A paradigmis a worldview or an overall way of looking at a discipline and its science.
It is seen as a universal view of life, rather than just a model or principle of a theory.
Kuhn (1962, 1996), a theoretical physicist turned science historian, awakened the sci- entific community to revolutions in understanding what he called paradigm shifts.
Paradigm shifts occur when empirical reality no longer fits the existing theories of sci- ence. As an example, he cited Einstein’s theory of general relativity, which came about when the extant theories no longer fit the evidence that was being generated regard- ing matter and energy (Kuhn, 1962).
Recent scientific revolutions in health disciplines have changed the way scientists currently view human beings and their health. For example, immunotherapy and gene therapy are currently being studied extensively. Human genes have been mapped and this knowledge has impacted areas of life as varied as ethics, the law, pharmacology, and medicine. The impact of these new ideas and research on health care delivery is, in effect, a paradigm shift.
Nursing scientists are finding that the theories that have guided practice in the past are no longer sufficient to explain, predict, or guide current practice. Further, older the- ories may not be helpful in developing nursing science because scholars working in nurs- ing’s new paradigm are finding evidence that distinguishes nursing science from the sciences that nurses have traditionally consulted to explain the discipline: anthropology, biology, chemistry, physics, psychology, sociology, and the like (Cody, 2000). The fol- lowing sections outline how three nursing scholars (Parse, Newman, and Fawcett) have categorized nursing theories based on paradigms or worldviews (Figure 6-2).
Parse’s Categorization
Parse (1995) categorized the various nursing theories into two basic paradigms.
These she termed the totality paradigmand the simultaneity paradigm. The totality paradigm includes all theoretical perspectives in which humans are biopsychosocial- spiritual beings, adapting to their environment, in whatever way the theory defines environment. The simultaneity paradigm, on the other hand, includes the theoretical perspectives in which humans are identified as unitary beings, which are energy sys- tems in simultaneous, continuous, mutual process with, and embedded in, the univer- sal energy system. In this classification scheme, the works of Orem, Roy, Johnson, and others would fit within the totality paradigm, and the works of theorists such as her- self, Rogers, and Newman would be part of the simultaneity paradigm.
TABLE 6-1Categorization of Nursing Theories by Meleis’s Domain Concepts
Domain Concept Nursing Theorist/Work
Nursing clients Johnson: Behavioral System Model for Nursing Roy: Roy Adaptation Model
Neuman: Neuman Systems Model Human being–environment Rogers: Science of Unitary Human Beings interactions
Interactions King: Theory of Goal Attainment
Orlando: Dynamic Nurse–Patient Relationship: Function, Process and Principles
Paterson-Zderad: Humanistic Nursing Travelbee: Interpersonal Aspects of Nursing Wiedenbach: Clinical Nursing: A Helping Art Nursing therapeutics Levine: Conservation Principles of Nursing
Orem: Orem’s General Theory of Nursing
Newman’s Categorization
Similarly, Newman (1992) classified nursing theories according to existing philosophical schools but found that nursing paradigms did not neatly fit; therefore, she created three categorizations of theories loosely based on the extant philosophies (i.e., positivism, postpositivism, humanism). She named the nursing paradigms: (1) the particulate–
deterministic school, (2) the interactive–integrative school, and (3) the unitary–
transformative school. In this classification scheme, the first word in the pair indicates the view of the substance of the theory and the second word indicates the way in which change occurs.
To Newman (1992), the particulate–deterministic paradigm is characterized by the positivist view of the theory of science and stresses research methods that de- manded control in the search for knowledge. Entities (e.g., humans) are viewed as re- ducible, and change is viewed as linear and causal. Nightingale, Orem, Orlando, and Peplau are representative of theorists in this realm of theoretical thinking.
The interactive–integrative paradigm (Newman, 1992) has similarities with the postpositivist school of thought. In this paradigm, objectivity and control are still im- portant, but reality is seen as multidimensional and contextual, and both objectivity and subjectivity are viewed as desirable. Newman lists works of theorists Patterson and Zderad, Roy, Watson, and Erickson, Tomlin, and Swain in this paradigm (Patterson and Zderad are not included in the discussion in Chapters 7, 8, and 9).
Into the unitary–transformativecategory, Newman (1992) places her works and those of Martha E. Rogers and Parse. Each of these theorists views humans as unitary beings, which are self-evolving and self-regulating. Humans are embedded in, and constantly and simultaneously interacting with, a universal, self-evolving energy sys- tem. These theorists agree that human beings cannot be known by the sum of their
Three Categories of Theory (Wills, 2002)
Classic Human Needs Theories
Interactive Theories
Unitary Process Theories
Two Paradigms of Theory (Parse, 1987)
Totality Paradigm Simultaneity
Paradigm
FIGURE 6-2Comparison of categories (paradigms) of theories.
parts; rather, they are known by their patterns of energy and ways of being apart and distinct from others.
Fawcett’s Categorization
Fawcett (2005) simplified Newman’s (1992) categorization of theories when she cre- ated three categories of worldview based on the treatment of change in each theory.
