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HSE3703/1/20092011
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INTRODUCTION
ix
STUDY UNIT 1
HSE3703/1/20092011
PHILOSOPHICAL FOUNDATIONS: INTRODUCTION TO FORMAL

SYSTEMATIC, INSTITUTIONAL AND PERSONAL PHILOSOPHY
1.1
Introduction
1.2
Definition of the term ``philosophy''
1.3
Formal systematic philosophy
1.3.1
Branches of philosophical thought
1.3.1.1 Philosophy of knowledge
1.3.1.2 Philosophy of science
1.3.1.3 Philosophy of mind
1.3.1.4 Moral philosophy
11
1.3.1.5 Political philosophy
13
1.3.1.6 Philosophy of language
14
1.3.2
Components of philosophy
16
1.3.3
Summary
16
1.4
Institutional philosophy
17
1.4.1
The philosophy of the SANC
18
1.5
Personal philosophy
20
1.6
Conclusion
21
(iii)
STUDY UNIT 2
THE OBJECTIVE PHILOSOPHIES
22
2.1
Introduction
23
2.2
Realism
23
2.3
Logical empiricism
24
2.4
Naturalism
25
2.5
Positivism
25
2.6
The downside of the objective philosophies
27
2.7
Implications of objective philosophies for health sciences
27
2.7.1
Subject contents
27
2.7.2
Outcomes or objectives
27
2.7.3
Teaching and teaching strategies
27
2.8
Implication of failures of objective philosophies for

the curriculum
28
2.9
Conclusion
29
STUDY UNIT 3
(iv)
THE SUBJECTIVE PHILOSOPHIES
30
3.1
Introduction
31
3.2
Idealism
31
3.3
Pragmatism
32
3.3.1
The implication of pragmatism for health sciences
33
3.4
Existentialism
33
3.4.1
Implication of existentialism for the curriculum
35
3.4.1.1 Outcomes
35
3.4.1.2 Curriculum content
36
3.4.1.3 Teaching strategies
36
3.4.1.4 The role of the educator
37
3.4.1.5 The role of the student
37
3.4.1.6 Evaluation strategies
37
3.5
Humanism
37
3.5.1
Implications of humanism for health sciences' curricula
39
3.5.1.1 Aesthetics and beauty
39
3.5.1.2 The naturalistic underpinning
39
3.5.1.3 The principle of holism
39
3.5.1.4 Quality of life
39
3.6
Holism
39
3.6.1
Multiple intelligences and holism
41
3.7
Ubuntu (African humanism)
41
3.8
Postmodernism
42
3.8.1
The implications of postmodernism for health sciences
43
3.9
Caring
43
3.9.1
The implications of caring for the curriculum
43
3.10
Phenomenology
43
3.10.1 The implications of phenomenology for health sciences
44
3.10.1.1 Subject content
45
3.10.1.2 The situation analysis
45
3.10.1.3 Nature of knowledge
45
3.11
Summary: the philosophical options
46
3.12
Conclusion
46
STUDY UNIT 4
EDUCATIONAL THEORIES
48
4.1
Introduction
49
4.2
The term ``theory''
49
4.3
Perennialism
50
4.4
Progressivism
51
4.5
Essentialism
52
4.6
Reconstructionism
53
4.7
Feminist pedagogy
54
4.8
Critical pedagogy
54
4.9
Conclusion
55
STUDY UNIT 5
HSE3703/1
LEARNING THEORIES
56
5.1
Introduction
56
5.2
Behavioural learning theories
57
5.3
Cognitive learning theory
57
5.4
Cognitive development theory
58
5.5
Cognitive development: sociocultural historical influences
59
5.6
Adult learning theory
59
5.7
Conclusion
60
(v)
STUDY UNIT 6
(vi)
NURSING THEORIES
61
6.1
Introduction
62
6.2
Elements of a theory
62
6.2.1
Concepts
62
6.2.2
Statements
63
6.2.3
Theories
64
6.2.3.1 Definition
64
6.2.3.2 Types of theories based on their scope
65
6.3
Constructs related to the concept of theory
65
6.3.1
Theory
65
6.3.2
Conceptual model
66
6.3.3
Paradigms
66
6.3.4
Theoretical frameworks
66
6.4
Analysis and evaluation of nursing theories
66
6.4.1
Reasons for theory analysis
67
6.4.2
Describing a theory
67
6.4.2.1 The purpose of the theory
67
6.4.2.2 Concepts contained in the theory
68
6.4.2.3 Definitions pertinent to the theory
68
6.4.2.4 Relationships and relational statements
69
6.4.2.5 Revealing the structure
69
6.4.2.6 Unravelling underlying assumptions
69
6.4.3
70
Critical reflection on theory
6.4.3.1 Clarity of the theory
70
6.4.3.2 Simplicity
71
6.4.3.3 Generality
72
6.4.3.4 Accessibility
72
6.4.3.5 Importance
72
6.4.4
73
Additional points for analysis of theories
6.4.4.1 The theorist
73
6.4.4.2 The aim of the theory and the reasons for its construction
73
6.4.4.3 The development of the theory
74
6.4.4.4 The connection with other theories or views
74
6.4.4.5 The implicit or explicit assumptions of the theory
74
6.4.4.6 What type of theory is it?
74
6.4.4.7 The meta-paradigmatic concepts
74
6.4.4.8 The concepts used in the theory
74
6.4.4.9 The nursing process
75
6.4.4.10 The theory's usefulness in practice
75
6.5
The general importance of theories
75
6.5.1
Importance to health care practice
75
6.5.1.1 Theories as a basis for ethics
75
6.5.1.2 Theories as a basis for quality assurance
76
6.5.1.3 Systematic approach to practice
76
6.5.2
76
Importance for education and the curriculum
6.5.2.1 Theories guide the selection and structuring of subject content
76
6.5.2.2 Professionalisation of health care professions
76
6.5.2.3 Professional developments: the need for direction
77
6.5.2.4 Theories and research
77
6.5.2.5 Additional points
77
6.6
Single or multiple theories?
78
6.7
Patterns of knowing
79
6.7.1
Empirical knowing
79
6.7.2
Personal knowledge and knowing
79
6.7.3
Ethical knowing
80
6.7.4
Aesthetical knowing
80
6.8
An illustration of the application of a theory in the curriculum
80
6.8.1
Orem and the situation analysis
82
6.8.2
Orem and objectives/outcomes
83
6.8.3
Orem and curriculum content
83
6.8.4
Orem and teaching strategies
84
6.8.5
The role of the educator and the student
84
6.8.6
Evaluation strategies
84
6.9
Conclusion
84
STUDY UNIT 7
HSE3703/1
HEALTH THEORIES: THE HEALTH BELIEF MODEL (HBM)
85
7.1
Introduction
85
7.2
Orientation
86
7.3
Core assumptions and statements
86
7.4
Structure of the model
86
(vii)
7.5
Definitions of concepts
87
7.6
Conclusion
89
STUDY UNIT 8
(viii)
CULTURAL THEORY AND THE CURRICULUM
90
8.1
Introduction
90
8.2
Culture
91
8.3
The foundations of intercultural communication
91
8.4
The anthropology of health
92
8.5
Multicultural education
92
8.6
Conclusion
92
LIST OF SOURCES
94
INTRODUCTION
Welcome to the Health Sciences Education module HSE3703, The Health Sciences
Curriculum: Foundation.
On completion of this module, you should be able to ground a health sciences' curriculum
firmly by virtue of your understanding of
& different philosophical orientations
& the values of formal theory in nursing, health, education and learning
& selected elements relating to cultural studies.
The overall activity for this module will require the use of a good English dictionary on all
new words that you will learn. You cannot successfully complete the module without using a
good dictionary like you would any other prescribed book.
This module (HSE3703) is a foundational module for HSE3704 on curriculum development.
The relationship of this module to module HSE3704 is depicted in figure 1.
!
Aims,
goals and
objectives
!
!
Content
!
Situational analysis
!
~
!
Curriculum
presage
Implementation
and modification
Learning activities
Instructional evaluation
Monitoring and
feedback
(curriculum
evaluation)
Phase 1
organisation
Phase 2
development
Phase 3
application
Source: Print, M. 1993. Curriculum development and design. 2nd Edition. St Leonards: Allen Urwin.
Module HSE3703 focuses on the first phase: Foundation. Throughout the current study guide,
activities request that you indicate the implications that different theories and philosophies
hold for the health sciences' curriculum. These implications should be spelled out for all
aspects relating to phase 2 (development) and phase 3 (application) as depicted in figure 1.
To execute these activities you need to keep all previous Health Sciences Education study
guides at hand. Remember to substantiate clearly the implications you list. At the third level,
mere listing of words and phrases is not at all adequate. This will earn you no marks in
assignments or in the examination.
Conquering the content of this module will definitely benefit your understanding and
HSE3703/1
(ix)
conquering of the contents of module HSE3704. The current module also draws on all
previous modules in Health Sciences Education. Consequently, we refer to other modules and
also to prescribed books from these modules. Thus, in addition to this study guide, the only
study guide for HSE3703, you will need to study the sections referred to in the prescribed
books. We further suggest you do some additional reading on these topics for selfenrichment.
The prescribed books for this module are
& Billings, DM & Halstead, JA. 2005. Teaching in nursing: a guide for faculty. St Louise:
Elsevier.
OR
& Billings, DM & Halstead, JA. 2009. Teaching in nursing: a guide for faculty. St Louise:
Elsevier.
& Gultig, J, Hoadley, U & Jansen, J. 2004. Curriculum: From plans to practices.Cape
Town: Oxford University Press.
& Tjale, A & de Villiers, L. 2004. Cultural issues in health and health care. Landsowne:
JUTA.
& A dictionary.
You are also referred to several internet websites.
Recommended reading
Quinn, FM & Hughes, SJ. 2007. Principles and practice of nurse education. London: Nelson
Thornes
We hope that you will find this course stimulating. Please consult us if you have problems
with the tutorial matter or with your study programme. We shall gladly help you.
WHAT THE DIFFERENT ICONS INDICATE

This symbol indicates the learning outcome(s) of the study unit that you are about to
work through.
This little book signifies a request to study or read a specific part of the prescribed
reading. Do this before continuing with the study guide since it provides the
background that you need to understand the work.
When this symbol is used you should spend some time performing the activities in
the block. We recommend that you first try to perform the activities in terms of your
own frame of reference before studying the text below it. Then study the feedback and
check your own work against it.
(x)
This symbol indicates feedback on the activity that you performed. Use the information
to add any points you may have overlooked. This will help you to summarise the work
you have studied systematically for revision purposes.
When you see this smiling face you will know that you have completed the section and
are now ready to test yourself. The ``test yourself'' questions are designed to allow for
revision, while also preparing you for answering objective item questions in the
examinations.
This icon indicates the revision exercises that you may do and which are designed to
allow for revision, while also preparing you for answering essay type questions in the
examinations.
HSE3703/1
(xi)
Philosophical foundations:
Introduction to formal
systematic, institutional and
personal philosophy
The contents of this study unit.
Key words
& Authenticity
& Empirical
& Epistemology
& Jargon
& Methodology
& Moral philosophy
& Ontology
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& Phenomenology
& Philosophy
& Philosophy of knowledge
& Philosophy of language
& Philosophy of mind
& Philosophy of science
& Political philosophy
& Pragmatism
& Qualitative research
& Quantitative research
& Reality
& Reliability
& Validity
1.1 Introduction
1.1
Please read the general introduction to this study guide before starting to work
through it.
Philosophy is a word that is used in many different ways. These include

& describing the obscure and impenetrable musings of the scholars of antiquity
& considering the casual speculations over things of which the individual has little or no
rational or scientific knowledge
& contemplating questions to which we do not know the answer
& reflection on the essence of being and the relationship between the knowing self and
what there is to know
& guidelines for practice pinned up in the office of hospital wards.
All of these uses are to some extent correct if we take philosophy to mean a careful
deliberation of ideas and issues. As defined here, we all engage in philosophy at some time.
In planning a curriculum, we shall do a lot of this. The question is, however, whether it is
good or bad philosophy we engage in.
There are different types of philosophies. For the purpose of this course, we use the following
classification: Formal systematic philosophies essentially describe individuals and their
relation to the world in broad general terms. Institutional philosophies such as the philosophy
of the South African Nursing Council (and other health institutions) may reflect moments of a
number of formal systematic philosophies and set the arena in which a specific profession (or
institution) conducts its work. Personal philosophies reflect the individual's personal opinion
regarding issues of a philosophical nature: the individual, life, meaning in life, right and
wrong, and the like.
The branches of formal systematic philosophy discussed in this study unit serve as an
introduction to the rest of the foundational aspects (philosophy proper, theories) covered in
this study guide. All philosophies and theories discussed later in this study guide should be
scrutinised with regard to the six branches of philosophy discussed in this study unit.
On completion of this study unit you should be able to philosophise about the
implications of the different branches of philosophy for the health sciences curriculum
by virtue of your ability to
&
&
&
&
&
&
&
define the nature of knowledge in your field of work

debate the scientific status of your profession
contemplate the essence of personhood
understand the impact of politics on the work environment
reflect on the importance of clear terminology (language) in the curriculum
appreciate the relationship between being (personhood) and language
delineate the origin of ethics for the health sciences' curriculum
Whatever our view on what philosophy entails and whether it is esoteric and only for the
intellectually informed or whether it is more exoteric and personal, three main areas of
philosophising and philosophy are also identified in this study unit, namely:
& Systematic philosophy
& Institutional philosophy
& Personal philosophy
1.2
What, in your opinion, would constitute ``good'' philosophy?
1.2 Definition of the term ``philosophy''

To produce good philosophy we need to return to the classical definition of the word, as
attributed to Socrates, who described himself as a lover (philos) of wisdom (sophia). Using
this definition we can begin to ask about the nature of wisdom, and then ask if our thinking
has moved us anywhere toward this goal. Wisdom, according to the Concise Oxford
Dictionary is having experience and knowledge together with the power of applying them
critically or practically, and the ability to think and act utilising knowledge, experience,
understanding, common sense, and insight. Philosophy is the pursuit of these by carefully
thinking through and analysing things. Wisdom is the fruit of such thought and analysis. In
analysing this definition of philosophy consider the following:
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& The word act suggests that wisdom is of practical use, and leads to action. It is not just
a matter of contemplation.
& The inclusion of the word experience indicates that wisdom is not purely abstract.
& The words common sense could mean that wisdom does not consist of developing
fanciful and highfalutin ideas, which are unintelligible to the rest of the world. There
should be some common ground between the words of the wise and the ideas of the not
so wise.
& The word insight is a more difficult one as it is often used to describe mystical flashes of
intuition, which presumably cannot be conjured up at will but are something for which
one simply has to wait. Insight can also be thought of as a corollary of understanding,
which is something toward which one can aspire. Insight can also mean to see
relationships among seemingly unrelated things (concepts).
Good philosophy should lead to all of the above. If our thinking leads us to more confusion,
avoids difficult dilemmas, or is inconsistent, it is not wisdom, and not good philosophy. If,
however, as a result of our thinking, we define questions more clearly, tackle difficult areas,
and there is coherence about our conclusions, then perhaps we have done some good
philosophising (Reed & Ground 1997:1). Note the word perhaps. Well-argued fallacious
disputes may reflect some of the same criteria. Caution is the key word.
Talking about philosophy in this way is, however, still very abstract. Following Reed and
Ground's (1997) layout, we have included a number of areas in philosophy that are of
particular relevance to health care. Keeping the action part of wisdom in mind, these authors
have also tried to show how these areas can be brought to bear on problems and dilemmas
that health care professionals face in practice. We trust that by discussing such real-life
(practice) events, the usefulness of philosophy will become clear.
1.3
In this study unit we give limited information on conclusions drawn by Reed and
Ground (1997) on several issues of philosophical importance. Our aim is to involve
you in philosophical discourse in philosophising. Please reflect on these issues.
Involve family and friends in lively discussions. You will find it most stimulating,
satisfying and creative.
1.3 Formal systematic philosophy

Formal systematic philosophy presents us with a model of the individual, what is known as
the philosophical anthropological model. (Also see HSE3705 in this regard.) The view that it
posits about the individual is basic and general and applies to all individuals, all over the
world for all times. It is thus foundational. There are, however, concepts associated with
positing a model of the individual that cannot be disregarded. These are explained in terms of
the six branches of philosophy and our summary of the contents of these six branches of
philosophy.
1.3.1 Branches of philosophical thought

1.3.1.1 Philosophy of knowledge
Philosophy of knowledge is closely related to another term, which you encountered in the
Research in the Social Sciences (RSC201H) module, namely, epistemology. Epistemology
endeavours to answer questions as to the nature of knowledge and truth and how to evaluate
these. This is a central concern in curriculum planning. The knowledge we include in
curricula is presented as truth. This makes knowledge and content selection a serious ethical
and moral issue. We shall consider the nature of knowledge from the perspective of different
formal philosophies and how proponents of these different philosophies define knowledge.
Health care professions are essentially practical disciplines that deal with the physical world.
To many health care professionals the physical world and knowledge derived from that world
is the only reality and the only truth. Accepting that our work deals with the world of physical
experience and has a imperative empirical base still leaves us with the problem of how to
assess and evaluate that base: the empirical world. Often, our senses deceive us, and there is
enough literature on psychosomatic disorders to indicate that the senses of patients also can
deceive them.
So, what do we do about these delusions? One way in which we deal with the evidence of our
senses is to make it public and open to scrutiny. We use measuring instruments that others
can check for validity and reliability. We record our observations so that others can confirm or
question them. In cases where there is agreement, we can at least say that the evidence of our
senses seems to be the same for everyone, and on that basis, we can proceed. However, we
cannot regard this sensory knowledge as anything more than provisional. Someone else may
come along who has a very different experience or who interprets that experience differently.
Where there is disagreement we tend to be more explicit about the provisional nature of
knowledge, we talk of conflicting interpretations, and following these through, looking at their
implications in terms of the action that they suggest. We base the action that we take on our
assessment of the risks involved in being right or wrong. If interpretation X suggests action A,
and interpretation Y suggests action B, we tend to opt for the interpretation that leads to the
lower risk if we were wrong.
This suggests a degree of pragmatism what is true is what works. Our pragmatism,
however, tends to take for granted our idea of what works. To take an example, many years
ago it was common to limit the amount of analgesics administered to terminally ill patients
because they were considered addictive. It took the hospice movement to suggest that what
works in this situation is relieving pain rather than preventing addiction. Health sciences'
knowledge, therefore, must not only be provisional, but must regard its values as provisional
too (Reed & Ground 1997:50).
The existential view of knowledge also has implications for health sciences. The description
that Heidegger gives of a carpenter using his tools without conscious awareness reflects
many situations in health care in which actions take place at some sort of intuitive or
automatic level. This kind of knowledge, however, comes with familiarity and experience. A
novice practitioner or carpenter is unable to operate in this way, the tools feel uncomfortable
or, as Heidegger might put it, they are operating as a subject in a world of objects, they are
not yet `ìn the world'' that is, they are not yet authentic. In teams of health professions
these persons are not yet fully socialised and professional, the ultimate aim of education and
the curriculum we plan and implement.
The different philosophical viewpoints on the nature of knowledge have several implications
for health sciences' education:
Firstly, health care practitioners need to be aware of the provisional nature of the knowledge
that they derive from their senses. Training health care professionals should involve teaching
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them ways of confirming or disputing this knowledge, and of making their processes of
acquisition public. Doing research and verifying our everyday practice are moral actions.
Secondly, the element of pragmatism, and the values on which ideas of `ìt is working'' are
based, must be made more explicit and open to challenge.
Thirdly, the existential (or lived) aspects of knowledge need to be fostered, in that health care
professionals need to have the practical experience necessary for them to become part of the
world of health care (Reed & Ground 1997:51). This suggests that health sciences knowledge
must be both theoretical and practical, and that neither will suffice alone.
Using the idea of all knowledge as provisional, and certainty as relative, allows us to
reformulate the relationship between practical and theoretical knowledge in a different way
as counterbalancing and contributing to each other. Practical knowledge can act as a check
on theory, and theory can act as a check on practice. The development of health sciences'
knowledge, therefore, depends on making this relationship clearer and more explicit (Reed &
Ground 1997:51). In planning and implementing a health sciences' curriculum, the theory/
practice gap and practice/theory gap are notorious, and deserve curriculum planners' serious
consideration.
1.3.1.2 Philosophy of science

Whereas early research in health science followed the traditions of orthodox or natural
sciences developed in the fields of biology, physiology, chemistry, and mechanics, later
research began to broaden its scope to incorporate social sciences' research in areas of health
care where there was a number of different ways of viewing science. The strongest challenge
to science came from phenomenology and qualitative researchers in general, who argued that
it was inappropriate to study the social world in the same way as the physical world, and that
alternative approaches were needed (Reed & Ground 1997:53). With regard to human beings
in health care this implied that statistics were not the only or even an appropriate way in most
times to study the human experience of health, illness and health care.
1.4
Revise the differences that exist between the traditional and the non-traditional views
of science in the study guide for the course in Research in the Social Sciences
(RSC201H). Summarise these differences.
Remember to consult your dictionary on the meaning of these words.
Jean Watson (1985), an internationally renowned nurse theorist and philosopher of

distinction, gives the following contrast between the two approaches:
TABLE 1.1 Emerging alternative nursing and human science context for caring
Nursing science and caring
Traditional medical
Ipsative
Transactional
Metaphysical Humanistic-contextual
Phenomena centred
Value laden; values acknowledged, clarified
Human response to illness and personal
meanings of human condition
Normative
Reductionistic
Mechanical
Method centred
Neutrality of values
Disease centred; patho-physiology, human
body
Human-social ethics morality

