Thoughts on the discipline of nursing as we approach the year 2000

A discipline is 'characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry' (Donaldson & Crowley 1978). Further, Chinn & Jacobs (1987) define discipline as a 'branch of instruction; a body of knowledge and of systematizing that knowledge within an area of concern or domain of inquiry'. The position taken in this paper is that nursing, as it approaches the year 2000, is an evolving discipline that is 'dedicated to the advancement of knowledge which contributes to the pursuit of excellence of care' (AARN 1985). The writer agrees with Jennings' (1987) position that theory gives definition to nursing's body of knowledge, and direction to research and practice. This paper addresses some of the issues and concerns related to the development of nursing knowledge which serves as a cornerstone for the discipline. It goes on to consider briefly a few tasks that face nursing as it approaches the year 2000.     

Critical theory: critical methodology to disciplinary foundations in nursing.

Increasingly in the nursing literature, theorists have examined the use of critical theory in nursing (especially as understood by Habermas) and many have advocated it as a research approach to guide knowledge development in nursing. There has been limited analysis, however, of critical theory's broader foundational implications for the discipline of nursing. Part of the difficulty stems from a failure to differentiate between the implications of Habermas's earlier work on knowledge interests and his later theory of communicative action. In this paper, Habermas's critical theory is explored along two dimensions: as a metatheoretical account of a methodology of critical theory as a research tradition; and as a theory of communicative action whose dialogical and normative assumptions have profound implications for a postfoundationalist grounding of nursing as a discipline and professional practice. The authors argue that critical theory is necessary for nursing and may be sufficient as a paradigmatic philosophical base for the discipline.     

The focus of the discipline of nursing.

The focus of nursing as a discipline has not been clearly defined but is emergent in the centrality of the concepts of caring and health. The authors propose a focus for nursing as a professional discipline in the form of a statement that identifies a domain of inquiry that reflects the social relevance and nature of its service. Several perspectives from which the focus can be studied are described. The authors assert that a unitary-transformative perspective is essential for the full explication of nursing knowledge.     

Nursing knowledge: women''s knowledge. A sociological perspective

As nurses approach the 21st century questions are being raised regarding the direction in which the profession is moving. The majority of leaders and educators in the field of nursing have, to this point, stressed the importance of defining nursing as a science and of developing a scientific knowledge base. Recently, however, there has been a move among some researchers and theorists in the field of nursing to question the ability of science and the scientific method to deal with nursing concerns. Using a variety of perspectives, including feminist theory, they are critiquing many of the basic assumptions about science, scientific method and scientific knowledge. This paper uses sociological and feminist theory to support the idea that nursing, as a discipline, has a distinct knowledge base which is not grounded in empirico-analytic science and its methodology but which stems from the lived experiences of nurses as women and as nurses involved in caring relationships with their clients.     

The Nature of Knowledge and Theory in Nursing

The formulation of nursing as a discipline is under way. Work on theory development, concept clarification and the development of a knowledge base is spurred by the creation of new doctoral programs and the emphasis on nursing research. As nursing establishes itself as an inventor of theory, the contrasts and similarities between its existence as both a practice profession and academic discipline come into sharp focus. As nursing strives to understand itself both as a user-applier and discoverer-inventor of knowledge and theory, it provides a model for other practice professions and academic disciplines to explore such questions as, What is the nature of theory in practice? What is the role of application in the formulation of theory? This paper examines the characteristics of theoretical constructs as they apply to the practice of nursing, the use of theory in that practice and the limitations of theory in application.     

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.     

