1

A theory of theories: A position paper (Dickoff & James, 1968).

The position taken can be seen in outline through four theses:

1. Theory is a conceptual system or framework invented to some purpose; and as the

purpose varies so too must the structure and complexity of the system.

2. Professional purpose requires a commitment beyond mere understanding or describing.

3. Significant nursing theory must be theory at the highest level-namely- so called

situation producing theory.

4. A profession or practice discipline has built in advantages that facilitate theory

development for that discipline.

Purpose of theory: is to guide, control, or shape reality, and it is not itself reality.
Entities on the conceptual or theoretic level are concepts, propositions, laws, and sets of
propositions.

Four levels of theories:

1. Factor-isolating theories
2. Factor-relating theories (situation depicting theories).
3. Situation-relating theories (predictive theories & prompting or inhibiting theories).
4. Situation producing theories (prescriptive theories).

Situation producing theory: go on to attempt conceptualization of desired situations as

well as conceptualizing the prescription under which an agent or practitioner must act in
order to bring about situations of the kind conceived as desirable in the conception of the
goal.

Essential ingredients of a situation producing theory:

1. Goal-content specified as aim for activity.
2. Prescriptions for activity to realize the goal-content.
3. Survey to serve as supplement to present prescription for activity toward the goal-
content.

Aspects of survey list:

1. Agency: who or what perform the activity. Not just registered nursing but considering
other professionals and nonprofessionals who might be directed toward realization of
nursing goal. Agency is explored with respect to

a. relevant dimensions to reality (external resources, internal resources, factors of agency)

b. relevant theories.
 2

2. Patiency: who or what is the recipient of the activity. The nursing activity is received
by many others in addition to the sick “patient”

3. Framework: makes it less plausible the instance on registered-nurse-sick patient dyad

functioning in isolation as the sole focal point of viable nursing theory.

4. Terminus: what is the end point of the activity. Considering terminus calls attention to
the function of the modes of conceptualizing activity as a possible contributor to the ease
of doing or receiving the activity in question.

5. Procedure: requires attending to safety, economy, and controlled performance.

6. Dynamics: what is the energy source for the activity. Brings up for specific
consideration such as aspects psychological input, and the need to the mutual interaction
of the dimensions and their relation to prescription and to goal.

Particular theories of biology, psychology, and sociology might be cited theory under any
heading of the nursing theory serving list. These theories are building blocks for nursing
theory.

The authors of this article suggested that proposing a theory of theories that sees theory
as a conceptual system invented to some purpose-when seen in its full consequences-has
revolutionary possibilities. The proposal allows for theory at last to be viewed as a proper
tool to man even in his role of providing himself with purpose.

The discipline of nursing (Donaldson & Crowley (1978)

By definition a discipline is not global; it is characterized by a unique perspective, a

distinct way of viewing all phenomena, which ultimately defines the limits and nature of
its inquiry.

Three general themes of nursing enquiry emerge:

1. Concern with principles and laws that govern the life processes, well-being, and
optimum functioning of human beings-sick or well.

2. Concern with the patterning of human behavior in interaction with the environment in
critical life situations.

3. Concern with the processes by which positive change in health status are affected.

The problem is not to devise the structure of the discipline of nursing, but to make this
structure explicit.

Discipline: “is a branch of instruction or education, a department of learning or

knowledge.” (Oxford dictionary).
 3

 In identifying disciplines and classifying them, we are dealing with the nature and
structure of the whole of human knowledge.

 Nursing has both scientific aspects and aspects akin to the art. Therefore,
nursing as a discipline is broader than nursing science and its uniqueness stems
from its perspective rather than its object of enquiry or methodology.

 Why bother to have this discussion?

1. The discipline of nursing was not created per se, but emerged within the
context of other disciplines.
2. Nursing as a discipline is subject to change based upon changes in its structural
conceptual base, nursing researchers and scholars have the responsibility of
questioning and revising nursing structure.

 It is important to recognize that a discipline emerges as a result of creative

thinking related to significant issues, because of its vital significance of nursing’s
perspective, its concern with human health and well-being.

 The aim of the academic disciplines is to know, and their theories are descriptive
in nature. Regardless whether the research is applied or basic. Fields emphasize
applied research would be correctly termed applied disciplines.

 In contrast, professional disciplines such as law, medicine, and nursing are

directed toward practical aims and thus generate perspective as well as
descriptive theories. The prescriptive theories characteristic of professional
disciplines deals with the actual implementation of knowledge in practical sense.

 Because of the uniqueness if each disciplines perspective and the context in which
knowledge from each discipline fits, it is not possible to simply “borrow” theory
or knowledge from other disciplines. From this standpoint, nurse scientists may
help in utilization of information from other disciplines, but this will not eliminate
the need for undertaking basic research from nursing’s perspective.

 Hierarchical nature of knowledge has not been demonstrated; in fact, acceptance

of hierarchical structuring of knowledge can be very limited and should be
questioned. Professional disciplines can be viewed as emerging along with rather
from academic discipline.

 Perhaps the most obvious interrelationship of disciplines is in their associated

practice realm. Every discipline has educators and researchers to impart
knowledge base to others (education) and expand the knowledge base through
research. In addition, professional disciplines have practitioners service by
engaging in professional practice in the form of clinical service, education, and
research.
 4

Relationship of the discipline to practice

 Both the discipline and practice evolved interdependently in response to societal

needs; as a result, both possess a common aim related to these needs.

 The goal of nursing service is to foster self-caring behavior that leads to

individual health and well-being. The clinical practice of nursing requires the
development of prescriptive theories on the part of the discipline.