More qualitative
Relativism, probabilism
Human as subject
Subjective-intersubjective experience
Experience, meaning
Idiographic and/or nomothetic
Abstract may or may not be seen
Dialectical, philosophical, metaphysical
Science as creative process of discovery
Human = mind-body-spirit gestalt of whole
beings
Existential-phenomenological-spiritual
``Real'' is abstract, largely subjective as well as
objective, but it may or may not ever be fully
known, measurable, observed; what is real
holds mystery and `ùnknowns'' yet to be
discovered.
Ethics of science
More quantitative
Absolute given laws
Human as object
Objective experience
Facts
Nomothetic (generalise)
Concrete observable things
Analytical
Science as product
Human = sum of parts (bio-psycho-sociocultural-spiritual-being)
Physical materialistic
``Real'' is that which is measurable, observable,
and knowable
(Watson 1985:10)
1.5
Study the above comparison between traditional and non-traditional science.
Consult a dictionary regarding those words that you are not familiar to you.
Paraphrase a concise definition of the term ``science'' from the point of view of each of
the two approaches.
Health care practice presents several challenges for the development of a science, and the
definition of health science. The need for facts that will guide decision making suggests that
at one level health care professionals need to support the traditional view of science as
objective and value-free, providing us with indisputable, verifiable, reproducible knowledge.
There is no room to entertain suspicions about research findings as being anything but the
truth. The demands of holistic care, however, suggest that health sciences need to embrace a
number of academic disciplines, some of which do not conform to the traditional view of
science, and indeed form its strongest critics. Individualised care puts this problem into even
sharper focus with the potential for direct conflict between scientific and non-scientific beliefs
about health care (Reed & Ground 1997:71). This conflict is, however, not limited to the
academic and scientific fields, but also involves the fields of anthropology (culture) and
theology (religion).
One of the ways out of this dilemma is to see nursing and other health care practices as both
scientific and artistic. The artistry of health care regards some of the things health care
practitioners do as ``craft'' and, therefore, subject to aesthetic debate rather than scientific
discussion. The idea of dividing health care into the domains of art and science, then, does
not really address the nature of health care science (or health care as a science); it simply
defines the limits of science in a particular way (Reed & Ground 1997:71). If applied to any
other health science, the same conclusion applies. This point should become clearer once
you have completed the section on the different patterns of knowing in study unit 6, upon
which you should be able to both distinguish between and integrate empirical and aesthetic
HSE3703/1
knowing. Aesthetic knowing, or artistry for that matter, is discussed in some detail in study
unit 6.
Another option is to reject the notion of a health care science altogether, and view all practice
as craft. This option rests on the traditional notion of science as objective and abstract. The
anti-science argument rests partly on the grounds that such an abstract science is
incongruent with the very practical and often emotional and lived or experiential nature of
health care. Another anti-science argument relates to the commendatory aspect of the term
``scientific'', that only one which meets with empirically and natural sciences research
methods deserving the title science. The claims of health care to be scientific or a science are,
therefore, regarded with suspicion, as a claim to a higher status for health care, which this
specific field of endeavour does not deserve. This makes ``science'' somewhat elitist. It is also
disturbing that health care practitioners should castigate themselves for claiming more
respect for what they do, but the argument is a little more understandable if it is reduced to its
constituent stages, which seem to be the following:
& Nurses (and other caring professions) should nurse (care) for the sake of their patients
(clients), not for personal glory.
Therefore
& If nurses (and other health professionals) seek personal glory, they are nursing
(working) for themselves and not for patients (clients).
The search for scientific status, it is argued, becomes an aspiration that forgets the ``real''
business of health care.
There are several problems with this argument, not least the difficulty in accepting that one
group can only gain what is to be gained from this, at the expense of the others. There are,
however, some grounds for agreeing that if health care practitioners want health care to be
considered a science only for the status it brings them, then it is not likely that this science
will be developed in order to meet patients' needs (although it may do so unintentionally). In
particular, this may be the case if the science being sought is traditional science, which exists
for itself and its practitioners, rather than the applied, culturally embedded science which has,
until fairly recently, enjoyed a lesser academic status (Reed & Ground 1997:72).
The argument at this point also relates to what science is. Is science only that which is
produced via the natural sciences' quantitative methodologies (research) or is science a broad
systematic structure of usable knowledge and information arrived at via different wellexecuted investigative operations? The anti-science arguments in health care (that health care
is not a science) seem to be based on the traditional notion of science as abstract, objective
and pure. As such, these arguments do have some weight, but if the notion of science is
changed, then this argument becomes weaker. If health care science broadens its definition to
incorporate critiques of traditional science, then it becomes possible to think about a science
that is part of the social world, rather than separate from it, that can accommodate different
explanations of events, and acknowledges the values that underpin it. This sort of science
seems to fit health care better than the traditional description.
But can we do this? Can we simply select the bits of science that we like, and add on bits that
we think are missing without creating something very different? Would the thing that we
create bear little resemblance to the thing that we started with and, therefore, become a nonscience and non-sense? What other problems will arise from this ``new science''? This
problem is related to the different positions that we outlined earlier, which can be described in
this way (Reed & Ground 1997:72):
& Traditionalists
Science is X (where X = objective, value-free, etc).
& Critics
Not only is science not X, but X is not possible.
While it may be possible to live with the idea that science is not X, the idea that X is not
possible creates more serious problems. By treating all science as simply a social occupation
and, therefore, a particular view of the world with no greater claim to truth than any other, we
find ourselves in a world where everything is uncertain, indeed where certainty cannot exist.
For health care practitioners faced with life threatening decisions to make, and things to do,
the idea that the basis of their actions is just another story about the world is very
disconcerting. What we need is a middle way between the opposing views of science. The
antitraditional view of science can be a useful cautionary check to passive acceptance of
scientific findings, while the traditional view of science can be seen as a description (though
flawed) of the process by which particular results were produced. Evaluating findings,
therefore, becomes a matter of placing scientific work in the context of the general
qualifications that can be made about science per se, and the particular conditions that
science aims to meet. When faced with a particular question, therefore, practitioners need to
ask whether it is a question for science, and if so, whether science has answered it in the way
that science does, traditionally. If health care practitioners decide that this is the case, then
the answers that science provides need to be considered in the context in which they were
elicited.
This middle way seems a little weak, hedged with qualifications and caveats; in short, it does
not tell us what can be regarded as true and what as false. Perhaps, faith that there can be
absolute certainty (never mind that science can provide it) is somewhat misguided. In this
regard, negative potential is a useful notion in that it suggests that decisiveness (certainty) is
not an unqualified virtue, and that there may be more merit in regarding knowledge (and
science) as indicative rather than definitive.
1.6
How do you view your profession with regard to the science/non-science debate?How
might this perception influence the type of curriculum you develop or approve of?
Qualify your argument in detail.
1.3.1.3 Philosophy of mind

Philosophy of mind is exceptionally important to health care practitioners and to
understanding health care and related theories. The concept of an individual is one of the
metaparadigms in health care theory. In nursing theory, for instance, the concept of
individual, together with the concepts of health, nursing and environment form the basic
(paradigmatic) concepts in theorising. Philosophy of mind contemplates what it means to be
a person, and addresses the questions as to when and whether the individual starts to be, or
ceases to be, a person.
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Reflect on your understanding of the concept of person.
When does a person become a person?
Write down your notions and reflect on them while studying the following section.
With regard to the question of the cessation of personhood, let us turn to persons with
Alzheimer's disease. If we consider the concept of soul as definitive of personhood, then
personhood remains intact because the soul is generally considered as immortal, everlasting,
permanent. If we apply the notion of experience, personhood in the Alzheimer's patient
becomes problematic because recent experiences, and at a later stage earlier experiences,
cannot be recalled and are therefore ``lost'' and personhood with it. If we apply body
theories, personhood is questionable because of the malfunctioning of the brain. These
theories, therefore, disagree as to whether or not people in the late stages of Alzheimer's
disease are persons. This may be true of any debilitating mental condition.
The notion of being a ``person'' is much more problematic than most of us ordinarily think. At
its heart, the problem is that the notion of ``person'' that we have inherited and which we use
in everyday discourse, including moral discourse, is an all-or-nothing notion. That is, our
notion of personhood does not allow for degrees of personhood. But, the reality of being a
human being is quite different. We need to remind ourselves of this. In health care, we are
familiar with patients who exhibit some, but not all, of the characteristics that we take to be
definitive of personhood; characteristics such as autonomy, reason, independence, presence,
time orientation and the like.
The problem is also not confined to dysfunctional or ill human beings. Perfectly ordinary and
healthy human beings are in exactly this condition, a condition of nonpersonhood, for a
significant period of their lives, namely the period which begins somewhere after their
conception and ends somewhere in childhood. Neither embryos nor foetuses, neonates,
babies or young infants are unambiguously persons. Indeed, much of the debate about the
morality of abortion seems to centre on the question of personhood (or lack of it) of prenatal
human beings. If it is a mistake to try and impose an all-or-nothing notion of personhood on
human beings, then attempts to settle the morality of abortion by appealing to notions of
personhood are doomed to fail. We may, of course, simply stipulate by law that abortion is
prohibited after a certain stage of gestation. However, this does not mean that we have
discovered or even decided what a person really is. Just as we cannot argue that personhood
gets switched on at a particular moment of gestation, so we cannot insist that it gets switched
off at a particular moment of decay or disease. Of course, persons can die and cease to be
persons. But then they do so by virtue of ceasing to be living, or alive, human beings.
In health care, especially, we should not accept the assumption that one's status as a person
is the force that should drive the moral reactions and judgements of others. Even if we were
able to settle the nature of personhood, it would not follow that it should remain at the heart of
moral care and respect. For this will mean that our moral respect is also likely to be all or
nothing and will move us not to admit to the degrees and shades that characterise the real
moral world. We may believe that even human beings at the remotest distances from persons,
namely, zygotes and victims of brain-stem injuries, are not to be treated in just any way we
like, to be used for this or that purpose (eg experimentation). And this is not because we are
overly squeamish or because we fear the slippery slope that may lead us to treating real
persons in the same way. Rather, we may believe that these human beings are deserving of
10
respect and of care commensurate with their nature. No one thinks we should confer the right
to vote on embryos. But, it does not follow that they can be disposed of as mere stuff. Most of
us are saddened, but nevertheless relieved, when our increasingly senile relatives are
prevented from driving a car. But, we do not conclude that they can now be deprived of all
other rights.
In the absence of any objective conception of what it is to be a person, we are in the end
obliged to turn to our experiences and our affective responses. Our affective responses rather
than objective characteristics must drive us morally in this area. And in the hard cases of
abortion, euthanasia and treatment of the very young, very old, very sick and demented, we
have to determine which feelings we are able to live with which feelings we can make part
of our own identity as persons, relatives and health professionals. So, in the end, the question
we have to face in health care is not `àre they persons?'' but rather ``what kind of person do I
want to be?'' We need to think about how we want to act toward others, rather than how those
others require action from us by virtue of definitions of personhood (Reed & Ground
1997:9293).
1.8
In what way could philosophy of mind influence curriculum development? For
instance, what kind of knowledge, experiences, and subdisciplines would you include
in the curriculum to provide for ``mind'' or personhood?
1.3.1.4 Moral philosophy

Applying moral and ethical theory directly to the dilemmas faced by health care practitioners
is a difficult thing to do, because of the complexity of the reality in which they work. (See
module HSE3705 in this regard.) A frequent dilemma that health care practitioners face is that
there is no single course of action that can be regarded as universally ``good'' by any criteria.
This is often because of the following:
& Health care professionals work in an area notoriously plagued by resource constraints.
They are constantly balancing the needs of different patients.
& What may help one patient may adversely affect another.
& What is acceptable practice to one client may not be to another.
& Personal moral values may not be supported by professional codes of ethics, legislation,
patient culture, religion and the like.
So even if a health care practitioner has only one patient to care for, this does not always
simplify decision making, because the complexity of health care actions and decisions is
rarely unequivocal (Reed & Ground 1997:109).
This point becomes more apparent when we consider the notion of holism, which informs
much of our current thinking about health care. Rather than reducing patients to constitutive
physiological systems or disease processes, holism exhorts us to treat the patient as a whole,
and to recognise the relationship between social, physiological and psychological aspects of
life. We are, therefore, aware that intervention in one of these areas may well affect others.
Health care practitioners, therefore, are obliged to consider the effect of their actions on the
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whole of the patient. The way that an injection is given, for example, can affect more than the
patient's physiology it can affect their psychology too in the way that they become more or
less anxious about treatment. Even if consideration is given to only one aspect of care (and in
general health care this would usually be the physiological), the whole of that aspect or
system is part of this consideration. Giving a powerful analgesic to a terminally ill patient, for
example, might not only control pain, but it could have an impact on other aspects of
physiology, perhaps respiratory function, and as such might shorten the patient's life.
These micro debates are engendered by the pragmatics of care, but they are not simply
pragmatic debates they also extend to, and incorporate, debate about persisting ethics or
values. The example of a patient being given analgesia, which may effectively shorten his or
her life, not only involves simply a debate about choice of drug, but can also be cast as one
that concerns the principles of doing good or beneficence (controlling pain) and preserving
life and not doing harm or non-maleficence (creating respiratory problems). In situations like
this, although the basic ethical principles might be well understood, their application to health
care dilemmas is far from straightforward.
Health care questions about the ``right'' thing to do, therefore, require more detailed
discussion than simply references to the often abstract debates of ethical theories and values.
Where actions have more than one consequence, and we would argue that this is the case in
many health care dilemmas, appealing to principles alone is likely only to reveal a conflict
between principles, and is unlikely to provide guidance in resolving conflict. The juggling of
perspectives is, therefore, inherent in health care.
Many other areas of human life demonstrate the same problems. However, health care, due to
its object of concern (human beings in need), shows our moral thinking more clearly. The
seemingly endless debates we may have about how to discipline children, whether to tell
colleagues the truth about their work, or whether electricity should be shared, can remain just
that, debates, for many of us. Where health care is concerned, however, the image of the ill or
suffering patient/client sharpens ethical issues.
It is a mistake to think that the moral high ground is both unreachable and inhospitable and
that there is something wrong with trying to occupy it. Actually, we live on high moral ground
all the time there is nowhere else to go. This is most pertinently stated in module
HSE3705. So, we may think about the use of ethical theories in the following ways:
& Moral thinking is not a matter of applying moral theories. It is a matter of seeing the
world correctly. But this requires moral vocabulary. The role of theory is to supply that
vocabulary. This is also true of all theory and disciplines you have been introduced to at
Unisa. Exact vocabulary can avoid many a legal and ethical situation.
& Moral thinking is about negotiating our way around the myriad different points of view.
& Moral thinking is not an optional extra, but a standard fitting for human life.
Thus, we can see ethical theory as a way of thinking rather than supplying ready-made
conclusions to our thought (Reed & Ground 1997:110). This point is also taken up again in
module HSE3705, in which we discuss ethical decision making and being able to live with
choices made during this process.
12
1.9
What guidance may moral philosophy provide regarding the development of a
curriculum in any of the disciplines in the health sciences?
How will you provide for moral philosophising in the curriculum?
1.3.1.5 Political philosophy

The term ``politics'' does not necessarily refer to party politics, the political party we support,
or the way that the state runs our daily affairs. In essence, politics has to do with power. This
often causes our private political agenda to be less than considerate toward others. As
Marquis and Huston (1994:176) indicate: ``the games being played in our job settings cripple
our ability to be powerful, effective participants in the world of work.'' Power, which is the
ability to obtain, retain, and move resources, requires two sets of attitudes: competence and
political savoir-faire. Much attention is given to improving competence, but little time is spent
in learning the intricacies of political behaviour. The most important strategy is to learn to
``read the environment'' through observation, listening, reading, detachment and analysis.
Networking and lobbying are used to refer to this ability to read the environment. In immoral
terms this may well become conniving.
1.10
Reflect on your work situation. Identify the ``political play'' that is involved in your
situation. Who are the people involved? How does this affect you? Is this personal
``playing'' in each case, or are these well established institutional politics and policies?
Ideas about politics, the best way to run a state, what the concepts of freedom and
justice mean, are all of immediate relevance to health care. They not only determine
the large-scale organisation of health care, but also affect the immediate decisions that
health care practitioners make at the point of care delivery. Whether practitioners work
in a health care system that allocates health care on the basis of ability to pay, or sees
health care as a right, they are working in a politically directed system.
1.11
Identify the political system in which you are working in terms of the previous
paragraph.
What are the implications of this political system regarding patients' dignity, equality,
patient rights, and so on?
Reflect on these issues as you read the rest of this section.
Ideas and debates in political philosophy can also help to inform many current debates about
health care practice and theory. For instance, humanistic psychology, humanism and
existentialism, which stress the facilitation of personal development, can be linked to ideas
about equality of opportunity and ideas about liberty, and can be helpful in putting health care
intervention in context.
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Political ideas are not, of course, the sole determinant of health care practice, but their
importance is undeniable. Some would argue that politics is simply about what happens in
the political world and that health care practice takes place in a different, personal arena.
Feminist theorists have argued, however, that the personal is political. The common concerns
of health care practitioners and political philosophers are closer than many would think
possible (Reed & Ground 1997:127).
It is also important to be aware, to read the general climate in the political sphere. For
instance, what about the fact that the responsibility and accountability for the deaths of a
statistically unaccountable number of neonates in a hospital merely vanishes somewhere
between individual, institution and the state? The same question can be asked regarding
grants provided for different categories and groups of people. Is it good or bad? What does it
tell us about the larger scene? Please note that such questions should not, although they
usually do, stem from suspicion, negative attitudes and the like. Political contemplation
(philosophy), like any other contemplation, should be balanced and well deliberated.
1.3.1.6 Philosophy of language

We are quite convinced that we have all experienced the inadequacies of language at some
time in our lives. It often happens that we say something, while intending to say something
quite different. Or, we say what we actually want to say without the intention of hurting
someone, but it is experienced or interpreted as hurtful.
1.12
Reflect on a recent incident in which what you said was either incorrectly interpreted or
came out in a different way to what you intended.
How could you have avoided this incident?
List a number of incidents in which patients understood you incorrectly.
Why did these misunderstandings occur? What was the result of these
misunderstandings?
Lets us consider the issue of talking about the elderly (to some a very sensitive issue). The
problem of finding words to talk about older people can be summarised as follows. If we say
the `èlderly'' cannot be defined, how can we sensibly talk about them? On the other hand, if
we can define them, do we run the risk of stereotyping them? The feeling is that we can only
talk about them as a group if we understand what makes them members of that group; if
we pigeon-hole them. But we should not put real individual people in pigeon holes (Reed &
Ground 1997:142).
What we need, therefore, is to think of language use rather than language accuracy, and to
use the notion of group resemblance, rather than search for exact characteristics, which will
make our use of words routine and unquestionable. We can then talk of ``the elderly'' as being
a term that does not convey universally shared characteristics within the group it refers to, but
which covers a range of different characteristics, lifestyles and health problems, none of
which is found in all members of the group. In this way, the term becomes a useful way of
thinking about the group without labelling individuals.
This does not mean that language is unimportant. Language is perhaps the single most
14
important achievement we humans have attained. Complex language separates us from other
mammals.
We also need to recognise that the language we use is not something separate from what we
are doing in using it. We do things with our words. The way language is used can, for
instance, be pejorative (think of words such as `àffirmative action'', and ``rationalisation'').
Language can also become offensive. As health care practitioners, we need to be careful and
thoughtful about our language, precisely because we ``do things'' with our words we
comfort, admonish, demean and support with what we say. Furthermore, we need to be aware
of these complexities when we listen to those for whom we care; their language ``does things''
too. Philosophical discussion about language is not only applicable to practitioners'
language, but also to clients' language, and even more importantly, it is applicable to the
interaction between practitioners and clients.
The problems that health care practitioners encounter with language can be intrinsic to health
care, in that it concerns mainly the language that practitioners themselves use. This involves
the often criticised use of technical terminology in health care. Although it is scientific
terminology that makes science, it is of utmost importance that that terminology be
understood in the same context. It is also specific disciplinary and academic terminology that
makes for clear understanding in these fields: the reason why we insist on students learning
new words, defining these pertinently and using these correctly. This is often, incorrectly,
considered to be jargon. Jargon is the use of specific terminology in general conversation. If
a physician uses medical terminology that is confusing to patients, that is jargon. Strictly
speaking, one cannot use jargon in a scientific and academic field. If it sounds like jargon,
one needs to catch up on terminology! Another point of importance in language issues
intrinsic to health professions is the use of abbreviations or slang terms as a form of
shorthand that can convey messages quickly to other practitioners. As such, these also need
to follow rules about clarity and brevity. The use of abbreviations and slang can also display
membership of a particular group, in which case the reason for using certain language is
about uniformity. For instance, the term ``cabbage'' is used to talk about coronary artery
bypass grafting. The jargon is clearly quicker and simpler than using the full term. When
practitioners use it in talking to each other, it presents few problems. If, however, the term is
used in conversation with a patient or visitor it can produce disconcerted or distressed
responses. Being told that the patient in the next bed is `à cabbage'' has many other
meanings. If the language game is about giving sympathetic and reassuring information, then
``cabbage'' clearly will not do (Reed & Ground 1997:143).
What we do need to do is to think about what it is that we wish to say, what we actually say,
and how it may sound. This has implications for much of the research into communication in
health care, which typically attempts to classify communication as being therapeutic, social or
instrumental, for example. When observing practitioners talking to clients, such researchers
then try to count the frequency of the different types of communication and/or to describe the
nature of the language used. Such research seems to rely implicitly on the idea of the
language game of practitioners/client communication being bound by certain rules, and
compliance with these rules is used to classify observations as examples of ``good'' or ``bad''
interaction. The questions that we must ask about this sort of research, however, are not just
about the findings, but whether the researchers have the right game in mind.
More generally, the philosophical discussion of language has relevance for much other health
care research, particularly when it involves talking to clients or practitioners. It may be useful,
for instance, to think of the interview as a particular sort of language game, and one for which
different participants may well have different sorts of rules.
Endless disputes tend to provoke the reaction that we are doing nothing more than playing
around with words. But sometimes, playing around with words is just what we need to do
HSE3703/1
15
because the words we use structure the way that we think. We often need to ``play around''
with the way we think in order to find new ways of thinking. For instance, while it is true that
some disputes about the concepts of health care can seem semantic; this does not
necessarily mean that they are nothing more than semantic.
Language is constitutive of our relationships, but it is not the only component of those
relationships. The relationships that we have with patients and clients are constituted by our
(and their) environments, motives, attitudes and beliefs. Language, however, is the main way
in which we convey and construct these relationships, and by examining our language we can
come to examine these other elements as well. Language is not something that comes from
outside us; it is not external to our life. Yet it is not entirely internal either: we do not all have
private languages. Language is therefore a social, interaction thing, and as health care
practitioners who are engaged in social, interaction practice, we need to place our disputes
and definitions and language use in this context.
To indicate how important language is to us humans, engage in the next activity.
1.13
Imagine what it would be like to be without language.
Could you do this? No! The reason is that you needed language to do it. We live in
terms of language. If we do not have language, we have nothing! So improving one's
language agility is really about improving one's life, one's lived experience.
1.3.2 Components of philosophy

