Theoretical Bases of Nursing - Essay Example

Theoretical Bases of Nursing Part- I The conceptual and theoretical knowledge that underpins nursing as a professional discipline: Nursing scholarship. Introduction: Nursing theories both implicitly and explicitly direct all avenues of nursing that includes nursing clinical practice, education, and administration. They provide the structural framework for developing, evaluating, and using nursing scholarship and for extending and refining nursing knowledge through research. These theories are the basis of the conceptual designs that determine the place of nursing in health and care of illness. Theories, therefore, build the structure and substances to ground the clinical practice and scholarship in nursing. With time, as expected, there would be paradigm shift in knowledge, and these would bring about changes in the discipline or practice. Therefore, it is the requirement of acceptable theories to be flexible and dynamic enough to keep pace with the growth and changes in the discipline in clinical practice (Barnum, 1998. 15-37). Nursing is now considered to be a discipline of knowledge that includes an array of facts, concepts, and approaches to inquiry. The discipline of nursing is acknowledged also to be a community of scholars that includes nurses in all places where nursing takes place, and this is indeed scholarship in the sense that it shares commitment to values, concepts, and processes to guide the thought and work of the discipline. Consistent with thinking of nursing scholars about the discipline of nursing, is the idea that it needs nursing theories more than anything else. Moreover, professional clinical nursing today is just scholarship due to the fact that nursing works, now, on a unique and vast knowledge base that has matured through phases of development. Nursing as a professional practice science that is dedicated to the problem solving for human health issues, calls for scholars who are accountable for understanding these theories and conceptual frameworks to be able to utilize them in guiding practice, research, education, and regulation (Chinn & Kramer, 1995, 27-48). Boyer's analysis of scholarship builds on one basic concept. The academic's first and foremost role is to be a scholar exclusively. Boyer's analysis of scholarship identifies 4 key roles, discovery, integration, application, and teaching. Teaching, in his opinion is not simply a matter of dissemination and transmission of knowledge, but a form of scholarship. Therefore, it would involve transformation and extension of knowledge through the process of critical debates and an insistent examination, investigation, and challenge of both content and pedagogy. His assertion, that this could involve analysis of "various kinds of academic work, while also acknowledging" their dynamic interactions in order to form an independent whole would enable one to look at nursing scholarship in a broader context, allowing it to be seen and perceived as an interrelated whole with distinctive components that opens avenues for a varied approach to knowing (Boyer, 1996, 1-6). Boyer is one of the pioneers in the recent times, who assigned a meaning to scholarship, and proposed that there are four different categories of scholarship. The most familiar of them is the scholarship of discovery which is very intimately associated with original research. As expected, this form of scholarship would call for deeper comprehension of research processes and intense involvement with activities emanating from that comprehension. According to Boyer, there are four different categories of scholarship. The first and the foremost area of scholarship is that of discovery. The scholarship of discovery is intimately related to original research, and this demands activities that enhance a deeper understanding of the methodical aspects of the research processes. The deeper understanding of the research processes would tend to answer the discipline's pressing questions. This specific category calls for standards, significance of the research, credibility of the investigation, and the standing of the investigators. For example, at nursing research, this category will produce breakthrough solutions or answers to problems encountered in the profession. But, this is not always possible due to the fact that a nurse researcher is basically a nurse first, then a researcher. Many other disciplines found this difficult to implement in conjunction with their professions, and the need for those disciplines were of other kinds to advance the profession. Therefore, a second area of scholarship, the scholarship of integration was proposed. By the name as it suggests, indeed, this is a quest for searching and finding connections between different discoveries that can lead to entirely new wisdom and insights about an area of investigation or discipline. Applying this concept in the discipline of nursing, if its goal is to expand the knowledge of human experiences through creative conceptualization and research, the nurse scholar need to focus on developing scientific enquiry that would advance the science of nursing. Thus, the nurse scholar would need skills in creatively conceptualizing, dialoguing, utilizing the findings from research to conduct either basic or applied research. This is befitting answer to the challenge of generating new knowledge for the discipline. Thus integration is not only just a category of scholarship, it also indicates that the nurse scholars will engage in integrated research-practice