The categories Fawcett delineated were (1) reaction, (2) reciprocal interaction, and (3) simultaneous action (Fawcett, 2005). Like Newman (1992), she showed that each category coincided with a philosophical tradition.
In describing the reactionworldview, Fawcett (2005) indicated that these theories classify humans as biopsychosocial-spiritual beings who react to the environment in a causal way. The interaction changes predictably and controllably as humans survive and adapt. She argued that in these theories, phenomena must be objective and observable and may be isolated and measured.
Fawcett (1993) established that in the reciprocal interactionworldview, humans are viewed as holistic, active, and interactive with their environments, with the environ- ments returning interactions. She noted that these theorists viewed reality as multi- dimensional, dependent on context (i.e., the surrounding conditions), and relative.
This means that change is probabilistic (based on chance) and a result of multiple an- tecedent factors. The reciprocal interaction theories support the study of both objec- tive and subjective phenomena, and both qualitative and quantitative research methods are encouraged, although controlled research methods and inferential statistical tech- niques are most frequently used to analyze empirical data (Fawcett, 2005).
In the third category of grand theories, the simultaneous actionworldview, Fawcett (2005) reports that human beings are viewed as unitary, are identified by patterns in mutual rhythmical interchange with their environments, are changing continuously, and are evolving as self-organized fields. She states that in the simultaneous action paradigm, change is in a single direction (unidirectional) and is unpredictable in that beings progress through organization to disorganization on the way to more complex organization. In this paradigm, knowledge and pattern recognition are the phenomena of interest.
Fawcett’s (2005) categorization explained the major differences among the many current and past nursing theories and conceptual models. Table 6-2 summarizes her grand theory categorization scheme. Table 6-3 compares the classification methods of Fawcett (2005), Meleis (2007), Newman (1995), and Parse (1995).
TABLE 6-2Fawcett’s Categorization of Nursing Theories
Paradigm Characteristics
Reaction Humans are biopsychosocial-spiritual beings Humans react to their environment in a causal way Change is predictable as humans survive and adapt Reciprocal interaction Humans are holistic beings
Humans interact reciprocally with their environment Reality is multidimensional, contextual, and relative Simultaneous action Humans are unitary beings
Humans and their environment are constantly interacting, changing, and evolving
Change is unidirectional and unpredictable
Specific Categories of Models and Theories for This Unit
For this book, the conceptual models and grand nursing theories were categorized based on distinctions that are similar to those presented by Fawcett (2005) and Newman (1992). Chapters 7, 8, and 9 thus present analyses of models and theories according to the following classifications: (1) the human needs theories (which relate to Fawcett’s reaction category), (2) the interactive theories, and (3) the unitary process theories.
The theories discussed in Chapter 7 are based on a classical needs perspective and are among the earliest theories and models derived for nursing science. They include the works of Nightingale, Henderson, Johnson, and others. In Chapter 8, each of the perspectives has human interactions as the basis of their content, regardless of the era in which they were developed. The works of Roy, Watson, King, and others are also included in Chapter 8. Finally, the simultaneous process theories (i.e., simultaneity theories) are described in Chapter 9 of this unit. The theorists presented include Rogers, Newman, and Parse. Table 6-4 summarizes the theories that are presented in Chapters 7, 8, and 9.
Theory Analyst Source Basis for Typology Categories
Fawcett Philosophy Worldviews Reaction
Reciprocal interaction Simultaneous action Meleis Patient care Metaparadigm concepts Nursing clients
Human being–environment interactions Interactions
Newman Paradigm Philosophical schools Particulate–deterministic Interactive–integrative Unitary–transformative
Parse Paradigm Dichotomy between Totality
worldviews Simultaneity
Sources: Fawcett (2000, 2005); Meleis (2005); Newman (1995); Parse (1995).
TABLE 6-4Categorization of Grand Nursing Theories for Chapters 7, 8, and 9
Models and Theories
Human Needs Interactive Process Unitary Process
Abdellah Artinian Newman
Henderson Erickson, Tomlin, and Swain Parse
Johnson King Rogers
Nightingale Levine
Neuman Roper, Logan, and Tierney
Orem Roy
Watson
TABLE 6-3Classification of Grand Theories by Current Theory Analysts
Analysis Criteria for Grand Nursing Theories
Describing how models and theories can be employed in nursing practice, research, administration/management, and education necessitates a review of selected elements through theory analysis. Seven criteria were selected for description and analysis of grand theories in this unit. As described in Chapter 5, these seven chosen criteria were among the earliest enumerated by Ellis (1968) and Hardy (1978), and promoted by Walker and Avant (2005) and Fawcett (1993, 1995).
Complete analysis of each theory was not performed; instead, the presentation of the models and theories in Chapters 7, 8, and 9 is largely descriptive rather than an- alytical or evaluative. Each theory’s ease of interpretation and application is also briefly critiqued. The criteria used for review of the grand theories in these three chapters are listed in Box 6-1. Each criterion is also discussed briefly in the following sections.