Teaching theoretical
nursing
William Lauder
Nursing science has been described as being either alive or inert. Acceptance of one or the other paradigm has important implications for the way in which theories of nursing are taught in the curriculum. In this paper these conflicting paradigms are discussed and the implications for nurse teachers are outlined. It is suggested that this may involve a reconceptualisation of where nursing theories are derived and a consequent shift of power from nurse teachers to the practising nurse.
study. They
THE PHILOSOPHY OF NURSING SCIENCE: PROCESS OR PRODUCT In his paper on the relationship and practice describes
in nursing,
science
Desmond
is at the
heart
of the
debate.
Ryan
describes
science
alive and inert.
Ryan (1988)
Science
structure
theory-practice as being
both
views knowledge
whose
fore static and certain.
This
knowledge
as an
is there-
The product is the valued
goal for those studying this type of science, the other hand live science is a process
on of
questioning
of
received simply
wisdom.
in a creative
product
philosophy
does not
but draws on it to solve and flexible manner.
paradigm
of science
(Silva & Rothbart
the boundaries
The living scientists
apply science
problems The
and challenging
has its roots
in the
called logical empiricism
1984).
The
logical empirical
view of nursing science does not understand
it in
terms of working scientists but views science as a compilation of data derived from empirical William Lauder RMN DipN (CT), Nurse Teacher, Highland College of Nursing and Midwifery, Raigmore Hospital, inverness, IV2 3VS. UK (Requests for offprints to WL) Manuscript accepted 29 October 1991
state that ‘the term science
refers
statements
theory
as having a dual nature.
duality
achieved
between
sense)
only
that purportedly
of knowledge.
The
terminology hypothesis Science
to a product product
and
values
one
accepts learn
hypothesis,
the
the
student
definitions,
and laws of one or more
Logical
than
empiricists
more
through
to attain it (Parse
the process
to teaching
called the process
theory.
paradigm
product approach
and
the develop-
terminology,
theories
theories.
methods
of nursing
this
1984, ~4).
a body of knowledge
that govern
ment and justification
nursing
scientific
propositions,
a variety of research
philosophical
should
the body
includes
and laws’ (Silva & Rothbart
that includes
If
constitute
definitions,
itself is therefore
(in this
i.e. a set of
1981).
nursing
approach.
value this
one The
theory
must
go
second can
be
In this approach
the nuts and bolts of a theory are less important than the cognitive whilst
studying
skills that may be developed theory
or
the
ability
working scientist to draw on theoretical solve the problems of practice. This scientific duality characterises
of
the
work to the two
main approaches to the way nurse theory is taught. It seems critical that teachers of nursing identify
which paradigm
which nursing riculum.
theory
will guide is included
the way in in the cur-
66
NURSE EDUCATION
TODAY
Meleis and Price (1988) are two nurse theorists
The product paradigm The notion
that the theory
main concern
itself should
of nurse teachers
be the
and students
is
arguably the predominant paradigm in nursing today. Within this paradigm there is some debate as to whether
we teach
one theory
Smith (1987) crystallises that, the critical what extent the
decision
are nursing
curriculum’
or many.
this debate when stating facing models
(~113).
nursing
is ‘to
to be taught in
She
outlines
three
possible alternatives:
and
is arranged
so that all the
teaching/learning
strategies
reflect only one theory. The
curriculum
should
tion on nursing integrated The
content
around Roberts should
on nursing with
and
that
round
would
nurse
curriculum
nurse science from the teachers
learn
this approach
and
it has
compartmentahse from
practice.
care from tice
and
research.
knowledge
He
Many
curriculum
design and formed
movement
in America
in the
must note,
nursing
intended
Theory
theories
to be used in
part of the 1970s
which legislated
that all
to
distinct
the business without
form
of
of
being
between theory,
This
prac-
structuring
as being
socially
has been in a sense misappro-
by teachers
property
of the
as something
classroom.
which is the
In essence
nurse
teachers may have been responsible for creating the practice-theory gap in an effort to maintain their status by promoting tualised
knowledge
based knowledge. mic credibility
the value of de-contex-
at the expense In an effort
nurses
body of free standing
of practice-
to achieve acade-
have sought knowledge
to create
a
and underva-
by the practising
nurse (Ryan
1988). The
third option
seeks to cross the practice-
theory gap by integrating and
both within a theory.