 The discipline of nursing should be governing clinical practice rather than being
defined by it. Of necessity, clinical practice focuses in the individual in the here
and now who has a problem requiring relevant and appropriate action. In contrast,
the discipline embodies a knowledge base relevant to all realms of professional
practice and which links the past, present, and future. Its scope goes far beyond
that required for clinical practice. Professional nursing is not limited to problem
relief; it serves a force for promotion of world’s health.

 Prescriptive theories essential to clinical practice and the appropriate design of

nursing can only be derived from the discipline of nursing.

 The need for philosophical, historical, and similar types of enquiry within the
discipline of nursing is crucial not only in terms of providing the knowledge base
for professional preparation but also for the development of the discipline. The
discipline and profession must be continually reevaluated in terms of societal
needs and scientific discoveries.

 The purpose in having nursing philosophers and historian is not to duplicate the
efforts of other disciplines, but rather to provide these approaches from
perspective of nursing. Clinical practice is always to some extent empirical,
pragmatic, intuitive, and artistic.

 In summary, the discipline and clinical practice of nursing share a common social
relevance and practical aim. However, the discipline, which is the body of
knowledge, must not be confused wit its associated practice realm, which
embodies the processes of conducting research, giving service, and educating.

 As a branch of knowledge, the discipline embodies more than the science of

nursing and requires researchers who employ a variety of approaches from
nursing perspective.

Structure of the discipline

 Disciplines have both substantive and syntactical structures.

1. The substantive structure is composed of conceptualizations which are
borrowed or invented, but their inclusion is always based on their fit with the
perspective of the discipline.
 5

2. The syntax of the discipline refers to the research methodologies and criteria used
to justify the acceptance of statements as true within the discipline.

 The authors incorporated the syntax of nursing as value systems (both of science
and of professional ethics) and research constraints. The substantive structure
determines primarily the scope and subject of enquiry (what is of interest), and the
syntactical structure determines primarily the procedure for conducting research
and criteria for acceptability of findings as truth.

 For continued growth, significance, and utility of the discipline of nursing,

researchers must place their research within the context of the discipline. Theories
must also be viewed in terms of the basic structural conceptualizations of the
discipline. The responsibility for revising and clarifying the structural
conceptions, the very framework of the discipline of nursing rests with nurse
researchers.

An analysis of changing trends in philosophies of science in nursing theory

development and testing. Silva and Rothbart (1984).

 Both philosophy of science and nursing theory are in a state of transition. Since
1940s, two major schools have influenced philosophy of science: logical
empiricism and historicism.
 The history of science became an essential element of any adequate philosophical
analysis.

School of Logical empiricism (orthodox Historicism

philosophical view)
thought
Years 1940s-1960s 1960s-present (the article was
published in 1984).
Major Most influential proponents include Major historicists include Kuhn
philosophers Braithwaite (1953), Ayer (1959), (1962, 1970), Laudan (1977).
Nagel (1961), Scheffler (1963),
Humpel (1966), & Runder (1966).
Components - Attempts to understand science in - Historicists like laudan (1977)
of science terms of theories and the attempts to understand science in
relationship among the components terms of research traditions.
of a theory. research tradition is a broadly
based foundation of many theories
and is accepted way of viewing the
fundamental phenomena within a
discipline.

- Empiricists see theories to be - Historicist believe research

specific, short-lived and stable tradition to be global, long-lived,
formulation. and changeable.
 6

- A deductive system is composed of - According to Laudan,

(1) most abstract statements are the components of research tradition
assumptions, (2) from them are: (1) specific theories (2)
propositions are deduced as the 2nd ontological commitment (3)
level of abstraction, to complete the methodological commitments
theory it is necessary to bridge these
principles to empirical
generalizations. (3) these bridge
principles in turn produce empirical
generalizations within the lowest
level of abstraction.
Conception of - Conceive science in terms of - Understand science as a process
science results of human activities, the term of human behavior and thought
science refers only to a product, (a exhibiting by practicing scientist.
set if statements that constitute the The scientific process includes the
body of knowledge). Empiricists are process of explaining how theories
interested in theory validation, not are conceived by practicing
theory discovery. scientists. They are interested in
theory construction which includes
(psychosocial factors of scientists
and environmental influences on
them).

Assessment of - Assess the degree of probability - Laudan argued that the questions
scientific that the theory is true, based on the about truth are irrelevant to
progress number of tests it passes. If theory scientific progress. The relevant is
predictions are repeatedly the theory’s problem solving
disconfirmed, the logic of testing effectiveness. The theory’s
requires rejection of the theory. progress is defined by the degree
to which it solve more scientific
problem.
- consider theoretical reduction as an - Laudan called the process of
important scientific goal, one theory synthesizing research tradition as
can be reduced to anther inclusive “integration of research
theory. traditions.” (combining two
traditions without modifications of
any tradition, or with
modifications of some elements
and combining the remaining in a
new way). The goal of integration
is to explain different dimensions
of the same phenomena (ex: in
nursing individuals are perceived
as bio-psychosocial human beings)
Goal of The goal is to present a formalized - share with empiricists that the
philosophy of account of the nature of scientific goal is to construct a general
 7

science knowledge. This includes an account about he nature of

application of logical principles to scientific knowledge. To meet this
questions about the nature of historicist engage in studies of the
science. actual activities, behaviors
patterns, and reasoning process of
working scientists. The belief is
that philosophy of science must
show how science as it is actually
practiced can yield knowledge
about the world.

Nursing theory development and testing

1964-1969

1. During 1960s there was a support given by Department of Health, education, and
welfare to nursing schools to sponsor programs on the nature and development of nursing
science.
2. The analysis of metatheoretical papers from the conference of Theory Development in
Nursing held in Case Western University in 1968, and the conference on the Nature of
Science in Nursing held at University of Colorado in 1969 gave insight into how nurses
scholars conceptualized the derivation of nursing knowledge.

