Role of Theory and Philosophy

¶ … Role of Theory and Philosophy in Nursing

In today's world of evidence-based nursing and knowledge utilization, few question the centrality of theory to nursing knowledge development and the importance of that process to the ongoing evolution of the discipline. Although even Florence Nightingale knew that the practice of nursing requires specialized, discipline-specific knowledge, (Gerri C. Lasiuk, Linda M. Ferguson, 2005) it would be several decades before the science of nursing had evolved sufficiently to systematically develop that knowledge. (Gerri C. Lasiuk, Linda M. Ferguson, 2005)

The importance of theory to nursing knowledge development received official sanction in 1965 when the American Nurses Association (ANA) issued a position paper declaring theory development to be the primary goal of the profession. Nursing scholars responded and the earliest nursing theories went to press in the late 1960s and through the 1970s.

By the late 1980s, nursing was primed to respond to Meleis' impassioned plea for a "reVisioning" of the goals of nursing scholarship. "For the discipline to go forward," she said, "it must refocus its efforts on developing substantive nursing knowledge built on concepts grounded in practice." (Gerri C. Lasiuk, Linda M. Ferguson, 2005)

Theory serves to organize disciplinary knowledge and to advance the systematic development of that knowledge.

The sociologist Merton introduced the notion of middle range theory as a tool for empirical inquiry. He described it a "limited set of assumptions from which specific hypotheses are logically derived and confirmed by empirical investigation. Early nursing advocates of midrange theory envisioned that a particular midrange theory might support a single or multiple grand-theories, thus cohering nursing knowledge. As well, Cody suggests that midrange theory testing provides a way to analyze the adaptability of non-nursing theories to nursing practice. (Gerri C. Lasiuk, Linda M. Ferguson, 2005)

Midrange theory has the potential to address the theory-practice gap that continues to plague nursing and to develop the substantive practice knowledge needed to advance nursing as a discipline.

From the middle of the 1980s onward, tremendous efforts in concept development were made with the introduction of qualitative philosophical thinking. From the beginning of the 1990s, numerous middle-range theories were developed and published, and philosophical pluralism in theoretical nursing became more prominent. Nursing has struggled to develop ready-to-wear theories. "Ready to wear" refers to easy applicability to research and practice. One type of "ready-to-wear" theory is situation-specific theory. (Im, 2005)

Application of nursing theory in practice depends on nurses having knowledge of the theoretical works as well as an understanding of how philosophies, models, and theories can relate to each other. (Dr. Sharon L. Van Sell, Ioannis a Kalofissudis)

For example, most basic premise of the theory as Caring is that all humans are caring persons; that to be human is to be called to live one's innate caring nature. Developing the full potential of expressing caring is an ideal and for practical purposes, is a lifelong process. The theory of Nursing as Caring is a general or grand nursing theory that can be used as a framework to guide nursing practice. The theory is grounded in some key, practical assumptions:

1. persons are caring by virtue of their humanness

2. persons live their caring moment to moment

3. persons are whole or complete in the moment

4. personhood is living life grounded in caring

5. personhood is enhanced through participating in nurturing relationships with caring others

6. nursing is both a discipline and a profession

All of these affect fundamental nursing values such as emotional support for patients and the importance of touch.

Imogene King's conceptual model includes three types of dynamic, interacting systems: personal systems (represented by individuals), interpersonal systems (represented by such dyadic interactions as nurse-patient dialogue), and social systems (represented by larger institutions such as hospitals and families). (Imogene King, J.P. Riehl-Sisca, 1989) further example of theory developing into concept and ultimately into model and practice is Katharine Kolcaba's Theory of Comfort. Holistic comfort is defined as the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psycho spiritual, social, and environmental) (Kolcaba, 1994)

The Concept of Philosophy in Nursing

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. 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? (Barbara Pesut, Joy Johnson, 2008)

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. 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. (Barbara Pesut, Joy Johnson, 2008)