Chalmers
(1987)
a theory
suggest
that
for this purpose,
the
theory will then determine
what is to be taught,
how teaching
and learning
take place and how
success
can
be
authors
have attempted
science
as a teacher-structured
learn theories
can be described
having accepted
perspective.
and that the student
reproduce.
priated
theory.
students
as something
able to create connections
a struc-
it as viewing
that must be covered
were in fact originally
theory Students
Aggleton
planning
encouraged
non-nursing
believe
1983). Ryan (1988)
is critical of this view and regards
time allocated
education identifiable
would provide
make
body of knowledge
Furthermore
lued that created in the first
a clearly
easier (Lawrence&Lawrence
describes
is taught organised
Many educationalists
that a theory of nursing that
theory
theory(s).
argues
theory of nursing. ture
curriculum.
sees advantages
take place
informa-
but this is not
experiences
a particular
(1985)
alternative
contain
theories
into mainstream
explicitly
created many of the myths that surround
organised.
The curriculum content
who claim that the very act of separating nurse theory from other parts of the curriculum has
measured.
Although
these
to cross the gap, their
is still fixed, static and determined
particular absorb
theory. and
approach explore
The
assimilate
restricts
problems
this
the freedom
a whole range
the freedom
student
knowledge.
to This
of the student to
of options
and creativity
by a
is required
by removing
to make decisions
in the face of the practicalities
on that
identified theory. The second option is to teach a self-contained
determine them (Ryan 1988). Ryan would regard these approaches as the transmission of inert theory, a type of theory which often func-
course in nursing
tions
nursing
lar
courses
way of
curriculum, America. approach
should be designed
theory.
around
This is another
including
nursing
theory
especially
in the United
an
popuin the
States
of
Botha (1989) advocates this pluralist when she suggests that nurses should
be exposed to as many models ‘as can be possibly and pedagogically fitted into a curriculum’ (p49).
at the level of anti-educational
Price (1989) education,
has levelled
this charge
dogma. at higher
when he suggest that universities
and
polytechnics must be helped to break out of the routine of decanting out of date knowledge into their students. It is arguable that if we wish to have creative problem-solving nurses the product paradigm is not the paradigm of choice.
Nursing theory-the living science _
process of
The other side of the scientific dualism would view nursing theory not as inert but as a living and changing process. Chinn and Jacobs (1978) propose that nurses accept such a paradigm in their model of theoretical development when they suggest that the process of developing a theory and not a specific outcome should be emphasised. Clearly these nurses give priority to the process as opposed to the product. Newman (1983), a proponent of the process paradigm, supports this view when she argues that nursing science is a process of knowing, challenging and a continuous revolution. Nursing theory is constantly evolving and is not enshrined in tablets of stone, therefore its contingent and relative nature should influence the way in which it is taught to students. The idea that nursing theory is a continual process of questioning, of pushing back the frontiers, of action and a search for knowledge are the characteristics of ‘living theory’ (Ryan 1988). Silva and Rothbart (1984) believe that nursing is in the process of moving from the product to the process paradigm. This paradigmatic shift is vital if the theory-practice gap is to be closed. Nursing should not be closing doors to theoretical growth by wholesale acceptance of one epistemological perspective to the exclusion of others. We require to adopt an open view of the world, how we come to know it and our place in it. ‘l‘his is made even more urgent if we accept Cull-Wilby and Pepin’s (1987) claim that nursing has only recently sought scientific status and still has much room for growth. l‘he process paradigm was the basis of the curriculum design of the first Diploma in Higher Education (DipHE) introduced at the North East London Polytechnic (NELP). In this course, primary importance was placed on method of learning and not on the learning of facts or any ordered group of facts (Burgess 1988). Burgess argued that the original concept of the DipHE within the school of independent study at NELP was radically different from other higher education courses. This innovative course was based not on subject disciplines or upon combinations
of subjects but on the logic of learning. Whilst it would seem highly desirable to focus on the logic learning, it is neither desirable to ignore the product of learning. Student nurses must acquire certain skills and knowledge in order that they are safe and competent practitioners. Evans ( 1980) a colleague of Burgess makes exactly this point when he comments that theoretical knowledge is to be learned at the same time as ‘course process’. These views are especially interesting to nurse education as the new Project 2000 course carries the academic award of Dip HE.