3. In 1968 Dickoff and James presented their position paper on theory of theories
introducing the idea that nursing theory should be situation-producing theory. The
language they used to describe theory supports logical empiricism, they spoke about
concepts and propositions, they assessed scientific knowledge in terms of truth, and they
insisted on a product orientation to science. Although they modified their orthodox view
about the purpose of the theory; that is it is capable of more than or less than prediction,
they nevertheless stated their faithfulness to empiricist tradition.

4. In 1969, Abdellah discussed the nature of nursing science. The criterion that Abdellah
used for assessment of scientific progress is an increase in scientific truths.

5. There was an exception of Leininger (1969) introductory comments to the conference

on the nature of science in nursing which offered an ethnoscience research methodology
to the discovery of scientific knowledge. This stressed viewing the behavior from the
subject perspective which is compatible with historicism.

1970 to 1975
Two major trends:

1. Metatheoritical formulations relevant to nursing theory and testing within the logical
empiricist tradition were developed to high degree by such investigators as Jacox (1974)
and Hardy (1974).
 8

 According to Jacox (1974), the goal of science is the discovery of truth and the
purpose of scientific theory is description, explanation, and prediction of part of
empirical world. Jacox used the language of empiricists including concepts,
propositions, axioms, theorems.

 Hardy (194) was more oriented to the formal logic underlying logical empiricism,
discussing nine possible relationships that can exist between concepts and
presenting a diagram that shows the concepts and the nature and sign of their
relationships.

 The irony was that at the same time, empiricism was strongly repudiated by a
growing number of philosophers of science.

2. A number of conceptual frameworks for nursing were published; for example Rogers
(1970), King ((1971), Orem (1971), and Roy (1974). These frameworks were essentially
devoid of any explicit linkage to philosophy f science.

1976- present

1. A continued and relatively stable commitment to logical empiricism, although a

beginning trend toward historicism is apparent.

 The relatively stable commitment to empiricism was reflected in the writings of

several nurse authors (Chin & Jacobs, 1983, Fawcett, 1983, Walker and Avant,
1983).
 However, a shift to historicism was done by Newman (1983) when she defined
health as a process of knowing, challenging and continuing revolution. Hardy
(1983), Carper (1978), Meleis 1983, and Munhall (982) cited Kuhn’s the structure
of scientific revolutions. Laudan’s work was cited by Watson (1981) and Parse
(1981).

2. A revision of several conceptual frameworks for nursing and the introduction of some
new frameworks.

 Orem (1980) King (1981), Roy (1981), and Rogers (1980) revised their work to
bring it more in the line with what nurse metatheorists of mid 1970s were
espousing-logical empiricism- so that they explicitly identify such elements as
concepts and propositions. Interestingly, these theorists have been updating trends
in philosophy of science as espoused in nursing literature f the mid 1970s, these
who espoused these views have begun to question them and some no longer
espouse them.
 Two other conceptual frameworks were developed in books published in 1976 by
Paterson and Zderad and in 1981 by Parse. They see science as a process, and the
envision a strong link between theory’s ontological commitment and its
methodological commitment.
 9

3. A questioning of the adequacy of strictly quantitative research methods to test nursing

theory deductions.

 In the late 1970s, nurse scholars (Silva, 1971) began to question the limits of
quantitative research methods because they too often scarified the meaningfulness
of rigor. Articles suggesting alternative approaches to logical empiricism
(Munhall, 1982; Watson, 1981). These approaches were sought of the inadequacy
of logical empiricism to deal with phenomena dealing with humanism and holism
in nursing. Alternative approaches help to bridge the gaps among philosophies of
science, nursing theory, and nursing research.

Implications and recommendations

This review shows not only that nursing theory in a state of transitions.
1. In future some of the conceptual frameworks for nursing may be integrated so that the
unimportant elements are scarified and the important elements are combined in a new
way.

2. The historicist’s conception of science as a human process suggests that nursing theory
should always be understood as a stage in its evolution and growth.

3. Data for nursing theory development and testing will include: common practices of
nurse clinicians, psychosocial factors affecting the profession of nursing, the beliefs of
the community of nursing, and the reasoning patterns of individual nurse theorist.

4. There will be more emphasis on the actual solution to nursing care problems, and this
shift will help to bridge the gap between nurse scholars and nurse clinicians.

Recommendations
1. Creation of cooperation between departments of nursing and departments of
philosophy.

2. Establishment of closer, cooperative working relationships among nurse metatheoritss,

theorists, researchers, and clinicians.

3. Exploration o f innovative qualitative methods for testing nursing theory.

4. continued and explicit emphasis in nursing theory courses.

Fundamental patterns of knowing, Carper (1978).

The four patterns of knowing are distinguished according to logical type of meaning:
 10

1. Empirics: the science of nursing:

 The term nursing science was rarely used in the literature until the late 1950s.
Since that time there seems to be general agreement that there is critical need of
knowledge about the empirical word, knowledge that is systematically organized
into general laws and theories for the purpose of describing, explaining and
predicting phenomena of special concern to the discipline of nursing.

 Nursing science does not presently exhibit the same degree of highly integrated
abstract and systematic explanations characteristic of the more mature sciences.
the conceptual structure, non of which have achieved what Kuhn (1962) called
scientific paradigm. It could be argued some of them have greater potential than
others for providing explanations for observed phenomena and may permit more
accurate prediction. However, this matter to be determined by research to test the
validity in the context of relevant empirical reality.

