Chapter: History and Philosophy of Nursing Science — Comprehensive Study Notes

Philosophical Foundations and Broad Definitions

Philosophy in its broadest sense is wondering and being curious about the big or fundamental questions humans have grappled with throughout history: ontology (what is real), epistemology (what is knowable), ethics (what is just), aesthetics (is there an art of caring) (Bruce, Rietze and Lim, 2014, p. 65).
In nursing practice, philosophy guides reflections on what constitutes reality, knowledge, value, and caring, shaping how we understand and practice nursing.

Historical Views of the Nature of Science

Science as a method for describing, explaining, and predicting causes or outcomes of interventions.
Scientific activity builds the evidence used to guide nursing practice.
The pursuit to know the unknown: identify cause, effect, and the significance of a difference an intervention makes for longevity of life. (Bronowski, 1979; Gale, 1979; Piaget, 1970).
Since the 1960s, nursing leaders aimed to position nursing as a scientific discipline with unique knowledge for care of individuals, families, and communities; enabling clinical and basic nursing research to establish a scientific base.
Formalizing nursing science prompts big questions: What is science, knowledge, and truth? What methods produce scientific knowledge? The answers depend on philosophy.
The choice of philosophical perspective influences how researchers conduct activities, interpret outcomes, and even what counts as science.
Two competing philosophical perspectives in science: rationalism and empiricism. Nursing science has historically reflected these stances in distinct forms:
- Empiricist, mechanistic, quantitative, deductive approaches.
- Interpretive, holistic, qualitative, inductive approaches.
Understanding these stances helps appreciate each form’s contribution to nursing knowledge.

Early Twentieth Century Views of Science and Theory

Knowledge in this era was viewed as a posteriori (inductive) and often seen as probable rather than certain; empirical facts and logical analysis were central (Positivism).
Positivism: empirical research plus logical analysis (deductive and inductive) would produce scientific knowledge (Brown, 1977).
Logical empiricists argued theoretical propositions must be tested through observation and experimentation; empirical facts are assumed to exist independently of theories (Brown, 1977).
The scientist is often portrayed as discovering objective truth, with science as a process of discovering that truth via induction.
The traditional view: a scientist sets up an experiment, observes, forms a preliminary hypothesis, tests it, and revises or rejects the hypothesis as results dictate (Gale, 1979).
Inductive method (induction first, then theory): collecting facts precedes generalization; in nursing, this is similar to formulating differential diagnoses via fact collection (Reynolds, 1971).
The strict empiricist position is associated with Skinner (behaviorism: emphasis on empirical data collection and caution against premature theory-building).
Limitations of induction: the world presents infinite possible observations, and observers bring prior ideas to decide what to observe; premature generalizations can be faulty.
Popper (1962) argued science advances by refuting ideas; a lack of universal proven generalizations (falsification) drives progress. Example: the social-support readmission hypothesis can be falsified by observing a counterexample.
Rationalism vs empiricism in practice: rationalism (Einstein) used mathematical reasoning and deductive methods; empiricism (Skinner, Bacon) emphasized observed facts first.
Reynolds (1971) contrasted two strategies:
- Theory-then-research (deductive) progress toward precise descriptions of phenomena.
- Research-then-theory (inductive) development of theory from empirical findings.
In nursing, both deductive and inductive approaches have been used and valued.

Emergent Views of Science and Theory in the Late 20th Century

Several authors challenged positivism, proposing emergent epistemologies that emphasize process, history, and context in science (Brown, 1977; Foucault, 1973; Hanson, 1958; Kuhn, 1962; Toulmin, 1961).
Foucault (1973) argued empirical knowledge is organized in patterns that vary by time and culture, and humans become objects of study within those patterns.
Brown (1977) advocated an intellectual revolution: history of science and the process of discovery replace formal logic as central analytical tools; science is a continuous process of building research rather than a product of findings.
Brown argued that theories influence what scientists observe and how observations are interpreted (epistemology shift).
The “an elderly patient” story (Alligood, 2018) illustrates Brown’s premise that observations are concept-laden and shaped by presupposed theories and values.
Brown’s observation examples: a chemist and a child perceive the same odor differently due to differing theoretical frames.
Concepts and theories set boundaries and determine what phenomena are reasoned about; observers interpret phenomena through their theoretical lenses.
Science progresses through interaction between theory construction (invention) and empirical testing; as this interplay continues, theories become more precise and useful (Reynolds, 1971).
Emergent epistemology emphasizes science as an ongoing process with consensus among scientists rather than final truth; consensus is tentative and established through collaboration and public review.
In nursing today, evidence-based science underpins interventions; presuppositions structure data collection methods and interpretation in each era.
Kuhn’s paradigm shifts explain how normal science gives way to crisis and revolution, followed by a new normal science. Paradigms shift within disciplines as problems arise and new frameworks gain acceptance.
Example of paradigm shift: emerging evidence that early mobilization in critical illness improves outcomes (Schweickert & Kress, 2011).

