NURSING: RECEDING AND EVOLVING PARADIGMS

ICUs and Nursing Web Journal ISSUE 10 th (April – June 2002) ISSN 1108-7366 All rights reserved

NURSING: RECEDING AND EVOLVING PARADIGMS (Editorial) Sharon L. Van Sell, RN, Ed.D., PAHM Associate Professor Coordinator RN/BS/M S Program Clemson University School of Nursing University Center of Greenville Greenville, South Carolina, USA

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Until one is committed there is hesitancy, the change to draw back, always ineffectiveness. Concerning all acts of initiative or creation there is one elementary truth, the ignorance of which kills countless ideas and splendid plans: that the mo ment one definitely commits oneself, then providence moves too…. Whatever you think you can do or believe you can do, begin it. Action has magic, grace and power in it. Goethe

T

he nursing profession is in the

nursing care

throes

increased

of

revolutionary

in

patient

an

environment of acuity,

advanced

change, a time when nursing

technology, aging population, decreased

leaders are frantically preoccupied with

resources, and a shortage of professional

change itself. However, change is not

nurses. While the bedside nurses is

always a welcomed guest in the nursing

focused on her patient, new concepts in

profession. Change is real, accelerating,

physics have results in a profound change

and

technological

in our worldview; from the mechanistic

innovation, the globalization of the health

worldview of Descartes and Newton to a

care industry, and not the least of it, the

holistic and evolving ecological view. The

arrival of the Internet and the new domain

paradigms for the nursing profession are

of Internet Healthcare Information. In

receding, shifting and evolving without

addition,

commitment from the nurses who are at

driven

the

by

rapid

nursing

profession

is

involved in receding, shifting and evolving

the bedside.

paradigms. Thomas Kuhn introduced the concept of The practicing nurse at the bedside is

scientific “ paradigm,”

defined as “ a

focused on providing the best possible

constellation of achievements---concept,

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values, techniques, etc. ---shared by a

a number of entrenched ideas and values,

scientific community and used by that

including the view of the universe as a

community to define legitimate problems

mechanical

and solutions.”

Kuhn

elementary building blocks, the view of

reported changes in paradigms occur in

the human body as a machine, the view of

discontinuous, revolutionary breaks called

life in society as a competitive struggle for

“paradigm shifts” (Kuhn, 1962).

The

existence, the belief in unlimited material

physicist

the

progress to be achieved through economic

paradigm shift in quantum physics as an

and technological growth and a belief that

integral part of a much larger cultural

a

transformation

and

everywhere subsumed under the male is

a

one that follows a basic la w of nature. The

scientific paradigm to that of a social

mechanical paradigm emerged when the

paradigm defined as “ a constellation of

newly perfected microscope lead to many

concepts,

distinguished advances in biology.

generalized

Additionally,

Capra

acknowledge d

(Capra,

Kuhn’s

values,

1982)

definition

of

perceptions,

and

society

system

in

which

composed

the

female

of

is

practices shared by a community, which forms a particular vision of reality that is

The mechanical paradigm is based on the

the basis of the way the community

concept of “ reductionism.” Libster stated

organizes itself” (Capra, 1986).

reductionism in medicine is the concept that all illness, including all of its cultural,

Three visions of reality are expressed in

social,

the three paradigms in existence within the

components, can be reduced, or explained

nursing

by the biological problem.

mechanical

profession paradigm, the

including the deep

the

physical,

and

emotional

Hence the

holistic

concept that the human body is like a

ecological

machine (Libster, 2001). The mechanical

paradigm,

and

paradigm.

The mechanical paradigm is

explained by Capra (1982) as consisting of

paradigm

according

to

Watson

is

comprised of mechanism, materialism, and

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physical medicine, which emphasized the

Watson expanded the health concept

body and the disease as functions of an

indicating:

objective world. T he body and the state of

harmony within the mind, body, and soul.

the body became the focus for medical

Health is also associated with the degree

treatment and cure, from the outside in,

of

while nursing focused on functional tasks,

perceived and the self as experienced.

skills and “ doing” the role of nursing

Such a view of health focuses on the entire

(Watson,

1999).

nature of the individual in his or her

paradigm

dominated our

The

mechanical

“health refers to unity and

congruence

between

the

self

as

for

physical, social, aesthetic, and moral

is now

realms---instead of just certain aspects of

receding. Many communities of nurses in

human behaviour and physiology. Such a

various areas of the world still practice

view is referred to as an euda imonistic

with a view of the human body as a

model of health (Watson, 1999). Utilizing

machine.

the holistic viewpoint, nurses focus on

several hundred years,

culture but

helping the patient or client reach a higher A paradigm shift occurred when the

degree of harmony within the mind, the

mechanical paradigm gave way to the

body and the soul and on providing

holistic paradigm. T he largest number of

“patient-centered” nursing practice.

nurses, especially in the United States, practice within a holistic paradigm, which

The deep ecology paradigm evolved from

views the world as an integrated whole

the holistic paradigm. The worldview of

rather than a dissociated collection of

deep ecology was initiated by Arne Naess,

parts. According to T winame and Boyd

a

the holistic view indicated “ health results

Sessions, 1985).

from

paradigm

a

balance

and harmony

with

Norwegian

philosopher (Devall & The deep ecology

recognizes the

fundamental

nature….If the balance is disrupted, the

interdependence of all phenomena and the

result is illness” (T winame & Boyd, 1999).