 At least at this stage in the development of nursing science, these pre-paradigm

conceptual structures present a new perspective of health. presentation of health
as more than the absence of disease is crucial change, it permits health to be
thought as a dynamic state or process which change over time. This change has ed
to attempts to observe, describe, and classify variations in health or levels of
wellness. Related research has sought to identify behavioral responses.

 The science of nursing at present (1978) exhibits aspects of both the “natural
history stage of inquiry” and the “stage of deductively formulated theory”. The
task for natural history stage is the description and classification of phenomena by
direct observation. But current nursing literature reflects a shift to explanation and
classification of empirical facts.

 In summary, the first fundamental pattern of knowing in nursing is empirical,

factual, descriptive, and ultimately aimed at developing abstract and theoretical
explanations.

Aesthetic: the art of nursing

 Not much effort is made to make explicit this aesthetic pattern of knowing in
nursing-other than vaguely associate the art with technical skills involved in
nursing practice.
 The concept of art includes the creative process of discovery in the empirical
pattern of knowing.
 Aesthetic versus scientific meaning:

1. Art is expressive rather than merely formal or descriptive.” An aesthetic experience

involves the creation and/ or appreciation of a singular, particular, subjective
expression of imagined possibilities or equivalent realities.
 11

2. For Wiedenbach (1964), the art of nursing is visible through action taken to
provide whatever the patient requires to restore or extend his ability to cope with the
demands of his situation. The perception of patient’s need expressed is not only
responsible for the action taken by the nurse but reflected in it.

3. Dewey (1958) refers to difference between recognition and perception.

Recognition serves the purpose of identification and satisfied when a name tag or a
label is attached to some stereotype of previously formed classification. Perception
goes beyond recognition in that it includes an active gathering details and particulars
into an experienced whole for the purpose of seeing what is there. It is the perception
which gives the action taken the aesthetic quality.

4. Orem (1971) spoke of the art o nursing as being expressed by the individual nurse
through her creativity in designing nursing that is effective. The art of nursing is
creative in that it requires development of the ability to envision valid modes of
helping and caring in relation to results which are appropriate. This is what is meant
by the whole patient concept in nursing.

 Empathy is the capacity for participating in another’s feelings. The more skilled
the nurse becomes in perceiving and empathizing with the lives of others, the
more knowledge or understanding will be gained of alternate mode o perceiving
reality. And increase awareness of subjective experience will heighten the
complexity of decision making involved.

 In summary: the aesthetic pattern of knowing in nursing involves the perception

of abstracted particulars as distinguished from the recognition of abstracted
universals. It is the knowing of a unique particular rather than exemplary class.

The component of personal knowledge

 Personal knowledge as a fundamental pattern of knowing in nursing is the most

problematic, the most difficult to master and teach.

 The “therapeutic use of self” implies that the way in which nurses view their own
selves and the client is of primary concern in any therapeutic relationship.

 Personal knowledge is concerned with the knowing, encountering and actualizing

of the concrete, individual self. One does not know about the self, one strives to
know the self.

 The nurse in therapeutic use of self rejects approaching the patient-client

relationship as an object and strives instead to actualize personal relationship
between two persons. The individual is considered as integrated, open system
incorporating movement toward growth and fulfillment of human potential.
 12

 Certainly empirical knowledge is essential to the purposes f nursing. None of the

abstract and generalized categories of human models can ever encompass or
express the uniqueness of the individual encountered as a person, as “self”. The
considerations of personal knowledge can be broadly categorized as subjective,
concrete, and existential. It is concerned with the kind of knowing that promotes
wholeness and integrity in the personal encounter. The achievement of
engagement rather than detachment.

Ethics: the moral component

 Moral dilemmas arise in situations of ambiguity and uncertainty, when the

consequences of ones actions are difficult to predict and traditional principles and
ethical codes offer no help or seem to result in contradiction.

 The fundamental pattern of knowing identified here as the ethical component of

nursing is focused on matters of obligation or what ought to be done. Knowledge
of morality goes beyond simply knowing the norms or ethical codes of the
discipline. It includes all voluntary actions that are subject to judgment of right or
wrong, including judgments of moral value in relation to motives, intentions, and
traits of character.

 Example: a common goal for nursing care in relation to the maintenance or

restoration of health is to assist patients to achieve independence. However,
valuing independence. However, valuing the independence may be at the expense
of patient’s learning how to live with physical or social dependence when
necessary.

 The ethical pattern of knowing in nursing requires an understanding of different

philosophical positions regarding what is good, what aught to be desired, what is
right, of different ethical frameworks devised for dealing with the complexities f
moral judgments, and the various orientations to the notion of obligation.

 Moral choices to be made must then be considered in terms of specific action to

be taken in specific concrete situations.

 The examination of the standards, codes, and values by which we decide what is
morally should result in a greater awareness of what is involved in making moral
choices and being responsible for the choices made.

 The knowledge of ethical codes will not provide answers to the moral questions
involved in nursing, nor will eliminate the necessity for having to make moral
choices.

Using patterns of knowing

 13

Understanding patterns of knowing makes possible an increased awareness of the

complexity and diversity of nursing knowledge. The major significances patterns of
knowing are summarized as:

1. The conclusions of discipline conceived as subject matter cannot be taught or

learned without reference to the structure of the discipline- the representative
concepts and methods of inquiry that determine the kind of knowledge gained and
limit its meaning, scope, and validity.

2. Each of the fundamental patterns of knowing represents a necessary but not

complete approach to the problems and questions in the discipline.

3. All knowledge is subject to change and revision.

Theory construction in nursing: An overview (Jacox, 1974)

Science: has what is called process-product ambiguity in that it refers both to an activity
or process and to the outcome or product of that process (Rudner, 1967).