Interdependence of Theory and Research

Theory and research are interdependent components of the scientific process (Dubin, 1978).
In theory construction, researchers must consider existing empirical findings to organize and formalize knowledge.
The theory is revised or abandoned when hypotheses fail to match empirical findings; new explanations may be developed to account for new information (Brown, 1977; Dubin, 1978; Kuhn, 1962).
In nursing, scientific questioning involves testing a theory, applying it to new contexts, or extending it; collaboration and cumulative evidence underpin progress.
The scientific community judges acceptability of nursing theories based on logical, conceptual, and empirical grounds rather than authority (Gale, 1979).
Evidence-based consensus in three key areas is necessary for theory acceptance:
- Boundaries of the theory (phenomenon addressed and excluded) — coherence criterion.
- Logic used to develop the theory — coherence criterion.
- Agreement that the theory fits the data (correspondence criterion).
Theory must be testable and subject to replication under various conditions to build cumulative evidence (Dubin, 1978; Giere, 1979).
In social and behavioral sciences (e.g., nursing), there are challenges to the universal-law focus and to assumptions about random assignment; phenomenology emphasizes context-bound knowledge (Mishler, 1979).
Phenomenology describes how people experience objects and constructs meaning from lived experience; it supports holistic, context-rich understanding.
Postpositivism emphasizes discovering patterns that describe, explain, and predict phenomena, while rejecting an ultimate objective knowledge exclusive of context (Ford-Gilboe et al., 1995; Weiss, 1995).
Interpretive paradigm focuses on meanings of participants’ social interactions, emphasizing situation, context, and multiple cognitive constructions (Ford-Gilboe et al., 1995).
Emergent, postmodern paradigm emphasizes social, political, economic, gender, and cultural factors in health experiences; phenomenology, hermeneutics, feminism, critical theory, and postconstructivism are part of postmodernism.
The philosophy of nursing has evolved through caring, naturalism, and holism, with caring reframing the wholeness of patients’ situations requiring interpretation and hermeneutic understanding (Adams, 2016).
Wholism and holism are philosophical approaches in nursing; wholism views subsystems (biophysical, psychological, sociological) as interrelated parts of a larger whole; mind–body interactions are acknowledged (Hennessey, 2011; Aghebati et al., 2015).
Naturalism asserts the natural world exists and knowledge is gained through senses guided by reason and scientific methods; there is no nonnatural or supranatural realm (Hussey, 2011).
Despite multiple philosophical proposals, nursing science remains in early stages of development; a growing body of nurse scholars advances knowledge through research and scholarly dialogue, including the emergence of middle-range theories that synthesize nursing and other disciplines (Peterson & Bredew, 2017; Sieloff & Frey, 2007; Smith & Liehr, 2013).

Structure and Analysis of Nursing Knowledge (Chapter 3)

Theoretical works in nursing are categorized by abstraction level: philosophies, conceptual models (paradigms/frameworks), theories, and middle-range theories; the metaparadigm is the highest level of abstraction.
Concept: a term describing a phenomenon or group of phenomena (Meleis, 2007). Concepts may be empirical (observable) or abstract (not directly observable, e.g., hope or caring) (Hickman, 2002).
Metaparadigm of Nursing: the global concepts that identify central interest of the discipline; most disciplines have multiple conceptual models; nursing’s metaparadigm concepts are: $4$ concepts — person, environment, health, and nursing (Fawcett, 2005).
Philosophies of nursing: broad, addressing general nursing meanings; guide direction, clarify values, and form a foundation for theory development (Alligood, 2006).
Conceptual Models of Nursing (Paradigms/Frameworks): abstract concepts and propositions that provide a frame of reference; configure how phenomena are viewed and questions are posed (Fawcett, 1944; Lippitt, 1973 cited in Fawcett).
Assumptions are taken as truth and form the basis for defining concepts and framing propositions (Meleis, 2007).
Propositions link concepts (Fawcett, 2005).
A nursing theory is a coherent articulation of statements about significant questions in a discipline, intended to describe, predict, or prescribe nursing care (Meleis, 2007; Meleis, 41).
The distinction between conceptual models and theories: conceptual models are highly abstract systems of global concepts; theories address one or more specific, concrete concepts and propositions (Fawcett, 1994).
Grand Theory vs Middle-Range Theory:
- Grand theory: broad in scope and highly abstract.
- Middle-range theory: narrower scope, more concrete, empirically testable, applicable to practice (Fawcett, 2005).
Nursing theories may derive from existing conceptual models or from perceptions of ideal nursing practice.

