Philosophy of nursing practice
Phi osophy, Science, and Nursing Melanie McEwen
Largely due to the work of nursing scientists, nursing theorists, and nursing schol- ars over the post five decodes, nursing hos been recognized os both on emerging profession and on academic discipline. Crucial to the attainment of this distinction hove been numerous discussions regarding the phenomena of concern to nurses and countless efforts to enhance involvement in theory utilization, theory generation, and theory testing to direct research and improve practice.
A review of the nursing literature from the late 1970s until the present shows sporadic discussion of whether nursing is a profession, o science, or arn academic discipline. These discussions ore sometimes pleading, frequently esoteric, and ocm- sionolly confusing. Questions that hove been raised include: What defines o profes- sion? What constitutes on academic discipline? What is nursing science? Why is it important for nursing to be seen os o profession or on academic discipline?
Nursing as a Profession
2
I 11 the p.1st, there has been rnnsidembk discussion .1bout whetlu:r nursing is ,1 proti:s- sion or ,lll occup,1tion. This is import.mt for nur~e~ to considcr for scn:r,11 n:.1son~. An occupJtion i~ a job or ,l c.u-en, where.1~ .1 profrssion i~ .1 learned n>~·.niun or ocnrpa- rion th.n h.1~ .1 statu~ of ~uperioriry .md precedence within .1 di,·i~ion of work. In gen- eral term~, uc~·up.nions require widely ,·arying k,•cls of training or niucation, , ·arying kn:1s of skill, .md widely \'Jriablc.: defined knowledge ba~n. [n ~hort, all protc:~siom .ire occupations, but not .1II occupations .u-e profrssions ( Finkelman & Kenner, 2016 l.
Prot~ssions .ire nlued by society because the sen·ices proti:ssionals proYide .1re benefici,11 fix members of the society. C har.1ctabtic:. of .1 protcssion indude (I) de- fined .111d speciJlized knowledge base, ( 2 l control .md Juthority 1J\"er training wd education, ( 3) credentialing system or registration to emure competence.:, ( 4) .1ltru- i,tic ~,.:r,·i,.:c.: to ~odc;ty, ( 5) .1 code of ethics, ( 6) fi.,rmal tr,1ining within imtitution:-, , ,f higher education, ( 7) lengthy socialization to th~· prokssion, and ( 8) autonom1' ( con- trol of rrofcssional actiYities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2016;
Chapter 1 Philo5ophy, Science, and Nursing 3
Rutty, 1998 ). Proti:ssiom mmt han: a group ohd10l.1r_.,, inv..:stig.1tnrs, or r..:..,c.in.:her.<, \\·ho \\·ork to continu.1lly adYanct: the k.11<1,Ylcdgc of the protcssion \\'ith tht' goal of impro\'ing pr.Kticc. i-=i1l.llly. prokssionals .m: re~ponsiblc .rnd .1ecount.1blc to thc pub· lie for their work\ Hood.201-l ). Tr.1ditio11.11l~·, protcssiom h,Wl' inclmkd thc clergy, la\\·, .rnd m-:dicinc.
l 1nril nl',lr tht tnd of the 20th century, nursing was viewed ,ls ,lll on:up.ition rather th.111 a profr!>sion. ~ursing ha_., lud ditliculry being deemed .1 profr..,_.,ion be· c.1w,c 111.111y of thc scn·ices pro,·idcd by nur,;es h;we been pcnxin:d .1.., .111 c:-.ten.<,ion of thmc otkn:d by wi\'es .md mother .... :\.ddition.1lly, historic.111\-, m1r~ing 11.1s bern ,ecn .1s subscn·icnt to medicine, and nur,c~ lun: dcl.1yed in identi~·ing: .md organizing pro· frssional k.110\\'lcdge. hrrthennon:, i.:duc.nion ti.ir nur,-:, is not yet ,t.md.1rdi.1.ed, .md tht· three-tier cntry-lcn~l -"Y-"tem ( diplom.1, .1ssociate degm:, .rnd b.1(hdor's dcgn:e l into practice th.H pcr~i<;t.<, ha_., hindered profes..,ionalization bl'.'c.iuse .1 college education is not yet .1 requin:ment. Fin.,11~· • .iutonomy in practice i~ incompktc bcc.1usc nursing is still 1..kpendcm on mcdicirn: to direct much of its practice.
On thc other 11.111d, nuny of the ch.u.1ctcri~tics of a protcs~ion c.rn be oh,erYcd in nursing. lmkcd, nur~ing has .1 -"<>L"i,1! nund.lte to prm·ide health c.m: for clients .it different point_., in the hcalth-illne,_., continuum. There i~ ,1 growing k.no\\·kd!,W base, .mthority ma educ.1tion, ,1l trui!..tic service, a code of cthiL"~, and registration require· mcnr~ for practice. :\It hough the deb.lte i~ Il<>t closed, it can b1..· successfully argued th.u nur~i ng i~ .rn .,~pi ring. n·oh-ing profr.,sion ( Fi11kdm;1n & Kenner, 2016; Hood, 201-l; Judd & Sitznun, 201-l I. Sec I.ink to Practice 1-1 for mmc inform.uion on the future of nursing .1.., a protes~ion.
Nursing as an Academic Discipline Disciplines .u-c di:.tinctiom between bodic~ ofknmdedgi.: found in academic settings. A discipline i~ "a br.1nch of k.nmdcdgc ordcred through the theoric~ .md methods cvoh·ing from more tlun one \\'orld,·ic\\' of the phenomenon of c1.mccrn" ( Par~e. 1997, p. 74). Jr ha_., .1l,o been termed .1 ticld ofinquiry ch.1r.:ic1crized by a unique per- ~pc:cti,·e and .1 distinl"t w.1~· ofYicwin!:( phenomi.:11.1 (f.1wcc:tt, 2012; Rodgers, 201;;1.
\'iewcd .mother way, a di~cipline i~ :i. branch of educ.1tion.1l instruction or ,l de· p.1rtmcnr of learning or knowledge. Instirution_., of higher educ.ltion .m.: org.mizcd .miund dis(iplinc~ into colkgc-", ~chools, .111d dcp.irtments (c:.g., bminc~_., .1dministr.1· tion, ch.:rnistry, history, .md engineering 1.
DiKipline~ ,ire org.mized by ~rrucrure .md tr.1dition. The ~tnKturc of the di..,ci- plinc pro,·ide~ organiz,ltion .1nd determines th-: ,unounr, rcl.uionship, .111d r.1tio of ,:ad1 ryp,: of knowledge that comprises th.: discipline. The tr,1dition of the di~dpline proYide_., the content,\\ hi,:h indud1.:, ethic..11, pcrson.11, ..:sthctic, .111d scicntihc knm,·1- edg;c ( Northrup .:t al., 2004; Ri~jor1..t, 20 IO). Ch.u.1cteri..,tic., of di~(iplines include ( 1) .1 distinct pl·r~pccti\'c ..1.nd synt.ix, ( 2) determination of what phenomena .ire of interest, ( 3) dctermin.uion of the c(,ll!CXt in which th.: phenomc;na ,uc ,·icwed, ( 4 l de· tennin.nion of wh.lt que..,tiom to .1sk., (;; J dctnmin::uiun of wh.n methods of study .uc used, ,111d ( 6J detcrrnin.uion of what e\'idcn(c is proof\ Don,1ldson & Crowley, 1978 1.
K.i1uwkdg:c de,·dopment within J. discipline proceeds from scwr;1l philmophi(.il ,md -"Ci..:ntifi<.: pc;rspecrives ~,r wor!.h ie,,·s ( Litchtidd & 1,·1mdt'>ttir, 2008; :-.:..:wm.111, Sime, & Corcoran-Perry, 1991; Ri..,jur1..t, 20 IO; Rodgers, 2015 ). In ~omc c.1s-:s. thnc \\'orllfric"·s 111.1y ,n, e to di\'idc or ,cgrcg.1te member, of .1 di~cipline. For exampk, in pwcholog;,·, prJ..:titioners might ..:on~idcr rhemscln:, beh.n·iorists, i-:reudi.in~, or any onl'.' of .1 number of othcr di,·i,ion,;.
4 Unit I Introduction to Theory
Link to Practice l - l The Future of Nursing The Institute of Medicine IIOM, 20 l 1) issued o series of sweeping recommendations directed lo the nursing profession. The IOM explained their "vision" is to make quality, patient-centered core accessible for oil Americans. Recommendations included o three- pronged approach to meeting the goal.
The first "message" was directed toward transformation of practice and precipi- tated the notion that nurses should be able to practice to the full extent of their edu- cation. Indeed, the IOM advocated for removal of regulatory, policy, and financial barriers to practice lo ensure that "current and future generations of nurses con deliver safe, quality, patient-centered core across all settings, especially in such areas as pri- mary core and community and public health" jp. 301.
A second key message related to the transformation of nursing education. In this regard, the IOM promotes "seamless academic progression" (p. 30), which includes a goal to increase the number and percentage of nurses who enter !he workforce with a boccaloureole degree or who progress lo the degree early in their career. Specifically, they recommend that 80% of registered nurses (RNs) be bachelor of science in nursing (BSN] prepared by 2020. Lost, the IOM advocated that nurses be full partners with physicians and other health professionals in the attempt to redesign health core in the United States.
These "messages" ore critical to the future of nursing as a profession. Indeed, standardization of entry level into practice al the BSN level, coupled with promotion of advanced education and independent practice, and inclusion as "leaders" in the health care transformation process, will help solidify nursing as o true profession.
An update IIOM, 2016) indicated that there hos been "significant progress" (p. 50) toward reducing APRN scope of practices issues from o notional perspective, as more slates now allow nurse practitioners (NPs] lull practice authority. Furthermore, although there hos been some progress with expansion of the percentage of RNs with o BSN jlrom 49°10 lo 51 %), there is still much to do to meet the gaol of 80%. Finally, the IOM concluded that data ore locking on efforts lo develop the skills and competencies nurses need for leadership. The report reinforced the goal for nurses to seek "leadership positions in order lo contribute their unique perspective and expertise on such issues as health care delivery, quality, and safety" [p. 149].
Si:n:r,11 \\'ays of d,1~~il}·ing academic discipline~ h,1, l" bci:n proposi:d. fur in~tanci:, they may be diYidcd into the b,1sic si:il·11ei:s ( physics, biology, chemistry, sociology, anthropology J .111d thl· hum.rnitie~ ( philmophy, l"thics, history, tini: .J.rts L In thi\ da~- siticarion scheme, it is .1rguabli: th.it m,r~ing. h.1~ ch.1r.1ctcri~rics of both.
Distinctiom nu,· ,1bo bl· m,1dc bcnn:cn .1i:.1dcmi..: di~ciplinc~ (e.g., physii:s, phy~- iolug\', ~m:iology, m.Hhl' lll.ltics, history, philmophy l .md prof.:~sion.11 di~i:iplinc~ (e.g., mi:dicine, l.rn·, nur~ing, ,ociJ! \\'Ork). In thi~ dJ~~ihi:Jtion si:hr1m.-, the JC.1di:rnic disi:iplincs aim to ''know," .rnd their rhcorie~ .1rc lk~criptiYc in nature. Re,c.uch in ac.1drn1ic di\ciplines i~ both hJsic .rnd applil·d. Conn:rsl·lv, the proti:ssionJI disci- plines are pr.1i:tii:al in 11.1tun:, ,rnd their rcsc,m.:h tends to b..: mori: pn:scripti,·..: .111d desi:ripri,·i: ( Don.1ldson & Crowley, 1978 ).
Box 1-1
Chapter 1 Philosophy, Science, and Nursing
Theory and the American Association of Col'leges of Nursing Essentials
"The scientific foundation of nursing practice hos expanded and includes o focus on both the natural and sociol sciences. These sciences that provide o foundation for nursing practice include human biology, genomics, the psychosocial sciences os well os the science of complex organizational structures" (American Association of Colleges of Nursing, 2006, p. 9).
5
Nursing's kno\\'ledge ba~c dr.m·s from many disciplines. In the p:1st, nursing de- pended he.1\'ily on physiology, ~oriolo!:-'Y, psycholob'Y, .md mnfo.:inc: to pro\'ide .Kademic standing .md rn inform praaice ( Box 1-1 ). In n:cem decJ.dc:~, howe\'cr, nursing 11.1~ bt·en seeking ,,·h.11 is uniqta: to nursing .md dewloping tho~c: .1spect.-. into an ,K,1dcmir di~ciplim: ( !\me, 2015 ). Arc:.1~ th,lt identi~· nursing .1~ .1 tfotim:t di~cipline Jre .1~ follm,·,:
An idrntiti.1bk philmophy At least one: conceptual framework ( pc:rspectin·) for dc:line.ttion of wh.1t can be ddind a~ nursing i\crept.ibk methodologil." .1pproa.:hc~ for the pur!>uit ,llld de,·dopmrnr of knowledge ( Old1ull, J 99S 1
To bt:gin the quest ro ,·alid;1te nur~ing .1.-. both .1 profrs~ion .rnd .111 academic dis- ciplint\ thi~ ch,1pter pro,·ides .111 o,·en·ie\\' of tht· concepts l)f srienrc .md philosoph~-. It o.1111ines the schoob of philmophir,1I thought th.It h.\\'e intlucnced nursing and explore~ rhe t'pistemolo1:,~· of nursing to rxplain \\ hy rerogni1.ing the multiple "ways of knowing" is aitical in the quc,t tc)r den·lopmcnt .md .1pplic,1tion of thcor~· in nur~- ing. h11.1lly, this chapter pn:sc:nrs is~L1c:s rdatrd to huw philosophical world\'ie\\'s .1tfrct knowledge dn·dopment through n:sc:arch. This duptcr concludes wi,rh a Cbe study that depicts how "the \\'.1ys of kno\\'ing" in nursing .1re u,ed lll1 .1 day-to-day, c:,·en momenr-hy-momcnt, basis by .1II pr,Kticing nurses.
