Research Paradigms, Knowledge and Practice in Nursing - Essay Example

? Research Paradigms, Knowledge and Practice in Nursing of Introduction The objective of research is to generate the most excellent knowledge or evidence to guide practice. It is hence vital to be aware of the nature, philosophy, methodology, strengths and weaknesses of a specific paradigm or approach. To allow a systematic review and analysis of a particular research, the central discourse demonstrated by the chosen paradigm in the study should be examined critically. As stated by Roberts and Taylor, “… the paradigm of a profession not only concerns the content of the professional knowledge, but also the process by which the knowledge is produced” (Taylor, Kermode, & Roberts, 2006, p. 5). This essay identifies and critically discusses the research paradigms to be the most relevant to the development of nursing knowledge: positivism/empiricism and phenomenology/interpretivism. Nursing has progressed as a unique discipline through the application of theories from other academic fields and the advancement of clinical research. The discipline of nursing focuses on the personal circumstances of individual patients. In essence, this suggests that research to enhance the clinical practice of nursing should focus on environmental factors and individual attributes that are not open to plain quantitative approach. Nursing has formulated research paradigms to address these challenging issues. The discipline of nursing revealed that there is a need to expand the foundation of nursing knowledge, and research is the best way to accomplish such goal. Focus of the Discipline of Nursing The discipline of nursing gradually grew from established theories, intuition, religious beliefs, apprenticeship, philanthropic intentions, and traditional women’s role, as well as diverse impact of feminism, economics, politics, technology, and medicine (Shaw, 1993). Florence Nightingale, the first practitioner of nursing, described nursing as a field of study that has social relevance and structured concepts different from the field of medicine. However, M.E. Roger’s (1970 as cited in Shaw, 1993, p. 1651) more recent holistic perspective of individuals have become an important foundation in developing theory by characterizing nursing as ‘an art and a science’ and by creating a concrete starting point for testing theories. Donaldson and Crowley (1978), in their seminal work, identify a discipline as “a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry” (as cited in Rich, 2010, p. 26). Nursing practitioners have long tried to identify, investigate, understand, and explain the concepts fundamental to the discipline of nursing—nursing, environment, health, and person. Issues defining the limits for nursing research and practice involve (Shaw, 1993, p. 1651): (a) laws and principles governing life processes and well-being of humans, (b) influences of the environment on human behavior, (c) processes whereby nursing positively affects health, and (d) families and communities as a focus of nursing practice. Several researchers found out an agreement on the frequent topics and similarities fundamental to nursing research and inquiry. Development of knowledge in a discipline could progress from a number of scientific and philosophic worldviews. The focus of nursing as a discipline has developed most significantly over the recent decades. Several concepts have been determined as fundamental to the discipline of nursing. A case in point is the often mentioned tetralogy, namely, ‘person, environment, nursing, and health’ (Polifroni & Welch, 1999, p. 20). Although recognition of these concepts helps simplify the focus of nursing, there is still the importance of social relevance and apparent interrelatedness to define the discipline that makes up nursing (Keele, 2010). Unrelated concepts do not create the scientific or philosophic questions that encourage inquiry. The discipline of nursing focuses on “caring in the human health experience” (Polifroni & Welch, 1999, p. 20). This emphasis merges into one description concepts widely related to nursing at the metaparadigm point. This focus embodies a service integrity and social responsibility and identifies an area for the development of knowledge. The service integrity and social responsibility are expressed by a dedication to caring as a morally mandated task. At the metaparadigm stage, the concepts are not related to any specific theory (Polifroni & Welch, 1999, p. 20). This focus states that the body of knowledge of the discipline of nursing involves the experience of health and caring. The purposes of nursing research will be to explore and explain the essence of ‘caring in the human health experience’, to determine the sufficiency of such focus for the discipline, and to look at the scientific and philosophic issues raised by the focus statement. Research Paradigms The word ‘paradigm’ is defined by Webster as “a pattern, example, or model” and “an overall concept accepted by most people in an intellectual community, as a science, because if its effectiveness in explaining a complex process, idea, or set of data” (Cody & Kenney, 2006, p. 28). Kuhn, who promoted the concept, gave various definitions of a paradigm, but was unable to accurately define it. In an attempt to settle the uncertainty that stem from his different definitions of the concept, Kuhn afterward presented two descriptions for a paradigm. The first description states that a paradigm is a “disciplinary matrix” (Cody & Kenney, 2006, p. 28), the structured components of which are accepted by professionals within a discipline. The second definition simply views paradigms