1. Theoretical Foundations in Nursing
Additional Notes to Review:
Famous Empricists and Rationalists:
1. RA 9173: Philippine Nursing Act of 2002: An act providing for a more responsive
nursing profession, repealing for the purpose republic act no. 7164, otherwise
known as "the philippine nursing act of 1991" and for other purposes.
2. ANA: American Nurses Association (ANA), formerly (1896–1901) Nurses’
Associated Alumnae of the United States and Canada and (1901–11) Nurses’
Associated Alumnae, national professional organization that promotes and protects
the welfare of nurses in their work settings, projects a positive view of
the nursing profession, and advocates on issues of concern to nurses and the
general public. In the early 21st century the American Nurses Association (ANA)
had a membership of some 150,000 nurses among its state
and constituent associations.
3. Tabula rasa, (Latin: “scraped tablet”—i.e., “clean slate”) in epistemology (theory
of knowledge) and psychology, a supposed condition that empiricists have
attributed to the human mind before ideas have been imprinted on it by the
reaction of the senses to the external world of objects.
2. Categories of Nursing Theory accdg to scope:
Grand Theory 1. Florence Nithingale( also among
philosophical theories: Lady with
the lamp
2. Madeleine Leininger
3. Nola Pender
4. Imogene King (also a conceptual
model
5. Virginia Henderson ( also among
philosophical theories)- first
defined what is nursing
Middle Range Theory 1. Hildegard Peplau
2. Ida Jean Orlando
3. Joyce Travelbee
Micro range Theory Social Learning theory, Stress and
Coping, Geriatrics Theory
Non Nursing Theory:
1. General Systems Theory
Karl Ludwig von Bertalanffy was an Austrian biologist known as one of the
founders of general systems theory.
The theory that all living systems are open systems constantly exchanging
information, matter, and energy with the environment. There are three le
vels of reference for systems: the system level on which one is focusing, (
such as a person); the suprasystems level above the focal system, (such a
s a person's family, community, and culture); and the subsystem, which is
below the focal system, (such as the bodily systems and the cell). The th
eory suggests that the treatment of people is more important than the tre
atment of illnesses.
Functional system- set of functions and a set of operations that are applied
to the functions. (different body systems
Structural System - interconnected paved carriageways
Information System- integrated set of components for collecting, storing,
and processing data and for providing information, knowledge, and digital
products
Social System- Social status
2. Change Theory
3. Kurt Lewin emigrated from Germany to America during the 1930's and is
recognised as the "founder of social psychology" which highlights his
interest in the human aspect of change.
Lewin's three stage theory of change is commonly referred to as Unfreeze,
Change, Freeze (or Refreeze).
Stage 1: Unfreezing
The Unfreezing stage is probably one of the more important stages to understand
in the world of change we live in today. This stage is about getting ready to
change. It involves getting to a point of understanding that change is necessary,
and getting ready to move away from our current comfort zone.
This first stage is about preparing ourselves, or others, before the change (and
ideally creating a situation in which we want the change).
Stage 2: Change - or Transition
Kurt Lewin was aware that change is not an event, but rather a process. He called
that process a transition.
Transition is the inner movement or journey we make in reaction to a change. This
second stage occurs as we make the changes that are needed.
People are 'unfrozen' and moving towards a new way of being.
That said this stage is often the hardest as people are unsure or even fearful.
Stage 3: Freezing (or Refreezing)
Kurt Lewin refers to this stage as freezing although a lot of people refer to it as
'refreezing'. As the name suggests this stage is about establishing stability once
the changes have been made. The changes are accepted and become the new
norm. People form new relationships and become comfortable with their routines.
This can take time.
3. Human Needs Theory: Maslow’s Hierarchy of Needs (as what have been
discussed)
****Read also regarding History of Nursing Science
1. 1. Chapter 2 The Evolution of Nursing Science
4. 2. Introduction • Nursing practice is a combination of skills and knowledge —what is
done and what is known. • Both areas require cognitive skills not readily recognizable
outside the profession. • Cognitive activities are the root of competent and effective care
and form the knowledge base of nursing science. • Nursing science is fluid and evolving.