activities using nursing methodologies to test and apply conceptual models of nursing and nursing theories in order to provide nursing services to people. The third type of scholarship defined by Boyer is that of application. There is conceived need to utilize research, and that can happen through building a bridge between theory, research, and practice. Therefore, scholarship of application encompasses translation of knowledge to solve problems for individuals, families, and societies. In order to achieve best outcome, this type of scholarship deals with integration of knowledge to solve problems for individuals, families, and societies. There are, however, examples where research has generated knowledge that has not apparent benefits inherent in it for the society. But, according to this category of scholarship, research must be relevant in the sense that knowledge that is developed must emanate from the necessities of the society, and relevant knowledge must be translated into social benefits. This interdependence when applied to nursing practice leads to practice that is evidence based, and nurses must be in continuous pursuit of integrating research findings and evidence from research to upgrade practice for the benefits of their patients. Since nursing is s discipline related to human responses, it is expected that disciplines oriented to human responses may require a different set of rules to determine its scholarly progress and development. As expected in nursing, these criteria would evolve from the subject-oriented nature of the clinical and human sciences. Therefore, scholarliness in such disciplines would provide different routes and different destinations. Their scholarship would be more congruent with the nature of nursing. The question is, would it fit to the Boyer's categories of scholarships Boyer's predictions of four categories of scholarships are on the assumption that the discipline needs to be scholarly. Before going into the discussion, whether nursing can be termed as a scholarly discipline, it is important to review the fourth category of Boyer's theory of scholarship (Northrup et al., 2004, 55-62). The fourth type of scholarship is that of teaching that is not identical with good teaching. For teaching to be a scholarship, the work must be communicated and public, should be peer reviewed critically, must be reproduced, should be compared to some accepted standards for quality control, must be cumulative, building on the works of other scholars. It is to be remembered that every scholarship is associated with a robust theoretical discourse, which nursing has already in place contributed by the scholars who have built the nursing theories. But to develop it further and to increase it in both effect and volume, it needs theoretical thinking and theory driven dialogues. The nursing has critical thinking as a tool to this end, and developing, refining, and analyzing theories needs integration through critical analysis, thinking, and synthesis of theories, and all these processes construe one category of Boyer's scholarship. Scholarship in nursing, thus, builds on its defined mission of client benefits and is indeed based on rigorous and credible research that is based on well-developed, well-supported, and significant nursing theories. The scholarship of this discipline is driven by the nurse theorists' theories that provide the members of this discipline with the means to articulate their focuses, and this actually has implemented the integration of theory, research, philosophy, and nursing practice. To the nurse as a scholar, the scholarship is evident in the synthesis and integration between a discipline's different components, so the nurse can critically examine the relationships among the theory, research, philosophy, and practice, and out of that clinical scholarship is synthesized and practiced, and to hasten its progress, the scholar feels the necessity of fundamental as well as clinical research (Boyer, 1996, 1-6). Nurses have used different means of analytical processes to conceptualize, collaborate, and corroborate the truth in their theory and practice, and this would not have been possible without nursing scholarship. They have used all these means to constitute multiple truths that combined subjectivity and objectivity. Because of the consideration of the relationship between science and the complex humanity, between philosophy and science, and between science and ethics, the nurse scholars have realized that the purpose of nursing as a human science would only be achieved through scholarship in nursing (Cody, 1997, 3-5). Part-II Identify and discuss the components of the structural hierarchy or holarchy of contemporary nursing knowledge. The notion of paradigm can be useful to understand nursing knowledge. Paradigm is a global, general framework made up of specific assumptions about aspects of the discipline held by members to be essential in development of the discipline. Paradigms constitute the models that guide scientific activity and knowledge development in any discipline. According to Kuhn, this does not take a smooth predictable path of knowledge development, rather it happens in surges when traditional or conventional thoughts are challenged by new ideas, and paradigm shift occurs, and the new convention replaces the older ones. This imbibes the concept that a community of scholars work in the context of the society to conceptualize novel theories that stands against the older ones. Like in any other disciplines, nursing