as “exemplars or shared examples” (Cody & Kenney, 2006, pp. 28-29). Basically, paradigms are essential to scientific disciplines because they not merely provide answers to major questions, but also influence the manner scientists carry out research. The paradigm’s epistemological and ontological principles bring forward its methodologies. A paradigm is valuable in that it gives scientists a broad understanding of a phenomenon, a means of structuring perspectives, standards for choosing problems, rules for methods and inquiry, and weaknesses of potential solutions (Keele, 2010). Hence, a paradigm offers a guideline for developing theories and principles, carrying out research, and addressing problems. For nursing professionals, paradigms guide the viewpoint from which research is designed, problems are examined, and research questions are raised. Nursing research has been carried out from a direction in line with at least two, and perhaps three, paradigms. Every paradigm identifies a perspective from which the discipline is envisioned, the underlying principles of that perspective, and the foundation of knowledge. These distinct paradigms demonstrate the change in focus from ‘physical to social to human science’ (Tappen, 2010, p. 25). The nursing literature identifies three perspectives inherent in the discipline, namely, unitary-transformative, interactive-integrative, and particulate-deterministic. From the unitary-transformative perspective, an observable fact or occurrence is seen as an integrated, self-structuring field within a bigger self-structuring field. Knowledge is individual, includes recognition of patterns. The focus involves purpose, choices, feelings, values, and thoughts. Individual reality portrays the reality of the entirety (Cody & Kenney, 2006, p. 30). On the other hand, from the interactive-integrative perspective, observable occurrences are seen as having several, interconnected parts with regard to a particular context. In order to understand a phenomenon, the interconnectedness of components and the impact of the context are considered. Hence, reality is believed to be contextual and multidimensional (Cody & Kenney, 2006, p. 30). Lastly, from the particulate-deterministic perspective, observable occurrences can be seen as phenomena having measurable and reducible attributes. Change is believed to be an outcome of previous circumstances—circumstances that, if adequately and correctly understood, may be exercised to foresee and manage change in the occurrence. Types of knowledge looked for involve universal laws and facts (Kim & Kollak, 2006). However, in spite of a widening agreement on a nursing paradigm, the description of the discipline of nursing is still unclear. Many conceptual frameworks and theories have been introduced since the 1960’s to help nurses methodically and analytically reflect on the nursing profession. Instead of a scientific revolution, the emergence and growth of nursing knowledge, research, and inquiry is an unusual, complicated process (Gerrish & Lacey, 2013). The development of nursing knowledge cannot be looked at in the same way as the psychological, medical, pharmacological, or physical sciences. Because nursing has accepted numerous complementary and contradicting perspectives, the discussion on the value of these perspectives will keep on influencing the academic evolution of nursing as a discipline. From a clinical point of view, not merely is acceptance of a particular perspective improbable in a discipline that recognizes complicated, multifaceted human behavior, but theoretical agreement is somewhat implausible in a discipline that gives importance to the individuality, distinctiveness, and perceptions in caring and health (Gerrish & Lacey, 2013). Because nursing professionals have personal perceptions of life, constructive dissimilarities of belief will remain in existence and to stimulate the academic discussion in the future as regards the ontological and epistemological goals of nursing. In fact, as stated by Keele (2010), nursing has currently shifted to philosophy for guidance with suitable techniques in line with the objectives, values, and perspectives of nursing. There are a large number of research paradigms, procedures, and methodologies that nurse researchers can use. As the field of research develops, an increasing number of paradigms are being inserted into this diverse selection of alternatives. One of the initial steps when conducting research planning is to determine which paradigm and then which methodology can most appropriately address the research question/s. This can be a very challenging, overwhelming endeavor for new researchers because there are diverse, differing definitions of paradigms known and terms and concepts are frequently applied interchangeably. All the same, the discipline of nursing is distinguished by two major paradigms that are widely categorized as positivism/ empiricism and intepretivist. These paradigms embody deeply conflicting perceptions of reality and development of knowledge. A number of nursing’s conceptual perspectives portray the metaparadigm concepts from the point of view of the various paradigms. Positivism/Empiricism The article of Suppe and Jacox (1985 as cited on Barker, 2009, p. 115) on the philosophical process of the development of nursing paradigm seems to be the primary basis for assumptions that nursing research has been based on positivism. Positivism/empiricism is derived from the principle that assumptions or theories can be confirmed through the senses. Positivism’s ontological assumption is that there is a single reality, which can only be confirmed through the senses. In the positivism/empiricism