History Nursing and

Philosophy of Science

Presented by:
Sharewin A. Pulido, BSBio, MAN, RN
 OBJECTIVES

At the end of our discussion, each

student/each of you should be able to:
1. Discuss the early practices and beliefs
2. Define what is Rationalism.
3. Define what is Empiricism.
4. Explain early 20th century views
about science
5. Describe emergent view of science &
theory in the late 20th century
6. Apply the structures of nursing
knowledge
History of Nursing
and Philosophy of
Science
 Early beliefs and practices
Diseases and their causes and treatment
were shrouded with mysticism and
superstitions.
1. Beliefs about causation of disease:
a. Another person (an enemy or a
witch)
b. Evil spirits
2. People believe that evil spirits could
be driven away by persons with
powers to expel demons.
3. People believed in special gods of
healing, with the priest physician (called
“word doctors”) as intermediary. If they used
leaves or roots, they were called herb
doctors (“Herbolarios”).
Early Beliefs & Practices. Two words—mysticism
and superstitions. These were the early beliefs of
health and illness in the Philippines.
 Mysticism:
Mysticism is popularly known as becoming one with God
or the Absolute, but may refer to any kind of ecstasy or
altered state of consciousness which is given a religious
or spiritual meaning.
 Superstitions: a widely held but unjustified belief
insupernatural causation leading to certain
consequences of an action or event, or a practice based on
such a belief.
 Early beliefs and practices
Early care of the sick
The early Filipinos subscribed to superstitious
beliefs and practices in relation to
health and sickness.
Herbmen were called “Herbicheros”,
meaning one who practice witch craft.
Persons suffering from diseases without
any identified cause were believed to be
bewitched by the “mangkukulam” or
“mangagaway”.
Difficult childbirth and some diseases (called
“pamao”) were attributed to “nonos”.
“Mangkukulam”
 Early beliefs and practices
Early care of the sick
Midwife assisted in child birth. During labor,
the “mabuting hilot” (good midwife) was
called in.
If the became difficult, witches were supposed
to be the cause. To disperse their influence,
gunpowder was exploded from a bamboo
cane close to the head of the sufferer.
 History and Philosophy of
NURSING Science

► Nursing Philosophy
► Most abstract type
► Sets forth the meaning
of nursing phenomena
.
through analysis,
reasoning, and logical
presentation.
 2 Competing PHILOSOPHICAL
PERSPECTIVES
► 1. Rationalism – emphasize the
importance of a “priori” reasoning
as the appropriate method for
advancing knowledge.
► “priori” reasoning – uses deductive
.
reasoning from Cause to an effect
(theory – then – research strategy)
► deductive:All birds have feathers. All robins
are birds. Therefore, robins have feathers; Red
meat has iron in it, and beef is red meat.
Therefore, beef has iron in it
 2 Competing PHILOSOPHICAL
PERSPECTIVES
► 2. Empiricism – based on the central
idea that scientific knowledge can be
derived only from sensory
experience.
► Francis Bacon – received credit for
. popularizing this approach.
► Scientific truth was discovered
through generalizing observed facts
(Inductive Method) research – then –
theory method
► Inductive:
 2 Competing PHILOSOPHICAL
PERSPECTIVES
► Deductive vs. Inductive –
► Inductive Reasoning: The first lipstick I pulled from my
bag is red. The second lipstick I pulled from my bag is red.
Therefore, all the lipsticks in my bag are red.
► Deductive Reasoning: The first lipstick I pulled from my
bag is red. All lipsticks in my bag are red. Therefore, the
second lipstick I pull from my bag will be red, too.
.
► Inductive Reasoning: My mother is Irish. She has blond
hair. Therefore, everyone from Ireland has blond hair.
► Deductive Reasoning: My mother is Irish. Everyone from
Ireland has blond hair. Therefore, my mother has blond
hair.
 2 Competing PHILOSOPHICAL
PERSPECTIVES
► Deductive vs. Inductive –
► Inductive reasoning is akin to deductive reasoning.
The main difference is that, with inductive reasoning, the
premises provide some evidence for the validity of the
conclusion, but not all.
► With deductive reasoning, the conclusion is necessarily
. true if the premises are true. With inductive reasoning, the
conclusion might be true, and it has some support, but it
may nonetheless be false. However, your educated guess
can become a hypothesis you could consider fleshing out
through research and an abundance of outside sources
 Early 20th century views
► There were little interest in the history of
science, the nature of scientific discovery.
► Positivism emerged as the dominant view
of modern science.
► Modern logical positivists believed that
empirical research & logical analysis
were 2 approaches that would produce
scientific knowledge.
► Propositions that affirm/deny something
must be tested through RESEARCH
 Emergent view of science &
theory in the late 20th
century
► Science was a process of continuously
building research rather than a product of
findings.
► The emphasis shifted to understanding
scientific discovery and process as theory
change overtime.
► Empericists view phenomena objectively,
collect and analyze data (inductive method)
to propose a theory.
 Emergent view of science &
theory in the late 20th
century
► New Epistemology: science is viewed as
ongoing process, concluded the myth that
science can establish final truth
► Introduction | What Is Knowledge? | How Is
Knowledge Acquired? | What Can People
Know? | Epistemology is the study of the
nature and scope of knowledge and
justified belief.
 It analyzes the nature of knowledge and how it
relates to similar notions such as truth, belief and
justification.
Emergent view of science &
theory in the late 20th
century
► Structure of Nursing Knowledge
► Nursing Philosophy
► Most abstract type
► Sets forth the meaning of nursing
phenomena through analysis,
reasoning, and logical presentation
 EPISTEMOLOGY OF
NURSING:WAYS OF KNOWING
AND BEING
3 Facets of Knowledge Development