• The DNP program places nurses with high levels of education in a role requiring
leadership and an ability to articulate about the nursing knowledge base.
3. Science and Knowledge • Science refers to a knowledge base that has been developed
rigorously and systematically. • The recognition of science as a specialized form of
knowledge is recent. – Science has specific methodologies and means to evaluate
credibility • the nursing discipline also involves a human component. • The nursing
context exists within a larger societal context that includes expectations and standards for
nurses. • Knowledge can change rapidly and radically. – Nurses must find and defend
“best practices” – Changes are evolutionary, but not necessarily a progression
4. Nursing as a Discipline • Articulating the components of the nursing knowledge base
raises question about what reflects nursing and what reflects other fields. • Nursing
diagnoses and taxonomies have been developed to respond to these questions. • Intuition
and critical thinking have also been examined due to their prominent roles in nursing.
5. History of Nursing Education (1 of 2) • Nursing education was long referred to as
“Training” due to the prevalence of on-the-job apprenticeships. • “Training” was
problematic because it focused on the ability to perform tasks rather than understanding
the purpose of actions. • As education shifted from training to learning, it was taught in
hospitals by physicians and gradually transitioned to universities.
6. • Master’s level education developed slowly, with some programs beginning in the
1920s, but had few enrollees and graduates. • In the 1960s, the U.S. Public Health
Service began a program supporting doctoral education, but lack of programs forced
nurses to pursue degrees in other disciplines. • For the last 30 years, doctoral level
nursing programs have been taught by those who have received doctoral nursing
programs. • In the last 10-20 years there has been an increase in research conducted by
nurse investigators with nursing viewpoints and perspectives. History of Nursing
Education (2 of 2)
7. Delineating Nursing as a Discipline • Early attempts to delineate nursing focused on
education and sought to develop a unique discipline with structures and boundaries. •
Effort was devoted to ensuring that nursing research was about nursing, not merely
research performed by nurses. • Understanding the substantive structure and syntax of
nursing was the focus of development and led to a logical positivist approach.
8. A “Professional” Discipline • the concept of nursing as a professional discipline
stemmed from its nature as an applied science. • The distinction was appropriate for
licensure and oversight, but problematic for academic association and acceptance. •
Concerns about borrowed knowledge do not hold up under scrutiny. • It is important that
5. knowledge that addresses the epistemic needs of nurses be generated. • Combining the
professional and academic knowledge resulted in a complex, integrated education.
9. The Emergence of Nursing Science • Logical positivist influence on nursing was
largely responsible for the focus on theory development that led to nursing science. • This
philosophical approach emphasized the demarcation of science from other forms of
knowledge via theoretical statements. • This led nurse scholars to suggest that there must
be a theoretical foundation for nursing knowledge if it were to be considered science.
10. The Theory Movement in Nursing • Science status required theory development using
existing theories as a research base. • Theory-driven focus led to a hard science
understanding that was problematic from humanistic and social standpoints. • Nurses
were left with three options: – Force nursing to fit the logical positivist model –
Acknowledge both the art and science of nursing – Acknowledge that nursing did not fit
logical positivist ideology – Carper’s four types of knowing inherent to nursing
11. Evaluating Philosophical Ideology • The imperfect fit of nursing and logical
positivism implied that nursing did not meet prevailing standards for science and failed to
address the legitimacy of the philosophy. • These types of problems remain key to
evaluating any philosophy or knowledge base. • Nurses should ask two evaluative
questions: – Is it a sound ideology—for nursing and other disciplines? – Does it enable
progress in nursing? • Logical positivism goal of precision and validity ignores elements
of phenomenon that are not measureable.
