Is the professional code still the cornerstone of clinical nursing practice?*

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century Up until the early 1970s they promulgated subservience to the medical discipline As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation The influence of the code in the areas of moral decision making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice     

Philosophy of science in doctoral nursing education revisited

Because every scientific theory and all research methods are tied to some philosophical framework, it is important that scientists within a given discipline be aware of the philosophical orientations that serve as the basis for developing theory and advancing knowledge. Nurse scientists have been challenged recently to examine the discipline's philosophical underpinnings in order to understand the evolutionary process of nursing science. The inclusion of the study of philosophy of science in doctoral nursing curriculum has remained a topic of periodic discourse. Whereas some assert that it promotes the essential process of philosophical reflection necessary for scientific exploration of relevant phenomenon, others contend that nurse scientists' preoccupation with this issue has diverted their attention from the real business of nursing science—that of knowledge development that will lead to legitimization of nursing as a discipline. Philosophy of science provides a useful frame of reference in which to appreciate the unfolding of nursing as a discipline. It should not be viewed as a distraction but rather a critical step in the transformation of the doctoral student into a productive nurse scientist. Doctoral programs remain the most logical place in which to educate future scholars regarding nursing's unique philosophical foundations and their implications for scientific inquiry and continued knowledge development. Creating and maintaining liaisons between nursing and philosophy departments—as well as requiring courses that emphasize the interrelationships among philosophy of science, nursing theory, and nursing research—are just a few of the strategies whereby doctoral programs can actively promote advancement of the discipline.     

Is the professional code still the cornerstone of clinical nursing practice?*

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century. Up until the early 1970s they promulgated subservience to the medical discipline. As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient‐advocacy, based on a personal and individualized care system. Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision‐making abilities, whilst having little or no active knowledge of the existing professional codes. Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation. The influence of the code in the areas of moral decision‐making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice.     

The acceptance of a philosophically based research culture?

Gullifer J. International Journal of Nursing Practice 1997; 3: 153–158
The acceptance of a philosphically based research culture
This paper addresses a trend that emerged at a nursing research conference held in New South Wales during 1996. The trend was a downplaying of the relevance of philosophical and theoretical bases for research in nursing. Such a trend would not be of concern if all research aimed to merely generate local, non-generalizable conclusions and recommendations. However, research that aims to develop knowledge that can provide relevant knowledge on a broader, or universal scale, needs to be based on coherent and relevant philosophical and/or theoretical foundations. To adequately critique such research it should ideally be linked to a philosophy or theory that situates it in both historical and intellectual loci and consequently, the raison d'etre for the research should arise. This paper begins with an exploration of Immanuel Kant's philosophy and proceeds to a discussion on the philosophical underpinnings of Dorothea Orem. It is intended that such discussion will assist the clinician to see the relevance that philosophy has to clinically based research in nursing and, importantly, the critique of such research. In conclusion, two possible reasons are suggested as to why philosophy and theory in nursing research may appear to be increasingly frowned upon. It is hoped that a greater understanding of the power of philosophically based research will contribute to an increased enthusiasm and uptake of philosophically based research projects by nurses.     

A critical analysis of the philosophy, knowledge and theory underpinning mouth care practice for the intensive care unit patient.

In the provision of high quality mouth care practice for the intensive care unit (ICU) patient, the nurse draws on philosophy, knowledge and theory. The complexity of mouth care for the ICU patient is compounded by their medical or surgical condition and the psychological effects of mouth care problems. Effective mouth care practice includes proactive prediction and prevention of complications, and prompt and skilled intervention in the problems arising. Therefore, critical analysis of the philosophy, knowledge and theory relevant to mouth care practice is important. The philosophical approach to mouth care requires the nurse to view the practice from different perspectives. Nursing knowledge has inextricable links with nursing practice that challenges the nurse in her/his everyday work. This application of knowledge to practice is conceptualised as ways of thinking, which is also based on what the nurse might know. Therefore, the judicious use of theory and the necessary skills are essential to provide high quality and effective mouth care practice. The purpose of this paper is to illustrate the ways in which philosophy, knowledge and theory all have an impact on the practice of mouth care for the ICU patient.     

