While numerous controversies are still heated among nursing professional regarding end of life care requirements, contradicting traditional nursing philosophies Sloma (2014) confirmed that research validates the necessity for acquisition of basic knowledge regarding nurses’ capacity of providing effective spiritual intervention during end-of-life care. Many issues surface at this stage of life. If the nurse is to fulfil his/her unique role of caring for an individual as a total unit according to Maslow’s hierarchy of basic human needs, this aspect of care must be addressed in nursing practice (Sloma, 2014).
ii. Reciprocal interaction
This relates to a nursing tradition, which has evolved into the world view perception of humans as holistic beings, while still being interpreted as entities with distinct separate parts. This perceptive was adapted from the social sciences where society is viewed as a whole with separate institutions. Also, humans interact with their environment and design it to meet their individual goals facilitating existence and function as a social, spiritual and physical being. World view reactionists have not yet grasped the holistic concept. Many health promotion programs have been executed based on this model (Pender, 2014).
iii. Simultaneous action
Simultaneous action as a world view denotes theoretical perspectives being used together in investigating knowledge. Some theorists call it a simultaneous concept analysis. In this approach a process model adapting four concepts are applied. Jean Watson’s theory of caring is considered a simultaneous action, since the nurse utilized dual care paradigms together in applying the nursing process. The model forges a nursing segment along with an individual care responsibility. Again the world view of holistic intervention is perpetuated within the science (Pender, 2014).
d. Description of the development of nursing philosophy
i. Early years-pre 1950’s
History communicates to the world that before Florence Nightingale there was no nursing philosophy. However, once philosophers existed abstract thinking pertaining to care of persons who were ill was always articulated. Simultaneously as the 17th and 18th centuries were considered the age of reasoning, similarly nursing philosophy could have embraced similar reasoning. Major philosophical developments included, nursing education emerging in Europe simultaneously with Florence Nightingale’s moving to Alexandria, Egypt to complete training as a nurse. The philosophy pertained to training for effective dispensation of care. This is evidence that philosophical thinking in Europe was way behind that of Egypt (Pender, 2014).
ii. Entry into academia and the received view (empiricism/positivism)
Conscious attempts at identifying nursing with the natural sciences forged entry of the practice into the scientific mode of functioning. Further, nursing was recognized as a practical human activity while it could not be fully verified as a natural science. However, the practice initiated applications of behavioral scientific techniques, which are definitely scientific in their modalities. Ultimately, nursing was considered an applied science. The scientific application encompassed theory formation and testing of knowledge through empirical evidence. These inflections provided nursing with credential of a scientific practice (Pender, 2014).
iii. Evidence of divergent thinking in nursing theoretical writing in the late
1970-1980’s (Newman, Parse, Watson, Rogers)
Newman, Parse, Watson, and Rogers have all emerged as divergent thinkers within the Science. For example, Margaret Newman theorized concerning ‘health as expanding consciousness,’ which completely differs from focusing on the body and environment as early thinkers. Newman’s thinking of mind body connection ultimately relates the holistic nature of nursing practice as an expanding science in integrating a number of other thinkers’ contribution to the science (Newman 1997).
vi. Development of the metaparadigm per Fawcett
These philosophical premises emerged from Florence Nightingale interpretation of the environment during her abstract thinking of optimum nursing care for her soldiers. Jacqueline Fawcet (1983) and many other middle range theorists have explored these philosophies to arrive at the metaparadigm in nursing stating that four features determine optimal nursing outcomes if considered within the nursing process. They are the person, environment, health and nursing itself (Kenney, 2014).
- Development of paradigms
According to Jacqueline Fawcet and Rebecca Lee (2014) metaparadigms have greatly influenced nursing practice since its development in the late twentieth century. Ever since other nursing theorists have added their distinction in reforming its use in the nursing process (Lee and Fawcet, 2014).
Simultaneity and totality
Simultaneity and totality in theory construction has been identified in utilization of metaparadigm forming the basis of its execution in nursing process implementation. Simultaneity exclusively relates to the use of two conceptual frameworks in finding a nursing process solution such as environment and people in the metaparadigm application. While simultaneity is achieved it is pursued as an total rendition of care regarding the patient/ client’s health need in the present.
Particulate-Deterministic; Interactive -Integrative, Unitary-Transformative
It could be argued that these three categories’ of additional paradigms emerging within nursing science practice are in response to the need of clarifying knowledge used for intervention among variables espoused in the first metaparadigm person, environment, health and nursing. Consequently, particulate-deterministic adopts a realist and critical ontological approach. The objective is establishing epistepistemologies, which depend on experimental and quasi-experimental methods of research in validating knowledge. Interactive –Integrative are paradigms emerging from grand theories, which validate the holistic approach of the nursing science. Unitary-Transformative paradigm confirms humans’ integration with their environment as a source of healing. This assumption coincides with Florence Nightingale’s environment philosophy (Kenney, 2014).
