Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory. Nursing theories play a vital role in the evolution of nursing as a discipline. They not only establish the critical contributions made by the profession, but also provide nurses with frameworks to guide their practice, grow professionally, and improve the care they deliver to patients.
Nature of Nursing as a Practiced Discipline, a Learned Profession
Nursing practice is both the source and goal of nursing knowledge. The scholarship, research, theories, and education of nursing are grounded in the practice of the discipline of nursing. Selecting and creating effective nursing education methods relies on an understanding that the content of nursing encompasses the goals and methods of nursing practice and the integral connections of practice with distinctive practice-related knowledge.
The use of a nursing-practice situation is a teaching method that draws on expert knowledge of the teacher and stimulates creative and thoughtful learning. Study of the complexity and beauty of nursing practice gives substance and meaning to the idea of a practiced discipline, a learned profession. Nursing as a practiced discipline and learned profession takes a unique focus on what it means to be human.
Nursing is a discipline that is often grouped with several disciplines categorized as human service or health-related disciplines, such as social work, medicine, and physical therapy. The interests and responsibilities of nursing as a distinct discipline within a group of disciplines are necessarily different from, although connected to, those of the other related disciplines. Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
For example, social work, medicine, physical therapy, and nursing are connected through their concern for the health and well-being of persons through practices to promote health and prevent disease. If there were no unique knowledge constructed from nursing’s perspective and contributed to the larger knowledge base, there would be no need for a discipline called nursing among the health and human service disciplines.
Without a unique body of nursing knowledge, there is no basis for a claim for a unique service or practice. In other words, it is nursing’s unique knowledge base that warrants a unique service or practice called professional nursing. One more link in this logical sequence brings us to the major purpose for nursing education and, thus, the central principle for designing curricula, whether at the program level or at the level of the single lesson.
That purpose is to assist persons desiring to enter into the professional role of nursing to develop knowledge and understanding of nursing as a basis from which to design, offer, and evaluate nursing care. Teachers of nursing can best facilitate learning by using distinctive knowledge of the discipline and practice of nursing for each learning experience while being open to and encouraging new ways of thinking, knowing, and being in nursing. Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
This analysis makes evident the principle that selection and use of teaching methodologies for nursing education must be tailored to the unique focus and purpose of the discipline of nursing. In the field of education, it is a well-accepted tenet that instruction be tailored to the content and to the learner.
Putting these three ideas together (discipline, content, learner) helps us understand that any teaching method used to educate for nursing must be in concert with the uniqueness of the nursing discipline and that students of nursing require educational strategies that maximize the development of the values , knowledge, and skills that make up the body of nursing knowledge.
Nursing’s Unique Focus
To arrive at a clear articulation of the content of the discipline, we now ask: What is the unique focus taken by nursing on human service/human health concerns? To answer this question, scholars have taken several approaches. One approach has been to articulate various conceptual systems descriptive of nursing as a unique discipline and profession, systems often-called grand nursing theories. The other approach has been to discern the universal unifying concepts addressed by the discipline; nursing’s met paradigm is one name given to this approach. Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
Grand Nursing Theory
Beginning in the 1960s and continuing through the remainder of the 20th century, formal systems of nursing value, thought, and action were developed by a number of nursing scholars. The impetus for theoretical development of the discipline was supported by the National League for Nursing (NLN) in recognition of the need for clarity about the discipline in curriculum development efforts.
These formal systems variously called grand nursing theories, conceptual models, conceptual frameworks, and nursing philosophical frameworks express explicit conceptualizations of nursing as a discipline and professional practice.
Some examples of the grand nursing theories or frameworks include but are not limited to Orem’s Self-Care Deficit Nursing Theory, Rogers’ Science of Unitary Human Beings, Parse’s Human Becoming School of Thought, and Boykin and Schoenhofer’s Theory of Nursing as Caring.
The content of each of the comprehensive integrated systematic views of nursing (the grand nursing theories) consists of three interrelated systems: a system of concepts and relationships among and between the concepts, an undergirding value system, and a language system that expresses a unique and organized perspective of the discipline.
To illustrate, these interrelated systems will be briefly described in relation to the theory of Nursing As Caring. The conceptual system dimension of the theory of Nursing As Caring can be expressed in its statement of focus of the discipline of nursing: nursing is nurturing persons living caring and growing in caring (Boykin & Schoenhofer, 2001, p. 1).
This statement contains the central organizing concepts (person and caring) in relationship, and is further amplified by the concepts of knowing person as caring, call for nursing, nursing response, nursing situation, caring between, and enhancing personhood (p. 1).
The value system undergirding the nursing as caring theory is expressed in the statements: persons are caring by virtue of their humanity (p. 1) and personhood is enhanced through participating in nurturing relationships with caring others (p. 1). Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
The language system is the vehicle that makes the value-oriented conceptual system accessible for use. The language system of the nursing as caring theory is everyday language enhanced by a language of caring that draws on Mayeroff’s (1991) caring ingredients and Roach’s (1992) 5 Cs of caring. At the heart of each of the grand nursing theories is a clear and explicit statement of the unique focus of the discipline.
The full conceptual or philosophical theory is an elaboration that brings that unique focus into integrated practical significance for use in direct practice, and in teaching, administration, and scholarship. Controversy about the use of these grand nursing theories continues among nursing educators. Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
At one extreme of the controversy is the position that unless a curriculum is grounded in and structured by one of the explicit grand nursing theories, there is no clear coherent guide to the nature and content of the discipline. At the other extreme is the argument that the pursuit of knowledge should be unbounded and that whatever nursing faculty teaches is by definition nursing knowledge.
Universal Unifying Concepts As part of the NLN conceptual framework movement in the 1970s, the idea of major encompassing concepts was introduced. Grand theories contain the major concepts accepted as essential in the discipline of nursing. Yura and Torres (1975), for example, wrote about person, environment, health, and nursing. Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
Fawcett’s (1978) study of a range of nursing literature led to the wide acceptance of what she identified as nursing’s metaparadigm concepts and stimulated further proposals for naming those concepts. For example, Kim (1987) articulated four domains of nursing as the concepts relevant to the discipline: client, client-nurse encounters, practice, and environment.
Newman, Simes and Corcoran-Perry (1991) proposed an integrated statement of nursing focus, intended to encompass and transcend other efforts at grand theory and specification of met paradigm concepts: “nursing is the study of caring in the human health experience” (p .3). Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
These and other various sets of met paradigm concepts have been used by nursing educators in several ways, as broad and complete or partial conceptual frameworks and curriculum organizers, and as detailed concepts that structure specific knowledge content. Some nursing curricula employ neither grand nursing theory nor sets of universal unifying nursing paradigmatic concepts, but rather the curriculum framework is imported from other disciplines, such as biology, anthropology, and psychology.
Some faculties may take the position that there is no unique body of nursing knowledge but that nursing is the skilled application of various other fields of knowledge in practical situations that occur in settings of nursing practice. This view was much more prevalent prior to the NLN conceptual framework initiative of the late 1960s and early 1970s, before widespread dissemination of the concept of nursing as a practice discipline (for example, see Dickoff , James, & Wiedenbach , 1968) and a learned profession (see Rogers, 1964). Nursing as a Practiced Discipline, a Learned Profession, Focuses and Grand Nursing Theory.
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