Hierarchy Of Evidence For Nursing
Hierarchy Of Evidence For Nursing
Write a 195-word message in which you discuss:
1-Why are both paradigms important to the development of nursing science?
2-How do the authors justify having an alternative hierarchy of evidence for nursing, as contrasted with medicine (pp. 24–26, Types of Evidence and Evidence Hierarchies, Ch. 2, Nursing Research)?
Read instructions: ( used attached documents to write the word message discussion. Stay on topic given on the 2 questions above. all information needed is been attached. thank you. ) Hierarchy Of Evidence For Nursing
Overview of Philosophy
Within any discipline, both scholars and students should be aware of the philosophical orientations that are the basis for developing theory and advancing knowledge (Dahnke & Dreher, 2011; DiBartolo, 1998; Northrup et al., 2004; Risjord, 2010). Rather than a focus on solving problems or answering questions related to that discipline (which are tasks of the discipline’s science), the philosophy of a discipline studies the concepts that structure the thought processes of that discipline with the intent of recognizing and revealing foundations and presuppositions (Blackburn, 2008; Cronin & Rawlings-Anderson, 2004).
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Philosophy has been defined as “a study of problems that are ultimate, abstract, and general. These problems are concerned with the nature of existence, knowledge, morality, reason, and human purpose” (Teichman & Evans, 1999, p. 1). Philosophy tries to discover knowledge and truth and attempts to identify what is valuable and important.
Modern philosophy is usually traced to Rene Descartes, Francis Bacon, Baruch Spinoza, and Immanuel Kant (ca. 1600–1800). Descartes (1596–1650) and Spinoza (1632–1677) were early rationalists. Rationalists believe that reason is superior to experience as a source of knowledge. Rationalists attempt to determine the nature of the world and reality by deduction and stress the importance of mathematical procedures. Hierarchy Of Evidence For Nursing
Bacon (1561–1626) was an early empiricist. Like rationalists, he supported experimentation and scientific methods for solving problems.
The work of Kant (1724–1804) set the foundation for many later developments in philosophy. Kant believed that knowledge is relative and that the mind plays an active role in knowing. Other philosophers have also influenced nursing and the advance of nursing science. Several are discussed later in the chapter.
Although there is some variation, traditionally, the branches of philosophy include metaphysics (ontology and cosmology), epistemology, logic, esthetics, and ethics or axiology. Political philosophy and philosophy of science are added by some authors (Rutty, 1998; Teichman & Evans, 1999). Table 1-2 summarizes the major branches of philosophy.
Table 1-2: Branches of Philosophy
| Branch | Pursuit |
| Metaphysics | Study of the fundamental nature of reality and existence—general theory of reality |
| Ontology | Study of theory of being (what is or what exists) |
| Cosmology | Study of the physical universe |
| Epistemology | Study of knowledge (ways of knowing, nature of truth, and relationship between knowledge and belief) |
| Logic | Study of principles and methods of reasoning (inference and argument) |
| Ethics (axiology) | Study of nature of values; right and wrong (moral philosophy) |
| Esthetics | Study of appreciation of the arts or things beautiful |
| Philosophy of science | Study of science and scientific practice |
| Political philosophy | Study of citizen and state |
| Sources: Blackburn (2008); Teichman & Evans (1999). | |
Science and Philosophical Schools of Thought
The concept of science as understood in the 21st century is relatively new. In the period of modern science, three philosophies of science (paradigms or worldviews) dominate: rationalism, empiricism, and human science/phenomenology. Rationalism and empiricism are often termed received view and human science/phenomenology and related worldviews (i.e., historicism) are considered perceived view(Hickman, 2011; Meleis, 2012). These two worldviews dominated theoretical discussion in nursing through the 1990s. More recently, attention has focused on another dominant worldview: “postmodernism” (Meleis, 2012; Reed, 1995).
Received View (Empiricism, Positivism, Logical Positivism) Hierarchy Of Evidence For Nursing
Empiricism has its roots in the writings of Francis Bacon, John Locke, and David Hume, who valued observation, perception by senses, and experience as sources of knowledge (Gortner & Schultz, 1988; Powers & Knapp, 2011). Empiricism is founded on the belief that what is experienced is what exists, and its knowledge base requires that these experiences be verified through scientific methodology (Dahnke & Dreher, 2011; Gustafsson, 2002). This knowledge is then passed on to others in the discipline and subsequently built on. The term received view or received knowledge denotes that individuals learn by being told or receiving knowledge.
