Health Science Journal

Keywords

Philosophy – theory – health - nursing framework - main-dominant problem.

Introduction

The theories and models of health, that were occasionally developed and are still being developed by major researchers, tended to provide a framework for understanding, predicting and determining health behaviours in order to offer qualitative health care to all users. These standards can be based on processes that occur within the individual and affect their behaviour in relation to health issues. Other models focus on interpersonal health behaviour and emphasize the way in which people interact in their environments, while others refer to the person as a member of a community and his/her behaviour in this community, always in relation to health decisions [1-3].

In general, there is no standard framework that is perfectly fair and valid or fully covers the needs of education, because the data related to health, health care, and health education are diverse and change rapidly, which makes the entire scientific world wonder. This theory is the progress and development of a long effort to form a picture of a new conception of structured knowledge, and information that give nursing science another approach in the same view of other theories and models [1-3].

The goal is to dominate and to strengthen the science of patient care through its aims, research, education, and clinical practice to those who practice Nursing.

Definition of terms

Science

Science deals with the causality (cause and effect). The scientific approach for understanding reality is characterized by observation, verification and experience.

The hypotheses testing and experimentation are considered scientific methods [4].

Science is both process and product [5]. As a process, it is characterized by the systematic search, based mainly on empirical observation of the natural world. As a product, is determined as empirically
fundamental knowledge, established through experience and as a result of research efforts [6]. Moreover, science is considered a consensus, substantiated opinion of the natural world, including the human behaviour and the social action.7 Science is synonymous to knowledge and is produced by applying a variety of procedures and methods of knowledge. Silva [4], considering Van Laer, lists six characteristics of science:

1. The science must have some degree of consistency

2. Science deals with a defined subject

3. Science is preferably expressed with global declarations

4. Scientific statements are most likely considered true

5. Scientific statements are rationally structured

6. Science has to define the research process and the arguments.

Science is classified in various ways. There is the net or basic science, physical science, humanistic or social science, and applied science or practice. The categories are not mutually exclusive, but their interpretation is possible in accordance with their philosophical orientation. Intrinsic differences exist between the various forms of science and their fields of knowledge [6].

It is believed that nursing, although derived from the basic sciences (eg, physiology and chemistry) and has many characteristics of the social sciences, is classified as applied or practical science. It is important to point out that it is a complex science and that knowledge is drawn from other fields [8].

Philosophy

Philosophy deals with the purpose of life, the nature of existence, reality, theory, and limits of knowledge. Intuition, introspection, and logical reasoning are examples of philosophical methodology. Science, in any field, is closely linked to the corresponding philosophy, from which the light of understanding and development of scientific theories is drawn [9].

Philosophy studies the concepts that compose the cognitive processes of each field, in order to identify and uncover the bases and conditions [10].

Philosophy has been described as «the ultimate study of the abstract and general problems related to the nature of existence, knowledge, morality, logic, and the purpose of human existence» [11]. Philosophy searches for knowledge and truth, and tries to recognize the important and useful. The roots of modern philosophy [12] are considered to start from Rene Deskartes (1596-1650), [13,14] Francis Bacon (1561-1626), [15] Baruch Spinosa (1632-1677), [16] and Immanuel Kant (1724-1804) [17].

Theory

A theory is a set of interrelated concepts, definitions and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain and predict the events or situations [18].

According to Dickoff & James, [19] a theory is a conceptual system or framework which is designed for a specific purpose, and varies according to changes in the structure and complexity. Theory consists of concepts, proposals, acts and sets of arguments that can be formulated verbally and announced.

Others argue that, in basic level, theory is described as a systematic interpretation of an event, in the context of recognized structures and concepts, suggested relations and formulated predictions [5].

Learning

According to Gagne, [20] learning is considered as the intellectual process by which the individual gains new knowledge and skills. What one learns derives from endogenous and exogenous factors and includes the following:

A). Rules
B). Codes
C). Knowledge
D). Information

The types of learning are:

1. Learning information
2. Learning of cognitive skills
3. Learning of cognitive strategy
4. Learning of attitudes and
5. Learning of motor skills

There is also the General Learning (general information, more than one sectors) and the Specific Learning (domain specific knowledge which refers to specific sectors).

Health

The concept of health might have varied among the different cultures throughout the centuries, but in most cases, health considered holistically as the harmony within the individual, and between individuals and their environment in which they lived [21-23].

