Nursing as Discipline - Essay Example

? NURSING AS DISCIPLINE by 13 March Nursing as Discipline Introduction What nursing is and how it works is a difficult question.A wealth of literature on the topic does not always help to develop a clear vision of nursing as discipline. The past decades were marked with the emergence of new, complex research paradigms that help the development of nursing as an academic discipline and knowledge. Nevertheless, the conflict of a professional vs. academic discipline in nursing remains unresolved. Nursing is believed to be a profession, since its rests on the ideas, beliefs, practices, and activities of nurses in clinical environments. Simultaneously, nursing would not be nursing at all, if not for a sound scientific knowledge base, which encompasses numerous elements of nursing philosophy and history and works to guide nursing decisions and practices. What research paradigms are the most useful and relevant to nursing knowledge is difficult to define, as far as the definition and concept of nursing knowledge itself lacks clarity and structure. Most probably, there is no best paradigm for nursing research and knowledge. It would be fair to assume that nursing is essentially a discipline that encompasses a multitude of perspectives, and different research paradigms will provide a unique contribution to nursing knowledge, to integrate professional identities with the external nursing reality. Nursing as discipline: history and evolution The past century witnessed a rapid shift in academic knowledge toward the development of nursing as a discipline. Despite the value and relevance of the nursing profession, its movement into the academy was not without controversy (Northrup et al 2004). Nursing’s transition to an academic discipline exemplified a complex process of transforming nursing into profession (Northrup et al 2004). Such transformation would have been impossible without a heightened awareness that nurses could no longer meet the changing professional demands without having access to a distinctive body of academic knowledge (Northrup et al 2004). It was not until the beginning of the 1960s that nursing education propelled to become a complex system of university-based education, including baccalaureate degrees and creating a foundation for turning nursing into a new, separate branch of knowledge (Northrup et al 2004). The United States is fairly regarded as the pioneer in nursing profession and science – the creation of the Associate Degree nursing programs in the U.S. marked a new stage in the evolution of nursing as discipline (Northrup et al 2004). Today, nursing is well-recognized as a discipline and profession (Tzeng & Yin 2007). University education is the basic prerequisite for preparing professional nurses, who are able to make wise professional judgments, pursue continuous education, and use their knowledge to expand the boundaries of the nursing profession. So, what is nursing discipline? A discipline is usually defined as “a community of interest that is organized around the accumulated knowledge of an academic or professional group” (Monti & Tingen 1999, p.64). The discipline of nursing is complex, and it describes and explores the complexity of the human caring paradigms and successfully balances the art and science of nursing (Monti & Tingen 1999). Within the nursing discipline, art helps to answer questions related directly to the profession, whereas science is expected to add to the body of academic knowledge related to human caring (Monti & Tingen 1999). The metaparadigm is a unique aspect of the nursing discipline, which describes concepts and themes that are directly related to the nursing profession and different nursing from other professions and disciplines (Monti & Tingen 1999). The metaparadigm also promotes, reflects, and describes “the shared beliefs and values of the nursing discipline” (Monti & Tingen 1999). These may include but are not limited to caring and respect, autonomy and beneficence, health promotion and ethical conduct (Monti & Tingen 1999). It should be noted, that there is a continuous disagreement about what really constitutes the nursing discipline and how its various paradigms operate. This disagreement is partially due to the failure to define a discipline and identify its implications for nursing. Newman, Sime and Corcoran-Perry (1999) suggest that a discipline can be readily defined in one sentence describing the area of study and value orientation of the profession. Nevertheless, most, if not all, concepts and paradigms within the nursing discipline require explicit social connectedness and relevance (Newman, Sime & Corcoran-Perry, 1999). In most cases, “the nursing discipline is treated as a combination of two essential concepts – that of caring and that of health” (Newman, Sime & Corcoran-Perry, 1999). However, there is no one unifying philosophy or statement that could describe both concepts; in the meantime, neither of these concepts alone can meet the criteria of a discipline (Newman, Sime & Corcoran-Perry, 1999). This is, probably, one of the