paradigm, the development of knowledge is carried out through sense observation in order to substantiate and explain theories that define, predict, and recommend (Barker, 2009). Theories describing reality are broken down into parts that can be either verified or invalidated in an empirical manner so as to explain the correlations presented. Empiricism originates from logical positivism. Positivists rejected metaphysical and religious interpretations of reality and looked for logical reasoning in theories. Yet, logical positivism was a radical variation of empiricism because it embraced the notion that the factuality of theories can only be verified through sense observation (Gerrish & Lacey, 2013). Positivism also was related to an obsolete perception of the universe that compared it with a mechanism guided by natural laws. The goal of science was to learn these laws, or outcomes, so as to be able to understand, clarify, and foresee occurrences in the world (Rich, 2010). Positivism began to lose its ground when it was heavily criticized in the 1960’s for employing faulty methods of study. Even though questioned and regarded as an obsolete school of philosophy since then, numerous nursing professionals keep on mentioning modern empiricism as if positivism were thriving. Several nurse-theorists think that empiricism has been granted temporary liberty in nursing, due to “… continued fallacious identification with logical positivism” (Polifroni & Welch, 1999, p. 158). Contemporary empiricism, also known as post-positivism, integrates a historical perspective into science alongside empirical approaches. Post-positivist empirical research continues the tradition of the major empiricist components: theory testing, objectivity, deductive reasoning, accuracy, and verification of theories with valid information, while at the same time acknowledging the implausibility of substantiation and the biased or value-filled attributes of observation and theory (Polifroni & Welch, 1999). Still, post-positivists also believe that the objective of empirical research in the discipline of nursing is patient care; that the nurse researcher should avoid personal prejudices from affecting research outcomes; that the circumstances or setting where in the occurrence takes place is vital; and that the significance of correlations or relationships can be explained (Tappen, 2010). The methodology related to positivism/empiricism is the scientific method. The scientific method emphasizes data quantification, statistical interpretation of findings, accurate measurements, objectivity, and experiment. Since empiricists suppose that the senses can be exercised to confirm reality, the favored data collection method is observation (Taylor et al., 2006). Numerical figures are attributed to data so as to verify correlations using statistical procedures. Empiricism is essential if the discipline of nursing is to verify theories about nursing care and patient outcomes, present descriptive or explanatory accounts, and develop and verify theory. The usefulness of the empirical paradigm to the development of knowledge lies in its capacity to verify assumptions, formulate generalizations, and compare approaches (Taylor et al., 2006). According to Barker (2009), generalizability is a crucial objective of the empirical paradigm because it enables correlations to be deduced to a bigger population or another context, an aspect that is useful in nursing practice. The following aspects reveal the strong points of positivism/empiricism (Kim & Kollak, 2006): (1) identification and explanation of factors believed to be ways to understand and explain the phenomenon investigated and (2) the possibility of formulating and testing theories. Intrinsic is the assumption that the phenomenon investigated can be ‘objectified’ or modeled. The important system for nursing would include (a) explanations and predictions; (b) observable and objectively recognizable human phenomenon; and (c) generalized knowledge. Due to these possibilities, modern empiricism has the capability for explanation and interpretation that is very crucial for nursing practice. Observable occurrences, such as vital signs, should be connected to those which are not observable, those anomalous and normal psychological and physiological functioning to indicate causal aspects and hence medication or treatment. The effectiveness of treatment is measured in terms of outcomes (Cody & Kenney, 2006). Nursing practice is now empirical and technologically oriented due to the necessity of diagnosing more and more complicated patient conditions, which necessitate prolonged durations of assessment and observation due to their complication, and for which different treatments are required. On the other hand, positivism/empiricism is also criticized. This paradigm has been granted temporary relevance in nursing because of its persistent misleading association with logical positivism, because of the criticisms given by critical social theorists, phenomenologists, and hermeneuticists, and because of the absence of knowledge of primary references on the paradigm (Barker, 2009). In other words, control and objectivity are components of empiricism that have been denounced by numerous nurse-theorists. When investigating humans, it is not possible to control numerous variables that could influence the research outcomes. Furthermore, too much controlling of variables in studies involving humans can eliminate key perspectives that affect a situation and influence its significance (Keele, 2010). Too much control creates a false condition that has no relationship to reality and hence reduces generalizability. Interpretivism