Nursing: the ontology of the discipline

Midrange Theory Evaluation to Advance Nursing Knowledge

The author in this article presents a midrange theory evaluation framework as an update to nursing publications over the past 50 decades on theory evaluation criteria and incorporates recent philosophical perspectives on scientific theory and knowledge development. The intent also is to encourage a theorizing style that advances understanding and explanations of nursing phenomena for nursing practice as well as for the pure joy of knowing why something happens.

Self-Transcendence: Moving from Spiritual Disequilibrium to Well-Being Across the Cancer Trajectory

OBJECTIVES

To synthesize research results on self-transcendence among people affected by cancer and their caregivers to inform oncology nursing practices that promote well-being across the cancer trajectory. Self-transcendence is an inherent capacity to expand self-boundaries beyond the person's usual form to create something meaningful, whether it is a new purpose, perspective, situation, or artifact that fosters well-being.

DATA SOURCES

Peer-reviewed, research-based publications, and peer-reviewed theoretical publications were used.

CONCLUSION

Research results are consistent with Reed's self-transcendence theory that proposes self-transcendence as a healing process for application in nursing practice. Self-transcendence facilitates well-being through the creative experiences afforded by expanding self-boundaries intrapersonally, interpersonally, and transpersonally. Nurses may use this knowledge in various practices that support well-being among people who have cancer and their families.

IMPLICATIONS FOR NURSING PRACTICE

Five comprehensive practice implications to support self-transcendence and foster well-being in individuals affected by cancer and their caregivers were synthesized from the research-based literature and aligned with Reed's self-transcendence theory.

Keeping the Nurse in the Nurse Practitioner: Returning to Our Disciplinary Roots of Knowing in Nursing

Nurse practitioners are a vital and growing body of primary healthcare providers. The ever-changing advancements in science and technology and the increasing complexities in health care delivery are significant factors culminating in the expanding role of nurse practitioner-led care. Nurse educators are striving to develop nurse practitioner curricula to keep pace with the increasingly sophisticated knowledge and competencies nurse practitioners must possess to render safe quality care as independent primary health care providers. However, nursing theory is losing its place as a formative foundation in nurse practitioner curricula. Multiple factors such as content-laden, competency-based, medically focused education have caused a diminishing presence of nursing theory, shrinking the philosophical basis for nursing in nurse practitioner education. The loss of the central unifying focus of the discipline and discipline-specific knowledge (nursology) risks losing the very identity that forms the basis and relevance for nurse practitioner practice. Moreover, the loss of the nurse in the nurse practitioner unmoors nurse practitioner practice from its theoretical and scientific basis, losing discipline-specific attributes that lead to higher levels of patient satisfaction and improved patient outcomes. Keeping the nurse in the nurse practitioner is a moral imperative in nurses' ethical and social contract with society. This article discusses relevant literature and offers recommendations to keep the nurse in the nurse practitioner.

Cardiovascular Consequences of Excessive Alcohol Drinking via Electrocardiogram: A Systematic Review

ABSTRACT

There is a link between excessive alcohol drinking and an increased risk to develop cardiovascular disease, including alcoholic cardiomyopathy. This association warrants further research on the potential utility for the electrocardiogram (ECG) in the participatory management of the chronic consequences of alcohol use disorder (AUD). Our goal is to enhance understanding about the pernicious role alcohol plays on cardiac health using the ECG, an accessible, cost-effective, validated tool to inform novel targeted treatments for AUD. In this systematic review of human studies, we examine the relationship between abnormal clinically significant changes to ECG variables and excessive alcohol drinking with the goal of identifying key patterns specific to quantity of alcohol consumed. Three independent reviewers and one consensus reviewer, adhering to the PRISMA guidelines, conducted an initial review on studies published from database inception to April 19, 2019, using PubMed, Embase, CINAHL and COCHRANE databases. The initial search generated 2,225 articles. The final selected number included 153 original articles. This systematic review provides evidence of patterns of clinically significant changes to ECG variables as a consequence of excessive alcohol consumption. Future directions include investigating whether a real-time assessment, such as the ECG, in conjunction with other key behavioral and cardiac measures, can help clinicians and patients realize the progressive and insidious cardiac damage because of excessive alcohol consumption. This theory-guided nurse science review supports the development of personalized symptom monitoring to deliver tailored feedback that illuminate risk factors as a potentially transformative approach in the management of AUD.