Nursing: an integration of art and science within the experience of the practitioner

In this paper it is proposed that whilst nursing knowledge is underpinned by the philosophies of art and science they are integrated in such a way that nursing is greater than their sum and is thus a unique discipline It begins with an exploration of the philosophies underpinning art and science, and their relationship to nursing The discussion then moves on to examine critically the nature and development of theory in nursing with reference to art and science, the nursing knowledge thus generated and how that knowledge is learned and expressed The paper concludes with an evaluation of how far the discipline of nursing lies within the paradigms of science and of art, and whether indeed art and science may be, to some extent, false distinctions The authors conclude that nursing may be viewed as an integration of art and science, expressed through the practitioner's unique, yet also shared experience     

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     

The focus of discipline in nursing: clarification with ontologic basis

The discipline of nursing is enhanced by the contributions of theoricians, researchers and practitioners in nursing who created ways that promote the knowledge development of nursing. The contribution of ontology allows for the clarification of the nature of reality from which stem the visions about phenomena to be studied. In nursing sciences, these visions are embedded in two different paradigms that influence the nature of the focus of the discipline as well. Some statements about the focus of the discipline are analysed and rules allowing for the choice of a coherent heuristic mode are set forth according to the chosen paradigm. The coexistence of paradigms deserves the respect of the different visions and the engagement to evaluate the theories of the discipline in relation with the values grounding our service to the society.     

Sociology and the nursing curriculum: a note of caution

One of the consequences of the expansion of degree, and diploma level Project 2000 courses in nursing, has been that students are now exposed to a significant amount of material from academic disciplines other than nursing, at a relatively advanced level In this paper, one such discipline, sociology, is considered, and its relevance to the nursing curriculum is assessed Following a consideration of two theoretical models of the relationship between academic disciplines and professional practice (the'personal education'and 'semantic conjunction'models), it is argued that whilst the implicit rationale for the inclusion of sociology in the nursing curriculum can best be understood in relation to the latter, neither model offers a convincing reason as to why we should teach sociology to nurses It is argued instead that the nature of sociological knowledge is inherently multi-paradigmatic, and hence reflexive, and so cannot in principle provide a knowledge base for action-oriented conduct such as nursing work     

Nursing theory: everything the artist spits is art?

This paper explores the concept and utility of nursing theory in and for the practice of nursing Working from the premise that many nurse practitioners appear uncertain as to the value of theory in relation to their everyday working experience, the paper investigates the contribution nursing theory makes in terms of sustaining and developing nursing as a practice discipline The fact that nursing theory remains at once poorly evaluated, articulated or understood appears to be compounded by a general perception of nurse theorists as being removed from the realities of the practice setting and by the confusion precipitated, not least, by the semantic ambiguity engendered by their writings The paper reviews the complex relationships extant between the development of nursing theory m regard to its utility for nursing practice, and concludes by suggesting a practice-led perspective by which nursing theory may be better articulated and assimilated with in the discipline In order to facilitate the study, it has been necessary to investigate the historical, theoretical and philosophical imperatives pertaining not only to the development of nursing theory but to nursing research and nursing practice per se     

Nursing theory development: successes and challenges

Central to this paper is the belief that developing nursing theory is fundamental to establishing nursing's scientific foundation. Therefore, the paper examines successes and challenges in nursing theory development. This is achieved by evaluating both the present status of nursing theory as well as ideas for future directions. Within present status, the author considers three areas--those in which there is agreement, those in which both opinions differ and the prescribed course of relationships has not yet been achieved, and those which may serve as catalysts for future progress. A tripartite framework is also used to contemplate future directions by evaluating how nursing's knowledge has developed, what improvements and refinements might take place, and how the domains of nursing might be expanded. The author concludes that satisfaction and pride in current successes are not only justified but may motivate future pursuits; pursuits that are necessary to advancing the discipline of nursing.     

The imperative to address institutional racism in nursing practice

Racism has been a part of nursing since its inception and has influenced its models, practices, selection of ascribed leaders, and problem framing. Reducing health disparities by effectively addressing how racism influences institutional practices is both necessary and relevant to the discipline of nursing. Using concepts from systems theory and business operations management this paper provides an important perspective for the discipline to begin to effectively address institutional racism and build nursing knowledge.     

