Philosophy of Nursing Science
OBJECTIVES:At the end of the students will be able to:
•Discuss the history of Philosophy development in different countries
•Understand different historical eras of Nursing in India
•Analyze the periodic evolution of nursing.
•Familiarize the students with impact of historical eventson nursing.
•Present social factor that have influenced thedevelopment of nursing.
INTRODUCTION:Philosophy literally means “the love of wisdom, Etymologically the term,
‘Philosophy’ has been derived from two Greek words: Philos means love, Sophia means
wisdom. It is a living force, a way of life, an attitude towards life and a search for truth and
reality. It is a speculation about the nature and value of things. It is a search for deeper and
finer values of life.
Philosophy of nursing science is an “ examination of nursing concepts, theories , laws
and aims as related to nursing practice” and also it explore the meaning of truth, the meaning
of evidence and the meaning of life. Through such an understand and deliberate thought
praxis evolves ( Poliforni and Welchi). Praxis is the planned, deliberate and thoughtful
creation of a plan of action to achieve a set of goal. Philosophy of nursing science explores
the meaning of truth, the meaning of evidence and the meaning of life through praxis.
Philosophy of nursing science is essential for nurse hence nurses’ responsibility is to view
science from a multitude of perceptive: as nurse scientist; as care provider; and from the
perceptive of patient, family and society.
DEFINITION OF PHILOSOPHY:Philosophy is a search for a comprehensive view of nature, an attempt at a universal
explanation of nature of things
– Alfred Weber
“Philosophy is an increasing effort to discover the general truth that lies behind the
particular facts to discern also the reality that lie behind appearance.” -Raymont
Philosophy is a persistent effort of both ordinary and persistent people to make life as
intelligible and meaningful as possible.
– Branold
“Philosophy is essentially a spirit or method of approaching experience rather than a
body of conclusions and results”
– Edgar S Brightman
Philosophy has been defined as “a study of problems that are ultimate, abstract, and general.
These problems are concerned with the nature of existence, knowledge, morality, reason, and
human purpose”
- Teichman & Evans, 1999, p. 1).
HISTORY OF PHILOSOPHY:Philosophical systems are thought to have developed first in the East, and a working outline
proceeds from Mesopotamia to Rome and on to the present:
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Egypt by c. 4000 BCE: depictions of gods and the afterlife appear on tomb walls
Mesopotamia by c. 2150 BCE: written form of the philosophical narrative of The Epic
of Gilgamesh
India c. 1500 - c. 500 BCE: the Vedic Period
Persia by c. 1500 BCE: development of Zoroastrianism
China c. 1046-256 BCE: the Zhou Dynasty
Greece c. 585-322 BCE: Time of Thales of Miletus to the death of Aristotle of
Stagira
Rome c. 155 BCE onwards: Beginning with the arrival of Stoicism in Rome.
Philosophical systems would continue in Europe during the Middle Ages (c. 476-1500 CE),
primarily focused on Christian teachings, and would develop further during the Renaissance
in the West. In the East, Islamic scholars after the 7th century CE as well as those of other
faiths continued to develop their own systems.
Philosophy in Egypt & Mesopotamia
The earliest philosophical system seems to have developed in Egypt as a response to the
religious vision of a paradise after death known as the Field of Reeds, a mirror image of one's
life on earth, where the souls of the justified dead would live eternally.
Egyptian philosophy developed the concept of ma'at (harmony and balance) as the central
value by which one could live the best life and be assured of paradise but then addressed
itself to the aspects of the soul, the concept of immortality, the possibility of reincarnation,
and the nature of the divine.
In Mesopotamia, the people understood themselves as co-workers with the gods. As in Egypt,
the gods had created humanity and humans owed them a debt of gratitude which was paid
through worship and proper behavior. In keeping with other ancient religious systems, the
Mesopotamians understood their gods as operating on a quid pro quo (“this for that”) basis,
which worked well as long as the individual felt the agreement was being honored, but when
it seemed to fail, one naturally questioned its validity, and this sort of existential crisis
inspires philosophical inquiry.
This situation is illustrated in The Epic of Gilgamesh in which Gilgamesh, King of Uruk,
loses his best friend, Enkidu and embarks on a quest to find an escape from inevitable death.
His story has been interpreted as a parable of philosophical development in that there is no
evidence that Gilgamesh questions his relationship with the gods until the death of Enkidu
which requires answers his religious beliefs cannot provide.
Indian Philosophy
In India, philosophy developed in response to the Vedas, the scriptures of Hinduism (known
as Sanatan Dharma, “Eternal Order”, to adherents), in the form of the Upanishads (the
earliest written c. 800-500 BCE). The Vedas were understood as the emanations of the
Universe, the literal words of God, and the Upanishads were composed to clarify and explain
aspects of this message. Around 600 BCE, a social and religious reform movement in the
region resulted in the development of other philosophical systems which rejected orthodox
Hinduism. These included the materialist school of Charvaka (c. 600 BCE), the system
of Jainism (formulated by Mahavira/Vardhamana, l. c. 599-527 BCE),
and Buddhism (founded by Siddhartha Gautama, the Buddha, l. c. 563 - c. 483 BCE).
Although Jainism and Buddhism would later take on religious dimensions, they were
originally philosophical schools of thought, although it should be noted there was no
distinction between “religious” and “philosophical” thought in Asia at that time nor is there in
the present.
Persian Philosophy
Persian philosophy was almost certainly already developed before c. 1500 BCE as evidenced
by the Avesta (Zoroastrian scriptures) which draws on concepts from the polytheistic Early
Iranian Religion. Zoroaster conceived of a new religious paradigm of a single god, Ahura
Mazda, creator and sustainer of the universe, whose supernatural adversary was Angra
Mainyu (also known as Ahriman), the lord of darkness and chaos.
The question left unanswered by Zoroaster's construct, however, was the source of evil and
suffering in the world since Ahriman was understood as a created being and Ahura Mazda,
who had no evil in him, as the source of all creation. This problem encouraged the
development of the philosophical school of Zorvanism, sometime in the late Achaemenid
Empire (c. 550-330 BCE) which claimed Zorvan, god of Infinite Time, created both Ahura
Mazda and Ahriman and these two brother-deities were locked in an eternal struggle which
human beings had no choice but to take sides in. One's purpose in life was the exercise of free
will in deciding to devote one's self to the cause of good or evil.