A paradigm for the production of practice-based knowledge

Aim  The aim of this paper was to explore trends, arguments and issues surrounding knowledge production and nursing practice, and to propose a paradigm of practice-based knowledge along with strategies to promote theory-based knowledge development in practice.
Background  Practice-based knowledge has been marginalized in the current practice and research paradigms. Several reasons for this are presented, some of which may be addressed to facilitate a more inclusive approach to knowledge that can potentially advance patient care and the discipline.
Evaluation  Classic and contemporary scholarly sources in nursing, philosophy, education, social sciences and other areas were critically reviewed and applied to support the argument and propose a paradigm of practice-based knowledge production.
Key issues  A key point identified in the paper is that theory, meaning conceptualizations at all levels of abstraction, is an important tool of knowledge development in nursing practice as it is in traditional research.
Conclusions  Various strategies exist that can be employed to promote development and use of practice-based knowledge in the clinical setting. The strategies are innovative yet practical, and require the support and encouragement of nursing management for their successful implementation.
Implications for Nursing Management  Nursing managers can influence if not facilitate all of the strategies to promote practice-based knowledge development identified in the paper. These efforts could give voice to the caregiver's knowledge and, in turn, enhance patient care and the satisfaction and retention of nurses.     

Respect for human dignity: a central phenomenon to philosophically unite nursing theory and practice through consilience of knowledge

Nightingale suggested that there should be no distinction between "men of thought" and "men of action" and that an "Ideal" or philosophy should not be isolated but incorporated into everyday activities. This construct is analogous to the belief that nursing theory and nursing practice should be incorporated, and both should reflect a common central phenomenon. The pursuit of nursing knowledge by women of "thought" is not viewed as a central phenomenon but is an outcome of scholarly inquiry. Outcomes pursued by practicing nurses, women of "action," depend on their particular role and scope of practice. A number of outcomes are possible ranging from prevention, public health and policy, alleviation of pain and suffering, and individual health promotion and healing to palliative care. These outcomes are not viewed as the source of unity to guide nursing since they may vary, especially with developments in science, technology, and philosophy. A more unifying central phenomenon could be viewed as the respect for, or the restoration of, human dignity, our being in community, our being in the world, and our sea of a moral imperative. Consilience, a way to unify the knowledge that is needed to support this phenomenon, is suggested as an example of an approach to a philosophy of nursing that embraces multiple forms and sources of knowledge in all-encompassing morality that ultimately ennobles the lives of all human beings in covenantal relationships with nurses both in theory and in practice.     

A personal nursing philosophy in practice

The use of a nursing philosophy as the basis for nursing practice promotes the proper application of nursing knowledge as well as the development of further nursing theory and knowledge. My personal philosophy of nursing seeks to encompass the art of conveying nursing science holistically with compassion and dignity. To illustrate this nursing philosophy, the four nursing metaparadigm concepts are described in relation to nursing as both a science and an art. Nursing science and art are also discussed in relation to nursing as a profession. The concepts of family-centered care and developmental care highlight the practice of nursing as an art. The use of nursing knowledge in practice is discussed through the use of nursing's five ways of knowing, nursing theories, borrowed theories, and nursing's paradigms. The concept of the nurse scholar and the further development of nursing knowledge is identified as a priority. Supportive examples from my nursing experience working in a Neonatal Intensive Care Unit (NICU) are utilized to highlight the importance of nursing knowledge development and the provision of optimal patient care.     