12. Measuring Un-measurable Phenomena • Hypertension can be measured as the
pressure of the blood against vessel walls. • Diabetes control can measured with glucose
or HgbA1c levels. • They do not, however, document how these conditions affect
individuals with these diagnoses or what it is like to live with and try to maintain control
of these physiological challenges. – Holistic approach
13. The Search for a Nursing Paradigm • In the 1970s, scholars proposed that philosophy
of science shift to knowledge development. • Kuhn proposed that science philosophy
examine the process rather than the product. – Allowed judgments about science to be
made relative to a viewpoint (not in reference to an objective reality) • Laudan proposed
that science address both conceptual and empirical problems and focused on science as a
problem-solving activity. • Kuhn and Laudan’s influence was shorter-lived that logical
positivists’ due to postmodernism.
14. Concept Development (1 of 2) • Historicism played a role in nursing development,
particularly in resolving conceptual problems. • Concept clarification and analysis were
popular in the 1980s and focused on theory development based in analysis, synthesis, and
derivation in the three categories of concepts, statements, and theories .
15. • More recent work focuses on developing concepts and resolving conceptual
problems without being limited to theory development. • A number of the significant
problems regarding nursing knowledge are conceptual in nature rather than empirical. •
6. Despite this, a great deal of conceptual work in nursing tends to be empirical in
orientation and poorly linked to resolution of conceptual problems. • There is a
continuing need for modes of inquiry that result in better ways to conceptualize important
phenomena in nursing. Concept Development (2 of 2)
16. • Postmodernism emphasized hermeneutics, narrative tradition critical social theory,
and feminism. • Based on the ideas of individual truths, individualized care, and the
reflection of societal power differentials. • Founded on uniqueness, diversity, power
structures, and multiple realities as a result of human and social variation. • Feminism
was seen as a particularly good fit for nursing because it was reflective of the major
values of the discipline. • In spite of the political tensions surrounding feminist ideology,
it has played an important role in nursing knowledge. The Postmodern Turn (1 of 2)
17. • Traditional scientific principles could not be applied to the study of human beings
given their individual and social contexts. – An increasing emphasis on language and
communication emerge, with a focus on individual story • Fueled the growth of
qualitative research, which is still somewhat controversial today. – Emergence of
interpretive approaches • Raised significant questions about the presumption of
objectivity in the conduct of science. – Notable: Gilligan’s work on gender bias • Myriad
viewpoints are necessary in the development of a view that meets the expectations of
being holistic and values the uniqueness of individuals. The Postmodern Turn (1 of 2)
18. • Each era in nursing has contributed to the discipline and knowledge base, building
the identity of nursing. • Each viewpoint has merits and limitations, and a pluralistic
approach is supported by some scholars. • Pluralism is problematic from a philosophical
congruency, coherence, and fit standpoint and can oppose the nursing worldview.
Emerging Trends in Nursing (1 of 3)
19. • Pragmatism proposes that nursing knowledge should support nursing work and
provide information about delivery of effective care and continuing development of the
discipline. • From a philosophical standpoint, a focus on problem solving pertains
specifically to epistemic problems in the discipline. • Pragmatism has received relatively
little attention as a nursing philosophy, though it is well-suited for development by
advanced practice nurses with practice-focused doctoral degrees. Emerging Trends in
Nursing (2 of 3)
20. Emerging Trends in Nursing (3 of 3) • Attempts to focus and direct knowledge were
advanced by conferences in the 1980s and 1990s and the creation of a consensus
statement in 1998. • The statement exemplifies the values and perspectives underlying
four aspects of nursing discipline: – The nature of the human person – The nature of
nursing – The role of nursing theory – The links understandings and nursing practice •
Allowed plurality of approach.
21. The Future of Nursing Knowledge Development • Preparation for the future is a
matter of perspective development, not anticipation of specific occurrences. • Requires
blending philosophy with social trends and needs in the discipline. • Requires analytical
7. nurses to identify research problems, promote awareness, and address needs through
leadership and interpersonal skills. • Theory development needs increased attention.
22. Conclusion • Nursing development has been non-linear and subject to a variety of
epistemologies. • Professionally and academically, nursing has long sought a paradigm to
call its own. • Modern viewpoints utilize individual and discipline-wide approaches to
nursing science. • Future developments will require philosophical blending and trend
analysis.