Introduction to Science and Philosophy Scirncc is concerned with c.rnsality ( r.wsc and dlect ). The ~cicntihc appro,Kh to un- derstanding n:'ality is char Jctt:rized by observation, ,·erifi,1hility, ~111d expcricnre; hy- pothesi~ trsting and experimentation .1re ronsidcrc:d scientihc methods. In contr,1st, pbilosop/Jy is roncemed ,,·ith the purpose of hum.rn lite. the 11;1ture ufheing ,md reality, ,111d rhe theory ,md limits of knowledge. Inn,ition, inrrmpcction, and reasoning ar,e t·xamples of philosophical methodologies. Science and philosopll\· share: the com· 1110 11 go.ii of increasing knowledge (Fawcett, 2012; Polifroni, 2015; Sih-.1, 1977). The ,ciem:e of .my discipline is tied to irs philmophy, which prm·ides rhe basi~ for undcrst,rnding and de\'eloping theories for srience ( Gust.1tsson, 2001; Morse, 10 l 7; Sih-a & Rothbart, 198-!J.
Overview of Science
51."iencc is both .1 pnKcs~ and a product. Parse (1 997 l dehncs science .1s rhe ",theoreti- cal c:xp!Jn,1tion of the subjc.:r of inquir~' and the: mc:thudnlogical prorcss of su~raining kno\\'lcdge in J discipline" ( p. 7-l ). Seiencc ha~ .1lsu bet·n described as a wa~· ofc:xpl.lining:
6 Unit I Introduction to Theory
Box 1-2 Characteristics of Science
l . Science must show a certain coherence. 2. Science is concerned with definite fields of knowledge. 3. Science is preferably expressed in universal stotements. 4. The statements of science must be true or probably true. 5. The statements of science must be logically ordered. 6. Science must exploin its investigations and arguments.
Source. Silva ( l 9771
oh~crn:d phe11omc11.1 .1s well .1s .1 sy~tcm of g.uhering, \'cri~·ing, .md systcm.1tizing in- for111.1tion .1hour re.1liry ( Srn:ubcrt & C.1rpcnter, 20 I I). A~ ,1 prncc~~. scicnce i~ d1.1rac- teri1ed b~- systcm,uic inquiry that rclic~ IK·,wil~- on empirical obsen-;1tions of the 11.m1raJ world. :\~ .1 product, it !us bccn ddined .1~ empirical knowledgc that i~ grounded .rnd testnl in expt'.ricnce ,rnd i~ the rc~ult of inn:stigatin: dfort\. furthcnnorc, sciL·nce is c011eci\·ed ,ls being the conscn~u.1I, inlc1rmed opinion ,1bour the n.uur.1I world, including human heh.1\·ior and ~oci.11 action {Gortncr & Schult/., 1988).
Science l1.1s come to rcpn:~ent knowledge, and it i~ gencrJtcd by .1ctiYitics that combine ,llh.mct'.mcnt of knowlcdgc {research) .md exphrn.nion t<.ir knmdcdge ( theory I ( Po\\',:r~ & Knapp, 2011 ). Citing Van Lu:r, Sih ,1 ( 1977) li~r, ,ix character· isrics of science ( 11ox 1-2 ).
Scien.:e hJ, becn d,1.\sit-ied in sc\"\:r,11 \\\l~·s. Thc~i.: induJc pun: or b,1si1: s1:irnn:, 11,uural scio:1Ke, hun1.111 or ~<Ki,11 sci.:ncc, and .1ppli.:J 11r pr.Kticc ,cicnce. Thc d,l.\sit-i- c.uiom .UL' nor mutuJlly cxdusi\·,: .md .1re open to intapn:ration b.1sed on philo~oph- ic.11 orienr,uion. T.1blc 1-1 li,b exampk, of ,1 number of .,cienn:s b~• thi~ manncr of d.1ssit-ic.1tion.
Some ~cienccs Lk-~- d.1!s~iti,·,1tion. for examplc, cumputer science is .1rgu.1hl~· .1p· plied or pcrlup:-. pure. LJ,, is certainly a prJctice sci1:11cc, but it i~ .1l~o .1 soci.11 sL·iencc. Psycholol:,~· might bc a b.tsiL· scicnce, .1 human sci,.:nc.:, or ,111 .1pplied science, Jc-pcnJ- ing on \\"h,ll aspect of psyd10logy onc is referring to.
There .1rc ,ignit-ic.mt ditfrn:nce~ b.:nwen the human .111d n.1tur.1l sciences. Human ,L°iCnL°CS rcti:r to thc field, of ps~·d1ology, .mthropology, .md sociology ,rnd mav i.:vrn extend to economic~ ;md politicJI sL·ictKe. The,c Lfo.:iplines de,1I with \'..trious ;h~x·cts of hum.111!-> .md human inter.1ctio11,. ;-,.;;itur.1I ,cicnces, on the other h.rnJ, arc co1Ken- trated 1111 demcnr, found in n,Hure that do nor rdJre to the ror,1lity of the inJi\ idual.
Table 1 · l Classifications of Science
Classification
Natural sciences
Bosic or pure sciences
Human or socio! sciences
Proctice or applied sciences
Examples
Chemistry, physics, biology, physiology, geology, meteorology
Mathematics, logic, chemistry, physics, English (longuoge]
Psychology, anthropology, sociology, economics, political science, history, religion
Architecture, engineering, medicine, pharmacology, low
Chapter 1 Philosophy, Science, and Nursing 7
There ,,re inherent Jiftcrc11ec~ between the h11nlJn .md 11,nur.11 scil.'ncc:, that make thl.' resl.'.1rch technique~ of thl.' 11atur.1I sci1..·11ee~ ( e.g., laboratory l.'xpetimcntarion l im- proper or pot,nti.1lly probkm;itic for hum,m ~cicm:cs l Gormer & Schultz, 1988 ).
It has been positcd that JI though nursing draws on the b.tsic and pure ~cicncl.'s ( c.g., physiolob~· .111d chcmistrr] anJ has 111.my dur,Kteristics of ,oci.11 s..:icnccs, it is without question .m .1pplicd or prJcticl.' science. Hm,·e,·cr, it is impnrr.rnt to notr.: th,lt it is JIM> synthesized, in that ir dr,1ws on the kno\\'kdge of orher l.'stablishl.'d dis..:iplincs-induding other prJcrice disripline~ 1 D.1hnkc &. f>rcht:r, 2016; Holzcmer, 2007; Risjord, 2010 ).
Overview of Philosophy Within .my discipline, both scholars ,md ~tudrnts ,hould bc J\\',ll'l' of thc philosoph- ical oricntarions thJt .m: the lusis for de\'doping theory ,ind ,1d,·Jncing knowkdge l D,1hnke & Drl.'h.:r, 20 I 6; Di Bartolo, I 998; Northrup ct al., 200-!: R.isjord, 20 l O l. R.11 hcr th.m J focm on ",kin~ probk1m, or am,m.:ring questions rd.1tl.'d to th.it dis.:i- plinc ( \\'hich ,1rc ta~ks of thc di!>..:iplinc '\ science I, the philosophy of .1 disciplinc ,rudir.:~ the concepts thJt ,trurrure the 1huugh1 proce!>scs of that disciplinl.' wi1h the intcllt of recognizing .111d rcvc.1ling foumhtiom .111d prcsuppositions ( Bla..:kburn, 2016 ).
Philosophy has been ddincd J, .. a ,tulh of probkms th.1r .1re ultimate, JbstrJ..:t, .md gcncrJI. These problem.~ arl· ..:om.:erncd with 1hc nanm· ofcxisten..:e, k.i1owkdg._., mnr.11- ity, n:ason, ,md hum.m purpo:-.l·" (Tei.:hm.111 & b·ans, 1999, p. l ). Philrn,ophy tries to discm·er k.iwwkdgc and truth ;md ;l!tempt, to idcnti~' wlut is \',1lu.1blc and import:.111t.
,\lodcrn philosoph~ is usuJlly tr.tccd to Ren._. IksC,Htl.'s, fr.mci, BJ..:on, B.1rueh SpinoLa, and I 111111.mul.'l K.rnt ( ca. I 600-1800 ). Dcscarte, ( I 596-1 ()50 l .111d Spinoza ( 1632-1677) \\'t:rl· early rationJli!>t!>. R.-nit ,nJli,1:- bclil·,·e th.11 r..:.1son i~ superior IO cx- pl.'riencc .1~ J ,our..:c ofknowkdgl.'. R.1rio11.1list:-. ,mempt to dctl·nnine th<: ll,llllfl" ofthl.' world .rnd rc.11ity hy deduction .md seres~ the importJnce of mathem.iti.:al proccdurt's.
B.Kon ( 1561-1626) \\',ls ,111 e.uly empiricist. Like rationalist!>, 111..· suppom.-d cx-
perirnent..1tion and srientitic methods for sol\'ing probkm~. Th.: work of K.1111 ( 172-1--1804 l sct the foundation for n1.111y l.1tl.'r dl.',·dopmcnts
in philosoph~·- K.111t bcli'-',-..-d th.it knowkdgc is rcl.nin.- .ind th.n the mind p!Jys ;in Jcti\'C role in kno\\'ing. Othu philo~ophers h,1,·c al,o influenced nur~ing J!ld thl.' ad- ' ,llKC of nur~ing !,Ciencc. Se,·er.1I .1rr.: discmscd I.Her in the chJpter.
.\I though there is ,omc ,·ariJtion, trnditinnally., thc hr.inc he'> of philosophy include mc1.1phy~ic!, {ontology .md cosmology), epistemology, lo~ic, l.'~thctic~ •. md cthi..:s or ;ixiology. PnliticJI philosophy and philosophy of scil.'ncc .m: ,Hidcd by so1m: Juthor~ ( Rutty, 1998; Tcichm.111 & E\'ans, I 999 l. T.1bk 1-2 ~u111111.1rize!> till· major br.mchc!> of philoi,ophy.
Science and Philosophical Schools of Thought Th~· ..:on..:ept of science .1~ under!,tood in the 21st century i!, rd.uin:ly nr.:w. In thr.: paiod of mmkrn science, three philosophies of science ( pllJdigm~ or world\'icws) dominate: rationali!>m, cmpiridsm, .rnd humJn s..:ience/phl.'non1e11olob~·. R.1tio11Jlism Jnd empirici!,111 Jre ofo:n rcrmcd rt·aii>nf l'frn• and human science/phenomenology .ind rd.1ted "'orkh·il·ws (i.e., histori..:ism) .ue ..:onsidcrcd po-ai1•crl Pin,• ( Hickman, 2011; .\kki'>, 2012 ). Thesl.' two world\·iews domin.ucd rh..:oreri~·.1I discus,ion in ntm- ing through the l 990~. i\1orc recently, .1ttcnrion !us foo1scd on .mother dominant workh-icw: ~posrmodernism" f Meidl>, 2012; Rcni, 199;; J.
8 Unit I Introduction to Theory
Table l -2 Branches of Philosophy Branch
Metaphysics
Ontology
Cosmology
Epistemology
Logic
Ethics (oxiology)
Esthetics
Philosophy of science
Politicol philosophy
Pursuit
Study of the fundamental nature of reality and existence-general theory of reality
Study of theory of being (what is or what exisfs)
Study of the physical universe
Study of knowledge (ways of knowing, nature of truth, and relationship between knowledge and belief)
Study of principles and methods of reasoning (inference and argument)
Study of nature of values; right and wrong (moral philosophy)
Study of oppreciolion of the orts or things beautiful
Study of science ond scientific practice
Study of citizen and stole
Sources: Blackburn 12016); Teichman ond E11ons iJ 999).
Received View (Empiricism, Positivism, Logical Positivism) Empiricism !1.1~ it~ roots in the writings of Frrnci!- B.icon, John Locke, .rnd D,1,·id Hume, who ,·.ilued ob~ern.tion, pcrcq1tiun bv sen~es, .md experience .1~ ~ource\ of knowkdgL· I (.;orrncr & Sdiultz, 1988; Pim ers & Kn.1pp, 2011 l. Empirici~m i~ founded on the bdicf th.1t what j5 cxperien..:ed i~ ,,·h.it ..:xisb, and it~ k.i1nwlcdge base: requires th.it rhese cxpe1iences be Ytrified through ~cicntific methodology ( D.ihnke & Dreher, 2016; Gust.ifi,son, 2002 ). This knowledge is then p.issed on to other~ in the dis..:ipline .rnd ~ub\equcntly built on. The term rrcci11cd Pit-11' or l'fffiPcd l.·1wwfrtf.._1TL' denote~ th.it inlii\iduab le.mi by bL·ing told or recei,·ing knowledge.
Empiricism hokh that truth ,orre~pond~ to ob!'>en·.1ble, redu..:tion, wrilication, control, and bia:-,-free ~cience. It emphasize!'> m.ithenuti..: formula:-, to nplain phc:- numeri.i .rnd prekrs simple dichotomies .ind cl.is\itic.1tiun of concepts. Additionally, e,·cryrhing can he redu..:ed to .i scientific formul.1 \\'ith little room for interpretation (Dilhrtolo, 1998; c.;onncr & S..:hultz, 1988; Risjord, 2010).
Empirici~m fo..:u~e~ on undcr~r.mding the part~ of the \\·hole in .111 .lttempt to underst,rnd the \\'hole. It stri,·es to explain nature through testing of h~·pothese!'> and de\'dopment of theorie:,. Theories .trc nude to dncribe, explain, ;.llld predict phe- JHimen.i in n.iture .md to pnwide undcrsr.inding of relationships herneen phenomena. Concepts mu~r be operationalized in the fixm of propositional stJtements, thereby m.1king me.i,urement possible:. Instrumentation, reliability, .rnd \',1lidity .ire ~tressed in empiric.ii research methodologies. On..:e me,1sure111ent i, determined, it i~ possible to tc:st theorie~ through experimentation or obsc:rvarion, ,,·hich re~ults in \'Critic1tion or falsitic.nion ( Cull-\\'ilb~· & Pepin, 1987; Suppl.· & Jacox, 198:i ).
Positil'ism is often equated with empirici5m. Like empiricism, positivi~m ~upports med1ani!'>tic, r~·dm:tionist principles, \\'here the complex cm be best understood in term:, of it~ b,1~ic components. Lit1Ticnl positiPism \\'JS the dominant empirical philosophy of science b.:tween the I XXO~ .111d l 9S(h. Logical positiYists recognized only the logi..:.11 and empirical ba~e~ of science .111d strt'~sed tlut there is no room for met.iphysic:s, un- der~tanding, or ml'.ming within thl.' rc.ilm of ~..:ience ( Polifroni, 2015; Ri~jord, 2010 ).
