The Focus of the Discipline of Nursing

Notable works

Newman, M.A., Sime, A.M. & Corcoran-Perry, S.A. (1991). The focus of the discipline of nursing, Advances in Nursing Science, 14(1), 1-6. https://doi.org/10.1097/00012272-199109000-00002

Based on my many years of experience in nursing education, I believe that the most important concept that students need to grasp is that nursing is a discipline. Nursing isn’t the application of knowledge from other fields like medicine, psychology, or public health to the care of people. Yes, nurses draw on this knowledge in their practice, but nursing is a discipline, a professional discipline, with its own knowledge base distinct from others. This is why some refer to the knowledge in the discipline as nursology. The suffix “ology” refers to a branch of knowledge; a subject of study. When students experience the epiphany that nursing has a distinctive knowledge base, their whole perspective shifts from nurses being consumers and appliers of knowledge from other fields to nurses being guided in their practice by the distinctive knowledge of their own discipline. Graduate students begin to grasp their responsibility to advance the knowledge of their discipline through developing and testing nursing theories through research.

With this revelation comes a greater sense of autonomy, pride and power.  But the purpose of clearly articulating and advancing this distinctive disciplinary knowledge is not merely for these reasons, but because this knowledge is essential for human health and wellbecoming, and it is incumbent on us as members of the discipline to advance it in practice and research. “Nurses are thirsting for a meaningful practice, one that is based on nursing values and knowledge, one that is relationships-centered, enabling the expression of the depth of our mission, and one that brings a much needed, missing dimension to current health care.  What is missing in health care is what nursing can provide when practiced from the heart of our disciplinary perspective” (Newman, Smith, Pharris & Jones, 2008, p. 25).

The discipline of nursing includes the philosophies (ontology, epistemology, ethics, aesthetics, etc.), science, and art of nursology. Nursing science, defined as the abstract body of knowledge arrived at through systematic inquiry related to the phenomena of concern to the discipline, is composed of theories of the discipline and the research that generates and tests them.

 Perhaps the article that I’ve cited the most in courses that I’ve taught and in my own writing has been “The Focus of the Discipline of Nursing” by Margaret Newman, Marilyn Sime and Sheila Corcoran-Perry, published in ANS a little over 30 years ago.  There are four important points made in this article: 1) the nature of a discipline; 2) the definition of the discipline of nursing; 3) the paradigm structure in the discipline; and 4) the proposed evolution of knowledge development of nursology. 

Newman, Sime & Corcoran-Perry (1991) state that a discipline is distinguished by a domain of inquiry that represents a shared belief among its members regarding it reason for being (p. 1).  I’ve heard Margaret Newman assert that we need to have a definition of our discipline that is succinct and clear… something that the public would understand if we were on a talk show and were asked to define nursing (a.k.a nursology).  This definition can be captured in a focus statement that specifies the area of study that characterizes nursology. There are both academic and professional disciplines (Donaldson & Crowley, 1978).  Professional disciplines are more than academic disciplines in that their focus encompasses social relevance [and] professional activities guided by the knowledge of the discipline” (Newman, et al, 1991, p. 1).  The focus of the discipline of nursing is “paradigm free”, meaning that it precedes the consideration of paradigms and applies to all paradigms within the discipline. (Newman et al, 1991,  p. 1).

The authors of this article then present what they consider to be the essential question of the discipline….how to facilitate health and wellbeing. They quote John Phillips, “Research should focus on …the study of people’s experiencing of their health, their sense of interconnectedness with others, and specifically how health emerges from a mutual process”. (Phillips, 1990, p. 103). Then (drumroll) the authors reveal the focus statement as: “Nursing is the study of caring in the human health experience” (Newman, et al, 1991, p. 3). This means that any scholarship that does not include caring and the human health experience is not nursing knowledge (p. 3).

Before this publication Parse (1987) had identified two paradigms in nursing: the human-environment totality paradigm and the human-environment simultaneity paradigm.  These authors offer another paradigm structure. They agree with Parse who drew from Kuhn’s (1970) assertion that the evolution of science frequently involves advancing scientific work from fundamentally different points of view within a field of study.  In the case of nursology, the paradigms are worldviews about the phenomena of concern to the discipline: human beings, health, human-environment-health interrelationships, and caring. The authors (Newman et al, 1991) define the paradigms as: particulate-deterministic, interactive-integrative, and unitary-transformative. The first word reflects the perspective on human beings (composed of parts, interactive systems, or irreducible wholes), while the second refers to the nature of the person-environment interaction (causal, relational, and unpredictable). They describe these paradigms as mapping a shift from physical to social to human science.  In the particulate-deterministic paradigm approaches to knowledge development are reductive, isolative, measurable, definable, predictable, controlling, causal and based on facts and laws. (Newman et al, 1991, p. 4).  Knowledge development in the interactive-integrative paradigm considers contexts, experiences, multidimensional factors, probabilities and predictability.  In the unitary-transformative paradigm knowledge development is focused on the understanding of irreducible fields in continuous, mutual process. Change is unpredictable and pattern recognition and thoughts, feelings and values are essential (p. 4).  