Science as process: is concerned with the methods or research strategies by which

knowledge is developed and tested.

Science as product: a body of accumulated knowledge that purport to describe some

selected aspects of the universe.

Scientific knowledge can be contrasted with nonscientific knowledge by the method in

which the knowledge is gained. The main business of science is the discovery of truth
about the world. Scientific knowledge is knowledge about the empirical world. Empirical
refers to what can be observed by senses.

The purpose of scientific theory is to describe, explain, and predict a part of the empirical
world

To develop a theory, efforts may proceed through various levels or stages (Jacox,
1974):

1. A period of specifying, defining, and classifying the concepts used in describing the
phenomena of the field.
2. Developing statements or propositions which propose how two or more concepts are
related.
3. Specifying how all of the propositions are related to each other in systematic way.

Concepts and the empirical theoretical continuum:

Concepts: are words that describe objects, properties, events, and relations among these.
 14

Groups of concepts may be formed into “higher-level” concepts that describe a wider
range of things. (example: professional nurse).

Concepts indicate the subject matter of a theory. For instance, concepts in a theory of
psychology might be “personality, “intelligence”. Concepts are abstract representation of
reality.

In forming concepts to use in a theory, it is important to define precisely what is meant by

each concept. A major task in the definition of concepts is to specify the part of the
empirical world that they are intended to present.

Empirical-theoretical continuum: the relationship between empirical reality and the

theoretical terms used to describe and explain that reality (Kaplan, 1964).

1. At one end of the continuum are those concepts that have a directly observable
empirical referent. (e.g.: Chair).

2. A move up in the continuum is when we indirectly observe an event and infer its
presence, i.e draw a conclusion based on certain evidence. (e.g. Pain).

3. Moving a long the continuum, still further from empirical referents, we encounter
concepts that are not clearly observable, either directly or indirectly, but may be defined
in terms of observables. (e.g. personality, role, and society). Such concept is called a
“construct” and is constructed of concepts that are directly or indirectly observable. We
do not observe society, although we can observe the people in the society.

4. A final point in the continuum is the theoretical term which has no meaning a part
from particular theory. (e. g superego has no meaning a part from psychoanalytical
theory).

Directly and indirectly observable: observational

Constructs and theoretical terms: symbolic (Kaplan, 1964).

Propositions and the process of induction

Proposition: is a statement of constant relationship between two or more concepts or

between two or more facts. All scientific propositions are based on empirical
generalizations that may be proved false in the future.

Induction: is the process by which empirical generalizations are established. Induction is

a type of argument in which one argues from the particular to the general or from
individual to the universal.
One observes empirical events to all similar events. By the process of induction basic
propositions are initially established.
 15

Laws: some propositions are called Laws. A law states an empirical regularity among
phenomena that as far as known is invariable under the condition stated in the law. (e.g.
Newton’s law of motion).

Hypothesis: when the relationship between two or more concepts or facts has been
asserted but enough data or empirical evidence have not yet been gathered to support the
assertion strongly. When a proposition has this very tentative and inconclusive nature it is
referred to as hypothesis.

Principle: is a term often used in nursing to refer to a universal proposition. Nurses have
used principles as basis for their practice, or to explain or predict what kind of action will
produce a given effect. (e.g if prolonged decreased circulation to a part occurs, a
decubitus ulcer will form.)

Theory and the process of education

Theory: is a systematically related set of statements, including some law-like

generalizations, that is empirically testable (Runder, 1967). This definition clearly
implies the clear relationship between theory construction and research.

Deduction: is another type of argument in which one reasons by taking one or more
premises or statements assumed to be true and deriving or deducing other statements or
conclusions. (A is larger than B and B is larger than C, then it can be concluded or
deduced that A is larger than C).

Axioms: are propositions which state the more general case (basic propositions)
Theorems: by combining the axioms in a certain way theorems are derived. (derived
propositions).

Science is cumulative, meaning that one scientist’s work builds upon, extends, and
modifies body of knowledge developed by other scientists. This cumulative nature of
science is facilitated when each researcher tries systematically to relate what he is doing
to what others have learned, through use and modification of theories.

Models

Model: is analogy or example that is used to help visualize and understand something
that cannot be directly observed or about which little is known.

Isomorphic: when a thing and a model if it are similar in certain respects they are said to
be “isomorphic” (Brodbeck, 1968). Degrees of isomorphism:

1. There is one-to one correspondence between parts of the model and the arts of the
thing (every blood vessel, muscle of the real heart is represented in the model).
 16

2. The relationships among the parts are preserved (the relationship in the model the same
as the real thing).

3. The model works n the same principle as the original one (the heart contracts and
expands).

A theory in one field may be used as a model for a theory in another field if the elements
of the original field are believed to behave in the same way as those in the field foe which
the model is developed.

One highly abstract kind of model is a mathematical model. Her, a theory of mathematics
is used as a model to express the interrelationships among persons, actions, and events in
numerical form. It is common in economics and when statistics are used to describe
empirical phenomena.

Construction of practice theory

Basic scientists: develop theory for the purpose of defining, explaining, and predicting
behavior.

Applied scientist: develop theories for the purpose of guiding their actions toward some
desired goal.

Practice theory: a theory used to guide practitioner in selecting the most effective means
for obtaining his ends.

Nursing practice theory: is that which guides the nurse’s actions in attaining nursing
goals in patient care. Given this nursing goal (producing some desired change), these are
the actions the nurse must take to meet the goal. This is practice theory or situation
producing theory.