fact that as individuals and societies,

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everyone is embedded in (and ultimately

Integrative thinking being intuitive,

dependent on) the cyclical process of

synthesis, holistic and nonlinear;

nature. The essence of deep ecology is

Integrative values of conservation,

characterized as asking deeper questions.

cooperation, quality, and partnership;

Discoveries in mathematics such as the

social organizations as networks;

Mathematics of Complexity have provided

Ethics as exocentric (earth-centered)

a new mathematical tool to model the non-

values thus resulting in scientists being

liner interconnectedness and characteristic

responsible for their research not only

networks

of

intellectually, but also morally; and

Therefore,

living

ecological systems

systems. as

self-

A shift from physics as the center of

organizing networks can be formulated

science to life being at the center with

through detailed models.

emphases on the life science (Capra,

Modelling of

relationship and patterns resulted in a shift

1996).

of emphases that is characteristic of

Thus,

system’s thinking ---from quantity to

demonstrates an

quality and from substance to patterns.

holistic view to the deep ecology view.

The

high-speed

Capra explained the difference by using

the

Cray

the bicycle as an example and stating:

supercomputer1 played a crucial role in the

“ …the holistic view means to see a bicycle

mastery of complexity. Now with the help

as a functional whole and to understand

of applied mathematicians, nurses are able

the

to solve complex equations previously

accordingly. An ecological view of the

intractable and to trace out the solutions as

bicycle includes that, but it adds to it the

curves in a graph.

perception of how the bicycle is embedded

availability

supercomputers

such

of as

The emerging

the

ecological evolution

interdependence

of

paradigm from

its

the

parts

ecological paradigm suggests:

in its natural and social environment---

1

where the raw materials that went into it

Develo pment of the Theory of Nursing Knowle dge and Nursing Practice was supported by research grants to Dr. Sharon Van Sell from Cray Research, Inc. (Meintz, 1995).

came from, how it was manufactured, how

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its use affects the natural environment and

of Cambridge once occupied by Isaac

the community by which it is used, and so

Newton, declared that the twenty-first

on.” (Capra, 1996, p.6). The difference is

century

even greater when considering humans or

complexity.”

living systems for which a connectness to

understanding

the environment is vital.

integrative systems of life has emerged.

“ will

be A

the new

the

century language

complex,

of for

highly

Difference scientists call it by different names---“ dynamical systems theory,” “the theory

of

complexity,”

“nonlinear

dynamics,” “network dynamics,” and so on. Chaotic attractors, fractals, dissipative structures, “Holistic view means to see the bicycle as a functional whole and to understand the interdependence of its parts accordingly.”

self-organization,

and

autopoietic networks are some of its key concepts.

Nurses are experiencing a paradigm shift from the holistic paradigm to the deep ecology paradigm, are asking deeper questions, and recognize the fundamental interdependence

of

all

phenomena.

Furthermore, deep ecology can be found “Deep Ecological view means seeing the bicycle not only as a functional who le and to understand the interdependence of its parts accordingly but also the perception of how the bicycle is embedded in its natural and social environment---where the raw materials that went into the bicycle came from, how it was manufactured, how its use affects the natural environment and the community by which it is used and so on.”

as a construct in the Evolving Essence of the Science of Nursing:

A Complexity

Integration Nursing T heory (Van Sell & Kalofissudis, 2001). The practicing nurse

In January 2000 Stephen Hawkins, author plays an important role in the evolving of A Brief History of Time and holder of paradigm shift from holistic to deep the chair of mathematics at the University

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ecology, and as Goethe said, the moment

for the global nursing community to

one definitely commits oneself, then

recognize and commit to the deep ecology

providence moves too. The time is now

paradigm.

REFERENCES 1. Capra, Fritjof, (1986). The Concept of Paradigm and Parad8igm Shift, Re-Vision, vol. 9, no. 1, p. 3. 2. Capra, Fritjof, (1982). The Turning Point, New York: Simon & Schuster. 3. Capra, Fritjof, (1996). The Web of Life, New York: Simon & Schuster. 4. Devall, B. & Sessions, G. (1985). Deep Ecology. Salt Lake City, Utah: Peregrine Smith. 5. Kuhn, T homas S. (1962). The Structure of Scientific Revolutions, Chicago: University of Chicago Press. 6. Libster, M. (2001). Demonstrating Care: The Art of Integrative Nursing. Albany, NY: Delmar, T homas Learning, p. 17.

7. M eintz (Van Sell), S. L, Yfantis, E. A, & Graebel, W. P. (1994). Future Directions in Computational Nursing Sciences, Mathematical and Computer Modeling, 19(68), 273-288, 1994. 8. Twiname, B. G. & Boyd, S. M . (1999). Student Nurse Handbook: Difficult Concepts Made Easy. Stamford, Connecticut: Appleton & Lange, p. 63. 9. Van Sell, S & Kalofissudis, I. (2001) T he Evolving Essence of the Science of Nursing: Complexity Integration Nursing T heory, ICUs and Nursing Web Journal, 8 th Issue (October 2001-January 2002), http://www.nursing.gr/index1.html. 10. Watson, J. (1999). Nursing: Human Science and Human Care A Theory of Nursing. Sudbury, Massachusetts: Jones and Bartlett Publishers, p. 49. 11. Watson, J. (1999). Postmodern Nursing and Beyond. Edinburgh: Churchill Livingston, p. 98.

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NURSING: RECEDING AND EVOLVING PARADIGMS

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