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Nurses have sought to understand the art and science of nursing since the time of Florence Nightingale. Six fundamental ways of knowing underpin nursing science. These ways of knowing include: (a) personal, (b) empirical, (c) ethical, (d) aesthetics, (e) emancipatory, and (f) unknowing. Consider how these ways of knowing contribute to knowledge development by addressing the following.
The Science of Nursing
What is nursing science and how does it differ from medical science? View this brief video by DNP scholar, Carole Eldridge, Chamberlain Administrator and nationally acclaimed expert on nursing science.
[BLANK_AUDIO] Hi, I’m Carol Eldridge, and I was asked to talk about nursing science, what it is and how I think it’s different from medical science. And I’m gonna do that, or try to do it, by just giving you an illustration from my own career. I was a lover of science as a child, and when I got into nursing school, I pondered this question.
What is it that nursing contributes uniquely to the body of knowledge that we call science? And in nursing school, I took care of a patient who died very early. She was a patient suffering from ovarian cancer and she died very young, and I was very new to the whole process, and I was very disturbed by the process and by the way she died.
She died in a great deal of pain with no family around her. And I ask myself all the questions you would ask yourself. Did it have to be this way? Could we make this better? And at the time, palliative care was very new in the United States, and hospice care was very young.
My questions eventually drove me into hospice nursing and into palliative care and into starting a hospice agency. And we devoted a great deal of time with our nurses at that agency in trying to discover some answers to that question. Could we make the process of death better? And we used the experiences of our patients and our nurses to contribute to the body of knowledge and we, with others, help to make hospice care more of a science than it is today, and a better process.
And I’m really proud of that work. And to me, it captures the essence of nursing science. And what was different about it to me was where we started. The physicians were starting from the disease process. This person had cancer and we’re gonna work on the cancer. We as nurses started with the person.
And we were gonna work on the experience that, that person was having, their experience with their illness, their experience with their death. And that was our focus and it changed everything about the science that we did. The other piece that was different was that we pulled from a much broader universe of interventions.
We were using the psychological, the social, the spiritual as well as the biological. We were using family, we were using community, we were pulling from so many different things that we could use to help this patient in a holistic manner. And this informed our science and became the particular viewpoint we had about it.
And it excites me when I realize what a difference that makes to science, that we bring that unique perspective of the individual person and their perspective and their experience, and what it brings to help and wholeness. And that to me captures what nursing science is all about. It’s where we start.
It’s what we pull from. It’s the unique perspective that we bring to it. It helps to make things better for all of humanity. And I am really passionate about nursing science being the way that we nurses can bring so much to the world.
Philosophical Foundations of Nursing
Nursing’s knowledge development is underpinned by two philosophical orientations: positivism and anitpositivism. Positivism or empiricism serves as the foundation for research in the physical sciences, while anitpositivism is the basis for the interpretive human sciences (Eldridge, 2017). Philosophical orientations have evolved over the years; the contemporary stance of positivisim now asserts that knowledge is developed within specific social and historical contexts. This philosophical orientation is called postpositivism. Postpositivism places value on both observable reality and the complex nature of human phenomena (Fawcett, 1997b; Toubell, 2018). Although positivists put emphasis on only quantitative methods of scientific inquiry, postpositivists place value on both quantitative and qualitative methods of inquiry. According to Eldridge (2107), nursing benefits from the philosophical knowledge that crosses disciplines; however, nursing’s philosophical positions are grounded on individual and collection perceptions and experiences. Doctorally prepared nurses benefit from the growing body of scientific knowledge and translate this knowledge into the real world of practice.
Ways of Knowing in Nursing
Ever since the groundbreaking work of Florence Nightingale, nurses have sought to understand the art and science of nursing. Before a structured process enveloping philosophy, conceptual models, and theory evolved, knowledge was gained through tradition and authority. Knowledge creation happened via a trial-and-error clinical experience. Scholars noted nursing intuition to be contributory during this time period (Heath, 1998). Since that time, nursing knowledge has evolved considerably. Beneath all knowledge are the ways of knowing (Alligood & Tomey, 2014). These phenomena are not unique to nursing; the ways of knowing inform all disciplines. The three most commonly recognized ways of knowing are epistemology, ontology, and axiology. Some would argue that nursing knowledge emerges at the intersection of these three ways of knowing.
View the inforgraphic below to explore epistemology, ontology, and axiology. Do you agree or disagree that nursing knowledge emerges at the intersection of these ways of knowing?
Ways of Knowing
Epistemology is the study of empirical knowledge, typically resulting from scientific inquiry. It is organized according to what we believe to be true (or factual), and when applied to nursing, best connects with the science of nursing. Epistemology encompasses not only empirical knowledge but also teleological knowledge, the process of knowledge (interpolation and extrapolation), and additional contributions to knowledge.
Ontology is the study of reality. It is organized according to what we believe to be real. Ontological knowledge focuses on application and is often attributed to the art of nursing or aesthetics.
Axiology is the study of what we believe to be good. This way of knowing accounts for one’s moral compass, which serves as our guide in the ethical dilemmas we commonly encounter in our profession.
Reflect on the infographic above and consider how each of the ways of knowing impact your nursing practice. When do you use each of the ways of knowing most, or least? Do you ever use all three ways of knowing simultaneously?
Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, e12243. doi:10.1111/nin.12243
Carper, B. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1(1), 13-23. https://chamberlainuniversity.idm.oclc.org/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=yrovft&AN=00012272-197810000-00004&PDF=y (Links to an external site.)
Heath, H. (1998). Reflection and patterns of knowing in nursing. Journal of Advanced Nursing, 27(5), 1054-1059 6p. doi:10.1046/j.1365-2648.1998.00593.x
Marrone, S.R. (2018). The art of knowing: Designing a nursing professional development program based on American nurses’ experiences of providing care to Arab Muslims. Journal of Nursing Education and Practice, 7(7), 104-111. doi: 10.5430/jnep.v7n7p104.
Polit, D. F., & Beck, C. T. (Eds) (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Tobbell, D.A. (2018) Nursing’s boundary work: Theory development and the making of nursing science, ca. 1950-1980. Nursing Research, 67(2), 63-73. doi:10.1097/NNR.0000000000000251
Zaccagnini, M. E. & White, K. W. (2017). The Doctor of Nursing Practice essentials: A new model for advanced practice (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.
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