Glaser and Strauss (1967) identified four requirements for practice theory:

1. Closely fit the area in which it is to be used.

2. be understandable to practitioners using it.
3. be general enough to cover many diverse practice situations and not just a few specific
ones.
4. Allow the user of the theory (practitioner) control over the everyday situations as they
change.

The need to recognize and make explicit values implied in the theory is also important
(Ellis, 1968). The goals in nursing practice are not value free; nurses place a negative
value of some kind of behaviors and positive value on other kinds. (e.g. the goal s to
relieve patient’s pain).
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Grand theory: is characterized as explaining everything while explaining nothing. The

practitioner is given a collection of all-purpose, all inclusive concepts and propositions
that offer few clear or relevant guides for practice.

Abstracted empiricism: the collection of facts isolated from a theoretical framework.

(at the opposite end of the continuum of generality).

Middle range theory: include a limited number of variables and focus on limited aspects
of reality. Propositions that are not all inclusive can be derived and submitted to
empirical test.

The debate in nursing theory

There is less consensus over the boundaries in the behavioral and social sciences. The
difficulty in practice discipline is that knowledge is commonly drawn from a variety of
basic sciences, rather than only one.

Can or should be we develop nursing theories?

Three opinions:
1. Those opposed to developing nursing theories often base their opposition on the
contention that there are no phenomena or tasks that are specifically nursing’s, and
therefore, nurses have nothing to develop nursing theories about.

2. Some make the distinction that there is no nursing theory, but that nurses use theories
from other fields in nursing. Their belie is that nurses should not be restricted to
researching only those problems which are immediate concern to nursing problem as it is
now practiced. Rather, they are interested in developing knowledge in basic science
which may or may not be used by nurses. Scientists, they say, are properly concerned
with the expansion f knowledge and not with whether it has an immediate practical use.

3. Those who believe that nurses should develop nursing theories base their argument on
the need for nurses to have a systematically organized body of knowledge on which to
base their practice. The proponents of nursing theory maintain that, although there is not
high consensus on what most appropriately constitutes nursing, there is sufficient
agreement to provide guides for the development of theories. Another assertion of those
who take this position is that nurses have great need for knowledge which scientists in
other fields may not be interested n developing, therefore, nurses must take responsibility
for developing this knowledge.

An opinion on the issue of nursing theory:

 It would be a mistake to define prematurely nursing’s areas of practice, and

equally wrong to use much of nursing resources to develop knowledge in areas
only very indirectly concerned with nursing practice.
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 There is sufficient consensus on concerning the definition of nursing practice to

enable the construction of some nursing theories, that these theories may not
include concepts unique to nursing is not an important consideration, although
these concepts could be developed.

 What is important is that the relevant concepts to be included are related by

propositions and that the propositions themselves are systematically interrelated.

 There is no pressing need to develop a “grand theory” that supposedly includes

everything that nurses need to know. Other sciences have not succeeded in this
effort.

 Rather, theory building efforts may more realistically be focused on developing

“middle-range” theories of limited aspects of nursing, such as nursing theory f
pain alleviation.

 Concepts and theories in any area are invented by those who attempt to describe
explain, and predict and (in case of practice theory control) events in the empirical
world. If the concepts and theories so invented are o longer useful or accurate,
they are modified to fit the known and existing empirical reality.

 It is after all. The experienced practicing nurse who is in the best position to make
the empirical observations basic to the construction of relevant nursing practice
theories.

Philosophy, science, theory: interrelationships and implications for nursing

research (Silva, 1977).

Philosophy was sought out to unify scientific findings so that man as a holistic being
might emerge.

The philosopher is concerned with such matters as the purpose of human life, the
nature of being and reality, and the theory and limits of knowledge. Intuition,
introspection, and reasoning are some of his methodologies.

-His approach to understanding reality is characterized by formulating sets of

assumptions and beliefs derived from his own personal experience and his
contemplation of it in relation to the studied experiences of others.

The scientist on the other hand, is primarily concerned with causality. Cause and
effect, in one way or another, are central to his goal of deriving scientific laws.

His approach to understand reality is characterized by tentativeness, verifiability,

observation, and experience. Reality becomes interpretable to him through such
mechanisms as hypothesis-testing, operational definitions, and experiments.
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However, despite different focuses and methodologies. The philosopher and scientist
share the common goal of increasing mankind’s knowledge.

Relationships between science and theory

Characteristics of science as a system:

1. Science must show a certain coherence: Science must constitute a coherent

whole of interrelated facts, principles, laws, and theories which are appropriately
ordered.

2. Science is concerned with definite fields of knowledge: man must be specialized

to know one field.

3. Science is preferably expressed in universal statements: science seeks to

discover the universal characteristics of phenomena under investigation.

4. The statements of science must be true or probably true: scientific statements

are true if they express the nature of things as they are.

5. The statements of science must be logically ordered: one does not draw
conclusions before stating hypotheses. Science is best served through scientific
methods such as deduction, induction, or analytic-synthetic method.

6. Science must explain its investigations and arguments: scientists have the
responsibility to explain their arguments which led them to their conclusions.

The aim of science is to describe understand, predict, control, or explain

phenomena. But kerlinger (1973) offers a different perspective: “ the basic aim of
science is theory.

Common denominators of theory:

1. Set: set is a well-defined collection of objects or elements. Facts, principles, and laws
that are interrelated and relevant to the problem.

2. Postulates: the central core of a theory consists of its postulates. These are statements
of general truth that serve as essential premises for whatever is being investigated.

3. Definitions: definition of terms is important for communication among scholars.

a. Primitive terms: are those which cannot be defined by specifying operations or

by referring to other operationally defined terms (e.g. purpose & need).
b. Theoretical terms: are those which cannot be defined pointing to particular
operations, but which can be defined by their relationship to other terms which
are operationally defined (e.g. Motivation).
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c. Key terms: are those which can and must be operationally defined so that
hypothesis under study can be tested (e.g. testing).

