This chapter discusses the evolution of nursing science from its origins in training to the current state. Early nursing education focused on skills but has shifted to an emphasis on understanding. Nursing science has been influenced by different philosophies over time, from logical positivism to postmodernism. Current trends incorporate pluralistic and pragmatic approaches. The future of nursing knowledge will require blending philosophy with social trends and research to identify and address problems in the discipline through leadership.

1. Chapter 2
The Evolution of
Nursing Science

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 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.
• 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 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.