Use of nursing grand theories in the development of nursing knowledge
The development of nursing knowledge is an ongoing process. Discuss the case for the ongoing development and use of nursing grand theories and conversely, make a case for the obsolescence of nursing grand theories for today’s practice and research.
Use of nursing grand theories in the development of nursing knowledge
Theory texts demonstrate innovative and scholarly applications of theory to practice. This emphasis on application, rather than origination, of theory in practice stems in part from our scientific heritage, in which knowledge has traditionally been regarded as a rational, cognitive process distinct from the social and practical (and messy!) contexts in which it is used (e.g., Longino, 2002, 2008). As a result, theories have arrived in our practice and research more or less ready-made, having been developed in a so-called rational, cognitive context, such as an armchair. However, shifts in philosophy of science—generally and specifically in nursing—are bringing together the development, translation, and application of knowledge in more deliberate ways, paving the way for theory innovation. Furthermore, Stehr (2004) reminds us that the amount of knowledge developed in the midst of the proliferation of research findings and other evidence for practice should be balanced with consideration for how knowledge is developed. Thus, the production of knowledge and theory in the patient-centered context of nursing practice is a frontier in knowledge development.
Researchers and theorists, it is widely assumed, provide new knowledge and theories for practicing nurses to apply, evaluate, and possibly modify in their practice. To be sure, nurses do look within their practice to inform their practice, such as their keen observations, interactions with patients and families, conversations with colleagues, and expert judgment. However, nurses have the ability to think theoretically as well as conduct research in order to develop scientific knowledge for use in practice. The science of practice has the potential to generate knowledge for interested nurses through scientific inquiry, practice-based interactions, and novel theoretical thinking.
A REQUEST FOR TRANSFORMATION
The ideas expressed in this book’s chapters are consistent with the four key recommendations for nursing education outlined by Benner, Sutphen, Leonard, and Day (2010) in their call for radical transformation of nursing programs. This book, in other words, encourages the development of contextualized knowledge for practice; promotes more deliberate strategies for linking theory to practice; supports the emphasis on clinical scholarship in exploring new ways of reasoning and theorizing in practice beyond the focus on critical thinking; and supports the transformation of practicing nurses’ identities by encouraging and guiding their participation as knowledge producers in practice rather than knowledge users in practice. Furthermore, innovative theoretical thinking in practice and the various knowledge sources from which it draws must not be overshadowed by more familiar reasoning processes such as critical thinking, evidence-based practice (EBP) procedures, problem solving, or decision making (Lester & Piore, 2004).
NURSING’S THEORICAL HERITAGE
Florence Nightingale of the United Kingdom professionalized nursing practice in the late nineteenth century by putting into practice her theoretical ideas about the importance of the physical and social environments in human health and well-being. Nightingale’s emphasis on facilitating a person’s inner healing processes through environmental care, combined with her expertise in statistics and other ways of knowing, made her a compelling leader for nursing science and practice. New leaders in theoretical thinking energized nursing’s advancement in education, research, and practice as the twentieth century progressed. Hildegard Peplau’s (1952) theory of interpersonal relations pioneered a major scientific treatise on the nurse-patient relationship, which is still a defining focus of nursing practice today. Martha Rogers’ (1970) work on the theoretical foundations of nursing presented progressive ideas about human complexity and person-environment processes that are still being developed in contemporary theorizing and science. Many other notable theorists, including some of you, have joined and will join these three historical icons in advancing nursing’s role in health care knowledge and practice.
Theoretical thinkers in nursing have a long history. Nursing scientist scholars who first received their education in theory-based or theory-enriched disciplines such as sociology, psychology, anthropology, and education provided a wealth of theoretical thinking and conceptual systems of, and for, nursing. Graduate-level nursing programs educated nurses who followed and produced nursing theories and theory-related writings. As a result, we may take for granted what some fields (e.g., McQueen, 2007) continue to seek—a theoretical foundation for the profession.
The goal of this chapter is to present a Path of Nursing Knowledge to encourage and guide participation in developing knowledge for the discipline among nurses, particularly practicing nurses. Because there is no ultimate goal or final theory in knowledge development, it is a path of rather than to knowledge. Today’s theories must be sensitive to the given situation as well as changing problems and experiences, while also illuminating patterns that broaden understanding of nursing phenomena. The Path provides a tentative but useful form of knowledge called “theories,” but it always leads us forward through the process of knowledge construction.
