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Beliefs of the Discipline and Practice of Registered Nurses

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• consists of *persons* and *health* in the *context* of *nursing*

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persons

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• are unique and holistic beings • physical, psychological, social, cultural and spiritual dimensions are integrated within the mind-body-spirit of self • have inherent worth, with rights to experience respect and dignity, to be autonomous, to be active participants in decision making and to seek quality of life • interplay of self, others, time and space influences individual meanings, perceptions and actions • nurses advocate value of persons across the lifespan in varying stages of growth and development

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health

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• a multidimensional and perceived state of well-being wherein the person is able to focus on strengths and capacity to realize human potential • occurs through interactions among person in diverse contexts and is influenced by physical, psychological, spiritual, social, cultural, economic and political dimensions

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illness

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• experienced when their is an alteration or disruption in that state of a person's health • is a multidimensional state that may occur with disease or injury

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illness and disease

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• are differentiated in that a person may have a disease but not necessarily experience illness

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health and illness

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• are influenced by time, perceptions of others, previous experiences and the immediate context • each person's perceptions influence the nurse-client interactions

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context

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• encompass time, place, and other persons • is inclusive of the physical and social environments • are dynamic and complex, with cultural economic, technological, geographical, political, spiritual and environmental dimensions

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nursing

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• a discipline with a distinct body of knowledge and a professional practice with standards and a code of ethics • also an art and a science, rich in history and traditions

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goal of nursing

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• promotion of health, prevention of illness/injury and provision of care for individuals, families, groups, communities and populations

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professional practice of nursing

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• to integrate knowledge unique to the discipline of nursing, personal and experiential knowledge and knowledge from other disciplines, including the arts and sciences • theory, research, standards of practice and a code of ethics are used to guide professional nursing practice

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registered nurses

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• contribute to individual and societal health through the domains of direct clinical practice, education, research and administration • serve society through the promotion of health and safety, prevention of illness and injury and provision of direct care to individuals, groups and communities, within experiences of health, illness, healing, crises, transitions, and at the end of life

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nursing as a service

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• is provided to persons diverse in culture, socio-economic status, political perspectives, customs, age and education • provided within a variety of contexts and in collaboration with clients, health care providers, students, and interprofessional/intersectoral members

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concept

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• symbolic representation of a phenomenon or set of phenomena

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conceptual model

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• "Set of abstract and general concepts and the propositions" (Fawcett, 1997, pp. 13-14) that represents a phenomenon of interest

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deduction

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• reasoning from the general or universal to the particular or specifie

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discipline

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• a field or branch of knowledge that involves research

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domain

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• related components or items that reflect the unified subject matter of a discipline

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empiricism

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• a philosophical theory of knowledge acquisition through experience, observation, and experiment

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ethics

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• a branch of philosophy concerned with moral principles

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epistemology

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• a branch of philosophy concerned with the sources of knowledge of truth and the methods used to acquire it

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induction

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• reasoning from the individual or particular to the general or universal

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logic

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• a branch of philosophy concerned with sound reasoning and validity of thought

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***logical positivism***

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• philosophical perspective that espouses logic, objectivity, falseness/truth, observable and operationally defined concepts, and prediction

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metaparadigm

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• global concepts specific to a discipline that are philosophically neutral and stable

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metaphysics

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• a branch of philosophy concerned with the study of ultimate cause and underlying nature of that which exists

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metatheory

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• a philosophical theory about theories, concerned with "logical and methodological foundations of a discipline" (Beckstrand, 1986, p. 503) • examines "how theory affects and is affected by research and practice within nursing, and philosophy and politics outside nursing" (McKenna, 1997, p. 92)

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ontology

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• examination of the nature of being or reality

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paradigm

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• a worldview, a common philosophical orientation, that serves to define the nature of a discipline • provide the basic parameters or framework for organizing a discipline's knowledge • similar to philosophies, they are an abstract means of expressing that knowledge • generally considered to be discipline specific, philosophical, and mutable • a metaparadigm of a discipline is distinguished from a paradigm in that the metaparadigm is global, philosophically neutral, and fairly stable

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differentiating paradigms

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1. Ontological: What is the nature of the "knowable" Or, what is the nature of "reality"? 2. Epistemological: What is the nature of the relationship between the knower (the inquirer) and the known (or knowable)? 3. Methodological: How should the inquirer go about finding our knowledge?

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phenomenon

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• a designation of an aspect of reality

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philosophy

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(a) a set of beliefs or values; (b) science concerned with the study of reality and the nature of being. Composed of but not limited to aesthetics, epistemology, ethics, logic, and metaphysics

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science

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• a systematized body of knowledge that has as its main purpose the discovery of"truths about the world" (Jacox, 1974, p. 4), confirmed through empirical investigation

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theory

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• "Set of interrelated concepts, based on assumption, woven together through a set of propositional statements" (Fitzpatrick, 1997, p. 37) used to provide a perspective on reality

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foundationalism

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• identifies basic beliefs as the justification for a belief • a belief is basic if it is self-evident, providing support for other beliefs

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coherentism

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• rejects the notion of basic beliefs as a form of justification • instead, this theory of justification claims that it is the interrelationship of a set of beliefs that supports the truth of a belief

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nursing knowledge

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• nurses are fundamentally "knowledge workers" in that they synthesize "a broad array of information and knowledge from a wide variety of sources and bring that synthesis to bear on nursing work" (Porter-0 'Grady, 2003, para. 2).