Billings and Halstead (2009:107108) (2005:128130) discuss three components of
philosophy. Study these three components and integrate the information from these authors
with that contained in this study unit:
& Metaphysics (Billings & Halstead 2009:107) (2005:128)
& Epistemology (Billings & Halstead 2009:107) (2005:129)
& Axiology (Billings & Halstead 2009:108) (2005:129130)
1.3.3 Summary
In summary, we agree with Joseph's (1985:25) statement that there are three central issues
with which any philosophy must deal. Looking closely you will find that they accommodate
all six branches of philosophy, although these may overlap. The three central issues are the
nature of reality, the nature of knowledge and the nature of value:
16
The nature of reality

In this regard, the following questions must be considered and answered:
& What does it mean to exist in the world?
& Do we have specific criteria for the quality of that existence?
& What part does the individual play in the world?
& Do we strive to deal with issues that exist in the real world?
The nature of knowledge
This pertains to the specialisation field in philosophy called epistemology. Knowledge,
naturally, is of utmost importance to education, including nursing education and education in
other health sciences. We shall consequently spend more time on this issue later in this
section.
The questions to be answered in this instance are the following:
& What are our beliefs about knowledge and how should it be generated?
& Is knowledge intuitive or is it scientific? (Or, could we accept both?)
& How does a person acquire knowledge?
& Does the learning environment support and enhance the acquisition of knowledge?
The nature of value
The relevant questions in this instance include the following:
& Do we believe that individuals are basically good or evil?
& Who determines the destiny of the individual?
& Do we have an appreciation of the value system of many cultures or do we impose our
own value system?
These questions also need to be answered in relation to curriculum issues. In this section it is
our main objective to guide you toward analysing philosophies according to the above three
issues and to apply the insights you gather from this to the components of the curriculum,
namely: outcomes, subject contents, learning and teaching experiences and strategies,
including the roles of the educator and the student, and evaluation and assessment. Although
this may seem rather theoretical and impractical at this point, we assure you that it is not.
Please consider the next activity.
1.4 Institutional philosophy

At a more specific level, institutional (and personal) philosophies are constructed loosely,
based on one or more of the more general and systematic philosophies. In this instance we
look at the South African Nursing Council's philosophy. Remember, if you are not in the
nursing profession or resident in South Africa, you should obtain the philosophy of the
Nursing Council or other registering body governing your profession in your country. If no
such registering body exists, please obtain a copy of the philosophy of the SA Nursing
Council and study it as an example of an institutional philosophy.
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An institutional philosophy is a guide or a framework for action. It identifies what are believed
to be the basic phenomena (pillars) of the discipline on which the institution focuses
(Salsberry 1994:13). Essentially, an institutional philosophy reflects the values and beliefs
held by members of an institution or profession about the nature of the work required to
achieve the mission of the organisation. An institutional philosophy, therefore, states what the
institution's (profession's) practice is and sets the stage for developing goals to realise these
beliefs (Wise 1995:169). In the health sciences a philosophy and mission statement are
beneficial only if they direct patient care. Each unit within an organisation should use the
organisational philosophy and each individual professional should have a personal
philosophy that corresponds to the organisational philosophy (Marquis & Huston 1994:61).
An institutional philosophy is, therefore, stated in such general terms that it would
accommodate an array of individuals' personal philosophies.
The philosophy of a service is the amalgamation of the vision, mission and value system of
the organisation. These statements describe the service conceptually, the specific context in
which the service operates.
1.4.1 The philosophy of the SANC

As an example of an institutional philosophy, we are now going to analyse the philosophy
and policy of the South African Nursing Council with regard to professional nursing
education. South African students should be in possession of this document as part of their
practical work. If not, please obtain a copy of this document from the Council without delay.
1.14
Critically analyse the philosophy and policy of the South African Nursing Council with
regard to professional nursing education, and answer the following questions:
& What is Council's view of the individual, the environment, knowledge and value?
& What are the implications of the SANC's philosophy for curriculum planning?
& How do the six branches of philosophy figure in the SANC's institutional
philosophy?
Once you have worked through the module, return to this activity and answer the
following questions as well:
& Of which formal philosophies do you find traces in the SANC's philosophy? Put
differently, which formal philosophies are accommodated, one way or another, by
the SANC's philosophy? (Please substantiate your answer fully. Also give a clear
reference as to which paragraph or definition in the document you are referring
to.) (If you are not resident in the RSA, you should obtain the philosophy of the
Nursing Council or other registering body governing your profession in your
country. If no such registering body exists, please obtain a copy of the
philosophy of the South African Nursing Council.)
18
SANC's perception of the individual

Let us consider Council's definition of the individual (the person); this is item 3 on
page 6 of the Council's philosophy.
& A total being, indivisibly body-psyche-spirit in inseparable dynamic
involvement with God/Supreme Being, self, fellowmen, time and world.
& The person as a total being is the concept that reflects the essence of the
person as a multi-dimensional, indivisible being: body-psyche-spirit.
& Self is the awareness of being a person, an individual with a separate
identity.
The implication of this view of the individual implies, among other things, that
curriculum contents should
& be comprehensive and integrated, as a holistic stance is evident
& include the biological sciences, the humanities, human sciences and
religious studies because the individual is viewed as a total being, indivisibly
body-psyche-spirit in inseparable dynamic involvement with God/Supreme
Being, self, fellowmen, time and world.
The purpose of nursing education

Now look at the purpose of nursing education as stipulated in paragraph 1.5 of the
SANC's philosophy. The purpose of nursing education as put forward by Council also
refers to the comprehensive nature of nursing education by stating that education
should lead to cognitive, affective and psychomotor development of the individual
students. The fact that student nurses are defined as adults in paragraph 1.5 of the
SANC's philosophy also implies that the principles of adult education (andragogics)
should be applied, reflecting the humanistic approach to education.
The learning process

Now consider paragraph 2.8 of the SANC's philosophy.
Council's insistence that the learning process ... be directed towards the continued
personal and professional development of the nursing student as an adult reflects
moments of the existential tenet of human becoming (Homo viator).
There are many more implications in the SANC's philosophy. It is up to you as a
student to identify these and to substantiate their meaning for the health sciences'
curricula.
At this point, turn to the prescribed book and study the following section:
& Philosophy and mission (Billings & Halstead (2009:113115) (2005:9496)
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1.5 Personal philosophy

Now that you have completed this introduction to the philosophical foundations of the health
sciences curriculum, it is time to determine whether this has brought about any change in
your knowledge and thinking. Please do the following activities:
1.15
State your personal philosophy regarding the individual, knowledge, the environment,
values and nursing. Use the following questions as guiding questions. Try to be
honest when answering them. Do not merely give ``scientific'' answers. Interrogate
yourself. Be honest with yourself.
& What makes for personhood?
& When does one become a person?
& When does one cease to be a person?
& What are the implications that might occur regarding healthcare and
education?
& What is the relationship between person and environment?
& What is implied by ``the environment''?
& Are there different spheres of `ènvironment''?
& What does health entail?
& What does illness entail?
& How do health and illness relate to person and personhood?
& What is knowledge?
& How does knowledge relate to the environment and experience?
& How does knowledge relate to person?
& Is personal knowledge and knowing really knowledge?
& What is science?
& What is scientific knowledge?
& How does personal knowledge and scientific knowledge differ?
& Which type of knowledge is the more acceptable one?
& What are your values relating to the individual (environment, health,
knowledge)?
& What about the individual is ``valuable''?
& What makes an individual valuable?
20
& Why should one value others, the environment, health, values, knowledge,
experience and the like?
& How do the six branches of philosophy reflect in your personal philosophy?
Having answered these questions, consider the implications they might have for the
curriculum you would design.
1.6 Conclusion
In this study unit, we introduced the concept of formal systematic philosophy, institutional
philosophy and personal philosophy. We discussed six branches of formal systematic
philosophy, as well the SANC's philosophy as exemplar of an institutional philosophy, and
we touched on formulating a personal philosophy or statement of conviction.
All philosophies and theories discussed later in this study guide should be scrutinised with
regard to the six branches of philosophy discussed in this study unit. Some of the questions
we need to ask with regard to these branches of philosophy are
& What type of knowledge does this philosophy or theory endorse?
& How does this philosophy or theory define science?
& How does this philosophy or theory define the individual person?
& What are the moral and ethical implications of this philosophy or theory?
& Does this philosophy or theory imply political influence over practice?
& What is the language of this philosophy or theory? What are key concepts in these
structures?
In-depth contemplation of these questions in relation to one another and within a specific
philosophy or theory (learning or health care theory) might help one develop a
comprehensive and integrated curriculum.
In the next study unit we shall consider a number of formal systematic philosophies that had,
and still have, bearing on health care curricula, before we proceed to more specific thought
structures, namely, educational, learning and nursing (health care) theories.
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The objective philosophies
The contents of this study unit

Billings, DM & Halstead, JA. 2005. Teaching in nursing: a guide for faculty. St Louise:
Elsevier
Or 2009 edition
Key words
& Axiology
& Determinism
& Epistemology
& Logic
& Logical empiricism
& Natural sciences
& Naturalism
& Objectivity
& Positivism
22
& Prediction
& Received view
& Verifiability
2.1 Introduction
In this study unit we are looking at, according to our ``classification'', positivist oriented
philosophies and the implications these hold for the curriculum. The philosophies we discuss
in this study unit can also be discussed as more objective in the traditional sciences terms.
These philosophies also take a deterministic stance. In most of them there is more or less of
a divide between the thinking being and that which we think about. Knowledge for the better
part is received; it comes from out there. Measurement, exactness, sense observation and the
like are all important to these philosophies. Science is discussed along more or less natural
sciences lines and knowledge (and epistemology) is viewed accordingly.
While studying these philosophies you need to keep the six branches of philosophy in mind.
In addition you need to consider the implications of these philosophies regarding the health
care curriculum, including content (the epistemological implications, philosophy of
knowledge, morality, science, language), implications for learning and teaching (personhood
and mind), and the general educational setup (politics).
We reiterate that the different philosophical orientations place different emphasis on issues
such as personhood, the environment, truth (knowledge), morality, and the like. For this
reason, the philosophy you adhere to will influence all aspects of the curriculum you design.
It is, however, also true that in designing a curriculum for an area in health care, one is more
often than not compelled to involve two or more philosophical traditions. One of the reasons
for this is that in the application of many natural sciences principles (objectivity) in the lives
of experiencing human beings, we also need to provide for such (subjective) experiences in
our philosophy. With regard to the latter, we shall continue with this in the next study unit.
On completion of this study unit you should be able to indicate the implications the
objectively oriented philosophies may hold for curriculum design by virtue of your
ability to do the following:
.
.
.
.
identify the objective philosophies

discuss the tenets of these philosophies
explicate the term logic
indicate the implications of these philosophies for the curriculum and curriculum
development
2.2 Realism
Realism is a nature-centred philosophy (Zais 1976:139). This represents the logical-empirical
scientific approach according to which the physical world is studied in an attempt to gain
knowledge. Truth is that which is scientifically verifiable. Mechanistic explanations are given
to explain the nature of the world and the world of individuals. Truth and human conduct and
behaviour are studied, explained and predicted according to laws of nature (natural laws). A
deterministic view of the world is maintained that is, it is believed that with the necessary
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information and tools, the past can be reconstructed and the future predicted. This rests upon
the principle of cause and effect. The world is studied via human senses and reason. Ideas are
the description of things that exist outside the individual. Good is pursued by conforming to
the laws and rules of nature (Bigge 1982:62; Ornstein & Hunkins 1988:2910; Zais
1976:123145).
2.1
Study the paragraph on Realism in Billings and Halstead (2005:131) (2009:109).
Integrate what these authors say with the contents of this study unit.
2.2
Based on the little bit of information on realism and your existing knowledge of the
branches of philosophy, to what conclusions do you come regarding the implications
that realism holds for health sciences curricula?
2.3 Logical empiricism

According to Higgs and Smith (2002:3) logical empiricism, as part of rationalism, claims that
``truth is found by looking at hard facts''. In this resides the notion that truth can be
discovered. This discovery relates to empiricism (often also referred to as logical positivism
or positivism). Like rationalism, empiricism claims that truth can only be determined by
sense experience. (This must be distinguished from experience as defined by the more
subjective philosophies in the next study guide.) The emphasis on sense experience is
founded on the belief that only knowledge arrived at in that way can be tested and checked.
With regard to science, research and curriculum contents, empiricists take all scientific
statements as empirical statements, statements based on what scientists say and what they
have discovered as truth via scientific methods (Higgs & Smith 2002:5). This also relates to
the empirical pattern of knowing discussed in study unit 6 and should be studied and
understood in those terms too.
The logic part of logical empiricism, which clearly indicates its ties with rationalism and
rationality is contained in four ways:
& In formal logic. According to Higgs and Smith (2002:4) formal logic, a branch of formal
philosophy, is similar to pure mathematics. Consider the following: If A=B and C=B;
then C=A.
& In mathematical propositions such as Y x Y = Y2
& In statements that are true by definition, such as: `À light bulb can either glow or not''.
& In strictly deductive reasoning such as:
Jane is a woman.
All women have long hair.
Therefore, Jane has long hair.
(Note that the outcome of the logical is not necessarily actual.)
24
2.3
Based on the information on logical empiricism and your existing knowledge of the
branches of philosophy, to what conclusions do you come regarding the implications
that realism holds for health sciences curricula? Add these to the list of implications
you have already started to compile.
2.4 Naturalism
Within the deterministic philosophy, and consequently related to empiricism, rationalism and
the like, the viewpoint of naturalism is perhaps the most harsh one. According to this
viewpoint, nature is the only reality. The physical universe is all that is. A spiritual dimension
that is any different to the natural is looked upon with some scepticism from a scientific point
of view.
2.5 Positivism
According to Urmson (1985:230), positivism in the broader sense `ìs the view that since all
genuine knowledge is based on sense experience and can only be advanced by means of
observation and experimentation, metaphysical or speculative attempts to gain knowledge by
reason unchecked by experience should be abandoned in favour of the methods of the special
sciences''. Hughes (1983:16) draws attention to the fact that what is called positivism is often
also referred to as naturalism, empiricism, behaviourism, or even science. In broad terms,
positivism refers to quantitative research. (You will be further introduced to this concept in
research modules as part of your study programme.) Our point of view is that positivism
embodies that application of the natural sciences and empiricist approach to the human
sciences and humanities that is using sciences to investigate human qualities such as found
in psychology, sociology, the health sciences and the like. As such, positivism has strong
epistemological implications; it can be seen as a way of doing science within the humanities.
According to Hughes (1983:20), positivism thus supports objective philosophies as it shows
the following elements:
& Reality consists essentially of what is available to the senses.
& Philosophy, while a separable discipline, is parasitic upon the findings of science.
& The natural and social sciences share a common logical and methodological foundation.
There is a fundamental difference between fact and value. Science deals with the former while
the latter represents an entirely different order of phenomena beyond the scope of science.
However, in social sciences, positivism rejects the view that all human qualities are beyond
the scope of science, but the methods by which this is investigated stay the same. There is,
therefore, a single scientific method, the way we see it: Positivism. (Note that this viewpoint is
later contradicted by phenomenology in study unit 3.)
Only two forms of knowledge are recognised as having any legitimacy and authority, namely,
the empirical and the logical. The former is represented by the natural sciences and the latter
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by mathematics. In positivism and in qualitative research, these two come together in the
application of statistics. According to Hughes (1983:21), by far the greater importance is
attached to the empirical. In this respect, it is said that all our ideas come in one way or
another from experience. Experience is defined, naturally, not as an inner personal emotional
awareness, but in terms of a sensory interpretation of experience, that is, an interpretation that
posits the independent existence of an external world made known to us by its action on our
senses. The knower contributes very little to the organisation of such experience. It is this
notion that forms the basis of the application of natural sciences in the form of positivism in
the human sciences. As such, positivism is fundamental to epistemology, or the question as
to what knowledge entails. And for positivists. like other objectivists, knowledge is the result
of the application of the natural sciences methodology of measurement, replication,
verifiability, experimentation, control, prediction, and so on.
From the above, it is apparent that positivism also holds a deterministic perspective. Putting
it differently, what one comes to know, is received from the outside. This places positivism
within the received view of science, the opposite of which is the perceived view, which we
shall discuss with more subjective philosophies in the next study unit.
According to Webster and Jacox (McClosky & Grace 1985:22), the following doctrines are
hallmarks of the received view:
& Theories are either true or false (and it is very important to determine which).
& The more mature or developed theories must be formalised.
& Theories must also be axiomised.
& The physical sciences are basic, especially physics.
& All descriptively meaningful statements are either analytic or empirically verifiable.
& The context of discovery is unimportant for the evaluation of scientific theories.
& The purpose of science is to predict the occurrence of events.
& Science has nothing to say about value.
& Science progresses by reducing earlier theories to later theories, and by reducing less
basic to more basic sciences (reductionism in two senses).
& There is a single scientific method.
2.4
Continue with the previous activity. Add these to the list of implications you have
already started to compile.
2.5
What negative elements might be harboured by the objective philosophies? What
aspects of the six branches of philosophy do they not define clearly?
26
2.6 The downside of the objective philosophies

Not withstanding the immense importance of the natural sciences, or the objective sciences,
empiricism, logical empiricism and positivism, realism at large failed in the following:
& Many factual statements are debatable. For this reason we have a judicial system
because the facts different people give about the same happening may differ, scientists
themselves differ about scientific facts.
& Logical empiricists fail to explain how what we say, what we see, and the mental
processes involved in this are linked together. Mind is often very much out of the
picture.
& Naturalism negates human spirituality, God and the like.
& Logical empiricism also fails to explain how an objective fact in the world becomes a
language statement; how fact is translated into language. (This is a point that
phenomenology addresses in detail, and we will look at this in study unit 3) (Higgs &
Smith 2002:9).
2.7 Implications of objective philosophies for health sciences

This section serves as feedback on your previous activities.
2.7.1 Subject contents

Naturally the subject content to be included should be scientific: that is, it should be from the
natural sciences world and, if from the humanities, then only include knowledge that was
arrived at through positivism. Thus the curriculum will include science subjects such as
anatomy, physiology, chemistry, biophysics, pharmacology, biochemistry, pathology and the
like. Knowledge from the humanities to be included in the curriculum should be in the form of
formally structured theories including both descriptive and inferential statistical data.
Knowledge, in a way, may be fragmented.
2.7.2 Outcomes or objectives

With the precise, exact and objective nature of the knowledge component of the curriculum, it
is quite understandable that behavioural objectives will be spelled out in detail. It may be
quite a challenge to objectivists to state broader outcomes.
2.7.3 Teaching and teaching strategies

As the curriculum is subject-centred, accommodating different knowledge of the laws of
nature as revealed by the natural sciences, is a major source that allows the individual to
know the world. So adherents to the objectivity oriented philosophies will be inclined to
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& focus on logic and on exercises intended to train the mind to think rationally
& focus on expert knowledge
& focus on students conquering and regurgitating knowledge (Remember, facts are facts
and should be learnt. They can only be changed by observation of better facts science
and positivism.)
The educator controls the learning environment to ensure the desired effect. Whatever exists
(is) does so in a certain amount or quantity. Everything can therefore be measured. For this
reason, measurement and allocation of marks (percentages) are important principles in the
evaluation of learning from the point of view of realism (Bigge 1982:6263).
A strict naturalist perspective would also emphasise that
& education must conform to natural processes of growth and mental development
& education should involve in spontaneous self-activity on the part of the learner
& acquisition of (pure) knowledge is an important part of education
& instruction should be inductive
& punishment should consist of the natural consequences of wrong deeds
2.8 Implication of shortfalls of objective philosophies for the

curriculum
The shortfall of empiricism as reflected by Higgs and Smith (2002:9) is presented as
indicative of all objectively oriented philosophies on the health sciences curriculum. Note that
our criticism here, like our application previously, is in rather absolute terms.
& The fact that many factual statements are debatable and that many scientifically arrived at
facts contradict one another fact has moral implications, including: What should
students learn and according to whose point of view? We need to guard against
indoctrination. In addition, taking into consideration that discrepancies call for reflection
and debate, rote learning and regurgitation are not really appropriate.
& Logical empiricists fail to explain how what we say, what we see, and the mental
processes involved in this are linked together. Mind is often very much out of the
picture. This has grave implications for learning and learning theory. Stimulus-response
theory and behavioural psychology may be very inviting, but do not account for the
whole of the person. The question can be asked: To what avail is pure knowledge and
regurgitation (stimulus-response)? This failure also promotes upfront, traditional ways
of teaching with little student involvement. Whenever such involvement occurs,
naturalists argue that it should come from the learners themselves. There is thus the
possibility of overemphasising either the learner or the teacher; however, cooperation
between the two is ill-considered. This shortcoming has further grave implications in
practice-oriented curricula such as those designed for health sciences and health care,
where student and professionals need to take moment-to-moment decisions that call for
an exercised mind, problem solving, critical thinking, judgement and the like.
& Logical empiricism also fails to explain how an objective fact in the world becomes a
language statement; how fact is translated into language. (This is a point
28
phenomenology addresses in detail and we shall look at this in study unit 3.) This
failure also relates to learning and the mental processes involved in learning.
2.9 Conclusion
In this study unit, we considered the so-called objective philosophies. In the next section we
look at the subjective philosophies and the implications these philosophies hold for health
sciences' curricula.
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The subjective philosophies