Evolution of Nursing Science: Implications For Nursing World Wide

This article uses the framework of professionalization and discussess one central criterion, generation of a unique body of knowledge, as a requirement for professional maturity. Following the lead provided by the nursing profession in the United States of America, the standards of nursing education and practice are steadily increasing around the world. However, success in this area of improving professional performance greatly depends on the generation of commensurate scientific knowledge. The writer pleads for systematic efforts for sharing and evaluating nursing theory across national boundaries, identifies additional possible channels, and hopes that the attempts of Sigma Theta Tau in this direction will be effective.     

Identifying alternative linkages among philosophy, theory and method in nursing science

The major concerns expressed in the literature regarding the development and expansion of nursing science stem from questions related to 'what sorts of science' and 'which scientific methods' are appropriate for nursing While there is a sector of nursing's scientific community that advocates a unified approach to philosophy and method, a growing sentiment for the position of philosophical and methodological pluralism is apparent This paper addresses the nature of scientific pluralism by presenting a framework for alternative linkages possible among the philosophy, theory and method appropriate for nursing science The nature of nursing knowledge that is produced within the discipline will thus depend on various forms of alternative linkages adopted by nursing scientists in addressing nursing's scientific questions In turn, such pluralism presents problems of choice to nurses in practice with respect to knowledge utilization     

Bridging the gulf between science and action: the "new fuzzies" of neopragmatism

Rather than a philosophy, pragmatism is a way of doing philosophy that has major implications for solving disputes involving nursing science, theory, and practice that may otherwise be interminable. Pragmatism weaves together theory and action so that one modifies the other continuously, but both maintain their mutual relevance. Pragmatism emphasizes pluralism and diversity, and depends on an ethical base for determination of what is reasonable. Recently repopularized by the philosopher Richard Rorty and others, pragmatic ideals seem inherent to nursing. We propose that a better understanding of the history and utility of pragmatism will enhance both clinically relevant nursing theory and theoretically relevant nursing practice.     

The relationship between qualitative research and positivism

Historically, positivism has been the dominant approach in the philosophy of science. In nursing, most quantitative researchers tend to employ positivism as their epistemological underpinning, which could be why positivism has long been identified as the epistemology of quantitative research. It can be argued, however, that some of the procedures of qualitative research reflect the perspectives on which positivists insist. This article takes grounded theory and phenomenology as examples, in order to observe how positivism influences their methodologies, evidence obtained is then used to support the aruthors' arguments. The article, furthermore encourages beginning researchers to familiarize themselves with background knowledge of philosophy of social sciences, especially epistemologies and methodologies, in order to make clear the philosophical context in which their research is conducted.     

Philosophy and nursing

It is claimed that philosophy has a distinctive contribution to make to the education of nurses and their teachers, as well as to the development of nursing theory and research. After a brief characterization of philosophy and philosophy of education, stressing its relationship with thinking processes, and the development of personal values, the above claim is supported in the body of the article by discussion of four central concerns in nursing. First the concept of caring where cognitive, moral and attitudinal aspects are examined and secondly, the importance of gaining a moral and political consciousness of assumptions underlying a nurse's work. Thirdly, a discussion of some ethical and other implications in adopting a systems approach to the nursing process. Finally an analysis of nursing theory and research which draws attention to the value of non-empirical work, and reiterates criticisms of the objectives approach as a research tool.     

Children's nursing: can it justify a separate existence in the UK?

There is currently debate about how the professional register for nurses is organized in the UK. Children's nurses, like the other minority registrants of mental health and learning disabilities nurses felt threatened with the potential loss of a separate register. Children's nurses should be able to articulate their own unique body of knowledge. Using Fawcett's framework for the hierarchy of contemporary nursing knowledge, the development of children's nursing knowledge is examined to determine if, indeed, children's nursing is a separate discipline, by having its own metaparadigm of children's nursing, philosophy, conceptual model of nursing, nursing theories and, finally, empirical indicators. Although some levels of knowledge appear to have been developed, it is considered that children's nursing is still lacking in some levels of knowledge, thus suggesting that the continuing development of children's nursing knowledge is necessary.     

