The science of coming of age.
nursing
is
The Mature of Science in Nursing KATHLEEN G. ANDREOU, Mas& R& THQMPSoNs M*SmN’s RmN*’are faculty membars sf the UnbedfY of AJabamaSchool of Nuning IR Bimlngham.
Nursing is striving for recognition as a scientific discipline. Accordingly, in order to attain a scientific status, nursing must make explicit the theoretical basis for its practice. This theoretical basis of practice i s the science of nursing, and it defines nursing’s uniqueness.
This theoretical basis of practice Is the science of nursing, and It defines nunlng’s uniquen9ss. For the first one hundred years of its existence, nursing established itself as an indispensable helping health profession with little emphasis on substantiating its scientific foundation. Since the 1950’s, however, the concept of a science in nursing has received high priority in the nursing literature and in nursing education. This trend is clearly related to the increase in the number of nurses with graduate preparation and advanced education in research methodology and the growing concern for the need to sysiematically test, organize, and expand the body of knowledge upon which the practice of nursing rests. Noncritical thinkers may accept the concept of a science i n nursing as fact, while others mav respond with an expressed need for more proof or at least a deeper explanation of the meaning of the c o r x q t . It is to this latter group that this paper i s dedicated. What is the nature of science in nursing? Before attempting to answer this question, one must first be cognizant of the meanings of the words ”science” and “nursing.”
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The Nature 03 Science in Nursing
What Is Science? Science is a word for which i t is difficult to find a clear and concise definition. Webster's dictionary defines science as a profession of knowledge, a system of knowledge based on scientific principles, concerned with the observation and classification of facts and establishing verifiable theories and general laws.' The theme of knowledge (truth) i s clear in this definition, and its pursuit i s the
sciences to develop their body of knowledge with a commitment to applying this knowledge toward some well-defined social goal. Therefore, these professions fall credibly under the "umbrella" of applied science. Since science i s a system of knowledge based on scientific principles, it depends upon its branch of knowledge or specialty area to pursue the quest for knowledge. This professional branch is called a scientific discipline, and it characteristically has the working parts of relevant concepts, theories, models the pathways to and conceptual frameworks scientific inquiry and existence. Scientific inquiry
...the ultlmafe goal of rclence b the dlscovery of new knowledge, tho expanslon of exlstlng knowledge, and/or the reafflrmlng of previously4mld knowledge. foundation of science. Thus, the ultimate goal of science is the discovery of new knowledge, the expansion of existing knowledge, and I or the reaffirming of previously-held knowledge. Given this relationship between knowledge and science, there are those who further subdivide science into "pure" and "applied" categories. The "pure" scientist pursues his work primarily for the sake of obtaining new knowledge; for example, mathematics; whereas the "applied" scientist i s primarily involved with the use of knowledge produced by the pure scientist; for example, sociology." In other words, the "pure" scientist is motivated solely to add knowledge by nonmoralistic content, use the scientific method to derive fact, and test fundamental knowledge which i s organized around maior ideas or scientific principles. In contrast, the "applied" scientist is motivated to solve everyday practical problems either through utilization of the scientific method or application of fundamental knowledge and principles. ' In categorizing science, it is often difficult to clearly differentiate the pure science from the applied science, since there exists evidence of necessary relationships among sciences. For example, every science has a quantitative aspect; therefore, all must depend upon mathematics. Moreover, biochemistry depends on biology and chemistry; biophysics on biology and physics; and psychology on physiology and philosophy. An additional argument supporting the integration of pure and applied science i s that any kind of knowledge, once it has been obtained, is used for application to concrete life situations in various ways. * A good example of this is early man who had to discover new knowledge and then immediately apply it for the purpose of survival. The distinction between the sciences, however, came with improved technology and specialization. The purpose of this discussion is not to argue for a distinction between pure and applied science, nor to place a value iudgment on which is better, but to offer a rationale for choosing the nomenclature which best describes nursing. Health professions draw upon the basic (pure)
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Sclentlflc lnqulry or research, then, k a n essential lngmdlent In sclence. or research, then, is an essential ingredient in science, and an understanding of the methodology inherent in the scientific process i s important if one wishes to identify the nature of science in a profession. Science approaches problems by attempting to develop more adequate knowledge through the conceptual and empirical analysis of data, using theories, concepts, models, and conceptual frameworks as instruments of conceptual analysis. Schrag * describes the scientific process, also called research, as follows: 1) isolating the problem; 2) devising conjectures, hypotheses, or theories founded on facts and testable by empirical observations - that may conceivably provide answers to the questions asked; 3) testing assumptions against evidence collected; 4) in case of disconfirmation, considering redefining the problem and re-testing: 5) determining the domains of experience i n which the hypotheses or theories hold true, and indicating the new problems of content or method that may arise; and 6) consolidating new hypotheses or theories with the existing body of knowledge by proposing appropriate modifications of current beliefs and practices. Schrag further points out that unless data lead to the construction and test of contestable theories, there is no science. Therefore, science operates under a model of contest and corroboration. These descriptions all have in common the type of
This knowledge must be capabie of belng independently vertned by others Only then does It come wlthln the domaln of science. knowledge that comprises a science. This knowledge must be capable of being independently verified by others. Only then does it come within the domain of science. An example of a science, that is, verified
