Theoretical Foundations & Ways of Knowing

History of Nursing

• Indigenous Peoples in North America had knowledge of health, healing, and herbal remedies before European settlers arrived.
• Early European settlers brought diseases that decimated Indigenous populations, who had no immunity to these new diseases.
• Religious orders, including male Jesuit priests and female nuns, provided care to settlers and Indigenous peoples, aiming to spread Christianity.
• Colonialism led to oppression, assimilation, and exploitation of Indigenous peoples, resulting in loss of culture, knowledge, and ways of life.

Florence Nightingale

• Founder of modern nursing, born in 1820, upper-class, wealthy, and educated.
• Challenged social norms by becoming a nurse, working outside the home, and triggering a shift in public attitudes towards nursing.
• Educated as a nurse in Germany in 1850, worked in England and France, and was appointed superintendent of English nurses in Turkey during the Crimean War.
• Improved sanitation, hygiene, and nutrition in hospitals, decreasing mortality rates from 42% to 2.2% in six months.
• Believed nursing was women's work, best practiced under the supervision of male physicians.

Gender and Diversity in Nursing

• Initially, nursing was considered suitable for unmarried, white, Christian women.
• Discrimination in nursing student admission, with segregation based on race, led to the exclusion of non-white, non-English speaking students, and men.
• Since the 1960s and 1970s, the profession has become more aware of the need for gender balance and social diversity in nursing.

The Role and Character of a Nurse

• Early nursing students were required to demonstrate good character, Christian conduct, and obedience to authority.
• Nursing education shifted from apprenticeship under nuns to formal medical education, with a focus on practical skills.

Evolution of Nursing Education

• The first official training school for nurses in Canada was established in 1874, with a focus on practical skills and medical education.
• Nursing education continues to evolve, with a growing emphasis on gender balance and social diversity.

Nursing Theory

• Nursing theory represents the body of knowledge used to describe or explain various aspects of nursing practice.
• Types of theory include grand nursing theories, midrange theories, and narrow theories.
• Nursing theories provide a framework for nursing interventions, guide practice, and inform research.

Nursing's Metaparadigm

• Nursing's metaparadigm includes the concepts of person, health, environment, and nursing.
• The metaparadigm framework helps to understand relationships between concepts and provides a way to organize knowledge about nursing practice.

Ways of Knowing

• Carper's (1978) "Ways of Knowing" theory includes empirics, aesthetics, personal knowledge, ethics, and emancipatory knowing.
• Chinn and Kramer's (2022) "Knowledge Development in Nursing" is based on Carper's theory.
• Ways of knowing are important for nursing practice, as they inform our understanding of the world and our role in it.

Personal Knowing

• Personal knowing involves self-awareness, reflection, and understanding of one's own biases and values.
• It develops from interactions and relationships and is essential for building therapeutic relationships.

Ethical Knowing

• Ethical knowing involves making moment-to-moment judgments about what is good and right.
• It goes beyond knowledge of ethical codes and involves exploring alternatives and experiencing moral distress.

Aesthetic Knowing

• Aesthetic knowing involves an appreciation of the meaning of a situation and allows us to connect with human experiences.
• It is expressed through actions, conduct, attitudes, and interventions, and entails drawing on experiences in health and illness.### Aesthetic Knowing
• Aesthetic knowledge involves grasping the meaning of an encounter and establishing a connection with others, which is fundamental to knowing how to connect.
• This type of knowing is unique to each individual and situation, and is often spontaneous, intuitive, and in the moment.
• It helps us deal with unique and unpredictable circumstances and grow through reflection.

Aesthetic Knowing Example

• Presley uses aesthetic knowing to remove casts from children in a way that minimizes distress, by understanding the child's perspective and using distraction and humor.

Empirical Ways of Knowing

• Empirical knowledge is based on the assumption that knowledge can be accessed through physical senses, particularly seeing, touching, and hearing.
• It is grounded in science and empirically based methodologies, such as logical reasoning, systematic methods, and testing hypotheses.
• Empirical knowledge assumes that an objective reality exists, and that truths can be understood through verifiable observations and understandings.

Empirical Ways of Knowing Example

• Chelsea, a new graduate nurse, uses empirical knowing by reviewing procedures, important considerations, and hospital policy on catheter insertion before completing the skill.

Emancipatory Knowing

• Emancipatory knowing is the ability to be aware of and critically reflect on the social, cultural, and political status quo, and to determine how and why it came to be.
• It involves examining relations of power, dominance, oppression, marginalization, and racialization, and identifying barriers to health and well-being.

Emancipatory Knowing Importance

• Emancipatory knowing is important in nursing because it helps identify barriers to health and well-being, determines factors causing and sustaining injustices, and enables nurses to see and "know" in various ways.

Praxis

• Praxis involves integrating the five knowing patterns (empirics, ethics, aesthetics, personal knowing, and emancipatory knowing) to support social justice.
• It requires nurses to move beyond just practicing tasks and engage in processes that undo social inequities in the healthcare environment.
• The goal is to raise awareness of injustices, reflect on situations, and act to improve them whenever possible.

Practice Question

• Theories in nursing are important because they provide a systematic view of explaining, predicting, and describing phenomena.