This paper compares the empiricist and humanistic paradigms in nursing, examining how each shapes patient care, professional identity, and nursing research. Beginning with the foundational role of nursing theory, the paper outlines the four universal concepts of nursing practice before tracing the historical development of empiricism as a scientific, data-driven approach. It then analyzes humanistic nursing as articulated by Paterson and Zderad, emphasizing experiential, dialogical, and holistic care. The paper concludes with a reflective assessment of what changing paradigms would mean in practice, ultimately arguing that a humanistic approach enriched by empirical methods best serves patients and the nursing profession.
The nursing profession has a reputation as one of the ultimate caring professions. Because nurses work with human beings, it is essential that nursing theory account for a large number of variables — variables that address both the science of health and the psychological context of caring for people in illness and in pain. A variety of nursing theories have emerged since the beginnings of the profession as it is known today. One of the oldest is the empiricist paradigm, while humanistic theory is among the newest additions to nursing care. Although many argue in favor of one over the other, both theories contribute genuine value to the nursing profession.
According to Current Nursing (2009), nursing theory is important for a number of reasons. In describing, predicting, and explaining the nursing profession, theories attempt to lay foundations for current practice while also stimulating research and development. Such development continually improves both the profession and the theoretical frameworks upon which it rests.
The benefits of well-developed nursing theories include improved patient care and a more clearly defined professional body of knowledge. Scholars emphasize that the core value and purpose of nursing remains caring, but that it is equally important to articulate the theory underlying that care. Nursing is thus grounded in a unique body of knowledge.
All nursing theory incorporates four basic concepts that determine and shape professional practice (Current Nursing, 2009): (1) the person; (2) the environment; (3) health; and (4) the goals, roles, and functions of nursing. Both the empiricist and humanistic paradigms encompass these four components, and it is generally recognized that each plays a role in patient care.
Cody and Kenney (2006, p. 32) describe empiricism as a paradigm in which knowledge is determined through the use of the senses. This is equally true in empiricist nursing. Observation is used to verify reality, and it serves as the primary method of data collection. The empiricist nurse uses tools and instruments to measure data accurately, and is expected to remain emotionally detached in order to maintain valid results that are free from personal bias. Data are presented as numerical values, which are then used to identify and test relationships through statistical analysis.
Cody and Kenney argue that the empiricist paradigm is a necessary component of nursing. It is vital for identifying the science of patient care as well as the human response to health and illness. Medicine is indeed a science, and nurses must be well educated in empirical methods and evidence-gathering in order to ensure competent patient care. The empiricist paradigm enables nurses to test hypotheses, compare interventions, generalize findings, and uncover influencing factors. Theories can then be tested and validated — a process that is indispensable to clinical practice.
Within the four components of nursing theory (Current Nursing, 2009), the empiricist approach requires a somewhat detached observation of the person. The patient is regarded as a study subject to be observed in a non-personal fashion, and personal bias is not acceptable within this paradigm. Work with people generally involves an empirical study of their illness and the most effective means of treatment.
The environment and health, from the empiricist viewpoint, are observed for their interaction with and influence upon the person under investigation. It is recognized that the environment can directly affect health, and that optimizing the environment for health promotion is an important outcome of empiricist study. Quantifiable observations are made of the interaction between the person, the environment, and the resulting health condition. This evidence can then inform nursing practice and serve as a basis for future research. Variables relating to either the person or the environment are suppressed or controlled to ensure a more precise reading of the data and a more accurate assessment of relationships among the various components. The role of the person in determining his or her own treatment, environment, and health is subordinated to concrete data. Persons are viewed simply as part of a study — as vessels for observable data that can be used in further inquiry. According to Cody and Kenney (2006, p. 33), empiricist nursing was a particularly useful paradigm during the 1950s and 1960s, when the profession was establishing itself as a distinct scientific discipline.
Cody and Kenney also note that many scholars have criticized the empiricist paradigm for its inability to accommodate human and environmental variability. In the current nursing landscape, human beings are seen as the most important component of the profession. The emphasis is on caring and understanding patients at a deeper level than physically observable phenomena such as illness, environment, and medicinal remedies. The variability and uniqueness of human behavior is frequently cited as one of the principal objections to the empiricist approach.
Empiricism requires that human beings and environmental factors be controlled in order to yield more accurate data. The humanistic approach, by contrast, requires an acceptance of the fact that none of the factors affecting a study can be fully controlled — and that imposing such controls may actually remove important contextual information needed for diagnosis. After the 1960s, a more humanistic form of nursing was required to place persons at the center of diagnosis and study. This shift created methodological challenges, as data could no longer be easily quantified. The underlying premise was nonetheless valid: empiricist control procedures tend to limit the generalizability of study outcomes, whereas humanistic inquiry accounts for the full range of variables within human experience.
The experimental framework of empiricist nursing investigation tends to decontextualize human experience, effectively separating the four components of nursing theory by investigating each in isolation. In investigating nursing paradigms within the humanistic framework, there is instead a recognition of the other as a person rather than simply a subject of study.
Humanistic theory considers the human being the center of the profession and its investigations. The patient is seen as a person rather than an object of study. In examining the four components of nursing, the person is placed at the center, with the environment, health, and the nursing profession playing a role only insofar as they affect that person and his or her care. Hypotheses are formed and tested, and their outcomes provide grounds for investigations of similar situations with future patients. This generates a wider and more realistic body of knowledge than the empiricist approach affords. Humanistic theory is therefore a holistic approach, in which objectivity is subordinated to the goal of providing the patient with optimal care.
Objectivity in nursing is thus replaced with a more interactive approach. The person is not viewed as an entity that responds to the environment in a predictable way, but rather as a biological and interactive agent subject to a multitude of variables and responses. Investigation revolves around forming and ruling out hypotheses as patient responses reveal themselves. This approach has been widely viewed as less dehumanizing than the empiricist methods of the past (Cody and Kenney, 2006, p. 34).
The most prominent proponents of humanistic nursing are Paterson and Zderad (2008). In their foundational work on the subject, they describe nursing as an experience rather than merely a profession — an experience that occurs between human beings. It is not only a science but also an art that engages the nurse's whole being in interaction with others. The nurse is therefore expected to have full awareness of herself as a person, and to strive toward a comparable awareness of others. Paterson and Zderad (2008, p. 1) call this "existential experience," referring to the "human awareness of the self and of others."
Humanistic nursing further recognizes that each individual experiences the world in a unique way, while collectively striving for survival, confirmation, and an understanding of his or her place within the world. A nurse is therefore first required to recognize herself as an individual in the world, with her own particular responses to it. When a patient enters the hospital, that patient is also to be seen as a unique individual who responds to the world and to his or her environment in a distinctive way.
Humanistic nursing is primarily experiential rather than experimental. New knowledge is gained with every patient who arrives for treatment. In providing care, responses are observed and noted for future reference in similar situations, but it is not assumed that a treatment will succeed simply because it succeeded before under similar conditions. Hypotheses are built upon past experience, and the recognition that any hypothesis may prove incorrect keeps the nurse open to new experiences. Each human being is treated as a "world," as it were, with its own opportunities to inform the future improvement of nursing.
"Interactive, relational, and environmental dimensions of care"
"Personal impact of switching nursing paradigms"
Having said this, I do believe that empiricism has an important role to play in the nursing profession. Indeed, without it, there would be no nursing profession as we know it, since empirical data is essential for establishing reliable frameworks for treatment. However, I do not believe it should be used as the sole nursing paradigm. Instead, it should be integrated into a holistic approach that is primarily humanistic.
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