Chapter 2The Evolution of Nursing Science

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.

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

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.

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 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)

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.

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.

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

ideology– 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 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.

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

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 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 .

• 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)

• 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)

• 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 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)

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.

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.

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.