THEORETICAL FOUNDATIONS IN NURSING
positions what is good and right in making moral
FOUR WAYS OF KNOWING
1. EMPIRICS
 Evidence-based practice
 Involves accurate and thoughtful decision making
about health care delivery for clients.
 Based on the result of the most relevant and
supported evidence
 Examples:
 Answers base on what we learned.
 Scientific method to produce desired study.
 NOTE: empirical Knowing
 There is a scientific, research-based, theoretical, &
factual information that is being use.
 Ex. Knowledge from books, etc.
2. AESTHETIC
 Esthetics Knowing
 EMPHATIC (Primary form) aspect of Nursing.
 Art and act of nursing through practice and critique.
 Related to understanding what is of significance to
particular such as a feelings, attitudes.
 Ex. When a nurse place himself in the “patient’s
shoes” when communication, giving judgment and
providing care.
 Shows compassion, mercy
 Uses laymen terms in explaining the needs of a
patient
 Notes
 Is using in the process of giving appropriate nursing
care through understanding the uniqueness of
knowledge.
3. ETHICAL
 Describes, analyzes, and clarifies moral obligation
and values in nursing.
 Moral directions of Nursing
 Requires knowledge or different philosophical
actions and decisions, particularly in the theoretical
 Code of morals or code of ethics that leads the
conduct of nurses is the main basis for Ethical
Knowing.
 Deeply rooted in the concept human dignity, service,
and respect for life.
 Lessening suffering, upholding and preserving health
is one of the key elements why nursing is a core
service and
 Respect for life.
 Ex. Presents patient advocate and defends his
client’s right to choose care.
4. PERSONAL
 Therapeutic use of self
 Takes a lot of time to fully know the nature of oneself
in relation to the world around
 Stresses that human beings are not in a fixed state
but are
 Ex. Good relationship between you and the patient
 Interpersonal relationship
 NOTES:
 Personal Knowledge is focused on realizing, meeting
& defining the real, true self. One term defines this
as self-
 Awareness.
HISTORICAL EVOLUTION OF NURSING
 Period of Intuitive Nursing/Medieval Period
o Nursing was “untaught” and instinctive. It was
performed of compassion for others, out of the wish
to help others.
o Nursing was a function that belonged to women. It
was viewed as a natural nurturing job for women.
She is expected to take good care of the children, the
sick and the aged.
o No caregiving training is evident. It was based on
experience and observation.
o Primitive men believed that illness was caused by the
invasion of the victim’s body of evil spirits. They
 believed that the medicine man, Shaman or witch
doctor had the power to heal by using white magic,
hypnosis, charms, dances, incantation, purgatives,
massage, fire, water and herbs as a mean of driving
illness from the victim.
o Trephining – drilling a hole in the skull with a rock or
stone without anesthesia was a last resort to drive
evil spirits from the body of the afflicted.
 Period of Apprentice Nursing/Middle Ages
o Care was done by crusaders, prisoners, religious
orders
o Nursing care was performed without any formal
education and by people who were directed by more
experienced nurses (on the job training). This kind of
nursing was developed by religious orders of the
Christian Church.
o Nursing went down to the lowest level
 Wrath/anger of Protestantism confiscated
properties of hospitals and schools connected
with Roman Catholicism.
 Nurses fled their lives; soon there was shortage
of people to care for the sick
 Hundreds of Hospitals closed; there was no
provision for the sick, no one to care for the sick
 Nursing became the work of the least desirable
of women – prostitutes, alcoholics, prisoners
o Pastor Theodore Fliedner and his wife, Frederika
established the Kaiserswerth Institute for the
training of Deaconesses (the 1st formal training
school for nurses) in Germany.
 This was where Florence Nightingale received
her 3-month course of study in nursing.
 Period of Educated Nursing/Nightingale Era 19th-
20th century
o The development of nursing during this period was
strongly influenced by:
1. trends resulting from wars – Crimean, civil war
2. arousal of social consciousness
3. Increased educational opportunities offered to
women.
o Florence Nightingale was asked by Sir Sidney Herbert
of the British War Department to recruit female
nurses to provide care for the sick and injured in the
Crimean War.
o In 1860, The Nightingale Training School of Nurses
opened at St. Thomas Hospital in London.
 The school served as a model for other training
schools. Its graduates traveled to other countries
to manage hospitals and institute nurse-training
programs.
 Nightingale focus vision of nursing Nightingale
system was more on developing the profession
within hospitals. Nurses should be taught in
hospitals associated with medical schools and
that the curriculum should include both theory
and practice.