Chinese Philosophy
Chinese philosophy was initially a response to social disorder as well as the failure of
religious belief to explain the world & reassure people of a divine plan.
The Spring and Autumn Period and the Warring States Period in China were times of chaos
as the Zhou Dynasty was declining, and Chinese philosophy was developed in response to
this disorder. The early texts of Confucianism are thought to have been composed during the
Zhou Dynasty and later developed by the sage Confucius (l. 551-479 BCE). Confucianism
was only one belief structure of many which developed during this time referred to as the
Hundred Schools of Thought and which included many others including Taoism (founded by
Lao Tzu c. 500 BCE) and Legalism (founded by Han Feizi, l. c. 280-233 BCE).
These schools, and the many others, differed from each other significantly but were all an
attempt to establish order in a time of chaos. The traditional understanding of Tian (heaven)
as maintaining order through a mandate which legitimized a monarch's rule could no longer
be sustained as the monarchs of different states fought each other for supremacy. Chinese
philosophy, then, was initially a response to social disorder as well as the failure of religious
belief to explain the world and reassure people of a divine plan.
Greek Philosophy
Greek philosophy began in the 6th century BCE with Thales of Miletus who initiated it with
the question “What is the basic 'stuff' of the universe?” (Ancient Philosophy, 8). Thales'
inquiry seems an anomaly because of the religious beliefs of his time which seem to have
been meeting the needs of the people. Ancient Greek religion held that the gods had created
the world and human beings and, as with other world religions of the time, questioning this
basic premise was not appreciated nor encouraged. Thales seems to have avoided problems
with the religious authorities by never denying the existence of gods, but this does not explain
his initial impulse. Scholars suggest that, since he studied at Babylon, he most likely drew on
Mesopotamian and Egyptian philosophies in formulating his own.
Thales established the Milesian School, considered the first philosophical school in the West,
and was followed by Anaximander (l. c. 610 - c. 546 BCE) and Anaximenes (l. c. 546 BCE)
who rejected Thales' claim that the First Cause was water and suggested their own.
Philosophical thought then developed through the efforts of the other Pre-Socratic
philosophers, finally culminating in the works of Plato and then of Aristotle. Later thinkers,
notably Plotinus (l. c. 202-274 CE), would develop these concepts further in establishing the
foundation of Western Philosophy.
Branches of Philosophy
Branches of Philosophy
Metaphysics
Axiology
Epistemology
Logic
Ontology
Theology
Cosmology
Ethics
Aesthetics
Deductive
Logic
Inductive
Logic
1. Axiology: Study of the nature of value and valuation
2. Metaphysics: Study of the fundamental nature of reality
3.
4.
5.
6.
7.
Epistemology: Study of the nature, origin, and limits of human knowledge
Ethics Philosophy: Study of what is right and wrong in human behaviour
Aesthetics: Study of beauty and taste
Logic Philosophy: Study of the nature and types of logic
Political Philosophy: Study of government, addressing questions about the nature,
scope, and legitimacy of public agents and institutions
8. Philosophy of science : Study of science and scientific practice
9. Cosmology: Study of origin and general structure of the universe
10. Theology: the study of the nature of God and religious belief.
11. Ontology: the study of concepts such as existence, being, becoming, and reality.
Major Traditional Philosophy
1, Idealism
2, Realism
3, Pragmatism
4, Existentialism
Idealism:Considered oldest philosophy of western culture the world of mind, Ideas and Reason
is primary The Real knowledge is perceived in mind. Plato is the father of Idealism.
Metaphysics of Idealism: stresses mind over matter (nothing is real except for an idea
in the mind)
Epistemology of Idealism: The ultimate knowledge is the knowledge on spirituality
All knowledge includes a mental grasp of ideas and concepts
Axiology of Idealism: Values are real existents Values are rooted in reality values are
absolute, eternal, and universal
Ontology of Idealism: existence of things depend upon the human mind
Aesthetic of Idealism: philosophical beauty in nature
Realism:Aristotle is the father of realism. Things we see and perceive are real and knowledge
acquired through senses only is true. Universe exists whether mind perceives it or not.
Metaphysics of Realism: The world is composed of matter (body) and form (mind) –a
person is a sensing, rational being. Human beings possess the power to sense objects
Epistemology of Realism: Sense realism (Knowledge can be acquired through senses)
Axiology of Realism: Values derived from nature
Aesthetic of Realism: Mind – independent aesthetic facts.
Pragmatism:Pragmatism is also known as Experimentalism, It is the philosophy of practical
experience. John Dewey is the father of pragmatism.
Metaphysics of Pragmatism: Regard reality as an event or process. Meaning is
derived from experience in environment. Experience is the ultimate basis for human
existence
Epistemology of Pragmatism: Truth is not absolute knowledge is arrived at by
scientific inquiry, testing, questioning, retesting etc....
Axiology of Pragmatism: values are tentative and constructed from experience.
Primarily focused on values determined by own experience.
Aesthetic of Pragmatism: Art as experience to show the integrity effort, culture and
every day experiences. Aesthetics are determined by shared experience between an artist and
the public
Existentialism:It is a philosophical movement that focuses on individuality, and the necessity
of making reasoned decisions for one’s self. It’s emphasis on the individual and self
fulfilment. De-emphasis the idea of the group. Soren Kierkegaard is the father of
Existentialism philosophy.
Metaphysics of Existentialism: There is no human nature: people exist, and each
creates his/her own essence. A person’s behaviour cannot be compared to someone else’s.
Each individual is unique.
Epistemology of Existentialism: knowledge is mainly gained through experience in
our everyday lives. They feel that too much intellectual analysis interferes with and active
participation in life.
Axiology of Pragmatism: Choice to determine Value.
Aesthetic of Pragmatism: Art as experience to show the integrity effort, culture and
every day experiences.
HISTORY AND PHILOSOPHY OF NURSING SCIENCE:History of Nursing In India:
•
The development of modern public health in India started much later as compared to
the developed countries of the west. But public health in India was in practice much
before its development in western countries. The Indian history revealed its public
health practice as early as 5000 BC. The period can be classified as Pre – Vedic Stage
(1000 – 1500 BC) Vedic Period (I500 BC – 500 BC) and Post – Vedic Period (500
BC – 700 AD).