Spiritual Knowing: Another Pattern of Knowing in the Discipline

Fundamental patterns of knowing in nursing have historically served to clarify the substance and structure of the discipline, significantly contributing to nursing's body of knowledge. In this article, we continue the scholarly conversation on patterns of knowing in nursing by advancing spiritual knowing as a pattern of knowing that helps advance nursing's agenda toward universal well-being and critical during this time toward interdisciplinarity. Implications for nursing are explored in relation to enduring and new questions that require our attention related to human beings, their environments, and healing.

The Prismatic Midparadigm of Nursing

The disciplinary perspective of nursing is guided in part by its metaparadigm, which includes the concepts of human beings, environment, health, and nursing. While relevant to the discipline as a whole, these abstract concepts are not meant for operationalization into the practice environment. The authors in this paper introduce a midparadigm of nursing-namely, the prismatic midparadigm-for applications in research, practice, policy, and education. It is a framework of concepts that are less abstract, but congruent with, the metaparadigm and more specific to the practice environment with the context of vulnerability as central.

Regenerating Nursing's Disciplinary Perspective

As we approach the 50th anniversary of the first national symposium on nursing theory development, the need to clarify nursing's disciplinary perspective is just as relevant as it was 50 years ago. The purpose of this article is to regenerate the disciplinary perspective by analyzing the literature on the focus of the discipline of nursing, synthesizing the themes and suggesting areas of knowledge development for the discipline, and imagining ways to move forward in claiming, clarifying, and strengthening the discipline. The 4 themes identified were human wholeness, health/healing/well-being, human-environment-health relationship, and caring. Nine areas of inquiry generated from the disciplinary perspective were suggested.

Linking the Unitary Paradigm to Policy through a Synthesis of Caring Science and Integrative Nursing

The principles of integrative nursing and caring science align with the unitary paradigm in a way that can inform and shape nursing knowledge, patient care delivery across populations and settings, and new healthcare policy. The proposed policies may transform the healthcare system in a way that supports nursing praxis and honors the discipline's unitary paradigm. This call to action provides a distinct and hopeful vision of a healthcare system that is accessible, equitable, safe, patient-centered, and affordable. In these challenging times, it is the unitary paradigm and nursing wisdom that offer a clear path forward.

Philosophical and theoretical content of the nursing discipline in academic education: A critical interpretive synthesis

BACKGROUND

Nursing as clinical practice, management and research are based on nursing philosophy and theory. Thus, the philosophical and theoretical content is required to be incorporated in academic education in order to enable nurses' skills for reflection, analysis, and thinking about the profession.

OBJECTIVE

The aim of this review was to describe what is known of the philosophical and theoretical content of the nursing discipline within academic education.

DESIGN

A critical interpretive synthesis (CIS).

METHODS

Electronic searches were performed across four databases, CINAHL, Scopus, Medline, and Web of Science, for papers published in English from 1980 to 2016. The selection of original articles was based on stages, and inclusion and exclusion criteria were used. Quality of the selected papers were evaluated by method sensitive appraisal criteria. The five phases of CIS were used to combine the selected data.

RESULTS

The searches resulted 9148 titles, whereas 13 were selected. Nurses need philosophical and theoretical education in order to be aware of human health and explain the complexity of the human experience of illness. The philosophy of science, the philosophy of care, and theory development were highlighted as the key contents in nursing academic education as these subjects are central to the discipline that ensures that nurses acquire advanced skills. A model was developed that linked disciplinary issues the progression nursing science through the influence of advanced skills.

CONCLUSIONS

Based on the findings in this study the philosophical and theoretical content of nursing discipline crates a basis for the academic education and enables a professional and exclusive vision for nurses. It provides an overall understanding of people's lives and support nurses to achieve deeper awareness of the meaning of illness and health in a person lifespan what is needed on the evidence-based decision making.

Nurse leaders' role in medical assistance in dying: A relational ethics approach

Recent changes to the Criminal Code of Canada have resulted in the right of competent adult Canadians to request medical assistance in dying (MAID). Healthcare professionals now can participate if the individual meets specific outlined criteria. There remains confusion and lack of knowledge about the specific role of nurses in MAID. MAID is a controversial topic and nurses may be faced with the challenge of balancing the duty to provide routine care, with moral reservations about MAID. The role of a nursing leader is to support nurses by ensuring they have the knowledge they require to care for patients requesting the service, whether or not the nurse is directly involved in the MAID process. The moral dilemmas raised by MAID provide an opportunity to look at a relational ethics approach to nursing leadership both for MAID and other difficult situations that arise in nursing practice. Relational ethics is a framework that proposes that the ethical moments in healthcare are based on relationships and fostering growth, healing, and health through the foundational concepts of mutual respect, engagement, embodiment, and environment. This article will use a relational ethics framework to examine how nursing leadership can support nurses who care for patients requesting MAID.