Billings, DM & Halstead, JA. 2005. Teaching in nursing: a guide for faculty. St Louis:
Elsevier
Or 2009 edition
Key words
& Epistemology
& Holism
& Humanism
& Indeterminism
& Nihilism
& Perceived view
& Phenomenology
& Pragmatism
& Subjectivity
& Transcendental idealism
30
3.1 Introduction
Whereas we considered the nature of objective philosophies and their implications for health
sciences curricula in the previous study unit, in this study unit we look at the subjective
philosophies. Within this group of philosophies, the position that positivism holds among the
objective philosophies, namely, that of methodology, phenomenology holds among the
subjective philosophies. Although all philosophies imply different views on the nature of
knowledge, it is the methodologies that provide the broad framework of thinking that gives
logic to our method of doing, of creating knowledge (or science if you wish).
Please note:
note: Our usage of the word ``man'' to refer to the individual, is in line with
philosophical tradition and is in no way intended to be sexist.
subjectively oriented philosophies may hold for curriculum design by virtue of your
ability to do the following:
& identify the subjective philosophies
& discuss the tenets of these philosophies
& indicate the implications these philosophies hold for the curriculum and
curriculum development
3.2 Idealism
Mautner (2000:264) lists the following view on idealism as deduced by different authors from
the work of the Greek philosopher Plato:
& a view which rejects materialism and naturalism in favour of a religious or otherwise
value-oriented world-view
& the view that only mind and mental representations exist, according to which there is no
independently existing external material world.
In Kant's Transendental Idealism, appearances, that which we think of (thus all perceptual
appearance too), are representations only. These are not things in themselves. Time and
space, for instance, are therefore only sensible forms of our intuition. These are not
determinations existing by themselves (Mautner 2000:569570).
Thus, objects of knowledge have no existence apart from the activities of the mind. Truth is
something that is created by the knowing mind, the individual. It is quite understandable that
later authors, such as Butler (1961:38) considered idealism as ``the philosophy of the dreamer
or visionary who dwells upon utopian ideals for himself and his society''. Objects of
knowledge have no existence apart from the activities of the mind that knows them. In other
words, truth is something that is created by the knowing mind, or the thinking individual.
Even if the objects of knowledge can exist apart from the mind, the ultimate nature of reality is
mental or spiritual.
The idealists' moral and social values stem from their belief that all we know about nature
comes to us as thought or ideas. Nature is dependent upon Universal Mind, or God; it is an
expression of mind.
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& Study the paragraph on Idealism in Billings and Halstead (2005:131)

(2009:109). Integrate what these authors say with the contents of this study
unit.
3.1
Contrast Mind to mind as contemplated by the philosophy of mind in study unit 1.
What are your conclusions?
Idealism's opposition to naturalism, in fact to all objective philosophies, is clear from their
emphasis on Mind (divine) rather than mind (human).
3.3 Pragmatism
Categorising pragmatism according to our objective/subjective taxonomy is somewhat taxing.
However, we deem that it implies more active thinking on the part of the individual so we
have placed it with other subjective philosophies.
Pragmatism is a human-centred philosophy (Zais 1976:145). It is an action-orientated and
practice-directed philosophy. According to the pragmatist, reality is relatively subjected to
change owing to interaction of the individual with the environment. Reality is embedded in
individual experience. For this reason, the primary focus of this philosophy is knowing (to
know), which refers to personal experience. Through personal experience, the individual
constructs knowledge. The individual is in interaction with the environment. The individual is
active and takes responsibility for the outcomes of such actions. This transaction generates
knowledge. Knowledge is tentative and subjected to change or is discarded owing to new
insights developed through continuing and continuous experience. The individual can
influence the future through reflective thinking and by acting upon the environment. The
individual is a biological organism and is self-subjected to ongoing change.
All of this may sound no different to any of the other subjective philosophies. However, it
should be seen against the main tenet of pragmatism, namely, knowledge is ``that which
works in practice''. The individual is involved in a struggle for survival. The individual uses
his/her reasoning and thinking abilities to adapt to changing circumstances through problem
solving. Knowledge has an instrumental function, namely, to assist the individual in adapting
to a changing environment. It is an important instrument and is applied for social
development and advancement. Knowledge is valuable if it yields practical results. Human
conduct and behaviour are judged in terms of their outcomes and the utility they have for the
majority of people. Norms for the judgement of conduct and behaviour are thus congruent
with public opinion (Kruger & Whittle 1982:4549; Zais 1976:146149).
Mautner (2000:441) indicates that in pragmatic thought, a proposition is true if it is
practically successful or advantageous. This stems from the principle that beliefs are habits in
action rather than a representation of reality. Dewey, an ardently proclaimed pragmatist, states
that there is no such thing as disinterested pursuit of the truth. All thinking is a matter of
problem solving. Dewey and other pragmatists, understandably repudiate dualisms such as
mind-body, reality-appearance and, most importantly, theory-practice. They repudiate the
theory-practice dualism because they see theory as stemming from practical need and utility.
Pragmatism is alive and well! As Mautner (2000:441) indicates, many contemporary
philosophers, such as Rorty, Quine and Putnam have again taken up Dewey's ideas.
32
3.2
Study the paragraph on Pragmatism in Billings and Halstead (2005:134) (2009:111).
Integrate what these authors say with the contents of this study unit.
3.3.1 The implication of pragmatism for health sciences

3.3
What would you say are the implications of pragmatism for health sciences' curricula?
The main purpose of the curriculum is to develop the intellect of the individual and to present
him or her with an opportunity to construct knowledge. The most important characteristic of
the curriculum is an emphasis on the process through which the individual gains knowledge
and the acknowledgement of the tentative nature of such knowledge. This tentativeness is
based on utility. The curriculum is student-centred and process-orientated. Content is
selected on the basis of the meaning students can deduce from it and the degree to which it
serves as a foundation for problem solving. Teaching and education are exploratory rather
than explanatory in nature. Method is emphasised above content and, consequently, learning
is achieved through problem solving. Students are taught to be critical thinkers, to handle
change and to contribute to social change. Subjects, topics and learning experiences are
aimed at conveying cultural elements, but are also aimed at preparing students for social
change (Ornstein & Hunkins 1988:3032; Zais 1976:150151).
3.4 Existentialism
In his work on existentialism and humanism, Sartre (1973:26) points out that there are two
different kinds of existentialists, namely, Christian existentialists and atheist existentialists.
What we present in this lesson are general attributes of existentialism. It is up to you (the
student) to decide whether the existential doctrine is acceptable to you or not.
3.4
Study the following on existentialism. While you are doing it, underline and number
all the basic tenets of this philosophy, for example: human longing, freedom of choice,
the individual as thinking being, responsibility and becoming, so as to compile a list
of these tenets.
Gulino (1982:352) says: `Àlthough there are many different approaches to existentialism, this
philosophy is basically concerned with human longing and the search for meaning within the
self''. To this Troisfontaines (1971:25) adds that existentialism is `à passionate return of the
individual to his own freedom''. Existentialism is thus a human-centred philosophy with its
primary focus on the individual. The individual is what he or she is because the individual
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has a choice as to how to live his or her life. The individual can choose to act and to live life
according to a supernatural, natural or human-orientated worldview. Individuals define
themselves through the choices they make and are always becoming (Homo viator). The
individual is compelled to make choices and is, however, also accountable for the
consequences of such choices.
The basic tenet of existentialism according to Sartre (1973:26) is that existence comes before
essence. As Kneller (1971:72) puts it, first of all, people exist, turn up, appear on the scene
and, only afterwards define themselves, asking ``Who or what am I?'' What people become is
their own responsibility. Either they make themselves or, in a sense allow themselves to be
made by others. This statement has huge implications for education from the point of view of
both the teacher (educator) and the student (learner).
The individual's freedom is a freedom of choice. According to Kneller (1971:7374) this
``freedom is neither a goal nor an ideal. It is the potential for àction'. I am free therefore I
`become'. Choose I must and choose in time''. With their freedom of choice, individuals must
also take responsibility for their actions (choices) because to act is to produce consequences.
The implication of this is that the individual should also be granted autonomy.`Ìt is pointless
to blame failure on the environment. Whatever the conditions (environment), these are for
choice to challenge'' (Kneller 1971:75).
Freedom of choice and autonomy are, however, not a cartes blanches to disregard others. On
the contrary, it does not spell egoism but communion especially communion in terms of
Marcel's (in Troisfontaines 1971:16) concepts of availability, presence and hope; Buber's
coinage inclusion; and Heidegger's (in Troisfontaines 1971) reference to the authentic
individual. As Kneller (1971:76) puts it, all these point to being unreserved to all. The result
of which is trust and true personal self-fulfilment.
Marcel (Troisfontaines 1971:16) rediscovered, in contrast to absolute knowledge (see
rationalism), the meaning of love, participation and subjectivity. The term disponsibility was
coined by Marcel, meaning: putting oneself at the disposal of (others), and also to be
available for others. Pertaining to people, this also includes the idea of free surrender of
oneself and of detachment from one's own concerns (Troisfontaines 1971:vi). This speaks of
a sensitivity to others.
Because of the existential assumption of the individual's freedom of choice, the question for
existentialists is whether the individual can live an authentic life. In education and ultimately
in caring in the educational setting, authenticity begins to show when educators have made
the subjects they teach part of their inner experience, presenting them to students as
something issuing from themselves (Kneller 1971:81). The same applies to clinical
experiences shared with students to realise theoretical knowledge. Further, an existentially
based education assumes the responsibility of awakening each individual to the full intensity
of his or her selfhood (Morris cited by Learn 1990:238). Recent application of the existential
approach to education is evident in the development of adult education theory (Learn
1990:240).
To the existentialist, the individual is unique and human nature is unpredictable. What
choices the individual will make and how he or she responds to the outcomes depend
completely on the individual. This in a sense also makes the outcomes of education
uncertain.
The aim and purpose of education is to develop critical thinking, assertiveness, cooperation
and a commitment to lifelong learning. The curriculum lends itself to philosophical dialogue
and the exercise of choices. Subjects such as drama, literature and art are included in the
curriculum. The validity of knowledge is determined through the individual self. This depends
34
upon its intrinsic value for the realisation of the self-actualisation ideal (Zais 1976:152154).
The curriculum supports open education. Education is student-centred and flexibility exists
with regard to curriculum contents, scheduling of time and learning experiences (Lefrancois
1997:327; Ornstein & Hunkins 1988:3032).
Reality is internal to the individual and consequently there are two ways of knowing, namely,
objective and subjective knowing. Objective knowing is an awareness of the external world.
Subjective knowing is an awareness of one's awareness of the objective world. The result is
personal knowledge.
To add to our brief discussion, study the section on existentialism in Billings and Halstead
(2005:95, 135136, 2009:81, 112). Note that these authors see existentialism as educational
theory. We prefer to consider it firstly as formal systematic philosophy and then to apply it to
the educational setting.
Now that you have studied existentialism, it is time to use your knowledge about this
philosophy. If we cannot use our knowledge it is useless. We are going to apply the
philosophy to education; more specifically to health sciences and health care curricula.
3.5
With regard to each of the tenets and statements central to existentialism, answer the
following questions:
& What implication does this hold for health sciences and the health care
curriculum? Remember the curriculum involves much more than mere
knowledge. It also involves outcomes, teaching strategies, the role of the
educator, the role of the student, and evaluation strategies.
& How does this affect the practice of health sciences education and health care?
Guidelines and assistance:

Take stock of everything that we have learnt in health sciences education and general
education up to this point, and try to match it to specific existential tenets. This calls for a lot
of involvement on your part. It is very important that you substantiate all statements you make
about the implication of the tenets of the philosophy you apply. You must provide reasons for
why you say what you say. Now remember, a statement is only completely motivated once it
is no longer possible to ask ``Why?'' in any intelligible sense.
3.4.1 Implication of existentialism for the curriculum

Now that you have tried to do this for yourself, and we are sure that it was not so easy,
consider the following possibilities. Remember, at this stage of your studies, if an implication
(application) is logically explained, it is acceptable. But, you must substantiate give
logical reasons for what you say.
3.4.1.1 Outcomes
Since the individual has freedom of choice, on the assumption that the individual is a
thinking being, behaviour is not precisely predictable. This implies that we must reflect on the
term ``specific outcomes''. A specific outcome, especially in behavioural terms, is a rather
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narrow prediction of behaviour and conduct after learning has taken place. This does not
mean that we shall not make use of specific outcomes, but that we shall also provide for
individual variation in the attainment of these specific outcomes.
We can also reflect on the actual outcomes we should like to attain in an existential
atmosphere, such as the following:
& Guide the student toward autonomy and authenticity. (This can be accomplished only by
experience, implying that students should be involved in their own education and
learning. It therefore has implications for teaching strategies.)
& Guide the student toward (existentially based/situational) decision making (since
humankind has freedom of choice).
& Assist the student in cultivating a responsible and accountable attitude (since all
decisions, acts and actions bear consequences). This implies guiding the individual
toward social responsibility. It is in line with SAQA's critical outcomes.
3.4.1.2 Curriculum content

Based on the emphasis on aspects such as commitment, unreserved regard for others,
communion instead of egoism, and the like, the conclusion is drawn that doing what is good
and right is advocated by existentialists. Thus, a course in ethics is sure to find its way into
the curriculum. Also, caring, consideration, appreciation and love should find their way into
the curriculum. This can be achieved through a whole array of subjects including the arts and
a generally liberal curriculum, meaning that a wide variety of cultural subjects should be
provided for. Also, transcultural studies would be indicated as well as studies in religion. In
addition, curriculum content should deal with the issue of human suffering, a part of the
human condition greatly neglected in health sciences curricula. In this regard see module
HSE3705, The caring ethic in health sciences.
Further, content must include that which is important (relevant) to the students in their
everyday life, aiming at providing them with alternatives so that they can make informed
choices. It should also enable them to some extent to make tentative predictions about the
outcome of their choices.
3.4.1.3 Teaching strategies

In this respect, also see the role of the educator and that of the student because these also
imply certain teaching strategies. Based on the eminence of commitment, unreserved regard
for others, communion instead of egoism, and the like, an open, student-centred educational
milieu is indicated. Educators will step down from their dais and, instead of being issuers of
knowledge, they will become resource persons, facilitators and guides. The educational
milieu will be less formal and definitely less autocratic and directive.
Problem solving will be utilised since students have to learn to make informed choices, and
to be happy with those choices. In the same vein, clarification of values will be applied to
bring the individual student in touch with his/her feelings and attitudes. Ethical decision
making will be taught, for the same reason, and will also be implemented as teaching
strategy. Furthermore, individual projects and real case studies (because of their authentic
nature and existential base) will be employed in educating students.
A main aim of these teaching strategies is to guide the student toward independence, selfdirection and lifelong independent learning.
36
3.4.1.4 The role of the educator

The statement that autonomy is not the key to egoism but to communion implies that the
educator must be available. Therefore, the educator should be open and approachable. This
calls for classroom democracy, guidance and facilitation rather than a directive autocratic
approach. However, in certain fields the educator sometimes does have to give more support
(even information) and at other times less; but the educator never indoctrinates, because that
is oppression. It limits the students' repertoire of possible future choices.
3.4.1.5 The role of the student

The role of the student is that of active participation and of taking responsibility. According to
existentialists, the individual is granted autonomy, the right of self-government, personal
freedom and freedom of choice. It is educators' moral duty to provide for informed decisions
on the part of students. Learning contracts can be used in which the students' responsibility is
stipulated.
3.4.1.6 Evaluation strategies

In order to respect individual freedom, evaluation should not be rigid to the extent that it
ignores this essential tenet of existentialism, nor should it be so lax as to refute the objective
and aim of education. Therefore, the educator should listen very carefully to the way in which
the student presents knowledge and what the student presents as knowledge. Remember,
students speak from the point of view of their own existence and experience, and their
interpretation may be an eye-opener. However, students cannot be allowed to generate
``knowledge'' at will! This also applies to skills and attitudes. Remember, not all students will
do the same procedure in exactly the same manner, at the same speed and with exactly the
same level of proficiency. In addition, not all students will accomplish specific outcomes
within the same period of time. Provision should be made for this in an evaluation schedule.
3.5 Humanism
Now that we have pointed out some of the implications of existentialism for health sciences
and health care curricula, we turn to humanism.
3.6
Study the following on humanism. While doing so, underline and number all the basic
tenets of this philosophy, for example: human longing, freedom of choice, the
individual as thinking being, responsibility, and becoming, so as to compile a list of
these tenets.
There is a close relationship between humanism and existentialism. Mairet's (Sartre 1973:15)
opinion is that existentialism is as much a reform as a form of humanism.
According to Quinn (2007:22), humanism generally pertains to the study of people as human
beings with ``thoughts'', ``feelings'' and `èxperiences''. The `àffective'' side of people, including
`àttitudes'' and ``values'', is therefore of prime importance. Quinn (2007:22) quotes Hamachek
in saying that the focus in humanism is
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& not so much on the individual's biological drives as on the `ìndividual's goals''
& not so much on the stimuli impinging on the individual as on ``the desire of the
individual to be or to do'' something
& not so much on past experiences as on ``current circumstances''
& not so much on life conditions as such as on the ``subjective qualities of human
experience'' the ``personal meaning of an experience'' for the individual.
From this Quinn (2007:2227) derives that humanism is concerned with human ``growth'',
individual ``fulfilment'' and ``self-actualisation''. It is also interesting to note that, according to
Quinn, there are two main principles that apply to a humanistic approach to teaching and
learning, namely, the educator-student relationship and the classroom climate.
Carter (1978:554) (also see study unit 6.7 on patterns of knowing) contends that whenever
beliefs about people are expressed that postulate a ``holistic, active, unique'' and ``meaninggiving being'', they reflect a humanistic perspective. To this author, the very nature of the term
``caring'' and other associated and concomitant terms such as ``commitment'' is not
expressible in other than humanistic terms (Carter 1978:556). This has vast implications for
the health sciences and health care curricula.
Joseph (1985:136137) abstracts the following six tenets of humanism:
& In the strictest sense, the humanist believes in a naturalistic view of the world. However,
in modern-day interpretation, the importance of religion in the life of the individual is
rightfully acknowledged.
& There exists a unity between the individual's body and soul.
& Humanists believe that all problems must be solved by using the scientific method.
& Humanism states that individuals are responsible for making their own choices and can
master their own destiny within limits.
& Humanism is the belief that ethical and moral values guide us as we enter the health
care system (or any human interaction for that matter).
& Humanism is concerned that everyone should attain a good life.
With the above background knowledge on humanism, study the section on this philosophy
from
& Billings and Halstead (2005:259261) (2009:210211)
3.7
What implications do you think humanism holds for health sciences education and
health care curricula? Remember to substantiate your answer.
38
3.5.1 Implications of humanism for health sciences' curricula

This section serves as feedback on the previous activity. You must supplement our
interpretation with that of Billings and Halstead (2005) (2009).
3.5.1.1 Aesthetics and beauty

Aesthetics and beauty can be included in a liberal curriculum in subjects such as art, music
and dance, whereby we can teach students appreciation. This may form the basis for teaching
caring and an appreciation for the work of art of the human body. Anatomy, for instance,
should not be presented as pure science but should be presented in such a manner that it
cultivates an appreciation for life in general in individual students.
3.5.1.2 The naturalistic underpinning

Naturalistic in this sense should not be confused with naturalism as discussed in the
previous study unit. Naturalism here implies the uncontrolled and uniquely human; being-inthe-world and being-in-the-world-with-others. Therefore, not only human experiences, but
also the human body and all other physical things are important to the individual and thus to
any curriculum. It means that anatomy, physiology and other hard sciences can be included
in the nursing curriculum as well as soft sciences such as psychology, philosophy, sociology
and anthropology.
3.5.1.3 The principle of holism

The fact that humanists accept the unity between body and soul expands the curriculum
content further. Also, this points to a philosophical approach that we shall deal with in the
next section, namely, holism. According to the humanist, therefore, the curriculum should be
both comprehensive and integrated.
3.5.1.4 Quality of life