Nursing in Pre – Vedic Age: Stone Age (1000 – 1500 BC)
Civilization at that time believed that disease and death were caused by external
agents such as wrath of gods, possession of demons and evil spirit, sorcery, and breach of
taboo. Nursing was instinctive and viewed as a natural nurturing job of women. Women were
caring, comforting, nourishing, and providing physical care and herbal remedies to their
children, aged, and sick members of the family on compassionate grounds with the desire to
provide health and comfort to the sick and needy.
Nursing in Vedic Age: Age of Reason (1500 - 500 BC)
The Vedic period was the period during which the oldest scripture Vedas were
composed. Vedas dealt with Philosophy and rational thinking, and led to reasoning. In 1400
BC, Sushruta, the father of surgery, wrote the book on surgery ( Sushruta Samhita). During
the same period, Acharya Charaka, the father of Indian medicine, wrote Charaka Samhita.
Both these portray nurses as essential components of medical practice and treatment. The
Characters of nurse were identified as pure or clean in physical appearance and competent,
willing to care and coordinate with the patient and the doctor. According to Charaka
Samhita, the physician provides knowledge and coordinates the treatment, whereas the nurse
must be knowledgeable, skilled at preparing formulation and dosages, and sympathetic
toward everyone.
Nursing in Post - Vedic Age: Ayurvedic Age( 600 BC to 600 AD)
During this period, medical education was introduced in ancient universities of
“Nalanda’’ and “ Takshila’’. In 264 BC, after being moved by the suffering of people during
the war of kalinga, King Ashoka (272 – 236 BC) constructed hospitals and monastery
universities. Doctor and midwives were expected to be hygienic, skillful, and humane. The
nurses were usually “men” or “old women” usually assistant in childbirth. Thos who cared
for sick were forced to provide hygienic care and were not included within religious frame.
These religious restrictions and superstitious practices during this time probably slowed down
the development of nursing.
Early Medieval Age (600 – 1300 AD)
A new religious cult, known as the tantric cult, dominated the Indian society for many
centuries. No evident developments in nursing profession happened in this period.
Late Medieval Age ( 1300 - 1600 AD)
New improved methods for diagnosis were taken from foreign sources. Works on
preparations of medicinal tinctures and essences were also recorded. Technique of feeling of
pulse was inventd during this period and was utilized for diagnosis of different diseases.
Nursing in the 17th Century
With the progress of the Mughal Empire, Arabic system of medicine, popularly
known as UNANI was introduced. This is now a part of the Indian system of medicine. Unani
medicine focused on treating patients in hospitals.
Nursing in the 18th Century
The Mugal dynasty declined during this time with rise in the British Empire. The
three major dimensions in nursing services in India during British rule were:
1, Military Nursing
1888
The first batch of 10 qualified and certified British
nurses from Florence Nightingale’s team was appointed in the
Indian hospitals to serve British Troops.
1896
Permanent cadre of British Army Nursing service was
established.
1914
A temporary Indian Nursing Service was started for
Indian soldiers.
1941
Due to shortage of nurses in World War II, Auxiliary
Nursing Service was started.
1947
Indian Military Nursing Services was renamed Military
Nursing Services. Chief principal matron was ranked as
Colonel.
2, Civilian Nursing:
It started as soon as 1797 when the first maternity hospital was built for people in
Madras. Nightingale wrote some suggestions on the system of nursing for hospitals in India.
Trained nurses from Nightingale school were sent to Indian hospitals to start similar schools.
In Delhi, St. Stephen School was the first one to start with training for Indian Nurses in 1867.
3, Missionary Nursing:
Missionary nursing was started in India under the influence of christinity.During the
British rule, many trained nurses came to India as members of the Medical Missionary
Association. With the increasing need of academically trained nurses, the South Indian
Examination Board (1911), the North Indian Examination Board (1912), Mid – India
Examination board (1934) were established. Formal Registration was started in 1935.
Development of Nursing from the 19th to the 21st Century
World War second has enormous effects on nursing. The War itself had created a
need for more nurses and resulted in a knowledge explosion in medicine and technology,
which broadened the role of nurses.
After World War second effort were directed at upgrading nurses education. School
of nursing were based on educational objectives and were increasing developed in university
and college settings, leading to degree in nursing for men, women, and minorities.
Nursing achievement has broadened in all areas, including practice in the wide variety
of health care settings the development of a specific body of knowledge, the conduct and
publication of nursing research, and the recognition of the role of nursing in promoting access
to affordable – quality health care. Increased emphasis on nursing knowledge as the
foundation for evidence – based practice (EBP) has led to the growth of nursing as a
professional discipline.
Concept and Definition of Nursing
The word nurse originated from the latin word nutrix, meaning “to nourish”. Most
definitions of nursing describe the nurse as a person who nourishes, fosters, and protects and
who is prepared to take care of sick, injured, aged, and dying people.
Virginia Henderson defined nursing as: “nursing is a unique function of the nurse, i.e.
to assist the individual, sick or well in the performance of those activities contributing to
health or recovery (or to peaceful death) that he / she would perform unaided if he / she had
the necessary strength, will or knowledge and to do so in such a ay to help him/her to gain
independence as rapidly as possible’’
The International Council of Nurses (ICN) captures much of what nursing in its
definition: “Nursing encompasses autonomous and collaborative care of individuals of all
ages, families, groups, and communities, sick or well and in all setting. Nursing includes the
promotion of health, prevention of illness, and the care of ill, disabled, and dying people.
Advocacy, promotion of a safe environment, research, participation in shaping health policy
and in patient and health systems management, and education are also key nursing roles.’’
Nursing Philosophy
 Nursing philosophy has been described as “a statement of foundational and universal
Assumptions, beliefs and principles about the nature of knowledge and thought
(epistemology) and about the nature of the entities represented in the metaparadigm (i.e.,
nursing practice and human health processes [ontology])” (Reed, 1995).
 Nursing philosophy, then, refers to the belief system or worldview of the profession
and provides perspectives for practice, scholarship, and research (Gortner, 1990).
 No single dominant philosophy has prevailed in the discipline of nursing. Many
Nursing scholars and nursing theorists have written extensively in an attempt to identify
the overriding belief system, but to date, none has been universally successful. Most
would agree then that nursing is increasingly recognized as a “multiparadigm discipline”
(Powers & Knapp, 2011), in which using multiple perspectives or worldviews in a
“unified” way is valuable and even necessary for knowledge development (Giuliano,
Tyer-Viola, & Lopez, 2005).