Theoretical be taught?
nursing - how should it
The notion of scientific knowledge as a continually evolving process, upon which nurses draw to solve the day to day problems of practice, has important implications for nurse teachers. If nursing is to accept the process paradigm we require to reframe the central question of nurse education (Meleis & Price 1988). The question of how do we teach nurse theory?, becomes how do we facilitate the development of theoretical nursing? These nurses define theoretical nursing as ‘the theoretical statements that guide nursing practice, that provide direction to nursing research and that constitute the propositions that answer its pressing questions’ (Meleis & Price 1988, p 593). Theoretical thinking has been said to stimulate creative thinking, to guide the application of research, identify nursing phenomena and assist in the recognition of the value of theory (Reed 1985). It allows students to take responsibility for their own learning an ability that is though to be a liberating experience (Gowin 8c Novak 1984). It is argued that, once students have developed the ability to think theoretically, they can assist in the further development of personal and professional knowledge. The emphasis when developing theoretical thinking should be on the ability to use theoretical knowledge creatively to solve the problems of care delivery. The idea that theory must assist the practitioner to solve her care problems and that practice can be a source of theoretical knowledge can help
68
NURSE EDUCATION
TODAY
create bridges between practice and theory. Real theory can be described as the systemisation of what practitioners are continually learning from experience. This forces nurse teachers to question the belief that they teach theory and practitioners simply put that to use. Practising nurses must see themselves as theorists whose theoretical knowledge is to a large extent derived from their everyday experience of caring. The transfer of this responsibility requires nurse teachers to accept that they are no longer the source of theoretical knowledge in nursing and accept the consequent shift of power and prestige that accompanies the possession of knowledge. Benner (1984) supports this view when she suggests that recognising the importance of knowledge embedded in practice empowers the practitioner. The challenge facing nurse teachers is to develop teaching strategies which facilitate the development of theoretical thinking. Many believe there are few if any teaching strategies for teaching theoretical nursing (Meleis 1985; smith 1987). Even if this worst case scenario is the case it should only act as a catalyst to speed up the development of such teaching strategies.
References Benner P 1984 From novice to expert: excellence and power in clinical nursing practice. Addison Wesley, California
Botha M E 1985 Theory development in perspective: the role of conceptual framework and models in theory development. Journal of Advanced Nursing 14: 49-55 Burgess T 1988 In: Robbins D (ed) The rise of independent study. Society for Research in Higher Education, London Chinn P, Jacobs M 1983 Theory and nursing: a systematic approach. C V Mosby, St Louis Cull-Wilby B L, Pepin J I 1987 Towards a co-existence of paradigms in nursing knowledge development. Journal of Advanced Nursing 12: 5 15-52 1 Evans D 1988 In: Robbins D (ed) The rise of independent study. Society for Research in Higher Education, London Gowin D B, Novak J D 1984 Learning how to learn. Cambridge University Press, Cambridge Lawrence S A, Lawrence R M 1983 Curriculum development: philosophy, objectives and conceptual framework. Nursing Outlook 31 (3): 160-165 Meleis A 1985 Theoretical nursing development and progress. Lippincott, Philadelphia Meleis A, Price M J 1988 Strategies and conditions for teaching theoretical nursing: an international perspective. Journal of Advanced Nursing 13: 592694 Newman N A 1979 Theory development in nursing. F A Davis, Philadelphia Parse R 1981 Man-living-health: a theory of nursing. Wiley, New York Price C 1989 Academics and society: freedoms seamless role. In: Ball C, Eggins C (eds) Higher education into the 1990s (new dimensions). Societv for Research in Higher Education, London ’ Reed P C 1985 Strategies for teaching nurse research: theory and meta-theory in an undergraduate course. Western Journal of Nursing Research 7,4: 482-486 Ryan D 1988 Theory and practice in the modular scheme. National Board for Scotland. Silva M C, Rothbart D 1984 An analysis of changing trends in philosophies of science on nursing theory development and testing. Advances in Nursing Science 6,2: 1-13 Smith L 1987 Application of nursing models to a curriculum: some considerations. Nurse Education Today 7: 109-I 15
nursing
William Lauder
Nursing science has been described as being either alive or inert. Acceptance of one or the other paradigm has important implications for the way in which theories of nursing are taught in the curriculum. In this paper these conflicting paradigms are discussed and the implications for nurse teachers are outlined. It is suggested that this may involve a reconceptualisation of where nursing theories are derived and a consequent shift of power from nurse teachers to the practising nurse.
study. They
THE PHILOSOPHY OF NURSING SCIENCE: PROCESS OR PRODUCT In his paper on the relationship and practice describes
in nursing,
science
Desmond
is at the
heart
of the
debate.