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The Nature of Science in Nursing knowledge, i s physics. The principles of thermodynamics have been independently verified, as have the laws of universal gravitation and hydrostatics. A non-example of a science is religion. Religion is not verifiable; it is based upon individual faith. By means of testing, one cannot prove or disprove religion. What I s Nursing? Since its beginning, nursing has taken on a variety of descriptions, broadening in scope and function over time, yet always focusing on man. To facilitate the identification of a knovdedge base for nursing, i t is useful to review how some of the prominent nursing authors describe nursing. For example, Virginia Henderson states, "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or t o peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." F;:rrsing is defined by King as a procass of tiction, reactlon, interaction, and transaction whereby nurses assist individuals of any age group to meet their basic human needs in coping with their health status at some particular point i n their life cycle. She suggests five concepts as a basis for orqmiziny knowledge for nursing practice: perception, communication, interpersonal relationships, health, and social institutions. lo Dorothy Johnson describes nursing as a discipline which focuses primarily on direct service to individuals and groups of individuals with the ultimate goals of promoting and maintaining optimum health, utilizing nursing care through the nursing process as the medium through which this goal is achieved. Dorothea Orem recognizes the role of nursing in assisting man in his need for self-care and the provision and management of it or! a continuous basis in order to sustain life and heaith, recover from disease or injury, and cope with their effect." Continuing in the vein of service, Yura and Walsh define nursing as "an encounter with a client and his family in which the nurse observes, supports, communicates, ministers, and teaches; she contributes to the maintenance of optimum health, and provides care during illness until the client is able to assume responsibility for the fulfillment of his own basic human needs; when necessary, she provides compassionate assistance with dying." Rogers views nursing as a discipline that aims to assist people in achieving their maximum health potential. Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompass the scope of nursing's goals. Nursing is concerned with people - all people - well and sick, rich and poor, young and old." In accordance %.vith these views, nursing as a discipline, that is, as a branch of knowledge, must posscss the following elements: a) concern for man in his entirity; that is, the biopsychosocial dimensions; b) recognize the recipient of care as the
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individual, family, and/ or community; c) contribute to the promotion and maintenance of health, prevention of illness, and to the recovery from illness for each client; d) provide a service to clients by means of a process; and e) coordinate client care. These elements are part of the uniqueness of nursing and are what distinguishes nursing from otker health care disciplines. For example, consider medicine. There i s little question that medicine i s recognized as an established science, drawing on the basic sciences in the application of its clinical science. Such basic sciences as physiology and microbiology support the ability of the physician to describe theoretically the body's response to invasion of certain infectious agents. Pharmacology, physiology and biochemistry provide the theoretical foundation for deciding on certain drugs, alone or in combination, which would offer the best possibility of prcveniing, controlling, or curing in a given situation. Therapeutic regimens are continuously refined through alert analysis of "accidenta1"'events and animal and human experimentation.
In dew of thls dlscu,sslon, one can recognlze the ernphasls In medicine as the thempeutlc process, Wereas, the emphasis In nursing is the nunlng process. In view of this discussion, one can recognize the emphasis i n medicine as the therapeutic process, whereas, the emphasis in nursing is the nursing process. Orern" views physicians as focuring on life processes as they have been disrupted and where further disruptions can occur. In contrast, she describes the nursing focus on the universal components of self-care, modified by disruption, and assis?ing !he @,??lentcn a c~n:iiiiicjus basis. Colaizzi" describes medicine as keeping separate the phenomena that are grounded in the biophysiological systems and those which are grounded in the psychosocial systems. I n other words, disease i s either functional or organic, and the methodologies of research, diagnosis, and treatment are different for each. In contrast, the focus of nursing has already been described as the total biopsychosocial man with no separateness of mind and body. The patient's problems, whether they be signs and symptoms of a disease, or the lack of self-recognition of a potential health problem, are considered as a total human experience, and i t i s realized that man can confer meaning upon this experience. Although it i s recognized that much overlay occurs between medicine and nursing, the differentiation appears to rest in the emphasis, with nursing exhibiting a greater emphasis on the psychosocial nature of man. Moreover, schools of nursing reflect this human interest as they focus their curricula on life processes and thc concepts inhwent therein. Science and Nursing After becoming cognizant /IMAGE
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meanings of the words "science" and "nursing," one must become aware of the ways in which these words are used to form various phrases. For the pL-oose of this paper, the phrases, science in W P S ~ : ~ ,science of nursing, and nursing science will be explored. Science in nursing conveys a different meaning than does science of nursing or nursing science. The prepositiqn "in" refers to "within the confines of; inside".16 Thus, when one speaks of science i n nursing, he i s referring to the body of verified knowledge found within the discipline of nursing. At the present time, this verified knowledge consists of knowledge from the biological and behavioral points out that nursing i s sciences. Leininger generally recognized as an applied field because the professional members draw heavily upon knowledge from the natural sciences, social sciences, and the humanities. The phrase, science in nursing, does not refer to a unique body o! nursing knowledge. Johnson, Hadley, and Gortner % all utilize the phrase, science of nursing. The preposition "of" means "derived or coming from; originating a t or from"!' Therefore, when these nursing leaders use the phrase science of nursing, they are referring to that body of verifiable knowledge that will be derived from nursing practice. Johnson states, "Knowledge of the science of nursing is necessary i f nursing care i s t o be purposeful and effective, for it provides a conceptual basis and a rationale for the methods or approaches chosen to achieve certain specified and appropriate nursing obiectives. The maior determindnt in the selection of knowledge from the basic and applied sciences pertinent to nursing is nursing's specific and unique professional goal. It is proposed here that the body of knowledge called the science of nursing consists of a synthesis, reorganization, or extension of concepts drawn from the basic and other applied sciences which in their reformulation tend to becorne 'new' concepts. These concepts will lead to the development of theories of nursing intervention which will yield predictable respmses In patients when implemented in nilrsing care". Hadley" agrees with Johnson that the science of nursing wi!l be comprised of a synthesis of knowledge from other disciplines.' But this is not to say that the science of nursing is only "...a summation of facts and principles drawn from other sources''.'' Nursing draws from the behavioral and biological sciences, but the way nursing utilizes this knowledge in the practice field i s unique to nursing and is therefore the science of nursing. Rogers states that "...the science of nursing does not arise out of a vacuum nor are the knowledges encompassed b y nursing science necessarily of meaning only to nurses"." The science of nursing then appears to be the unique way in which nursing
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The science of nursing then sppean to be the unlque way In which nursing utiilzes the bornwed knowledge.