1. Ontology – refers to
what exist.
2. Epistemology – ways of
knowing.
3. Methodology – means
of acquiring knowledge.
Epistemology
• Episteme=knowledge
• Logos=study, science or
discourse
PROFESSION
• What is this knowledge
that we require?
• How much of it do we
need to know?
• What ways can we put it
to use?
NURSING Epistemology

• The study of the origins

of nursing knowledge, its
structure, method,
Epistemology
• Knowledge about
knowledge
• Science or study of
knowledge
• Branch of philosophy
that defines and classify
knowledge
4 WAYS OF
KNOWING
NURSING EPISTEMOLOGY
(CARPER)
 KNOWING
–Implies the possession
of knowledge which is
a product of thinking
 Patterns of
knowing in Nursing
»1. Empirics
»2. Ethics
»3. Personal
»4. Aesthetic
 1. Empirics-the
science of nursing
–Derived from
observation and
experience that is
subjected to the
scientific method of
confirming the
knowledge claim
Empirics-the science of nursing

–Knowledge obtained
from books, lectures,
journals, on line
resources
2. Ethics-moral knowledge in
nursing
–Notions of moral
right and wrong
–Addresses even the
practical nature of
decisions of a moral
nature
Ethics-moral knowledge in
nursing
–Nurse Carl defends the
client’s right to choose
care
–Nurse Renato explains the
concepts behind organ
donation to terminally ill
patient
 3. Personal knowing in
nursing
–Concerns the capacity to be
introspective and to be
aware of one’s inner being
–*Encompassess knowledge
of the self in relation to
others and self
Personal knowing
in nursing
–Involves therapeutic use
of self
–More effective and
helpful if you are aware of
who you are as a person
Personal knowing
in nursing
–involves a planned interaction
with another person in order to
alleviate fear or anxiety, provide
reassurance, obtain necessary
information, provide information,
give advice, and assist the other
individual to gain more
appreciation of, more expression
of, and more functional use of his
or her latent inner resources”
Personal knowing
in nursing
–Involves therapeutic use
of self
–Ruel, a nursing student
undergoes Psychological
Counseling and self
awareness before his
psychiatric nursing
rotation
4. Esthetic-the art of
nursing
–Knowledge of doing or
“know how”
–Spontaneous expression
of the art/act of doing
nursing
–May be termed as artistry
or mastery
Esthetic-the art of
nursing
–Focuses on empathy
–nurse’s ability in changing
ways and manner or
rendering nursing care based
on individual client’s needs
• Nurse Moses places himself in the
« patient’s shoes when communicating,
giving judgment and providing care
• Nurse Miguel uses layman terms in
explaining the needs of the patient
• Among 4 types of knowing, which do
you think is the most important that a
nurse should have to provide quality
care to patients. Justify your answer.
Case no. I
• Nurse Femy, goes on her routine rounds.
She carefully reads the patient’s chart,
noting that the medication prescribed
require precise monitoring and observation
due to its potency. She greets her patient
with a welcoming and caring attitude, and
understands the client’s needs, showing
much compassion. Her advice was sought
by a novice nurse over a moral dilemma.
She told her to be a firm patient advocate
while upholding her moral beliefs.
Case no. I
• Questions
• How did the nurse accomplish
this? What does she know that
others don’t? What does it take
to become a good nurse?
 CASE ANALYSIS
• Nurse Susan was assigned to medical ward for 3
years now. She was noted because of her skills and
attitude towards her work. When receiving the end
of shift report, she gathered information useful for
the care of her patients like medications, treatments
and other pertinent data. She greets her patients in a
welcoming and caring manner that’s why she is well
loved by every one in her unit. She also teaches new
nurses whenever they are confronted with ethical
dilemma. She is a patient advocates and stand firm to
what she believe as morally right.
• How did Susan accomplish this?
• What does she know that others don’t?
• What does it take to become a good, effective
and efficient nurse?
THEORY DEVELOPMENT
PROCESS
Importance of Nursing Theory
 1. Offers structure & organization to nursing knowledge & provide a
systematic means of collecting data to describe, explain & predict nursing
practice

