Theoretical Affective and Cognitive Components of Quality Nursing

By Smith, Linda S.; Bar, Bonnie | Journal of Theory Construction and Testing, Winter 2002 | Go to article overview

Theoretical Affective and Cognitive Components of Quality Nursing


Smith, Linda S., Bar, Bonnie, Journal of Theory Construction and Testing


Abstract: What is the relationship between affective and cognitive components of quality nursing? How strong a relationship is there between theoretical concepts of holism and caring? These were the questions we asked after the department of nursing in a publicly supported Southeastern university changed its curricular focus to include additional emphasis on caring and holism. Data from this study suggest a clear relationship between affective and cognitive components of quality nursing and among subgroups of these components.

Key Words: holism, caring, quality nursing, Cantril Self-Anchoring Ladders, Canonical Correlation

Faculty dissatisfaction with the previous curriculum stemmed from several areas. First, students demonstrated lack of self-care and support for each other. Second, faculty had developed an autocratic, evaluative role with nearly blind adherence to behavioral objectives, demonstrating little support for students. Our nursing faculty were troubled with the role of expert evaluator, a person who controls passive students' learning and mandates students' thought and performance.

Several events occurred simultaneously among faculty members in the department of nursing at a Southeastern US public-supported university. These events created the desire and need for a major curriculum revision that included cognitive and affective components of quality nursing. Two faculty members experienced a caring curriculum while earning their doctorates in nursing. Another faculty member's interest in holistic nursing led her to attend national, regional, and educational conferences, including "Healing Circles" sponsored by the American Holistic Nurses Association (AHNA). Healing Circles are small groups of nurses organized for the purpose of supporting one another. It was by participating in Healing Circles that this faculty member saw the possibility of helping students learn caring and holism within a caring environment. As a result of these experiences, faculty members began a spiritual journey that included claiming the heritage of holism and caring that has always been present in nursing and learning to incorporate holism and caring into our nursing curriculum.

Thus, as a group, our faculty decided on a new and different way to conceptualize the curriculum. We became excited about integrating the art of nursing and caring with nursing science concepts. We strongly believed that nursing based solely on cognitive competence needed to be complemented with the additional balance of holism and caring.

Theoretical Perspective

Theoretical literature has supported the curricular integration of nursing science and art (Orlick & Benner, 1988). Tanner (1990) wrote "what it is to nurse cannot be separated from what it is to care for and about others" (p. 71). Caring is critical in the nurse/client and student/teacher relationships and is "what allows the nurse, or the teacher, to understand and to act on the concerns and issues of the clientele" (p. 297). Thus, theoretical pluralism has allowed nursing education to shift from the classic Tyler model (1950) of behavioral objectives to the development of teaching strategies supportive of the concepts of caring, holism, and relationship-building. Nursing education needs to facilitate learner-acquired knowledge and reasoning skills. It also must produce nurse healers who will respond to society's need for health and holistic care (Benner & Wrubel, 1989; Edwards, 2001; Guzzetta, 1998; Holden, 1991; Johnson, 1990; Koithan, 1994; Nelson, Howell, Larson, & Karpiuk, 2001; Norton, 1998; Wilson, Grams, & Kosowski, 1997). The very concept of holism implies caring for the whole person in a dramatic interplay of art and science (Cheek, Gibson, & Heartfield, 1993; Holden, 1991; Falk Rafael, 2000).

Proposition I: Within the caring profession of nursing, holism and caring are clearly theoretically linked as are concepts related to knowledge and reasoning skill-building.

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