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     

Nursing Specialty Knowledge as Expressed by Standardized Nursing Languages

PURPOSE. To describe how nursing specialty knowledge is demonstrated in nursing records by use of standardized nursing languages. METHODS. A cross‐sectional review of nursing records (N = 265) in four specialties. FINDINGS. The most common nursing diagnoses represented basic human needs of patients across specialties. The nursing diagnoses and related interventions represented specific knowledge in each specialty. Sixty‐three nursing diagnoses (nine appeared in four specialties) and 168 nursing interventions were used (24 appeared in four specialties). CONCLUSIONS. Findings suggest that standardized nursing languages are capable of distinguishing between specialties. Further studies with large data sets are needed to explore the relationships between nursing diagnoses and nursing interventions in order to make explicit the knowledge that nurses use in their nursing practice. PRACTICE IMPLICATIONS. Nursing data in clinical practice must be stored and retrievable to support clinical decision making, advance nursing knowledge, and the unique perspective of nursing.     

Conceptual Basis for the Organization and Advancement of Nursing Knowledge: Nursing Diagnosis/Taxonomy

An analysis of the conceptualization embedded within the development of nursing diagnoses, including the historical perspective on this process, is presented. Although there are conceptual issues still to be resolved, nursing diagnosis can be considered as a conceptual approach to developing disciplinary knowledge.     

Transforming Practice Knowledge into Nursing Knowledge—A Revisionist Analysis of Peplau

Nursing practice typically has been viewed as applying knowledge. However, currently, there is increasing awareness that nursing practice is also a process of knowledge development. Still, research and practice are not always connected. Analysis of Peplau's works illuminates a scholarship of nursing practice that is relevant today. This paper focuses on a specific strategy and philosophic perspective, as derived from Peplau, for integrating nursing practice more fully into today's knowledge development. Emphasis is on the need for nursing practice-based theory, as well as nursing theory-based practice.     

Nursing research: on what basis?

In the past 150 years nursing science has developed into a discipline of its own which has integrated features of various stages of theory development. So far most nursing theories, originally borrowed from other disciplines, have been adapted and moulded to suit the nursing context. The theories developed after Nightingale, such as developmental, need-oriented, interaction, system-oriented and simultaneity theories have come about this way. They have depicted the areas of interest in nursing which has thus been defined as the domain of main concepts and their interconnections. The methodological characteristics of research in science are derived on the basis of ontological and epistemological principles. The domain of nursing science is assumed to be an integral whole which is not divided into parts even for the purpose of research. Scientific data are obtained from this undivided world by means of man's human signification. In research, this undivided world is approached from the phenomenological tradition of science: particular topics are thematized as something, while the other aspects of the phenomenon are excluded. The accumulating scientific data are integrated to form a holistic body of knowledge which helps in understanding the phenomena in greater depth and from different perspectives. The historical development of nursing science reveals problems and conflicts which are derived from the tradition of empirical science of the last few decades. Research solutions following the empiricist tradition offer only limited opportunities to focus on the central research objects of nursing. Therefore nursing research should proceed from the phenomenological basis and follow solutions made on the ontological level. Recognition of this solution helps in defining and clarifying nursing research.     

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.     

The current status and future significance of nursing as a discipline

The nature of nursing and the need for knowledge distinct from medicine was first spoken of by Florence Nightingale in 1859. Her notions may be regarded as the earliest formations of nursing as a discipline. Since that time there has been substantial effort committed to the development of a distinct theory base for nursing. Increased interest in nursing's unique body of knowledge has been particularly evident in the last decade, as seen by the growth in research undertaken from a nursing perspective, and by the numbers of publications which focus on the nature of knowledge and theory in nursing. These efforts have served not only to advance the discipline of nursing but also to challenge all nurses to articulate for themselves the theoretical foundations of their own practice. The main thesis of this paper is that nursing is an evolving discipline. Aspects of its evolution will be discussed using the four characteristics of a discipline; domain, syntax, history, and output of knowledge.     

Nursing diagnosis: a strategy for teaching etiologies

In teaching the nursing process, educators ask students to identify nursing diagnoses for patients in the clinical area. Nursing diagnoses provide structure and focus for the student's plan of care. However, beginning nursing students have little or no clinical knowledge upon which to base decisions in the area of etiology determination. A model is presented which limits etiologies to four categories. The four categories can also assist the nurse in practice to assess needs in order to comprehensively plan and implement care. Examples of nursing diagnoses pertaining to the neuroscience patient using the four categories of etiologies are described.     

Knowledge Deficit: Not a Nursing Diagnosis

This paper challenges the conceptual validity of the approved nursing diagnosis "Knowledge Deficit (specify)." The concept is examined in relation to four criteria for legitimate nursing diagnoses: appropriate conceptual focus, necessary diagnostic attributes, theoretical validity and clinical utility. Using these criteria, the author concludes that knowledge deficit is not a legitimate diagnosis and suggests that it can be dropped from the taxonomy. This would encourage clinicians to focus on patients' Problem state using lack of knowledge as a risk factor, etiology or defining characteristic. Patient outcomes would then be defined in terms of state resolution rather than knowledge increment alone.     