Empiricism holds that truth corresponds to observable, reduction, verification, control, and bias-free science. It emphasizes mathematic formulas to explain phenomena and prefers simple dichotomies and classification of concepts. Additionally, everything can be reduced to a scientific formula with little room for interpretation (DiBartolo, 1998; Gortner & Schultz, 1988; Risjord, 2010).
Empiricism focuses on understanding the parts of the whole in an attempt to understand the whole. It strives to explain nature through testing of hypotheses and development of theories. Theories are made to describe, explain, and predict phenomena in nature and to provide understanding of relationships between phenomena. Concepts must be operationalized in the form of propositional statements, thereby making measurement possible. Instrumentation, reliability, and validity are stressed in empirical research methodologies. Once measurement is determined, it is possible to test theories through experimentation or observation, which results in verification or falsification (Cull-Wilby & Pepin, 1987; Suppe & Jacox, 1985). Hierarchy Of Evidence For Nursing
Positivism is often equated with empiricism. Like empiricism, positivism supports mechanistic, reductionist principles, where the complex can be best understood in terms of its basic components. Logical positivism was the dominant empirical philosophy of science between the 1880s and 1950s. Logical positivists recognized only the logical and empirical bases of science and stressed that there is no room for metaphysics, understanding, or meaning within the realm of science (Polifroni & Welch, 1999; Risjord, 2010). Logical positivism maintained that science is value free, independent of the scientist, and obtained using objective methods. The goal of science is to explain, predict, and control. Theories are either true or false, subject to empirical observation, and capable of being reduced to existing scientific theories (Rutty, 1998). Hierarchy Of Evidence For Nursing
Contemporary Empiricism/Postpositivism
Positivism came under criticism in the 1960s when positivistic logic was deemed faulty (Rutty, 1998). An overreliance on strictly controlled experimentation in artificial settings produced results that indicated that much significant knowledge or information was missed. In recent years, scholars have determined that the positivist view of science is outdated and misleading in that it contributes to overfragmentation in knowledge and theory development (DiBartolo, 1998). It has been observed that positivistic analysis of theories is fundamentally defective due to insistence on analyzing the logically ideal, which results in findings that have little to do with reality. It was maintained that the context of discovery was artificial and that theories and explanations can be understood only within their discovery contexts (Suppe & Jacox, 1985). Also, scientific inquiry is inherently value laden, as even choosing what to investigate and/or what techniques to employ will reflect the values of the researcher.
The current generation of postpositivists accept the subjective nature of inquiry but still support rigor and objective study through quantitative research methods. Indeed, it has been observed that modern empiricists or postpositivists are concerned
with explanation and prediction of complex phenomena, recognizing contextual variables (Powers & Knapp, 2011; Reed, 2008). Hierarchy Of Evidence For Nursing
Nursing and Empiricism
As an emerging discipline, nursing has followed established disciplines (e.g., physiology) and the medical model in stressing logical positivism. Early nurse scientists embraced the importance of objectivity, control, fact, and measurement of smaller and smaller parts. Based on this influence, acceptable methods for knowledge generation in nursing have stressed traditional, orthodox, and preferably experimental methods.
Although positivism continues to heavily influence nursing science, that viewpoint has been challenged in recent years (Risjord, 2010). Consequently, postpositivism has become one of the most accepted contemporary worldviews in nursing.
Perceived View (Human Science, Phenomenology, Constructivism, Historicism)
In the late 1960s and early 1970s, several philosophers, including Kuhn, Feyerbend, and Toulmin, challenged the positivist view by arguing that the influence of history on science should be emphasized (Dahnke & Dreher, 2011). The perceived view of science, which may also be referred to as the interpretive view, includes phenomenology, constructivism, and historicism. The interpretive view recognizes that the perceptions of both the subject being studied and the researcher tend to de-emphasize reliance on strict control and experimentation in laboratory settings (Monti & Tingen, 1999).