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The Nature of Science in Nursing uti Iizes the borrowed k n u ~ l e d g e . For all practical purposes, the terms "science of nursing" and "nursing science" are the same. Rogers uses the terms interchangeably, while Mathwig 'O and Colaizzi refer exclusively to nursing science. Abdellah states, "Nursing science is defined as a body of cumulative scientific knowledge, drawn from the physical, biological, and behavioral sciences, that i s uniquely nursing" " In essence, this definition is the same as the definition of the science of nursing which was stated by Johnson. Basically, these two phrases possess the same meaning. It seems reasonable, then, for, the sake of clear communication that only one of the descriptions be used consistently. The phrase science of nursing conveys the greatest clarity of thought in terms of a unique body of nursing knowledge. As previously mentioned, ?he purpose of this paper was to answer the question, what i s the nature d science in nursing? On the basis of the aforegoing discussion, it i s the opinion of the authors that the nature of science i n nursing is still in the formative stages. In other words, there is science i n nursing, but at the present time, one cannot specifically isolate the science of nursing. Nursing will attain the status of a science once it has clearly identified a verifiable knowledge base which can be contested and corroborated. This knowledge base will come from practice.
Nurslng wlll clttaln the status of a science once It has cleady IdentMed a veMable knowledge base whkh can Re contested and combomted. This i s not to imply that nursing has not been actively involved ;n th2 dzvc!cpment cf a knn\rl!edge base. For over the years a number of "scientific" activities have been conducted in this regard. More specifically, attention is given to the scientific methodologies of nursing research, conceptual models in nursing, the nursing process, and nursing diagnosis. Nursing Research In nwsing research, scientific inquiry begins with observations of seemingly unrelated phenomena. These observations are then organized into intelligible systems that show the relationship2 among the Nursing phenomena - a linking of truths knowledge is then organized i n such a way that it possesses certainty, structure and generalizations, thereby demonstrating the characteristics of a science. Thus, i f the purpose of research i s to delineate and advance the theoretical core of nursing knowledge, this research is the beginning of a science of nursing. Moreover, nursing research describes, understands and predicts the life process of man, supporting the probability that nursing can intervene effectively to promote the maximum
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The Nature of Science in Nursing health of the well and ill, in individuals and social groups. This process is the beginning in the developinent of a nursing theory the "umbrella" encompassing concepts in inten relation. In other WQi-ds, theory directs attention to relationships in x e a s of study and application of proce;:es involved in nursing actions in various situations. Accepting this assumption, concepts require clarification with an adequate description for operational purposes, since the facility and efficiency in learning the content of nursing knowledge depend upon the concepts within conceptual models in nursing. Conceptual Models in Nursing The development of conceptual models in nursing has provided a significant contribution to the foundation for selett'ng knowledge to be transmitted in nursing education, the framework for nursing practice, and the impetus and direction for nursing research.'' Recognizing the importance of prediction in science, nursing models have provided a device by which assumptions can be transformed into postulates; that is, conceptualizations of reality that can he tested. In this regard, over the past decade a number of models in nursing have been developed which are being tested and validated. These include the Johnson Behavior System Model, the Roy Adaptation Model, the Neuman Health-Care Systems Model and the Systems-Developmental Stress Model. The reader i s referred to these for further study of the scientific nursing approach via nursing models. It is clear that nursing practice i s being outlined in such a way that i t can be contested and corroborated - the essentials of scientific inquiry. ~
It is clear that nursing practice is being outlined in such Q way that it can be contested and coffoburaied ihe euentials of scientific inquiry.
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The Nursing Process Inherent in nursing models i s a set of actions intended to fulfill the purpose of nursing, known as the nursing process. Although not prevalent in the nursing literature until the mid-sixties, the nursing process has evolved as a framework of reference for research. The process is defined as "an orderly, systematic manner of determining the client's problems, making plans to solve them, initiating the plan or assigning others to implement it, and evaluating the extent to which the plan was t?!fective in resolving the problems identified'''4 The basic steps of the nursing process inc!uiie: 1 ) assessment, 2) planning, 3) implementation, and 4 ) evaluation. Each step i s dependent on the others - none stands alone. The elements can be distinguished for analysis and scrutiny, but for practical purpose>, a total concept of the process is necessary. Lest the reader interpret the nursing process as having only a focus on the individual client, one
should consider the social system in which the process takes place. The process would then affect the nurse and client as well as the individuals involved in the environment within which the nursing process is activated; the social organization within which the process takes place, and finally, the community within which the social organization functions. This, of course, supports the social focu. of nursing. In order to use the nursing process, nurses must possess intel lectua I ski I Is for problem -solving, cr itica I thinking, and nursing judgments; interpersonal skills for ability to communicate, listen, inform and obtain necessary data in a manner that enhances the individuality of the client as a person; and finally, technical skills to relate methods, procedures, and machines used to bring about specific results or the desired behavioral responses of the client. Regarding the final skill, some might argue that technology i s not science. According to Crowley, technologies apply knowledge to concrete situations. Additionally, they employ empirical knowledge, intuition, and "calculated guesses" in solving problems -the extent of the empiricism used varies with different technologies. In some respects, technology serves to bridge the gap between science and human experience. In other respects, however, it can serve to obscure the distinction, since a technology can be used without comprehending the knowledge which would explain its operation. In assigning parts of the nursing process to lesser trained individuals, this concept is held as true, but the professional nurse is able to discern what can be safely delegated i n the process, i n order to safely achieve the final goal of the nursing plan. Clearly, the nursing process i s a fruitful area for research. Studies can be undertaken relating to heal?h needs, decisions inherent in the nursing process, utilization of the nursing process by nurses with varying backgrounds in education and experience, roles of the client in S P ! ~ - C S : C , impact o i direct nursing care upon the client, and so on. Additionally, it is important to mention that theories from other disciplines suggest a relationship to the nursing process; e.g., general systems theory, intormation theory, communication theory, decision theory, theories of perception, among others. Selections from these theories give credence to the nurse's and client's actions and provide a framework within which the nursing process can be analyzed and applied." The Nursing Diagnosis A final area ciarifying the nurse's role in the research process i s one of recent innovation and growing precedent - the nursing diagnosis. Abdellah" defines the nursing diagnosis as a determination of the nature and extent of nursing problems presented by individual patients or families receiving nursing care. Moreover, she states that it i s an independent function of the professional nurse to make a nursing diagnosis and to decide upon a course of action to be followed for the solution of the problem - an argument for the unique contribution of nursing to health care.