Ryan
describes
science
alive and inert.
Ryan (1988)
Science
structure
theory-practice as being
both
views knowledge
whose
fore static and certain.
This
knowledge
as an
is there-
The product is the valued
goal for those studying this type of science, the other hand live science is a process
on of
questioning
of
received simply
wisdom.
in a creative
product
philosophy
does not
but draws on it to solve and flexible manner.
paradigm
of science
(Silva & Rothbart
the boundaries
The living scientists
apply science
problems The
and challenging
has its roots
in the
called logical empiricism
1984).
The
logical empirical
view of nursing science does not understand
it in
terms of working scientists but views science as a compilation of data derived from empirical William Lauder RMN DipN (CT), Nurse Teacher, Highland College of Nursing and Midwifery, Raigmore Hospital, inverness, IV2 3VS. UK (Requests for offprints to WL) Manuscript accepted 29 October 1991
state that ‘the term science
refers
statements
theory
as having a dual nature.
duality
achieved
between
sense)
only
that purportedly
of knowledge.
The
terminology hypothesis Science
to a product product
and
values
one
accepts learn
hypothesis,
the
the
student
definitions,
and laws of one or more
Logical
than
empiricists
more
through
to attain it (Parse
the process
to teaching
called the process
theory.
paradigm
product approach
and
the develop-
terminology,
theories
theories.
methods
of nursing
this
1984, ~4).
a body of knowledge
that govern
ment and justification
nursing
scientific
propositions,
a variety of research
philosophical
should
the body
includes
and laws’ (Silva & Rothbart
that includes
If
constitute
definitions,
itself is therefore
(in this
i.e. a set of
1981).
nursing
approach.
value this
one The
theory
must
go
second can
be
In this approach
the nuts and bolts of a theory are less important than the cognitive whilst
studying
skills that may be developed theory
or
the
ability
working scientist to draw on theoretical solve the problems of practice. This scientific duality characterises
of
the
work to the two
main approaches to the way nurse theory is taught. It seems critical that teachers of nursing identify
which paradigm
which nursing riculum.
theory
will guide is included
the way in in the cur-
66
NURSE EDUCATION
TODAY
Meleis and Price (1988) are two nurse theorists
The product paradigm The notion
that the theory
main concern
itself should
of nurse teachers
be the
and students
is
arguably the predominant paradigm in nursing today. Within this paradigm there is some debate as to whether
we teach
one theory
Smith (1987) crystallises that, the critical what extent the
decision
are nursing
curriculum’
or many.
this debate when stating facing models
(~113).
nursing
is ‘to
to be taught in
She
outlines
three
possible alternatives:
and
is arranged
so that all the
teaching/learning
strategies
reflect only one theory. The
curriculum
should
tion on nursing integrated The
content
around Roberts should
on nursing with
and
that
round
would
nurse
curriculum
nurse science from the teachers
learn
this approach
and
it has
compartmentahse from
practice.
care from tice
and
research.
knowledge
He
Many
curriculum
design and formed
movement
in America
in the
must note,
nursing
intended
Theory
theories
to be used in
part of the 1970s
which legislated
that all
to
distinct
the business without
form
of
of
being
between theory,
This
prac-
structuring
as being
socially
has been in a sense misappro-
by teachers
property
of the
as something
classroom.
which is the
In essence
nurse
teachers may have been responsible for creating the practice-theory gap in an effort to maintain their status by promoting tualised
knowledge
based knowledge. mic credibility
the value of de-contex-
at the expense In an effort
nurses
body of free standing
of practice-
to achieve acade-
have sought knowledge
to create
a
and underva-
by the practising
nurse (Ryan
1988). The
third option
seeks to cross the practice-
theory gap by integrating and
both within a theory.