 It was the 1st school of nursing that provided
both theory-based knowledge and clinical skill
building.
o Nursing evolved as an art and science
o Formal nursing education and nursing service begun
FACTS ABOUT FLORENCE NIGHTINGALE
o Mother of modern nursing. Lady with the Lamp
because of her achievements in improving the
standards for the care of war casualties in the
Crimean war.
o Born May 12, 1800 in Florence, Italy
o Raised in England in an atmosphere of culture and
affluence
o Not contended with the social custom imposed upon
her as a Victorian Lady, she developed her self-
appointed goal: To change the profile of Nursing
o She compiled notes of her visits to hospitals and her
observations of the sanitary facilities, social
problems of the places she visited.
o Noted the need for preventive medicine and god
nursing
o Advocated for care of those afflicted with diseases
caused by lack of hygienic practices
o At age 31, she entered the Deaconesses School at
Kaiserswerth in spite of her family’s resistance to her
ambitions. She became a nurse over the objections
of society and her family.
o Worked as a superintendent for Gentlewomen
Hospital, a charity hospital for ill governesses.
o Disapproved the restrictions on admission of
patients and considered this unchristian and
incompatible with health care
o Upgraded the practice of nursing and made nursing
an honorable profession for women.
o Led nurses that took care of the wounded during the
Crimean war
o Put down her ideas in 2 published books: Notes on
Nursing, What It Is and What It Is Not and Notes on
Hospitals.
o She revolutionized the public’s perception of nursing
(not the image of a doctor’s handmaiden) and the
method for educating nurses.
 Period of Contemporary Nursing/20th Century
o Licensure of nurses started
o Specialization of Hospital and diagnosis
o Training of Nurses in diploma program
o Development of baccalaureate and advance degree
programs
o Scientific and technological development as well as
social changes marks this period.
1. Health is perceived as a fundamental human
right
2. Nursing involvement in community health
3. Technological advances – disposable supplies
and equipment
4. Expanded roles of nurses was developed
5. WHO was established by the United Nations
6. Aerospace Nursing was developed
7. Use of atomic energies for medical diagnosis,
treatment
8. Computers were utilized-data collection,
teaching, diagnosis, inventory, payrolls, record
keeping, and billing.
9. Use of sophisticated equipment for diagnosis
and therapy
HISTORY AND PHILOSOPHY OF SCIENCE (Sonya R.
Hardin)
“Why should nurses be interested in the history and
philosophy of science? The history and philosophy of
science is important as a foundation for exploring
whether scientific results are actually truth. As nurses
our practice should be based upon truth and we need the
ability to interpret the results of science. Nursing science
provides us with knowledge to describe, explain and
predict outcomes. The legitimacy of any profession is
built on its ability to generate and apply theory.”
(McCrae, 2011, p. 222)
Modern science was established over 400 years ago as
an intellectual activity to formalize given phenomena of
interest in an attempt to describe, explain, predict, or
control states of affairs in nature. Scientific activity has
persisted because it has improved quality of life and has
satisfied human needs for creative work, a sense of
order, and the desire to understand the unknown
(Bronowski, 1979; Gale, 1979; Piaget, 1970). The
development of nursing science has evolved since the
1960s as a pursuit to be understood as a scientific
discipline. Being a scientific discipline means identifying
nursing’s unique contribution to the care of patients,
families, and communities. It means that nurses can
conduct clinical and basic nursing research to establish
the scientific base for the care of individuals across the
life span. For example, research revealed gaps between
the pain management needs of patients and the
information communicated by patients and clinicians
during office visits. Although many older adults have
painful but not readily visible conditions (e.g.,
symptomatic osteoarthritis), little research has
examined how the style or format of a health care
practitioner’s questions influence the quality and
amount of diagnostic information obtained from older
adults. A recent study tested the theory that a certain
type of question would elicit the most response. The
theory was confirmed when findings supported that the
open-ended questions prompted patients to provide a
larger amount of diagnostically useful pain information
than did the closed-ended questions (McDonald, Shea,
Rose, & Fedo, 2009). While this study is one example of
nursing science, advance practice nurses should be
familiar with the long history of the science of nursing.
Previous author: Sue Marquis Bishop.
Historical Views of the Nature of Science
To formalize the science of nursing, basic questions must
be considered, such as: What is science, knowledge, and
truth? What methods produce scientific knowledge?
