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Philosophy, Science and

Knowledge of Nursing

Lely Lusmilasari
• Mahasiswa diharapkan mampu memahami :

1. Filosofi Keperawatan
2. Nilai-nilai dalam Keparawatan
3. Nursing Theory
Discussion Question :

1.What are the implications of identifying (as opposed to not identifying) a

philosophy of nursing?
2.Is the nursing profession best served by the development of one
philosophy of nursing or a number of philosophies of nursing? Why?
3.Speculate on the outcome if the scientific mode of inquiry were to be used
to establish the philosophy of nursing.
4.What is the object or purpose of nursing the science ? Explain why you
came to the conclusion you did.
5.Should nursing seek knowledge of how to control phenomena? Explain
your position.
6.How does philosophic knowledge differ from scientific knowledge?
7.Would you say that the body of nursing knowledge consist of propositions
that are absolutely true, probably true, or simple opinion ? why ?
8.What do you think are the phenomena of concern to nursing ?
9.Is it important and/or useful to determinan the nature, scope and object of
nursing knowledge ? why ?
10.Do the nature, scope and object of nursing knowledge change over time,
place and person ? why ?
Apa Filosofi Keperawatan ?
 Pemahaman kita, konsepsi kita tentang apa itu Keperawatan

 Dalam Filosofi dikenal:

- Ontologi adalah teori tentang “ada” yaitu tentang apa yang dipikirkan dan
yang menjadi obyek pemikiran.
- Epistemologi adalah teori pengetahuan yaitu membahas tentang bagaimana
cara mendapatkan pengetahuan dari obyek yang ingin difikirkan.
- Aksiologi adalah teori tentang nilai yang membahas tentang manfaat,
kegunaan maupun dari obyek yang dipikirkan

 Pengetahuan mencakup ciri-ciri spesifik mengenai apa (ontologi),

bagaimana (epistemologi) dan untuk apa (aksiologi) ilmu itu disusun.

• Knowledge is defined as "understanding of or information about

a subject which has been obtained by experience or study, and
which is in either a person's mind or possessed by people
• Two types of knowledge are inherent in nurses' ways of
knowing, explicit and tacit. Polanyi (1962) described explicit
knowledge as the formal information gained from written words,
maps, or symbols and tacit knowledge as the knowledge gained
from experience, interaction, and the acquisition and
combination of skills, "knowing that" (Eade, 1992)
Knowledge cont .
• The term “knowing” to refer to the individual human processes of
experiencing the world and comprehending the self and the world in ways
that can be brought to some level of conscious awareness. (McKenna, 1997,
p.24; Marriner-Tomer, 1994, p.3)
• Knowing has been defined as being "highly educated, having extensive
information or understanding", being "alert and fully informed" (OneLook,
2003), "having or reflecting knowledge, information, or intelligence", and
"indicating possession of exclusive inside knowledge or information"
(Merriam-Webster, 2003).
• Polanyi (1964) defined knowing as "an active comprehension of things
known, an action that requires skill" (p. xiii, p. xiv). Chinn and Kramer (1999)
described knowing as "an ontologic, dynamic, changing process" that is
associated with how the self and world are perceived and understood (p. 1).
Slife and Williams (1995) bring knowing to the present consideration with
their statement, "Knowing is vitally involved in every discipline, though not
always explicitly" (p. 65)
• Knowing is dynamic and changing process
Based on an analysis of the conceptual and syntactical structure of
nursing knowledge, there four fundamental pattern of knowledge
(Carper, 1978) :


Ethics Esthetics

Empiric knowledge is part of larger whole of knowing; each of the patterns of

knowing is essential; is a distinct aspect of the whole; makes a contribution to
the whole; is equally vital
Empirics, the science of nursing

•Empirics as the science of nursing emerged as a concept

in nursing during the late 1950s (Carper, 1978)
•Empirics, the science of nursing, is concerned with the
objective, abstract, and general knowledge that is
quantifiable and verified through repeated testing over time
(Carper, 1978, 1992)
•The processes related to creating empiric knowledge are
describing, explaining and predicting
•Empiric knowing may also be expressed as conceptual
models and theories that explain and predict relationship
Empirics : based on creative and expressive dimension

Describing Explaining Predicting facts, models,

theories and description

Creative dimension :
Expressive dimension :
•Involve drawing
•Human action ---words,
experience and making
behavior or other symbols
sense of that experience to
move toward what can be •Empirics is expressed in
or might be in the future familiar form of language
•Human activities that
individuals can pursue
alone or can work together
in concert with other who
share a common interest
Ethics, the component of moral knowledge in nursing

