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Similar to Chapter 2 the evolution of nursing science
Chapter 2 the evolution of nursing science
- 1. Chapter 2 The Evolutionof Nursing Science
- 2. Introduction • Nursing practiceis 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 aDiscipline • 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 NursingEducation (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 leveleducation 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 asa 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 ofNursing 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 Movementin 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 • Hypertensioncan 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 fora 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 (1of 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 recentwork 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 emphasizedhermeneutics, 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 scientificprinciples 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 erain 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 proposesthat 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 inNursing (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 ofNursing 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 developmenthas 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.