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Nursing – An
Occupation or a
Profession?
In your course readings, McEwen (2019a) defined “ occupation ” as a job or career. Occupations have widely varying levels of training/education, knowledge, and skills. Contrast that criteria with the criteria of a profession :
- Altruistic and valued as beneficial to members of society
- Defined and specialized knowledge base
- Control and authority over education provided in colleges/universities
- Credentialing/registration to ensure competence
- Ethics code
- Socialization to profession takes time
- Autonomous, with control of professional activities
- Scholars and researchers to advance knowledge and improve practice
- Professionals are responsible and accountable to the public “All professions are occupations, but not all occupations are professions” (McEwen, 2019a, p. 2).
Nursing as an Academic
Discipline
Nursing knowledge relies on knowledge from many disciplines, as well as sharing our knowledge with a wide variety of disciplines (McEwen, 2019a). Theorists strive to identify what is unique to nursing. Nursing is now considered a separate discipline because nursing has at least one identifiable philosophy that is specific to nursing, at least one conceptual framework/perspective to define
what constitutes nursing, and suitable methods and approaches to develop knowledge that are respected in the wider scientific community (McEwen, 2019a).
What is an example of an “empirical source”, and what is an example of a “metaphysical source”?
Developing the Art of Nursing
Both empirical and metaphysical sources are used to develop the nurse’s skilled use of knowledge and values in the art of nursing (Finfgeld-Connett, 2008). Consider and reflect on the following question, then click on it to compare your answer.
Relationship-Centred Practice
and the Art of Nursing
Finfgeld-Connett (2008) emphasized the importance of mutual trust and respect between the client and nurse in relationship-centred practice. Foundational to the relationship is respect for and comfort with the uniqueness of clients and their informed choices, even those that may differ from the choices the nurse would make. A strong relationship-centred practice that allows the nurse to implement the art of nursing requires an intense awareness of the client’s situation, the ability to get at the underlying concerns, and a deep appreciation of the patient’s needs (Finfgeld-Connett, 2008). The nurse’s use of kindness, healing touch, humour, and thoughtful doing are behaviours that support relationship- centred practice and the art of nursing.
The Science of Nursing
A focus on discovering “truth” is the basis of science (Rosenfeld, 2012). However, scientists recognize that it’s impossible to know the whole or absolute truth because truth can change over time. Our ability to accept and understand how these “truths” and knowledge change is important to improve nursing practice. For example, for years, reality orientation was thought to be the best way to reorient people who were confused and had dementia; this nursing practice was very upsetting to the clients and contributed to many responsive behaviours, such as withdrawal or striking out. Why does nursing need its own, broad body of knowledge, developed using scientific methods? Think back to the definition of a profession – a defined and specialized knowledge base, and scholars and researchers to advance knowledge and improve practice (McEwen, 2019a).
Nursing Science: Defined
“Nursing science describes the frameworks and theories of
the [ nursing ] discipline” (Parse, 2001, p. 1). Barrett (2002,
- has explored the definition of nursing science over many years. She defines nursing science as a basic science that aims to discover facts and expand knowledge in nursing. Nursing science is:
- Communicated in nursing theories and frameworks
- Focused on the human-universe-health process
- Informed by philosophies
- Informed by processes to develop and use knowledge to make it specific to nursing
- Existence (i.e. what does it mean to be human?)
- Knowledge
- Morality
- Reason
- Human purpose Philosophy seeks to identify truth and knowledge by asking deep, ultimate questions, such as What is valuable? and What is important? (McEwen, 2019a). Philosophers study the concepts and processes of thought and thinking to reveal foundations (e.g., nursing process) and presuppositions (e.g., caring is central to nursing).
Traditional Branches of Philosophy
Table 1-2 on page 8 of the McEwen and Wills (2019) text identifies branches of philosophy and their area of study. Listed below are six of those philosophical branches that have particular influences on nursing practice, for the purposes of this course. Below is a brief description of the focus of each philosophical area of study and examples from movies and television that explore them.
- Metaphysics – The study of nature and rules of
reality and existence. What is reality? ( The Matrix ,
Avatar )
- Ontology – The study of the theory of being. To be or not
to be? ( The Truman Show , Avatar , Fight Club )
- Epistemology – The study of the theory of knowledge, truth, belief. How can we know for certain? Is belief
different from knowledge? ( Polar Express , Wizard of
Oz , Phenomenon )
- Logic – The study of principles and reasoning.
Mathematics ( Hidden Figures , A Beautiful Mind )
- Ethics (axiology) – The study of morals, values, right and wrong. Is something that is right always moral? Is something that is moral always right? (e.g., Should we rearrange “abnormal” gene sequences to make people
“normal”? ( Schindler’s
List , Breaking Bad , The Sopranos )
Positivist scientists believe that they are separate and independent from the participants in their research studies and, therefore, they
do not influence the research. A movement within positivism, called logical positivism (1880s to 1950s), stressed the need for logical approaches to science and to provide evidence that a theory is either true or false. Challenges to positivism emerged in the 1960s at a time when newer philosophies and ways of thinking about “truth” were appearing (McEwen, 2019a). Postpositivism recognizes subjective approaches to science. Postpositivist researchers believe that the researcher cannot be separated from the research or the research participants. The researcher decides what to research, develops the research question, designs and conducts the study, interprets the findings, and formulates recommendations. Postpositivists believe that approaches to research, theories, and findings have to be understood within their context. While quantitative research methods are widely used by postpositivist scientists, qualitative methods are also accepted as an approach to science. This short video presents an overview of postpositivism and its relation to science [3:00] and provides more information about epistemology and ontology.