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The area of nursing diagnosis has yet to be clarified, but nursing leaders are now in the business of attempting to clearly articulate those health problems that comprise the domain of nursing and classify these problems into a taxonomic system. In 1973, the First National Conference on the Classification of Nursing Diagnoses convened as a response to identifying the relevance of a classification system for nursing research and the relevance of nursing research for a classification system. It was felt that agreed-on categories and definitions would enhance the study of nursing actions and lead to a greater consistency between investigations." Obviously, a number of issues have to be resolved in this project, such as the criteria used to determine the diagnostic categories; the validation of category definition; the hierarchy of diagnoses and the scope of the diagnoses. The fact is that nursing continues to move forward in its search for knowledge and validation of current knowledge -true qualities of a scientific discipline.
The iact is that nursing continues to move forward in its search for knowledge and validation of current knowledge true qualities of a scientific discipline.
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Conclusion The purpose of this discussion was to explore the nature of science in nursing. Science and nursing were described independently followed by a discussion of their relationships. The existence of a science in nursing was established in accord with the conclusiori that there was a growing science of nursing which had not yet matured. Since nursing is actively involved i n this developmental process, the "scientific" activities of the profession were elaborated. With regard !c ?he "state of the art," i t is encouraging to note that over 50 percent of our currently federally-supported nursing research projects deal with investigations into nursing practice, both in the laboratory and in clinical settings. Moreover, there has been a decided trend toward increased rigor in the research being conducted so that it permits the establishment of cause and effect relationships, as well as reproduction i n other settings. I' Another note of encouragement i s that more interest is being devoted to the development of doctoral programs in nursing in this country, where nurses can refine their study of behavior and physiological phenomena, thereby adding to or validating previous knowledge about human phenomena. Furthermore, they are given time, guidance and incentive to contribute theory relevant to nursing practice and to investigate unsolved clinical problems that have challenged nursing practice. In view of this and the supporting evidence presented here, one can truly say that the science of nursing is coming of age. June 1977
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The Nature of Science in Nursing In view of this and the supporting evidence presented here, one can truly say that the science of nunlng Is coming of age.
REFERENCES 1. GROVE, P. B. (editor). Webster's Third New International Dictionary (unabridged), Springfield, Mass., G. and C. Meriam Co., 1965, p. 2238. 2. CROWLEY, D. M. "Perspectives of Pure Science, Conference on the Nature of Science and Nursing." Nurs. Res., 1968, 17 :497-501. 3. LEININGER, M. "Introductory Comments, Conference on the Nature of Science and Nursing." Nurs. Res., 1968, 17 :484-486. 4. FOLTA, J. R. "Perspectives of an Applied Scientist, Conference on the Nature of Science and Nursing." Nurs. Res., 1968, 17:502-507. 5. JOHNSON, 0. E. "The Nature of a Science of Nursing." Nurs. Outlook, 1959, 7:292. 6. NADEL, S. F. The Foundation o f Social Anthropology, Glencoe. Ill., Free Press, 1951, p. 2. 7. LEININGER, M. "Introduction: Nature of Science in Nursing, Conference on the Nature of Science in Nursing." Nurs. Res.. 1969, 18:388-389. 8. SCHRAG, D. "Science and the Helping Professions, Conferepre on the Nature of Science and Nursing." Nurs. Res., 1968, 17:486-496. 9. HENDERSON, V. Tho Nature o f Nursing, New York, The Macmillan Company, 1966, p. 15. 10. KING, i. "A Conceptual Frame of Reference for Nursing." Nurs. Res., 1968, 17:27-31. 11. OREM, 0. E. Nursing: Concepts of Practice, New York, McGraw-Hill Book Co., 1971, p. 1. 12. YURA, H. AND WALSH, M. 8. The Nurslng Process, 2nd ed.. New York, Appleton-Century-Crofts, 1973, p. 14. 13. ROGERS, M. E. An introduction t o the Theoretlcal Basis of Nursing, Philadelphia, F. A. Davis Co., 1970, p. 86. 14. OREM. D. E. op. cit.. p. 49. 15. ~- COLAIZZI. J. "The ProDsr Obieci o i i'iuCSifiG S t k X C . " Int. J. Nurs. Stud.,' 1975.'12:197-200. 16. MORRIS, W. (editor). The American Heritaae Dictionarv of the English Language, Boston, Houghton Miff116 Co., 1971, p. 663. 17. GORTNER. S. R. "Scientific Accountabilitv in Nursing." Nurs. Outlook, 1974, 22:764-768. 18. HADLEY, B. J. "Evolution of a Conception of Nursing, Conference on the Nature of Science in Nursing." Nurs. Res., 1969. 18:400-404. 19. MORRIS. W. (editcr). op. cit.. p. 911. 20. MATHWIG. G. M. "Nursing Science." Image, 1969. 3: 9-1 4 . 21. ABDELLAH. F. G. "The Nature of Nursing Science, Conference on the Nature of Science in Nursing." Nurs. Res., 1969, 18:390-393. 22. KING, I. "Nursing Theory - Problems and Prospect." Nursing Science, October 1964, pp. 394-403. 23. RIEHL, J. P. AND ROY, C. Conceptual Models for Nursing Practice, New York, Appleton-CenturyCrofts, 1974, p. 1. 24. YURA, H. AND WALSH. M. B. op. cit., p. 23. 25. YURA, H. AND WALSH. M. B. op. cit., p. 35. 26. GEBBIE, K. E., LAWN, M. A. (editors). Classification of Nursing Diagnoses, St. Louis, the C. V. Mosby Co., 1975, p. 25.