In correspondence with the principle of ``the good life'', what are we to teach students
currently where health professionals' efforts to improve ``quality of life'' often lead to an
unintended extension of suffering due to mechanical and bio-support? We should probably
include caring and human suffering in the curriculum. Economics may also help as will
appreciation of human life, the worth of human life, the right to life and death, and euthanasia.
3.8
Now return to Billings and Halstead (2005:259261) (2009:210211) and add our
insight to theirs, and rewrite all of it in your own words.
3.6 Holism
During our discussion on humanism we encountered the term ``holism'' as a tenet of
humanism. However, for several reasons it is necessary to distinguish and discuss this ``tenet
of humanism'' as the independent philosophical approach that it actually is. From the
discussion that follows, it will become clear that there are different definitions of holism, and
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that in the health sciences, it has a very special and specific meaning. In this lesson, we are
also going to deal with the issue of knowledge again, as seen from the perspective of holism.
Holism as an independent systematic philosophy focuses on wholes. According to Bevis
(1982:10), the 20th century concept of ``wholes'' was first expounded in the 1920s here in
South Africa by Jan Smuts. He coined and defined the term ``holism'' as a unity of parts. This
implies that these parts are so mutually supportive and intense that the whole is greater than
and entirely different from the sum of its parts (Bevis 1982:10). In its original form, this
definition of holism pertained to the biological sciences. However, in health care, this leads to
comprehensive health care and caring for the patient in totality. In education, holism refers
more precisely to education that considers both left and right hemisphericity and alternating
accompanying teaching strategies, and thus also the cognitive, affective and psychomotor
domains; it refers to confluent education and also to multimodal education. Hemispericity is
also related to multiple intelligences (Billings & Halstead 2005:251254) (2009:205206).
Four ideas may be interpreted as the central convergence of holism:
Holism seems to have taken the form of a philosophy or an approach to the care of others
(and all other human interaction including education) that facilitates the `ìntegration'',
``harmony'' and ``balance'' of body, mind and spirit.
The focus in the mind of the educator or clinical practitioner is on ``wholeness''. Attention is
paid to the ``spirituality, consciousness, self-concept, life-style'' and ``wellbeing'' of the one
being cared for or educated.
The experience of a need for care (and other human interactions) is viewed as an opportunity
for ``growth'' and an expansion of consciousness.
The relationship between the caregiver and the receiver of such care is ``reciprocal''. In
education, this reciprocity figures between the educator and the student too. Each benefits
from the interaction with the other and each grows in ``self-awareness'' (Johnson 1990:137).
Please note that applied to nursing and health sciences education, holism implies a
comprehensive course and provision for multiple intelligences. But, ``comprehensive'' must be
qualified. The essential accompanying word in this instance is `ìntegrated''. Whatever makes
up the whole must be integrated. In this regard the curriculum needs to indicate clearly, and
provide for, the relationships between subjects and the implications they have for one
another.
3.9
Indicate what implications holism holds for nursing and health sciences education and
curricula. Remember to substantiate your answer.
To guide you in doing this activity, consider how different subjects and modules in a health
care curriculum may be sequenced so that there is the absolute minimum duplication of work.
For instance, anatomy and physiology of the reproductive system will be covered as part of
midwifery. However, types of tissue will be covered much earlier in the curriculum in an
introductory and overview module in anatomy and physiology. Learning experiences should
be coordinated to follow as soon as possible on theoretical sessions.
40
3.6.1 Multiple intelligences and holism

To prepare you more fully as future health educator, with regard to creating a holist curriculm,
study the section on multiple intelligences in
& Billings and Halstead (2005:251254) (2009:205206).
Please note that the concept of multiple intelligences does not refer to differences in the IQ
levels of individual students but, rather, to different areas in which individuals have a certain
disposition. In this regard also revise module HSE2601 on the different domains of learning,
namely, the cognitive, the affective and the psychomotor.
3.7 Ubuntu (African humanism)

We now turn to the last of our more subjective philosophical contemplations, namely, Ubuntu
or African humanism.
Ubuntu is an African view of life and view of the world (Khoza 1994 in Prinsloo 1998:41). As
such, it represents African humanism (Chikanda in Prinsloo 1998:42), the acknowledgement
of the supernatural in explaining the why, what and how of things; it is a profound spiritual/
religious experience that is primarily emotional, expansive, transcendental and centrifugal
(Khoza in Prinsloo 1998:46). It represents the collective consciousness of the people of Africa
according to which Africans have their own religion, their own ethical views and their own
political ideologies. The distinctive collective consciousness of Africans is manifested in their
behavioural patterns, expressions and spiritual fulfilment in which values such as the
universal brotherhood of Africans, sharing and treating other people as humans, are manifest.
The idea of ``brotherhood'' is also reflected in a sensitivity toward the needs of others, the
understanding of others' frame of reference and the individual as a social being (Khoza 1994
in Prinsloo 1998:41). Brotherhood is also reflected by other attributions of ubuntu, namely,
respect, dignity, solidarity, compassion and survival (Mbigi & Maree 1995:111).
As African humanism, ubuntu involves alms giving, sympathy, care, sensitivity to the needs
of others, respect, consideration, patience and kindness (Chikanda in Prinsloo 1998:42).
Traits such as warmth, empathy, understanding, the ability to communicate, interaction,
participation, sharing, reciprocation, harmony, cooperation and a shared world view, which
collectively make up the ubuntu culture, are all required for the development of human
potential (Makhudu 1993:4041). However, Makhudu (1993:4041) also implies that these
attributes, which are ascribed to the phenomenon of ubuntu, are not merely philosophical in
nature. She is convinced that these attributes exist in every person as true humaneness.
Particular emphasis is placed on the values of empathy, congruence (being oneself and being
proud of and true to one's identity) and open communication (fearlessly establishing direct,
open, and honest lines of communication, which involves getting in touch with oneself and
admitting, inter alia, to one's biases and prejudices about other cultures and ethnic groups)
(Makhudu 1993:4041 in Prinsloo 1998:42).
In ubuntu, the individual's moral nature is also emphasised. Morality is acquired during a
progressive process of socialisation, which includes accepting obligations to others the
basis of morality. This social morality is manifested in the social setting, law, communalism,
nature conservation and in reconstructive development programmes. Social relations are
internalised in the extended family and contact with distant relatives and friends. Such groups
form a closely knit social web, which brings solidarity between persons. The ultimate
expression of regard for another is by showing concern in the sense of spontaneously and
voluntarily assuming a self-imposed sense of duty toward the needy, destitute or bereaved.
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This constitutes a consciousness of social responsibility. Nobody should be condemned as

worthless (Teffo 1992 in Prinsloo 1998:42).
In ubuntu, society is divided in terms of age and gender classes that provide a framework for
orderly status distribution and social interaction. The distribution of wealth is according to the
prescriptions of status classification. Social responsibility is expressed in looking after the
less privileged, the poor, orphans and nature. Nature conservation has a definite place in the
ubuntu system. Humankind and nature are one in ubuntu ethics. In the same vein, social and
economic reconstruction and development should include moral development as well,
because without such development, not even massive amounts of money can guarantee real
economic and social development (Teffo in Prinsloo 1998:42).
For Schutte (1992 in Prinsloo 1998:42), ubuntu centres on the worthwhile, the good and the
valuable in human life. It is concerned with visions of happiness and fulfilment and with ideas
of how these feelings might be realised. In this, family life is once again emphasised, and the
interpersonal character of ubuntu is the source of many of its distinct virtues such as
patience, hospitality, loyalty, heartiness, sociability, munificence and respect.
In ubuntu, the nature of the individual is linked with the concept of respect , primarily respect
for the aged (Schutte in Prinsloo 1998:43). This implies a view of personhood correlated with
development. According to this, an older person is more of a person than a younger one
because he/she has more to offer by way of knowledge and experience, personal influence
and power. This is in sharp contrast to the social dominance of the younger generations in
Western societies.
In ubuntu societies, although a strong emphasis is placed on duties and virtues, rights
are always implied. Ubuntu also emphasises that every member of society should visibly
participate in society and not disappear in the whole. Thus, ubuntu takes seriously the
view that the individual is basically a social being. Understandably, the central dictum of
ubuntu is `Ì am because you are'' or `à person is a person through other persons''
(Makhudu 1993:4041).
3.10
Indicate what implications ubuntu holds for health sciences and the health care and
health sciences' curriculum.
For assistance in doing this activity, revise all our feedback on the implications that the
different subjective philosophies hold for health sciences and the health care curriculum.
3.8 Postmodernism
Currently we live in an era described as the postmodern era. Consequently, we need to
consider the influence this philosophical tendency may have on health sciences, education
and health care. This philosophy is most striking in the arts, particularly in film productions,
it is also well illuminated in literature and on the stage.
Study the section on postmodernism in
While studying this section in Billings and Halstead (2005) (2009) keep in mind the general
42
notions of the subjective philosophies. Ascertain a relationship among all these philosophies.
Also note that in a more extreme sense, postmodernism states that we can understand neither
truth nor falsity (Higgs & Smith 2002:132).
3.8.1 The implications of postmodernism for health sciences

3.11
Describe the implications postmodernism holds for health sciences and the health
care curriculum.
Remember to include the information contained in Billings and Halstead in your
answer to the previous activity.
3.9 Caring
Considering that in its application, health sciences knowledge and skill represents a moral
act, namely, the act of caring, we include caring as a subjective philosophy at this point. In
module HSE3705 we explicate caring as an ethic in detail.
While studying the following section on caring, keep in mind the implications that caring
might hold for the health sciences' curriculum
3.9.1 The implications of caring for the curriculum

3.12
Indicate the implications caring might hold for the health sciences' curriculum.
How do these implications compare with the implications of other subjective
philosophies?
3.10 Phenomenology
Just as positivism forms an methodology, an argument providing logic for our ways of
implementing the objective philosophies in constructing knowledge, phenomenology serves a
similar purpose regarding the more subjective philosophies. This has far reaching
epistemological implications.
Phenomenology is a belief system about how we come to know (epistemology) as well as a
method of research. It is both a formal philosophy and a research methodology. In essence,
phenomenology asserts that things must be known in their entirety (holistically) rather than
by reduction to parts. Knowing the parts is not enough to know the thing itself. It is, therefore,
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understandable that as a method (ie a method of obtaining knowledge), phenomenology is

closely associated with the other subjective philosophies. Existentialism, as you will
remember, focuses exclusively on human beings, their actions, feelings and being.
Phenomenology in its broadest sense, signifies a descriptive philosophy of these experiences
(Urmson 1985:216). Therefore, the link between existentialism and phenomenology is a
natural one, since, like existentialism, phenomenology examines the phenomenon in context,
as it is experienced.
According to Barnum (1990:172), the link with holism is equally obvious. Phenomenology
also attempts to see its subject matter as a whole, that is, in its entirety. From the beginning,
phenomenology was committed to the ideal of the greatest possible freedom of
presuppositions (Urmson 1985:216), thus, not limiting the subject of investigation by one's
own thinking.
According to Barnum (1990:165): ``Phenomenology attempts to reinstate the primacy of the
subjective qualities of the matter under consideration. It is a deliberate effort to set aside
scientific interpretations that reduce an entity to its component parts (like positivism does);
... For example, a phenomenologist would not separate the scientific concept of pain (as
measured in dolorimetry) from the hurt that accompanies it.'' Phenomenology does not
oppose scientific operationalisation of meaning such as in dolorimetry, but, it also states that
no such rationalised description can fully explain the meaning (or experience by the
individual) of the phenomenon.
To quote Van Manen (Barnum 1990:76): ``Phenomenological study is the study of lived
experiences. To say the same thing differently: phenomenology is the study of the lifeworld the world as we immediately experience it rather than as we conceptualize,
categorize, or theorize about it. Phenomenology aims to come to a deeper understanding of
the nature or meaning of our everyday experiences. It asks `What is this or that kind of
experience like?' Phenomenology differs from almost every other science in that is attempts to
gain insightful descriptions of the way we experience the world.''
With this brief introduction, study the study the section on phenomenology in
Remember to incorporate this information into our explication of the implications
phenomenology holds for the health sciences and health care curricula following the next
activity.
3.10.1 The implications of phenomenology for health sciences

3.13
What implications does phenomenology hold for health sciences and the health care
curriculum?
In addition, remember the situation analysis and phenomenological method for data
gathering.
Which subjects would be included in a curriculum based on a phenomenological
perspective? Or, what type of knowledge would be included in such a curriculum?
44
3.10.1.1 Subject content

Naturally, all the different applicable sciences will be included, because phenomenology does
not oppose scientific operationalisation of meaning. However, it also states that no such
rationalised description can fully explain the meaning (or experience of the individual) of the
phenomenon. Therefore, the humanities and personal experience of the patient, client,
educator and student will be provided for in curriculum content. We shall therefore pay
serious attention to such issues as human suffering, joy, happiness, hope and, most
importantly, caring!
3.10.1.2 The situation analysis

Phenomenology as methodology can help with the situation analysis conducted to
contextualise the proposed health sciences curriculum, because valuable first-hand
knowledge can be obtained from all stakeholders. In addition, knowledge obtained via
other phenomenological and qualitative research will also be acceptable to the
phenomenologist. This is not the case with the positivist.
3.10.1.3 Nature of knowledge

According to Meleis (1991:86), all philosophy of science approaches culminate in two rather
different points of view. These are the received view and the perceived view. For the purpose
of this course, we categorise phenomenology as the perceived view, and positivism as
belonging to the received view.
The main argument that perpetuates our entire discussion is the subject-object relationship or
the nature and degree of such a relationship. This can also be equated with the perceived and
the received views.
TABLE 3.1 Comparison of the received (objective) and the perceived (subjective) views
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Received View
Perceived View
Objectivity
Subjectivity
Deduction
Induction
One truth
Multiple truths
Validation and
Trends and patterns
Replication
Discover
Justification
Description and
Prediction and control
understanding
Particulars
Patterns
Reductionism
Holism
Generalisation
Individualisation
Empirical positivism
Phenomenological
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3.11 Summary: the philosophical options

OPTIONS (Dimensions) OPENED UP BY PHILOSOPHICAL DISCOURSE
Learning activities should:
But they should also:
be immediately enjoyable
lead to desirable future experiences
show the ideal: the just, beautiful and honour- show life as it is, including corruption, violence
able
and profanity
treat the thought and behaviour of the group to treat the thought and behaviour of groups other
which the learner belongs
than those to which the learner belongs
minimise human variability by stressing com- increase human variability by stressing indivimon outlooks and capacities
duality
stress co-operation so that individuals share in stress competition so that the able person
achieving a common goal
excels as an individual
allow learners to clarify their own positions on instruct learners in the value of moral and
moral and controversial issues
intellectual integrity rather than allow students
to engage in sophistry and personal indulgence
be under the direct influence of the educator be removed from direct educator influence,
who demonstrates the learning activity so that allowing learners self-actualisation by finding
the learner imitates and acquires
meaning in a situation in which the educator is
a resource person
be pleasant and comfortable for the learner
allow for hardship and perplexity so that

significant growth can take place
teach one thing at a time, but teach it to acquire bring about several outcomes at once, helping
mastery, simplifying the environment and giving the student to develop interests and attitudes as
enough instances to help the learner abstract well as cognitive growth
desired generalisations
allow the learner to acquire simple basic allow the learner to grasp the meaning and
patterns before being exposed to higher-order organisation of the whole before proceeding to
learning
study the parts
allow the learner to see and imitate the best allow the learner to create and practise new and
models of talking, feeling and acting
different ways of talking, feeling and acting
feature repetitive practice on a skill not mastered feature novel and varied approaches to an
(Do not let the learner practise error.)
unlearnt skill (Recognise that students can learn
from error.)
(Adapted from Ornstein & Hunkins 1988:32)
3.12 CONCLUSION
In this study unit, we investigated different subjective philosophies and the implications they
hold for health sciences and the health care curriculum. Whereas philosophies are broad
conceptualisations of the individual, environment, the relationship between the individual
(subject) and the environment, others and things (objects); theories, usually based on a
philosophy, give much more detailed and pertinent guidance as they usually reconstruct
single issues within philosophical thought. For instance, a theory may pertain to a single
46
branch of philosophy, or even more pertinently to a single aspect of human life viewed in
detail from a comparatively philosophical perspective(s). Take for instance education, health
care, health, nursing, learning, personality; the list is almost infinite.
In the next study units we thus consider specific theories, namely: educational theory, nursing
theory and learning theory.
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Educational theories

Elsevier
Or 2009 edition
Key words
& Critical pedagogy
& Essentialism
& Feminist pedagogy
& Perennialism
& Progressivism
& Reconstructivism
& Theory
48
4.1 Introduction
In this study unit we look at a number of theories of education and the implications they have
for health sciences and the health care curriculum. We do this in exactly the same way as we
did with regard to the objective and subjective philosophies.
We also need to consider the difference between educational theory and theories in the field
of health care and health sciences. The former are more focused on education, instruction of
teaching and the overall purpose of education, although not exclusively related to these
issues. They are reconstructions of the phenomenon of education. Strictly speaking, learning
theories also resort under this heading. However, theories in health sciences refer to theories,
or mental reconstructions of phenomena within the arena of health sciences and health care.
These theories can be included in the curriculum as content, for instance, for teaching a
specific nursing theory to students. On the other hand, such theories may greatly assist in
gathering appropriate contents and learning experiences for students. But, we are getting
ahead of ourselves. To do this systematically, we shall consider the following educational
theories first:
& Perennialism
& Progressivism
& Essentialism and
& Reconstructionism.
These theories flow from formal philosophies, but take on a special character because they
are conditioned largely by experiences unique to education. In this regard also note the
following:
We merely want to introduce you to these theories. The contents of this study guide and the
prescribed book (Billings & Halstead 2005) (2009) do not focus on these theories in any
depth.
Our classification of philosophies and theories differs slightly from that given by Billings and
Halstead (2005) (2009), although the two sets of classification do agree fundamentally.
On completion of this study unit you should be able to indicate the implications
selected educational theories hold for curriculum design by virtue of your ability to do
the following:
& identify these educational theories
& discuss the tenets of these educational theories
& indicate the implications of these educational theories hold for the curriculum and
curriculum development
4.2 The term ``theory''

The term ``theory'' has several meanings, such as
& any form of scientific and academic writing, such as the sentence you are currently
reading
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& a formal reconstruction of some aspect of reality such as a model, diagram or cognitive
map
& a hypothesis or a set of hypotheses that have been verified by observation or experiment
as in the case of the theory of gravitation, or
& a synonym for systematic thinking or a set of coherent thoughts
For the purpose of this and the following study units, adhere to the following definition: ``The
expression of knowledge within the empirics' pattern. Creative and rigorous structuring of
ideas that projects a tentative, powerful, and systematic view of phenomena'' (Chinn & Kramer
2008:305).
4.3 Perennialism
4.1
While studying this section on perennialism, note the moments from (allusions to)
different philosophies.
Perennialists call for allegiance to absolute principles. Despite momentous social upheavals,
permanence is more real than change according to perennialists. It is also more desirable as
an ideal. The basic principles of perennialism may be outlined by the following points:
& Despite differing environments, human nature remains the same everywhere; hence,
education should be the same for everyone. Knowledge, too, is the same everywhere. If
it were not true, learned individuals could never agree on anything. Opinion is, however,
different. Here individuals may disagree. There are two central questions in this regard
that perennialists pose:
Are we not fostering a false notion of equality when we promote students on the basis of
their age rather than on the basis of intellectual attainment?
Is it not likely that students will gain greater self-respect from knowing that they have
earned promotion by passing the same tests as other students?
& Since rationality is individuals' highest attribute, they must use it to direct their
instinctual nature in accordance with deliberately chosen ends. However free to choose,
individuals must learn to control themselves. Hurdles in learning should be overcome
through an essentially intellectual approach to learning, which will be the same for all
students. Students should not be permitted to determine their own educational
experiences, for what they want may not be what they should have.
& It is education's task to import knowledge of eternal truths. Education should seek to
adjust the individual not to the world as such, but to what is true. Adjustment to truth is
the end of learning.
& Education is not an imitation of life but a preparation for it. The classroom can never be
a ``real life situation''. It is artificial. The task of students is to realise the value of this
heritage and, where possible, add to its achievements through their own endeavours.
& Students should be taught certain basic subjects that will acquaint them with the world's
50
permanencies. For this purpose, subjects such as language, history, mathematics,