Chapter 1 Philosophy, Science, ond Nursing 9
Logical positi,·ism m.1int.1incd th.1t scic11ec i~ ,-.1luc frce, iJll.kpen<-knt of thc scientist, .1nd obt,1incd using objectin: methods. Thc gu.1! of si.:icncc is to cxpbin, predict, .md control. Thcorici,, arc cithcr truc or tnlse, .. ubjcct ro cmpirii.:al obscrntion, Jnd capabk of being rcdui.:cd to cxisting ~i.:icntitic thcorics ( Rutty, 1998 l.
Contemporary Empiricism/ Postpositivism Positi\'ism c;1111e under (riricism in thc l 96lh \\ hcn pos1tmstii.: log.ii.: w.1s decmed faulty ( Rutty, 1998 ). An m·crreli.111ec 1111 srrictl~· ..:ontrolkd experimentation in .1r- tifii.:i.1I \ettings produi.:cd rc,ults th.u indi..:atcd that mui.:h ~ignifi..:ant kno\\"kdgc or information w.1s mi-.sni. In recent years, scholars han: dctcrminl.'d tl1.1t thc positi,·ist \"ic"· of s..:kncc is outd.m:d .1nd mislc,1ding in that it comributl.'., to m-crfragmcnration in knowkdge and thcory dc,·clopmcnt ( Di Bartolo, 1998 ). It !us bccn ob.scn·cd th.1t positi,·istic a11.1lysis of thcorics is fu11d.1mcm.1lly ddi:..:ri, c duc to imistence 011 an.ilyz- ing thc logii.:.1lly ideal, whi..:h results in t-indings rl1.1t l1.1n: link to do with reality. It was 111.1int.1ined thJt the contcxt of diKowry "·as artificial .111d th.it thl.'ories .111d cxp!Jn.1- tiom can be understood 0111\· "·ithin their discovery conrcxts I Suppc & JJ.cox, 1985 ). Also, scientific inquiry is inhcrcmly ,·a]ul.' l.idcn, .1s ..:,·cn choosing wh,H to inwstigatc and/or \\·hat tcdmiqucs tu i.::mploy will rdki.:t th.: ,·.1lui.:::, ofthi.: rcsc.uchcr.
Thc rn1-rc11t g,cncration of postpositi,·ist~ .1i.:cq1ts the subjccti,·c 11-1ture of inquiry but still ~upport~ 1igor .md objccti,·c study through qu.mtit.uivc: rc:se.1ri.:h mcthmh. Indeed, ir ha~ hccn ob:,ern:d that molkrn empiricist~ or postpo~iti,·ist~ arc ..:unci.:rncd \\"ith nplanation and pri.::dii.:tion of complcx phcnomcn.1. rccog,nizing conti.:xtu.11 ,·.1ri- .1bk, ( Powcr\ & Kn.1pp, 2011; Rced, 2008 ).
Nursing ond Empiricism As an cmcrg,ing disciplini.::, nursing, l1.1~ followed established di:,cipline~ (c-.g., physiol- ogy) .md the mi.::dic.11 model in stre:,sing, logical positi,·ism. EJrl\" lllll'i,C ,cientist~ cm· br.1ccd thc import,rnce of obji.::cti,·ity, control, fact, J.nd mca:,uremcnt of s111.1l kr .rnd smalkr pans. B.1scd 011 this influcnce, acceptable mcthods for knmdcdgc gencrJ.tion in nursing h.wc strcssnl tradition.11, orthodox, and prcfrr.1bh· i.:xpcrimenral mcthod~.
Although positi,·ism continue~ to heavil~- influence nursing, science, tlut ,·ie\\"- poinr h.1s l1C<-'ll ..:halkngcd in rci.:t:nt ~-e.ir~ ( Risjord, 2010 ). Comc:quently. posrpositi\·- ism h.is hecomc onl.' of the- rrn >~t accepted conremporJ.r~· world\'i,:w:, in nursing.
Perceived View (Human Science, Phenomenology, Constructivism, Historicism) In the l.lte l 960s .md early 1970s, ~e,-er.11 philosophers, including Kuhn, rcycrbend, .md Toulmin, ch.11leng,ed the pmiti\·i~t ,·i._·w by arguing that the influence of history on science should be emphasized ( D.1lmkc & Dreher, 2016 ). Thc percein:d \'iew of sci- ence, which m.1y .1bo bc rcfrrrcd to J~ the intcrpreri,·e Yicw, include, phenomcnology. constructiYism, .rnd historicism . The interpreti\'e ,·iew recognizcs that thc pcn:eptiom of both thc subject bi.:ing studicd .md the rcse.1rchcr tend to dc:-emphasizc rdia11ec on stria ..:onrrol ,md experimenr.1tion in l,1boratory settings ( Monti & Ting,cn, 1999 ).
Thc pcn:ei\"cd Yiew of scic:11ec cenrcr~ on descriptions that .u-c dcri\·cd from col- lei.:ti,·cly lived experiences, inrerrcbtcdncss, human interpretltion, .md lc.irned rc:,1lity, .1~ oppo~ed to :.1rtifici.1lly im·entcd (i.e., l.1boratory-b.1scd) ri.::.11ity I Ru try, 1998 ). It is argued rh.1t the pursuit ufkmm·ledge .md truth is narur.1lly hi~torical, contcxru.11, .111J \"Jluc ladrn. Thus, thcre is no single truth. R;1thc:r, knowlcdgr i~ deemed true i f it withstand~ practic.11 tesr, of utili~· and rc.ison ( Di Bartolo, 1998 l.
Phowmmolo,_ff.l' i~ the study of phenomi:na and empl1.1sizc~ thc .1ppc.1r.1ncc of thing~ .1~ opposed lo thc thing~ rhemselws. In phcnomenolo~•Y, 1wdo:rtn1ufilw i~ the goal of
10 Unit I Introduction to Theory
scie11-:c, with the objcctin: of rccog:nizing the connection between one', experience, ,·alucs, .md pt·rspccti,·e. It maintaim dut each indi, idu.11\ experience is unique, .ind then: ,ll"t' 111.111~· interpretatiom of n::J.lity. Inquir\' begim with indi,·idu.ib .ind their ex - pericnn:s with phenomena. Perceptions, feelings, ,·alues, and the me;rning~ rhJt ha,·e come to be .ltt.Khl·d to things .md c-,·cnts ,uc the fixus.
hll· ,cKial ~cienti5ts, the co11srn1criPist Jppro,iches of the pcn:ci,·cd ,·iew l<xu~ 0 11
undcr~tanding the ,Ktions ot~ and m eJning to, indi,·iduab. \\'lut cxisb depends on wlut indi,idu.1ls paccin: to exist. Knowledge is subjcctin: .ind cre,\ted by i1Hfo·iduals. Thm, n:~carch methodolog:,· enuib the im-estigation of the indi, idtr.11 \ world . T hen: i~ .rn empl1.1~is on ~ubjccti,·ity, multi pie truths, t renlh .rnd pattern~, di~cm·cry, de~crip- tion, and undcr~t.rnding.
Fcmini~m .ind critic.11 soci,11 theory ma~· .1lso be considered to be pen:cin:d ,·icw. Thl·,c philo~ophical schools of thought recognize the influence of gcndt·r, cul ture, society, .rnd slurcd history as being essential component~ of ,cicno.: I Riegel ct .11., l 992 l. Critiol ,ocial theorists contend that realitY i~ dynamic .md sh.1pcd by so- cial, political, cultural, economic, ethnic, and gender , ·~1lucs ( Streubcrr & C.1rpcntcr, 20 l l ). Critical ~<>eial thi.:or~· and feminist thcorii.:s will bi.: dc,cribcd in mlln: detail in Ch,1ptcr 13.
Nursing and Phenomenology/ Constructivism/ Historicism Bcc,w~c thi.:y cx.1111inc phenomena within cnntcxt , phcnomcnolog~·- .1~ wdl ,15 other percci,·cJ ric\\·~ of philosophy, arc conduci\ e to disco,·cn· ,111d k.nowlcdg:c dc,·clop- mcm inhi.:rcllt to 1rnr~ing. Phenomc-nolog;~· i~ open, rnriabk, .md rc!Jti,·i~tic .md b.1scd on hum.111 experience ,rnd personal intapn.~t~1tions . .-\s such, it i~ .111 important, guid- ing p,1radig111 for m1rsing praaicc theory and educ.ition ( DiB,1rtnlo, 1998 ).
In nun,ing. ~ciencc. the dichotomy of philosophic thought between the rci.:civcJ, empiric.ti \'iC\\' of science ,111d the percci\'cd, intcrprct.itivc ,·iew of science h,1s per· sistcd. This m.1y h.1,·e resultt·d, in part, bccamc nur~ing dr.m·s hca\'i lv both from n.ltu· ral science~ { ph~·siolog:y, biolos~· l and s<Ki,11 sciences ( psychology, ~ociol<>!:,~' l.
Postmodernism (Poststructuralism, Postcolonialism) Postmoderni,m began in Europe in tht· 1960s .1s ,1 sn<."ial 1110,•1.:1111.:nr centered on ,1
philosoph~· that ri.:icct, the norion of ,1 single "'truth." .-\l thoug.h it recogniles the \'aluc of science ,md ~cicntitic methods, postmndcrnism allows for multiple mc.m- ings of re,1li ty ,rnd multiple \\',1ys of knowing .rnd interpreting rc.1lit~· ( H ood, 20 I{; Rl·i.:d, 1995 ). In postmmkrnism, knowledge is \'icwcd ,1s unci.:rt.1in, <.'Onti.:xtu..1.l, .md relative. Knowledge dC\·elopmenc lllO\' l'.S from cmplu~is on idcntif\ing .1 truth or foa in research to di~co,·t:ring; practical sig,nificancr.: Jnd rele\'anci.: of resc.1rch tindings (Recd, 199;;),
Similar or rd,ucd construct~ and \\·orlth·icw~ found in the nur5ing Htr.:1-.1rurr.: in- cludi.: "decon~truction," "posrcolonialism," .md, .lt timi.:s, ti:111ini~t phih 1~l1phit:~. In nursing, the prn,tcoloni.11 \\'orldvic\\' can bi.: connecti.:d to both fi:minism .md crit i- cal theory, particulJrly when considering nursing;\ hi~tori..:al rdi,mcc 011 medicine ( Holmes. Roy. & Perron, 2008; 1\kGibhon, i\lul.\lldzi, Didham, B,1rton, & Sochan, 201-!; R,Kini.:, 2009 1.
Po~tmodcrni~m 11.1s l005cncd rhc notions of whJt l'.ount:, J.!oo knowledge dc,·clop· 111cm tlut h:in: pcr~istcd .1mong s upporter~ of quJlitati,·e .ind quanrit,1ti\'e rese.irch methods. R..llhr.:r th.m foi.:ming on ,1 single rr.:search mcthrnfology, pmtmodernism pro- motes usi.: of multipk mcthmh for .. k,·dopmi.:nt of ~ci.:nrific undt·rst.mding .md i1Ko r· poration of difti:rent \\',1~·s to impn.>,·e understanding of human nanll"c ( Hood, 20 l-!;
Chapter I Philosophy, Science, and Nursing 11
Mdc.:i~. 2012; Rodgers. 20 IS l. Inc.:r~:a\ing;ly. in postmodernbm, lherc.: is ,1 .:onst·mu~ lh.11 ~~·nrhcsis ofhoth rese,1n:h method~ .:.m he med ,lt difti:n:nt time, to ,c.:rn- difti:n:nt purpmcs ( Hood, 2014; ~klcis • .2012; Risjord, Dunh.ir, & Moloney. 2002 ).
C:ritici\ms of postmrn .. krni~m ha,·e btl."ll 111.1dc.: .111d frl-"4uently rd,lte to the per- .:cin:d rdu.:t,11Kc to adJro, error in resc.:.u.:h. T.1kcn to thl." cxtr..:mc a:- Paley ( 20051 pointed our, \\'hl."n ther..: i, .1bsenc.:e of stric.:t .:ontrol mer methodolog\· and interprc.:- t.1tion of rc.:se.uc.:h. "~ohody .:,lll c.:H:r be wrong about ,mything.~ ( p. l07 ). Chinn .md Kr.11ner (201~) ..:dlol·d tht· c.:011.:..:rn, by .1drnowlc.:dging th.H knowledge.: d..:\·d- opmc.:nt ,hould m·,·,:r be.: "sloppy." Indeed, .,!though ,1pplic1tion of ,·ariow. mc.:lhods in l'l'w.uc.:h is legitim,lt..: .md n1.1y be ad,·antageous. research must ,till he c.:,uried our .:ardi.11ly .rnd rigorouslv.
Nursing and Postmodernism Pmtmmkmi:--m has bt·cn di::sc.:ribed .1s .1 dominanl \C.:ienritic.: thnm.:tic.:.11 p.u.1digm in m1r\ing. in the l.ue 20th c.:cnniry ( 1\klc.:is. 2012 ) . .-\s the discipline nurures. then· has bt·c.:n n:c.:ognition of thl· pluralistic.: n.lturL· of nursing and .m c11h.11h:ed undcr\tanding tll.lt lhe goal of rese.1rc.:h i~ to prm·ide .m integr.iti\'e b.1~is for nur~ing; ...-:ire I Walker & Avant, 2011 ).
In ti:nm of ~c.:icnti~c.: lllL'thodology, the .1ttent11>n is increasingly on 1:ombining multiple mcthu~h within a singk rn..:,uc.:h projeet ( Chinn & Kr.1mer, 2015 ). Posr- modcrni\m ha~ helped dislodgl·d the ,H1thority of,\ ~inglc rc.:~e.1rd1 p.1r,1digm in nur~- ing: ~c.:icnc,: by cmplu~i,ing the blending: or inreg:ration ofquAlitatin: and qu.mtiuti,-c rc.:~l'.1rc.:h into .1 holi~tic. d~·namiL· model to impron: nursing. practkc. Table.: l-3 l'.om- p,1r,:~ rh..: do111in,u1t pbilo!.ophi...-,11 view, of science in nursing.