ICN Philosophy of Nursing
The ICN states the philosophy of nursing as:
 We work as a collaborative team to continuously improve health and well-being and
community.
 We accept and respect the patient’s unique view of self and his or her world.
 We believe in shared governance and incorporate research and EBP in the
development of standard of care.
 We are responsible for lifelong learning, accountability for our practice, and
participation in interdisciplinary activities.
Philosophy of Science in Nursing
Philosophy of science in nursing helps to establish the meaning of science through an
Understanding and examination of nursing concepts, theories, laws, and aims as they
Relate to nursing practice. It seeks to understand truth; to describe nursing; to examine
Prediction and causality; to critically relate theories, models, and scientific systems; and to
explore determinism and free will (Nyatanga, 2005; Polifroni & Welch, 1999).
SCIENCE AND PHILOSOPHICAL SCHOOLS OF THOUGHT
Philosophical School of Meaning of Philosophical School
Thoughts
of thoughts
Empiricism
Truth is based on experience and
relating to our experience (Francis
Bacon, John Locke, and David Hume)
Positivism
Logical Positivism
Phenomenology
Constructivism
Truth is science the fact that science
discover(Comte, Mill, Spencer)
Truth is science the fact that science
discover through logic /
Mathematics (Alfred Jules
Ayer, Moritz Schlick, Rudolf
Carnap)
Truth is the human
consciousness(Husserl, Heidegger)
Philosophical school of
Thoughts in nursing
Empiricism in nursing is a
valuable aid to the nurse in
delivering quality patient
care by experience.
Positivism emphasis the
objectivity in nursing care
Logical Positivism explore
the standard of nursing
practice
Phenomenology in nursing
broaden understanding of
human phenomena relevant
to nursing practice,
Truth is Cognitive development
Constructivism explore
(Jean Piaget, Lev Vygotsky, Herbert new ideas and concepts in
Simon)
Nursing (Nursing Theory)
Historicism
Truth is Historically Conditioned
( Karl Wilhelm, Hegal)
Poststructuralism / Post
Modernism
Truth can be found in the
destruction of language (Derrida)
Truth is( evolves from )the outcome
of the events (Foucault)
Truth is created through dialogue
with the purpose of emancipator
action( Habermans, Freire)
Truth is unique to gender (
Feminists)
Historicism in nursing
provided insight into
knowledge development
Postmodernism created
multiple and diverse
paradigms of nursing
theory as well as nursing
research.
NURSING AS A SCIENCE AND A DISCIPLINE (EVOLUTION AND
DEVLOPMENT):
Nursing as a Science
Barrett (2002) defined nursing science as “the substantive, discipline-specific knowledge
That focuses on the human-universe-health process articulated in the nursing Frame works
and theories”.
To develop and apply the discipline-specific knowledge, nursing science recognizes the
relationships of human responses in health and illness and addresses biologic, behavioural,
social, and cultural domains.
The goal of nursing science is to represent the nature of nursing—to understand it,
To explain it, and to use it for the benefit of humankind. It is nursing science that
Gives direction to the future generation of substantive nursing knowledge, and it
is nursing science that provides the knowledge for all aspects of nursing (Barrett,
2002; Holzemer, 2007).
Nursing as a Discipline:
As definitions of nursing have expanded to describe more clearly the roles and action of
nurses, increased attention has been given to nursing as a professional discipline. Nursing
uses existing and new knowledge to solve problems creatively and meet human needs within
ever-changing boundaries. It is recognized as a profession based on the following defining
criteria:
o Well – defined body of specific and unique knowledge
o Strong service orientation
o Recognized authority by a professional group
o Code of ethics
o Professional organization that sets standards
o Ongoing research
o Autonomy and self- regulation
Nursing involves specialized skills and application of knowledge based on an
education that has both theoretical and clinical components. It is guided by standards set by
professional organizations and an established code of ethics.
Evolution and Development of Nursing Profession
Ancient civilizations & Nursing
 Illness earlier was seen as “magic”, “sin” or “punishment”.
 During 700-600 B.C - Sushruta Samhita was written by the great surgeon Sushruta,
who said "the physician, the patient, the drugs and the nurse are four feet of `Padas' of
the medicine, upon which the cure depends".
 The first nursing school started in India in 250 B.C. during Charaka's time and only
men were considered pure enough to be nurses
 Other civilisations as Egyptians, Babylonians, Hebrews, Greeks and Romans also
show evidences of nursing care.
 The earliest references to women as nurses are to be found in the Old Testament (500
BC) and they journeyed from Bethel; and… she had hard labour. And it came to pass,
when she was in hard labour that the midwife said unto her Fear not; thou shall have
this son. (Genesis 35).
 Hippocrates in the 5th century BC known as “Father of Medicine” Developed system
of assessment, observation, record keeping ,Developed terms prognosis, diagnosis,
cure.
Early Christian Era (AD 60)
 Women began nursing as an expression of Christianity (acts of mercy)
 Women were recognized as important members of community
 Phoebe—considered the first Deaconess and visiting nurse
 Fabiola—was a wealthy Christian in Rome and founded the first public hospital in
Rome
 Paula -was a friend of Fabiola. She devoted herself for the services of the sick. She
built a hospital for strangers, pilgrims, and travellers and for the sick. She constructed
a monastery in Bethlehem. They gave good nursing care for the sick.
Middle Ages (AD 476 – 1475)
 Throughout the middle ages, care was provided primarily by religious orders to
sick and poor. The monasteries became the places of education, medical care and
nursing.
 Knight Hospitaliers of St. John’s of Jerusalem cared for the injured on the
battle field —their symbol: a bright, Red Cross. Knights organized nursing care
 Some of nurses were nuns and deaconess
Rennaisance(1500AD – 1850AD) - The dark period of nursing.
 Rise of Protestantism meant that many Catholic monasteries offering nursing care and
medicine was closed down.
 Nursing ceased to be valued as an intellectual endeavour it lost much of its economic
support and social status
 The Protestants viewed the woman's place as being in the home raising children.
Hence nurses of this period consists of
 Wayward” women of low status who became “nurses” instead of going to
jail
 Women of ill repute
 Poor, single women with no family or hope of marriage
 1633 -Sisters of Charity founded by Louise de Marillac -established the first
educational program to be affiliated with a religious nursing order
 1809 -Mother Elizabeth Seton introduced the Sisters of Charity into America, later
known as the Daughters of Charity.