natural sciences, philosophy and the fine arts are indicated (Kneller 1971:44).
& Students should study the great works of literature, philosophy, history and science in
which society, through the ages, has revealed its greatest aspirations and achievements.
The mind should be exercised intellectually. Self-realisation demands self-discipline,
and self-discipline is attained only through external discipline (Kneller 1971:46). Also
read about perennialism in Billings & Halstead (2005:94) (2009:81).
4.2
What is your opinion on the ``permanency doctrine'' of perennialism? What about the
history of nursing?
Which philosophical tradition does perennialism resemble most: objective or
subjective philosophies?
Indicate what implications perennialism holds for health sciences education. It may be
necessary to revisit study unit 3 to complete this assignment.
4.4 Progressivism
Taking the pragmatist view that change, not permanence, is the essence of reality,
progressivism in its purest form declares that education is always in the process of
development. Educators must be ready to modify methods and policies in the light of new
knowledge and changes in the environment. The special quality of education is not to be
determined by applying perennial standards of goodness, truth and beauty, but by construing
education as a continual reconstruction of experience.
The basic tenets of progressivism are as follows:
Education should be life itself, not a preparation for living. Intelligent living involves the
interpretation and reconstruction of experience.
Learning should be directly related to the interests of the student. A ``student-centred''
approach is implied, in which the process of learning is determined mainly by the individual
student. Students naturally resist whatever they feel is imposed on them. This, however, does
not mean that students may follow every prompting of their own desires. The student is not
the final arbiter. Students need guidance and direction from educators who are equipped to
perceive meaning in their discrete activities. Even so, the progressive educator does not
influence students' growth by drumming bits of information into their heads, but rather by
controlling the environment in which growth takes place. Growth is defined as the `ìncrease of
intelligence in the management of life'' and `ìntelligent adaptation to an environment'' (Kneller
1971:49).
Learning through problem solving should take precedence over the inculcation of subject
matter. Progressivists reject the view that learning consists essentially of the reception of
knowledge, and that knowledge itself is an abstract substance that the educator loads into the
minds of students. Knowledge to the progressivist is a tool for managing experience (Kneller
1971:50). Experience and experimenting are the key words in education for progressivists.
Thus, instead of teaching formal subject matter, we should substitute specific problem areas
such as transportation, communication and trade. The curriculum, according to some
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progressivists, cannot be more than outlined broadly in advance by the educator, and will
consist largely of an array of resources, which the educator anticipates may be called upon as
the current activities of the class lead on to new interests and new problems. The actual
details of the curriculum must be constructed cooperatively in the classroom from week to
week (Kneller 1971:51). Students therefore engage in projects that spring from their natural
curiosity to learn; the projects acquire significance as they are worked out in cooperation with
other members of the class and under the guidance of the educator.
The educator's role is not to direct but to advise.
The educational setting should encourage cooperation rather than competition. However,
progressivists do not deny that competition has some value, but believe that cooperation is
better suited to the biological and social facets of human nature. Rugged individualism is
permissible only when it serves the general good (Kneller 1971:52).
Only democracy permits, indeed encourages, the free interplay of ideas and personalities that
is a necessary condition of true growth. Democracy and cooperation are said to imply each
other. In order to teach democracy, the school itself must be democratic (Kneller 1971:51).
With this in mind, study the paragraph on progressivism in
& Billings and Hastead (2005:95 and 135) (2009:81 and 112)
4.3
Indicate what implications progressivism holds for health sciences education. It may
be necessary to revisit study unit 3 to complete this activity.
4.5 Essentialism
Essentialism is not formally linked with any specific philosophical tradition, but is compatible
with a variety of philosophical outlooks. The essentialists devote their main effort to reexamining curricular matters, distinguishing the essential and the nonessential in educational
programmes, and re-establishing the authority of the educator in the classroom. Like
perennialism, essentialism stands for the reinstatement of subject matter at the centre of the
educational process. However, it does not share the perennialists' view that the true subject
matter of education is the `èternal verities'' preserved in the ``great books'' of Western
civilisation.
To summarise the essentialist point of view:
& Learning, by its very nature, involves hard work and, often, unwilling application.
Essentialists insist on the importance of discipline. Instead of stressing the student's
immediate interests, they urge dedication to more distant goals. Against the progressive
emphasis on personal interests, they posit the concept of effort. The slogan of the
essentialists is: The appetite comes with the eating.
& The initiative in education should lie with the educator rather than with the student. The
educator's role is to mediate between the adult world of the educator and the world of the
student. This also applies to the `àdult world'' of professionalism. The essentialist is no
less interested than the progressivist in the principle that learning cannot be successful
unless it is based on the capabilities, interests and purpose of the leaner, but
essentialists also believe that those interests must be made overt by the skill of the
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educator. Therefore, essentialist educators wield greater authority than their progressive
colleagues (Kneller 1971:59).
& The heart of the educational process is the assimilation of prescribed subject matter.
This view accords with the realist's position that it is largely the individual's material and
social environment that dictates how the individual lives. The essentialists agree that
education should enable individuals to realise their potential, but such realisation must
take place in a world independent of individuals; a world whose law they must obey. The
reason for education is to get students to know the world as it really is and not to
interpret it in the light of their own peculiar desires. The essentialists emphasise the
importance of ``race experience'' the social heritage over the experience of the
individual. The wisdom of many, tested by history, is far more reliable than the untested
experience of the individual.
With is basic information in mind, study the paragraph on essentialism in
4.4
Indicate what implications essentialism holds for health sciences education. It may be
necessary to revisit study unit 3 to complete this activity.
4.6 Reconstructionism
Reconstructionism can be summarised in the following five tenets:
& Education must commit itself here and now to the creation of a new social order that will
fulfil the basic values of culture and at the same time harmonise with the underlying
social and economic forces of the modern world. Society must be transformed, not
simply through political action, but more fundamentally through the education of its
members to a new vision of their life in common.
& The new society must be genuinely democratic, its major institutions and resources
controlled by the people themselves.
& The individual, educational institution and education itself are conditioned conclusively
by social and cultural forces. Since civilised life by and large is group life, groups
should play an important part in the school and in education. Through this, education
becomes social self-realisation (Kneller 1971:64).
& Educators must convince their students of the validity and urgency of the
reconstructionist solution, but must do so with scrupulous regard for democratic
procedures. Educators allow for open examination of evidence both for and against their
views. The educator presents alternative solutions fairly and permits students to defend
their own ideas. Moreover, since all of us have convictions and partialities, we should
not only express and defend them publicly, but also work for their acceptance by the
largest possible majority (Kneller 1971:64).
& The means and ends of education must be completely refashioned to meet the demands
of cultural crises and to accord with the findings of the behavioural sciences. The
importance of the behavioural sciences is that they enable us to discover those values in
which people most strongly believe, whether or not these values are universal. The
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behavioural sciences allow us to formulate human goals, not for reasons of sentiment,
romanticism, the mystical or similarly arbitrary reasons, but on the basis of what we are
learning about cross-cultural, and even universal, values. We must construct a
curriculum whose subjects and subdivisions are related integrally rather than treated as
a sequence of knowledge components (Kneller 1971:64).
With this information on reconsructionism in mind, study
4.5
Indicate what implications reconstructionism holds for health sciences' education. It
may be necessary to revisit study unit 3 to complete this activity.
4.7 Feminist pedagogy

Many women serve in health care and the health sciences. It is not our opinion that all
women are feminists; however, gender and gender philosophy may influence one's
perceptions substantially. For this reason, we have included feminist pedagogy as stemming
from feminist philosophy in this study unit.
Study the following section, keeping in mind the implications that feminism and feminist
pedagogy might hold for the health sciences' curriculum:
4.6
Indicate the implications feminist pedagogy might hold for the health sciences
curriculum.
4.8 Critical pedagogy

Health sciences education and health care in general have a moral duty to advocate (speak
up) on behalf of those that cannot do so for themselves. Critical pedagogy might assist in
this.
Keeping the health sciences curriculum in mind, study the following section:
4.7
Indicate the implications critical pedagogy might hold for the health sciences'
curriculum.
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4.9 Conclusion
In this study unit we considered several educational theories; theories that reconstruct the
phenomenon education. In the next study unit we delve deeper into theory relating to
education by considering different learning theories.
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Learning theories

Elsevier
or 2009 edition
Recommended reading
Quinn, FM & Hughes, SJ. 2007. Principles and practice of nurse education. London:
Nelson Thornes
Key words
& Adult learning theory
& Behavioural learning theories
& Cognitive development theory
& Cognitive development: sociocultural historical influences
& Cognitive learning theory
5.1 Introduction
In this study unit we consider a number of learning theories. These theories each have their
56
own underlying philosophy. Understanding the different formal philosophies as explicated in

study unit one, will help you understand these learning theories better, and will also help you
to select a single theory, or a combination of different learning theories to guide your
teaching. Learning theories, understandably, are based on, among other things, an underlying
philosophical perspective on the individual and epistemology.
On completion of this study unit you should be able to discuss the implications of
learning theories for the health sciences' curriculum by virtue of your ability to
& identify and define different learning theories
& indicate the implications each theory might holds for the health sciences'
curriculum
& differentiate between different learning theories
5.2 Behavioural learning theories

Behavioural theories, according to our broad classification of philosophies as subjective and
objective philosophies, belong to the objective category. The central premise of these theories
is that all behaviour is learnt and can be shaped by reward to attain desired ends (Billings &
Halstead 2005:236) (2009:193).
Study the following section, keeping in mind the implications behavioural learning theory
holds for the health sciences curriculum.
& Behavioural learning theories (Billings & Halstead 2005:237239) (2009:194195)
5.1
Explain the implications that behavioural learning theory might hold for each of the
components of the health sciences' curriculum.
5.2
For additional information on behavioural learning theory, read Quinn and Hughes
(2007:9198).
5.3 Cognitive learning theory

Cognitive theories, according to our broad classification of philosophies as subjective and
objective philosophies tend more to the subjective side. Human thinking, problem solving,
decision making, and the like are emphasised by these theories. The central premise of these
theories is that conditions of learning influence acquisition and retention by modifying
existing cognitive structure (including knowledge and comprehension). Assimilation,
accommodation and construction of knowledge are basic processes in learning (Billings &
Halstead 2005:236) (2009:193).
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Study the following section keeping in mind the implications of cognitive learning theory for
the health sciences curriculum:
& Cognitive learning theories (Billings & Halstead 2005:240245) (2009:195200).
Note the different cognitive perspectives these authors mention, namely:
& Information processing theory
& Constructivism
& Assimilation theory
5.3
Explain the implications that cognitive learning theory might hold for each of the
5.4
For additional information on cognitive learning theory, read Quinn and Hughes
(2007:7591)
5.4 Cognitive development theory

The central premise of cognitive development theory is that ``[D]evelopment is sequential and
progresses in an uneven and interrupted manner through several identifiable phases'' (Billings
& Halstead 2005:236) (2009:193).
Study the following section keeping in mind the implications cognitive development learning
theory holds for the health sciences' curriculum:
5.5
Explain the implications of cognitive development learning theory for each of the
5.6
For additional information on cognitive learning theory, read Quinn and Hughes
(2007:7591)
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5.5 Cognitive development: sociocultural historical influences

The central premise of this approach is that ``[L]earning is interactive and occurs in a social,
historical context. Knowledge, ideas, attitudes, and values are developed as a result of
relationships with people'' (Billings & Halstead 2005:236) (2009:193).
Study the following section, keeping in mind the implications of sociocultural issues in
cognitive development learning theory for the health sciences' curriculum:
5.7
Explain the implications of sociocultural cognitive development for each of the
5.6 Adult learning theory

Adult learning theory is important to health sciences education and the curriculum, because
much of the education and training in the health sciences is vocational and professional in
nature, and many adult students enrol for programmes in the health sciences. Although
Billings and Halstead (2005:254) (2009:207) view adult learning as a philosophy, we see it
more as a learning theory.
Study the following section, keeping in mind the implications adult learning (andragogics)
might have for the health sciences curriculum:
& Adult learning theory (Billings & Halstead 2005:254258) (2009:207210)
5.8
Explain the implications of adult learning theory for each of the components of the
health sciences' curriculum.
5.9
For additional information on adult learning theory and humanistic learning theory
read Quinn and Hughes (2007:1755)
NB:
NB: We support Quinn and Hughes' (2007) classification of adult learning theory as a
humanistic learning theory.
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5.7 Conclusion
In this study unit, we looked at select learning theories representative of the different
philosophical traditions and educational theory. We reflected on the implications of these
theories for the health sciences curriculum. These theories mostly affect the way in which we
go about our teaching and the nature of learning experiences in which we involve students. In
the following study units we look at theories more specific to the health sciences.
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Nursing theories

Elsevier
Or 2009 edition
Key words
& Aesthetical knowing
& Assumptions
& Concept
& Concept analysis
& Conceptual framework/paradigm
& Conceptual model
& Empirical knowing
& Ethical knowing
& Patterns of knowing
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& Personal knowing

& Statements
& Theory
& Theory construction and development
6.1 INTRODUCTION
We need to distinguish between nursing theories (including those of other health sciences)
and educational theories. In the previous section we outlined general educational theories. In
this section we shall demonstrate the implications of a specific nursing theory (as an example
of a health sciences' theory) for the health sciences' curriculum.
Most nurses have a broad picture of the general parameters of nursing, which includes ideas
about the nature and role of the individual receiving care (including the family and the
community), the environment in which nursing takes place, and the main field of nursing
function, that is, health care and the nature of nursing methods and actions. Most traditional
nursing theories and models have four major components (paradigmatic concepts) namely:
& People (the individual, family, community)
& Environment (society)
& Health and
& Nursing (and more recently caring).
But, before we can enter into a discussion on what implications theories hold for the health
sciences curriculum, we must first ponder on what theories are, as well as distinguish theory
from related concepts.
On completion of this study unit you should be able to indicate the implications that
nursing and other theories hold for curriculum design by virtue of your ability to
& define the elements, characteristics and significance of theories
& analyse and evaluate theories
& apply nursing theory to curriculum development
6.2 Elements of a theory

Knowing what constitutes a theory, or what the elements of a theory are, and what makes for a
``good'' theory will certainly help you to select an appropriate health sciences theory for
practice; to analyse theories for their applicability and worth. It will also help you to teach
students about different theories.
6.2.1 Concepts
Concepts are the basic building blocks of theories. A concept is a mental image of a
phenomenon, an idea or a construct in the mind about a thing or an action (Walker & Avant
1995:24). According to Chinn and Kramer (2008:294, 260) a concept is a complex mental
62
formulation of experience. Concepts are the major components of theory and convey the
abstract ideas within the theory. Kim (2000:254) defines the term concept as follows: ``Term
or symbolic statement used to denote and label a class of phenomena, which could be things,
events, experiences, ideas, and other forms of reality.'' A concept has a specific meaning and
semantic value. Concepts may be very general, shared by a specific linguistic culture, or very
specific to a given scientific discipline. To Meleis (1991:12), a concept is `à label used to
describe a phenomenon or a group of phenomena''. From all the above definitions it is clear
that concepts are expressed in language. It should be clear to you that elements of the
importance of language, sciences and epistemology in general are involved in concepts and
thus in theories.
We can distinguish between three types of concepts, namely:
& Primitive concepts are those that have a common shared meaning among all individuals
in a culture. Primitive concepts cannot be defined other than by giving an example, for
instance, the colour yellow.
& Concrete concepts are those that can be defined by primitive concepts, are limited by
time and space, and are observable in reality.
& Abstract concepts are also capable of being defined by primitive or concrete concepts,
but they are independent of time and space (Walker & Avant 1995:24).
When concepts can be defined operationally, it means that the definitions contain within them
the means of measuring the concept, that these concepts can be used in quantitative
(positivist) research, and that they are considered variables in the research design. For
instance, today the term IQ is used colloquially to refer to a person's level of intelligence.
However, this term as it stands is not measurable. But if IQ is defined as the score that the
individual achieves on a specific IQ measurement scale, the term IQ is being operationalised.
6.2.2 Statements
Statements also are very important elements of a theory. Statements can occur in two forms,
namely, relational statements and non-relational statements:
A relational statement declares some kind of relationship between two or more concepts.
These statements assert either association (correlation) or causality. Associational statements
are those that simply state which concepts occur together. The nature of the association may
also be indicated and could be positive, negative or neutral.
& A positive association implies that if one variable changes in a particular direction, the
other also changes in the same direction.
& A negative association implies that if one variable changes in a particular direction, the
other variable changes in the opposite direction. In addition, causal statements
demonstrate a cause-and-effect relationship. The variable that causes the change in the
other variable(s) is called the independent variable, and the variable in which the change
occurs is called the dependent variable (Walker & Avant 1995:25).
A non-relational statement may be either an existence statement that asserts the existence of a
concept, or it may be a definition, either theoretical or operational in nature. Non-relational
statements serve as adjuncts to relational statements. They are a way in which the theorist
clarifies meaning in a theory. Existence statements are usually simple statements of assertion
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about a concept. They are especially useful when the theorist is dealing with highly abstract
material.
Theoretical definitions are another strain or element of importance in theory building. These
definitions are the means by which the theorist introduces the reader to the critical attributes
of each concept. These definitions are usually abstract and may not be measurable. To Chinn
and Kramer (2008:304) the term ``theoretic(al) definition'' implies a ``statement of meaning that
conveys essential features of a concept in a manner that fits meaningfully with the theory of
which it forms part. It specifies conceptual meaning and implies empirical indicators for
concepts. This term may be used synonymously with that of conceptual definition.''
Operational definitions, on the other hand, reflect the theoretical definitions. As indicated
previously, however, they have measurement specifications included in them. Both the
theoretical and operational definitions are critical in theory building. Without them there is no
way to test and thus to validate the theory in the real world (Walker & Avant 1995:25). Chinn
and Kramer (2008:301) define the term `òperational definition'' as a ``statement of meaning
that indicates how the term or concept can be assessed empirically. Operational definitions
are inferred from theoretical definitions. They specify as exactly as possible, the empiric
indicators used to observe, assess, or measure the concept empirically. It sets the standards
and criteria to be used in making observations.''
6.2.3 Theories
The third element relating to the concept of theory, is theory itself.
6.2.3.1 Definition
Chinn and Kramer (2008:305) define the term theory as `à creative and rigorous structuring of
ideas that project a tentative, purposeful, and systematic view of a phenomenon''. Walker and
Avant (1995:26) consider the term theory to imply `àn internally consistent group of relational
statements that presents a systematic view about a phenomenon and that is useful for
description, explanation, predictions, and/or control''. These authors also note that associated
with a theory there may be a set of definitions, which are specific to concepts in that theory.
To Kim (2000:256) theory indicates `à set of theoretical statements that specify the nature of
phenomena or relationships between two or more classes of phenomena, providing the basis
for understanding a problem or the nature of things. A well-formed theory contains at least
three components, namely assumptions, concepts and the theoretical statements that are
integrated together to provide a specific type of scientific understanding.''
The term assumption refers to the structural components of a theory that are taken for granted
or thought to be true without systematically generated empirical evidence. Assumptions
underlying a theory may be value statements or may have potential for empirical testing but
are assumed to be true without the theory because they are reasonable (Chinn & Kramer
2008:293).
Other authors also support the above definitions. A theory is `à set of propositional
statements'' (Oermann 1991:34) which describes internally consistent (Nicoll 1986:391)
relationships between the various concepts for the purpose of description, explanation, and/or
prediction, which provides a basic derivative for the development of research hypotheses, and
which is testable, according to Hardy (in Nicoll 1992:88). The concepts described are
concrete (can be found in the real world) (Oermann 1991:34), are relatively specific and serve
to characterise phenomena of interest in reality (Fawcett 1989:23). Theory separates irrelevant
64
factors from the ``critical and necessary factors or relationships'' (Stevens Barnum 1994:1) that
highlight the components of characteristics that clearly identify a certain phenomenon, or one
or more of the `èssential units of nursing'' (Chaska 1983:417), which include people, the
environment, health and nursing, and according to Lancaster (in Nicoll 1992:34), facilitate
scientific understanding and contribute to the body of knowledge. Remember, disciplines
other than nursing probably have other `èssential units'' contained in their theories.
6.2.3.2 Types of theories based on their scope

There are different ways of classifying theory and, therefore, there are different types of
theories. As far as the scope of theory applies, the following types of theories can be
distinguished:
& Atomistic theories refer to theories that deal with a narrow scope of phenomena. The
term often implies, in addition, an assumption that the whole may be understood from a
study of the parts (Chinn & Kramer 2008:294). The term atomistic theory may be used
synonymously with the term microtheory.
& Grand theory deals with broad goals and concepts representing the total range of
phenomena of concern within a discipline. This term may be used to imply macrotheory
and molar and holistic theory (Chinn & Kramer 2008:298).
& Meta-theory refers to the nature of theory and the processes for its development (Chinn
& Kramer 2008:299). This is the theory of theorising.
Holistic theory deals with a broad scope of phenomena. The use of the term holistic theory
often implies, in addition, an assumption that the whole is greater than the sum of the parts.
This term may also be used to imply macro and grand theory (Chinn & Kramer 2008:305).
In addition, theories can be classified as
& developmental theories
& interaction theories
& care ideology theories, and so on
6.3 CONSTRUCTS RELATED TO THE CONCEPT OF THEORY

If you have previously confused the term and concept of ``theory'' with other related concepts,
you are in good company. Theorists themselves seem to do this all the time, and the
definitions of constructs related to theory more often than not contribute to this confusion,
rather than clarifying it. Here is our attempt to make some sense of the confusion surrounding
the concepts of theory, conceptual model, conceptual framework and paradigm.
6.3.1 Theory
Revise the previous paragraph on the definition of the term theory. Study this section in
conjunction with those on conceptual model, conceptual framework and paradigm that follow.
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6.3.2 Conceptual model

A conceptual model represents a group of concepts, based on assumptions that serve to
integrate them into ``meaningful configurations'' (Fawcett in Nicoll 1992:434), are highly
abstract and not directly observable or testable in the real world. These models represent
global ideas and are derived from an author's personal philosophy and particular orientation
(Fawcett 1980:13). Bush (Nicoll 1992:439) maintains that models are used to observe, order,
clarify and analyse events. These models contain words that describe mental images of
phenomena and provide systematic structure only, and may be either inductively or
deductively developed (Fawcett 1989:4) to reflect different and sometimes ``logically
incompatible'' views of the world. Conceptual models are developed to give diagrammatical
representations of how the various concepts connect with or cause other concepts, and may
be of four types: linear/directional, circular, core identity and foundational (Riehl-Sisca
1989:7).
6.3.3 Paradigms
These reflect the most global views of a perspective and act as an `èncapsulating unit ...
within which the more restricted structures develop'' (Fawcett 1989:5), and are more abstract
and general than conceptual models.
Paradigms are also defined as ``world views'' (Chinn & Kramer 2008:301) within a discipline
that organises processes and outcomes, leading ultimately to theory development. Scientific
paradigms are known to offer a particular deterministic view, with the integration of aspects
that interact and that are `ùnitary transformative'' (Stevens Barnum 1994:269). Paradigms
function like maps, which give direction to concepts that should be included in explanations
in order to obtain agreement as to a theory construct, research methodology and standards.
Paradigms can be either quality or quantity paradigms, as in the qualitative research
paradigm and the quantitative research paradigm.
6.3.4 Theoretical frameworks

Our notion about these frameworks is that they usually represent a summary of an in-depth
literature review (``theory''), a reconstruction of one's understanding of a phenomenon based
on literature. This is often found in research dissertations and theses as a conclusion to a
literature review or where more than one theory proper has been eclectically combined to
restructure the researcher's personal (pre-scientific) understanding of a phenomenon.
6.4 ANALYSIS AND EVALUATION OF NURSING THEORIES

To be able to select an appropriate health sciences or health care theory to base practice on,
or to teach to students in order to illuminate some aspect or perspective of health science and
health care, you need to be able to analyse and evaluate health sciences and health care
theories. This is a very important cognitive skill you need to develop. In this regard, we shall
look at the way in which Chinn and Kramer (2008) go about analysing and describing nursing
theory. Although the meta-paradigmatic concepts for the different health sciences and allied
health sciences may differ, the basic principles apply.
66
6.4.1 Reasons for theory analysis