Tobie 1-3 Comparison of the Received, Perceived, and Postmodern Views of Science
Received View of Science-Hord Sciences
Empiricism/positivism/ logical positivism
Reolity/truth/focts considered ocontextuol (objective)
Deductive
Reolity/truth/focts considered ohistorical
Prediction and control
One truth
Volidotion and replication
Reductionism
Ouontitotive reseorch
Perceived View of Science - Soft Sciences
Historicism/ phenomenology
Reality/truth/facts considered in context (subjective)
Inductive
Reality /truth/facts considered w,th regard to history
Description ond understanding
Multiple truths
Trends and patterns
Constructivism/holism
OLJolitot,ve research methods
Sources Melei~ (20121. Moody {19901
Postmodern ism, Poststructuralism, and Postcolonialism
Mocroonolysis
Contextuol meaning; norrotion
Contextuol, political, and structural analysis
Reality /truth/facts considered with regard to history
Metonorrolive analysis
Different views
Uncovering opposing views
Mocrorelotionship; micro structures
Methodalogic pluralism methods
12 Unit I Introduction to Theory
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing
Tiu: term.'> 1111rsi11 ... 1T p/Jilosopl1y, 11111·si11,1T scimu, and p/Jilosop/Jy ofscimu in 1111rsi11g .m: ,omctimc.'> used intcn:hang.cably. The diffi:rcn..:c.'>, howe,·cr, in the gcncrJI meaning of these .::om:cpt.', arc importJnt to rc..:ognize.
Nursing Philosophy 1':ur~ing. philosophy h,1.'> been dc~..:ribcd ,b "a ~t.1tc1111.:nt of found.1ti01ul .111d uni\'cr- .',JI Jssumptiom, bdid~ .md prin..:iplc~ Jbout the 11,1turc of knowlnigc .rnd thought ( ..:pistcmolo6'Y) and .1bout the n.irurc of the cntitic.', repn:.',ented in the metap,lradig.m (i.e., nur!iing pr,1..:ricc .rnd hum:rn he.11th processcl. [ontology])" (Recd, 1995, p. 76). :--:ur~ing. philosophy, then, refer.., to the bclicf sy~tcm nr ,nirkfrie\\· of the protcssion ,rnJ pro,·idl's perspectiw~ fr>r pr.11:til'l', scholarship, .md n:sc.1rd1.
:--lo ~inglc dominant philosophy ha~ prc,·aikd in the di~..:ipline of 11Ur.'>ing. ~[Jn~· nur.'>ing M.:hobr~ and nur.'>ing. thcnri,t~ h,n·e \\Tittn1 cxtl·nsiH·ly in an .lttempr to iden· tifr thc m·crriding. bclicf ~ystcm, hut ro date, nonc h.1~ bcl·n uni,·..:r~all~- succl'~sful. Mo5t I\ otdd Jgrcc thl"n that nursing is incn:.1,ingly rccognizcd .1s ,1 "multipar:iJigm disdplinc" ( Pm,·crs & Kn.1pp, 2011, p. 129 ), in whid1 using multiplc pcrspcctivcs or world\'il'\\', in ,1 "unitied" wJy i.'> v,11 u,1bk ,md l"\'l'll ncCC5.',Jry tcir knowledge dcn:lop· mrnt ( liiuliano, Tycr-Viob, & Lopez, 2005 ).
Nursing Science Parse ( 2016 \ ddincd nursing. scicncc as "th..: 5Ubstanri,·c, disciplim:-spl·citic kno\\'l - cdgl" tlut ti.Kmc~ on rhc human-unin:rse-hl';tlth prfKCS\ ;\rticubtcd in the nmsing fra1m."\\'orb and thcoril"s·• (p. 101 ). To di:,·clop and apply the dis..:iplinc-spc..:iti.:: knowledge, nur~ing ,cicnci: recognizes thc rcl.nion~hip~ ofhumJn ri:sponscs in he.11th Jnd illncS.'> and ,1ddrc,scs biologic, bd1,wiorJI, so..:ial, .rnd ..:ulrural dom,1ins. Thc go.11 of nursing ~..:ie1Kc is to rcpn:scnt thc nature of nursing- to undcrst,md it, to explain it, Jnd to use it for the bcnetit oflrnmankind. It is nur5ing science th,H gives dirl"dion to the future gencr.ition of subst;111ti\'c nursing k.nmdedgc, .111d it is nur5ing 5l'.il'tKc thJt prm ides the knowledge for JI! ;1spc..:ts of nursing ( Holzcmcr, 2007; P.1r.'>c, 2016 1.
Philosophy of Science in Nursing Philo~ophy of ~Cil·ncc in nu r,ing hclp5 to l'\tabli.'ih the 1m.-:ining of ~cien,c through .111 undcrst.111ding .111d c:..amin.1tion of nursing conccpts, thcorics, laws, .md aims ,\.'i
they rel.He to nursing practice. It seeks to t11llkr~t.111d trmh; to dcs..:ribc nursing; to examinl' prcdiction .md camJlity; to criticJlly rcbte thcoric\, modcl~, .md .'>cientiti, s~·stem~; .md to explore 1.ktcrminism and frec \\·ill I .\!y,1tJ11g,1, 2003; Polifroni, 2015 ).
Knowledge Development and Nursing Science Dewlopmcnt of nursing. knowledge rdk..:ts the interface bct\\'Cl'll nur~ing science: .rnd rc5carch . The ultim.1tc purprn,c ofknowledgl· dc,·elopmcnt is to imprm-c 1rnrsing pr.1..:- tice. Approa..:hcs w k.110,Ylcdge den:lupment h.1,·c three facl'tS : ontology. cpisremol- og~', and mc:thodulugy. Onrolob'Y rders to thl' study of being: whJt is or whJt o:xist.'>.
Chapter 1 Philosophy, Science, and Nursing 13
Epistemology n:ti:rs to the- study of knowkdgc- or ways of knowing. ~kthodology i~ the mcans of ,11.:quiring knowlcdg.i: ( Pmwr~ & Knapp, 2011 ). Thr following ~c.:c.:tiom Jiscms nursing ,..·pistc-mology .md i~~uo n:l.w:d to method~ of .ic4uiring knowkdg:c.
Epistemology Epistt111r1litf1." i~ the- ~tudy of the chcor\' of kmm kdgc. Epistemologi.: qu ... ·stions in- clude: \\'hat do ,w know: \\'h,1t i~ thc rxtc:nt of our kno\\-lcdg ... ·? Ho\\ do \\T decidr whc:thn we know) ,md \\'l1Jl ,m.: the- criteria of knowkdge? (Sdmlr1, & i\ld:i~. 1988 L
:\..:cording to Streubert ,llld Carpcnta ( 2011 ). it is important ro undcr~t.rnd thr way in whid1 mming knowkdgc dcH"lop~ to prcwide ,1 ..:ontcxr in whkh to judge: the ,1ppropri,ltc:1ll's~ of mir~ing ki1m,·kdgl· .111d methods that m1r~n use to lk\'dop th,1t knowledge. This in turn will refocus metlmd, fr>r ~3.ining knowlc:Jg;e ,1, well .1~ esr.1.~- li~hing the kgitin1Jc.:y or qu,1liry of the knowledge:. gained .
Ways of Knowing In epistemology, there .ue l,C\t'.l'JI basic.: typ ... ·s of kno\\·kdgl'. These indudc the follo\\'ing:
Empirics-the ~c.:ientihc.: form of knowing. Empiri(,11 ki1owkdg ... · Will<:~ from observation, testing, ,ind rcpli(ation. l'erl,onal knowkdgc-,1 priori knowledge. Pa:,.rnul knowledge pertain~ to knowkdgc gained from thought .1lonc. lntuitin: knowkJg ... ·-indud ... ·s kding~ and hunchc-,. lntuitiYe kncm·lc:dgc is not gm·ssing but rdies on nonconsc.:ious p.lttl·rn rcL·ognition .ind cxpcricnc.:c. Som.Hi( knowkJgc- knowkJgc nf the body in rel.11iun to phyl,ic.11 mo,cmcnt. Som.Hi( knowledgl· indude~ cxp ... ·rienti.11 u, .... of mus.:k~ .1nd balance to pl·rfonn ,l physiGtl t.1sk. J\tct.1physil:Jl (spiritual J knowkdg;e-sccking th ... · prc~cnc.:c of a higher po\\'cr . • -\.~p ... ·..:ts of spiritual knowing indudc mJgic, mirac.:le~. p,~·d10kincsi~, cxtr.1~cn · ~ory pcrc.:cption, .md 111:ar-di:ath cxpcricnccs. Estherin-knowkdgc rebtcd to bcaurY. harmony, .md c-xpn:ssion. El,thcti( knm, kdge incorpor.1tei, art. creati\'ity, ,md \'Jiues. 1\lor.11 or l'thic,tl knowkJgc-knowlcJg.c of what is right and wrong. \ '.1.luc\ ,111d ~rn:i.tl .ind (Ultural norms ofbeh,wior ,\re (omponcnts ofcthi(J.I k.t1m,kdgc.
Nursing Epistemology Nursing. i::pistcmology ha~ be~·n ddim·d .1~ "the study ofthl· origim of nursing knowl - edge, it~ ,rructurc and method~, the p.1ttcrns of knowing of itl> mcmhcr~, ,\lld the ni- teria for ,·,1Jid.tting itl> knowledge daims" ( Schultz & .Ml'ieis, 1988, p . 21 7 ). I .ike rrn >\t dis(ipli1K·s, nursing h.u, both \C.:icntilic knowkdge .1.nd knowledge: th.1t c.rn be termed crnwenrional wi~dom ( knowkdi:w that lus not lwcn empirkall~· tested l-
Tr,1ditionally, only what ,t.t.nlh thl· test of n.:pcat~·d measure, (omtitutc:~ truth or knowledge. ('l,1ssic.1l s(ientific pnKes~es (i.e., cxperimi:ntation ), ho\\'cwr, .lrl' not .~uit.1blc for c.:rl-ating .rnd desaihing .1II type~ of knowledge . Social sc.:ienc.:c~, beh.wior.il sdo::n(,..·s, and the ,ut, rd~- on other ml·thods to l"stahlish kilm,·ledgc. B ... ·~-.rnse it h,1\ characteriMic~ of ,oci.1.I .md beh.1Yior.1I sc.:ic1Kcs, ,1\ wdl a~ biologi~· sci~·no.:es, nursing rnmt rely on multipk ways of knowing.
In ,l da~~k work, Carper(_ 1978) iJc:ntifieJ four funJ.1ment.li pJtterns for nursing knowlcdg ... ·: ( l) empirics-the s(ie1Kc of nursing, ( 2) l'Sthcrics-the art of nursing, l J personal knowledge in nursing, .md ( 4) cthic.:~-mo ral knowledge in nun.ing:.
14 Unit I Introduction to Theory
Empiriml L·1wwla(.11c is objectin·, ahstr.Kt, gencrally quantifiahk, excmpbry, di~-:ursiH:ly formulated, and wrifi.ihlc. \ Vh<-'11 \'l.'tifil·J through rq11.:ated testing. m·n time, it b formul.ned into ~l.'ientilk g.:ner.11iz.nions, laws, thl·orie,, .111d principks th.n l'Xplain .md pn:dil·t ( C.1rpl'r, 1978, 1991 l. It Jr.n,·, on tr.1dition.1I idt.:,1!> th.n .:.111 be \'crifil·d through obsen·.nion and prm·,:J by hyporhcsi~ tl·sting.
Empirical knowledge tends to bl· the moM l"mpha~iud way of knowing in nurs- ing bec.lll~l' thlTe is .1 nt.:l.'li to kno\\ ho\\' knmdl·dge .:.111 be organiz.:d into IJ.,,., .md theoril'S for the purpose of describing., explaining, .md predi.:ting phenoml·na of nm- c'crn ro nur,es. ,\lo~t theory den:lopml·nt .111d n:sc.m.:h cftixt\ .1 rc eng.1gcd in sn:king and gl·ncrating l"Xpl.mations th.11 ,Ul' s~·stl·n1.1tic .md l·ontroll.tbk by fanu.11 c,·idl'IKl' ( Cu-per, 1978, 1991 ).
Est/Jaic k11oll'frdgr is l"Xprl·ssi\·l•, subjl·ctin:, unilJue, .111d c:xpcriential r.nher 1h.111 form.ii or lkscriptiH: . Esthl·tics includes sl·nsing thl· me.ming of .1 morm:nt. It i~ lTi- dcnt through J.Ctions, conduct, attitudes, .111d intcracrioth of the nur,l.' in n:spon~e to ,ltlothcr. It is not .:xpresscd in langu.1g.: ( Carper, l 97~ ).
Esthl·tic knmdedgc rclio 011 percl·ption. It i~ ac.ui,·e Jnd in-:orpor.tt<-'s emp.1th~· .mJ undcr~tJnding. lt i~ intl'rprt:tih', .:ontextu.11, intuiti,·e, .md subjectin: .mJ requir.:s synthesis rather th.111 analysis. Furthermore, .:stheti-:~ goes beyond wh.1t i.~ expl.tined by prinl"ipks .rnd crt.:.lt.::, ,·.1lues .111d m,:aning to ~Kcount for v.1ri.1hle~ th.1t c.111not be qu.111tir.ni,·cly formul.ned I C.up.:r, 1978, 1991 ).
Pcrm11nl k11111l'la(lft' refers to thl· way in whi-:h nur~l'S \'i,:w themsdws and the client. Persrnul knm,·kdgl· i:, subjec.:ti\'e and promotes whokne:,s .md integrity in plT~ !,Oll.11 encounters. Eng.1gcmcnt, r.1th.:r than det,Khmcnt, is .1 compo1wnt of pl-rsonal knowledge.
Pcrson.11 knowledge incorpor.1tl'S experience, knowing, c:nculllltl·ring, .111d .ll.'tll-
.1lizing thl· sdfwithin th.: pr,Ktice. Pa\on.11 111.nurity .md freedom an: c.:ompunl·nts of pl·rsrnul knowledge, which 111.1y indudl' spiritu,11 .111d metaphy:,i-:al form:, of knowing. Bec.iu~e person.11 knm\ lcdgl· is difliculr to l'Xprc~s linguistically, it is larg,l'ly cxpn:s~nl. in p.:rsrn1.11ity ( Cupl·r, 1978, 1992 l.