Dawn of Modern Nursing
 In 1836 Pastor Theodur Fliedner opened the Kaiserwerth Deaconess Institute—the
first REAL nursing school Its most famous student: Florence Nightingale
(1820-1910)
 In 1860 Nightingale established nursing school at St. Thomas’ Hospital, London .
 1884 - Mary Snively assumed directorship of Toronto General Hospital and began to
form the Canadian National Association of Trained Nurses. Later became the
Canadian Nurses Association.
 1890 - establishment of the Nurses Associated Alumni of the United States and
Canada & this later became the American Nurses Association.
 1901 - first university affiliated nursing program, Army Nurse Corps established.
 1901 - New Zealand was the first country to regulate nurses nationally, with adoption
of the Nurses Registration Act on the12September 1901.
 It was here in New Zealand that Ellen Dougherty became the first registered nurse.
 1911 - formed American Nurses Association
Evolution and Development of Nursing Profession in India
 Military nursing was the earliest type of nursing.
 Florence Nightingale had a great influence over nursing in India especially in the
army.
 St Stephens Hospital at Delhi was the first one to begin training the Indian girls as
nurses in 1867.
 1871, the first School of Nursing was started in Government General Hospital,
Madras.
 1897, Dr.B.C.Roy did great work in raising the standards of nursing and that of male
and female nurses.
 1908, the trained nurses association of India was formed
 In 1918, first Lady Health Visitors course was started in lady reading Heath school
Mumbai
 Later diploma in General Nursing and Midifery and
 In 1926, Madras State formed the first registration council
 In 1946 the first four year basic Bachelor Degree program were established at the
college of nursing in Delhi and Vellore.
 The Indian Nursing Council was passed by ordinance on December 31st 1947. The
council was constituted in 1949.
 First master’s degree course, a two-year postgraduate program was begun in 1960 at
RAK College of Nursing, Delhi.
 1963, the School of Nursing in Trivandrum, instituted the first two years post
certificate Bachelor Degree program.
 In 1986, M phil at RAK college ofnursing New Delhi was started
 In 1991, the first doctoral programme in nursing was established in institute of nursing
science, MV Shetty memorial college Mangalore.
 Post Basic Diploma programs in super- speciality are offered in Cardio Thoracic
Nursing ,Operation Room Nursing, Neurology Nursing, Midwifery Nursing.
Critical Care Nursing Psychiatric Nursing Emergency & Disaster Nursing
Oncology Nursing Geriatric Nursing Neonatal Nursing Forensic Nursing
Haematology Nursing-Residency Programme Burn & Reconstructive Surgery
Nursing – Residency Programme
 Recently INC has commenced 2 year Nurse Practitioner in Critical Care
postgraduate Residency programme.
NURSING KNOWLEDGE DEVELOPMENT
History of Knowledge Development in Nursing
Nursing knowledge is drawn from a multifaceted base and includes evidence that comes from
science (research and evaluation), experience and personally derived understanding.
•Scientific knowledge is developed through enquiry and can use the research approaches
•However, not the only form of evidence used by nurses in their practice,
nursesalsouseexperiencegainedfrompracticeitselfandtheirownpersonal learning
•“Nursing knowledge refers to knowledge warranted as useful and significant to nurses and
patients in understanding and facilitating human health processes.”(Reed &Lawrence, 2008,
p. 423cited in Risjord, 2010)
From antiquity to nightingale
 Routine care of the sick
 Influenced by the healing traditions within society
 Healers linked disease with spirit world
 Rituals or ceremonies were used to dispel perceived evil and invoke good
 Plants and herbal remedies were used for healing
 The work of scientists and philosophers such as Copernicus, Galileo, Bacon, and
Newton began to lay the groundwork for a view of disease as the result of natural
rather than spiritual causes.
Nightingale’s legacy
 The need for a uniformly high standard of nursing care that required both education
and certain personal characteristics
 Recognition of nursing as a professional endeavour distinct from medicine
 After her service in the war, Nightingale wrote Notes on Nursing (Nightingale,
1860/1969), in which she set forth the basic premises on which nursing practice
should be based and articulated the proper functions of nursing.
From nightingale to science
The period from the beginning of the 1900s to about 1950 was a time of great change in
nursing that still continues to mould and shape knowledge development processes.
Loss of the nightingale ideal
 Early during the 1900s, the Nightingale era was ending, and medical care was taking
shape as a science. Women were viewed as incapable of practicing medicine and
unqualified to be scientists. With industrialization, large populations of people moved
to urban areas, and the number of hospitals increased dramatically in these areas.
 Nurses were exploited both as students and as experienced workers. They were
treated as submissive, obedient, and humble women who were “trained” in correct
procedures and techniques. Ideally, they fulfilled their responsibilities to physicians
without question
The entrenchment of apprenticeship learning
 The control of nursing education and practice was transferred from the profession to
hospital administrators and physicians during the early 1900s, when most of the
Nightingale-modeled schools in the United States were brought under the control of
hospitals (Ashley, 1976).
 Although training was acceptable and even necessary, true education for women and
nurses was discouraged, discouraging, and limited. Indeed, education was
counterproductive for women who, as nurses, were expected to follow orders and
serve the needs and interests of physicians when it came to providing care (Melosh,
1982; Reverby, 1987a, 1987b).
 Nursing students were presumed to learn at random through long hours of experience
(with limited exposure to lectures or books) and to accept without question the
prescriptions of practical techniques. The novice nurse acquired knowledge of what
was right and wrong in practice by observing more experienced practitioners and by
memorizing facts about the performance of nursing tasks.
Persistence of nursing ideals
 Despite social impediments to the development of nursing knowledge, nursing
philosophy and ideology remained committed to the idea that nursing requires a
knowledge base for practice that is distinct from that of medicine (Abdellah,
1969; Hall, 1964; Henderson, 1964, 1966; Rogers, 1970).
 Consistently throughout the early 20th century, nursing leaders in the United States
worked together nationally and internationally in strong connecting networks and
called for a social and political ethic that would restore the control of nursing practice
to nurses and that would promote the health and welfare of citizens.
 Margaret Sanger, Lillian Wald, Lavinia Dock, Susie Walking Bear Yellowtail, Mabel
Staupers, and Adah Thoms are among those nurses who were challenged by specific
needs in society and set about to change problematic practices that affected health
care. Example Sanger developed knowledge about reproduction and birth control
(Sanger, 1971).