Synthesis in nursing knowledge: an analysis of two approaches

The need for synthesis in nursing knowledge development has been attested to by many authors. It is consistent with nursing's holistic focus and is the mark of a mature discipline. This paper examines two approaches to synthesis: the use of multiple paradigms and the possible emergence of a new paradigm based on chaos theory. It argues that in their current form both approaches have flaws and neither achieves synthesis as it is here defined. However, both may make significant contributions to the development of nursing knowledge.     

Martha E. Rogers: a life history

The 20th century in nursing has focused heavily on theory development. While theorizing about nursing--what it is, and what it is not--can be traced back to Nightingale, Martha E. Rogers' An Introduction to the Theoretical Basis of Nursing (1970) marked the advent of a new era in nursing science. With a view of nursing as a "learned profession," this landmark work staked out a substantive knowledge base for the discipline. The science of unitary human beings proposed by Rogers was a radical departure from all that had come before and is seen by many as pioneering the beginning of a paradigmatic shift within the profession. The purpose of this inquiry is to document the self-described events across the life span of Martha E. Rogers that she perceived as having influenced the development of the science of unitary human beings. A life history approach is utilized and the data are organized chronologically. This life story of Martha E. Rogers is essential to the current and future understanding of the evolution of the culture of nursing. Likewise, more is learned about the nature and process of theory development.     

Toward more clarity in terminology: frameworks, theories and models

Lack of precision in a person's choice of words, which perhaps indicates a lack of clarity and accuracy in ideas, may become a subtle form of negative teaching. It is suggested that such terms as "conceptual frame of reference" and "theoretical framework" should be used as broad terms for conceptions of reality, reserving "philosophy," "theory" and "conceptual model" as more restricted terms for conceptions of reality. Nurse authors do not agree that nursing theory exists, that nursing has its own body of knowledge, that nursing is a science or even a discipline. Yet nursing is fully equipped to justify its claim to such terms. Starting from a nursing perspective rather than from a borrowed one, nursing theory can be developed, nursing knowledge can be accumulated, and nursing science can be advanced, all in the interests of a worthwhile contribution to society's health.     

Unity of knowledge in the advancement of nursing knowledge

During the past 20 years, we have witnessed an explosion in nursing knowledge providing the discipline with diverse and multifaceted theoretical frameworks and paradigms. One knowledge theme that pervades the dialogue in the scholarly literature is that of multiple ways of knowing. With the acknowledgement that the fundamental nature of nursing knowledge is grounded in the understanding of human nature and its response to its environment, comes an imperative for a consilience of knowledge. The purpose of this article is to present such a unified worldview by articulating a vision of nursing knowledge, a meaning of unity of knowledge, and a challenge to the discipline to embrace inclusive rather than exclusive ways of knowing.     

Reinstating the 'Queen': understanding philosophical inquiry in nursing

Title. Reinstating the ‘Queen’: understanding philosophical inquiry in nursing Aim. This paper is an introduction to the characteristics of philosophical inquiry. Background. Despite over a century of philosophical thinking in nursing, philosophical inquiry has yet to be positioned as contributing substantially to the field of nursing’s inquiry. There is a need to articulate the nature and characteristics of philosophical inquiry for researchers new to this perspective. Method. We begin by addressing a common question that surfaces when one begins a work that is philosophical in nature, how does one differentiate between nursing philosophy and nursing theory? We then address the nature and characteristics of philosophical inquiry. We conclude by considering the question of whether philosophical inquiry might be considered a form of qualitative inquiry. Findings. Unlike science, which relies upon investigative methods, philosophical inquiry relies upon the capacities to think and reason. Problems characteristic of philosophical inquiry include conceptual clarification, analysis of arguments and problems related to the ontology, epistemology and ethics of nursing. Although methodological approaches to philosophical inquiry are diverse, common tools include assumptions and the intellectual processes of conceptualizing, judging and reasoning within a context of wonder. Conclusion. Some have argued that to neglect philosophy in nursing is to place the discipline at risk. However, there is little guidance available to researchers new to this method of inquiry. By providing a beginning roadmap, our hope is that philosophical inquiry will take its place alongside scientific methods of inquiry with the goal of constructing robust knowledge for the discipline of nursing.