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.     

Nursing diagnoses: a Dutch perspective

• ? In this article, the authors adopt a position with respect to the definition of ‘nursing diagnosis’.
• ? Two central functions of a classification system for nursing diagnoses are distinguished: domain and communication.
• ? Seven issues related to the development of such a classification system are discussed. These issues are of a methodological, philosophical and practical nature.
• ? A proposal is made for further study and development of a Dutch classification system for nursing diagnoses, preferably in collaboration with NANDA.

     

Toward a Unique Knowledge Base in Nursing

This article explores the subject of unique knowledge in nursing by attempting to answer three questions: 1) what is unique knowledge, 2) does nursing have a unique knowledge base, and 3) is a unique knowledge base essential to nursing? It argues that knowledge becomes unique because of the unique perspective of the discipline in which that knowledge is incorporated. A survey of various attempts to define the unique focus of nursing is followed by a discussion of the importance of such a definition if nursing is to establish itself as a professional discipline.     

Nursing informatics: state of the science*

The phenomena of interest in nursing informatics are nursing data, nursing information and nursing knowledge The current state of knowledge related to these phenomena suggests four implications for the development of systems to support nursing First, research has provided evidence that knowledge and experience is related to the quality of nursing assessment, diagnosis or clinical inference, and planning of nursing care, and also that knowledge is task-specific Information technology can provide access to a variety of information resources, such as knowledge bases and decision support systems, to increase the level of knowledge of the nurse decision-maker Second, structured patient assessment forms with linkages to knowledge bases of diagnoses have the potential to improve the quality of the patient assessment and the accuracy of the diagnosis or clinical inference Third, studies on planning care have demonstrated the complexity of the task when a number of options are potentially appropriate Model-based decision support applications such as decision analysis and multi-attribute utility theory can assist the clinicians and patients to analyse and compare the treatment alternatives in a systematic manner Fourth, there is modest support for demonstrating the relationship between the process and outcomes of clinical decision making Large databases built upon nursing data are needed to further examine this relationship     

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.     

Accuracy of Nursing Diagnoses: Concept Development

The concept of accuracy of nursing diagnoses was developed by the author as a first step of theory development related to nursing diagnosis. Accuracy is conceptually redefined as a continuous variable and as such contrasts with the prevailing view of accuracy that diagnoses are either accurate or inaccurate. The conceptual definition of accuracy of a nursing diagnosis and a delineation of the characteristics of accuracy emphasize the relativistic nature of the concept.     

A Framework for Hospice Nursing

The paper presents a conceptual framework for hospice nursing. Nursing is viewed as assistance to the person whose self-care activities are insufficient to meet self-care needs. A literature review on needs of the hospice client is included toward developing a hospice nursing philosophy. The paper shows how guidelines for nursing practice in hospice can be structured around the client’s self-care needs. Such guidelines include common nursing diagnoses, standards, policies and procedures. A suggested nursing documentation system is built upon the nursing process and structured around the patient’s self-care needs.     

Nursing theory and administrative practice: agenda for the 1990s

Despite past progress in the development of nursing theory, a theoretical nursing perspective is not yet common to the practice of nursing administration. Such a perspective could serve as a catalyst both to advance knowledge development for administrative nursing practice and to align clinical and administrative practice within a common framework. In this article assumptions, concepts, and questions common to both clinical and administrative nursing practice are identified. Select domain concepts are used to exemplify the themes shared by nurse clinicians and nurse administrators. The article concludes with a five-item agenda as a guide for future theory development.     

Contributions of Rosemary Ellis to Knowledge Development for Nursing

The late Rosemary Ellis outlined a path for knowledge development for nursing that has the potential for increasing the knowledge base for practice. She viewed the mission of the discipline of nursing to be the development, transmission, and organization of a coherent body of knowledge. The development of such knowledge should begin with the identification of phenomena of concern and questions for study. Moreover, said Ellis, the utilization of knowledge should be deliberate and artful so as to produce the human beneficence for which nursing exists.     

Nursing assessment and nursing diagnosis in patients with peripheral vascular disease

Effective nursing interventions are determined by the nursing diagnoses and associated etiologies. The diagnoses are derived from a complete data base that results from a thorough assessment. As the nurse proceeds through the process of differentiating among diagnoses, the focused cue search is essential. For the client with PVD, lifestyle changes, symptomatology, chronicity of the disease, and frequent contact with the health care system are the major influences on the diagnoses. These clients are likely to have potential for injury, potential for infection, impaired skin integrity, activity intolerance, alteration in tissue perfusion, alteration in comfort, and knowledge deficit. Other diagnoses are probable but are determined by the unique characteristics of each client.