The emergence of nursing as a science
 The shift toward a concept of nursing knowledge as predominantly scientific began
during the 1950s and took a strong hold during the 1960s. This shift toward
knowledge as science produced significant changes in what was considered important
in nursing.
 The shift toward science as the basis for developing nursing knowledge was
influenced by the involvement of nursing in the two world wars that occurred during
the early 20th century.
 The U.S. government instituted war-related programs to make nursing preparation
available to women who agreed to serve in the war (Kalisch & Kalisch, 2003; Kelly &
Joel, 2001).
 After the end of World War II, many educational programs were established within
institutions of higher learning, and graduate programs for nurses began to appear.
Academic institutions required faculty to hold advanced degrees and encouraged them
to meet the standards of higher education with regard to providing service to the
community, teaching, and performing research.
 Nurse-scientist programs were established to enable nurses to earn doctoral degrees in
other disciplines with the idea that the research skills that were learned could then be
applied in nursing. As academically based nurses gained skills in the methods of
science, conceptual frameworks and other types of theoretic writings began to
emerge.
 In 1950, Nursing Research was established; this was the first nursing research journal.
Books about research methodologies and explicit conceptual frameworks, which were
often called “theories of nursing,” began to appear.
 By the 1960s, doctoral programs in nursing were being established. By the end of the
1970s, the number of doctorally prepared nurses in the United States had grown to
nearly 2000. Master’s programs began focusing on preparing advanced practitioners
in nursing rather than on preparing educators and administrators, whereas doctoral
programs increasingly focused on the development of nursing knowledge.
Early trends in the development of nursing science
Throughout the second half of the 20th century, two major trends contributed to evolving
directions in the development of nursing knowledge. Two important trends are
(1) The use of theories that have been borrowed from other disciplines, and
(2) The development of conceptual frameworks that define nursing.
The use of theories borrowed from other disciplines
 As the educational preparation of nurses expanded, theories developed in other
disciplines were recognized as also being important for nursing For example, nurses
recognized that young children needed the continuing love and support of their
parents and families during hospitalization. The strict rules of hospitals that severely
restricted visitation interrupted these primary family ties. As psychology theories of
attachment and separation developed, nurses found an explanation for the problems
experienced by hospitalized children and were able to change visitation practices to
provide for sustained contact between parents and children.
 The trend of using theories from related disciplines may have been an outgrowth of
predoctoral and postdoctoral fellowship funding for nurses that began in the mid1950s. This funding nurtured a cadre of nurse scientists who studied research
approaches in fields related to but outside of nursing. After these nurses were
educated, they would return to nursing and conduct research, thereby contributing to
nursing’s knowledge base.
Development of philosophies and conceptual frameworks that define nursing
 As nurses began to reconsider the nature of nursing and the purposes for which
nursing exists in the light of science, they began to question many ideas that were
taken for granted in nursing and the traditional basis on which nursing was practiced.
They wrote and published idealized views of nursing and of the type of knowledge,
skills, and background needed for practice. Many early nursing conceptual
frameworks and philosophies include a description of the nursing process. This
process, which is similar to both scientific methods of problem solving and research
processes, is a framework for viewing nursing as a deliberate, reflective, critical, and
self-correcting system. The nursing process replaced the rule- and principle-oriented
approaches that were grounded in a medical model in which the nurse functions as a
physician’s assistant. The nursing process relied heavily on what could be accessed
through observation.
 Conceptual frameworks for nursing education and practice proliferated during the
1960s and 1970s. The then-current emphasis on systems theories is evident in the
work of Callista Roy, Imogene King, Dorothy Johnson, and Betty Neuman.
 The movement of psychiatric care into community-based settings after the
development of new drugs for the management of psychiatric illness contributed to a
theoretic focus on the importance of interpersonal communication; this focus is
notable in the work of Hildegard Peplau, Joyce Travelbee, and Ida Jean Orlando.
 The emergence of chronic disease with the control of communicable disease and a
focus on wholism is reflected in Myra Levine’s conservation principles framework as
well as in Dorothea Orem’s theoretic writings on self-care.
 Many nurse scientists who benefited from early funding for doctoral education
received training in fields such as sociology and anthropology, in which a focus on
the development of broad, grand theories was prominent; this influence is notable in
the work of Madeleine Leininger.
 The conceptual frameworks of Martha Rogers, Rosemarie Parse, and Margaret
Newman reflect theoretic perspectives linked to developments in modern physics that
moved beyond earlier system concepts of equilibrium.
 There was considerable debate about whether the writings of leaders such as Callista
Roy, Betty Neuman, Imogene King, and Dorothea Orem and others were to be called
“models,” “theories,” or “philosophies.” This debate reflected an underlying
acknowledgment that empiric knowledge alone was an inadequate metatheory for
practice. How to name these theory-like constructions: theories, conceptual models,
theoretic frameworks, conceptual frameworks? This remains a debatable subject, and
various terminologies can be found in the contemporary theoretic literature. We have
chosen to refer to these broad theory-like structures as conceptual
frameworks or theoretic frameworks, and their authors we call theorists.
The nature of nursing knowledge
The study of knowledge is termed 'epistemology', a word derived from the Greek words
'episteme', meaning knowledge, and 'logos', meaning discourse (Bernstein 1983). Thus,
epistemology is a discourse on knowledge. Such discourse raises and attempts to answer
questions related to the history, nature and origins of knowledge, its methods of derivation
and criteria for validation
Epistemology has been defined as 'a branch of philosophy that investigates the origin, nature,
methods; and limits of human knowledge.' (Kothari & Mehta, 1993)
Ways of Knowing Knowledge
In epistemology, there are several basic types of knowledge. These include the
Following :
■ Empirics — the scientific form of knowing. Empirical knowledge comes from
Observation, testing, and replication.
■ Personal knowledge — a prior knowledge. Personal knowledge pertains to
Knowledge gained from thought alone.
■ Intuitive knowledge — includes feelings and hunches. Intuitive knowledge is
not guessing but relies on non conscious pattern recognition and experience.
■ Somatic knowledge—knowledge of the body in relation to physical
Movement. Somatic knowledge includes experiential use of muscles and
balance to perform a physical task.
■ Metaphysical (spiritual) knowledge — seeking the presence of a higher power.