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nursing
is
The Mature of Science in Nursing KATHLEEN G. ANDREOU, Mas& R& THQMPSoNs M*SmN’s RmN*’are faculty membars sf the UnbedfY of AJabamaSchool of Nuning IR Bimlngham.
Nursing is striving for recognition as a scientific discipline. Accordingly, in order to attain a scientific status, nursing must make explicit the theoretical basis for its practice. This theoretical basis of practice i s the science of nursing, and it defines nursing’s uniqueness.
This theoretical basis of practice Is the science of nursing, and It defines nunlng’s uniquen9ss. For the first one hundred years of its existence, nursing established itself as an indispensable helping health profession with little emphasis on substantiating its scientific foundation. Since the 1950’s, however, the concept of a science in nursing has received high priority in the nursing literature and in nursing education. This trend is clearly related to the increase in the number of nurses with graduate preparation and advanced education in research methodology and the growing concern for the need to sysiematically test, organize, and expand the body of knowledge upon which the practice of nursing rests. Noncritical thinkers may accept the concept of a science i n nursing as fact, while others mav respond with an expressed need for more proof or at least a deeper explanation of the meaning of the c o r x q t . It is to this latter group that this paper i s dedicated. What is the nature of science in nursing? Before attempting to answer this question, one must first be cognizant of the meanings of the words ”science” and “nursing.”
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The Nature 03 Science in Nursing
What Is Science? Science is a word for which i t is difficult to find a clear and concise definition. Webster's dictionary defines science as a profession of knowledge, a system of knowledge based on scientific principles, concerned with the observation and classification of facts and establishing verifiable theories and general laws.' The theme of knowledge (truth) i s clear in this definition, and its pursuit i s the
sciences to develop their body of knowledge with a commitment to applying this knowledge toward some well-defined social goal. Therefore, these professions fall credibly under the "umbrella" of applied science. Since science i s a system of knowledge based on scientific principles, it depends upon its branch of knowledge or specialty area to pursue the quest for knowledge. This professional branch is called a scientific discipline, and it characteristically has the working parts of relevant concepts, theories, models the pathways to and conceptual frameworks scientific inquiry and existence. Scientific inquiry
...the ultlmafe goal of rclence b the dlscovery of new knowledge, tho expanslon of exlstlng knowledge, and/or the reafflrmlng of previously4mld knowledge. foundation of science. Thus, the ultimate goal of science is the discovery of new knowledge, the expansion of existing knowledge, and I or the reaffirming of previously-held knowledge. Given this relationship between knowledge and science, there are those who further subdivide science into "pure" and "applied" categories. The "pure" scientist pursues his work primarily for the sake of obtaining new knowledge; for example, mathematics; whereas the "applied" scientist i s primarily involved with the use of knowledge produced by the pure scientist; for example, sociology." In other words, the "pure" scientist is motivated solely to add knowledge by nonmoralistic content, use the scientific method to derive fact, and test fundamental knowledge which i s organized around maior ideas or scientific principles. In contrast, the "applied" scientist is motivated to solve everyday practical problems either through utilization of the scientific method or application of fundamental knowledge and principles. ' In categorizing science, it is often difficult to clearly differentiate the pure science from the applied science, since there exists evidence of necessary relationships among sciences. For example, every science has a quantitative aspect; therefore, all must depend upon mathematics. Moreover, biochemistry depends on biology and chemistry; biophysics on biology and physics; and psychology on physiology and philosophy. An additional argument supporting the integration of pure and applied science i s that any kind of knowledge, once it has been obtained, is used for application to concrete life situations in various ways. * A good example of this is early man who had to discover new knowledge and then immediately apply it for the purpose of survival. The distinction between the sciences, however, came with improved technology and specialization. The purpose of this discussion is not to argue for a distinction between pure and applied science, nor to place a value iudgment on which is better, but to offer a rationale for choosing the nomenclature which best describes nursing. Health professions draw upon the basic (pure)
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Sclentlflc lnqulry or research, then, k a n essential lngmdlent In sclence. or research, then, is an essential ingredient in science, and an understanding of the methodology inherent in the scientific process i s important if one wishes to identify the nature of science in a profession. Science approaches problems by attempting to develop more adequate knowledge through the conceptual and empirical analysis of data, using theories, concepts, models, and conceptual frameworks as instruments of conceptual analysis. Schrag * describes the scientific process, also called research, as follows: 1) isolating the problem; 2) devising conjectures, hypotheses, or theories founded on facts and testable by empirical observations - that may conceivably provide answers to the questions asked; 3) testing assumptions against evidence collected; 4) in case of disconfirmation, considering redefining the problem and re-testing: 5) determining the domains of experience i n which the hypotheses or theories hold true, and indicating the new problems of content or method that may arise; and 6) consolidating new hypotheses or theories with the existing body of knowledge by proposing appropriate modifications of current beliefs and practices. Schrag further points out that unless data lead to the construction and test of contestable theories, there is no science. Therefore, science operates under a model of contest and corroboration. These descriptions all have in common the type of
This knowledge must be capabie of belng independently vertned by others Only then does It come wlthln the domaln of science. knowledge that comprises a science. This knowledge must be capable of being independently verified by others. Only then does it come within the domain of science. An example of a science, that is, verified