6.1
Without reading the rest of the contents of this study unit, first list the reasons that you
think necessitate the analysis and evaluation of theory.
There may be several reasons for analysing theories. Some of these reasons are implied in
the processes of analysis that follow. However, overall, theories are analysed for the following
reasons:
& To assess and assert their worth in order to decide whether a theory is applicable in a
specific field. This is mostly done by describing the theory and by critically reflecting on
the theory.
& To compare descriptions, to set forth facts about the theory, or asking: What is this?
& To ascertain how well a theory serves some purpose. Critical reflection is a process that
asks: How does it (the theory) function or work? Critical reflection follows on the
description of the theory.
The following outline of theory description and of critical reflection on a theory has been taken
from Chinn and Kramer (2008:219249).
6.4.2 Describing a theory

Before one can analyse a theory, one needs to acquaint oneself thoroughly with what the
theory entails. Describing a theory is the way toward this.
The descriptive components of a theory include the purpose of the theory, the concepts used
in the theory, the definitions of these concepts, the nature of the relationships of these
concepts to one another, the structure of the theory and the assumptions on which the theory
is founded. A number of questions should be asked to clarify each of these descriptive
components.
6.4.2.1 The purpose of the theory

The questions regarding the purpose of the theory address why the theory was formulated and
reflect the contexts and situations to which the theory can be applied. The following questions
should be answered:
& Why has this theory been formulated?
& Is there an overall purpose for the theory? Is there a hierarchy of purposes? Are there
several separate purposes?
& Is there a purpose for the nurse, the person receiving care, the society and/or the
environment?
& How broad or narrow is the purpose?
& What is the value orientation of the purpose? Is it positive, negative or neutral?
& Does achieving the theoretical purpose require a nursing context?
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& Does (do) the purpose(s) reflect understanding? Does the purpose create meaning,
description, explanation and predication of the phenomenon the theory describes?
& When would the theory cease to be applicable?
& What is the end point (or ultimate goal) of the theory?
& What purposes can be identified that are not explicitly embedded in the matrix of the
theory? (Chinn & Kramer 2008:220223 and 235).
6.4.2.2 Concepts contained in the theory

The following questions identify the ideas that are structured and related within the theory.
They question the qualitative and quantitative dimensions of concepts and include questions
such as
& How many concepts are there?
& How many major concepts?
& How many minor concepts?
& Is there one major concept with minor ones organised under it?
& Can the concepts be ordered or related, or arranged into any configuration?
& Are there concepts or groups of concepts that cannot be related?
& Are the individual concepts broad or narrow in scope?
& How abstract or empirical are the concepts?
& What is the balance between highly empirical and highly abstract concepts?
& Do concepts represent objects, properties or events? (Chinn & Kramer 2008:223225
and 235)
6.4.2.3 Definitions pertinent to the theory

Questions about the definitions of concepts contained in a theory clarify the meaning of
concepts within the theory. They question how empirical experience is presented by the ideas
within the theory. Some of the questions that need to be answered are
& Which concepts are defined and which are not?
& Which concepts are defined explicitly and which are only implied?
& How much meaning about concepts must be inferred?
& Which concepts are defined specifically and which generally?
& Are there competing definitions for the same concept?
& Are there similar definitions for different concepts?
& Do any explicitly defined concepts not need any definition?
& Are any concepts defined contrary to common convention? (Chinn & Kramer 2008:225
227 and 235)
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6.4.2.4 Relationships and relational statements

These questions look at the way in which concepts are linked together within a theory. They
focus on the various forms that relational statements can take and how these give structure to
the theory. The following questions should be pondered in this regard:
& What are the major relationships within the theory?
& Which relationships are obvious?
& Which relationships are implied?
& Do relationships include all concepts? Which ones are not included?
& Are some concepts included in multiple relationships?
& Is there a hierarchy of relationships?
& Do relationships create meaning and understanding? Do they do this by describing,
explaining, predicting or a mix of these?
& Are relationships directional? What is the direction? Are they neutral?
& Are there mixed, competing or incongruent relationships?
& Are relationships illustrated? (Chinn & Kramer 2008:227228 and 235)
6.4.2.5 Revealing the structure

Questions on the structure of the theory address the overall form of the conceptual
interrelationships. They discern whether the theory contains partial structures or has one
basic form. Drawing diagrams of the structure could be quite helpful in understanding the
theory. The following questions needs to be considered in this regard:
& How are overall and individual ideas organised?
& If outlined or diagrammed, what would the theory look like?
& Do relationships expand concepts into larger wholes or vice versa?
& Do relationships link concepts in a linear, spiral, bifurcating, circular or cluster fashion?
& Does the structure move concepts away from, or toward the purposes of the theory?
& Are there several structures that emerge? What is their form? How do they fit together?
& Could more than one structure represent the overall structural relationships sensibly?
& Are there areas in which there is no structure? (Chinn & Kramer 2008:228231 and 235)
6.4.2.6 Unravelling underlying assumptions

These questions address the basic truths that underlie theoretic reasoning. They question
whether assumptions reflect philosophical values or factual assertions. These questions
include
& What assumptions underlie the theory?
& Are assumptions implicit, explicit, or derived from context and meaning?
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& What are the individual, the nurse (health care practitioner), society, environment and
health assumed to be like?
& Do assumptions have an obvious value orientation? What is this orientation?
& Can the assumptions be verified?
& Do they need to be verified?
& Where are assumptions located within the structure, prior to, within, or following
theoretical reasoning?
& Can assumptions be hierarchically arranged or otherwise ordered?
& Do assumptions have any identifiable relationship to theoretical relationships or
structures?
& Are there competing assumptions? (Chinn & Kramer 2004:92105)
6.2
This activity is a practical exercise in conceptualisation.
Study the questions relating to the descriptive component of a theory and paraphrase
them. In other words, describe each of the descriptive components without restating
any of the questions.
NB: Please do this activity. If in the examinations a question is asked on the
description of a theory, restating the questions as they appear in this section will
not earn you any marks.
6.4.3 Critical reflection on theory

Critical reflection on a theory scrutinises the clarity, simplicity, generality, accessibility and
importance of the theory. In this instance there are also a number of questions relating to
each of these aspects that need to be answered.
6.4.3.1 Clarity of the theory

Questions on the clarity of a theory address the consistency of presentation of concepts,
definitions and relational statements. Clarity and consistency may be both semantic and
structural. The questions that need to be answered include the following:
& How clear is the theory?
& Are major concepts defined?
& Are significant concepts not defined? Are definitions clear, congruent and consistent?
& Are words coined? Are coined words defined?
& Are words borrowed from other disciplines and used differently in this context?
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& Is the amount of explanation appropriate, too much or too little?

& Are examples or diagrams helpful or not?
& Are the diagrams and examples that have been used meaningful?
& Are basic assumptions consistent with one another and with the purpose?
& Are the views of person and environment compatible?
& Are the same terms defined differently?
& Are different terms defined similarly?
& Are concepts used in a manner consistent with their definition?
& Are diagrams and examples consistent with the text?
& Are compatible and coherent structures suggested for different parts of the theory?
& Can the theory be followed? Can an overall structure be diagrammed?
& Where are there gaps (if any) in the flow of the theory? Do all concepts fit within the
theory?
& Are there any ambiguities as a result of the sequence of presentation?
& Does the theorist accomplish what he or she set out to do? (Chinn & Kramer 2008:238
242 and 246)
6.4.3.2 Simplicity
Theories are not always complex; neither are they always easy to understand. Questions on
simplicity address the number of structural components and the relationships within the
theory. In this instance complexity implies numerous relational components within the theory,
while simplicity implies fewer relational components. Although simplicity is more desirable,
completeness of the theory should also be considered. Nonetheless, the following questions
deserve attention:
& How many relationships are contained within the theory?
& How are the relationships organised?
& How many concepts are contained in the theory?
& Are some concepts differentiated into subconcepts and others not?
& Can concepts be combined without losing theoretical meaning?
& Is the theory complex in certain areas and not in others?
& Does the theory tend to describe, explain, or predict?
& Does the theory impart understanding?
& Does the theory create meaning? (Chinn & Kramer 2008:242 and 246247)
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6.4.3.3 Generality
Questions in this regard address the scope of experience covered by the theory. Generality
infers a wide scope of phenomena whereas specificity implies a narrower range of events
included in the theory. Generality combined with simplicity yields parsimony. The following
questions apply in this regard:
& How specific are the purposes of the theory? Do they apply to all or only some of the
areas of practice?
& Is the theory specific to nursing? If not, who else could use it? Why?
& If subpurposes exist, do they reflect nursing actions?
& How broad are the concepts within the theory? (Chinn & Kramer 2008:243 and 247)
6.4.3.4 Accessibility
The questions posed in this regard address the extent to which concepts within the theory are
grounded in empirically identifiable phenomena. They include questions such as
& Are the concepts broad or narrow?
& How specific or general are definitions within the theory?
& Are the empirical indicators of concepts identifiable in reality? Are they within the realm
of nursing?
& Do the definitions provided for the concepts adequately reflect their meaning?
& Is a very narrow definition offered for a broad concept? Or, similarly, a broad meaning
for a narrow concept?
& If words are coined, are they defined? (Chinn & Kramer 2008:243244 and 247)
6.4.3.5 Importance
Questions on the importance of a theory address the extent to which the theory leads to valid
health care practice, goal attainment, research and education. Questions include
& Does the theory have potential to influence nursing actions? If so, to what end?
& How specific are the purposes of the theory? Do they provide a general framework within
which to act or a means to predict phenomena?
& Is the theory's position on people, nursing and the environment consistent with
nursing's philosophy?
& Given the purposes of the theory and its orientation, has anything of significance to
nursing or health been omitted?
& Is the stated or the implied purpose one that is important to nursing? Why?
& Will use of the theory help or hinder nursing in any way? If so, how?
& Will application of the theory resolve any important issues in nursing?
& Is the theory futuristic and forward-looking?
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& Will research based on the theory answer important questions?

& Are the concepts within the domain of nursing?
& Do I like this theory? Why? (Chinn & Kramer 2008:245 and 247)
6.3
This activity is a practical exercise in conceptualisation.
Study the questions on critical reflection on a theory and paraphrase these. In other
words, describe each of the components of critical reflection without restating any of
the questions.
Your answer to the above activity would also be the answer to a question such as the
following:
What are the features of a theory that describe a good theory or a theory that meets the
purpose for which it was designed?
NB: Please do this activity. If in the examinations a question is asked on the
description of a theory, restating the questions as they appear in this section will
not earn you any marks.
6.4.4 Additional points for analysis of theories

Hunink (1995:5561) focuses on the following aspects, which add a number of alternative
insights into theories.
6.4
Study the following section and add it to the outcomes of the previous two activities.
6.4.4.1 The theorist

To get a more complete view of a theory, it may be worthwhile learning something about the
theorist's training and education, experience in the specific field of study, and the
developmental history of his or her thinking. These aspects will provide the investigator with
an understanding of the frame of reference from which the theorist operates.
6.4.4.2 The aim of the theory and the reasons for its construction
These issues give one more insight into the background, the context and the intentions of the
theory. Also see Chinn and Kramer above in this regard.
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6.4.4.3 The development of the theory

Some theories are a once-off presentation, while others have a longer history of development.
When we have revised editions of a theory, we can check previous publications on the theory
and previous formats of the theory and so establish whether the theory has been revised
following research, practical experience or criticism. Close attention should be paid to any
alteration of the theory to make sure that previous errors have not been repeated.
6.4.4.4 The connection with other theories or views

The degree to which the theory is based on knowledge from other theories is assessed. In this
instance the possible derivation of contents and structure must be noted as well as the correct
use of definitions in a transposed context. This exercise can prove helpful during curriculum
planning because, by relating theories to one another, congruence in the presentation of
different disciplines within the health sciences' curriculum can be established.
6.4.4.5 The implicit or explicit assumptions of the theory

These assumptions can be of ethnic, cultural, social, legal, philosophical or ideological
nature. Assumptions may be stated explicitly, but unstated or implicitly stated assumptions
may also influence the theorist's thinking. We need to know what assumptions underlie the
theory in order to decide on the application of the theory in practice.
6.4.4.6 What type of theory is it?

It is necessary to determine whether the theory was designed for description purposes only or
whether for prediction or control. This will ultimately determine whether its inclusion in the
curriculum will lead to knowledge of its properties only, or whether it will support the
generation of new knowledge through research.
6.4.4.7 The meta-paradigmatic concepts

Meta-paradigmatic concepts are those concepts that are essentially related to the discipline in
which the theory is developed. In sociology such concepts may include social change, status,
ideology and the like. In psychology it may be personality and others. In nursing these are
person, health, environment and nursing (caring).
These concepts are very important in the evaluation of theories. Congruency among the
definitions of the meta-paradigmatic is absolutely essential. For instance, it will be quite
unacceptable if the individual is defined in a humanistic indeterministic way, while the
individual's relationship to the environment is described in a deterministic fashion.
6.4.4.8 The concepts used in the theory

It is in the concepts that theorists use that theories differ particularly from one another. As
stated earlier, we need to establish whether concepts are clearly defined and how they relate
to one another. Although a theorist will usually state the most important concepts explicitly,
this may be lacking in some theories hence the need to evaluate theories. To understand
this section better, please refer to the section on concepts and statements above.
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6.4.4.9 The nursing process

Different nursing theories describe and apply the nursing process differently. In evaluating
nursing theories we must establish whether the particular theory has a characteristic
presentation of the nursing process, and whether it only prescribes specific actions within the
more generic nursing process. You will become more aware of this issue when applying
specific nursing theories later on in this study guide. This is a very important aspect of
nursing theories in particular, as this will definitely impact upon nursing practice and with it
the learning experiences that need to be designed for students. In other health sciences the
same applies. Cognitive oriented theories in psychology will probably imply cognitive
therapy. While existentially oriented theories might imply logotherapy.
6.4.4.10 The theory's usefulness in practice

For the purpose of this course, the usefulness of nursing theories is not limited to the clinical
area only, but includes their usefulness in education and training. Hunink (1995:60)
pertinently points out that for insight into the usefulness of nursing theory, we should look at
what the theory says about certain specific nursing topics such as
& the nursing discipline in general
& nursing education
& nursing management
& nursing research
Naturally, in any of the allied health sciences, we need to consider theories' implications with
regard to these points, and how they might influence aspects of the curriculum such as the
content component and learning experiences, including clinical experiences and the like.
6.5 THE GENERAL IMPORTANCE OF THEORIES

What is said in this section about the application and general importance of nursing theories
is true of most theories in the health and human sciences. We trust that considering the
general importance of theories will impress upon you the importance of integrating formal
theory into the health sciences' curriculum.
6.5.1 Importance to health care practice

6.5.1.1 Theories as a basis for ethics
According to Hunink (1995:33) a formal theory functions as a basis for ethics and conduct.
According to this author, it seems that there is at present a tendency to give a broader
meaning to ethics than simply the boundaries of what is permissible and what not. Our
contention is that if a theory is supported by research and it is accepted as ``true'', not acting
in accordance with that theory may constitute unethical and immoral conduct. Naturally, there
are also ethical theories that have a direct influence on nursing ethics. With regard to the
latter see module HSE3705.
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6.5.1.2 Theories as a basis for quality assurance

The quality of nursing care can be assessed using a theory to provide criteria or standards for
assessment. When a theory describes the care that is desirable or necessary, the actual care
delivered can be assessed/evaluated using the theory as a standard (Hunink 1995:33).
6.5.1.3 Systematic approach to practice

Health care practice has been looked at critically recently, resulting in claims that health care
is based on inadequate problem definition, subjective recall of evidence and unsophisticated
generalisation. One response to these criticisms has been to intensify the development of
models for health care within which to identify more concrete, realistic goals for practice
(Kershaw & Salvage 1989:7).
6.5.2 Importance for education and the curriculum

The implications of theories and their importance for health sciences education and the health
sciences' curriculum are discussed below.
6.5.2.1 Theories guide the selection and structuring of subject content

Theories guide students in the clinical area regarding important observations that must be
made for adequate problem definition. They also give students a firm scientific foundation
from which to approach patient care in contrast to an otherwise traditional, subjective recall of
evidence.
6.5.2.2 Professionalisation of health care professions

Historically the practice of nursing (perhaps other health care professions also) has taken
place within a modified medical model, which had a disease/treatment orientation. Most of
the nursing models that have been constructed as alternatives to the disease/treatment
approach have been founded on ``human needs''. This has identified nursing's scope as an
independent profession. Theories, therefore, also
& provide focus on professional goals in health care practice
& bring about desirable changes
& stimulate ideas and spark political (health politics) action
& provide a basis for self-identity and esteem for health professionals
& expand nursing and other health professions as a science
& set boundaries to the scope of the profession (demarcate the sphere of professional
endeavour)
In nursing education specifically, nursing theories provide a frame of reference, which assists
in professional socialisation; they circumscribe the phenomenon of nursing adequately. It is
also our contention that the fight for nursing's professional and independent character (that of
all allied health sciences) will in future be fought at the academic and the practice level where
theory and practice are integrated, and not via professional bodies.
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6.5.2.3 Professional developments: the need for direction

A change in the framework for nursing (and other health professions) and, within this, the
adoption of a systematic approach implicit in which is the process of critical reflection
have given a new perspective to the problems within the profession, ultimately leading to an
improvement of patient care. It is assumed that this approach will unite practice, education,
management and research in a joint effort to meet the changing needs of health care. New
possibilities for solutions to apparently insoluble problems are revealed when the problems
are viewed from a different standpoint (Kershaw & Salvage 1989:9). Thus, theories in health
sciences
& present particular solutions to particular problems
& direct health professionals toward some purpose
& fill gaps in existing knowledge
& guide health practitioners in making choices in the clinical field
& indicate actions (interventions) to be taken (Kershaw & Salvage 1989:9).
Congruence in theoretical structuring could unite practice, education, management and
research in a joint effort to meet the changing needs of health care. For health sciences
education, the curriculum and the student, such congruence spells a better integration of
theory and practice. This is perhaps the most important implication theories have for the
health sciences curriculum.
6.5.2.4 Theories and research

Theories provide hypotheses for empirical testing. Theories therefore contribute to the
following:
& The ultimate goal of science, namely the advancement of theories themselves as well as
scientific knowledge and scientific endeavour through research.
& A pool of scientific knowledge (which again has implications for the nursing
curriculum).
& Description and, often, prediction and control of nursing phenomena.
& In education and the curriculum, theory-linked research is a constant source of up-todate, grounded and relevant knowledge for inclusion in the curriculum as subject
content.
& Professionalisation and the maintenance of professional status.
6.5.2.5 Additional points

In addition to the above, and to recap, theories are important in curriculum construction in
general and the selection of curricular content specifically. Theories have an influence on the
type of curricular content that will be focused upon, the depth, breath and sequence of
content. They may even indicate core curricular content. In health sciences education,
theories and models clarify the meaning of a profession and describe the tasks for which the
learner is being prepared. The following issues should also be kept in mind:
& The definitions the theory has for the person, environment, health and nursing (or your
profession) and its implications for practice. The importance here is that the patient, the
student, the client, and the educator are all human beings in relation with an
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environment. These individuals are all defined by a single definition. As human beings,
they cannot be described differently from one another. In this regard they must be treated
equally!
& The way in which the theory describes the nursing process. Different nursing theories
define the phases of the nursing process differently.
& The role of the professional practitioner and the patient, respectively.
& The essence of a profession, its task and so on.
& Radical issues/problems or curtailments within the theory. For instance, Orem's theory
of self-care would probably cause a lot of problems since people, especially men (and I
am a man) in our country still believe that it is someone else's duty to look after them
and to care for them when they are ill. Health professionals need to educate South
African citizens to accept responsibility regarding their own health.
& By applying health sciences' theory to the educational setting, we do not redefine that
theory as an educational, teaching or learning theory. We merely bring our educational
practice into congruence with the character of that theory.
& Theories, owing to their philosophical underpinning demand congruence between theory
and practice if the theory is to be implemented with any measure of authenticity.
& Theories are applied to the curriculum in two ways. Firstly, a theory is applied as an end
in itself. This implies teaching the theory per se as subject content. Secondly, a theory is
applied as a means to an end. In this instance the theory serves as a vehicle toward
some other end such as structuring the curriculum, selecting specific contents for the
curriculum, guiding the situational analysis and determining the nature of education
itself.
6.6 SINGLE OR MULTIPLE THEORIES?