Aspects of spiritual knowing include magic, miracles, psycho kinesis, extrasensory
perception, and near-death experiences.
■ Aesthetics—knowledge related to beauty, harmony, and expression. Aesthetic
knowledge incorporates art, creativity, and values.
■ Moral or ethical knowledge—knowledge of what is right and wrong.
Values and social and cultural norms of behaviour are components of ethical knowledge.
Nursing Epistemology
Nursing epistemology has been defined as “the study of the origins of nursing knowledge, its
structure and methods, the patterns of knowing of its members, and the criteria for validating
its knowledge claims” (Schultz & Meleis, 1988, p. 21).
Carper’s Patterns for Nursing Knowledge:
In a classic work, Carper (1978) identified four fundamental patterns for nursing knowledge:
(1) empirics—the science of nursing,
(2) aesthetics—the art of nursing
,(3) personal knowledge in nursing, and
(4) ethics—moral knowledge in nursing
Pattern of
Knowing
Empirics
Relationship
Source of
Source of
to Nursing
Creation
Validation
Science of
Direct or
Replication
nursing
indirect
observation
and
measurement
Purpose or
outcome
Description,
explanation,
prediction
Esthetics
the art of
nursing
Personal
knowledge
Therapeutic
use of self
Move beyond
what
can be
explained,
quantitatively
formulated,
understanding,
balance
Therapeutic
use of
self
Ethics
Creation of
value
and
meaning,
synthesis of
abstract and
concrete
Engagement,
opening,
centering,
actualizing
self
moral
Values
knowledge in clarification,
Method of
Expression
Facts,
models,
scientific
principles,
laws
statements,
theories,
descriptions
Appreciation;
Appreciation;
experience;
empathy;
inspiration;
esthetic
perception of
criticism;
balance,
engaging,
rhythm,
intuiting, and
proportion, and envisioning
unity
Response,
Empathy,
reflection,
active
experience
participation
Dialogue,
justification,
Principles,
Evaluation of
codes, ethical what is
nursing
rational and
deliberate
reasoning,
obligation,
advocating
universal
theories
generalizability
good,
valuable, and
desirable
Schultz and Meleis Patterns of Nursing Knowldge
Although Carper’s work is considered classic, it is not without critics. Schultz and
Meleis (1988) observed that Carper’s work did not incorporate practical knowledge
into the ways of knowing in nursing. Because of this and other concerns, they
described three patterns of knowledge in nursing: clinical, conceptual, and empirical.
Clinical knowledge refers to the individual nurse’s personal knowledge. It results
from using multiple ways of knowing while solving problems during client care provision.
Clinical knowledge is manifested in the acts of practicing nurses and results from
Combining personal knowledge and empirical knowledge. It may also involve intuitive
and subjective knowing. Clinical knowledge is communicated retrospectively through
Publication in journals. (Schultz & Meleis, 1988).
Conceptual knowledge is abstracted and generalized beyond personal experience.
It explicates patterns revealed in multiple client experiences, which occur in multiple
situations, and articulates them as models or theories. In conceptual knowledge, concepts
are drafted and relational statements are formulated. Propositional statements
are supported by empirical or anecdotal evidence or defended by logical reasoning.
Conceptual knowledge uses knowledge from nursing and other disciplines.
It incorporates curiosity, imagination, persistence, and commitment in the accumulation
of facts and reliable generalizations that pertain to the discipline of nursing.
Conceptual knowledge is communicated in propositional statements (Schultz &
Meleis, 1988).
Empirical knowledge results from experimental, historical, or phenomenologic
research and is used to justify actions and procedures in practice. The credibility of
empirical knowledge rests on the degree to which the researcher has followed procedures
accepted by the community of researchers and on the logical, unbiased derivation
of conclusions from the evidence. Empirical knowledge is evaluated through
systematic review and critique of published research and conference presentations
(Schultz & Meleis, 1988).
Chinn and Kramer Pattern of Nursing Knowledge
Chinn and Kramer (2011) also expanded on Carper’s patterns of knowing to
include “emancipatory knowing”—what they designate as the “praxis of nursing.”
In their view, emancipatory knowing refers to human’s ability to critically examine
the current status quo and to determine why it currently exists. This, in turn, supports
identification of inequities in social and political institutions and clarification of
cultural values and beliefs to improve conditions for all. In this view, emancipatory
knowledge is expressed in actions that are directed toward changing existing social
structures and establishing practices that are more equitable and favorable to human
health and well-being
Lee Khuan Way of Knowing Nursing Knowledge
Empirical knowing: is the science of nursing, It is factual, descriptive and ultimately aimed
at developing abstract theoretical explanation. Empirical knowing is the science of nursing.
As a pattern of knowing it draws on traditional ideas of science in which reality is viewed as
something that can be verified by other observers (Winfrey, L999).An example of the
empirical outcome measurement will be maternal mortality ratio. From an empirical
perspective, one might ask: what is this, and what does this represent?
Chronologically, empiric ways of knowing has dominated the nursing profession
since Nightingale's era. Nurses are inclined to believe that only valid and reliable knowledge
is factual, objective, descriptive, and generalizable. However, not all aspects of knowing are a
result if empirical investigation. For example, helping clients in daily living such as feeding
an elderly, comforting bereaved family members, and educating a diabetic patient on foot
care are integral parts of nursing. Such activities are not necessarily empirically based but
Help the client to recover quickly
Esthetic knowing: the art of nursing Winfrey et al., (1999) stated that esthetic practice is
making "visible through actions" of the nurse's perception of what the patient needs. In other
words, esthetic knowing is the comprehension of meaning in a singular, particular, subjective
expression that we call the art of nursing. Empathy, or the ability to participate in and
vicariously experience another person's feelings, is an important aspect of the esthetic pattern
of knowing. Experience is another important component of esthetic knowing, for example,
through the practice of nursing process in assessment planning, implementation and
evaluation. Past knowledge as experienced is enfolded into esthetic and clients are uniquely
cared for. The critical question in understanding pattern of esthetic is" what does this mean?
Personal Knowing: Reflection and response are the processes of personal knowing that
contribute to an understanding. Carper explained that the pattern of personal knowing
develops when a nurse approaches the patient not as an object or diagnosis but strives instead
"to actualize an authentic personal relationship between two persons." Nursing knowledge
requires us to be alert to models of human nature and focus on interpersonal relationship. Jill
(1995) added that it is through knowing the self that one is able to know another human being
as a person.
