As noted in the lead group’s forum, “through observation, [Florence Nightingale] collected empirical evidence that supported her environmental theory and used it to develop evidence-based guidelines that other nurses faced with similar circumstances might find useful” (Selanders, 2010). Nightingale, in essence, was a pioneer to evidence-based nursing practice.
She focused on the patient’s symptoms and examined possible environmental causes of these symptoms to steer the care given. McCurry, Revell, and Roy (2009) state that “nursing as a profession has a social mandate to contribute to the good of society through knowledge-based practice” (p. 42). No moves, however, can be made without a vision, or a formulation of what is wanted as the end result. This vision starts the process of producing a thought, or a philosophy; which can advance to a theory. Silva (1977) examines the research process by exploring the relationships among philosophy, science and theory. As a result of this analysis, she suggests that all nursing theory and research derives from our leads, or data, to philosophy. Silva also argues that information gleaned from philosophical introspection and intuition should be valued as much as that provided by scientific experimentation.
Silva proposes that philosophical intuition is gained by having a thorough understanding of a subject; it is not simply a belief or idea without evidence. This is supported by advances in other fields, such as mathematics, that rely on reasoning, experience and logic and not solely on observation or experimentation. As a result, philosophical intuition can complement the scientific method and serve as another valid and promising means to obtain nursing knowledge. These steps are all intertwined to form future nursing care. Knowledge is built upon theories, for as Lauden (1984) noted, “problems constitute the questions of science, but theories constitute the answers” (McCurry et. al 2009, pg. 42).
Theories are based on a hypothesis, data and research, as well as formulated models, or in essence paradigms. Whall and Hicks (2002) assert that for the discipline of nursing to maximize its research potential, multiple paradigms should be considered. Recognition of the value of philosophy in nursing is an important first step, after which the choice of how to use philosophical paradigms to frame research efforts can be made. As argued by the authors, the current generation of nursing students is integral in affecting change from a rigid either/or approach to positivist and postmodern influence in research to a more applicable both/and approach.
Nursing affords researchers and clinicians the opportunity to appreciate the positivist medical model- A leads to B leads to C- while maintaining that each situation is subject to circumstance, culture, and an endless array of nuances, and these variables must be considered in research. Thus, the most appropriate approach is flexibility and utilization of both positivist and postmodernist philosophies, which will yield the most pertinent scientific results to apply to clinical settings. Experience in clinical settings will then inform philosophical approaches and theory development to facilitate best practice research. Despite the inarguable necessity of implementing well-researched, knowledge-based evidence in clinical practice, these readings suggest the importance of maintaining the holistic approach that defines nursing care throughout the process.
McCurry, M. K., Hunter Revell, S. M., Callista Roy, S. (2009). Knowledge for the good of the individual and society: linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42-52. Selanders, L. C. (2010). The power of the environmental adaptation: Florence Nightingale’s original theory for nursing practice. Journal of Holistic Nursing, 28(1), 81-88. Silva, M. (1977). Philosophy, science, theory: Interrelationships and implications for nursing research. Image, Journal of Nursing Scholarship, 29(3), 210-3. Whall, A.L., & Hicks, F.D. (2002). The unrecognized paradigm shift within nursing: implications, problems, and possibilities. Nursing Outlook, 50(2), 72-6.