The perceived view of science centers on descriptions that are derived from collectively lived experiences, interrelatedness, human interpretation, and learned reality, as opposed to artificially invented (i.e., laboratory-based) reality (Rutty, 1998). It is argued that the pursuit of knowledge and truth is naturally historical, contextual, and value laden. Thus, there is no single truth. Rather, knowledge is deemed true if it withstands practical tests of utility and reason (DiBartolo, 1998). Hierarchy Of Evidence For Nursing
Phenomenology is the study of phenomena and emphasizes the appearance of things as opposed to the things themselves. In phenomenology, understanding is the goal of science, with the objective of recognizing the connection between one’s experience, values, and perspective. It maintains that each individual’s experience is unique, and there are many interpretations of reality. Inquiry begins with individuals and their experiences with phenomena. Perceptions, feelings, values, and the meanings that have come to be attached to things and events are the focus.
For social scientists, the constructivist approaches of the perceived view focus on understanding the actions of, and meaning to, individuals. What exists depends on what individuals perceive to exist. Knowledge is subjective and created by individuals. Thus, research methodology entails the investigation of the individual’s world (Wainwright, 1997). There is an emphasis on subjectivity, multiple truths, trends and patterns, discovery, description, and understanding.
Feminism and critical social theory may also be considered to be perceived view. These philosophical schools of thought recognize the influence of gender, culture, society, and shared history as being essential components of science (Riegel et al., 1992). Critical social theorists contend that reality is dynamic and shaped by social, political, cultural, economic, ethnic, and gender values (Streubert & Carpenter, 2011). Critical social theory and feminist theories will be described in more detail in Hierarchy Of Evidence For Nursing Chapter 13.
Nursing and Phenomenology/Constructivism/Historicism
Because they examine phenomena within context, phenomenology, as well as other perceived views of philosophy, are conducive to discovery and knowledge development inherent to nursing. Phenomenology is open, variable, and relativistic and based on human experience and personal interpretations. As such, it is an important, guiding paradigm for nursing practice theory and education (DiBartolo, 1998).
In nursing science, the dichotomy of philosophic thought between the received, empirical view of science and the perceived, interpretative view of science has persisted. This may have resulted, in part, because nursing draws heavily both from natural sciences (physiology, biology) and social sciences (psychology, sociology).
Postmodernism (Poststructuralism, Postcolonialism)
Postmodernism began in Europe in the 1960s as a social movement centered on a philosophy that rejects the notion of a single “truth.” Although it recognizes the value of science and scientific methods, postmodernism allows for multiple meanings of reality and multiple ways of knowing and interpreting reality (Hood, 2010; Reed, 1995). In postmodernism, knowledge is viewed as uncertain, contextual, and relative. Knowledge development moves from emphasis on identifying a truth or fact in research to discovering practical significance and relevance of research findings (Reed, 1995).
Similar or related constructs and worldviews found in the nursing literature include “deconstruction,” “postcolonialism,” and at times, feminist philosophies. In nursing, the postcolonial worldview can be connected to both feminism and critical theory, particularly when considering nursing’s historical reliance on medicine (Holmes, Roy, & Perron, 2008; Mackay, 2009; Racine, 2009). Hierarchy Of Evidence For Nursing
Postmodernism has loosened the notions of what counts as knowledge development that have persisted among supporters of qualitative and quantitative research methods. Rather than focusing on a single research methodology, postmodernism promotes use of multiple methods for development of scientific understanding and incorporation of different ways to improve understanding of human nature (Hood, 2010; Meleis, 2012; Reed, 1995). Increasingly, in postmodernism, there is a consensus that synthesis of both research methods can be used at different times to serve different purposes (Hood, 2010; Meleis, 2012; Risjord, Dunbar, & Moloney, 2002).
Criticisms of postmodernism have been made and frequently relate to the perceived reluctance to address error in research. Taken to the extreme as Paley (2005) pointed out, when there is absence of strict control over methodology and interpretation of research, “nobody can ever be wrong about anything” (p. 107). Chinn and Kramer (2011) echoed the concerns by acknowledging that knowledge development should never be “sloppy.” Indeed, although application of various methods in research is legitimate and may be advantageous, research must still be carried out carefully and rigorously.
Nursing and Postmodernism
Postmodernism has been described as a dominant scientific theoretical paradigm in nursing in the late 20th century (Meleis, 2012). As the discipline matures, there has been recognition of the pluralistic nature of nursing and an enhanced understanding that the goal of research is to provide an integrative basis for nursing care (Walker & Avant, 2011). Hierarchy Of Evidence For Nursing
In terms of scientific methodology, the attention is increasingly on combining multiple methods within a single research project (Chinn & Kramer, 2011). Postmodernism has helped dislodged the authority of a single research paradigm in nursing science by emphasizing the blending or integration of qualitative and quantitative research into a holistic, dynamic model to improve nursing practice. Table 1-3 compares the dominant philosophical views of science in nursing.