 2. Promote rational & systematic practice by challenging & validating

intuition

 3. Make nursing practice more purposeful by stating the focus, specific goals
& outcomes of practice

 4. Define & clarify nursing & the purpose of nursing practice to distinguish it
from other caring professions by setting professional boundaries.

 5. Leads to coordinated & less fragmented care

 3. Nursing theory
Comprises works derived from
nursing philosophies, conceptual
models, abstract nursing
theories, or works in other
disciplines
Nursing theories are organized
bodies of knowledge to define
what nursing is, what nurses
do, and why they do it.
 Types of Theories
3.1. Metatheories: Theories whose
subject matters are some other
theories. These are theories about
theories, concerned with the
investigation, analysis, or description of
theory itself.
3.2. Micro –range theories: Most
concrete and narrow in scope
Situation specific and limited to
particular population
 Types of Theories
3.3. Grand Theories: theories broad
in scope and complex. Requires
further specification through research
before they can be fully tested.
 Grand theories

Orem’s self care theory

Neuman’s system model
Roy’s adaptation model
 Types of Theories
3.4. Middle-Range Theories: More
limited scope, less abstraction,
address specific phenomena or
concepts and reflect practice
(Administration, Clinical or
teaching).
Middle-range theories are precise
and answer specific nursing practice
questions. Reflect a wide variety
of nursing care situations
They address the specifics of nursing
situations within the perspective
of the model or theory from which
 Middle –range theories
• Emerged when theory guides
practice
• Practice generates research
question
• Research creates understanding
of theory and practice
 Middle –range theories
• Hildegard Peplau-
Psychodynamic nursing
• Madeleine Leininger
Transcultural Theory in Nursing
 Types of Theories
3.5. Descriptive Theories: are the
first level of theory development.
They describe phenomena, speculate
on why phenomena occur, and
describe the consequences of
phenomena.
Example: Theories of Growth and
development.
 A. Descriptive theories

► Also known as Factor-Isolating

theories
► Identify and describe major
concepts of phenomena
► Present phenomena based on five
senses
 Descriptive theories

► Example :
► Descriptive research about
Filipino Nursing Practice like use
of herbal medicine and other
alternative form of treatment
 Types of Theories
3.6. Explanatory theories: are Factor
- Relating Theories
Present relationship among
concepts and propositions
Present cause and effect
relationship
Example:
Factors affecting newborns in failing
to thrive
A model of Chronic Dyspnea
 Types of Theories
3.7. Predictive theories: Situation-
Relating theories
Relationships of concepts under a
certain condition are able to describe
future outcomes consistently
Example :
Theoretical model based on the observation
of the effects of unsanitary environmental
condition on the recovery of post operative
patients
 Types of Theories
3.5. Prescriptive Theories: Address
nursing interventions and predict the
consequence of a specific nursing
intervention.
Prescriptive theories are action oriented,
which test the validity and predictability
of a nursing intervention.
Example: Mishel’s Theory of Uncertainty predicts
that increasing the coping skills of clients with
gynecological CA assists their ability to deal with
the uncertainty of the CA diagnosis and treatment
(Mishel and Sorenson, 1991; Mishel, 1997).
 Prescriptive theories