These are philosophical questions. The term
epistemology is concerned with the theory of knowledge
in philosophical inquiry. The particular philosophical
perspective selected to answer these questions will
influence how scientists perform scientific activities, how
they interpret outcomes, and even what they regard as
science and knowledge (Brown, 1977). Although
philosophy has been documented as an activity for 3000
years, formal science is a relatively new human pursuit
(Brown, 1977; Foucault, 1973). Scientific activity has only
recently become the object of investigation.
Two competing philosophical foundations of science,
rationalism and empiricism, have evolved in the era of
modern science with several variations. Gale (1979)
labeled these alternative epistemologies as centrally
concerned with the power of reason and the power of
sensory experience. Gale noted similarity in the
divergent views of science in the time of the classical
Greeks. For example, Aristotle believed that advances in
biological science would develop through systematic
observation of objects and events in the natural world,
whereas Pythagoras believed that knowledge of the
natural world would develop from mathematical
reasoning (Brown, 1977; Gale, 1979).
Nursing science has been characterized by two branching
philosophies of knowledge as the discipline developed.
Various terms are utilized to describe these two stances:
empiricist and interpretive, mechanistic and holistic,
quantitative and qualitative, and deductive and inductive
forms of science. Understanding the nature of these
philosophical stances facilitates appreciation for what
each form contributes to nursing knowledge.
 Rationalism
Rationalist epistemology (scope of knowledge)
emphasizes the importance of a priori reasoning as the
appropriate method for advancing knowledge. A priori
reasoning utilizes deductive logic by reasoning from the
cause to an effect or from a generalization to a particular
instance. An example in nursing is to reason that a lack
of social support (cause) will result in hospital
readmission (effect). This causal reasoning is a theory
until disproven. The traditional approach proceeds by
explaining hospitalization with a systematic explanation
(theory) of a given phenomenon (Gale, 1979). This
conceptual system is analyzed by addressing the logical
structure of the theory and the logical reasoning involved
in its development. Theoretical assertions derived by
deductive reasoning are then subjected to experimental
testing to corroborate the theory. Reynolds (1971)
labeled this approach the theory-then-research strategy.
If the research findings fail to correspond with the
theoretical assertions, additional research is conducted
or modifications are made in the theory and further tests
are devised; otherwise, the theory is discarded in favor
of an alternative explanation (Gale, 1979; Zetterberg,
1966). Popper (1962) argued that science would evolve
more rapidly through the process of conjectures and
refutations by devising research in an attempt to refute
new ideas. For example, his point is simple; you can
never prove that all individuals without social support
have frequent rehospitalizations since there might be
one individual that presents with no rehospitalization. A
single person with no social support that does not have
a readmission disproves the theory that all individuals
with a lack of social support have hospital readmissions.
From Popper’s perspective, “research consists of
generating general hypotheses and then attempting to
refute them” (Lipton, 2005, p. 1263). So the hypothesis
that a lack of social support results in hospital
readmission is the phenomena of interest to be refuted.
The rationalist view is most clearly evident in the work of
Einstein, the theoretical physicist, who made extensive
use of mathematical equations in developing his
theories. The theories Einstein constructed offered an
imaginative framework, which has directed research in
numerous areas (Calder, 1979). As Reynolds (1971)
noted, if someone believes that science is a process of
inventing descriptions of phenomena, the appropriate
strategy for theory construction is the theory-then-
research strategy. In Reynolds’ view, “as the continuous
interplay between theory construction (invention) and
testing with empirical research progresses, the theory
becomes more precise and complete as a description of
nature and, therefore, more useful for the goals of
science” (Reynolds, 1971, p. 145).
 Empiricism
The empiricist view is based on the central idea that
scientific knowledge can be derived only from sensory
experience (i.e., seeing, feeling, hearing facts). Francis
Bacon (Gale, 1979) received credit for popularizing the
basis for the empiricist approach to inquiry. Bacon
believed that scientific truth was discovered through
generalizing observed facts in the natural world. This
approach, called the inductive method, is based on the
idea that the collection of facts precedes attempts to
formulate generalizations, or as Reynolds (1971) called
it, the research-then-theory strategy. One of the best
examples to demonstrate this form of logic in nursing has
to do with formulating differential diagnoses.
Formulating a differential diagnosis requires collecting
the facts and then devising a list of possible theories to
explain the facts.