Philosophies, Conceptual Models, Theories, and Middle-Range Theories in Nursing (Examples)

Philosophies of Nursing (examples/examples spotlight):
- Nightingale’s Philosophy of Nursing (1946): What is nursing? Distinguishes nursing from household work and emphasizes health over illness.
- Watson’s Philosophy of Nursing (1979): Emphasizes caring; proposes ten carative factors and transpersonal caring; aims for harmony of body, mind, and soul; illness as disharmony in relationship.
- Ray’s contributions noted in the synthesis (contextual references).
Conceptual Models (Paradigms/Frameworks) examples: Levine, Rogers, Orem, King, Benner, Eriksson, Parse, Leininger, Neuman, Roy (and others listed in chapter visuals).
Nursing Theories and Grand Theories (examples):
- Orlando’s Theory of Nursing Process (1961, 1990): Theory of effective nursing practice; differentiates automatic vs deliberate action in nurse–patient interaction.
- Modeling and Role-Modeling Nursing Theory (Erickson, Tomlin, Swain, 1983): Theory of nursing grounded in developmental theory, stresses relationship with patients and learning from patients’ realities.
- Other named theories and theorists include Mercer, Mishel, Reed, Wisner & Dodd, Eakes, Burke & Hainsworth, Barker, Kolcaba, Beck, Swanson, Ruland & Moore, and more.
Middle-Range Theories: more concrete and testable; include work by Mercer, Mishel, Reed, Wisner & Dodd, Eakes et al., Barker, Kolcaba, Beck, Swanson, Ruland & Moore, etc.
Grand theories and middle-range theories provide various lenses to view nursing phenomena and guide research and practice.
Examples of models and theories by specific authors (brief):
- Johnson’s Behavioral System Model (1980): Person as a system of seven subsystems; three derived theories: Theory of the Person as a Behavioral System; Theory of the Restorative Subsystem (Grubbs, 1974); Theory of Sustental Imperatives (Holaday et al., 1997).
- King’s Conceptual System (1971, 1981, 1997): Three interacting systems — Personal, Interpersonal, Social; goals include perceptual congruence and transactions leading to goal attainment.
- Levine’s Conservation Model (1967, 1991): Focus on conserving energy, structural integrity, personal integrity, and social integrity; several derived theories (Conservation, Therapeutic Intent, Redundancy, Health Promotion for Preterm Infants).
- Neuman’s Systems Model (1982, 1989, 1995, 2002): Client as a system of variables interacting with the environment; central core of five variables (physiological, psychological, sociocultural, developmental, spiritual); lines of defense and stressors.
- Orem’s Conceptual Model (1971, 1980, 1985, 1991, 1995, 2001): Self-care framework with theories of Self-Care, Self-Care Deficit, and Nursing Systems; major concepts: Self-Care, Self-Care Agency, Therapeutic Self-Care Demand, Self-Care Deficit, Nursing Agency, Nursing System.
- Roger’s Science of Unitary Human Beings (1970, 1986, 1990, 1992): Life process and patterning; concepts include Openness, Energy Field, Pattern, Pandimensionality; homeodynamic principles: Helicy, Resonancy, Intergrality; theories include Health as Expanding Consciousness, Human Becoming, etc.
- Roy’s Adaptation Model (1980, 1984; Roy & Andrews, 1999; Roy & Roberts, 1981): Person as an adaptive system; four coping modes (physiological, self-concept, role function, interdependence); some middle-range theories include adaptation to specific health conditions (e.g., diabetes, chronic pain).
Additional nursing theories highlighted as influential: Parse’s Human Becoming; Newman’s Health as Expanding Consciousness; Leininger’s Cultural Care Diversity and Universality; Benner’s Novice to Expert and Caring; Watson’s Caring; Nola Pender’s Health Promotion; Rogers, Roy, Leininger, Orem, Johnson, King's contexts, etc.

