A discipline is also shaped, and it reflects the definition attached to it by its members and by the soci- ety at large. Several definitions of nursing could drive the process and the goals of knowledge devel- opment in the discipline and, in turn, help to further define the structure of the discipline. These definitions, in turn, were shaped by the progress made in theoretical nursing. One of the most influ- ential definitions of nursing has been the one offered by Nightingale (1859, 1946), in which nursing was defined as “taking charge of the personal health” of individuals and to “put” the individual in the best possible state and “allow nature to act upon him.” This definition although old, continues to hold true, and it set the stage for nursing to claim “personal health” as part of its domain.
CHAPTER 6 The Discipline of Nursing: Perspective and Domain 107 A second influential definition is one that was commissioned by the International Council of Nurses (ICN) for international use. Henderson offered a definition that emphasized a unique role for nursing and brought in the notion that patients have a role in caring for themselves; when patients are not able to care for themselves due to health problems, nurses provide the care they need. Once the patient is again capable, self-care can resume, and nurses are not then expected to do for patients what they are capable of doing for themselves (Henderson, 1966).
A third significant definition was offered by the ANA (1980). Nursing was defined as “the diagnosis and treatment of human responses to actual or potential health problems” (p. 9). This earlier version of the definition has been discussed and critiqued for ignoring the environment, for its inconsistency with nursing values, for its limitation to individual care instead of commu- nity care, and for its problem orientation and lack of health orientation (Allen, 1987; Field, Kritek, Christman et al., 1983; Silva, 1983; White, 1984). However, the definition did help in fur- ther identifying the domain of the discipline and in providing boundaries that have been reflected in theory development and in research priorities. In 1995, an updated version of the definition included affirmation that nursing is committed to caring for ill and well people as individuals, groups, or communities (ANA, 1995). That definition of professional nursing was further modi- fied and updated in 2003. At the time of this writing, professional nursing is defined in the United States as:
The practical, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. (ANA, 2003, p. 6) Nursing is also defined by the ICN in Geneva as:
The use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability until death. (Royal College of Nursing, 2003)
The concept, “response,” that appears in the ANA’s definition is yet to be fully defined; nev- ertheless, it reflects a more integrated approach to viewing clients’ behaviors and actions. It legit- imizes nurses’ abilities to diagnose and treat or deal with these responses and acknowledges the significance of giving attention to the daily lived human experiences. The taxonomy of responses provided as examples reflects the influence of theoretical nursing. Future definitions will need to reflect progress in other components of the domain, such as the emphasis on environment and its relationship to nursing care. The addition of such concepts as prevention, protection, promotion, optimization of abilities for individuals, families, and communities better reflects nurses’ con- cerns. Each of these concepts requires further analysis and development.
I have selected three other definitions to illustrate the dialectic relationship between domain definitions and progress and development in disciplines, as well as to demonstrate the systematic conversion of leading thoughts in the discipline. Based on earlier definitions of nursing, on the identification of central concepts, and on the authors’ theoretical research and curricular explo- rations, Newman, Sime, and Corcoran-Perry (1991) defined the focus of the discipline of nursing as the “study of caring in the human health experience” (p. 3). Similarly, Meleis and Trangenstein (1994), although their definition is more specific, defined nursing as being concerned with the process and the experiences of human beings undergoing transitions; therefore, nursing is defined as “facilitating transitions to enhance a sense of well-being” (p. 257). A third definition reflects an evolving, coherent approach to defining the discipline of nursing. In searching for a unified focus of the discipline, Roy and her colleagues engaged in a lengthy dialogue about their work for 2 years. The result is a definition of nursing as:
a health care discipline and healing profession, both an art and science, which facilitates and empowers human beings in envisioning and fulfilling health and healing in living and dying through the development,
refinement and application of nursing knowledge for practice. (p. E33) LWBK821_c06_p085-112 07/01/11 6:08 PM Page 107
They further defined the central unifying focus for the discipline as:
facilitating humanization, meaning, choice, quality of life and healing in living and dying. (p. E33)
All these definitions evolved from previous definitions of nursing, from identification of cen- tral concepts, from established research traditions, and from previous theoretical work by nurse scholars. Each of these definitions drives the development of different levels of investigation, one relating to caring acts and lived experiences in health and illness, and the other focusing on the nature of transitions, responses, and consequences of transitions, and the different strategies by which nurses can enhance healthy transitions.
CONCLUSION
Disciplines are defined by the structure and substance that define their missions and goals. In this chapter, the nursing perspective, the domain of nursing knowledge, and the definition of nursing are provided. By identifying, acknowledging, and affirming the discipline’s perspective, we could focus our knowledge development efforts on the phenomena that nurses deal with, using a per- spective that best reflects nursing views and values. A nursing perspective is known by exploring nursing as a human science, with a practice orientation, caring tradition, and a health orientation.
The domain of nursing deals with clients who are assumed to be in constant interaction with their environments, human beings who have unmet needs related to their health or illness status, who are not able to care for themselves or are not adapting to their environments due to interruptions or potential interruptions in health. The domain of nursing incorporates a central focus on environ- ments that includes sociopolitical and economic contexts for nursing clients and their significant others. The domain of nursing includes a focus on nursing therapeutics to help in meeting the
cussed in this chapter? Why do you think these components are essential or core?
In what ways would each of these core components transform the discipline’s quest for knowledge development?
5. Identify the implicit and explicit assump- tions that the author had in formulating the ideas in this chapter. Why do you agree or disagree with them?
6. In what ways is the discussion in this chapter about the core domain of nursing and the nursing perspective reflected in current dialogues about disciplines in general and about the discipline of nurs- ing in particular?
7. Define and analyze the core and second- ary components of the nursing domain within your field of nursing. Compare and contrast them with those presented in this chapter.
REFLECTIVE QUESTIONS
1. What are the key questions addressed in this chapter? What are the main points of view? What could be gained or lost by critical discourses on disciplines, per- spectives, domains, and definitions?
2. Discuss your views on the relationships between domain, perspective, science, and theory? Present your view of these relationships schematically. Now, try to identify questions that incorporate differ- ent combinations of these relationships.
Discuss ways by which different combi- nations may or may not advance the knowledge base of nursing.
3. What inferences might you make about the discipline of nursing after reviewing this chapter? What would change these inferences?
4. What are other essential components (core) of a discipline that were not dis-
(Continued on page 109)
CHAPTER 6 The Discipline of Nursing: Perspective and Domain 109
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