HLT54115 Diploma of Nursing: Different Ontological Lenses

Introduction

Nursing concept is usually defined as a rigorous and creative structuring of a range of ideas that are found to project in a purposeful, tentative, and systematic observation of phenomena. Although there was lack of formal nursing related knowledge in the early years, with a development of nursing education, the requirement of categorising knowledge helped in the development of different nursing theories that allowed the nurses to critically evaluate complex situations that are encountered while caring for patients. Health has been identified as a basic concept in nursing theory that is continually evolving over time (Cook & Peden, 2017). Traditional paradigms that are related to health, have disorders or illness as the primary focus and have gradually emerged into multifaceted multidimensional models that centre on a holistic and positive approach towards the phenomenon, commonly referred to as health. This essay will elaborate on the health concept, in relation to different ontological lenses, besides identifying ethical issues related to it.

Health: the nursing concept

Traditionally, the concept of health has had different meanings, depending on the person, circumstances and time, during its definition. The word health was found to first appear around 1000 AD, and denoted the condition or state being whole or sound. The concept of mind-body dichotomy considered the body to function in the form of a system, based on chemical and mechanical laws that could be distinguished from the mind. The onset of the conception of disease or illness during the time of Hippocrates made people embark on a journey that focused on unravelling the different causes of disorders (Lee et al., 2017). This was followed by the conception of the germ theory of disease by Pasteur and Koch in 1800s. However, in the words of Larsen (2017) it was argued in 1941 by Sigerist that health did not just mean the absence of any illness, but represented presence of a positive attitude and acceptance of life. This was followed by the formulation of different paradigms such as, the ecological model and psychosocial model that placed a due focus on the interaction of the body, society, and mind, for attaining good health. In other words, the concept of health is fundamental to nursing and comprises of both physiological and mental wellbeing of a person, the service user.

3 ontological traditions

The critical theory was established by several professors from the Institute of Social Research during the 1920s and was supported well by the Marxist philosophical base. Marx defined it in the form of a self-clarification that needs to be gained through the present time of the desires and struggles. Considering nursing as a major discipline of dialectic nature, upon imparting the theory, it should immediately be put to practice for accomplishing better learning, via feedbacks (Gathercoal, Gathercoal, Seegobin & Hadley, 2017). Thus, the critical theory provides for novel and broader exploration questions and holds the potential to encompass the information base of nursing discipline. In the words of Mill, Allen and Morrow (2016) the critical theory holds the potential of advancing the understanding of a nursing professional of the collective organization of commonplace practice situations and the ways by which they can be reorganized.

Nursing professionals who are found to adhere to the critical theory have often elaborated on the necessity to advance the building of knowledge with an unshackling and liberating determination, which allows the delivery of responses in a manner that helps in approaching reality through a dialectic and global vision. The complexity theory refers to a manner of understanding the communities and organisation that have been considered as a method, existing within the healthcare management, in place of a nursing tool (Mitchell, Jonas-Simpson & Cross, 2012). The term complexity theory is most commonly used interchangeably with different terms, most particularly complex adaptive systems. It has been defined by Plsek in the form of a gathering of discrete agents who are allowed to act in means that are not completely foreseeable and whose activities are consistent. According to Thompson, Fazio, Kustra, Patrick and Stanley (2016 each group of persons who work together in a clinical team, have discrete pattern of behaviours that arise over time and progress within the practice environment. Thus, the complexity ontology facilitates development of a sound understanding of the role that organisations and communities have, in relation to healthcare management.

Thus, the nursing professionals must engage in the work and behaviour complexity leadership, in addition to the awareness that change and interconnectedness are normal functioning conditions (Beuthin, 2015). Nursing has also been found to be influenced by the ontology of positivism, the primary feature of which relies on the scientific explanation of contrasting the outcomes with several favourable events. Gortner and Schultz (1988) stated that positivism goes back to the year 1907, during the formation of the Vienna Circle. The nursing conception related to positivism dates back to Nightingale during the end of 19^th century when due focus was placed on the principles of space, cleanness, air, and light.  Positivism has also been found to exert a direct influence on the clinical capacity that is reflected in most nursing practice where the approach of ontology is used by professionals via inductive reasoning.