4. Hypotheses: hypotheses are predictions which have been deduced from a set of
postulates and which sate the relationship between two or more variables. They imply
that the relationship between these variables can be observed and tested. Because well
sated hypotheses are based on observation of fact which permits them to be “proven” or
“disproven”, they are powerful instruments of science.

Theory refers to a set of interrelated statements (most commonly, postulates and

definitions) which have been derived from scientific data and from which plausible
hypotheses can be deduced, tested, and verified. If verified, theory becomes part of the
body of science from which other sets of postulates can be derived. The process of theory
building, therefore, involves the formulation and testing of hypotheses which have been
deduced from a set of statements derived from scientific knowledge and philosophical
beliefs.

Implications for nursing research

1. Ultimately, all nursing theory and research is derived from and leads to
philosophy: if one examines the four main branches of philosophy, one begins to see the
links between them and the process of nursing research.

- Logic: through logic, researchers are able to establish the validity of various
thoughts and the correctness of their reasoning. Logic of deriving valid
conclusions form hypotheses.

- Epistemology: the study of the theory of knowledge. Concepts of knowledge are

the conditions of truth. If one knows something to be true, he also believes it to be
true. The evidence condition states that one evaluates knowledge against all
adequate standards of evidence at a particular time.

- Metaphysics: studies the most general concepts used in ordinary life and science
by examining the internal structure of the language used in various disciplines. Of
particular interest to nurses is an examination of the concept of causality.

- Ethics: the study of ethics comes to grips with moral principles and values.
Consideration of the ethical requirements of informed consent and the rights of
human subject. Research cannot be conceived apart from its moral implications.

2. Philosophical introspection and intuition are legitimate methods of scientific

inquiry: the time has come to value truths arrived at by intuition and introspection as
much as those arrived from scientific experimentation. Intuition is not knowledge arrived
at out of nothing; rather, it knowledge arrived at by a deep grasp of a subject. Although
 21

one may not be able to articulate the process by which a conclusion is reached. The point
to be made here is that we must keep our minds open to all potential avenues which lead
to advancement of nursing knowledge.

3. Nursing knowledge arrived at by the scientific knowledge method too often

scarifies meaningfulness for rigor: too much rigor can lead to trivial research problems
with the logical outcomes of trivial research results. In statistics, one can find statistically
significant differences among groups if a large enough sample is used. However, for
practical purposes, the differences may be so small to be negligible. Such statistics offer
little advancement of nursing knowledge, and at best be misleading.

In summary, when nurse researchers examine the total philosophy-science-theory triad,

they develop a more holistic and less traditional approach to the possibilities of deriving
nursing knowledge. They are more open to contributions of other disciplines.

Competing theories of science: (Jacox & Webster, 1980s)

- During the last 25 years two activities have been occurring but no close relation to each
other: theory development and revolution in the philosophy of science.

- During the same 25 years nurses began to give attention to theory construction in
nursing. Such people as Rogers, Peplau, and Johnson were among the first in 1960s.

Jacox and Webster identified some of their concerns about the view of science and theory
and its effects on nursing activities.

1. The constricted view of theory represented is incompatible with the philosophy of

nursing that the majority of nurses espouse. Our philosophy of science does not match
our philosophy of nursing.

2. Research methods reflecting this notion of science have restricted our research.
Nursing research has overemphasized precision, quantification, and numbers.

3. Some nurses continue to spend their time and energy in activities that appear to be
scientific , but require far too much time and energy for results to be achieved. (e.g.
behavioral objectives).

4. Attempts to develop taxonomies in nursing. The belief that categories should be

mutually exclusive creates confusion and frustration. (e.g. one attempts to separate
anxiety and depression). These phenomena are very interrelated in reality.. For heuristic
purposes, it may be necessary to say that for the time being we will arbitrary categorize a
behavior in this way.
5. It is dysfunctional to develop nursing classification systems that do not overlap with
medicine. What nurses do in practice overlaps tremendously with what physicians do.

Changes in philosophy of science

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Kuhn (1962) published a book titled the structure of scientific revolutions in which he
proposed a different view of science:
He said there are three stages of science:

1. Preparadigm stage: “immature science”.

2. Paradigm: “normal science” the stage of rational puzzle solving on the basis of shared
metaphysical and methodologic assumptions about how the part of the world being
studied operates and how it should be studied. It is the condition of most developed or
recognized sciences.

3. Revolutionary science: it is the stage of abandonment of previously shared

assumptions, of challenge from new potentially shared assumptions. Such shift takes
place for non-cognitive reasons (i.e. social, political, or economic concern).

One of the major definitions for paradigm is that it is the general theory that a normal
science shares. (now Kuhn moved to talke about disciplinary matrices).

Kuhn says that professional education consists of socialization, a kind of brain washing
of students. They are taught to thin about the world by the intellectual leaders of the
discipline.

Phage group: is a group of frequently communicating scholars, usually not more than a
hundred, who share common beliefs and goals through their network of communication
and are thus much more effective politically than are the smaller groups and isolated
scholars.
 Thus it is through a dominant phage group that paradigm controls a discipline,
and the control is largely social and political rater than cognitive and rational.
 A paradigm is rejected when a number of a anomalies or unresolved problems
accumulate.
 But a paradigm is not refuted. Rather the process of socialization of students
breaks dawn, and an increasing number of young scholars in the discipline begin
to explore solutions to problems outside of the accepted assumptions of the old
paradigm. This is the stage of revolutionary science, which is largely non rational
in nature.
 A new phage group comes to dominate the discipline, and it is the new phage
group that selects and enforces the new paradigm.