The practice of nursing, that is, facilitating processes of health and well-being within and among human systems in a variety of settings, is the linchpin of this path (Reed, 1997). The integral link between practice and knowledge is not new, and emphasizing this link in nursing’s network of knowledge presents some scientific and theoretical challenges for innovation. The challenges, however, are worthwhile given their potential to advance nursing’s unique and innovative contributions to human health and health care. This and the following chapter are just the beginning of what I hope will be a long conversation about new approaches to developing nursing knowledge. The dialogue is continued in subsequent chapters by authors with diverse practices and perspectives.
THE SPIRAL ROAD
Petroglyphs, ancient carvings or inscriptions embedded in the rocks and boulders, can be found along hiking trails in mountains where the ancients once walked. Some of them depict a spiral shape that can be found on every continent. I used this spiral shape to represent a nursing knowledge development process. The spiral form represented one of several ideas to the ancient people that can apply to the process of knowledge development: energy; a life-giving source like water; a process of emerging or transcending; a portal or gateway from the mundane to the eternal realms; or perhaps most relevant to the career of being a nursing student or scholar is its symbolization of a life journey and the challenges for growth faced along the way.
The petroglyph that inspired the spiral design is earthy and imperfect, with many turns. It is not a perfect spiral, as you might find in a catalog, but rather an imperfect representation of the natural, dynamic, and often messy processes of nursing practice, science, and theorizing.
The spiral path traverses the geography of nursing knowledge six times. Each turn corresponds to a specific focus and inquiry tool for knowledge development. Unlike other models of nursing knowledge structure, the Path’s components are not arranged hierarchically. Instead, the spiral is an ongoing and nonlinear path that can be influenced for innovative and unpredictable change. The Path is a spiral form to convey continuity across dimensions; from everyday knowledge work to scientific theories, knowledge construction is a “fundamentally continuous” process, as described by practicing scientist Fleck in his book on comparative epistemology, Genesis and Development of a Science Fact (cited in Smith, 2005, p. 26).
The spiral path is a way of thinking about how different aspects of knowledge development are organized and linked. What follows may be modified or expanded depending on your context of nursing science and practice, as well as what you want to emphasize—a pragmatic turn? an ethical reversal? or a spiritual shift? Any approach to knowledge development, however, is likely to involve a dynamic network or web of components that include philosophical, empirical, and theoretical dimensions of the discipline.
Above all, knowledge development is an emergent process, mirroring the process of change that its creators go through over time—open and ongoing, developmental and sometimes decremental, patterned yet unpredictable, complex yet organized, producing outcomes that are greater than the sum of its various turns while still being influenced by each turn. The theory circle indicates that the scientific knowledge produced is not necessarily cumulative, nor is it unchanging or unchangeable, but it is relevant to the practice situation or problems to which it is linked. Of course, other types of knowledge can be found along the way. Many patterns of knowing enrich nursing knowledge, which inform and are informed by the scientific pattern represented by the Path’s theory component.
THE THEORY CONTEXTS
The Path of Nursing Knowledge includes a significant amount of theory. Theory is the “vehicle of scientific knowledge that becomes involved in most aspects of the scientific enterprise in one way or another” (Suppe, 1977, p. 3). Theory exists within a context of philosophical, empirical, and theoretical dimensions, and theory emerges from nursing practice and research. Theory also serves to inform nurses’ practice and research in a reflexive manner. Figure 1.1 depicts this line of inquiry, highlighting key aspects of the philosophical, empirical, and theoretical dimensions of knowledge development.
Philosophical components influencing knowledge development include philosophy of science, the nursing metaparadigm, and philosophy of nursing, as well as personal beliefs and values. These philosophical components express conceptual perspectives that influence (or are related to) a discipline’s substantive focus on theories (ontology) and process focus on empirical methods and patterns of knowing and justifying knowledge (epistemology). The philosophical dimension broadly describes how things are from a certain point of view of reality, and how they should be from a point of view of morality.