According to Diemert-Morch, (1990) as cited by Wong (1998), the described
component of personal knowing is:
Experiential knowing – becoming participation of being in the world
Interpersonal knowing – increased awareness through intense interaction with others
Intuitive knowing - immediately knowing something without use of reason. This
pattern of knowing is most difficult to master and to teach but, is important in understanding
the individual's experience of health and wellness.
The type of question that we will ask from personal way of knowing are: Do I know
what I know? Do I do what I know
Ethics: Carr(1999) described ethical knowing as a focus on matters of obligation or what
ought to be done. Knowing in ethics is to explore the norms or ethical codes of discipline in
making moral choices and being responsible for the choices made. Ethical knowing leads one
to seek an answer to the question: is this right and is it just? For example, if we have a
terminally ill patient who refuses to be fed through nasal gastric tube by a nurse and ask to
end her life, does that mean the nurses should leave her alone as a respect for the client's
autonomy or decide to resolve this matter through ethical reasoning? The decision the nurse
makes would fall into the component of moral knowledge as a fundamental way of Knowing.
Social political knowing: It is a context of nursing The fifth pattern of knowing which is
essential to an understanding of all the others is socio political knowing. Jacob-Kramer and
Chinn, (1988) as cited by jill (1995) pointed out that what appears to be missing in Carper's
four fundamental ways of knowing is the social political environment of the person and their
interaction. Social political knowing consists of two levels, firstly the social political context
of the person (nurse and the patient) and secondly, the social political context as a practice
profession. Unequal class structure, power relationship, political and economic power
produce sexism, racism, ageism, and classim, which in turn affect health and result in illness.
Nursing practitioners are required to articulate and continually confront human responses to
social problems such as poverty, unemployment, under nutrition, isolation and alienation,
precipitated through the structures of society. These problems are inherently political rather
than simply personal problems. Nurses must critique on how social political factors affect the
health of a person and community. Therefore, involvement of nursing in policy planning and
decision making about health issues is vital.
Social political context in nursing profession is undeniable in the present globalize world.
With the forces of health care reform, nurses must look into "health and "health care" in a
broader perspective, find means of enabling all concerned parties to have a voice in care
provisory and develop processes of shared governance for the future.
Research Methodology and Nursing Science
Being heavily influenced by logical empiricism, as nursing began developing as a
scientificdiscipline in the mid-1900s, quantitative methods were used almost exclusively in
research. In the 1960s and 1970s, schools of nursing aligned nursing inquiry with scientific
inquiry in a desire to bring respect to the academic environment, and nurse researchers and
nurse educators valued quantitative research methods over other forms.
A debate over methodology began in the 1980s, however, when some nurse scholars
asserted that nursing’s ontology (what nursing is) was not being adequately and sufficiently
explored using quantitative methods in isolation. Subsequently, qualitative research methods
began to be put into use. The assumptions were that qualitative methods showed the
phenomena of nursing in ways that were naturalistic and unstructured and not misrepresented
(Holzemer, 2007; Rutty, 1998).
The manner in which nursing science is conceptualized determines the priorities for
nursing research and provides measures for determining the relevance of various scientific
research questions. Therefore, the way in which nursing science is conceptualized also has
implications for nursing practice
Nursing as a Practice Science
In early years, the debate focused on whether nursing was a basic science or an
applied science. The goal of basic science is the attainment of knowledge. In basic research,
the investigator is interested in understanding the problem and produces knowledge
for knowledge’s sake. It is analytical and the ultimate function is to analyze a conclusion
backward to its proper principles.
Conversely, an applied science is one that uses the knowledge of basic sciences
for some practical end. Engineering, architecture, and pharmacology are examples.
In applied research, the investigator works toward solving problems and producing
solutions for the problem. In practice sciences, research is largely clinical and action
oriented (Moody, 1990). Thus, as an applied or practical science, nursing requires
research that is applied and clinical and that generates and tests theories related to
health of human beings within their environments as well as the actions and processes
used by nurses in practice.
Nursing as a Human Science
The term human science is traced to philosopher Wilhelm Dilthey (1833–1911).
Dilthey proposed that the human sciences require concepts, methods, and theories
that are fundamentally different from those of the natural sciences.
In human sciences, scientists hope to create new knowledge to provide understanding
and interpretation of phenomena. In human sciences, knowledge takes the form of descriptive
theories regarding the structures, processes, relationships, and traditions that underlie
psychological, social, and cultural aspects of reality. The purpose of research in human
science is to produce descriptions and interpretations to help understand the nature of human
experience.
Nursing is sometimes referred to as a human science (Cody & Mitchell, 2002;
Mitchell & Cody, 1992). Indeed, the discipline has examined issues related to behavior and
culture, as well as biology and physiology, and sought to recognize associations among
factors that suggest explanatory variables for human health and illness. Thus, it fits the
pattern of other humanistic sciences (i.e., anthropology,sociology).
Quantitative Versus Qualitative Methodology Debate.
The two dominant forms of scientific inquiry have been identified in nursing:
(1) empiricism, which objectifies and attempts to quantify experience and may test
propositions or hypotheses in controlled experimentation; and
(2) phenomenologyand other forms of qualitative research (i.e., grounded theory,
hermeneutics, historicalresearch, ethnography), which study lived experiences and meanings
of events( Gortner & Schultz, 1988; Monti & Tingen, 1999; Risjord, 2010).
Reviews ofthe scientific status of nursing knowledge usually contrast the positivist–
deductive–quantitative approach with the interpretive–inductive–qualitative alternative.
Quantitative Methods
Traditionally, within the “received” or positivistic worldview, science has been uniquely
quantitative. The quantitative approach has been justified by its success in measuring,
analyzing, replicating, and applying the knowledge gained (Streubert & Carpenter,
2011). According to Wolfer (1993), science should incorporate methodologic principles
of objective observation/description, accurate measurement, quantification of
variables, mathematical and statistical analysis, experimental methods, and verification
through replication whenever possible.
.
Qualitative Methods
The tradition of using qualitative methods to study human phenomena is grounded
in the social sciences. Phenomenology and other methods of qualitative research
Arose because aspects of human values, culture, and relationships were unable to
be described fully using quantitative research methods. It is generally accepted that
qualitative research findings answer questions centered on social experience and give
meaning to human life.