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The Nature of Science in Nursing knowledge, i s physics. The principles of thermodynamics have been independently verified, as have the laws of universal gravitation and hydrostatics. A non-example of a science is religion. Religion is not verifiable; it is based upon individual faith. By means of testing, one cannot prove or disprove religion. What I s Nursing? Since its beginning, nursing has taken on a variety of descriptions, broadening in scope and function over time, yet always focusing on man. To facilitate the identification of a knovdedge base for nursing, i t is useful to review how some of the prominent nursing authors describe nursing. For example, Virginia Henderson states, "The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or t o peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge." F;:rrsing is defined by King as a procass of tiction, reactlon, interaction, and transaction whereby nurses assist individuals of any age group to meet their basic human needs in coping with their health status at some particular point i n their life cycle. She suggests five concepts as a basis for orqmiziny knowledge for nursing practice: perception, communication, interpersonal relationships, health, and social institutions. lo Dorothy Johnson describes nursing as a discipline which focuses primarily on direct service to individuals and groups of individuals with the ultimate goals of promoting and maintaining optimum health, utilizing nursing care through the nursing process as the medium through which this goal is achieved. Dorothea Orem recognizes the role of nursing in assisting man in his need for self-care and the provision and management of it or! a continuous basis in order to sustain life and heaith, recover from disease or injury, and cope with their effect." Continuing in the vein of service, Yura and Walsh define nursing as "an encounter with a client and his family in which the nurse observes, supports, communicates, ministers, and teaches; she contributes to the maintenance of optimum health, and provides care during illness until the client is able to assume responsibility for the fulfillment of his own basic human needs; when necessary, she provides compassionate assistance with dying." Rogers views nursing as a discipline that aims to assist people in achieving their maximum health potential. Maintenance and promotion of health, prevention of disease, nursing diagnosis, intervention, and rehabilitation encompass the scope of nursing's goals. Nursing is concerned with people - all people - well and sick, rich and poor, young and old." In accordance %.vith these views, nursing as a discipline, that is, as a branch of knowledge, must posscss the following elements: a) concern for man in his entirity; that is, the biopsychosocial dimensions; b) recognize the recipient of care as the
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individual, family, and/ or community; c) contribute to the promotion and maintenance of health, prevention of illness, and to the recovery from illness for each client; d) provide a service to clients by means of a process; and e) coordinate client care. These elements are part of the uniqueness of nursing and are what distinguishes nursing from otker health care disciplines. For example, consider medicine. There i s little question that medicine i s recognized as an established science, drawing on the basic sciences in the application of its clinical science. Such basic sciences as physiology and microbiology support the ability of the physician to describe theoretically the body's response to invasion of certain infectious agents. Pharmacology, physiology and biochemistry provide the theoretical foundation for deciding on certain drugs, alone or in combination, which would offer the best possibility of prcveniing, controlling, or curing in a given situation. Therapeutic regimens are continuously refined through alert analysis of "accidenta1"'events and animal and human experimentation.
In dew of thls dlscu,sslon, one can recognlze the ernphasls In medicine as the thempeutlc process, Wereas, the emphasis In nursing is the nunlng process. In view of this discussion, one can recognize the emphasis i n medicine as the therapeutic process, whereas, the emphasis in nursing is the nursing process. Orern" views physicians as focuring on life processes as they have been disrupted and where further disruptions can occur. In contrast, she describes the nursing focus on the universal components of self-care, modified by disruption, and assis?ing !he @,??lentcn a c~n:iiiiicjus basis. Colaizzi" describes medicine as keeping separate the phenomena that are grounded in the biophysiological systems and those which are grounded in the psychosocial systems. I n other words, disease i s either functional or organic, and the methodologies of research, diagnosis, and treatment are different for each. In contrast, the focus of nursing has already been described as the total biopsychosocial man with no separateness of mind and body. The patient's problems, whether they be signs and symptoms of a disease, or the lack of self-recognition of a potential health problem, are considered as a total human experience, and i t i s realized that man can confer meaning upon this experience. Although it i s recognized that much overlay occurs between medicine and nursing, the differentiation appears to rest in the emphasis, with nursing exhibiting a greater emphasis on the psychosocial nature of man. Moreover, schools of nursing reflect this human interest as they focus their curricula on life processes and thc concepts inhwent therein. Science and Nursing After becoming cognizant /IMAGE
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meanings of the words "science" and "nursing," one must become aware of the ways in which these words are used to form various phrases. For the pL-oose of this paper, the phrases, science in W P S ~ : ~ ,science of nursing, and nursing science will be explored. Science in nursing conveys a different meaning than does science of nursing or nursing science. The prepositiqn "in" refers to "within the confines of; inside".16 Thus, when one speaks of science i n nursing, he i s referring to the body of verified knowledge found within the discipline of nursing. At the present time, this verified knowledge consists of knowledge from the biological and behavioral points out that nursing i s sciences. Leininger generally recognized as an applied field because the professional members draw heavily upon knowledge from the natural sciences, social sciences, and the humanities. The phrase, science in nursing, does not refer to a unique body o! nursing knowledge. Johnson, Hadley, and Gortner % all utilize the phrase, science of nursing. The preposition "of" means "derived or coming from; originating a t or from"!' Therefore, when these nursing leaders use the phrase science of nursing, they are referring to that body of verifiable knowledge that will be derived from nursing practice. Johnson states, "Knowledge of the science of nursing is necessary i f nursing care i s t o be purposeful and effective, for it provides a conceptual basis and a rationale for the methods or approaches chosen to achieve certain specified and appropriate nursing obiectives. The maior determindnt in the selection of knowledge from the basic and applied sciences pertinent to nursing is nursing's specific and unique professional goal. It is proposed here that the body of knowledge called the science of nursing consists of a synthesis, reorganization, or extension of concepts drawn from the basic and other applied sciences which in their reformulation tend to becorne 'new' concepts. These concepts will lead to the development of theories of nursing intervention which will yield predictable respmses In patients when implemented in nilrsing care". Hadley" agrees with Johnson that the science of nursing wi!l be comprised of a synthesis of knowledge from other disciplines.' But this is not to say that the science of nursing is only "...a summation of facts and principles drawn from other sources''.'' Nursing draws from the behavioral and biological sciences, but the way nursing utilizes this knowledge in the practice field i s unique to nursing and is therefore the science of nursing. Rogers states that "...the science of nursing does not arise out of a vacuum nor are the knowledges encompassed b y nursing science necessarily of meaning only to nurses"." The science of nursing then appears to be the unique way in which nursing
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The science of nursing then sppean to be the unlque way In which nursing utiilzes the bornwed knowledge.
