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Nursing Knowledge Development:


Relationship to Science
and Professional Practice
Joyce J. Fitzpatrick

Nursing is an evolving discipline, both in its science development (theory and


research) and in its professional practice. At the same time, we have a rich his-
tory of thought from Florence Nightingale to the present-day nurse theorists,
researchers, and clinicians. In addition, today much of nursing science and
professional practice includes integration of nursing knowledge, from the
broad conceptualizations of the nursing models to the level of practice theory.
Nursing conceptual models often are understood as the embodiment of
nursing philosophies, presenting its beliefs, understandings, and purposes.
Flowing from these grand theories are the middle range and practice theo-
ries that are more closely associated both conceptually and practically to the
everyday activities of nurse educators, researchers, and clinicians. This de-
ductive process of knowledge development leads nurses to discover new
ideas and potential applications of knowledge. Scientists also can engage in
inductive processes of building knowledge from their data. Both processes
have relevance in the discipline of nursing.
In addition, nursing conceptual models provide the overall direction
for practice, education, and research. Components of basic and applied re-
search, ethics, and knowledge from philosophical and historical inquiry
can be derived from these broad conceptualizations. The research and
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ISBN: 0-536-26229-2

Conceptual Models of Nursing: Analysis and Application, by Joyce J. Fitzpatrick and Ann Whall. Published by Prentice-Hall. Copyright © 2005 by Pearson Education, Inc.
2 CONCEPTUAL MODELS OF NURSING: ANALYSIS & APPLICATION

professional practice of the discipline also include integration of knowl-


edge from other disciplines, particularly the health sciences.
Although it is imperative to address the process of our knowledge de-
velopment in nursing, the content component of our knowledge develop-
ment is as critical. Both process and content components of the knowledge
within the nursing discipline are embedded in nursing conceptual models
and the middle range and practice theories that flow from these models.
This chapter addresses the following questions: What is science?
What is the nature of knowing in a science and a professional practice?
How do the patterns of knowing of the scientist and professional practi-
tioner complement each other?
Science represents one means of understanding ourselves and our
world. In Kuhn’s (1977) revolutionary view of science, the development
of disciplines is based on the convergence of scientific thought. Kuhn pro-
poses that the predominant model within a discipline is subject to the so-
ciological development of the discipline, and that the processes for
knowledge development are as important as the content that is being de-
veloped. Kuhn’s view includes attention to both the theory and the research
components of science; both are necessary for scientific development.
In a clinical discipline such as nursing, there are two distinct ways of
knowing, requiring different sets of skills (Fitzpatrick, 2002, 2003). Clin-
icians develop knowledge through a process of synthesizing information
quickly. They make clinical judgments based on this rapid synthesis of in-
formation. The more expert the clinician, the more quickly the information
can be synthesized, and presumably the more accurate the clinical judg-
ment. Clinical scholars use knowledge developed through evidence-based
practice to further advance their clinical understandings. Best practices in-
form current clinical practice, and the clinical scholar relies on evidence
from a variety of sources to guide clinical judgments.
One of the ways in which we develop knowledge in nursing as a dis-
cipline is through science. The scientific process provides the means for
this knowledge development. Researchers view the world by examining
each component in great depth. They are much more likely to spend time
cautiously, viewing each detail from many different perspectives and gath-
ering much data before reaching conclusions. The research process takes
things apart, and only after considerable data collection and analyses does
the research arrive at the interpretations and conclusions.
It is not common for the expert researcher also to be an expert clini-
cian. Rather, because a different set of skills is required of each, the most
effective teams for development of clinical nursing knowledge would in-
clude both clinicians and researchers, each bringing their different per-
spectives and their different skills to the knowledge development process.
ISBN: 0-536-26229-2

Conceptual Models of Nursing: Analysis and Application, by Joyce J. Fitzpatrick and Ann Whall. Published by Prentice-Hall. Copyright © 2005 by Pearson Education, Inc.
NURSING KNOWLEDGE DEVELOPMENT 3

