THE THEORY of NURSING KNOWLEDGE (Editorial)
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THE THEORY OF NURSING KNOWLEDGE (Editorial) Kalofissudis I., RN, MBA, MSc, Head of Quality Assurance and Education, Henry Dunant Hospital of Athens or decades, nursing educators have invested sert that when one's perspective is the human sci- heavily in developing a philosophy and con- ence paradigm, and particularly, the human becom- Fceptual framework specific to a given school of ing theory, one person can and does make a differ- nursing, regardless of the level of nursing education. ence in global health. As Metatheory, the Complexity Consequently, there is a great deal of variability, and Integration Nursing Theory evolves new viewpoints, often opposing schools of thought, across schools of approaches and creative tools in order to utilize the nursing. A theoretical foundation applicable across Human Being’s perspective. In this way, the four nursing education programs, therefore, has emerged metaparadigms of the Nursing Science, which is the as a significant missing factor. This missing theo- person, the environment, the health and the nursing retical piece is of critical importance for the student (Powers & Knapp, 1990), emerge within their inter- seeking nursing education at a variety of colleges relations as self-organized networks within the and universities and through multiple programs Nursing Science’s network. such as practical nurse, associate degree nurse, bac- calaureate degree nurse, masters degree nurse and even as a doctorate prepared nurse. The Theory of Nursing Knowledge/Wisdom and Nursing Praxis Traditionally, the nursing profession had been a sci- ence subsumed from other disciplines with non- During the early 1990’s, a unique opportunity to en- mathematical and non-computational research hance and add to the theories of nursing science originating from nurses. Recently, however, nursing emerged with the advent of the supercomputer and science has broken out of the traditional mold and its capabilities for dealing with tarabyte-sized data- has added a strong scientific and theoretical founda- bases. A nursing scientist leading a transprofes- tion and mathematics are becoming an integral sional team resulted in new tools and methodologies component of nursing. Nursing scientists have rec- necessary for analyzing large-scale databases and ognized the value of using mathematics for graphi- the development of a theory regarding nursing cally representing abstract conceptualizations, par- knowledge and nursing practice. The Theory of ticularly for describing, explaining, and predicting Nursing Knowledge/Wisdom and Nursing Praxis nursing practice (Walker & Avant, 1995). evolved during the development of Nurmetrics and computational nursing, which introduced a new era For instance, the Theory of Nursing Knowl- for nursing science with emphases on mathematical edge/Wisdom and Nursing Praxis, a mathematics form, statistical analysis, and computer simulation. based approach to nursing education, when utilized Serving as an initial foundation for Nurmetrics was refines and enhances the structural foundation for the evolution of a nursing theory utilizing mathe- nursing curriculum, nursing courses, and nursing matical form (Meintz, et. al.). The Theory of Nursing textbooks, emerging a new viewpoint of the Science Knowledge/Wisdom and Nursing Praxis expressed of Nursing in the most global perspective. Further- through mathematical form analyzes nursing sci- more, this global perspective that The Theory of ence as it relates to nursing practice; whether it is Nursing Knowledge/Wisdom and Nursing Praxis clinical nursing practice, nursing education, nursing illustrates, subsuming the parts of the Nursing administration, or nursing research. The Theory is a Knowledge/Wisdom and Nursing Praxis, creating a revolutionary manner of understanding the intrica- whole. The whole centered to the Human Being, the cies of nursing knowledge with a mathematical nurse as individual human being, and the implemen- statement. Development of the Theory delineates tation of this understanding in the community and the diverse factors that constitute professional nurs- in the Social Entirety Nursing Theory, creating The ing practice, to explain the relationship between the Complexity Integration Nursing Theory, a Nursing separate elements, and to predict nursing practice Metatheory. Paille M and Pilkington FB (2002) as- patterns through examination of identified vari- ISSUE 4, 2007 Health Science Journal http://www.hsj.gr ables. The Theory of Nursing Knowledge/Wisdom Disciplined Inquiry (DI) refers to investigation or (Appendix I, Figure 1) elucidates the uniqueness of experimentation aimed at the discovery and inter- the nursing profession by systematically identifying pretation