• 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
• 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.
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
• 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
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
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.
• Master’s level education developed slowly, with some
programs beginning in the 1920s, but had few enrollees and
• 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
• In the last 10-20 years there has been an increase in research
conducted by nurse investigators with nursing viewpoints and
History of Nursing Education (2 of 2)
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
• Understanding the substantive structure and syntax
of nursing was the focus of development and led to a
logical positivist approach.
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
• Concerns about borrowed knowledge do not hold up
• 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.
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.
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
– Carper’s four types of knowing inherent to nursing
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
• 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.
• 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
– Holistic approach
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.
Concept Development (1 of 2)
• Historicism played a role in nursing
development, particularly in resolving
• 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 .
• More recent work focuses on developing concepts and
resolving conceptual problems without being limited to
• A number of the significant problems regarding nursing
knowledge are conceptual in nature rather than
• 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)
• 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
• In spite of the political tensions surrounding feminist
ideology, it has played an important role in nursing
The Postmodern Turn (1 of 2)
• 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)
• 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)
• 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
• 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)
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
• The statement exemplifies the values and
perspectives underlying four aspects of nursing
– 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.
The Future of Nursing Knowledge
• Preparation for the future is a matter of perspective
development, not anticipation of specific
• 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.
• 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.