Table 1-3: Comparison of the Received, Perceived, and Postmodern Views of Science
| Received View of Science—Hard Sciences | Perceived View of Science—Soft Sciences | Postmodernism, Poststructuralism, and Postcolonialism |
| Empiricism/positivism/logical positivism | Historicism/phenomenology | Macroanalysis |
| Reality/truth/facts considered acontextual (objective) | Reality/truth/facts considered in context (subjective) | Contextual meaning; narration |
| Deductive | Inductive | Contextual, political, and structural analysis |
| Reality/truth/facts considered ahistorical | Reality/truth/facts considered with regard to history | Reality/truth/facts considered with regard to history |
| Prediction and control | Description and understanding | Metanarrative analysis |
| One truth | Multiple truths | Different views |
| Validation and replication | Trends and patterns | Uncovering opposing views |
| Reductionism | Constructivism/holism | Macrorelationship; microstructures |
| Quantitative research methods | Qualitative research methods | Methodologic pluralism |
| Sources: Meleis (2012); Moody (1990). | ||
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing
The terms nursing philosophy, nursing science, and philosophy of science in nursing are sometimes used interchangeably. The differences, however, in the general meaning of these concepts are important to recognize.
Nursing Philosophy
Nursing philosophy has been described as “a statement of foundational and universal assumptions, beliefs and principles about the nature of knowledge and thought (epistemology) and about the nature of the entities represented in the metaparadigm (i.e., nursing practice and human health processes [ontology])” (Reed, 1995, p. 76). Nursing philosophy, then, refers to the belief system or worldview of the profession and provides perspectives for practice, scholarship, and research (Gortner, 1990).
No single dominant philosophy has prevailed in the discipline of nursing. Many nursing scholars and nursing theorists have written extensively in an attempt to identify the overriding belief system, but to date, none has been universally successful. Most would agree then that nursing is increasingly recognized as a “multiparadigm discipline” (Powers & Knapp, 2011, p. 129), in which using multiple perspectives or worldviews in a “unified” way is valuable and even necessary for knowledge development (Giuliano, Tyer-Viola, & Lopez, 2005). Hierarchy Of Evidence For Nursing
Nursing Science
Barrett (2002) defined nursing science as “the substantive, discipline-specific knowledge that focuses on the human-universe-health process articulated in the nursing frameworks and theories” (p. 57). To develop and apply the discipline-specific knowledge, nursing science recognizes the relationships of human responses in health and illness and addresses biologic, behavioral, social, and cultural domains. The goal of nursing science is to represent the nature of nursing—to understand it, to explain it, and to use it for the benefit of humankind. It is nursing science that gives direction to the future generation of substantive nursing knowledge, and it is nursing science that provides the knowledge for all aspects of nursing (Barrett, 2002; Holzemer, 2007).
Philosophy of Science in Nursing
Philosophy of science in nursing helps to establish the meaning of science through an understanding and examination of nursing concepts, theories, laws, and aims as they relate to nursing practice. It seeks to understand truth; to describe nursing; to examine prediction and causality; to critically relate theories, models, and scientific systems; and to explore determinism and free will (Nyatanga, 2005; Polifroni & Welch, 1999).
Knowledge Development and Nursing Science
Development of nursing knowledge reflects the interface between nursing science and research. The ultimate purpose of knowledge development is to improve nursing practice. Approaches to knowledge development have three facets: ontology, epistemology, and methodology. Ontology refers to the study of being: what is or what exists. Epistemology refers to the study of knowledge or ways of knowing. Methodology is the means of acquiring knowledge (Powers & Knapp, 2011). The following sections discuss nursing epistemology and issues related to methods of acquiring knowledge. Hierarchy Of Evidence For Nursing
Epistemology
Epistemology is the study of the theory of knowledge. Epistemologic questions include: What do we know? What is the extent of our knowledge? How do we decide whether we know? and What are the criteria of knowledge? (Schultz & Meleis, 1988).
According to Streubert and Carpenter (2011), it is important to understand the way in which nursing knowledge develops to provide a context in which to judge the appropriateness of nursing knowledge and methods that nurses use to develop that knowledge. This in turn will refocus methods for gaining knowledge as well as establishing the legitimacy or quality of the knowledge gained. Hierarchy Of Evidence For Nursing