Chalmers
(1987)
a theory
suggest
that
for this purpose,
the
theory will then determine
what is to be taught,
how teaching
and learning
take place and how
success
can
be
authors
have attempted
science
as a teacher-structured
learn theories
can be described
having accepted
perspective.
and that the student
reproduce.
priated
theory.
students
as something
able to create connections
a struc-
it as viewing
that must be covered
were in fact originally
theory Students
Aggleton
planning
encouraged
non-nursing
believe
1983). Ryan (1988)
is critical of this view and regards
time allocated
education identifiable
would provide
make
body of knowledge
Furthermore
lued that created in the first
a clearly
easier (Lawrence&Lawrence
describes
is taught organised
Many educationalists
that a theory of nursing that
theory
theory(s).
argues
theory of nursing. ture
curriculum.
sees advantages
take place
informa-
but this is not
experiences
a particular
(1985)
alternative
contain
theories
into mainstream
explicitly
created many of the myths that surround
organised.
The curriculum content
who claim that the very act of separating nurse theory from other parts of the curriculum has
measured.
Although
these
to cross the gap, their
is still fixed, static and determined
particular absorb
theory. and
approach explore
The
assimilate
restricts
problems
this
the freedom
a whole range
the freedom
student
knowledge.
to This
of the student to
of options
and creativity
by a
is required
by removing
to make decisions
in the face of the practicalities
on that
identified theory. The second option is to teach a self-contained
determine them (Ryan 1988). Ryan would regard these approaches as the transmission of inert theory, a type of theory which often func-
course in nursing
tions
nursing
lar
courses
way of
curriculum, America. approach
should be designed
theory.
around
This is another
including
nursing
theory
especially
in the United
an
popuin the
States
of
Botha (1989) advocates this pluralist when she suggests that nurses should
be exposed to as many models ‘as can be possibly and pedagogically fitted into a curriculum’ (p49).
at the level of anti-educational
Price (1989) education,
has levelled
this charge
dogma. at higher
when he suggest that universities
and
polytechnics must be helped to break out of the routine of decanting out of date knowledge into their students. It is arguable that if we wish to have creative problem-solving nurses the product paradigm is not the paradigm of choice.
Nursing theory-the living science _
process of
The other side of the scientific dualism would view nursing theory not as inert but as a living and changing process. Chinn and Jacobs (1978) propose that nurses accept such a paradigm in their model of theoretical development when they suggest that the process of developing a theory and not a specific outcome should be emphasised. Clearly these nurses give priority to the process as opposed to the product. Newman (1983), a proponent of the process paradigm, supports this view when she argues that nursing science is a process of knowing, challenging and a continuous revolution. Nursing theory is constantly evolving and is not enshrined in tablets of stone, therefore its contingent and relative nature should influence the way in which it is taught to students. The idea that nursing theory is a continual process of questioning, of pushing back the frontiers, of action and a search for knowledge are the characteristics of ‘living theory’ (Ryan 1988). Silva and Rothbart (1984) believe that nursing is in the process of moving from the product to the process paradigm. This paradigmatic shift is vital if the theory-practice gap is to be closed. Nursing should not be closing doors to theoretical growth by wholesale acceptance of one epistemological perspective to the exclusion of others. We require to adopt an open view of the world, how we come to know it and our place in it. ‘l‘his is made even more urgent if we accept Cull-Wilby and Pepin’s (1987) claim that nursing has only recently sought scientific status and still has much room for growth. l‘he process paradigm was the basis of the curriculum design of the first Diploma in Higher Education (DipHE) introduced at the North East London Polytechnic (NELP). In this course, primary importance was placed on method of learning and not on the learning of facts or any ordered group of facts (Burgess 1988). Burgess argued that the original concept of the DipHE within the school of independent study at NELP was radically different from other higher education courses. This innovative course was based not on subject disciplines or upon combinations
of subjects but on the logic of learning. Whilst it would seem highly desirable to focus on the logic learning, it is neither desirable to ignore the product of learning. Student nurses must acquire certain skills and knowledge in order that they are safe and competent practitioners. Evans ( 1980) a colleague of Burgess makes exactly this point when he comments that theoretical knowledge is to be learned at the same time as ‘course process’. These views are especially interesting to nurse education as the new Project 2000 course carries the academic award of Dip HE.