The received view theory of science

Kuhn’s ideas of science provide a good background for understanding the “received
view” theory of science that has dominated nursing and science generally.

Received View: is a label that was adopted in the recent literature of the philosophy of
science. Suppe (1977) is one of the major philosophers that is responsible for the label. It
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is a name given for the theory concerning the nature of science that dominated the
philosophy of science through the 30s, 40s, 50s.

The near consensus concerning the basic nature of the world that dominated much of
the seventeenth and eighteenth century gave way to two competing world view
traditions:

1. The philosophy of nature: taking its cues concerning that basic nature of reality
from the physical science especially mathematical physics.

2. The philosophy f mind: concerned with the nature of human experience.

Logical positivism: in the twentieth century is part of the philosophy of nature in the
nineteenth-century sense.

Received view of science was composed of philosophers who gathered in Vienna in the
1930s and labeled themselves logical positivists.

Its interest in formal logic and formalization issues, and its rejection of metaphysics or
theory of reality, since the only reality was physical reality and the physical sciences
were the only appropriate disciplines for its study. Implicit in this assumption the view of
mind as either not appropriate subject for science or that it is reducible to physical reality.
Those who developed the Received View later criticized, refuted, and abandoned it.

Vienna circle Logical positivism in the 1930s: Tenets or doctrines:

1. Theory is either true or false and it is very important to determine which. There is no
room for degrees of truth or adequacy; this comes partially from the heavy emphasis on
mathematics and formal language to express science.

2. More mature or developed theories must be formalized. That is they have to be

expressed in formal language.

3. They must be axiomatized, although this doctrine was rejected very early as the result f
work done in the formal logic. They found very soon that nay set of necessarily true well
formulated in logic could be used as an axiom set.

4. Physical science are basic, especially physics.

5. Observational terms or language should be distinguished from theoretical terms or

language, and that the two can be clearly separated. (in reality, some concepts and
theories are theoretical and some are empirical, but the belief that they can be completely
separated is false [Jacox & Webster] ).

6. The purpose of science is to predict the occurrence of events by combining descriptive

laws with statements of initial conditions.
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7. Science has noting to say about value. It is value free and completely objective, and
value is not a proper subject of its concern.

8. The science progresses by reducing earlier theories to later theories, with all previous
theories being incorporated into the most recent. Science also progress by reducing less
basic to more basic sciences (sociology reduced to psychology).

9. There was a single scientific method was espoused.

None of these tenet is unequivocally true. All have been rejected or seriously modified by
recent philosophers of science.

Two related doctrines were that physical sciences are basic, and that less basic sciences
can be reduced to more basic sciences. The holistic view of persons espoused by nursing
in incompatible with these ideas. The rejection of this doctrine and acceptance of
interrelatedness of the body and mind are crucial for nursing.

The biological scientists are still dominated by the received view theory of science, due
in part to recent success in microbiology (according to the article in 1980s).

Another received view hallmark, the refutation of which has positive implications for
nursing, is the tenet that theoretical and observational terms can be clearly separated. This
is not possible; there is no such thing as a theory free observation. A researcher always
works back and forth between the theoretical and empirical.

The argument whether theories are or should be deductively or inductively developed

also is false argument, based on a false dichotomy. All theory construction includes both.

The doctrine that science is value free is also false: Science is not value free, neither is
nursing value free. Nursing places positive value on health, human well-being, and
similar states and processes. It is better to try to understand how our values influence the
science and the theories that we construct rather than to continue with the notion that
science is value free.

The refutation of these and other doctrines of Received View is important to nursing.
Newly developed alternative views are much more consistent with the development of a
relevant knowledge base for nursing practice than is the outdated Received View of
science and theory.

Alternative theories of science

Historicism is one of the alternative theories of science to Received view.
 25

Where received view believed that the meaning and truth of scientific theories were
absolute, historicism holds that both meaning and truth are both relative to social and
historical context within which theory is developed and asserted.

Kuhn allows only for the rational evaluation of individual theories within a disciplinary
matrix, but no for he evaluation of the disciplinary matrix itself.

Laudan (1977) of one of the historicists. Laudan said his concern is to offer objective
criteria for determining when progress has occurred. The particular kind of progress with
which laudan is concerned is cognitive progress, which is nothing more than progress
with respect to the intellectual aspirations of science.

Cognitive progress has both empirical and conceptual dimensions:

1. Progress in empirical dimension is achieved by generating new specific
theories allowing for the coverage of new facts in a manner that related them to
lad facts and theories.
2. Progress in the conceptual dimensions is achieved by more adequately placing
specific theories and their supporting research programs within the body of
scientific knowledge as a whole.

Science for laudan is problem-solving activity. Problems constitute the questions of

science; theories constitute the answers. The first test for any theory is whether it
provides acceptable answers to interesting questions or satisfactory solutions to important
problems.

There are two major points with respect to Laudan’s work that have particular interest for
nursing:
1. What is crucial for evaluation of theory in any cognitive assessment of a theory is how
it fares with respect to its competitors.

2. His delineations two classes of what is usually called scientific theory:

a. Theory refers to a very specific set of related doctrines, such as Marx’s labor
theory.
b. The term theory is also used to refer to much more general, less testable, sets of
doctrines or assumptions, the atomic theory or the evolution theory each refers
not to a single theory but to a whole spectrum of individual theories.

Often the raised question in nursing is should there be one theory or many? The answer,
of course is “there should be several traditions and numerous theories within those
traditions. Viewing theories in this broader context would free us to become more
creative in development and evolution of nursing theories.
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