Ethical issues

Nursing professionals encounter ethical dilemmas on a regular basis, while maintaining and enhancing the health and wellbeing of their service users. Ethical issues encompass the practice of providing care that is correct, good and rational. The patients should also be provided with the opportunity of expressing their freedom of choice, in relation to the procurement of services and the way by which they want to be cared for. Some of the common ethical issues that might arise in professional nursing practice, while taking into consideration of the concept of health are the respect for autonomy of patients, beneficence, justice, and non-maleficence (Grace & DRN, 2017). According to Cherry and Jacob (2016) perspective of the essence of nursing ontologies often drive the ethical behaviour that is demonstrated by nurses towards the clients. Under situations where a nurse perceives the service user as a means to a culmination, the patient becomes objectified and ends to have significance as an individual. On the other hand, considering the patient as an end-in-themselves, the nurses are subjected to a dramatic change in scenario. By observing others as ends foreshadows that the nurses grip the exclusive and subjective kind of each client.

Controversies and intersections

The definitions of complexity theory are often indefinable in nursing practice and there is an absence of consensus statement on how complicated and multifaceted an entity must be, in relation to the theory. Chandler, Rycroft?Malone, Hawkes and Noyes (2016) opined that complexity theory is able to deliver a standpoint to reviewing complex systems in a method that does not lessen the system to discrete constituents. From a perspective of the complexity theory, the communications between constituents of a system are significant for reading a system. Furthermore, it is the exchanges of system elements that result in the general performance. Hence, the complexity theory is able to acknowledge that elements existing within the nursing system interact with one another, to produce certain behaviour, in relation to the concept of health. In other words, complexity theory is able to offers a set of conceptual tools for explaining the assortment in contemporary modernity experiencing globalisation. This is in stark contrast to the ontology of critical theory that emphasises on the critique and reflective assessment of the society, which is facilitated by application of knowledge from humanities and social sciences (Dallaire & Krol, 2018).

Thus, in contrast to the other ontologies that are oriented towards explaining and understanding the society, this theory is directed towards changing and critiquing the entire society (Alligood, 2017). Conversely, positivism is often not used as an ontological approach by nurses since it presents arbitrary practice and confines the nurses to one science. Upon the implementation of positivism, advanced practice nurses reach a position where they can assess their practice via a particular method, thus eradicating the certainty that the domain of nursing also comprises of art (Williams, Rycroft?Malone & Burton, 2017). Additionally, “logical positivism” has been found to exert serious impacts for theology and ethics.

Best ontological tradition

The ontological tradition that focuses on complexity theory can be considered best for nursing practice. This can be accredited to the fact that ambiguity is inherent in the practice. As the healthcare becomes progressively multifaceted, nurses must endure to efficaciously deal with larger expanses of clinical ambiguity (Kitson et al., 2018). Though uncertainty is often debated in nursing, negligible concept modification occurs to capture the circumstantial complexities. Perception of nurses on an equivocal clinical occasion, in amalgamation with tolerance level for complexity, can influence the nurse response. Furthermore, there are a range of external and internal context that are associated with the skill of capturing social variations, besides rapid reaction.

Conclusion

A comprehensive systematic inquiry in nursing practice allows nursing professionals to develop their knowledge and awareness on enhancing the quality of care that is delivered to patients. Recent trends show an evolution of the health concept into a multidimensional format. The concept of disease has been the dominant focus in the inspection of the spectacle of health. Application of the critical theory to nursing helped in the establishment of a dialectic vision of health. Conversely, positivism is primarily characterized by the explanations or particular involvements processes that facilitate arrival at a generalised result. Complexity theory has become progressively prevalent in healthcare research over few decades. Thus, the complexity theory is able to offer an exhaustive approach to nursing practice that elaborates on the concept of health.