Translating Nursing Philosophy for Practice and Healthcare Policy

This article introduces the feature article on policy implications of integrative nursing. It describes unitary ontology in nursing, highlighting the Rogerian view of holism. The importance of linking philosophy to practice policy is emphasized.

Empowerment: Reformulation of a Non-Rogerian Concept

The authors present a reformulation of empowerment based upon historical and current perspectives of empowerment and a synthesis of existing literature and Rogerian thought. Reformulation of non-Rogerian concepts familiar to nurses is proposed as a strategy to accelerate the mainstreaming of Rogerian thought into nursing practice and research. The reformulation of empowerment as a participatory process of well-being inherent among human beings may provide nurses with new insights for practice. This paper may also serve as a model for reformulating other non-Rogerian concepts and theories for wider dissemination across the discipline.

Thoughts about the Name of Our Discipline

This essay addresses the name of our discipline. Discussion of the use of the term, nursology, focuses on the origin of the term, its use as a name for our discipline and its use as a research method and a practice methodology. Advantages and disadvantages of nursology as the name for our discipline are gleaned from PhD program students’ responses to a question posed by Reed (1997).

Wellness in older adults: a concept analysis

PURPOSE

The purpose of this analysis is to examine the concept of wellness within the context of older adulthood. Identifying characteristics of wellness will clarify and develop conceptual strengths and limitations, providing a step toward evaluating its relevance in older adults and increasing utility in geriatric nursing.

ORGANIZING FRAMEWORK

Rodger's evolutionary perspective.

METHODS

Computer and manual searches were conducted of articles in the English language from 1950 to 2010, addressing wellness across the life span or among older adult populations. An inductive analysis of articles produced descriptive themes.

FINDINGS

A historical time line traced the evolution of the wellness concept and its operationalization. Wellness has evolved from a little used concept to one commonly applied across many industries. Antecedents, attributes, and consequences of wellness are described. Concepts related to wellness are also identified.

CONCLUSIONS

This concept analysis adds clarity to wellness in older adults. The state of wellness development as a concept in geriatric nursing is moving from conceptualization to use and testing in nursing theory and interventions. Increased knowledge of wellness will enable geriatric nurses to discover the strengths of older adults thereby promoting their ongoing growth and development while simultaneously guiding care for their changing and diverse health.

Emergence of Nordic nursing research: no position is an Island

This paper reports on a detailed analysis of findings from a larger study of 'Nordic nursing theorists and clinical nurses' reflections on and experience with production and use of research, theory and findings'. The development of nursing science in the Nordic countries goes back to the late 1970s. With use of a sociological approach the aim was to explore whether nursing science has constituted itself as an autonomous nursing research field in Bourdieu's terms. In-depth interviews were undertaken with a purposive sample of 10 professors drawn from seven universities in the Nordic countries. The interview agenda explored the participants' research activities and knowledge production. Our conclusion is that one cannot speak of nursing research in the Nordic countries as a fully developed and autonomous field. Yet we see the outlines of an emerging nursing research field with a common doxa. At least three distinct positions operate in Nordic nursing research: a clinical and applied oriented position, a profession and knowledge oriented position and a theoretical and concept oriented position. Epistemologically speaking the positions are of a 'spontaneous', 'cyclical' and 'break' character. In a relational perspective each position has created its specific form via its relations with other positions in the field.

Nursing gaze as framework for nursing practice: a study from acute care settings in Korea, Norway and the USA

The aim of the study was to investigate the nature of nurses' clinical practice in terms of what frames their clinical engagement, and to examine how clinical constructions were made. The study is based on a descriptive design using a clinical field approach in acute care settings in Korea, the USA and Norway. A theoretical sample consisted of between four and six Registered Nurses in each country: up to three from medical wards and three from surgical wards. Data were collected through participant observation of and in-depth interviews with the nurses, as well as from nursing documentation about the patients. The result showed an overall model of a theory of nursing practice consisting of three processes: nursing gaze, clinical construction and clinical engagement. This first article outlines the overall descriptive theory of nursing practice and provides a detailed description of the first aspect: the nursing gaze. The model of the structuring of nursing gaze is set within the philosophy of nursing, consisting of the ontology of client and the ontology of practice. The dimensions of normality and needs constitute the ontology of client, and the dimension of clinical expectations constituted the ontology of practice.