Et/Jfrs rcK-r., to th.: mor.11 code for nursing .111d i:, b.1~ed on oblig.uion to \lTYi-:e .md fl'SPl'Ct for hun1.111 lik-. r.thic.1I knowledge lll'Curs .l!, 111or~1I dikr111n.1s Jrise in sit- u.1tion~ of .unbiguit\' Jnd uncatainty .rnd ,, hl·n conse1.juencl·!, .ire diffil·ult t< > pre- di.:t. Ethic.ii knowkdge requires r.nional ,rnd ddihl.'t\ltl· c,amin.1tion .rnd e,·;1lu.1tion of wlut is good, nlu.1blc •. rnd de:.irabk a:, go,1ls, motiws, or ch,1r.1ct1:ri,tics ( CJ.rper, 1978, 1991 ). Fthil·~ must .1ddn:s.\ conflicting. norms, intl'rl'Sts, and principk, .md pro\'id.: insight into .uca~ that cannot be testl·d.
FJ.wccrt, \V.n~on, :--leum;lll, \Valkt'rs, .md Fitzpatri-:k ( 200 I ) strl'% th.1t integr.1• tion of .1II pattern, of kno\\'ing is C!,Sl'ntial for prok~sion.11 mir~ing pr.1.:tice .md th.u no onl· p.1ttcrn \hould bl· used in isolation from other!,. Inlkcd, they .lrl· intarcl.tt.:d .111d intc:rd.:p.:nJent be.:.msc thl'rl' arc multi pk points< 1f conta-:t bctwl.'cn .md .1mong thl·m ( C.uper, 1992 1. Tlrns, nun,c~ should Yiew nursing pr,1-:ti.:-e from .1 bro.1den.:l\ pl'r~pl·cri,·l' th.ll pbCl'S ,·.1lue on \\'.,~·~ of knowing hl·yond the t.:mpiric.11 (Sih·a, Sorrell, & Sorrell, 199;; ). T .1bk 1--! summarizl's sdect.:d dur.Kteri:,tics of C.1rper's pattnns of knowing in nursing.
Other Views of Potterns of Knowledge in Nursing Although Carpa' s work is comid.:n:d .:bssic, it is nnt without critics. Sdrnlt1 . . rnd ~kleis ( 1988 1 ob~ern;d rh.n Carpc-r'~ work. did not incorporate pr.1ctical knowl- l'dge inro the ways of knowing in nur~ing. lk-:.1t1~c of this .md othc-r concnns, they lks-:rihl·d thr.:e p.1ttems of k111)wkdge in nursing: dinicJl, conceptual, .rnd l't11piril-al.
Chapter 1 Philosophy, Science, end Nursing 15
Table l ·4 Characteristics of Carper's Patterns of Knowing in Nursing
Pattern of Relationship Source or Source of Method of Purp0se or Knowing to Nursing Creation Validation Expression Outcome
Empirics Science of Direct or indirect Replication Facts, models, Description, explo- nursing observotion ond scientific princi• notion, prediction
measurement pies, lows stote- ments, theories, descriptions
Esthetics Art of nursing Creation of value Appreciation; Appreciation; Move beyond end meaning, experience; empothy; esthetic who! con be ex- synthesis of ob- inspiration; criticism; engog- plained, quantile- street ond concrete perception of ing, intuiting, lively formulated,
balance, rhythm, ond envisioning understanding, proportion, end balance unity
Personal Therapeutic Engagement, Response, reflec- Empathy, active Promote wholeness knowledge use of self opening, centering, lion, experience participation ond integrity in per•
actualizing self sonol encounters
Ethics Morel Values clorificotion, Dialogue, justifi- Principles, Evaluation of whet component rational ond cation, universal codes, ethicol is good, voluoble, of nursing deliberate reason-
ing, obligotion, generalizability theories end desirable
odvocoting
Sources· Carper (1978, 1992); Ch,nn and Kromer (2015).
Cli11irnl k11ml'la(_nt' rder~ to the illlii\·idu.11 nurse·~ peP,nn.tl knowkdg..:. It rc,ult~ from using multiple way~ of knowing. while soh·ing. pniblem, during dicnt Ltr..: provi- sion. CliniG1l knowkdge i~ manik~red in the ,Kt~ of pr.i-:ti.:in~ nurw~ .111d r..:,ult~ from combining pi:rson,11 knowkdg;e .111d empiri(,tl knowkd~e. It may .1lso in\'oh-e intuiti\'c: ,\Jld subjectiYe knowing. Clinical knowledge: i~ communic,tt1.:d n:trospectin:J~- through publication in journ,1ls r Sdrnlt7 & J\ Ide is, 1988 l.
Ct111Ct'pt1111! k1111wlt-dpt· is .1b~trJcrc:d .rnd gena.1lized bc~·ond per~onal cxpericnc..:. It cxplkate~ p.1nerns re\'ctkd in nrnltipk dknt t:.\pcriem:c-s, whid1 oc..:ur in multipk situ,ltiom, Jnd artit..·ul.tte~ them.\\ 11101..kl~ or thc.:oric.:~. In conceptual knmdedgc, (on- cept~ .ire drafted .rnd rd.uion.tl ,r.uement!> ,\re.: formul.1teJ. PropositionJl ~r.ttc:menr~ .uc: supported by empiri..:.1I or ane..:dot.11 e\'idence or ddcndcd by logi(,11 rc.:.isoning.
Conceptual knmdedgc me~ kn<m ledge: from nursing .rnd other di~cipline~. It in- .:urpor.ttcs curiosity, im.tgin,llion, persistence, ,\l\d commitment in the .1ccumulation of fa(t\ and reli.1ble gener;1liLntium thJt pcrt.1i11 to the di:.cipline of nursing. C:on..:cptual knowledge is communic.nc:d in proposition.ii lil,ltemc:m~ ( Schultz & ,\klcis, 1988 ).
Empit-irnl lmowlaf...m· results from c:xpt·rimental, hi.~tori.:al, or phenomcnologic re- !,eJrch .ind i~ med to ju~ri~· Jl"tiom md prm:c:dure!, in practice.:. The cn·dibiliry ofc:m- piric.11 knowlcdgc: rc:st~ on thL· degree: to whkh the rc:sL·archer hJs lt>llowed procedures accc:pted by the: n>mmunity of rc:sc.irchcrs ,md on the logic.11. unbiased dc:ri\'ation of .:ondusions from the c,·i,.kn.:c:. Empiric.11 kncm-kdge i~ c,·.ilu.ttcd through syHematic review .rnd critiqul' of puhli~hed re~e.uch .rnd (onfrrcn..:c prcs..:ntJtion~ ( Schultz & ,\kids, 19881.
Chinn .md Kr.imer (2015) Jlso expanded on C:Jrpcr\ p.mcrns of kno\\'ing to in· dude: .. emancipatory knowini;"-whJt they Lfosign,uc J~ till' .. praxis of nursing." In their
16 Unit I Introduction to Theory
,·icw, cmancipJtory knowing rd~r~ to hum.ui·.~ Jbility to aitic:ilh· examine the cum:nt statlls quo and tn determine why it cum:ntly exists. This, in rnrn, ~upport~ identitic.nion of inequities in ~<Kial :ind politic.1I institutions and da1ification of .:ultur.11 v.1lucs ,md bdid~ ro impron: conditions for ,111. In this ,·ic,,-, emancipatory knnwkdgc is expn:sscd in actions that arc directed row.ml .:h.111!:,rillg cxi.sting ~<Kial strw:tun:s .111d establishing practices that .m.: more equit.1bk .md fanir.1blc to hum.111 he.11th .md \\'di-being.
Summary of Ways of Knowing in Nursing For decade~, the importance nf the multiple way~ of knowing h.1~ been recognized in the discipline of nursing. If nur~ing i~ to ad1ic,·e a true integration between rhc- on·, research, .111d practice, theory den:lopment .111d research must integr.1te ditkrcnt smirce~ of knowledge. Kidd .ind i\lorrison ( 1988) st,lll' that in nursing, s,·nthcsi~ of thcorie~ derived from different ~ource~ of k11<m-kdge will:
1. Encourage the u~c of ditkrcnt types of knowledge in pr.Krice, educ.1tion, theory de,·dopment, and res.:.1n.:h.
2. Encourage the use of dilkn:nt methodologie~ in pr.1ctiee and rcsc.m.:h. 3. i\ 1.1kt mtr~ing cdt11:.1tinn mon: rcle\·,1nt for nur,e~ 1,·irh ditkrcnt edu(,ttion.11
b,1Lkgrounds. 4 . . -\ccommodJte nurse~ ,lt difti:rent lc,·cls of diniL,11 co111pete1Kc. 5. llltim.1tcly promote high-qu,11ity ditnt (;11'L' .md diem ~arisfa.:tinn.
Research Methodology and Nursing Science Being he.1\'ily influcn(ed by logi.:.11 cmpirii.:ism, ,is nursing hegan de,·doping .1~ .1 s.:ien- titi.: di~Lipline in the mid-1900~. qu.1nrit.1tiw method~ "en: med almost cxdusi,·dy in rc~c.1rch. In the l 96(h .md 1970s, ~choob of nur~ing .1lig.ned nursing inquiry with SLi• entific inquir~· in ,\ desire to bring respc.:t to th.: ,K,KkllliL ern·ironment, .ind nur,c rc- se.1rchcr~ .rnd nun,c educators v.1lucd quantit,ttin:: rcsc.m:h methods m·er other forms .
.-\. deb.UL' m·er methodology began in the l 980~. howe,·cr, \\'hen ,omc nur~c scholars ,\sscrtcd tlut nursing's ontology I what nur,ing. i~) \\',1, not being adequatc]~- and sufficiently explored using quantitati\'e method~ in isol.nion. Subsequently, qual- it.1ti1·c research methods bcg.111 to be put into use. The .1ssumptions were th.n quali- t.Hi\'e methods ~howed the ph.:nomcna of nursing in \\·ays th.It ,,-en: n.1tur.1listic and unstnKturcd .111d not misrcpre~cntl:'d ( Holzemer, .2007; Rutty, 1998 ).
The m.mner in which nur.~ing science is con(cptu.1lizcd determines thr priorities for nursing rcseard1 .111d proYides measures for determining the relna1Kc of \'.lriom scientific rescan:h questions. Therefore, the ,,·.1y in \\'hich nursing science i~ conLep- tu,1lized also h.1s impliL,ltions for nursing pr.1.:ticc. The phiki5ophical issue~ rcg.1rding method~ of rcsc,trch relate back to the deb.1te o\'\'.I' the work-h-iews of received ,-cr~m percei,·ed ,·iew~ of ~cicn.:e , ·er~u~ postmodcrni~m .md whether nursing is a practice or .1pplied sLiC1Ke, .1 human SLien.:e, or some (ombinatiun. The notion ofc,·iden.:e-bascd praLtice lu~ emerged oYcr the la~t K·"· years, largely in re~pome to the~e ,11hi rd.m:d co1Kem~. EYidl'nce-based pr.1ctiee ,\~ it r~·lates to the theon:tic.1I ba~i~ of m1rsing \\'ill be ex.1111ined in Chapter 1 ~-
Nursing as o Practice Science In c.1rly year~, the deb.He fon1sed on whether nursing was .1 basic ~(ie1Ke or .111 ,1pplied sci1:11cc. The goal of basic.: scien.:c i~ the .ltt,1i11mcnt of knmdedgc. In b.1si.: research,
Chapter 1 Philo~ophy, Science, and Nur~ing 17
the i1ll'cstig.1tor i~ intcrc,tni in undcr~tJnding the problem ,md produce~ knowledge for knowledge·~ s.1.kc. It i~ .rn.1.lytic.11 .md the ultim.1te timction i~ to Jnalyzc .1 condu· ,ion b.1ck\Y.1.rd to its proper principle~.
Co1wa~dy, .in .1.pplicd ,cic11ec i, one th.u me, the knowlcdgt· of b.1sic scit·nce~ for some pr.1.:tic:1I end. Engineering, .1.rchit1xture, .rnd pll.!.rm.1o>logy .m: oJmplcs. In applied n:~e;.m:h, the investig.uor worb tcm.mJ solYing problems ,md produ.:ing ,olutiom for the probkm. In pr.1ctice sciences, rcsc.uch i~ l.1rgcly dinic.11 and ,Ktion oriented I l\\ood\'. 1990 ). Tlrns, .1~ .111 .1pplicd or prJ.ctical ~cience, nm~ing requires rc,e.irch that is .1pplied .md clinic.ii .rnd th.it gcm•rJtc~ :ind te,t, thcnrie, n:l.ued to hc.\lth of hum.rn bl.'.ing~ within their cm·irnnmcnt~ .b well.\~ the ,\ctiom .md proccssc~ uwd lw m1r,cs in pr.ictice.
Nursing as o Human Science The term b11111f111 srirnu i, tr.1.ced to philmopher \\'ilhdm Dilthey ( I l-LB- 19 I I). Dilthcy propmcd tl1Jt the hum.rn science, n:l]uirc co1Kept~, method~ .. md theories th.u .1rc ti.111damcntally Jilfrrcnt from thme of the nattirJ.I ,cicnce~. Hum.m ,ciences ~tuJy hum.111 lite by ,·aluing the livcJ expcricncc of per..ons and ~cek to u1Kkr~tand liti: in its m.uri" of pattern~ of meJning .mJ , .tlucs. Some ~cholars belie, e that there i~ .1 m:cd to J.ppro,H:h hum.m science~ Jifti:rently from co1wentiunJI empiricism and contend th.H hum.m experience nm,t be unJer,tocxi in cnntc\t ( Cody & ~litd1dl, 2002; Polifroni, 2015 ).