Let us consider some ways in which theories and models can be applied to the health
sciences' curriculum. There are a variety of ways in which models and theories related to the
health sciences can be applied to the curriculum.
One suggestion is that curriculum developers of health sciences curricula should design an
eclectic model, incorporating concepts from several models. There are, however, problems
that may arise from this approach. Firstly, what is gained in breadth may be lost in depth. In
using ideas from several models, there is the risk that the network and structure that link the
ideas together may be lost. Furthermore, when using this approach, it is essential to identify
not only the underlying beliefs, values, goals and knowledge, but also their relationship to
one another in practice.
Another suggestion is the single model (theory) approach. Here a single well-developed
theory is chosen, such as Orem's theory of self-care or Watson's caring model, from which
the curriculum is developed. A major problem is that there seems to be no single (general)
theory that suits all health care situations. For example, Orem's theory may be completely
suitable for community nursing but totally unsuitable for psychiatric nursing. Furthermore,
students who only have the opportunity to see health care from a single theoretical approach
may develop a narrow view. Rather than slavishly following one approach, students should be
helped to develop skills to choose the right approach themselves. However, to illustrate the
implications a nursing theory might have for the health sciences curriculum, we shall use part
of a single nursing theory.
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The third suggestion is to follow a modular design. Here the curriculum is divided into
modules, for example, primary care for the aged, maternal and children's health, community
health care, medical and surgical nursing, psychiatric nursing, and so on. A suitable theory
would then be selected for each module. This is, however, a very complex exercise.
6.7 PATTERNS OF KNOWING

Carper (1978) identified four patterns of knowing in nursing epistemology, namely:
& Empirical knowing
& Personal knowing
& Ethical knowing and
& Aesthetical knowing
These patterns of knowing are discussed at this point as they hold importance in health care
theorising, because they add a certain dimension to health care theory and practice, namely,
scientific knowledge, personal experience, moral conduct and the aesthetics on art of health
care.
Study the following section.
6.7.1 Empirical knowing

This is also known as the science of nursing (or health science). According to Carper
(Kikuchi & Simmons 1992:76) the empirical patterns of knowing are concerned with matters
of fact that are expressed in descriptions or statements of relationship between phenomena
that are asserted to be true or probable. Empirical data, obtained by either direct or indirect
observation and measurement, are verified through repeated testing over time, and are
formulated as scientific principles, generalisations, laws and theories that provide explanation
and prediction. Scientific knowledge is objective, abstract and general. Quantifiability of data
allows objective measurement, which yields evidence that can be replicated by multiple
observers and is therefore publicly verifiable (Carper in Kikuchi & Simmons 1992:76; Chinn
& Kramer 2008:8).
Scientific curriculum content such as anatomy and physiology could be included in the
curriculum to make provision for empirical knowing.
6.7.2 Personal knowledge and knowing

This pattern of knowing is concerned with knowledge of self, and self in relation to others.
Self-consciousness permits us to know ourselves and other selves, unmediated by
conceptual categories or particulars abstracted from complex wholes. Personal knowledge is
necessarily subjective, concrete and existential, and does not require mediation through
language. It does require engagement rather than detachment, and an active, empathetic
participation of the knower (Carper in Kikuchi & Simmons 1992:76). Students can be guided
toward personal knowledge by making provision for, for example, self-knowledge exercises
(Chinn & Kramer 2008:7).
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6.7.3 Ethical knowing

This is the moral component. The moral dimension of a profession is concerned with
choosing, justifying and judging action. It involves the notion of moral duty and obligation.
Ethical choice requires rational and deliberate reasoning. Ethical knowledge is normative and
abstract as well as singular and particular. Moral choice is personal in that decisions are
voluntary and deliberate and the moral agent is held accountable for the judgement made and
the action taken. Ethical judgements are particular in that choices and actions occur in
concrete situations. But, they are also abstract and general in that the moral rules and
principles that justify the action taken are held to be universally valid and generalisable to
similar situations. Moral actions are not simply a function of personal values, but are
informed and mediated by members in the moral community of a profession. Ethical
knowledge also involves the examination and evaluation of what is good, valuable and
desirable as ends of goals, motives and traits of character (Carper in Kikuchi & Simmons
1992:76; Chinn & Kramer 2008:6).
Ethics and moral decision making could be included in the curriculum to make provision for
ethical knowing.
6.7.5 Aesthetical knowing

This pattern of knowledge represents the art of nursing (or any other profession). It contains
knowledge of that which is individual, particular and unique. Aesthetic knowledge requires the
active transformation of what is observed, through the experience of subjective acquaintance,
into a direct, nonmediated perception of significant relationships and wholes rather than
separate, discrete parts. Aesthetic knowledge is the comprehension and creation of value and
meaning from both generalised abstractions and concrete particulars. It enables us to go
beyond what can be explained by existing principles and theories and to account for variables
that cannot be systematically related or quantitatively formulated. It is interpretive, contextual,
intuitive and subjective knowledge. It requires synthesis rather than analysis (Carper in
Kikuchi & Simmons 1992:76; Chinn & Kramer 2008:7). Students can be guided toward
aesthetical knowing by developing their critical thinking skills, for instance.
Now study Billings and Halstead (2005:269271) (2009:218).
6.5
Indicate the implications the different patterns of knowing may hold for the health
sciences' curriculum.
6.8 AN ILLUSTRATION OF THE APPLICATION OF A THEORY

IN THE CURRICULUM
The application of part of a specific nursing theory: Orem's self-care theory.
As an example we shall use a single theory, or part of a more elaborate theory. Consider the
following graphic presentation of the different basic nursing systems according to Orem's
theory of self-care.
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SELF-CARE
!
Agencies
. self-care agency
. therapeutic self-care agency
. dependent-care agency
Self-care requisites
. universal
. developmental
. health deviations
Self-care deficit
. lack of
knowledge
skill
motivation
orientation
!
Nursing systems
. wholly compensatory
. partly compensatory
. supportive educative
!
Elements of nursing systems

.
.
.
.
scope
general and specific roles
reasons for relationships
kind of actions
!
Methods of help
Activities for nursing practice

.
.
.
.
.
.
.
FIGURE 6.1
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entering and maintaining

nurse/patient relationships
determining help
responding to needs
prescribing
providing and regulating direct help
co-ordinating and integrating nursing with
daily living
.
.
.
.
acting or doing for another

guiding
supporting
providing environment for
development and teaching
Outline of Orem's self-care theory
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In addition to this schematic representation of part of Orem's theory, also keep the name of
this theory in mind when contemplating the implications this theory has for the health
sciences curriculum. Also remember that what we present here is but part of Orem's theory of
self-care. The interested reader is referred to the numerous books available on nursing
theories.
6.6
Looking at the above diagram, what would you say is the main characteristic of Orem's
theory?
There are a number of possible answers. However, in our opinion, the main feature of this
section of Orem's theory is a human potential for development. Keep this in mind when trying
to spell out the implications that this theory has for health sciences' education and the health
sciences' curriculum.
6.7
Looking at the above diagram, what would you say are the possible implications that
Orem's self-care theory holds for curriculum planning?
With regard to this activity, also see the section above on the general importance of theories
in nursing. Naturally, you are expected to apply these general points.
The best way to apply a theory in curriculum development is to spell out the possible
implications the theory holds for each of the components of curriculum development.
However, remember, you need not rewrite the health sciences or health care theory as an
educational theory, or as a learning or teaching theory. What you have to do is to apply the
theory in such a manner that both the content to be taught (as implied by the theory) and the
way in which it is done are congruent with the stipulations and the general character of the
theory. Therefore, the essence of the theory must serve both as a means to an end and as an
end in itself.
6.8.1 Orem and the situation analysis

This has mostly to do with the social acceptability of the theory. For instance, the
implementation of, and acting upon, Orem's theory in health care could save various
countries a lot of money as it implies personal responsibility and prevention rather than cure.
However, at present, too many people still prefer a directive, supportive, non-committed
approach to health care in which they can shift their responsibilities onto others. So we shall
have to investigate, in addition to all the other things we should investigate during a
situational analysis, the extent to which the theory is socially acceptable. The general culture
needs to be investigated, primarily with the aim of establishing people's perception of the
locus of control. If a magico-religious worldview is adhered to it is quite possible that people
might blame disease on the supernatural, seeing it as inevitable and not due to their own
actions. Deciding on implementing Orem's theory will need an in-depth investigation into
these issues. If we find that the theory is not at all acceptable, it does not necessarily mean
that we are not going to implement or use the specific theory. Perhaps such a finding might
82
indicate the need to implement exactly this specific theory. It will definitely tell us how to
implement the theory, pointing to, with the necessary caution, client education and the like.
6.8.2 Orem and objectives/outcomes

Although outcomes are based on the findings of the situation analysis, this will account for
only a part of the outcomes contained in the curriculum. The theory itself will also stipulate or
imply certain outcomes to be attained. Remember that you will have to formulate both
teaching and learning outcomes, that is, outcomes specific to the educational approach and
strategies that you are going to use to provide education congruent with the general ``spirit'' of
the theory, and outcomes on what students have to know and should be able to do on
completion of their study programme.
Based on the knowledge component of the curriculum, students should be able to
& guide patients and clients toward self-care
& provide primary prevention through patient education (basic self-care)
On the other hand, based on the teaching strategies implemented, students should be able to
& study independently (do academic self-care)
& reflect on the situation and learn from personal experience
6.8.3 Orem and curriculum content

The chosen theory will be part of the content. This is an end in itself. Much of what we have
said previously also applies at this point. However, there must be certain supportive subjects.
In the case of Orem's theory the following supportive subjects and topics may be selected:
& Sociology and social-psychology might be important, especially social roles, role
reversal, role change and the like.
& Cultural issues and the traditional role of women in the society may be important. The
``sick role'' in culture applies.
& Primary health care and the philosophy underlying this approach are probably the most
important subjects to teach.
& Skills such as changing people's attitudes and bringing about change, in addition to all
the clinical skills that students need to conquer, will also be important.
& The general philosophy underlying the theory can also be taught to students. But, the
nursing school must then also embrace that specific philosophy to ensure internal
consistency between philosophy, theory and practice. Most of the later theories of
nursing, in some or other way, embrace the humanistic and existential philosophies.
This is definitely the case in our example, namely, Orem's self-care theory. Human
becoming (Homo viator) is definitely implied in this theory.
& If we look at the diagram above, the concept of patient classification according to acuity
also comes to mind. Therefore, in health service management, we shall teach students
precisely this concept and its implications.
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83
6.8.4 Orem and teaching strategies

Orem's self-care concept as a means in nursing education implies that self-care, and the
different nuances of such self-care as defined by Orem, will be implemented in the
educational setting to teach students. In accordance with Orem's theory, students must be
guided toward a more independent and self-reliant teaching and learning style: self-care in
education. One would probably begin with a more pedagogical approach followed by a more
andragogical approach later on. The ultimate goal in health sciences' education will be to
guide the students to self-education (self-care), independence, lifelong learning, and so on.
Doing so will be congruent with what your students do in practice: to approach patients and
clients as potential self-care agents.
6.8.5 The role of the educator and the student

For guidelines, look at the role of the patient and the nurse (health professional) in the above
diagram. Replace the nurse with the educator and the patient/client with the student. Place
them in an educational setting. However, we reiterate, you are not converting a nursing theory
(or theory pertaining to your profession) into an educational theory, but are only aiming for
maximal congruency between theory and practice. Do this in conjunction with section 6.8.4.
The student must take an active role in the educational setting. Tutors must take a flexible
position and should adapt their position according to the needs of the student, from sources
of information (pedagogic) to co-learner and co-discoverer (andragogic).
6.8.6 Evaluation strategies

These must also be congruent with the theory's definition of the individual, the teaching
strategies, the general educational approach and the underlying philosophy. From the
diagram above it is deduced, among other things, that students' ability to ``work
independently'' will be of highest priority during evaluation. In addition, assessment sessions
and formative evaluation can also be conducted to ``diagnose'' problems that students are
experiencing and that are hampering their progress (development). Assessment and
evaluation are always formative, as growth and development are central to attaining and
maintaining self-care (in education).
6.8
Take any nursing theory, describe and evaluate it and indicate the implications it holds
for the development of a health sciences' curriculum.
6.9 CONCLUSION
In this section we considered the concept of theory and related concepts and structures, and
the value of formal theory, and we illustrated the application of theory to the health sciences
curriculum via Orem's self-care theory. In the next study unit, we introduce you briefly to a
popular model in health research, namely, the Health Belief Model.
84
Health theories: The health

belief model (HBM)

http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/Health_Belief_Model.doc/
Key words
& Perceived susceptibility
& Perceived severity
& Perceived benefitsPerceived barriers
& Self-efficacy
7.1 Introduction
In this study unit, we continue our discussion on the use of theory (and models) in
curriculum planning and design. This is truly a do-it-yourself study unit. We supply you with
information on the Health Belief Model from the internet site
HSE3703/1
85
http://www.tcw.utwente.nl/theorieenoverzicht/Theory%20clusters/Health%20Communication/
Health_Belief_Model.doc/ and you need to spell out the implications this model might hold
for the health sciences' curriculum.
HBM holds for curriculum contents by virtue of your ability to
&
&
&
&
describe the HBM

indicate the assumptions underlying the HBM
give a diagrammatic representation of the HBM
define the components of the HBM
7.2 Orientation
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict
health behaviours. The model focuses on the attitudes and beliefs of individuals in general.
7.3 Core assumptions and statements

The HBM is based on the understanding that an individual (patient or client) will take an
action in relation to health and illness if the individual
& feels that a negative health condition or illness can be avoided
& has a positive expectation that by taking a recommended action, he/she will avoid a
negative health
& believes that he/she can successfully take a recommended health action
7.4 Structure of the model

The HBM is explicated through four constructs representing the perceived threat and net
benefits as
& perceived susceptibility
& perceived severity
& perceived benefits
& perceived barriers
These concepts anticipate the individual's readiness to act.
Additional concepts include the following:
& Cues to action, that activate readiness and stimulate overt behaviour.
& Self-efficacy, or one's confidence in the ability to perform an action successfully. This
concept was added by Rosenstock and others in 1988 to help the HBM better fit the
86
MODIFYING FACTORS
LIKELIHOOD OF ACTION
Age, sex, ethnicity

Personality Solio-economics
Knowledge
INDIVIDUAL PERCEPTIONS
Perceived benefits versus

barriers to behavioural
change
challenges of changing habitual unhealthy behaviours, such as being sedentary,

smoking or overeating.
Likelihood of behavioural
change
Perceived susceptibility to/

seriousness of disease
Perceived threat of disease
Cues to action
. education
. symptoms
. media information
(Glanz et al 2002:52)
FIGURE 7.1 Diagrammatic representation of the HBM
7.5 Definitions of concepts

7.1
Consider the definitions and applications of the concepts contained in the HBM as
indicated in the table below. Indicate to which component of the curriculum the
`àpplications'' apply.
TABLE 7.1 Definition of HBM concepts

Concept
Definition
Application
Perceived Suscep- One's opinion of chances of Define population(s) at risk, risk levels;
tibility
getting a condition
personalise risk based on a person's
features or behaviour; heighten perceived susceptibility if too low.
HSE3703/1
87
Perceived Severity One's opinion of how serious a Specify consequences of the risk and the
condition and its consequences condition
are
Perceived Benefits One's belief in the efficacy of the Define action to take; how, where, when;
advised action to reduce risk or clarify the positive effects to be expected.
seriousness of impact
Perceived Barriers
One's opinion of the tangible and Identify and reduce barriers through
psychological costs of the ad- reassurance, incentives, assistance.
vised action
Cues to Action
Strategies to activate ``readiness'' Provide how-to information, promote

awareness, reminders.
Self-efficacy
Confidence in one's ability to take Provide training, guidance in performing

action
action.
Table adapted from ``Theory at a Glance: A Guide for Health Promotion Practice'' (1997)
7.2
Complete the following table. In the far right-hand column, indicate possible
curriculum contents to be included in the health sciences' curriculum (patient
education programme), taking into consideration the information we have in the
middle column, on a community's perception of HIV/AIDS, gathered through a
situation analysis. This table is adapted from (http://www.etr.org/recapp/theories/hbm/
Resources.htm)
88
Concept
Condom Use Education Example Curriculum content
1 Perceived
Susceptibility
Members believe they will not

contract the HI-virus
2 Perceived
Severity
Members believe that the consequences of getting HIV are

significant enough to try to avoid.
3 Perceived
Benefits
Members believe that the recommended use of condoms will

protect them from contracting HIV
4 Perceived
Barriers
Members see condom use as:

Limiting pleasure
Being embarrassed
Condoms are not readily available Religious/cultural objections
Not knowing how to use a
condom
5 Cues to Action
Members indicate lack of incentives and motivation to practice

safe sex; and lack of information
sources in this regard
Concept
Condom Use Education Example Curriculum content
6 Self-efficacy
Members not confident that they

will be able to use condoms
correctly
7.6 Conclusion
In this study unit, you were introduced to the Health Belief Model (HBM). The aim of the
study unit was to provide learning experience in applying a basic health care model to the
health sciences' curriculum
HSE3703/1
89
Cultural theory and the

curriculum

Prescribed material
Tjale, A & de Villiers, L. 2004. Cultural issues in health and health care
(Chapters 7, 8 &10)
Key words
& Communication
& HealthAnthropology
& Culture
8.1 Introduction
In this study unit we draw your attention to cultural issues relating to developing a health
sciences' curriculum. The content of this study unit is not new to you. It is merely revision of
a section of the HSE3701 module. However, we are going to mould the information to fit the
objectives of the current study guide on foundations of curriculum planning and development.
Like philosophies and theories of a differing nature, culture also serves as a foundational
element in the design and development of the curriculum.
90
With regard to the curriculum, there are two aspects In particular relating to culture, which we
consider foundational, namely:
& Intercultural communication
& The anthropology of health
And, just to alert you further to the importance of culture in curriculum development, and to
help you to fully comprehend its importance, let us also revise the section on multicultural
education.
On completing this study unit you should be able to indicate the importance of culture
for the health sciences' curriculum by virtue of your ability to attain the objectives set
out in the prescribed book by Tjale and De Villiers (2004) with regard to
& Foundations of intercultural communication (Tjale & De Villiers 2004:106133)
& The anthropology of health (Tjale & De Villiers 2004:134158)
& Multicultural education (Tjale & De Villiers 2004:175200)
8.2 Culture
8.1
To ground your thinking and to get you going, define the term culture.
What is culture?
Helman (1996:2) states two acceptable definitions of the term culture, namely:
& Culture is that complex whole that includes knowledge, belief, art, morals, law, custom
and any other capabilities and habits acquired by the individual as a member of society.
& Culture is systems of shared ideas, systems of concepts and rules and meanings that
underlie and are expressed in the ways that human beings live. In short, culture includes
everything the human race has achieved at any specific point.
Of importance to the current study unit and module context are the references made in these
definitions to aspects such as knowledge, belief, custom and so on, and the fact that these are
collectively held and exercised.
8.3 The foundations of intercultural communication

Study the following section on
& Foundations of intercultural communication (Tjale & De Villiers 2004:106133)
Ascertain that you attain all the outcomes for this section as listed in the prescribed book. In
HSE3703/1
91
addition, also indicate how intercultural communication might influence the development of a
health sciences' curriculum and how this might feature in such a curriculum.
8.4 The anthropology of health

Study the following section on
& The anthropology of health (Tjale & De Villiers 2004:134158)
Ascertain that you attain all the objectives for this section as listed in the prescribed book. In
addition, also indicate how the anthropology of health might influence the development of a
health sciences' curriculum and how this might feature in such a curriculum.
8.5 Multicultural education

Study the section on
& Multicultural education (Tjale & De Villiers 2004:175200)
Ascertain that you attain all the objectives for this section as listed in the prescribed book. In
addition, also indicate how multicultural education might be provided for in the development
of a health sciences' curriculum, and how this might feature in such a curriculum.
8.2
Indicate how
& Intercultural communication
& The anthropology of health
& Multicultural education
might feature in each of the components of curriculum development and each
component of the curriculum.
8.6 Conclusion
In this section we revisited aspects from module HSE3701 and applied them to the health
sciences' curriculum. This brings us to the end of our study of the foundations of curriculum
development. The foundational issues we considered in this study guide are
& Philosophical foundations
& Educational theory
& Learning theory
& Nursing theory
92
& Health care theory

& Culture
In module HSE3704 we shall discuss different curriculum models and associated issues. You
will be referred to this module (HSE3703) repeatedly. So, if you involved yourself in all the
activities in this module and studied the prescribed contents well, it will definitely benefit you.
We trust that you found working through this module illuminating and rewarding.
HSE3703/1
93
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Kneller, GF. 1971. Introduction to the philosophy of education. New York: John Wiley.
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96

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PHILOSOPHICAL FOUNDATIONS: INTRODUCTION TO FORMAL

Definition of the term ``philosophy''

Formal systematic philosophy

Branches of philosophical thought

1.3.1.1 Philosophy of knowledge

1.3.1.2 Philosophy of science

1.3.1.3 Philosophy of mind

1.3.1.4 Moral philosophy

1.3.1.5 Political philosophy

1.3.1.6 Philosophy of language

The philosophy of the SANC

The downside of the objective philosophies

Implications of objective philosophies for health sciences

Teaching and teaching strategies

Implication of failures of objective philosophies for

THE SUBJECTIVE PHILOSOPHIES

The implication of pragmatism for health sciences

Implication of existentialism for the curriculum

3.4.1.2 Curriculum content

3.4.1.3 Teaching strategies

3.4.1.4 The role of the educator

3.4.1.5 The role of the student

3.4.1.6 Evaluation strategies

Implications of humanism for health sciences' curricula

3.5.1.1 Aesthetics and beauty

3.5.1.2 The naturalistic underpinning

3.5.1.3 The principle of holism

3.5.1.4 Quality of life

Multiple intelligences and holism

Ubuntu (African humanism)

The implications of postmodernism for health sciences

The implications of caring for the curriculum

3.10.1 The implications of phenomenology for health sciences

3.10.1.1 Subject content

3.10.1.2 The situation analysis

3.10.1.3 Nature of knowledge

Summary: the philosophical options

The term ``theory''

Behavioural learning theories

Cognitive learning theory

Cognitive development theory

Cognitive development: sociocultural historical influences

Adult learning theory

6.2.3.2 Types of theories based on their scope

Constructs related to the concept of theory

Analysis and evaluation of nursing theories

Reasons for theory analysis

6.4.2.1 The purpose of the theory

6.4.2.2 Concepts contained in the theory

6.4.2.3 Definitions pertinent to the theory

6.4.2.4 Relationships and relational statements

6.4.2.5 Revealing the structure

6.4.2.6 Unravelling underlying assumptions

Critical reflection on theory

6.4.3.1 Clarity of the theory

Additional points for analysis of theories

6.4.4.1 The theorist

6.4.4.3 The development of the theory

6.4.4.4 The connection with other theories or views

6.4.4.5 The implicit or explicit assumptions of the theory

6.4.4.6 What type of theory is it?