of facts, revision of accepted theories or the fulcrums of practice law in the light of new data, and the practical appli- cation of new or revised theories or laws. Nursing NF stands for the Nursing Foundation, a combina- knowledge is influenced by disciplined inquiry (or tion of knowledge from both the sciences and hu- research) from the nursing sciences and associated manities. The sciences contribute the empirical disciplines. knowledge base procured by the science of nursing and associated disciplines such as biology, the NKW is Nursing Knowledge/Wisdom, the under- physical sciences, medical science, and chemistry. standing of nursing as a science and an art. There- Behavioural, social or natural sciences supply ab- fore, nursing knowledge/wisdom equals the nursing stract scientific theories. For example, the humani- foundation (derived from the combination of knowl- ties contribute knowledge from the philosophical edge from the sciences and the humanities), plus the and cultural studies that investigate human con- nursing essence, plus methodology, and plus disci- structs and concerns, as contrasted to physiological plined inquiry. processes such as physics or chemistry. The Theory of Nursing Knowledge/Wisdom is appli- Methodology (M) applies a methodology for prob- cable to practice through the following formula: lem solving to a specific practice domain such as in (NKW) (IB) = P clinical practice the staff nurse uses the nursing process or Outcome, Process, and Test (OPT) model, Here, (IB) represents the individual nurse’s integra- strategic thinking for nursing administration, scien- tion and synthesis of nursing knowledge through tific inquiry for nursing research, or adult learning cognitive, psychomotor, and affective/spiritual do- theory for nursing education. main of self. Whereas, (P) represents the depth and breadth of nursing praxis, which increases or de- Nursing Essence (NE) represents the evolution of creases according to the application of nursing nursing as a profession and is defined according to knowledge to this integration. the practice domain. NE includes the principles of the science of nursing, legal parameters, the defini- The depth and breadth or nursing praxis (P) is de- tion of person, environment, health, and nursing; termined by the individual nurse’s Being (IB) and technical skills; and all other esoteric components of the integration and synthesis through domains of nursing practice. Additionally, nursing essence ac- cognitive, psychomotor, affective/spiritual domains counts for the various existing nursing conceptual of self, times nursing knowledge/wisdom (NKW). models and nursing theories. The conceptual models Therefore, if P = Y, and (NKW) (IB) = X, then the and the nursing theories may provide the basis for greater the X, the greater the Y. As X increases (or clinical practice for some nurses (i.e. Johnson’s Be- decreases) Y increases (or decreases). X is posi- havioral System Model, King’s General Systems tively (or negatively) related to Y. The reverse is not framework, Levine’s Conservation Model, Neuman’s true because this is a nonreversible, or unidirec- Systems Model, Orem’s Self-Care Framework, tional causality. Rogers’ Science of Unitary Human Beings, Roy’s Ad- aptation Model, Leininger’s Theory of Culture Care The final synthesis statement of the Theory of Nurs- Diversity and Universality, Newman’s Theory of ing Knowledge/Wisdom and Nursing Praxis affirms Health as Expanding Consciousness, Parse’s Theory that: The degree of change in Nursing Praxis, which of Human Becoming, Orlando’s Theory of the Delib- an individual nurse emits, is directly related to the erative Nursing Process, Wiedenbach’s Clinical degree of integration and synthesis of Nursing Knowl- Nursing: A Helping Art, Henderson’s Nature of edge/Wisdom, which includes: nursing foundation Nursing, Travelbee’s Interpersonal Aspects of Nurs- (science and humanities) plus nursing essence plus ing, Peplau’s Theory of Interpersonal Relations, methodology plus disciplined inquiry. Watson’s Theory of Human Caring, and so forth). Thus, Nursing Essence is defined differently for each The Theory of Nursing Knowledge/Wisdom and of the nursing practice domains, including clinical Nursing Praxis was developed utilizing inductive nursing practice, nursing education, nursing admini- reasoning from a historicist perspective. Inductive stration, and nursing research. reasoning is the process of combining discrete con- cepts into a more global abstraction. This theory ISSUE 4, 2007 Health Science Journal http://www.hsj.gr links psychometric variables pertaining to nursing 4. The uniqueness of the individual nursing sci- knowledge and practice to create a more pervasive entist influences the depth and breadth of clinical understanding of the nursing phenomena. practice,