Example :
Theory that validates and explains
the different nursing management
in the emergency room in
relieving anxiety among clients
Nursing theory development
For any profession to exist and to
be of service to society, it must
have an extensive base of
knowledge and proper means to
communicate
Nursing theory development
Provides the core structure
that gives direction and
purpose to those who practice
it
 Nursing EDUCATION
Nursing education refers to formal
learning and training in the science
of nursing.
Primarily used to develop and guide
nursing education in universities
and institutions
Curriculum was built based on
recognized nursing models
Prepares the students for practice as
members of the professional
community
 Nursing Research
Nursing research has a tremendous
influence on current and future
professional nursing practice, thus
rendering it an essential component
of the educational process.
Evolution of technology, ideas and
emerging nursing issues provide
answers to questions r/t practice
Nursing research develops knowledge
about health and the promotion of
health over the full lifespan, care of
persons with health problems and
disabilities, and nursing actions to
enhance the ability of individuals to
respond effectively to actual or
potential health problems.
 Clinical practice
Clinical practice is defined as a
model of practice that involves
those activities with and on behalf
of clients, especially those activities
completed in the client's presence
and with the client's collaboration.
Clinical practice
Guides critical thinking and decision
making in clinical nursing practice
Strengthen professional independence
by guiding the deepest and most
important part of their practice
Interdependence of theory
and research
Research vs Theory
R – Validates and modifies theory
NR – Stimulate nurses to explore significant
problems in the field of nursing.
Results of R – used to verify support or
disprove proposition.
 Theory and Practice
T – Explain the relationship between
phenomena.
T – guides Practice
T- Give insights, provision of goals,
diagnosis, and intervention on
Nursing practice
T – renders an efficient, effective and
improved client care
Research and Practice
R – key to development of a
discipline
Nurse practitioner who wants to
develop expertise must participates
in research.
Nurses is encouraged to test and
redefine theories and models – to
develop own personal models of
practice
 SIGNIFICANCE OF
NURSING THEORY
DISCIPLINE
Proliferation of University baccalaureate
degree program
Standardized curriculum
Addressed major questions whether
nursing was an applied science or a
basic science
Nursing doctoral programs began to open
to generate nursing knowledge
Journal for nursing was published in 1977
 SIGNIFICANCE OF
NURSING THEORY
Moved Nursing forward
Moved Nursing forward to a new nursing
knowledge for practice.
Nursing scholars were recognized.
Theory was brought together on the same
stage
The creative conceptualization of nursing
metaparadigm was clarified. *
Knowledge of metaparadigms forms the
basis for recognition of nursing as a
discipline **
 SIGNIFICANCE OF
NURSING THEORY
PROFESSION
Theory also helps nurses to
understand their purpose and role in
the healthcare setting.
Nursing is recognized today because
its development was guided by the
criteria of a profession*
Theory based evidence for practice is
beneficial to patients in that it
guides systematic knowledgeable
care
 SIGNIFICANCE OF
NURSING THEORY
PROFESSION
Theory is used as a tool for
reasoning, critical thinking and
decision making for quality
nursing practice.
Provides the nurse a view of the
patient and a guide for data
processing, evaluation of
evidence, and decisions regarding
actions to take in practice.
What are the Purposes of
Nursing Theory
It guides nursing practice and
generate knowledge
It helps to describe or explain
nursing
Enable nurses to know WHY they
are doing WHAT they are doing
 FIELDS
OF
NURSING
Hospital or institutional
nursing
o The nurse as a member of the
health care team, participates
in all phases of patient care of
the acutely ill, the
convalescing and the
ambulatory patient.
Public /Community health
nursing
o The community nurse focus on the
promotion of health and prevention
of diseases rather than care of the
sick. It needs a deeper involvement
and close cooperation with all
members of the health team.
 Nursing education
o The career ladder of nursing
education starts with a clinical
instructors position up to the
dean of a college of nursing.
Responsible for classroom and
clinical setting.
Private duty or special duty nursing

o A private duty nurse gives comprehensive

nursing care to a client on a one-on-one ratio.
o She is an independent contractor.
o The patient maybe provided care in the
hospital or in the home.
Industrial/ Occupational Nursing
o The nurse provides and delivers
health care services to workers.
o The practice focuses on promotion,
protection, and supervision of
workers health
School Nursing
o The nurse is responsible for the
school’s activities in the areas of
health service, health education
and environmental health and
safety.
Clinic nursing
o Clinical nursing requires that a
nurse possess general skills.
Works in rehabilitation and
mental health centers.
Independent Nursing Practice
o the nurse is self-employed and
provides professional nursing
service to clients and their
families. The nurse reach out and
offer their services rather than
expect clients to seek their help
(psychiatric nursing specialist,
Inc.)
Roles and Responsibilities of
a Nurse
ROLE
 a socially expected behavior
pattern, associated with an
individual’s function in various
social groups.

RESPONSIBILITY
A legal or moral duty or obligation
to deal with.
Care Provider
Supports the client by attitudes and
actions that show concern for client
welfare and accepts of client as a
person

Communicator
Communicates with clients, support
persons and collegues to facilitate all
nursing actions

Teacher
Provides health teaching to effect
behavior change which focuses on
Counselor
Help the client to recognize and cope
with stressful psychological or social
problems to develop improved personal
relationships and to promote personal
growth

Client Advocate
The nurse promotes what is best
for the client, and protects the
client’s right

Change Agent
The nurse initiates changes and
Leader
The nurse helps the client make decision
in establishing and achieving goals to
improve his well being

Manager
The nurse plans, gives directions and
delegates nursing activities to ancillary
workers and evaluates their performance

Researcher
the nurse participates in Scientific
investigation and uses research findings
in practice