In human ~cietKC~, ~cicnti~t, hope to ..:re,\ll.: new knowkdgc to provide t1111.kr- ,tJnding .md interpretation of phenomena. In hum.m ~ciern:cs, knowledge t.1kc\ the fi.,rm of descriptivc theorie!> rcg.1rding thc structure~, procc~~e~, rclatiomhips, .md tr.1dition, th.u undcrlit· p\yd10logic.1I, ~cKial •. md cultur.11 aspects of re.1liry. D.1t.1 .1rc inrerprcted within context to derive mc.1.ning .md unJasunding. Hum.111- istk ,cienti~t~ \".1lue the ~ubjecri, e component of knmdcdge. They recognize tl1.1t hu111.1m .ire not cJp;1bk of tot.11 objecti,·ity .md cmbr.1ct· the ide.1 of subjectivity I Strcubcrt & Carpcnter, 20 I I). The purpme of rc~c.uch in lrnm.m \Cicnce is to produce Je,criptions .md interpretarion~ to help under~t.md the n.nun.: of hum.m experience.
1\:ursing i~ sometime~ rcti:rrcd to .1~ a humJn scit·ncc (Cody & f..litchdl , 2002: Polifroni, 2015 l. Indeed, the di~ciplin~· h:is l'\Jmined issues rcl,1tcd ro beh,wior Jnd culture. ;l~ well .1~ bioh>g1· .md phy~iology, .rnd sought to recognize J.~~ociJtion~ .1111ong factor\ thJt suggc,t cxplan.uury \·,ui.1blcs for lrnm.rn he.11th J.nJ illnc~!,. Tlrns, it fir,. the pJttcrn of other hum.111i-;ric sciences ( i.e., .mthropolo!:-,'"Y, sociol<>!:-,')" ).
Quantitative Versus Qualitative Methodology Debate Nur!>ing ~chol.1r~ accept the premise that scit·ntific knowledge is gcncr.ltcd from ~~·stenu.tk study. The rt·sc.1.rch mcthoJologies Jnd criteria U!,Cd to jusri~· the a.:- cept.mce of ,t.ncment~ or condmions .1~ true within the discipline.: re,ult in con - dmions .rnd ,tatcment, th.it .ue .1ppropri.1tc, \'.1.lid , .rnd rcliabk fr,r the purpmt· of the Ji,~·iplim:.
The t\\o Jomin.mt forms of scientific inquiry h.1.,·c been idcnrined in nursing: (I) empiricism, \\·hid, objectifies .111d .ntempts to quJntif-)· expcric111:e .rnd may tc,1 proposition~ or h~·pothcse~ in controlled expcri1ncnr.1tion, and (_2) pht·nome110lo~')· .1.nd othcr t<.>rr11, of4u.tlit.1.ti\'e ro.:se.1.rch (i.e., groumkd theory, hermeneutics, histor- ic.1.I rt:!,C:lrd1, ethnography), which srndy li,·cJ experiences .md meaning, of e,·c.:nt~ I Cortner & Schultz, 1988: f..lorsc, 2017; Risjord, 2010 I. Re,·icw, of rh,.: 'iC.:ienrific
18 Unit I lnlroduclion to Theory
st.nm of nur..ing knowledge: lNIJll~· conrr.1st the positi\'ist-1..icdul."tin.·-quantit.1tin_. J.pproad1 \\ ith the intc:rprctin:- inductin:-l]U,11it.1tivc .1hlTll.1tiw.
Although nursing thl·ori~t, .md m1r,ing sl."it:ntist, l'mphasizc thl· import,mcc of sodohi,toric.11 contc:\t!> .md pc:n,on;:m·ironmcnt intc:r,Ktiorn,, the:\· rend ro fol·u, on "l1.1rd ~..:icn..:c" .111d thc fl''l"J.rch pro..:c,~. It hJ\ hl·cn .ugucd th.1t tl~c:rc i, .m m·cn·Jlu- .1tion of the cmpiric.1l/9uJ.ntit,1tiw \·icw hc..:.rnsc it is ~n:n ,1' "true: sl·icn..:c" 1 Tinkk & lk.1to11, 19831. lndccd. the: l'xpcrirnrnt.11 method i, hdd in the: higlK·,t regJrd. A \'il'\\'point h,1, persistl·d into the: 2 I ,t l'l•ntur~· in whi..:h ,chol.m, .1~~11111c th,u dl'Sl·rip- tiw or qu.1lit,lti\ c rc:,c.1rd1 ,hould be p.:rformc:d on!~- where: thlTC i, link inform.uion .w.1il.ibk or when thl· ',dcn..:c i, \'mlllg. ( ·orrd.1tiot1JI n_.,c:an.:h 111.1y folio" and thl·n n- paimcnr.1I 111l'thod~ c.111 bc usl·d when the: two lower ("1c:ss rigid" or "k~s ,c:ientifi..:" \ k\·cl, h.irc: bl·cn l'Xplon:d.
Quontitative Methods Trndition.111\', within rhc "n:l·ciwd" or po~1ti\ isti..: workh·icw, ,..:ic1Kc h.1, bccn uniqud\' qu.mtit.1tiw. The quantitJti\'t: .1ppro.1i:h h.1~ bc:cn ju~titied by its slic..:..:ss i11 llll',1su1ing., ,111,1lyzing., rcplkaring, and appl~·ing. tl1l· knowkdgc gai1wd ( Strcuhat & C.irpcntl·r, 20 l I) . .-\c..:ording to \Vo1ti:r ( 1993 1, ,i:icn..:c should in..:orpor.uc mctlwdolog.i,: prin- .:iplc~ of obji:..:1iw obscn·ation/dcscription, ,K..:ur.nc mc.1srn-c111~·11t. quamifi..:ation of \'Jriablcs, marh.:nuti..:.11 ,111d st.1tisti~·.1I .111.1lysis, ,xpcrimc:ntJI methods, .md \Yriti..:.1tio11 through rcplii.:ation "hcncwr pos~ibk.
Kidd Jnd ,\ lorri" 111 ( 1988 1 ,t.ltc that in thcir h,lMl' to prow the: CTl'dibility of nursing. .1, .1 protcs~ion, nursing ,dmbrs h.1w cmph,1'izcd rc:Ju.:tioni~m .md cmpiri..:,11 \',tlid.niun through l]U,rntit,Hi\·l· mt:thodolog.ic~. cmph.1~i1ing. hypothe~is t,:sting. I 11
thi, frJmework, the s..:ii:nti,r dc,·dop~ .1 hypoth.:,i, .1bout ,1 phl'IH>lllC:llllll .111J ,,c:k~ to pro\"l' or disprm·c: it.
Qualitative Methods Th,: tr.1dition of using. ~1ualit.1ti\'l' ml·thod~ to ~rudy hum.111 pht:nomcn.1 is groundl·d in th..: so.:i.11 ~..:icn..:~·,. Phcnomcnology .111d oth,:r 11wthod, of qu.1lit,lti\"i.: rl·sc:.u..:h .1n>sl· bc..:.msc .1~p..:cts of hum,111 values, ..:ulrurc, .rnd rd.itionship, wcrc un.1bk to bl· d~·,cribl·d folly ming. qu.111tit,niw rcs..:.1rd1 llll'thod,. It is gcnl'rally J..:..:cptl·d tl1.1t qu,1lit,1tiw rl·,c.uc:h tinding.s .1n"1·cr questions ll'ntc:rcd on ~o..:i.11 expc:ri.:11,:,: .md g.iw 111c;111ing to humJ.n lik. !kg.inning: in the l 970s, nur,ing. ,dc:ntists \\ ,:rc d1alkngcd to cxpl.1in phenom.:11.1 dut de~· qu.1ntitarin: 1m:.1smemc:nt, .rnd qu,\liratiYc: JpproJchcs. whid1 cmphasizc the: importance of the ..:lime's persrc:..:til'I::, bcgJn to bc used in nurs- ing rl'~l·an:h ( Kidd & i\lorrison, 1988).
Rcpc.ucdh·, sc:hol.tr., ,t.1r..: th.n nur..ing re~.m:h ,houkl incorporuc: 1111:.111, for d.:tn· mining: intcq,ret.uion of the: phenumcn.1 of ..:oni:l-rn from the: pcrspccrirl'. of the diem or ,:,,re: rcl·ipknr. Contr.1n· to thl· ,1ssc:rtions ofc:.irly ~l·ientists, 111.1ny bra 1rnr,c s..:il·nti.~t~ bdic:, c th.u qu.1lic.uivc: inquir~- contJim tc.1turcs of good science induding. theory .rnd obscn·.uion, logic, prc..:ision, d.1rity, .md rcproducibiliry I ,\1onti & Tingen, I 999 ).
Methodologic Pluralism In man~· ro:spc..:r~. nursing i~ ..rill und.:~·idc:d .1bout which mcthodologil- apprn,1d1 ( qualitati\·c or quJntitJti\·e) hl·,r dcmun..rr.itcs thc csscn(c .111d uniqucnl'" of nursing: bc..:amc both mi:thod~ hJw strcngth, Jnd limir.1riom. Bc..:k .1nd HJrriM>n (10161. Risjord ( 2010 ), and \\'nod .1nd H.1bcr ( 2018 I, .1mong other~, belie:\ c th,H thl· t\\ o approJchcs m.1\· bl· ..:onsidcred c:umplcmcntary .ind appropriJ.t, for nursing .1s ,1 rc:sc:ar.:h·h.ised discipline. Indecd, it is repe.ircdly .1rgucd that hoth .1ppro,1d1l'.~ .1rc equ.1lly important .rnd l'.\ ..:11 csscnrial for nursing. ~..:icn..:-1.' dcwlopmc:nc.
Chapter 1 Philosophy, Science, and Nursing 19
.-\lthoug:h bJ:,i..: phi)o:,ophic.11 ,·il·wpoint~ lun: guided .md dirl'Ctl·d n.:!,c.uch ~tr.lt· cgic!, in the p.1~t, n.:..:ently, ,chol.1rs h,HT c,1lkd for theorctic.11 .rnd mcthodologi..: plu- rJ!i!,m in nur~ing philo!>ophy ,rnd nursing ~..:ie1Kc ,\!, prc~ented in rhc di,cmsion on pmtmodcrnism. Plur.1lism of rl'Sl'areh desigm i!> c!>:,cnti.11 for rcflc..:ting the uniquc- nc,s of nursing, .rnd multiple .1ppro.1..:hc~ to theory de,·clopmem .111d testing ~hould be encour;iged. lkcausc thl·rl· i~ no one be,t method of dl'\·cloping knmdcdgc, it is import.mt to n.:cogni1.c th.tt Y.1luing one ,1.md.ud .is cxdw,i\'t' or ~upl·rior restrict~ the Jbility ro progress.
Summary Nursing is .111 cn>l\'ing prnfes~ion, .111 .1c,Hkmi..: discipline, .rnd .1 ~ciencc. ,-\:, nursing progrc,~C!. .md grow,.,~ .1 profession, ,omc contro\'crsy rl·m.1in, 011 whl'thcr to l'lll· pha~izc .1 hununi~tic, lwli~tic ti.Jl'u!, or .111 objecti\'c, s..:icntitically deriH:d mc.rn, of comprd1cnding reality. Wh.u i!, ncnkd, ,md is in..:re.1singly mon: c,·idrnt ,h nursing m.1tL11T, J\ .1 protession, i~ ,lll op..:11 philosophy th.it tics empirical ~·onn·pts th.ll are capable of lxing \',tlid.m:d through thl· ~ense~ wirh thcoreric.11 ClllKl·pt::, of m..:aning .u,d ,·alu~.-.
It i~ import.mt that futurl· nursing le.llkr~ .md nm·in- nur,e ,~·i...-mi~ts po~sess ,lll
undcrst.u1ding of nur~ing's philmophicJI t<iund.uiom. Thi: leg.tcy of philosophicJI pmitiYism continues to drin: bdid\ in the scicntifo: method and r..:\e.ud, str.ttcgil'S, but it j:, rim..: rn moY..: tiirw.1rd to fa..:c rh...- challenge~ of thl' incn·Jsingly complex .rnd nil.ttik he.11th c.1rc l'm·irnnmcnr.
Key Points Nursing cJn be considered an aspiring or evolving proti::ssion. ~ursing is J professional disdplin...- that drJw, much of its knowledge bJse from other dis..:iplines, induding p\y..:holog~·, so..:iology, physiology, and medi..:inc. =--:ursing is .rn .1pplied or practice ~ci..:11..:e tl1.1r h.1s been intlucn..:cd by ,c,·er.11 philrn,ophicJI ,chools of thought or worldview!>, including rhc rccci,·ed view ( empiricism, positi,·ism, logi..:.11 posiri,·ism ), the pcr..:civcd ,·iew { lrnm.rnism, phenomenology, <.:onstructi,·ism l. and postmoJcrnism. NII rsi 11J7 p/Jil11sop/Jy rcfrr., to th..: worldvit:\\'( s J of th..: proti::ssion Jnd pro\'ides pcrspc..:ti,·c for prJ..:rice, schol.1r~hip, .ind rcse.ud1. :-Jursill~ff uirnu is the dis..:iplinc-sp..:..:ifi..: knowkdg..: th.it fornses un th..: hum.rn-t:11\'ironmcnt-he.1lth pro..:ess Jnd is arti..:ul.1.ted in nursing theories Jnd g:ener,m:d through nursing r..:~eJr..:h. P/Jilosop/Jy ,fscirnu in 11111:fiTtff c,rJblishc\ th..: ml'.llling of ~...-ii::n..:c through cx.1mination of nursing ..:on..:..:pt!., theories, and law, .1~ they rdJte to nursing pr,i..:ricc. ~•ursing, epistemology (ways of knowing in nursing) )u:, fiicu,..:d on four predominant or "fund.lln..:nt.11" ways of knowledge: empirical knowkdge. csthetii: knowlcdgc. person.ii knowledge, .md ...-thic,11 knowkdgc. .-\~ nursing s..:icn..:e has developed, there )us been a dcl)Jre rn·cr wh.lt research llll'thmi, to me (Le., qu.rntit.Hin: methods\'!>. qu,1lit.ni,·c methods). In..:rc:.1singly. there ha~ bc...-11 .1 i:.111 for "methodolog;ic plurJ)ism" tu better ,:n\llrt:: tl1.1t r..:,cJrch tinding~ .uc ,1ppli..:.1bk in nursing practice.