An Ontological View of Advanced Practice Nursing

Identifying, developing, and incorporating nursing’s unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.

Analysis of Integration in Nursing Science and Practice

PURPOSE

To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care.

DESIGN

An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical.

METHODS

Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health.

FINDINGS

A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance.

CONCLUSIONS

Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.

Respect for human dignity: a central phenomenon to philosophically unite nursing theory and practice through consilience of knowledge

Nightingale suggested that there should be no distinction between "men of thought" and "men of action" and that an "Ideal" or philosophy should not be isolated but incorporated into everyday activities. This construct is analogous to the belief that nursing theory and nursing practice should be incorporated, and both should reflect a common central phenomenon. The pursuit of nursing knowledge by women of "thought" is not viewed as a central phenomenon but is an outcome of scholarly inquiry. Outcomes pursued by practicing nurses, women of "action," depend on their particular role and scope of practice. A number of outcomes are possible ranging from prevention, public health and policy, alleviation of pain and suffering, and individual health promotion and healing to palliative care. These outcomes are not viewed as the source of unity to guide nursing since they may vary, especially with developments in science, technology, and philosophy. A more unifying central phenomenon could be viewed as the respect for, or the restoration of, human dignity, our being in community, our being in the world, and our sea of a moral imperative. Consilience, a way to unify the knowledge that is needed to support this phenomenon, is suggested as an example of an approach to a philosophy of nursing that embraces multiple forms and sources of knowledge in all-encompassing morality that ultimately ennobles the lives of all human beings in covenantal relationships with nurses both in theory and in practice.

Nursing theory across curricula: a status report from Midwest nursing schools

This article reports on an informal survey conducted for the Theory Development Section of the Midwest Nursing Research Society. Its purposes were to describe current practices in teaching nursing theory at three levels of curricula and to compare these practices between nursing programs in liberal arts colleges and research universities, between schools with and without doctoral programs, and between faculty with nursing and nonnursing doctorates who teach nursing theory. Findings indicate greatest consistency of practices at baccalaureate and doctoral levels, though few baccalaureate programs have required courses in nursing theory. Few differences were found between types of schools, but faculty with nursing doctorates tended to emphasize theory-practice linkages at the baccalaureate level. Further study that uses this work as a platform is suggested.

Practice wisdom

A participatory process approach in research and scholarship is proposed in the context of the postmodern movement and a disciplinary emphasis on practice. Two sequential studies are presented to illustrate praxis in nursing in which health is expanding consciousness. A framework of personal practice was developed from the first study and reconceptualized in the second as a process of modeling practice involving partnership, dialogue, pattern recognition, and health as dialectic. This praxis illustrates the merging of theory, practice and research as practice wisdom. Health and caring can be seen as the same process.

Exercise: a unitary concept

Nursing science provides the opportunity to frame one's vision of humans and health and create interventions that facilitate wellness. This article contributes to nursing science by reconceptualizing exercise as a unitary concept using Parse's process of concept inventing. Concept inventing is a way to uncover the uniqueness of particular concepts and articulate their essence within the simultaneity paradigm. It differs from traditional, linear processes that are derived from the totality paradigm. Through the process of concept inventing, exercise is described within Rogers's science of unitary human beings and conceptualized as the purposeful, rhythmic flow of human movement.

A holistic view of nursing concepts and theories in practice

This article offers an alternative view to Hall's statements concerning concepts and theories in nursing practice. This article also represents an example of how journal articles can be forums for ongoing dialogue about the complex matters related to developing nursing knowledge. New ideas are presented by which the concept of self-transcendence, developmental theory, and theory in general are viewed from a holistic perspective rather than the perspectives offered in Hall's article. In contrast to Hall's claims about theory and about developmental theory in particular, theory is discussed as integral to holistic nursing practice.

Ontology, epistemology, and methodology: a clarification

The vistas of scholarly discourse in nursing are open to philosophical as well as scientific exploration. Careful attention to intersubjectivity in the use of language shared with other fields will continue to be a mark of nursing's rightful presence in an intellectual community committed to the pursuit of knowledge in the interest of advancing human welfare.