Perceived View:
Phenomenology and
Constructivism
Phenomenology and constructivism are two branches of the perceived/interpretive/humanistic worldview of science (McEwen, 2019a). Scientists in the perceived/interpretive/humanistic worldview of science believe in the importance of context and how people perceive and interpret their experiences. Scientists use this
Phenomenology
The goal of phenomenology is to understand experiences in a phenomenon/situation from individuals’ unique perspectives (McEwen, 2019a). The focus of phenomenology is to recognize connections between experiences, perceptions, feelings, meanings and values, and perspectives. Many interpretations of reality and ways of knowing are foundational to the worldview of phenomenologists. Qualitative research is the approach used in phenomenology. This short video provides an overview of phenomenology [2:59].
Constructivism
Constructivism is a perceived or interpretive view (Gergen, 1997; McEwen, 2019a). The goal of constructivism is to understand how people construct their own understanding/knowledge through experiences and reflection on experiences. The focus of constructivism is to describe the actions of and interactions with the environment that construct meaning for an individual. Subjectivity (individual perceptions), patterns, and multiple truths based on consensus are emphasized. Social constructivism focuses on how people construct meaning through their social interactions and the influences of society. Qualitative research is the research approach that is most commonly used by constructivist researchers. This short, upbeat video provides an overview of constructivism [2:50].
Ways of Knowing
Commonly Used in Nursing
In 1978, Barbara Carper was working on her PhD in nursing at the University of Michigan (Wolters Kluwer, n.d.). She was required to develop new knowledge in nursing, a typical expectation in all PhD programs. Dr. Carper created a philosophy that included four basic patterns of knowing ( empirics , esthetics , personal knowledge , and ethics ) that reflected the science, art, and practice of nursing. The characteristics of these four types of knowing are outlined in Table 1-4, on page 15 of the McEwen and Wills (2019) text. Since that time, her work has been expanded on; other ways of knowing have been developed by epistemological nurse scientists (McEwen, 2019a).
Reading
Take time to review these epistemological ways of knowing that are described on pages 13–16 in your McEwen and Wills text – i.e., empirical , personal , intuitive , somatic , metaphysical/spiritua l , esthetics , and moral/ethical knowledge. In addition to the epistemology/types of knowledge described in the text, a few others have emerged. For the purposes of this course and how we will approach the application of theory, it will be useful to also be aware of these additional ways of knowing:
- Clinical knowledge is described in the text as the nurse’s personal knowledge and may “involve intuitive and subjective knowing” (McEwen, 2019a, p. 15), i.e., our “know how” knowledge (Hall, 2005). A broader view of clinical knowledge includes the following types of knowledge: o Procedural knowledge , such as inserting a catheter (Mantzoukas & Jasper, 2008). o Theoretical knowledge is sometimes referred to as the “know that” knowledge (Hall, 2005), such as
may be revealing and what they may be concealing when you are conducting an assessment. o Ward/workplace cultural knowledge that determines so much of our behaviour at work, such as where we eat, how we approach complex client issues, etc. (Mantzoukas & Jasper, 2008) o Reflexive/reflective knowledge that is gained through experience and critical reflection to help us to question our practice (Mantzoukas & Jasper, 2008).
- Traditional knowledge is the knowledge that is passed down through generations of nurses (Moule & Goodman, 2009), such as the tips and strategies that we learn from other nurses to help manage certain phenomena or take better care of clients and/or ourselves, or rituals that have developed over time (Hall, 2005).
- Emancipatory knowledge recognizes social and political issues and policies that are associated with repression, injustice, and inequality (Snyder, 2014). Through an understanding of how it could be better, nurses using emancipatory knowledge to develop a variety of strategies to deal with these complex phenomena. As you can see, critical social theory and feminist theory have had a major influence on this type of knowing.
- Academic knowledge encompasses so much of the knowledge that you’re exposed to through your courses here at Ryerson and your previous places of learning (Hall, 2005).
- Knowledge from other sciences and professions , such as the humanities, psychology, sociology, anthropology, and others (Hall, 2005).
- Communication and interpersonal skills knowledge may
be grouped together with other sciences and professions , but can also be separated out, as these skills are so crucial in nursing (Hall, 2005). We are often caring for people at some of
inexperienced nurse. However, as the nurse learns from experiences and education, these parts are used and understood in different ways and at different times depending on
the situation. The expert nurse has the ability to quickly focus on the most relevant parts and develop priorities in order to take appropriate action.
Stages of the Novice to Expert Theory
As you review the stages, keep in mind that Benner recognizes that not all nurses, or people, learn from experience, and not all nurse reach the expert stage (P. Benner, personal communication, 1989). In the novice to expert theory (Benner, 1982, 1984), the nurse experiences five levels of proficiency: Novice > Advanced Beginner > Competent > Proficient > Expert
Novice Stage
In the novice stage, the nurse has no experience in the situation and lacks confidence (Benner, 1982, 1984). Frequent cues are needed and it takes a long time to effectively perform nursing role requirements
- think back to your early nursing education. Nurses in the novice stage lack discretionary judgment and decision- making skills to meet patient needs and address a phenomenon.
Advanced Beginner Stage
In the advanced beginner stage, knowledge and skill are developing (Benner, 1982, 1984). The performance of skills required for nursing are slightly acceptable, as learning has developed related to previous experience in the same/similar situations. Occasional cues are still needed, and it may take longer than expected to complete tasks.
Competent Stage
Benner (1984) estimates that it takes two to three years of