as a discipline is not an exception to this phenomenon (Cody, 2003, 225-231). Paradigms and worldviews of nursing are subtle and powerful, permeating all aspects of the discipline and practice of nursing. Today's nursing also experiences newly articulated perspectives, where some traditional views are strengthened, while some are discarded and replaced by newer knowledge, and it can be confidently stated that the science of nursing, as an integral part of broader medical science, is developing continuously with infiltration of newer paradigms and world views with fresh and innovative perspectives on persons, nursing, and knowledge development. This would not have been possible without scholarship in nursing that has critically addressed and conceptualized disciplinary concerns and questions based on values and beliefs about humanistic aspect of the nursing science, care processes in nursing, and holistic nursing. As it occurs in any other discipline, there are additional or alternative ways to describe and understand nursing theory (Pearson et al., 2005, 43-55). Fawcett views it in a different manner asserting that nursing theory is one component of the hierarchical structure of the nursing knowledge development that includes metaparadigm, philosophy, conceptual models, nursing theory, and empirical indicators. According to her, these conceptual levels of knowledge development in nursing are interdependent in that development in each level is influenced by knowledge development at other levels. This indicates that theoretical work in nursing is dynamic and extremely collaborative and corroborative in such a way that it must be continually in process and useful for the purposes and work of the discipline (Fealy & Mc Namara, 2007, 1187-1195). At the same time, it must be accommodative and extensive with a goal to guide nursing endeavours so it may serve as an indicator for the development of knowledge in the discipline of nursing. In this hierarchical structure, based on level of abstraction, metaparadigm is the most abstract component in the structural hierarchy of knowledge. This hierarchy consists of highly abstract component concepts that can be used to identify the topic of interest to a discipline and general propositions that might interconnect the relationships in the components of the phenomenon. Being the most abstract, staying at the top of this hierarchical model, metaparadigm provides the broadest consensus of the discipline, and therefore, it represents extremely global propositions and concepts, and is consequently able to provide no definite directions to research or practice. Viewed from a different perspective, metaparadigm would set the general parameters of the field and provides scholars with a very broad orientation. Thus metaparadigm only just provides a summary of the intellectual and social aspects of the discipline in order to mark a boundary delineating the area it is supposed to cover. Metaparadigm is the identity and distinction of a discipline from others. Historically, the metaparadigm of nursing described concepts of person, environment, health, and nursing. Modifications and alternative concepts for this framework is consistently and continuously explored in the practice of nursing. A dialogue about these perspectives can only lead to knowledge development in nursing since it covers the general domains of nurse and her environment that comprises of client, client-nurse encounters, practice, and environment. As the metaparadigm develops in nursing, these are accompanied by changes in statements of values and beliefs that connote directly to nursing philosophies. Therefore, the philosophy, the next level in the hierarchy represents the statements of beliefs and values about human component in the discipline. Thus, it encompasses claims and notions about human natures, and the goal of the nursing discipline as it relates to that. This would give rise to epistemic claims about the origin and development of knowledge and would be governed by ethical philosophy about what the members of the disciplines would do. There is, however, possibility that different stratum of philosophy would lead to different concepts behaving as the core of the discipline, and a result, different statements correlating the links of those concepts (Fawcett, 2005, 3-25). Therefore, as a hierarchical step, philosophy does not emanate from metaparadigm directly, and it does not directly lead to conceptual models. More accurately, metaparadigm points to the phenomenon on which the philosophical structure builds up the conceptual models. The content of the conceptual model and the theory then substitute the claims based on the philosophical model. It relates to the practice of nursing in a predictable manner. Developments in the metaparadigm of nursing are associated with changes in statements of values and beliefs (Fawcett, 1993, 68-123). The nursing philosophy is a collection of statements of enduring values and beliefs that comprise the major concepts of the discipline, about what nursing is, how to think about and do nursing, and the relationships of nursing, and the environment of nursing. Philosophical statements about the practice guide for examining issues and clarifying priorities of the discipline (Fawcett, 1999, 47-98). Conceptual models represent global ideas about phenomenon and are classically used to clarify, describe, and organize the concepts. They are used to segregate the relevant models from the less important ones, and they thus serve as the frameworks