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The Nature of Science in Nursing uti Iizes the borrowed k n u ~ l e d g e . For all practical purposes, the terms "science of nursing" and "nursing science" are the same. Rogers uses the terms interchangeably, while Mathwig 'O and Colaizzi refer exclusively to nursing science. Abdellah states, "Nursing science is defined as a body of cumulative scientific knowledge, drawn from the physical, biological, and behavioral sciences, that i s uniquely nursing" " In essence, this definition is the same as the definition of the science of nursing which was stated by Johnson. Basically, these two phrases possess the same meaning. It seems reasonable, then, for, the sake of clear communication that only one of the descriptions be used consistently. The phrase science of nursing conveys the greatest clarity of thought in terms of a unique body of nursing knowledge. As previously mentioned, ?he purpose of this paper was to answer the question, what i s the nature d science in nursing? On the basis of the aforegoing discussion, it i s the opinion of the authors that the nature of science i n nursing is still in the formative stages. In other words, there is science i n nursing, but at the present time, one cannot specifically isolate the science of nursing. Nursing will attain the status of a science once it has clearly identified a verifiable knowledge base which can be contested and corroborated. This knowledge base will come from practice.
Nurslng wlll clttaln the status of a science once It has cleady IdentMed a veMable knowledge base whkh can Re contested and combomted. This i s not to imply that nursing has not been actively involved ;n th2 dzvc!cpment cf a knn\rl!edge base. For over the years a number of "scientific" activities have been conducted in this regard. More specifically, attention is given to the scientific methodologies of nursing research, conceptual models in nursing, the nursing process, and nursing diagnosis. Nursing Research In nwsing research, scientific inquiry begins with observations of seemingly unrelated phenomena. These observations are then organized into intelligible systems that show the relationship2 among the Nursing phenomena - a linking of truths knowledge is then organized i n such a way that it possesses certainty, structure and generalizations, thereby demonstrating the characteristics of a science. Thus, i f the purpose of research i s to delineate and advance the theoretical core of nursing knowledge, this research is the beginning of a science of nursing. Moreover, nursing research describes, understands and predicts the life process of man, supporting the probability that nursing can intervene effectively to promote the maximum
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The Nature of Science in Nursing health of the well and ill, in individuals and social groups. This process is the beginning in the developinent of a nursing theory the "umbrella" encompassing concepts in inten relation. In other WQi-ds, theory directs attention to relationships in x e a s of study and application of proce;:es involved in nursing actions in various situations. Accepting this assumption, concepts require clarification with an adequate description for operational purposes, since the facility and efficiency in learning the content of nursing knowledge depend upon the concepts within conceptual models in nursing. Conceptual Models in Nursing The development of conceptual models in nursing has provided a significant contribution to the foundation for selett'ng knowledge to be transmitted in nursing education, the framework for nursing practice, and the impetus and direction for nursing research.'' Recognizing the importance of prediction in science, nursing models have provided a device by which assumptions can be transformed into postulates; that is, conceptualizations of reality that can he tested. In this regard, over the past decade a number of models in nursing have been developed which are being tested and validated. These include the Johnson Behavior System Model, the Roy Adaptation Model, the Neuman Health-Care Systems Model and the Systems-Developmental Stress Model. The reader i s referred to these for further study of the scientific nursing approach via nursing models. It is clear that nursing practice i s being outlined in such a way that i t can be contested and corroborated - the essentials of scientific inquiry. ~
It is clear that nursing practice is being outlined in such Q way that it can be contested and coffoburaied ihe euentials of scientific inquiry.
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The Nursing Process Inherent in nursing models i s a set of actions intended to fulfill the purpose of nursing, known as the nursing process. Although not prevalent in the nursing literature until the mid-sixties, the nursing process has evolved as a framework of reference for research. The process is defined as "an orderly, systematic manner of determining the client's problems, making plans to solve them, initiating the plan or assigning others to implement it, and evaluating the extent to which the plan was t?!fective in resolving the problems identified'''4 The basic steps of the nursing process inc!uiie: 1 ) assessment, 2) planning, 3) implementation, and 4 ) evaluation. Each step i s dependent on the others - none stands alone. The elements can be distinguished for analysis and scrutiny, but for practical purpose>, a total concept of the process is necessary. Lest the reader interpret the nursing process as having only a focus on the individual client, one
should consider the social system in which the process takes place. The process would then affect the nurse and client as well as the individuals involved in the environment within which the nursing process is activated; the social organization within which the process takes place, and finally, the community within which the social organization functions. This, of course, supports the social focu. of nursing. In order to use the nursing process, nurses must possess intel lectua I ski I Is for problem -solving, cr itica I thinking, and nursing judgments; interpersonal skills for ability to communicate, listen, inform and obtain necessary data in a manner that enhances the individuality of the client as a person; and finally, technical skills to relate methods, procedures, and machines used to bring about specific results or the desired behavioral responses of the client. Regarding the final skill, some might argue that technology i s not science. According to Crowley, technologies apply knowledge to concrete situations. Additionally, they employ empirical knowledge, intuition, and "calculated guesses" in solving problems -the extent of the empiricism used varies with different technologies. In some respects, technology serves to bridge the gap between science and human experience. In other respects, however, it can serve to obscure the distinction, since a technology can be used without comprehending the knowledge which would explain its operation. In assigning parts of the nursing process to lesser trained individuals, this concept is held as true, but the professional nurse is able to discern what can be safely delegated i n the process, i n order to safely achieve the final goal of the nursing plan. Clearly, the nursing process i s a fruitful area for research. Studies can be undertaken relating to heal?h needs, decisions inherent in the nursing process, utilization of the nursing process by nurses with varying backgrounds in education and experience, roles of the client in S P ! ~ - C S : C , impact o i direct nursing care upon the client, and so on. Additionally, it is important to mention that theories from other disciplines suggest a relationship to the nursing process; e.g., general systems theory, intormation theory, communication theory, decision theory, theories of perception, among others. Selections from these theories give credence to the nurse's and client's actions and provide a framework within which the nursing process can be analyzed and applied." The Nursing Diagnosis A final area ciarifying the nurse's role in the research process i s one of recent innovation and growing precedent - the nursing diagnosis. Abdellah" defines the nursing diagnosis as a determination of the nature and extent of nursing problems presented by individual patients or families receiving nursing care. Moreover, she states that it i s an independent function of the professional nurse to make a nursing diagnosis and to decide upon a course of action to be followed for the solution of the problem - an argument for the unique contribution of nursing to health care.