References

Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=l7stDwAAQBAJ&oi=fnd&pg=PP1&dq=critical+theory+nursing&ots=yVtF_QROfa&sig=KAV0w5UUSmqrQBCflOBEZlvhGi0#v=onepage&q=critical%20theory%20nursing&f=false 

Beuthin, R. E. (2015). Cultivating a narrative sensibility in nursing practice. Journal of Holistic Nursing, 33(1), 98-102. https://doi.org/10.1177%2F0898010114536633 

Chandler, J., Rycroft?Malone, J., Hawkes, C., & Noyes, J. (2016). Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice. Journal of advanced nursing, 72(2), 461-480. https://doi.org/10.1111/jan.12815

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=vzzdCwAAQBAJ&oi=fnd&pg=PP1&dq=ethical+issues+nursing+practice&ots=mNtc9hCvgt&sig=9HgjB1oLGHheU1ipiCRWggzBr4E#v=onepage&q=ethical%20issues%20nursing%20practice&f=false 

Cook, L. B., & Peden, A. (2017). Finding a Focus for Nursing: The Caring Concept. Advances in Nursing Science, 40(1), 12-23. doi: 10.1097/ANS.0000000000000137

Dallaire, C., & Krol, P. (2018). Revisiting the roots of nursing philosophy and critical theory: Past, present and future. Nursing Philosophy, 19(1), e12204. https://doi.org/10.1111/nup.12204

Gathercoal, R. O., Gathercoal, K. A., Seegobin, W., & Hadley, S. (2017). Nurturing constructive change that works: a critical theory-informed model for transforming health service psychologists’ views of people with disabilities. Qualitative Research in Medicine & Healthcare, 1(1). https://doi.org/10.4081/qrmh.2017.6391 

Gortner, S. R., & Schultz, P. R. (1988). Approaches to nursing science methods. Image: the Journal of Nursing Scholarship, 20(1), 22-24. https://doi.org/10.1111/j.1547-5069.1988.tb00023.x 

Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=1OQlDgAAQBAJ&oi=fnd&pg=PR1&dq=ethical+issues+nursing+ontology&ots=eMLwK2Fxu7&sig=cElaHiz9kqz5mWmpkv9fCDdL9Lc#v=onepage&q=ethical%20issues%20nursing%20ontology&f=false

Kitson, A., Brook, A., Harvey, G., Jordan, Z., Marshall, R., O’Shea, R., & Wilson, D. (2018). Using complexity and network concepts to inform healthcare knowledge translation. International journal of health policy and management, 7(3), 231. doi:  [10.15171/ijhpm.2017.79]

Larsen, L. T. (2017). LEGITIMIZING POSITIVE HEALTH FOR ALL A GENEALOGY OF THE WORLD HEALTH ORGANIZATION’S DEFINITION OF HEALTH. Retrieved from https://pure.au.dk/portal/files/120910908/APSALarsThorupLarsenWHOHealthDefinition.pdf 

Lee, Y. S., Ryu, Y., Jung, W. M., Kim, J., Lee, T., & Chae, Y. (2017). Understanding Mind-Body Interaction from the Perspective of East Asian Medicine. Evidence-Based Complementary and Alternative Medicine, 2017. https://doi.org/10.1155/2017/7618419 

Mill, J. E., Allen, M. N., & Morrow, R. A. (2016). Critical theory: Critical methodology to disciplinary foundations in nursing. Canadian Journal of Nursing Research Archive, 33(2). Retrieved from https://cjnr.archive.mcgill.ca/article/view/1638/1638

Mitchell, G. J., Jonas-Simpson, C. M., & Cross, N. (2012). Innovating nursing education: interrelating narrative, conceptual learning, reflection, and complexity science. Journal of Nursing Education and Practice, 3(4), 30. https://doi.org/10.5430/jnep.v3n4p30 

Thompson, D. S., Fazio, X., Kustra, E., Patrick, L., & Stanley, D. (2016). Scoping review of complexity theory in health services research. BMC health services research, 16(1), 87. https://doi.org/10.1186/s12913-016-1343-4 

Williams, L., Rycroft?Malone, J., & Burton, C. R. (2017). Bringing critical realism to nursing practice: Roy Bhaskar's contribution. Nursing Philosophy, 18(2), e12130. https://doi.org/10.1111/nup.12130