The authors seem to suggest that the paradigms are evolutionary. “Although multiple perspectives are appropriate for knowledge development in nursing, we are convinced that a unitary-transformative perspective is essential for a full explication of the discipline” (Newman et al, 1991, p. 5).

This classic, notable work, has been important as one of the first to succinctly capture the focus of the discipline, include caring in the definition of the discipline, articulate an alternative paradigm structure for the discipline, and propose that the entire discipline needs to evolve toward a unitary worldview. 

References

Donaldson, S.K. & Crowley, D.M. (1978). The discipline of nursing. Nursing Outlook. 26(2), 113-120. https://www.ncbi.nlm.nih.gov/pubmed/245616

Kuhn. T. S. (1970). The Structure of Scientific Revolutions. Chicago: University of Chicago Press.

Newman, M.A., Sime, A.M., Corcoran-Perry, S.A. (1991). The focus of the discipline of nursing. Advances in Nursing Science, 14(1), 1-6. https://doi.org/10.1097/00012272-199109000-00002

Newman, M.A., Smith, M.C., Pharris, M.D, & Jones, D. (2008). The focus of the discipline of nursing revisited. Advances in Nursing Science, 31(E16-E27). doi: 10.1097/01.ANS.0000311533.65941.f1

Parse, R.R. (1987) Nursing Science: Major Paradigms, Theories and Critiques. Philadelphia: W.B. Saunders. 

Phillips, J.R. (1990). The different views of health. Nursing Science Quarterly, 3(3), 103-104. https://doi.org/10.1177/089431849000300303

6 thoughts on “The Focus of the Discipline of Nursing

  1. Thank you for illuminating the centrality of the discipline of nursing. It is time that nurses demonstrate the courage and fortitude to identify and appreciate the value of nursing alongside other disciplines that have a unique body of knowledge specific to the phenomena of concern to the profession. Regardless of what nurses (researchers, practitioners, educators, and leaders) name their work, their contributions to helping humankind have been extraordinary. And, while it can be said that other disciplines share a common interest in phenomena related to health, well-being, and the experience of illness and other health challenges and conditions, nursology offers the body of knowledge that distinguishes what it offers the society it was founded and evolved to serve. Awarding degrees specific to the discipline at the bachelors, master’s, and doctoral levels comport with the claim of a unique body of knowledge. I admit to my own struggles at shifting to new terminology – in fear of confusion the profession has created and suffered from in its past. I am working to call upon my own bravery founded in my deep connection to the work of nursing and care for advancing unitary-transformative knowledge that supports human betterment. Some 50 years ago, Martha Rogers called for nursing to be considered a noun – also implying a basic knowledge of the discipline. As I ponder my resistance and struggle, perhaps I can evoke similar courage to use the term nursology more readily, remembering Rogers’s boldness in revolutionizing thinking about nursing.

    Appreciatively,
    Richard Cowling

  2. Marlaine, I agree wholeheartedly with you. The realization of nursing as a discipline, early in my career (thanks to Marilyn Parker), has had a significant impact on my thinking and on my work. I would like to suggest to serious readers that they also gain access to what I consider to be the classic “discipline” book in Nursing, Concept Formalization in Nursing: Process and Product, edited by Dorothea Orem, the work of the Nursing Development Conference Group.

  3. Thank you for the post and for reminding me about the paper by Newman et al. It certainly is one that should be revisited from time to time. In addition to Newman et al.’s focus statement for the discipline, there is another that I often cite and refer others to: “facilitating humanization, meaning, choice, quality of life, and healing in living and dying” (Willis, Grace, & Roy, 2008, E28). These authors offer this as the “central unifying focus of the discipline.” While longer than Newman et al.’s, it is still parsimonious. “Facilitating” is the gerund of choice, and “caring” is not included. An important takeaway from the two papers is that this type of thinking and inquiry continues; that others have used their time and energy to give the rest of us a foundation from which to educate, practice, and research. I hope many of us continue to ponder our disciplinary foci, and participate in confirming them, expanding them, etc. Happy New Year’s Eve!

    Reference: Willis, D. G., Grace, P. J., & Roy, C. (2008). A central unifying focus for the discipline: Facilitating humanization, meaning, choice, quality of life, and healing in living and dying. Advances in Nursing Science, 31(1), E28-E40. https://doi.org/10.1097/01.ans.0000311534.04059.d9

  4. I agree with Peggy, Tim. A blog on the Willis, Grace &Roy article as a “Notable Work’ would be a welcomed contribution. As you said, it’s good to revisit these articles. I get new insights every time I do.

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