reasons why the concept of knowledge in the nursing discipline and its implications for academic development remain poorly understood. Nursing: the nature of knowledge Despite the growing body of research about nursing, the logic behind nursing knowledge remains one of the greatest professional and academic enigmas. In 1978, Carper published his seminal work that sought to describe four different patterns of nursing knowledge: empirical, aesthetic, ethical, and personal (Bonis 2009). Since then, the term “knowing” has become a distinctive feature of the nursing discipline and science. Simultaneously, the multitude of knowing patterns and the lack of research into nursing knowing made it extremely difficult to define and conceptualize nursing knowledge (Bonis 2009). Bonis (2009) suggests that, in the nursing discipline, knowing manifests in three different forms: personal reflection, technical understanding, and a cognitive process. In this situation, the concept of knowledge in nursing can be broadly defined as “a uniquely personal type of knowledge, constructed of objective knowledge interfaced with the individual’s awareness and subjective perspective on personal experience; it is a dynamic process and result of personal reflection and transformation” (Bonis 2009, p.1330). Simply stated, knowing in nursing is a unique combination of objective, scientific and personal features. The role of intuition in nursing knowledge can hardly be overstated (Smith 2009). Knowing in nursing looks like processing objective scientific knowledge through personal transformation and reflection. Also, reflection and personalization can serve effective instruments of scientific and academic analysis. Throughout the history of scientific development, personalization and reflection were considered as serious impediments to the creation of an academic body of knowledge. Thousands of scientists would seek to pursue objectivity and impersonal judgments, to ensure that the basic criteria of scientific knowledge were met. Nursing seems to deny this established belief and proposes a new idea of knowing, which presupposes that personal reflection, experience, and awareness heavily contribute to theory and practice of the nursing discipline (Bonis 2009). All these concepts, definitions, paradigms and metaparadigms create a picture of complexity in the nursing discipline. Yet, they also create a foundation for assessing the research paradigms that can be most relevant to nursing knowledge. Understanding the usefulness and implications of these research paradigms to nursing knowledge is impossible without having a clear idea of what nursing knowledge is and how it operates. Today, academic and practical nurses have access to a variety of research paradigms and perspectives. Each perspective demonstrates a remarkable scientific and knowledge potential. However, no one single research paradigm can dominate nursing knowledge. Given that knowing in nursing is all about personal transformation, reflection, and experience, no single research paradigm can help to develop a sound system of academic and practical knowledge in nursing. Personal reflection is unique; and so is nursing knowledge. Simultaneously, science and discipline is always objectives and unbiased. This gap between experience and science is not easy to close, but nursing is a discipline of multiple perspectives. As a discipline and a body of knowledge, is preoccupied with the possibilities and problems of reconciling multiple discussion viewpoints (Ceci 2000). Therefore, different research paradigms can provide a contribution to nursing knowledge, helping to integrate professional and personal identities with the external reality of being a qualified nurse. Critical social theory: Relevant or not? Critical social theory is rightly considered as one of the most important research paradigms in the nursing science. CST can add value to nursing knowledge, since it exemplifies a complex but comprehensible metatheoretical framework for nursing science (Browne 2000). CST rests on several premises: (1) there is no knowledge outside of human consciousness; (2) historically and socially mediated power relations produce heavy impacts on knowledge; (3) there is power and domination in every form of social order; (4) language is the central component and instrument of knowledge; and (5) research generates and reproduces the systems of power, race, and oppression that operate in the given society (Browne 2000). In this situation, the goal of knowledge is to transform and shift the existing social status quo toward the greater social good for everyone (Browne 2000). Needless to say, the CST research paradigm fits in the conditions and circumstances of nursing knowledge and knowing. CST holds a promise and fosters the exploration and analysis of nursing experiences with the help of new methods of inquiry and expands the emancipator potential of the nursing discipline (Browne 2000). CST creates a foundation for interrupting the conventional lines of power and re-directs nursing practice toward the greater ideals of equity, justice, and