The evolution of scientific thinking during the 18th century resulted in, among other developments, the continuous progress of medicine, nursing and other health sciences, which started taking into account the different approaches in studying the causes of a disease. The mechanistic view in the interpretation of health and disease that was leading in the beginning, gradually helped to solve some problems such as the dramatic reduction in mortality and morbidity from infectious diseases, and also developed the perception that health was just the lack of disease or disability. This concept was adopted by the health professionals and the public and still, the organization of most health care systems is based on this concept [24-26]. The basic science on which the health care systems are based and materialized is Nursing.

Nursing

According to Newman, [27] Nursing is the art of helping a person to use his/her own inner forces, to evolve towards higher levels of consciousness. It is directed towards recognition of the standards from the individual in interaction with the environment, and the acceptance of interaction as a process of consciousness. It facilitates the process of recognition of standards with a rhythm that connects the nurse with the patient, in order to reveal the standards and the rules of a higher level of organization.

The last four decades, researchers-nurses that are part of the International Council of Nurses have adopted the following definition of nursing: «Nursing is a health science, an integral part of the health system. It incorporates the health promotion, the disease prevention and the care of sick and disabled people as physical-psychological-social human beings of all ages, in all structures and levels of health services (primary, secondary and tertiary care - hospital, clinic, home, community). It is practiced with nursing acts and interventions directed to the individual, the family, and the society with obvious or imminent health problems. As a service, nursing is spread from promoting and restoring health, to the nursing-care of the sick people and to participation in programs for improvement of the health population. It has the primary responsibility for the quality of nursing-care of the people» [28].

Basic Nursing is defined as the care that is necessary in order for the physical-psychological-social needs to be fulfilled, which are common to all people, regardless of the specific health problem [29].

Nursing is science and art. It is a combination of scientific knowledge, techniques and human behaviour. Today «the arena of Nursing Services extends wherever people are» [30].

Theory of Nursing

Nursing is an ongoing function, an academic discipline and a science field. There hasn’t been yet a concerted effort to recognize and agree on the existing base of knowledge, which is fundamental for nursing [31]. In the beginning of the 21st century, nurses are wondering about whether they should allow a humanitarian, holistic treatment or an objective, scientific approach to reality. Therefore, an introduction to an open philosophy is required, which will link the empirical and the theoretical concepts that give meaning and value. It is time for nursing to face the challenges of the increasingly complex area of health care.

It is widely accepted that the use of a theory helps to structure and organize the nursing-knowledge, and provides a systematic means of collecting data in order to describe, interpret and predict the practice of nursing.
Bearing in mind that the theory identifies and explains nursing and its practice, and defines its limits, it distinguishes nursing from other health-caring professions [32]. Also, using the theory, nursing is able to provide coordinated and less fragmented care.33 The authors that are in agreement with the above concept, having studied theories and conceptual models related to nursing science, created a theoretical model and tried to establish and to demonstrate it, according to their own point of view. A model that there is a significant probability to help many of the scientists and health professionals, and especially the nurses in practicing their profession.

The general framework of the conceptual model is «from the whole to one». A concept in which the person is treated holistically, but an important problem comes first which might lead the person to a difficult position. If the specific problem is not addressed, the person enters a situation of continuous anxiety, and the holistic treatment becomes almost impossible. In contrast, when the specific problem (probably a symptom) is addressed directly, the anxiety is reduced and the person enters another level of communication and cooperation. In particular, it could be said that the theory developed, aims to treat the patient holistically and focus on the specific problem too.

Specialists believe that nursing will be developed not only in the theoretical aspect but also in the clinical practice at all levels (research-education-profession).

Structure of the theory

Theories, according to Popper, are created by humans to explain their world and they are not discovered by the world. In addition, the expressions of observations can never be free from theory [34].

The introduction of a theory, especially in a field where the human existence is leading, is very difficult, with many features. All basic sciences - natural and social – strengthen the foundation of nursing, because it is one of the most complex sciences.

Theory is based on the principle of a few points of the modern theory of the critical-theoretical Jurgen Habermas (theory of the differences that constitute knowledge) [35,36]. One of these theories is that knowledge is never a product of a mind that is detached from the daily care, but is always constituted according to the interests that arise from the physical needs of the human, which are shaped by the specific circumstances of his/her life. Without the variety of needs and desires that are inherent in human nature, people would have no interest to acquire knowledge.