Re-establishing psychodynamic theory as foundational knowledge for psychiatric/mental health nursing

Psychiatric nursing care is based on an interpersonal process that relies on the therapeutic use of self in the service of patient care. Despite acknowledgment of the importance of the relationship, there has been little attention paid to the knowledge embedded in psychodynamic theory that can provide a basis for understanding the nurse-patient relationship. This paper argues that nurses need to understand and apply such theory if they are to pursue the assertion that the relationship with the patient is the foundation of their practice. The authors discuss the essential components of psychodynamic theory and their application to nursing as well as the possible reasons for the loss of interest in such theory.     

Re-Establishing Psychodynamic Theory as Foundational Knowledge for Psychiatric/Mental Health Nursing

Psychiatric nursing care is based on an interpersonal process that relies on the therapeutic use of self in the service of patient care. Despite acknowledgment of the importance of the relationship, there has been little attention paid to the knowledge embedded in psychodynamic theory that can provide a basis for understanding the nurse-patient relationship. This paper argues that nurses need to understand and apply such theory if they are to pursue the assertion that the relationship with the patient is the foundation of their practice. The authors discuss the essential components of psychodynamic theory and their application to nursing as well as the possible reasons for the loss of interest in such theory.     

From vocation to profession: the quest for professionalization of nursing

This article examines some of the complex factors in the transition of nursing from vocation to profession. These factors include university education, knowledge, gender, and workplace environment. It argues that the conventional definitions and characteristics of the professions and knowledge are tainted with gender bias. The uniqueness of nursing knowledge lies in the combination of scientific and holistic knowledge required for patient care, which is different from other healthcare professions. It suggests an alternative means of recognizing the clinical expertise of frontline nurses so that their contribution to patient care can be acknowledged. Together with the extended and expanded role of specialist nurses and nurse managers, nurses can impose their presence and consolidate their power base in the quest for professionalization.     

Professionalization—Theoretical Analysis of the Implications for Nursing Practice

The aim of the present paper is to examine ideas of professionalization, and to explore in what way they might give directions for the development of nursing practice. An examination of the literature on professionalization in social science reveals that the existing ideas of professionalization may be divided into two paradigms, denominated naive paradigm and cynical paradigm. Both paradigms have been criticized on the grounds of being idealistic and ahistoric. A contemporary view has developed from this criticism, oriented towards the historical and social contexts of professions. The implications for nursing practice of this view brings into focus the development of nursing practice in relation to the public and the tradition of nursing. This view of professionalization contributes to a contemporary view of nursing practice, and an expanded idea of professionalization is discussed.     

Nursing Values and Science: Toward a Science Philosophy

Several premises are proposed for nursing science philosophy in contrast to nursing practice philosophy. These include human understanding, a critical tradition that views science as public knowledge, and use of observation, rationality, explanation, and prediction as a guide to therapy. No argument is made for or against a particular philosophy of science (e.g., positivist, historicist, critical theorist). The debates on the fit of philosophic paradigms with research strategies may soon run their course on the North American continent, as they appear to have done in Scandinavia.     

Looking at discourse in a literature review of nursing texts

The issue of knowledge has generated much literature, recently from writers influenced by post-modernism These writers argue that an epistemological space has existed since the time of the Enlightenment with which anyone concerned with value or truth has to grapple The analysis of nursing texts detailed in this paper gives an account of such grappling The link between discourse, knowledge and power is also explored Using a discourse analysis approach, this paper offers an examination of nursing texts on research, education, professionalization or conceptualizations known as nursing models It argues that groups in nursing have responded to the dominant biomedical discourse by seeking to re-establish their activities within a different discourse, one involving caring, holism and, within research, a qualitative approach Others have aligned their search for appropriate truth claims with feminist projects After examining some of these responses, this paper attempts to point to some of the problems of aligning a professional strategy with one of political emancipation and philosophical shift The paper argues that the issue of a philosophical and moral base for nursing is particularly crucial at a time when so-called market rationalism dominates not only in health care but in an increasing range of human activities