20 Unit I Introduction to Theory
Case Study The.: following i~ .1d.1ptc.:d from .1 p.1pc.:r 1Hirtc.:11 bv .1 !):radu.1tc.: ,tudc.:nt dc.:~c.:ribing .111 c.:n- countc.:r in m1r~ing pr.Kticc.: th.lt hi~d1lighrs C.irper•~ { 1978) w.1~·~ of knowing in mm,ing.
In hc-r work, C.upc-r ( l 978 l idi.:ntitic.:d t<ntr p.ucc.:rm of knowing in nursing: c.:m- piric.:.11 knnwlcdgc.: I ~cic.:ncc.: of nur,ing. ), c.:,thc.:tic kncl\\·kdgc.: ( art of nursing), per~onal knmdc.:dge, .md c.:thic.:.11 knowkdgc.:. 1-:.Kh is c.:~~cnti.11 .md dc.:pc.:nds on the.: othc.:r~ to m.1kc.: the.: "he ,le.: of nursing pr.1cticc.: .. md ir i~ impossible.: 1,, ,t.ltc.: "hid1 of the.: p.Htc.:rm of knowing is mmt import.mt. If nur,c.:~ foc.:u~ cxclu,i,·d~· 011 t:mpiric1I knm,·kdg;c.:, for cx.1mpk, nur~ing c.:.1rc.: 11cndd become mon: like.: mc.:dic.:al ~·.1rc.:. But ,1·i1hout .rn c.:mpiri- c.:.1I b.1~4.:'., the.: .ut of nur~ing i~ jmt rr.,dirion . Pc.:r~on.11 kno\\'kdgc i~ g.1inc.:d from rxpc.:- 1ic.:ncc and require.:, .1 ,c.:ic.:ntitic basis, undcr\tanding, .md c.:mp.uhy. fin,1l1y, the.: mor,1! c.:omponc.:nt is nc.:cc.:s,.1ry to determine.: \\'h,u is 1·alu.1blc:. cthic.11, .md compul,ury. Each of thc.:,c.: way~ of knm,·ing i, illu,u-.1tc.:d in 1hc.: following ,c.:c.:n.uio .
. \!rs . .'i111itf1 ll'ns 11 2-1--ymr-olri pri111i_,1ml'irin wlm /Jl'L'S01ttri to 1111r 1111ir i11 mr~v lllbt11: Her /111sbm1ri, 1111ri _tiu/Ja of /Jcr 1111b11m r/Jilri, lmri nb1111ri11mri /Jn- 2 11w1u/Js pri111· to ridfrn:11, nJ/II sbt 111,ktri c/ostfnwily suppol't.
I mrcri ji,r .\!rs . .\111it/J t"1·01tnfJ/111t /J,-,. lnbor 1111ri nssisttri ri11rinJT her ndiPLT_1•. D11ri11.11 t/Jis prnccss, I tnttn/Jr brcnr/Jinp rcdmiq11cs w msr pni11 1111ri i111pro1•c ropi11p. l'osiri,m c/;n11pcs tl'fl't' rnco11rnprri pLTioriirnl~v. ,mri nssist1111cr 11·11s pro11iricri ns 11ccricri . . \/rs . .'i111ir/J'.( mrc i11d11rit'ri co11ti111w11s_ti·tnl 111m1iwri11p, i11tm11,·11om byrimtio11, n11nf- l1csit 11ri111i11istmrio11. b11r!.· rubs, concbi11J1 n11ri 01co1,r11J101101t. 1usistn11L't' rPIJifrJ1ati1tn 1111 cpiriuml, strni._r1ht wtbatrizntio11 ns 11anfri. ritnl s~1111 111011irori11J7 /'fl' policy, 11.,:1•to- fi11 11ri111i11isrrnti,m nfta ridil'o:v. lh'll'fl()rll rnrc, a11ri b1·nz.(~fi-crii11_n nssistm1Ct', n,11011_11 1111111_1· others. Alf mrr ll'm cxplni1uri ill derail prior ro ro11frri11Jr.
Empiricnl ~·,wwlt-rilTc was clmrly uti/i::,rri in .\!rs . .\111it/J \ mrc. E,·nmplrs 11•,mlri be tf}(ISt' pmcricn lmst'ri 011 tbr A.-:(ocin1io11 rf Hi1111rn 's Hmft/J, Obstetric 1111ri ,\'nmntal X111:(,'J 1AU'HO,\',\'J ,·Pirimff-bnHri stn11rinrris. n1t·s,· i11d11ritJ711iricli11tsfi11•.fi•tnl lm1rt mt, 111011it1ll'i11p auri i11tcrp1't'tntio11, nsscss,11n1t n11ri 111nlJ(IJ]t'lllt'llt ,!(Jin S111it/J whiff 1·c- cciPi11J1 brr tpiriuml n11a[t1csin, t/Jt' msnm1c11t ,wri 111n11np,·111,·11t ,~(side i:f.Y1·rts St'w11rinry to brr n~ni01rnl nnn{rrcsin, n11ri rPrn Jh·q1tmL:1•jill' 111/111itori11 ... rr T'itn/ si..rrm. ()r/JtT c.rn111plcs 1rio11/ri br nssisti11_n .Hrs. S11Jir/J fll n11 11pr(l1/Jt position ri11ri11 ... rr /Ja sn-onri stn,rrr ,flnbor to fncilimtr ridii•n:v 1111ri ridnyi11.rr 11011riirfftt'ri J1ushi11_rr onrr slJr 1Pns cmnplctr~,, nilntrd.
Estbctic k1wll'lfri.r1c. or t/Jr an tf 1111ni11J1, is riisplnytri i11 obstrtricnl 11111·si11.r1 rini~l'- Rnt/Jcr tb,111 jmt i-,·spo11rii11.._11 to biolo ... rric rin•d11p11101ts or sp11l•t11 1·rq11rsrs, tlJr 11'/JO!t- pcrsm1 Jl'l!J pn/ucri n11ri mo JJ'ITC f'l'l'Cl'il'tri anri rnpo11ricri to fi,r tbr .. fToori 1!( the patient. T/Jt' cnl'l' 1 _r,nl't' :\Jr.<. Smit/; Jl'as bolistfr; IJLT social, .1pirit11nl, psyclJo!o .. niml, 1111d p/Jysicnl llfffl.(
11'<'1'1' nil nrirircsscri i11 n rn111prd,cmil'c n11ri scm11/cssjirshi1111. 17,c 011pntlJy C/11/l'c:vrri to tbc pnrimt tool.· into 11ao1111t 1Jrr 1111iq11t ff~(nnri sit11nti1111, n11ri tbc cnl't' fmn•irirri H'ns n:fhx- i!'d_l' tnilorrri to /Ja 11t't'ris. I r,·c1(f1llizrri rlJr Jm:fi11111ri cxpn-imcr rfwhirb l 11•ns n pnrt 1111ri nrinpffri my nai1111s n11ri nttit11rit to /Jonor r/Jc pntimr n11ri l'nl11,· tf1t· lm~nr.,. c.\'fhTiotcf.
Jinny aspects ,!f' pci·.rn11nl lmoll'frdp,: st'rn1 i11tn-twi11cri ll'itb csrbaits, t/11111 ... rr/J 1110/'C ouplmsis src111s to br 011 t/Jt 111m11i11_n_fiil i11tcmaio11 bt'f11•co1 rl,r pntio1t ,mri 111trsc. As nbol'f, the pnticut 11'/IS cnffri Jin· ns n 1111iq11c i11rifriri11n/. 'J71011_qb saonrinry to tb<' nll't'- so11/f 1111t11rc 1!(birtb. 11111d, 1!f't/Jc cxpfl'io1rc raofrcri 11r111111ri t/Jc pon•ojili i11tcrpO'so11nl rdnti1111sf1ip cstnblis/Jt'ri . .\!rs. Smit/J rPnJ nccrptrri ns !JC1:ic{t: Tb01v11J ,:{fiwrs ll'1Tt 111nri<' by 111.- to 111n11n_nc catni11 nspcct.< 1f t/J,· t'xprrir11a, .\!rs .. 'w1ith 11·ns n/10111cri ro11trol n11ri Jin·ri11111 ufc.,-pn-ssio11 n11ri rmctim1. ,\/Jr 1111ri l 11'0'L' lmr/1 m111111itffri tot/Jc 11111t11nl tlm11,rr/J britf rclntio11s/Jip. 171i.( l·11ml'frrf._nt strnts jh1111 111_1· 011'>1 flcT.mllnlit:,' 1rnri nhility to nat'pt ot/Jfn. 11•illi11.r,11css to ,m111cct to orbas. 1111n dtsirc to co/111/mrntc IJ'it/; the pnrfrnt n~nnrri- i11_n bfl' ml'f 1111ri 11/timatc cxpcrfr11cc.
Chapter 1 Philosophy, Science, and Nursing 21
"Jl1c rtbicnl lmoll'lcr(f1C 1!f'11111-si11.11 is m11ti1111"mZ1• utifi:::.t'd i111111ni11_11 cnrr to promou t/Jr '1t"a!t/J a11d 1pr://-bci11p of thf pntimt; n11d in t/Jis circu111stn11ff, r/J,· 1111bon1 ,/Jild ns wt'//. £po:,· derision 111nd,- 111wr b,- 1Pci._11/1td npniust dt'sir,:d .._1111nls n11d Pnlua. 1111d 1111r.rl's 111wt srril't' to ncr 11S nifromtl'S for mcb patimt. \\'hrn rnri11.._IT Jiir n pnrimt n11d 1111 1m- bm·11 thild, t/Jl'l'c is a mmt1111t nttl'mpt to do 1w /Jnrm to citl1t-r, w/Jilr bnln11ri11,._q t/Jc ml't' af lmt/J. A l't'l'_V .-011111w11 l'X11111pfr is tilt' nd111i11isrn1tio11 "I 111t'dirnti11m Ji1r t/J,· 11111t/Jn-~, m11~fin-t t/J(lr m11 rnus,· Sfdnrio11 mid rnpiratory dtprnsio11 in r/Jf 11t1111ntf. n,is ms,- i11- J'11/p,·ffJi·ll'cr er/Jim/ nmsidrrntio11s thn11 111n11y or/Jen i1I ,,bsrttrfrs. '17,tsf i11d11dc imrnnrn i11 11'/Jic/J p/Jysfrinns do 11ot n-spo11d w/Jm tbr 11111·st.fi·ds t/J,.,-,· is i111111i11,·nt dn11po- n11d r/Jc dmin 1fro111111n11d mmt he uri/i:::.t'd, ,1r wbm nssfrtnua is rcq11irrd Jiw rbr ml't" 1fnl111nio11 p11rio1ts or i11 or/Jt•r sit1111tio11.i rhnt 111ny be ill c1111jlict ll'it/J r/J,- 1111rscs lllm'fll or 1·tl(1Tio11S t",m 1•ictio11s.
A closl' bond 11•ns Ji1r111cd wbil.- I en red jbr .Hrs. S111irb n11d btT /Jnhy . .\'111111 nftcr ndmissi1111, s/Jt' Jl'/1.i /Joldi11,1T my /1n11d d11rill.._1T rn11rrnctio11s n11d /}(Id s/mrrd l't'1'.V i11ti11111tc danils of ha l1F, scpnmtio11, nnd Ji·ars. 77)()11.,fTb s'1c lmd s/Jnr.·d /Jr,- fi11n11cin/ conn-rm n11d lmd 11 /It'll' b11hy to prnPidt Jin; n ,ti·w u•t'fb nfttT /Ja ddil'f1'_1' l 1-i:Cfil'rd 11 brn11t~fi,l .IT~ft lms/,,-, n11d cn1·d. In btT I/Oft .ihc ,/Jnrcd tbar I lurd t1111rbrd bt'l' inn 11•ny sbr blld llt'J't'I' t'.\'/h'Cft'fl n11d she J'rill't'fl 11/'l'fl' to.fo1~qt't 111c; l'l'L' 1111tfU1g()ttOl bcr rirh,·1:
Contributed lw Shelli Cuter, R:--:, ,\IS:\
Learnin Activities
1. Reflect on the previous case study. Think of a situation from personal practice in which multiple ways of knowing were used. Write down the anecdote and shore it with classmates.
2. With classmates, discuss whether nursing is o profession or on occupation. What con current and future nurses do to enhance nursing's standing os o profession?
3. Debate with classmates the dominant philosophical schools of thought in nursing (received view, perceived view, postmodernism). Which worldview best encom- passes the profession of nursing? Why?
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Cull-1\'ilh). II. L. & Pepin. I I l<J87, 'ln"•n1' J '"""'t"""~ o( f'J.r.1..:ltt:tnl' u, mir,111~ kmmk\1~l" ,kh:lnpmc:m. /tmnurl t~/' A.d1•1111mf :-.·urmtll, 12'+>, ~!~-~.!I
ll~hnkc. "1. [) __ & llrchcr. II ,\I ,20l11,. /'l,r/,,sor/,. ufs,·imr,-JiJr 11uni,1_{J prnaut. Crmapls and nppl1<ntum 2nd cJ.1, ~cw \·ork.. ~, ',prinicr ruhli~hing.
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111~ cdUl'.Jtl'1r\ r ... •,'i(i,1tcJ. /1111r11nl ,f Pr"fruim11JI ~·,,r1111.n. /./146~. .t51) JtiO
l}o1ul"bon, S. K .• & ( ·ruwk,·. L'>. ,\( I l97Xi. The J1\4..'.1phnc c1fmir., 101,1 • .\'111·,-m_q CJurJ,,.,k, 2r,. 2 J. I U- I 2ll.
Elli,, I. ll-. & H.mk,. C. I .. '2012 .\'111yiu.11 i11 11Jd~.,, "'u,-lt(· Trr11dr. HJIJ(S, nmf UJ{Jlld.lfl'tllftl/ t l U1h cd ' r1ul.add1,hi.1. P.-\ UpJ,incott l\'illi,m., & \\',lk,n,
l-Jw.:i:tt~ J 120l1 /. ·1111.: 1i1tun.: of nur.,n~; 1--Jm\ m1purt.1nt 1, lli~·ir'inc-~f'C'Cdk km,wkJgc~ .\ "·tlll\l"rJWm \\i,h [.1.l'.quclim: fJ\h.'.Ctl . lnn.:n·tc\\ h, nr. }JJll(, Ulltl"'- .Jllll tlr t-.:..J.1c1> Rid, .\'11nimr Sdoia Qrmrrrr~,. 1.~ 11. I 5J-1 ;lo-i
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r-111k.d01.m, :\. f..:cnncr. <.:. 2016) l~·u_ti·1JWJIII/ JIIO'H11._lf .-mtapr,_ < lm1parnoo .fi,r qua/in J.·11t/fnb,p i .. ~rd nl. 1. l\ur\m~tnn. ,\1.-\: Jone~ & R.1rtktt U~rnin~.