The interpretative paradigm in the discipline of nursing progressed due to a number of causes. Primarily, numerous early nurse-theorists were trained in human disciplines like anthropology, sociology, and philosophy that introduced them to other worldviews and the methodologies related to such perspectives. In addition, to several nurse-theorists, the empiricist paradigm did not consider the personal, ethical, and artistic wisdom intrinsic in nursing (Rich, 2010). The interpretative paradigm believes that reality has diverse meanings and significance and that knowledge can be acquired through other means besides sense observation. Hence, other forms of knowledge creation and development vital to nursing practice are valued by the interpretative paradigm. This paradigm was regarded to be more compatible with the values and language of nursing, such as autonomy, individualism, self-sufficiency, and holism. The discipline of nursing wanted to build its own theoretical foundation (Tappen, 2010). The interpretative paradigm offered methods for formulating theories that represent nursing perspectives. A qualitative design provides new methodologies and conceptual frameworks for working out the issues and questions of the nursing profession. The interpretative paradigm is distinguished by the ontological beliefs that reality is dependent on context, relative, holistic, and multifaceted. The focus of study is on individual experiences; hence subjectivity is more valued that objectivity (Gerrish & Lacey, 2013). Thus, the method involves procedures that lead to prolonged contact or interaction of the researcher with the research participant. A natural situation is chosen because “… wholes cannot be understood in isolation from their contexts…” (Kim & Kollak, 2006, p. 92) Inductive analysis is employed to find out patterns of value or meaning in the data. Widely classified under the concept of ‘qualitative research’, some of the methods of the interpretative paradigm are ethnography, grounded theory, hermeneutics, phenomenology, etc. The common objective of these methods is to appreciate and find value from the human experience (Kim & Kollak, 2006). General attributes of these research approaches are a holistic perspective of investigation, an emphasis on human experience, the participation of the researcher in the study, continued communication with participants, and specific conditions for validity and reliability. Participant observations, open-ended questions, and in-depth interviews are employed for data collection (Taylor et al., 2006). A strong point of interpretivism is the value of this paradigm for formulating theories. When not so much is known about an issue, a qualitative approach is helpful in establishing patterns and meanings of experiences and the connections among them (Keele, 2010). For instance, the grounded theory method can reveal core social mechanisms through comparative analysis. The findings are afterward related to a theory. However, the interpretative paradigm is not without weaknesses. Although this paradigm places emphasis on humanistic perspectives, it does not take into consideration the existence of physiological factors that are a vital component of a discipline that focuses on health and illness (Rich, 2010). Nursing should recognize that psychosocial and physiological factors are at the center of it. Research paradigms that depend entirely on understanding and interpreting are not open to theory testing. Professionals require theories that orient and inform their practice and work out problems raised by clinical conditions (Rich, 2010). Even though qualitative methods can formulate theories explaining the knowledge entrenched in practice, verification of these emerging theories in an empirical manner is needed. Moreover, interpretative methodologies have been disapproved of due to lack of precision, mainly based on the standards used to evaluated quantitative research. Problems that have been mentioned as revealing a lack of precision involve inability to conform to the philosophy of the chosen method, weakly formulated methods, inability to recognize assumptions and values that may negatively influence the study, and insufficient time allocated for data gathering (Polifroni & Welch, 1999). The findings of qualitative research have been described as “… a set of interesting stories” (Gerrish & Lacey, 2013, p. 530) that lead to remote outcomes that do not benefit nursing practice because they do not build the foundation for future efforts. Even though nursing is focused on individuality, in everyday activity, nurses should look for patterns, and determine priorities. Although the outcomes of qualitative studies could reveal some of the personal, ethical, and artistic wisdom of the nursing profession, practice requires that this knowledge also be applied in the actual world (Shaw, 1993). Knowledge that does not contribute to the nursing profession is futile. Conclusions The discipline of nursing has a long, painstaking history of knowledge development. Early nurse-theorists have struggled to resolve the ambiguity inherent in the complexity of the discipline. Contemporary nursing researchers are still trying to understand the nature of nursing knowledge through examining the different research paradigms that has guided the evolution of the discipline over time. In order to formulate a clear path into the future, the discipline of nursing should embrace a passionate and committed philosophy of knowledge development that not merely explores and encompasses the current discourse, but also connects the fields of theory, practice, and research. 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