Critical Thinking, Analysis, and Evaluation of Theoretical Knowledge in Nursing

Critical thinking is central to professional nursing practice; theory guides critical thinking and decision-making, linking knowing and doing (Daiski, 2000; Simpson & Courtney, 2002).
Paul and Nosich define critical thinking as an intellectually disciplined process of conceptualizing, applying, analyzing, synthesizing, and evaluating information gathered through observation, experience, reflection, reasoning, and communication to guide belief and action.
Kuhn (1970) asserts that models or paradigms prepare students for practice within a discipline; paradigms provide a framework guiding practice; practitioners learn their trade by studying these models and paradigms.
The paradigm serves as a practical framework; without it, vast information may seem equally relevant; students are oriented to the discipline’s models and paradigms to practice effectively.
Analysis and evaluation of nursing knowledge involve critical appraisal of theory, guiding its use in education, research, administration, and practice.
Criteria for analysis (Chinn & Kramer, 2015):
- Clarity: How clear is the theory? Are concepts defined consistently within the framework? (often aided by diagrams and examples)
- Simplicity: Is the theory sufficiently comprehensive yet as simple as possible?
- Generality: What is the scope? How general is the theory?
- Accessibility: Can empirical indicators be identified to test the theory? Is the theory testable and practically usable?
- Importance: Does the theory generate meaningful understanding for nursing and contribute to practice?
Additional evaluation considerations include the theory’s origins, values, and philosophical claims; the comprehensiveness and logical structure; potential to generate new theory; and social utility, congruence, and significance.
A theory’s credibility in practice rests on its contribution to understanding phenomena, not on authority; replication and accumulation of evidence are essential to establish robust knowledge.

Chapter Summary and Practical Implications

Science is a method to describe, explain, and predict outcomes of interventions; nursing science seeks to establish a scientific base for care of individuals, families, communities, and populations.
Two competing stances—rationalism and empiricism—have shaped nursing knowledge, along with the later emergent views emphasizing process, context, and consensus.
Emergent views challenge the positivist view, highlighting that science is an evolving process with theories shaping observations and consensus built through collaboration and critique.
Theory and research are interdependent; theories guide research questions and interpretation; research findings refine or replace theories.
The profession moves forward through the development of knowledge, critical thinking, and scholarship; middle-range theories and conceptual models provide practical bridges between research and practice.
The metaparadigm of nursing comprises four global concepts ( $4$ ): person, environment, health, and nursing, around which philosophies, models, and theories organize.
The knowledge structure in nursing ranges from philosophies to conceptual models to theories to middle-range theories, with metaparadigm as the highest abstraction.
The art of nursing includes applying science creatively to promote human betterment (Rogers, 1990).

Knowledge Structure Levels with Examples

Metaparadigm: $4$ concepts — Person, Environment, Health, Nursing.
Philosophy: broad meanings and guiding values for nursing.
Conceptual Models: abstract frames and propositions guiding inquiry and practice.
Grand Theory: broad, highly abstract frameworks.
Theory: one or more concrete concepts and propositions.
Middle-Range Theory: narrower scope, more testable, more applicable to practice.
Examples (selected):
- Nightingale (Philosophy)
- Watson (Philosophy)
- Levine (Conservation Model; Theory of Conservation, etc.)
- Neuman (Systems Model; Theory of Optimal Client System Stability, Prevention as Intervention)
- Orem (Self-Care Deficit Theory; Self-Care Theory; Nursing Systems Theory)
- Johnson (Behavioral System Model; subsystems: $7$ subsystems)
- King (Conceptual System; three interacting systems: $3$ )
- Roy (Adaptation Model; four coping modes: $4$ )
- Erikson, Tomlin, Swain (Modeling and Role-Modeling)
- Parse (Human Becoming)
- Newman (Health as Expanding Consciousness)
Middle-range theories often originate from grand theories or from perceived needs in practice and may specify a bounded population or context for testing.

Practical Implications for Exam Preparation

Know the core epistemologies: rationalism vs empiricism; understand how emergent views shift the emphasis from final truths to ongoing processes, consensus, and the role of theory in guiding observation.
Be able to describe key models/theories and their core propositions, major concepts, and the practical nursing implications.
Distinguish between philosophes, conceptual models, theories, and middle-range theories; know how metaparadigms anchor nursing knowledge.
Recognize the criteria for evaluating theories: clarity, simplicity, generality, accessibility, and importance, plus steps of evaluation and considerations of social utility and significance.
Recall notable theorists and models (e.g., Nightingale; Watson; Leininger; Levvine; Neuman; Orem; Roger; Roy; Johnson; King; Erickson/Tomlin/Swain) and the major contributions they offer to nursing knowledge and practice.
Understand the interdependence of theory and research and how paradigm shifts influence nursing research, education, and practice.
Be able to discuss how current nursing practice is shaped by evidence-based science and how new problem framings may shift practice in light of new theory and discoveries.