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aesthetic knowing

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• is a process of "perceiving or grasping the nature of a clinical situation; interpreting this information in order to understand its meaning for those involved, while envisioning desired outcomes in order to respond with appropriate skilled action; and subsequently reflecting on whether the outcomes were effectively achieved" • comes from the nurse's ability to grasp and interpret the meaning of a situation • makes use of nurse's intuition and empathy • involves the nurse's skills in imagining a desired and practical outcome in the actual situation and responding based on an interpretation of the whole situation, analyzing the interrelationships of its various aspects

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four distinct patterns of nursing knowledge

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(a) *empirics*: the science of nursing; (b) *aesthetics*: the art of nursing; (c) *personal knowing*: the intra- and interpersonal nature of nursing; (d) *ethics*: the moral component of nursing • each of the ways of knowing represents a necessary but incomplete representation of the discipline of nursing • there is also an inherent interrelationship between the four patterns

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empirical knowing

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• *positivistic science*, i.e, it is logically determined and based on observable phenomenon • observable phenomenon. It is knowledge that is systematically organized into general laws and theories that serve to describe, explain, and/or predict the phenomena of interest to nursing • sources are research and theory and model development • for the practicing nurse must always be interpreted within the context of specific clinical situations

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personal knowing

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• is knowledge of the concrete, individual self; it is not knowledge about the self • enables the nurse to transcend the notion of other individuals as objects but instead to engage with others in authentic personal relationships • these relationships result in an increasing willingness to accept ambiguity, vagueness, and discrepancy in oneself and others

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personal knowing involves three interrelated factors:

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l. Perceiving the self's feelings and prejudices within the situation 2. Managing the self's feelings and prejudices in order to respond appropriately (to the other) 3. Managing anxiety and sustaining the self

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ethical knowing

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• is knowledge of what is right or wrong and the commitment to act on the basis of that knowledge • involves "judgments of moral value in relation to motives, intentions and traits of character" and focuses on obligations, on what ought to be done related to those judgments • sources include nursing's ethical codes and professional standards

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nursing philosophy

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• term used in two distinct ways: 1) as a unique discipline 2) as a set of beliefs of a separate discipline (e.g., nursing) • "is a statement of foundational and universal assumptions, beliefs, and principles about the nature of knowledge and truth (epistemology)"

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philosophical schemes to describe the nature of nursing

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• modern, postmodern, and neomodern: (a) Socratic- know self; (b) realism- be self; (c) humanism- give self; (d) rationalism- understand self; (e) naturalism- describe self; (f) pragmatism- prove self; (g) idealism- imagine self; (h) existentialism- choose self

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Lerner schema (1986)

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• considered the nature of human development, is useful in categorizing nursing philosophies as 1) *Mechanistic* 2) *Organistic* 3) *Developmental-Contextual*

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1) Mechanistic nursing philosophies

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• in which the machine is the metaphor for the human being. The whole is equal to the sum of the parts, and the goal is a return to equilibrium.

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2) Organistic nursing philosophies

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• in which a biologic organism composed of complex interrelated parts is the basic metaphor. The organism is active in a passive environment. Change is probable, goal directed, and developmental.

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3) Developmental-Contextual nursing philosophies

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• in which historical events are the metaphor. The individual is immersed in a dynamic context. Change in the person and the environment is ongoing, irreversible, innovative, and developmental. Chaos and conflict are an energy source for change

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core beliefs

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• controversy about nursing philosophy centers on the belief systems that exist within the discipline of nursing and the relative value of unity or diversity in nursing thought • the search for unitary nature of phenomena of concern to nursing will lead to the recognition of core beliefs: - *a holistic view of persons* - *a commitment to caring* as an expression of the human mode of being - *a perspective on education that acknowledges the unity of mind-body-spirit* and recognition of the universe of knowledge that is necessary to achieve and makes a contribution to human understanding - *a view of humans in relationship*, with awareness of ethical-moral bonds

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additional ways of knowing

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• Carper described 4 fundamental patterns of knowing as: empirics, aesthetics, ethics, and personal knowing • subsequent patterns of *sociopolitical knowing* and *unknowing*

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Nightingale and Aesthetics

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• is experiential, often non-verbal, unique, and shared by the nurse and client • invites the imagination and creativity of the nurse-client encounter • "expressed through the actions, bearing, conduct, attitudes, narrative, and interactions of the nurse in relation to others" • critical questions "What does this mean?" and "How is this significant?" • Nightingale expressed this view when challenging nursing profession to examine the "how" nurses know about their patients beyond science and statistics in decision making

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Nightingale and Empirical Knowing