freedom (Browne 2000). CST contributes to nursing knowledge in the sense that it allows and even encourages nurses to criticize conventional assumptions behind nursing research and promotes self-transformative potential of the nursing discipline through self-reflection (Browne 2000). However, as previously noted, no single research paradigm can meet the demand for better academic knowledge in nursing. CST is no exception: as long as CST promotes collective social good, it leaves little room for personal identities and actions that are vital to continued progress in the nursing discipline (Browne 2000). CST is beneficial to the extent, which requires creating a generalized body of knowledge that can be successfully applied across a variety of nursing situations. Bearing in mind that nursing knowledge and the discipline, in general, relies on consciousness, self-analysis, and personal reflection CST can serve only the starting point in the development of new scientific concepts and paradigms. These general concepts and paradigms will have to be further reconstructed through the prism of one’s subjective reality and individuality, without which nursing is impossible (Browne 2000). Reductionism: the value of holism and multidimensionality The problems and controversies within the CST paradigm support a thesis that no one single scientific paradigm can solely contribute to nursing knowledge. In a similar vein, there is no research paradigm which is the most relevant to the nursing discipline. CST presents a useful framework for knowledge development and scientific analysis in nursing. Yet, there are also other, no less relevant research paradigms that can successfully actualize the underlying meanings of nursing knowledge and scientific development. Here, reductionism holds a promise to add to nursing knowledge. According to Hawley, Young and Pasco (2000), reductionism is the core element in explaining causal relations and phenomena in science. Reductionism effectively explains the principal, fundamental causes of various phenomena (Hawley, Young & Pasco 2000). That reductionism presents complex phenomena in a simple form is one of its major benefits. Moreover, the use of reductionist research perspectives creates a picture of completeness in the nursing discipline and fosters subsequent actualization of the core values in nursing. The fact is in that nursing professionals cannot successfully actualize the core values of nursing knowledge, unless they are able to embrace more than one research methodology (Hawley, Young & Pasco 2000). Apparently, reductionism adds value to the use of CST research paradigms in nursing knowledge. Reductionism pursues the same philosophic line, which prescribes the need for understanding former social relations and developing means to reduce social oppression and bias. Reductionists never deny the presence of a direct link between oppression and health (Hawley, Young & Pasco 2000). Reductionism requires that emancipator inquiries be used to advance knowledge and understanding of oppressive factors in nursing (Hawley, Young & Pasco 2000). Nursing knowledge must incorporate a descriptive and prescriptive element of knowing about objective reality, which only reductionism can provide. Reductionism can become an effective instrument of explaining irregularities and patters in the nursing science (Hawley, Young & Pasco 2000). Eventually, reductionism is an integral component of nursing knowledge, without which nursing as an academic discipline loses its relevance. Like other research paradigms, including the critical one, reductionism incorporates an objectivity component and exemplifies a sign and symptom of traditional science in nursing. Feminist and postmodernism: subjectivity or uniqueness? As previously mentioned, nursing knowledge is essentially a unique combination of the subjective and objective elements. To be more specific, knowledge in nursing presupposes reflecting and rethinking objective phenomena through the prism of personal experience and self-reflection. As a result, where reductionism and CST serve the needs of objectivity, postmodernist and feminist approaches to nursing knowledge are believed to create the atmosphere of subjectivity and individuality in the nursing discipline. Where reductionism and CST paradigms serve the needs of traditional science, postmodernism and feminist create conditions that require thinking beyond traditional scientific ideology. They even add a so-called anarchistic angle to nursing knowledge, which denies singularity and promotes multidimensional vision of the nursing theory and practice. In this sense, postmodernism holds a promise to make a unique contribution to the development of the nursing discipline. Postmodernism is unique in the sense that it expands and transcends the boundaries of conventional science and rejects the monolithic notions of rationality and truth (Holmes & Warelow 2000). The postmodern research paradigm can provide successful explanations and recommendations to the multiple realities in nursing. According to Holmes and Warelow (2000), a