Since nursing is the science which deals mainly with the daily care needs of the individual, the theory of «the differences that constitute knowledge» and the positive attitude towards the object, according to the fundamental rule in the learning theory of Bruner, [37] support the principle of our theoretical model where the essential element is the existence of the nurse’s interest to the subject of nursing-science, that is the individual-patient, his/her needs and the ability to satisfy them.

No scientist rejects the holistic treatment of the individual - with which a great number of theoretical and scientific researchers have been working-, the special needs, the types of needs and the ways these needs are fulfilled. But the new theoretical model is mainly dealing the ability to treat and cover the needs, namely the third «different» and object of nursing science for us, which will be discussed below. The founder of Social Psychology, Kurt Lewin, [1] who is classified among the morphological psychologists, gives great importance to the concept of entirety in learning, in his theory. As entirety, he defines the breathing space which is nothing but all the events that happen that particular moment, and its components are: a) the person and b) the environment. The perception of the entirety (holistic mental process - morphological learning) is the state where the nurse comes, when is in contact with the individual-patient and his/her natural environment.

This environment is called by Lewin, [1] as psychological and it includes: a) the natural environment, b) the needs and c) the objectives. When the nurse enters the holistic perception of the patient, understands his/her needs and what the patient expects from him/her, the nurse takes the role of the leader of the psychological orientation, as confirmed by the Field Theory (field theory). In the Field Theory, the nurse moves in a psychological force field and is accordingly attracted or repelled by the elements linking the field. The nurse, located within these holistic dynamics, understanding the overall situation of the patient, enters the permeable border zone of the vital area of the individual, and according to the extent of the perception, knowledge, and information, is processing all the data without omitting any values or experiences.

According to Lewin, [1] the researcher is constantly related to the subject studied and establishes a theory where he/she develops the appropriate action, in order to connect all theories with the practice overcoming the subjectivity, the whole, the non-linearity, etc. Thus, the nurse develops his/her own theory (Lewin) in accordance with his/her own data derived from the patient using experience, expertise, and scientific data to start focusing and concentrating in the particular or the prominent problem of the patient, which has to be solved first.

The above theories are supported by Elliot, [38] the research team of Katsarou-Tsafos [39] who bring together the theories of Habermas and Lewin, and the introduction of the alternative scientific example (compared with the dominant positivist, experience-analytical) in the social sciences "research-action". Elliot believes that any situation in education is perceived as unique and unpredictable.

Toffler [40] argues that a situation can also be described as “proteiki”, especially when there is time pressure (need for achievement of concrete results in time frames). According to the above assumptions, the basic principle of the nurse is the understanding of the situation that is supported by the action.

The nursing theory is particularly important for developing an understanding of the whole situation, having all the individual links in a frame with a particular effort to point out the main problems that need to be resolved according to Toffler’s theory of “proteikotitas” [40].

The nurse needs to use the intuition, the imagination, the knowledge and the information so that the problem can be identified from the whole. Consequently, during continuous processes, the nurse will provide progressively more focused attention to the prominent problem or to the main, at that particular time, need that troubles the patient and makes him/her unable to consider anything else.

Papas [41] believes that all the procedures that are done in order a situation to be detached from the whole and to be treated, consist the framework of a systemic approach, which defines a strong basis with many possible solutions. According to this, the nurse-scientist, after having identified the part of the whole - the main problem - focuses all the efforts to address the specific problem. Also, he/she incorporates specific decisions in this focused context, based on a specific action plan (selected by deduction), not only by interpreting scientific data, but also by changing them, if and where necessary [2].

Perception and awareness of the whole.

Resulting from: a) personality of the individual, b) experiences, c) knowledge, d) information.

According to the dynamic personality of Lewin and absorption, which is characteristic of the theory of J. Piaget [42].

Critical approach of all parts of the whole.

In the theory of rational-mathematic learning of J. Piaget, critical approach of all parts of the whole is a process with:

X = organic status, Z = psychosocial status, Y = whole or holistic existence.

Focus on-through deductive method- the specific problem

Here, the combination of skills of the person providing solution and focused care (affects all stages and the kind of treatment is relative) is present. Requirement for all of us, in order to pass through the stages of this theory and to properly manage the problem that has been identified, is sufficient knowledge of the objective. This, combined with the characteristics required in the first stage of the theory, creates the ability to resolve the identified problem.

Conclusions

The in-focus care will be organized, managed and applied by all relevant sectors and specialties of Nursing Science. Each stage consists a unique total of strategies for this innovation to be improved. For better apply of this theory in practice each stage should be evaluated under proper methods and the results to be used accordingly to each case so that each time to be safe and functional.

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