•Ethical knowing, the moral component, was described by

Carper (1978) as being concerned with choosing, justifying,
and judging actions involving moral duty, rights, and obligations
•Practicing within an ethical discipline requires a philosophical
foundation concerning the concepts of good, rights, duties, and
•Carper (1992) further describes ethical knowing as "normative
and abstract as well as singular and particular" (p. 75). Ethical
decision-making occurs in the context of a concrete situation;
therefore, it is particular, but the decisions made are based on
moral principles that are abstract and general. These principles
are considered universally valid and applicable to all similar
Ethics : based on creative and expressive dimension

valuing clarifying Advocating ethical theory,

principles, and
Creative dimension :
•The processes of valuing Expressive dimension :
and clarifying explicate
different philosophic •Ethics is expressed in familiar
positions about what is form of language
good, what is right, whose
interest is being served,
which action are
responsible, and what the
goals are those actions
•Clarifying and valuing form
the foundation for a
personal ethics
The component of a personal knowledge in nursing

•Personal knowledge involves an awareness of self and others in a

relationship that is subjective, concrete, and existential and does not require
mediation through language (Carper, 1978, 1992; Liaschenko & Fisher,
•Personal knowledge requires "engagement rather than detachment, and an
active, empathetic participation of the knower" (Carper, 1992, p, 77)
•Personal knowing is knowing how to be authentic with others, knowing
one's own way of "being with" another person; it focuses on how nurses
come to know how to be authentic in relationships with patients (Fawcett et
al,, 2001), Personal knowing involves planned or spontaneous respectful
interaction focusing on a shift or change in a relationship that fosters a new
connectedness or transcendence (Moch; Sarosi, 1968)
Personal knowing : based on creative and expressive dimension

Opening centering Realizing

Authentic genuine self

Creative dimension : Expressive dimension :

•Opening involves taking in the fullness of •The expression of the pattern
experience with conscious awareness of personal knowing is human
action and behavior rather than
•Centering is the process of
contemplation and introspection that
forms inner personal meaning from life
•Realizing is a process of expressing
through personality, behavior, word, and
deeds the genuine, real, whole self that is
consistent with what is experienced in the
inner life
Esthetic, the art of nursing

•Carper (1978, 1992) described esthetics, the art of nursing, as individual,

particular and unique
•Esthetic knowing requires the nurse to interpret the patient's behavior in
regard to relationships and wholes rather than separate discrete parts. It is
conceived as going beyond the explanations provided for by existing
principles and theories to account for the intangible entities
•Esthetic knowing involves the creative processes of engaging, intuiting,
and envisioning
•As esthetic knowing develops, the art/act of nursing emerges; that is the
nurse action take on the element of artistry, creating unique, meaningful,
deeply moving interactions with others that touch common chords of human
Esthetic : based on creative and expressive dimension

Engaging intuiting Envisioning


Creative dimension : Expressive dimension :

•Engaging is a direct •Esthetic is not expressed in
involvement of the self with language but artistically in the
in the situation moment of experience-action
•Intuiting leads directly to
creative responses to the
unique meaning of the
moment and envisioning of
new creative possibilities
For example….

• An example of using Carper's (1978, 1992) ways of knowing in nursing

occurred when the author was working in the Marshall Islands with a
group of nursing students from the U.S.A Marshallese man from one of the
outer islands had been brought to the hospital for an emergency below the
knee amputation of his right leg. He was septic and for the first few days
existed on intravenous (IV) fluids. After his condition improved from very
critical to critical, he demanded that the IV be removed. The patient's
doctor ordered Gatorade to replace the fluids and electrolytes formerly
provided by the IV. The patient refused to drink it. Upon informing the
author of their patient's refusal to drink the Gatorade, the students were
instructed to ask the man's wife to give him some water from the coconuts
she had in the room {esthetics). The students were shocked and asked for
rationale for this direction. During a prior experience in the Marshall
Islands the author had been told about coconut water being used during
the Second World War when no IV fluids were available {empirics). After
this episode, a special relationship or bond developed between the
Marshallese man, who wanted to be in charge of his situation, and the
author, who he allowed to take charge when necessary {personal).
For example….

• Another poignant example was provided by a nurse from Cameroon.

Shortly after graduation, the nurse was assigned to the pediatric ward of
the provincial hospital. One of the nurse's assignments involved care of a
two year old girl with cleft lip and palate. The girl's mother remained with
her at the hospital while the father went to find money for the girl's
surgery, which was to be done by a visiting maxillofacial surgeon. After
about two weeks the nurse noticed that neither the mother nor the girl
had enough food to eat. In Cameroon food is purchased by the family for
the patient; it is not provided as part of hospitalization. When the nurse
mentioned this to the mother, she indicated that the little money the
father was able to leave with her was gone. The nurse, recognizing the
need for the girl to be healthy for her upcoming surgery and having some
extra money, gave it to the mother {ethics). Several weeks after surgery, on
the day of the girl's discharge, the mother approached the nurse saying she
had nothing to give to the nurse but her heart felt thanks, not for the
money, but for not avoiding her daughter and for treating her as the child
she was, not some disfigured creature to be avoided {personal).

Nursing Theory is defined as a

conceptualization of some aspect of nursing
reality communicated for purpose of describing
phenomena, explaining relationship between
phenomena, predicting consequences, or
prescribing nursing care