postmodern inquiry into the nursing science exposes the significance of metanarratives that shape the basis for the emergence of new nursing science paradigms. Postmodernism helps to revalue patient and nurses’ experiences and insights (Holmes & Warelow 2000). Postmodernism allows demystifying the existing nursing practice discourse and rejects the established universals, opening new research and scientific frontiers. Eventually, postmodernism abandons and rejects the illness-wellness dichotomy and transform the role of a practicing nurse, followed by the need to revise the conventional notions of care and treatment (Holmes & Warelow 2000). Postmodernism does not simply pose questions but helps to answer them in a scientifically valid but comprehensive format. Postmodernism does not deny but, on the contrary, makes practicing nurses accept and re-evaluate the existing discontinuities and tensions within their practices (Holmes & Warelow 2000). This is how nurses can successfully develop and utilize alternative ways of knowing. In a broader sense, postmodernism is a form of alternative knowing in itself. This is, probably, the most valuable contribution the postmodernist research paradigm can make to the nursing discipline and science. In a similar vein, feminist approaches to knowledge in nursing present unique professional and academic advancement opportunities. Feminist perspectives are particularly relevant for nursing ethics (Peter 2000). However, since effective knowing is impossible without ethics, nursing knowledge is impossible without feminist approaches and frameworks. Feminist research paradigms fit in the nursing knowledge discourse perfectly well: like nursing, feminist seeks to foster human good (Peter 2000). Feminist approaches to research rely on phenomenology while interpreting various nursing concepts and events (Peter 2000). Moreover, feminist ethics exemplifies a better perspective than phenomenology in the sense that it does not accept any forms of oppression within knowledge and makes visible the significance and ethical implications of the professional values held by women (Peter 2000). That the prevailing majority of nurses are women is a well-known fact and here, feminist approach to nursing knowledge presents a serious gender dilemma. An effective instrument of fighting oppression and marginalization in nursing, feminist approach promotes and emphasizes the values that are mostly held by women. As a result, feminist ethics can be readily contrasted to the values of fairness and justice in nursing knowledge. These limitations, however, cannot reduce the value of the feminist perspectives in nursing knowledge and research. Rather, they imply that nursing knowledge cannot be the product of one single research paradigm. Nursing knowledge is multifaceted. It exemplifies a unique balance of objective information and personal experiences. For this reason, different research paradigms will provide a unique contribution to nursing knowledge, to integrate professional identities with the external nursing reality. Conclusion The past decades were marked with the emergence of new, complex research paradigms that “contribute to the development of nursing as an academic discipline and knowledge” (Peter 2000). In the nursing discipline, knowing manifests in three different forms: personal reflection, technical understanding, and a cognitive process. Simply stated, knowing in nursing is a unique combination of objective, scientific and personal features. Given that knowing in nursing is all about personal transformation, reflection, and experience, no single research paradigm can help to develop a sound system of academic and practical knowledge in nursing. Personal reflection is unique; and so is nursing knowledge. Simultaneously, science and discipline is always objectives and unbiased. This gap between experience and science is not easy to close, but nursing is a discipline of multiple perspectives. Reductionism and CST, feminism and postmodernism are just some of many research paradigms that can contribute to nursing knowledge. Different research paradigms provide a unique contribution to nursing knowledge, helping to integrate professional and personal identities with the external reality of being a qualified nurse. References Bonis, SA 2009, ‘Knowing in nursing: A concept analysis’, Journal of Advanced Nursing, vol.65. no.6, pp.1328-1341. Browne, A 2000, ‘The potential contributions of critical social theory to nursing science’, Canadian Journal of Nursing Research, vol.32, no.2, pp.35-55. Ceci, C 2000, ‘Not innocent: Relationship between knowers and knowledge’, Canadian Journal of Nursing Research, vol.32, no.2, pp.57-73. Hawley, P, Young, S & Pasco, AC 2000, ‘Reductionism in the pursuit of nursing science: (in)congruent with nursing’s core values?’, Canadian Journal of Nursing Research, vol.32, no.2, pp.75-88. 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Tzeng, HM & Yin, CY 2007, ‘Said another way: Seeing the nursing profession from a different perspective’, Nursing Forum, vol.42, no.4, pp.185-188. Read More