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The area of nursing diagnosis has yet to be clarified, but nursing leaders are now in the business of attempting to clearly articulate those health problems that comprise the domain of nursing and classify these problems into a taxonomic system. In 1973, the First National Conference on the Classification of Nursing Diagnoses convened as a response to identifying the relevance of a classification system for nursing research and the relevance of nursing research for a classification system. It was felt that agreed-on categories and definitions would enhance the study of nursing actions and lead to a greater consistency between investigations." Obviously, a number of issues have to be resolved in this project, such as the criteria used to determine the diagnostic categories; the validation of category definition; the hierarchy of diagnoses and the scope of the diagnoses. The fact is that nursing continues to move forward in its search for knowledge and validation of current knowledge -true qualities of a scientific discipline.
The iact is that nursing continues to move forward in its search for knowledge and validation of current knowledge true qualities of a scientific discipline.
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Conclusion The purpose of this discussion was to explore the nature of science in nursing. Science and nursing were described independently followed by a discussion of their relationships. The existence of a science in nursing was established in accord with the conclusiori that there was a growing science of nursing which had not yet matured. Since nursing is actively involved i n this developmental process, the "scientific" activities of the profession were elaborated. With regard !c ?he "state of the art," i t is encouraging to note that over 50 percent of our currently federally-supported nursing research projects deal with investigations into nursing practice, both in the laboratory and in clinical settings. Moreover, there has been a decided trend toward increased rigor in the research being conducted so that it permits the establishment of cause and effect relationships, as well as reproduction i n other settings. I' Another note of encouragement i s that more interest is being devoted to the development of doctoral programs in nursing in this country, where nurses can refine their study of behavior and physiological phenomena, thereby adding to or validating previous knowledge about human phenomena. Furthermore, they are given time, guidance and incentive to contribute theory relevant to nursing practice and to investigate unsolved clinical problems that have challenged nursing practice. In view of this and the supporting evidence presented here, one can truly say that the science of nursing is coming of age. June 1977
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The Nature of Science in Nursing In view of this and the supporting evidence presented here, one can truly say that the science of nunlng Is coming of age.
REFERENCES 1. GROVE, P. B. (editor). Webster's Third New International Dictionary (unabridged), Springfield, Mass., G. and C. Meriam Co., 1965, p. 2238. 2. CROWLEY, D. M. "Perspectives of Pure Science, Conference on the Nature of Science and Nursing." Nurs. Res., 1968, 17 :497-501. 3. LEININGER, M. "Introductory Comments, Conference on the Nature of Science and Nursing." Nurs. Res., 1968, 17 :484-486. 4. FOLTA, J. R. "Perspectives of an Applied Scientist, Conference on the Nature of Science and Nursing." Nurs. Res., 1968, 17:502-507. 5. JOHNSON, 0. E. "The Nature of a Science of Nursing." Nurs. Outlook, 1959, 7:292. 6. NADEL, S. F. The Foundation o f Social Anthropology, Glencoe. Ill., Free Press, 1951, p. 2. 7. LEININGER, M. "Introduction: Nature of Science in Nursing, Conference on the Nature of Science in Nursing." Nurs. Res.. 1969, 18:388-389. 8. SCHRAG, D. "Science and the Helping Professions, Conferepre on the Nature of Science and Nursing." Nurs. Res., 1968, 17:486-496. 9. HENDERSON, V. Tho Nature o f Nursing, New York, The Macmillan Company, 1966, p. 15. 10. KING, i. "A Conceptual Frame of Reference for Nursing." Nurs. Res., 1968, 17:27-31. 11. OREM, 0. E. Nursing: Concepts of Practice, New York, McGraw-Hill Book Co., 1971, p. 1. 12. YURA, H. AND WALSH, M. 8. The Nurslng Process, 2nd ed.. New York, Appleton-Century-Crofts, 1973, p. 14. 13. ROGERS, M. E. An introduction t o the Theoretlcal Basis of Nursing, Philadelphia, F. A. Davis Co., 1970, p. 86. 14. OREM. D. E. op. cit.. p. 49. 15. ~- COLAIZZI. J. "The ProDsr Obieci o i i'iuCSifiG S t k X C . " Int. J. Nurs. Stud.,' 1975.'12:197-200. 16. MORRIS, W. (editor). The American Heritaae Dictionarv of the English Language, Boston, Houghton Miff116 Co., 1971, p. 663. 17. GORTNER. S. R. "Scientific Accountabilitv in Nursing." Nurs. Outlook, 1974, 22:764-768. 18. HADLEY, B. J. "Evolution of a Conception of Nursing, Conference on the Nature of Science in Nursing." Nurs. Res., 1969. 18:400-404. 19. MORRIS. W. (editcr). op. cit.. p. 911. 20. MATHWIG. G. M. "Nursing Science." Image, 1969. 3: 9-1 4 . 21. ABDELLAH. F. G. "The Nature of Nursing Science, Conference on the Nature of Science in Nursing." Nurs. Res., 1969, 18:390-393. 22. KING, I. "Nursing Theory - Problems and Prospect." Nursing Science, October 1964, pp. 394-403. 23. RIEHL, J. P. AND ROY, C. Conceptual Models for Nursing Practice, New York, Appleton-CenturyCrofts, 1974, p. 1. 24. YURA, H. AND WALSH. M. B. op. cit., p. 23. 25. YURA, H. AND WALSH. M. B. op. cit., p. 35. 26. GEBBIE, K. E., LAWN, M. A. (editors). Classification of Nursing Diagnoses, St. Louis, the C. V. Mosby Co., 1975, p. 25.
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