for organization of thinking. This would guide observation and interpretation. If activities generate from concepts, then they provide the systemic structure and the logic for any action based on them. Although concepts are visibly abstract in nature, the propositions based on them are less abstract than them, yet having potential to appear abstract (Fawcett, 2003, 131-136). Although explanations appear perplexing, conceptual models provide different perspectives or reference frames for the phenomena that are identified by metaparadigm of nursing discipline. These conceptual models would thus consist of philosophy, orientation, research tradition, and practice modalities of the scholars. Conceptual models are sets of general concepts and propositions that provide perspectives on the major concepts of the metaparadigm, such as person, health and well-being, and the environment. Conceptual models also represent the values and beliefs also in terms of preferences for practice and research approaches. Fawcett points out that direction of research must be described as a part of the conceptual model that would guide the development and evaluation of the nursing theories. Nursing theory is an organized and systematic articulation of a set of statements related to significant questions. It describes observations, presents current evidence, offers explanations, and generates hypothesis that can further be researched. All in all, these serve as frameworks for presentation of a phenomenon that is discovered, explained, predicted, and controlled. They vary in level of abstraction, and there is a perceptible continuum that would be existent within the structural hierarchy of knowledge. Although the boundaries are not very distinct, there actually is distinct boundary between conceptual models and levels of theory that can overlap in order to translate the knowledge. Nursing theories, practically speaking, would allow understanding of the phenomena for use in nursing practice and research. Nursing theories again have their hierarchies of grand and middle-range theories that descend into nursing practice theories which has most limited scope and abstraction and can be used in a specific range of nursing scenarios (Marrs & Lowry, 2006, 44-50). These have most practical implications and most direct impacts on nursing practice than do theories that are more abstract. These provide frameworks for nursing interventions and predict outcomes and the impacts of the practice in nursing. The interesting fact is that nursing questions, actions, and procedures may be developed as nursing practice theories. As is evident, due to hierarchical nature of the nursing knowledge and due to higher levels of abstraction, middle-range theories often are interrelated with nursing practice theories, and practice theories may be deduced from middle-range theories. The same can be said about the middle range theories as is applicable to grand theories. The daily nursing experience is the major source of nursing practice theory, at this prescriptive level. The depth and complexity practice is appreciated totally as nursing phenomena, and in that way, relations among aspects of particular nursing situations are described and explained (Austgard, 2006, 11-19). Dialogue and interaction with the expert nurses in the practice area is a very fruitful for discovery and development of practice theory. Research findings on various nursing problems offer data to develop nursing practice theories, as nursing is essentially evidence based and it engages in research-based development of theory and practice. Nursing practice theory, in turn, should be articulated using multiple ways of knowing through reflective practice. The process involves critical reflection on practice, remembering and noting features of nursing scenarios, attending to one's own feelings, reevaluating the experience, and integrating new knowing with other experience to develop the new knowledge. References Boyer E.(1996) Clinical practice as scholarship,Holistic Nursing Practice 10(3),1-6 Barnum, B. S. (1998). Nursing theory:Analysis, application, evaluation (5th ed.). Philadelphia: Lippincott. Chinn, P., & Kramer, M. (1995). Theory and nursing: A systematic approach (4th ed.). St. Louis: Mosby-Year Book. Cody,W. K. (1997). Of tombstones, milestones, and gemstones: A retrospective and prospective on nursing theory. Nursing Science Quarterly, 10(1), 3-5 Fawcett .(2005)Contemporary Nursing Knowledge,'The structure of contemporary nursing knowledge,3-25. Fawcett, J. (1993). Analysis and evaluation of nursing theory. Philadelphia: F. A. Davis Company. Fawcett, J. (1999). The relationship of theory and research (2nd ed.). Philadelphia: F. A. Davis Company. Northrup D et al.(2004)Nursing; Whose discipline is it anywayNursing Sciences Quarterly 17,55-62 Cody W.(2003)Nursing theory as a guide to practice,Nursing Sciences Quarterly 16,225-231 Fawcett J.(2003)Theory&practice;A conversation with Marilyn E.Parker ,Nursing Sciences Quarterly 16,131-136 Pearson et al.(2005)Nursing models for Practice(3rd ed),The traditional model for nursing practice(nursing and the so-called medical model),43-55 Fealy G.& Mc Namara M.(2007)A discourse analysis of debates surrounding the entry of nursing into higher education in ireland,International Journal of Nursing Studies 44,1187-1195 Marrs J.& Lowry L.(2006) Nursing theory and practice;Connecting the dots,Nursing Sciences Quarterly 19,44-50 Austgard K.(2006) The aesthetic experience of nursing,Nursing Philosophy,7,11-19. Read More