The strict empiricist view is reflected in the work of the
behaviorist Skinner. In a 1950 paper, Skinner asserted
that advances in the science of psychology could be
expected if scientists would focus on the collection of
empirical data. He cautioned against drawing premature
inferences and proposed a moratorium on theory
building until further facts were collected. Skinner’s
(1950) approach to theory construction was clearly
inductive. His view of science and the popularity of
behaviorism have been credited with influencing
psychology’s shift in emphasis from the building of
theories to the gathering of facts between the 1950s and
1970s (Snelbecker, 1974). The difficulty with the
inductive mode of inquiry is that the world presents an
infinite number of possible observations, and, therefore,
the scientist must bring ideas to his or her experiences to
decide what to observe and what to exclude (Steiner,
1977).
In summary, deductive inquiry uses the theory-then-
research approach, and inductive inquiry uses the
research-then-theory approach. Both approaches are
utilized in the field of nursing.
Early Twentieth Century Views of Science and Theory
During the first half of this century, philosophers focused
on the analysis of theory structure, whereas scientists
focused on empirical research (Brown, 1977). There was
minimal interest in the history of science, the nature of
scientific discovery, or the similarities between the
philosophical view of science and the scientific methods
(Brown, 1977). Positivism, a term first used by Comte,
emerged as the dominant view of modern science (Gale,
1979). Modern logical positivists believed that empirical
research and logical analysis (deductive and inductive)
were two approaches that would produce scientific
knowledge (Brown, 1977).
The logical empiricists offered a more lenient view of
logical positivism and argued that theoretical
propositions (proposition affirms or denies something)
must be tested through observation
experimentation (Brown, 1977). This perspective is
rooted in the idea that empirical facts exist
independently of theories and offer the only basis for
objectivity in science (Brown, 1977). In this view,
objective truth exists independently of the researcher,
and the task of science is to discover it, which is an
inductive method (Gale, 1979). This view of science is
often presented in research method courses as: “The
scientist first sets up an experiment; observes what
occurs …. reaches a preliminary hypothesis to describe
the occurrence; runs further experiments to test the
hypothesis [and] finally corrects or modifies the
hypothesis in light of the results” (Gale, 1979, p. 13).
The increasing use of computers, which permit the
analysis of large data sets, may have contributed to the
acceptance of the positivist approach to modern science
(Snelbecker, 1974). However, in the 1950s, the literature
began to reflect an increasing challenge to the positivist
view, thereby ushering in a new view of science in the
late twentieth century (Brown, 1977).
Emergent Views of Science and Theory in the Late
Twentieth Century
In the latter years of the twentieth century, several
authors presented analyses challenging the positivist
position, thus offering the basis for a new perspective of
science (Brown, 1977; Foucault, 1973; Hanson, 1958;
Kuhn, 1962; Toulmin, 1961). Foucault (1973) published
his analysis of the epistemology (knowledge) of human
sciences from the seventeenth to the nineteenth
century. His major thesis stated that empirical
knowledge was arranged in different patterns at a given
time and in a given culture and that humans where
emerging as objects of study. In The Phenomenology of
the Social World, Schutz (1967) argued that scientists
seeking to understand the social world could not
cognitively know an external world that is independent
of their own life experiences. Phenomenology, set forth
by Edmund Husserl (1859 to 1938) proposed that the
objectivism of science could not provide an adequate
apprehension of the world (Husserl 1931, 1970). A
phenomenological approach reduces observations or
text to the meanings of phenomena independent of their
particular context. This approach focuses on the lived
meaning of experiences.
In 1977, Brown argued an intellectual revolution in
philosophy that emphasized the history of science was
and
replacing formal logic as the major analytical tool in the
philosophy of science. One of the major perspectives in
the new philosophy emphasized science as a process of
continuing research rather than a product focused on
findings. In this emergent epistemology, emphasis
shifted to understanding scientific discovery and process
as theories change over time.
Empiricists view phenomena objectively, collect data,
and analyze it to inductively proposed theory (Brown,
1977). This position is based upon objective truth
existing in the world, waiting to be discovered. Brown
(1977) set forth a new epistemology challenging the
empiricist view proposing that theories play a significant
role in determining what the scientist observes and how
it is interpreted. The following story illustrates Brown’s
premise that observations are concept laden; that is, an
observation is influenced by values and ideas in the mind
of the observer:

“An elderly patient has been in a trauma and appears to

be crying. The nurse on admission observes that the
patient has marks on her body and believes that she has
been abused; the orthopedist has viewed an x-ray and
believes that the crying patient is in pain due to a
fractured femur that will not require surgery only a
closed reduction; the chaplain observes the patient
crying and believes the patient needs spiritual support.
Each observation is concept laden.”