A Philosophical Analysis of Conceptual Models of Nursing Sandra Courtney Sellers Iowa State University
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Iowa State University Capstones, Theses and Retrospective Theses and Dissertations Dissertations 1991 A philosophical analysis of conceptual models of nursing Sandra Courtney Sellers Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/rtd Part of the Medical Education Commons, Nursing Commons, Other Education Commons, and the Social and Philosophical Foundations of Education Commons Recommended Citation Sellers, Sandra Courtney, "A philosophical analysis of conceptual models of nursing " (1991). Retrospective Theses and Dissertations. 9580. https://lib.dr.iastate.edu/rtd/9580 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Retrospective Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. 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Ann Arbor, t^l 48106-1346 USA 313/761-4700 800 521-0600 Order Number 9136348 A philosophical analysis of conceptual models of nursing Sellers, Sandra Courtney, Ph.D. Iowa State University, 1991 UMI 300N.ZecbRd Ann Aitor, MI 48106 A philosophical analysis of conceptual models of nursing by Sandra Courtney Sellers A Dissertation Submitted to the Graduate Faculty in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Department: Professional Studies in Education Major: Education (Historical, Philosophical and Comparative Studies in Education) Approved: Signature was redacted for privacy. In Charge of Major Signature was redacted for privacy. For tne Department Signature was redacted for privacy. For the Education Major Signature was redacted for privacy. FO Ahe Uraduate College Iowa State University Ames, Iowa 1991 ii TABLE OF CONTENTS Page CHAPTER I INTRODUCTION 1 Statement of the Problem 1 Purpose of the Study 4 Significance of the Study 5 Methodology 6 Limitations 7 Organizational Structure of the Study 9 CHAPTER II REVIEW OF THE LITERATURE 10 Introduction 10 Nursing Education 10 Nursing Theory Development 34 Summary 56 CHAPTER III CONCEPTUAL NURSING MODELS 59 Introduction 59 Peplau's Psychodynamic Nursing Model 59 Orlando's Deliberative Nursing Process Model 70 Rogers's Model of Unitary Human Beings 80 Roy's Adaptation Nursing Model 94 Watson's Human Science and Human Care Model 110 Summary 121 iii CHAPTER IV PHILOSOPHICAL ANALYSIS OF THE MODELS 123 Introduction 123 Framework for Philosophical Analysis 123 Ontology 124 Epistemology 129 Axiology 138 Philosophical Analysis of the Five Conceptual Models 140 Peplau's Psychodynamic Nursing Model 140 Orlando's Deliberative Nursing Process Model 144 Rogers's Model of Unitary Human Beings 147 Roy's Adaptation Nursing Model 150 Watson's Human Science and Human Care Model 153 Discussion of Findings 157 CHAPTER V SUMMARY AND EDUCATIONAL IMPLICATIONS 163 Summary 163 Implications and Recommendations for Nursing Education 165 REFERENCES 176 ACKNOWLEDGMENTS 199 1 CHAPTER I INTRODUCTION Statement of the Problem In the 1950s, American nursing practice was based on the medical model. During the last four decades, however, nurse scholars began to think seriously about the unique scope and domain of nursing. They began to explore the nature of nursing and the purposes for which nursing exists. They also began developing nursing theory as a foundation for nursing practice and education. This endeavor has presented nurses with the motivation to examine nursing's heritage, its goals and the values upon which nursing is based. Since the 1950s, American nursing theory development has focused on the establishment of a metaparadigm for nursing as well as many paradigms for nursing. The metaparadigm of nursing is comprised of the global concepts that represent the phenomena of interest to nursing. A review of the current nursing literature reveals a consensus about the global or metaparadigm concepts of nursing: person, environment, health and nursing (Fawcett, 1983; Flaskerud and Hailoran, 1980). The paradigms of nursing are represented by abstract, diverse conceptual models of nursing that provide distinct perspectives of the four metaparadigm concepts. Between 1952 and 1989, twenty conceptual nursing models were published (Fawcett, 1989; Marriner-Tomey, 1989). Each model provides a different conceptualization of nursing and a different world view. The models present distinct views about the nature of person- 2 environment relationships and different cognitive orientations to nursing. The models provide guides for the organization of nursing knowledge and prescribe nursing practice, research and education. With the proliferation of nursing conceptual models, there is a need for nurses to examine these models for their relevance to current nursing practice and education. Specifically, there is a need for nurse educators to analyze the models since nursing knowledge is becoming organized rapidly around and developing from these abstract conceptual models. In addition, the models prescribe the purposes to be fulfilled by nursing education and the curriculum and educational processes needed to achieve these purposes. Various critiques of the conceptual nursing models have been conducted and generally have consisted of detailed examinations of the content of the models. Fawcett (1989) asserted that these critiques have failed to analyze thoroughly the assumptions and philosophical bases of the models. "They have not examined, in any depth, their philosophical orientations or their world views of the nature of human beings, the nature of knowledge and truth and the nature of nursing science" (Fawcett, 1989, p. 42). In addition, a review of nursing dissertation abstracts from August 1988 through August 1990 revealed that no studies have explored whether or not there has been a change in the espoused philosophy of nursing since the inception of the conceptual nursing models in 1952. This is surprising, since philosophy provides a holistic perspective about the beliefs, values, goals and social significance of nursing. 3 Behaviorism, in the form of the Ralph Tyler rationale, has prescribed nursing education curriculum development and the direction of nursing educational thought since 1952 (Bevis and Watson, 1989). In addition, state boards of nursing and the national nursing educational accrediting agency (National League for Nursing) have adopted Tylerian/behaviorist curriculum products as criteria for approval and accreditation of all nursing educational programs in the country. This institutionalized behaviorism is nursing's tacitly agreed- upon version of truth in educational curriculum. It has become uniformly applicable to all nursing curriculum efforts and has limited curriculum exploration to behavioral theory. The use of the Tylerian curriculum development model has frozen nursing in a behaviorist framework. It has entrenched nursing education in a training modality, brought behavioral objectives and evaluation methods into primacy, and has been responsible largely for the rise of competency-based education and evaluation in nursing education. Similar to the medical model, behaviorism is materialistic, reductionistic and empirical. It proposes that all learning is evidenced in some form of empirically observable behavior. It consists of deductive logic and supports procedural knowledge. It is based on the traditional sciences, and tends to allow for one concept of reality and one way of knowing. With recognition of the inadequacies of the medical model and the development of nursing theory, some nurse educators are 4 advocating a curriculum revolution in nursing education (Tanner, 1988). These educators base the identified need for a radical change in nursing education on the assumption that the philosophy of nursing, through theory development, no longer supports pragmatic behaviorism. If this assumption is accurate, a dissonance within nursing exists between nursing theory and nursing education. Although a change in nursing education is being proposed, there