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• the science of nursing, "based on the assumption that what is known is accessible through the senses: seeing, touching, and hearing." • objective, knowable reality, which scientist may objectively draw conclusions and generate testable hypotheses • empirical data collected by Nightingale's practice, devoted to observations obtained via 5 senses, meticulously recorded and maintained, results were measurable, verifiable and influential • however relied on more than statistical, empirical scientific knowledge and implied additional ways of knowing and kinds of knowledge to guide research, practice and social change

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Nightingale and Ethics

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• determining whether the moment-to-moment nursing decisions are morally responsible and deliberately positive • "self-regulation is a characteristic of an accountable, therefore mature, profession" • asks critical question "Is this right? Is this responsible?" • Nightingale a moral compass, even as she encountered questionable practices by nurses in her charge • chose to educate through her notes on nursing to heighten ethical awareness and positively influence the practice

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Nightingale and Personal Knowing

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• involves a measure of self-knowledge, confidence, self-responsibility, and engagement with life • a state of being, a personal experience reflecting inner and outer harmony • critical questions "Do I know what I do? Do I do what I know?" • accomplished through personal reflection

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reflection

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• requires integration of a wide range of information and understanding derived from all forms of knowing and from other knowers • the ability to enter an altered state of consciousness... for the purpose of understanding with great discrimination subtle differences in the personal and psychological states of others • as responses of others are received, the individual gains insights that can be used in the self-reflection process, and the self becomes, or is realized, as an authentic being"

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Sociopolitical Knowing

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• situates nursing practice in the world of society, community life, culture, economics, and politics, all of which impact human health • central questions "Whose voice is heard? Whose voice is silenced?" • Nightingale emphasized deep concern and sympathy for the intense social deprivation and suffering outside of privileged society, within the labouring classes, as well as her interest in feminsim

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Unknowing

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• "is an awareness that the nurse does not and cannot know or understand the client when they first meet, and by recognizing this unknowing, the nurse remains alert to the client's perspective of the situation" • "knowing that one does not know something, that one does not understand someone who stand before them and that perhaps this process does not fit into some preexisting paradigm or theory is critical to the evolution and development of knowledge" • suggests need for nurse to approach each new encounter with an openness and readiness for all possible types and sources of knowledge

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What is a "discipline"?

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A discipline is a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry

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What is the "aim" of nursing?

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• To promote health • To prevent illness • To restore health • To facilitate coping with disability or death

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What is knowledge?

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• A belief that is justified as true (Peterson, 2009)

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Nursing Knowledge: Empirics, The Science of Nursing

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• Knowledge that is organized into general laws and theories that describe, explain, and/or predict phenomena (Carper, 1978). • Critical Questions: "What is it?" and "How does it work?"

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Nursing Knowledge: Aesthetics, The Art of Nursing

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• Nurses ability to utilize intuition, and empathy to experience the nurse/client relationship (Clements & Averill, 2006). • Critical Questions: "What does it mean?" and "How is this significant?"

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Nursing Knowledge: Personal Knowing

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• In order to enter into a therapeutic relationship Carper (1978) stated that nurses must first understand themselves. But how??? • Critical Questions: "Do I know what I do?" and " Do I know what I know?"

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Reflective Practice Defined

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• It is the active process of asking why you do the things you do (Dewey, 1933). • It involves asking questions that ultimately explore your values, beliefs, assumptions, and perspectives.

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The 4 attributes of Reflective Practice:

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1) Being Present, 2) Open Mindedness, 3) Whole Heartedness, 4) Responsibility

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1) Being Present

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• Are you able to set aside your own thoughts, cares and concerns in order to be fully engaged with another?

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2) Open Mindedness

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• Do you have a sense of curiosity to learn more about the way you see yourself and the world? Are you willing to explore the concept that other people see the world differently? Are you willing to hear the viewpoints of others?

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3) Whole Heartedness

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• Are you passionately engaged in the process? Are you willing to do the work in order to understand others?

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4) Responsibility

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• Are you willing to be responsible for your thoughts, opinions, and assumptions that result in actions and choices that impact the world around you?

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Nursing Knowledge: Ethical Knowing

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• Knowledge of what is right or wrong and the commitment to act on the basis of that knowledge (Petersen, 2009). • Critical Questions: "Is it right? and "Is this responsible?"

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Nursing Knowledge: Sociopolitical Knowing

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• Aims to identify the impact society, community life, culture, economics, and politics have on health (Clements & Averill, 2006). • Critical Questions: "Whose voice is heard?" and "Whose voice is silenced?"

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Nursing Knowledge: Unknowing

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• The need to approach each encounter with an openness and readiness for all possible types and sources of knowledge (Clements & Averill, 2006). • Critical Questions: ???

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What is a Paradigm??

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• A world view, a common philosophical orientation, that serves to define the nature of a discipline. • World Views Received View One truth Objective Quantitative Perceived View Multiple truths Subjective Qualitative

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What is a Metaparadigm??

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Nursing's four metaparadigms: Person Nursing Environment Health

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