Both research and clinical practice are guided by general and specific
understandings of the world. At times, the broad understandings are re-
ferred to as “world views.” Within the nursing discipline, as these models
have become more deliberate and more systematically developed they
have been understood as nursing conceptual models. As models and frame-
works, these structures provide the foundation for development of both
clinical and scientific knowledge. These models provide both the form (or
the structures) and the content on which we base our science and profes-
sional practice. The more specific understandings are referred to as theo-
ries. Both the broad conceptualizations and the specific theories guide both
research and professional practice in nursing.
Nursing as a discipline must attend to both the process of knowledge
development and the content of nursing knowledge. The nurse scientist and
the nurse clinician must have the tools with which to develop their knowl-
edge, at the same time knowing the content parameters of the knowledge
that is to be developed. Multiple modes of inquiry within both research and
clinical practice are warranted, especially given that nursing has staked a
knowledge claim to understandings of the holistic persons and their health.
Nurse scientists and clinicians together can develop knowledge that builds
the holistic framework, thus adding a dimension of knowledge that is not
developed through other disciplines, or through the application of knowl-
edge from these other disciplines to professional nursing practice.
Quality research is rather simple to identify from a general scientific
standard. Peer-reviewed evaluation of the merit of research serves as the ba-
sic criteria, including use of the peer review process in judging both the
award of research funds and the acceptance of manuscripts in scientific jour-
nals. Quality theory is also possible to evaluate, although a different set of
criteria is used. There exists a basic set of evaluation criteria that is consis-
tent across levels of theory. There also exists a set of standards upon which
clinical knowledge can be judged. Thus, each component of knowledge de-
velopment has its own parameters for judging the quality of the work.
Some characteristics are desirable in both clinical scholarship and re-
search. Knowledge development from either approach would be enhanced
by attention to excellence and creativity. At the same time it is important
to attend to the desired outcomes and anticipated products of the knowl-
edge development processes, whether developed through clinical scholar-
ship or research. Outcome-driven models are most valued in contemporary
professional work. Thus, both the clinical and the scientific way of know-
ing in nursing are built on a strong foundation of inquiry, with attention to
both the process and content of the inquiry.
Both clinical scholarship and research are likely to flourish in envi-
ronments where there is support for knowledge development, including
ISBN: 0-536-26229-2

Conceptual Models of Nursing: Analysis and Application, by Joyce J. Fitzpatrick and Ann Whall. Published by Prentice-Hall. Copyright © 2005 by Pearson Education, Inc.
4 CONCEPTUAL MODELS OF NURSING: ANALYSIS & APPLICATION

attention to nurturing of innovation and creativity. Attention to the out-


comes of knowledge development also is an important factor. Improve-
ments in clinical outcomes now serve as important criteria by which we
judge our professional nursing practice. The use of clinical knowledge also
is important in anticipating trends, predicting needs for services, and de-
signing and managing health services. As clinical scholars become more
experienced, it is important for them to assume an active role in creating
the environments in which knowledge development can advance. In addi-
tion, as scientists become more tuned in to the clinical phenomena uncov-
ered by partners in professional nursing practice, they can engage in
scholarship that is directly relevant to health outcomes of the individuals,
families, and communities they serve.
In summary, it can best be understood that clinical scholarship and re-
search together provide the core knowledge on which expert professional
nursing practice is developed. One without the other is not sufficient to in-
form a clinical discipline such as nursing. Rather, clinical scholarship and
research are intertwined and interdependent. Both professional practice and
science benefit from the strengths inherent in a knowledge development ap-
proach that incorporates attention to these interrelated ways of knowing.

REFERENCES
Fitzpatrick, J. J. (2002). The balance in nursing: Clinical and scientific ways of knowing
and being. Nursing Education Perspectives, 23, 57.
Fitzpatrick, J. J. (2003). The case for the clinical doctorate. Reflections in Nursing Leader-
ship, 29, 8, 9, 13.
Kuhn, T. S. (1977). The essential tension: Selected studies in scientific tradition and
change. Chicago: University of Chicago Press.

ISBN: 0-536-26229-2

Conceptual Models of Nursing: Analysis and Application, by Joyce J. Fitzpatrick and Ann Whall. Published by Prentice-Hall. Copyright © 2005 by Pearson Education, Inc.