Theoretical be taught?
nursing - how should it
The notion of scientific knowledge as a continually evolving process, upon which nurses draw to solve the day to day problems of practice, has important implications for nurse teachers. If nursing is to accept the process paradigm we require to reframe the central question of nurse education (Meleis & Price 1988). The question of how do we teach nurse theory?, becomes how do we facilitate the development of theoretical nursing? These nurses define theoretical nursing as ‘the theoretical statements that guide nursing practice, that provide direction to nursing research and that constitute the propositions that answer its pressing questions’ (Meleis & Price 1988, p 593). Theoretical thinking has been said to stimulate creative thinking, to guide the application of research, identify nursing phenomena and assist in the recognition of the value of theory (Reed 1985). It allows students to take responsibility for their own learning an ability that is though to be a liberating experience (Gowin 8c Novak 1984). It is argued that, once students have developed the ability to think theoretically, they can assist in the further development of personal and professional knowledge. The emphasis when developing theoretical thinking should be on the ability to use theoretical knowledge creatively to solve the problems of care delivery. The idea that theory must assist the practitioner to solve her care problems and that practice can be a source of theoretical knowledge can help
68
NURSE EDUCATION
TODAY
create bridges between practice and theory. Real theory can be described as the systemisation of what practitioners are continually learning from experience. This forces nurse teachers to question the belief that they teach theory and practitioners simply put that to use. Practising nurses must see themselves as theorists whose theoretical knowledge is to a large extent derived from their everyday experience of caring. The transfer of this responsibility requires nurse teachers to accept that they are no longer the source of theoretical knowledge in nursing and accept the consequent shift of power and prestige that accompanies the possession of knowledge. Benner (1984) supports this view when she suggests that recognising the importance of knowledge embedded in practice empowers the practitioner. The challenge facing nurse teachers is to develop teaching strategies which facilitate the development of theoretical thinking. Many believe there are few if any teaching strategies for teaching theoretical nursing (Meleis 1985; smith 1987). Even if this worst case scenario is the case it should only act as a catalyst to speed up the development of such teaching strategies.
References Benner P 1984 From novice to expert: excellence and power in clinical nursing practice. Addison Wesley, California
Botha M E 1985 Theory development in perspective: the role of conceptual framework and models in theory development. Journal of Advanced Nursing 14: 49-55 Burgess T 1988 In: Robbins D (ed) The rise of independent study. Society for Research in Higher Education, London Chinn P, Jacobs M 1983 Theory and nursing: a systematic approach. C V Mosby, St Louis Cull-Wilby B L, Pepin J I 1987 Towards a co-existence of paradigms in nursing knowledge development. Journal of Advanced Nursing 12: 5 15-52 1 Evans D 1988 In: Robbins D (ed) The rise of independent study. Society for Research in Higher Education, London Gowin D B, Novak J D 1984 Learning how to learn. Cambridge University Press, Cambridge Lawrence S A, Lawrence R M 1983 Curriculum development: philosophy, objectives and conceptual framework. Nursing Outlook 31 (3): 160-165 Meleis A 1985 Theoretical nursing development and progress. Lippincott, Philadelphia Meleis A, Price M J 1988 Strategies and conditions for teaching theoretical nursing: an international perspective. Journal of Advanced Nursing 13: 592694 Newman N A 1979 Theory development in nursing. F A Davis, Philadelphia Parse R 1981 Man-living-health: a theory of nursing. Wiley, New York Price C 1989 Academics and society: freedoms seamless role. In: Ball C, Eggins C (eds) Higher education into the 1990s (new dimensions). Societv for Research in Higher Education, London ’ Reed P C 1985 Strategies for teaching nurse research: theory and meta-theory in an undergraduate course. Western Journal of Nursing Research 7,4: 482-486 Ryan D 1988 Theory and practice in the modular scheme. National Board for Scotland. Silva M C, Rothbart D 1984 An analysis of changing trends in philosophies of science on nursing theory development and testing. Advances in Nursing Science 6,2: 1-13 Smith L 1987 Application of nursing models to a curriculum: some considerations. Nurse Education Today 7: 109-I 15