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III. Discuss knowledge development in nursing
- Capers ways of knowing
Carper's fundamental ways of knowing was espoused by Professor Barbara Carper. She advanced a typology classifying various avenues from which knowledge and beliefs related to professional nursing practice could evolve. Examples offered were empirical, personal, ethical and aesthetic (Kenney, 2014).
- Emancipatory Knowing
This relates to knowledge gained by striving to liberate stereotypes within the science. For example, ideas pertaining to feminism in nursing practice, is a way of emancipatory knowing that this tradition signified marginalization of both sexes with regards to them achieving full potential in the practice. Now men have entered the profession making their significant contributions in areas dominated by female emancipation has occurred (Kenney, 2014).
- Ways of unknowing
Epistemology is the concept in nursing science, which explains how knowledge is obtained and validated. Traditionally, it was through mere abstract thinking classified as philosophy. When nursing began to search for validation research became the hallmark of knowing. Modern nursing scientists are trained to conduct research providing evidence- based ways of knowing (Kenney, 2014).
- Role of research
As such, the role of research has significantly influenced the body of knowledge, which now exists in the science. Advanced practice nurses are frequently engaging in scientific research projects to validate evidence. Besides, they are trained in formulating hypotheses formation and testing; gathering data and arriving at conclusion after analyzing information obtained as evidence (Kenney, 2014).
- Role of the socio political environment
Ultimately, the socio-political environment has a great impact regarding knowledge obtained and utilized. Social determinants of health influence factors that impede research among minorities. Essentially, research has to be funded by organizations of interest. If advanced nurses receive no financing, knowledge in that field of interest cannot be pursued .
IV. Application/Synthesis for Advanced Practice
Description of how the new advanced knowledge, in this course to date has informed and influenced my own perspective on nursing
- Philosophic
Before enrolling in this course, it was my philosophy that nursing was a job whereby professionals were trained and as they practice rules were outlined to be followed. This is how I functioned prior to taking this course. Now, I know that I have the power to contribute knowledge to the nursing science through research practice.
- What philosophy is most congruent with your own personal philosophy and why?
The philosophy, which is most congruent with the one I now have pertains to research in nursing. This is so because I am amazed at how much nursing science has evolved since its introduction during the Florence Nightingale era
ii. Paradigm of Nursing
a. Discussion of congruence between my nursing philosophy and your nursing paradigm
The paradigm, which I believe is most consistent with my philosophy, relates to particulate-deterministic because it adopts a realist and critical realist ontological approach. The objective is establishing epistepistemologies, which depend on experimental and quasi-experimental methods of research in validating knowledge.
- Description of which ways of knowing are most integral and important to your theory, philosophy and paradigm of practice.
The ways of knowing relate to epistemology because it offers explanations as to how knowledge is obtained and validated.
- Identification of research questions I might ask based on my philosophy and paradigm of nursing.
- What irregularities occurred in nursing when here was no scientific methods of executing care?
- What forged philosophers to adopt a scientific approach towards nursing interventions?
- Has the introduction of metaparadigms significantly improved nursing outcomes?
Explanation of why you might be interested in this discovery.
These questions uphold one common theme. This relates to what extent development in nursing science has improved nursing practice. Currently, there is so much research in almost every aspect of nursing science, providing evidence for most interventions. However, there seems to be more malpractice today, than during Florence Nightingale’s era when nursing was based on mere philosophical assumptions. Perhaps, there were no ways of knowing the extent to which they (malpractices) existed!
V. Summary
The purpose of this scholarly exposition was to offer insights into nursing philosophy, tracing significant developments with the science. Part 1 gave an analysis of the foundation; part 11 synthesized major philosophies that have shaped nursing; part 111 profoundly discussed knowledge development in nursing; part 1V reflected on my perceptions of philosophy, paradigms and ways of knowing. This section forged me into taking a position regarding the philosophy I have inherited after embarking on this course of study.
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Lee, R., & Fawcett, J. (2014). The Influence of the Metaparadigm of Nursing on Professional
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Newman, M. A. (1997). Evolution of the theory of health as expanding consciousness. Nursing
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http://research2vrpractice.org/wp-
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Retrieved on October 6th, 2014 from
http://www.wholistichealingresearch.com/31sloma.html
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