22 Unit I Introduction to Theory
t;iuh.1110, Is:. K., T,·cr I "i.,IJ, I.., & 1..,,pc,, R. I' 121105 1. L'111tv of knj 1\, k1..l~c in till" Jd\·Jni.·1.:rncm: of mus111~ k11owlcd~c:- "/1.'m:rrn.1, ,',r,rnu Q,,n,·urh. J.,, .-:. . 14-J- 2-l-S
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liU!ro[.l!~nn. l\ ! .2002 1. fhl:' phllosoph~ of ~(ICJKC t'rnm .l nun.in~ ~icntifo: pcrsrc(tl\c. -nu11dtt, /111,1·w1/ 11{ Xunin . .tr '111tm:1r·. l 1( 1 ). 3---B.
lli1.k.111,rn. J. S. , 2011 i. :-\11 mrrndu.:ttcm tu 11ur,in~ t.hcon. [11 f. B. licorgc I EU. J, .\'ursi•ttr t/1,-m·ic-s: n,, luut Jin- pr;,ft·n11m;il m,rsiJ!n prnrtirr 16th ed., pp. 1-n, l"pp<r ~.,d.lk R.i\<r, SJ: Parson 1-.du..:Jtil,n.
Holmes~ l1. Ro~. B .. & Pi.·rron •. \ :!OON l"11c ll"'-C o(pustculom.1I ,.,.min the tH1~1ng.th•mJtn. ( ,1ltin1.1I r,un111.1~t.·, ccmn.:n.1, m, and rcr;.J~tJIKC .-\ .\1.\. Atil'tJIICt'S ,n Xnnw,1 .\oo,u. 31' l 1. 42-;\ J.
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H,11xl. L. J. 1201~1. l.rdd1·.::• i'fpp1·r's (,1111·.-r11m/ lnw.,,fpriijimmrnl 11111·sm.1r I Hoth ed.,. PbtlJddph1,1. P:\: l.ipp111c11tt \\'illiam:-. & \\",lkm,.
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Kidd. P., &. ~lun1s1111. ~-· l- I l 98X I Th,: pro~n.:,~1011 of "-nowkd!,!.c m nur!rlm~ n.·~t.·.1rd1 • ..\ -.c.i.rd, t<•r 1111.:.u11n~. fnm..trr-'f1rt fm,nu,I of \'11r,111_!1 .\dui/,1nhip. 2(A ..J. ,. 111 :! :!-4
I i1 .. hth:ld. ~1 ('., &. J11n,d,,n1r. H .2tlOX,. A pr.u:-t1cc di..,c1phm:- th.1t", here .1n,i 110,, ~-l~r.\ .• -ld1•,111,o rn .\'111·s,11p .\c,cnu, 3/i I 1. ,lJ---'11
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~lclCls~ A. 1. i 20 I! L "171corr11a1! ,mni,, __ n: IJ,-,,d11p11unt 11111{ pn~"rrJ5 , 5th «i. 1. l'h1l.1,klphi.1. I'.-\ Li1>pin,on ll'ilh.um & \\'ilkim.
~tomi. E I . & Tin~cn. ~t. S t 1999 1. ~luhtplt.- p,1r.1d1gm" ot' nur, m~ , c1,111.:L" A,\',\ .. -l,f1·1111us 111 Xnnmp '\no1r,-, 2 Ir 4 1, r-,-J, 80.
~h,c,.>d~·- L. l:.. 119901. A_dpar,a,tn tl11ni11J1 fftfllff rb,·1111 .. "J, r,·stnrrh. ~cwhun l'.,rk. c·A: S.igc.
,\h,r\c. J. ~, ( 20171 ~-t,rn~,~in .. " nud t'mu,·111wr/i:,w!r ,1,,. t/J(c1rttu,tJ JiH11uiaum11 ,f,wrsi11._11. ~C\\ York., ~L \pnn~cr l,.ubhc;.hmg:.
1'cwm.J.J1, M. A.,Simc. A. M .. & Curcnr,111 l'ern. S .-\. 1 19911. The tOCus of the "ii!r.,.:iplim.· of nur..mµ .• -1 ,\".\ .~11'1•,wrts 111 Xursm ... " Scim<r. I ./1. I 1, l -<1.
Northrup, I) T .. T,,:lun,. C:. L.. Olymk. \' l;., M.,kJrul{ t,;_ L. S., Szaho. J ., & H1.t1i10. H . .-\. 1 2004 L S:ur1,111~: \\'ho~c: lfo,L:iplinc i~ n anywJy? ,\l11n·J11,!1 •\t101rc <.J..1rnrta(~·. Ji I ,. ~S-6.2
:'\yJtJ.ng_J. 1. (200fq 'Sur ... ing .mJ Lht.· rhil<Nlplw nf,cit:1KC. )991 Xuru Etlurnt11m Ttufd.,,. 25. 670-674.
Oh.inJlt. :\. S. l 1 lJt.J5 1 :\u"111g. J" J!l crtlal,?.ltl~ .1..-.1dcmk discipline. Journal o_fAd1•n11ad .\"111·n11.n. 21. t105-hl2
PJky. ) . , 1005 1. Phcnumcnulog.\ ,\.., rhc.:torii:. S.11rsi" .. " /11q111r_v. 12121. 10<>---IJc, r.,r,.,c, R. R. I ) l)1,l7 I l'hi: l.\ng.11,l~l ot nllf'>lf'll! knowlt:d.~t:'' SJ\'lllg \\ hJt w1,• mcJn. ln l. ,\ \. l(j11\! & J. F.1\\ ,en I l:.d~. 1. "l11t /n11nnn"r (f11un111J1 tbm1·.,· 1111rl mantl;nin l Pl'· 73-77 ,. Indi.,nJpolL,. l~: L1.·ntcr S"ur,in~ Pr,,,
P.1r.!I~. R. R 1.20) ~ , ~ur-.m~: .--\ h,l°'IK nr ,tpphc~i c.t.:1cn..:c . . \ '11rm1..n V1011'1' Q1111rt1·,·~,,_ 2,~ .:i 1. l Xl - 1 M.2 .
P.ir,i:, R.R. l2Ul('>I. \\'here Juve .111 the nu r!rlm~ thco n~, e,0111.·~ X11rm,_lf ~nrnn- Qrm.-r,·rl,·. 21>, 2 J. 111 1-102
i><>lifr<mi. F.. ( 1101~. Philt>"it )ph\ t,f,,;1cn..:..-: ,-\.i1111tn,dth.:ru u,. I11 J. II. llun, & K L. R,d, , hk ,. l'lulw11plu.-, n11d 1/J,·urus.fo>· rrrl· r•n,11cd 11m·s111Jr p1·,ur1c,· 12nd t.·,t .• pp .. ~- ) 81 Hurlmµton. ~l:\. tonc.-. & B.utlt.-tt t c-.uning:
P11\\t.'f', B .-\., & io-:..11.1pr. 'I. R. 201 I 1. l)icri,,,mr_v,f1111r.Hll..'7 tltrnr,· ,111rl r,·..,-,..-d, ~•h n!. 1. :--," York. S'Y: Spnngcr l'uhl"l1111~.
ll.1..:mc, L t :!00(J I \pph·1ng :\ntt,11u, (.~r.tm"-i.:1· -. phil11-.11ph,· U> p1l, t ,.;0l011i.1l tcm1111, t °'oi..::1.11 .rnd polit1..:.1I .t'1i , 1~m in m1r,in~ . .\'Jll'ilH,fl
l'hilowp/<1·. W 3 ,. I SO-] <111. R1.:ni . P. ti. 1 IYY~ 1 . ..\ 1rcJt1~ on m1r,mg l.no \\ lc.·,i~.; dnclopmcnl
in the 21..,t ...-c11tH1T· 1kyond po,tmckil:rm,111 .. 1..\'.\. ~1,frntJft'J ,,, .\'11n11:n .\iu11u. / 7 3 1, 70-.H4.
Recd. P. ti. 120IIX) .-\1..h,.,•ro.,1~ .md .,lh.111'-mµ mir,ing kml\\ k dt,t~. .\'t1t'Jt11J1 \(io1(1 (.J._111u-1rdy. 1/11 1~ 13-~- l ~l-1
Riegel, B. Omen, \., ( .11'1llu, l·., l·l,.wc,I. S. G., I.cc. I' .. ~hulcr. P.~ ct .ti. 1 Jl)92 1 .\t,,\111~ b-.:,·ond. '1. ~t:'IK"J'Jtl\'I.' philo~nplH ot ..,..::icn..::c /mo.1rt-111,. / rwnml of Xro-fWJJ .\r/111/nn lnp. 2-li 2 t, 11;;....120
Rhjc,rd, ~l. \V 1 .. :?0101. ,\'11rs111p l.:1111ll'frt{f1t . \ t 11·1ut . p,·,utur, ,rmf plli/t1soph_t• London, l"mtcd KJ11gdo111. \\'ilcr -Hl.1..:K\\dl
Ri,1ord, M. \\'. DunbJr. S B .. & Molone,, .\I. 1-. 20011 .-\ l1C\\
fr.mnd.1ntin f(lr mcthci...tcll«l~KJI rri.m!!:ul,ltitin. Jour,ur/ 4{ .\"11 ,·.r1t1:r Vlmlttrship. 3-lt -~ ,. 1(,9-17~.
Rc~f"-i.;-r,, B l.. 1.!0};; ~. The c\olu11111t o f ll tlr'-!111.!. -.dc11(1.' In j . B. Bun1o. & K. L. R.h.::h 1 .b.h. ), PJ,ilowplno ruui ;/Jnwrn fin- ,1d · 1•nnn-tf 11111·si,(n prnct1ff ,2nd c.:-d .. pp 19-;0 i .. Burling.t1m, ,\\:\ lone, & R.1.r1k u l.c.1rnin~.
Runy. J. F. ( l Y9X) Thl' tlJtU;C of philo11ioph> ,,r ".:1cni.:i: . thcon amt k,oo\\ lt.·dtt...- rclJllng to nu"ing JnJ prufrs..,mn .. 1.hsm. /mrnm/ <f .id,•a11i'td S11n111 .. n, 2~t 1 1. 243-250.
Schulr1. I'. R .. & ,\kk" .. -\. 1. t ICJ~~ I :--ur,ingcpi,tcm,iln~) T ro- Jirinn~. in~i~ht,, t.JlH,"",rJOll\. hnn.11t-·n,,- Journ{J/ ,!( .'i11nrn .. 11 Sdmim:<lnp. 2tH I. 2 I 7-221.
\ihJ., 1'.l. (.'. t 19771 l'hiln~oph,·~ !tUl.'1hx. thc-oq·: ]nrl.'.rrd,1tion-.hip~ .111d 1mphc.1tl011, l<1r nur,lng l\0 "'4.'.,11\.h, bw1_,1,·-'/1J( ,,,,,,.,,,1/ or ,\·m·~111.n Sdm/11rJhip, (Ji 3 J, ~Q-(1~.
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'ttn.·ub,:rt. H I ... & LJ.rpcntl.'T, n. ll 1.201 .. t 1. (21, rr/,t,1t11'1" roorn·/J rn ,im·.<rnp. Arf1•nurn(n thr hum,111i1111' 1111ptTnti1·.- 15th cit.). l'hilJ,lclphi•. I':\: l.ippincotc 11·,11,.m,.. & ll'r lkrn,.
"'lurpc. r & l-tt.11\, A. j l 98~ I. rhiloo.,oph, of ..._f.'.icll(C ,u,J thl' dc."n:I opmcnt of nuf'inet tl1t'nr~·. In H. H . \\"t.·rlc, & J I flur,urid.:.. 1 Eth. 1. ,-l,011111/ ,·n•ior 11( 1111,...,,1{11 rlJt·,,,-d, ipp 241-267 1 ~ 1.'\\' \'nrk. S\' \prm~a Pllhli,IHnµ
Ti.:id,m.111. J. & l-t.,11,, 5', <..:. I 1,>9'-l. J•J11/1m1pl,:v· .-I b(11iwu1·•~ .. 11u 11fr , .~rd l'd • C.u11hr1d~<, :>I.-\. n, .. ~" ,·II.
Tink.k, ~1 B .. & Be.urn; , J. L. 1 198.~ I ·1,m.u1.! .1 new vie\\ uf,,.:k11t.:c: lmplil'.H111n-. for llUl'lll~ rc~.u d, .• -\ .\ '.\ . .Adi•nuat ,n ,\'11nm .. n S.-frtlf,. _.; 1 ; • .?,.. - A6
\\~.ilk.er. I (). & .-\,.1111. K 20 l I 1. \tr.rum(J fm· r/ww1 t m1ftnurw11 m ,,,,,.,,,y, 1 ;Lh 1.·d I L'ppi.:r !-1.ulllk K1H-'r. ~ I l't.•.J..n,utl Pn.:nriL::1,,• H.1II
\\~nltCr, J. f l 'N.i , . .-hp'-'.'ch o1 .. rl'Jli t\·"' .md \\,\\, of L..1111\\ inµ Ill 1111r, . Jll!,!. . '" ,l.',U1.:h of .m i11tq?.r.u1ng. p.tr.ld1µ111 !m"!r,--17,c" ] 1mr1ml 1{ .\w', 111,!1 \dwl11nlup. 231 .21, 141- 1 +t1
\\'<M"-1. (.; l..~ & ll.1tx·r. I 1101~!.1'.:w·rm11 1·nt·a1·cb: .\JnhdtfJ aud n-it - tml ,1p['rn w,I fm· 1·1•i,fru1"t"-lm.rnl J'rnct,~f ( ')th ed. l. "it. L: 1ul,, ~H )· El......-,11.'r