In Search of Nursing Science

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Edited by: Anna Omery, Christine E. Kasper & Gayle G. Page

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    Preface

    This book began as a quest of its own. It grew out of our personal struggles to identify a specific philosophy of science that was consistent with the discipline of nursing. It quickly became apparent to us, however, that no one specific philosophy seemed adequate. There was no one school of thought that seemed to definitively indicate to us that our journey had been completed, that here in this place, in these ideas, nursing could safely harbor its future knowledge development.

    In studying the traditional schools of thought on science, we found insufficiencies. Although there were schools of thought that appealed to each of us as individuals, there was no single school of thought that we could agree on as reflecting nursing. No one belief system seemed to reflect our small group, a group that might be seen as representative of nursing in all of its diversity, for in our group is a phenomenologist, a feminist, and an empiricist—and this is a single individual!

    In our journey, we made another discovery that seemed very important to us. We could identify no centralized forum that had as its purpose the comparison of various philosophies of science and how a particular philosophy guides knowledge development; therefore, on our journey we had to embark on as many trails as there were philosophies. Although there was much to wonder at and appreciate in having to take such an extensive journey, it was also frustrating. We longed for a more comprehensive roadway for our exploration. This book is the culmination of our effort to try to build such a roadway for those who are attempting a similar journey.

    This does not mean that we wish to keep others from exploring the trails we have explored; rather, the effort here is to assist those embarking on their journey. We desire in this volume to give our novice fellow explorers an easier beginning for their quest, recognizing that the ways to knowledge development will always require sustained effort. For those who are more expert explorers, we hope this volume will provide a vista for their journey, a lookout as it were from which they might review the territory that they have traveled previously and gain some perspective for those regions they have yet to chart.

    Before embarking on this trail, we wish to share with our fellow explorers the compass that guided our direction, our aim. What we are attempting to accomplish with In Search of Nursing Science is to promote our belief that a plurality of philosophies may be necessary to reflect the many facets of nursing science; that is, no one view may be sufficient to embrace or drive nursing knowledge in its totality. Herein, we provide an anthology of conceptions of Western science in all their diversity. We leave it to our fellow travelers (readers) to ponder which of these competing and often, at least at first glance, incompatible philosophies can or should reflect nursing knowledge. We hope that you, the reader, will be encouraged to think openly and consider each view, including empiricism, pragmatism, paradigmatic, problem solving, feminism, phenomenology, hermeneutics, critical theory, and poststructuralism, for its relevance to the science of nursing.

    The book is organized into four sections. The first three explore the different schools of philosophical thought of science currently being debated as the basis in and for nursing knowledge development. The final section concentrates on the possible relationships between science and practice. Our organization is designed so that selected chapters describing a particular view of science are usually followed by companion chapters that are intended to provide the reader with an explication of how that particular view guided nurse scholars in the development of their idea.

    In Section I, the Introduction is accompanied by two chapters that explore schools of thought regarding a science that is based in the more traditional empiricist views of science: empiricism and pragmatism. These traditional schools of thought emphasize the view of science as an observable process that results in knowledge that is objective and empirical.

    It may be perplexing to some to find no chapter on logical positivism. Our decision to omit such a chapter was deliberate. The limits of this philosophy of science has been well established since the 1960s. Ridiculed as “the Received View,” logical positivism has moved beyond its initial tenets and been reformulated within the empiricist tradition. We believe that to present logical positivism as an option, as a possible trail, would lead the traveler to a dead end. For this reason, we have chosen to focus on empiricism and pragmatism, two schools of thought with an origin in positivism. Many of the tenets of empiricism and pragmatism are traditional and bear more than a passing resemblance to positivism. Yet each of these schools has moved beyond the antiquated notions that have limited positivism, and as such, they provide more viable alternates on which to base a belief system for nursing science.

    Section I is also the only section in which each chapter does not have a companion chapter providing an example of how the philosophy has been operationalized. The empiricist tradition has been so prevalent in the history of nursing's knowledge development that any work chosen as an example would not necessarily be reflective of the diversity of these traditional philosophical schools of thought in and for nursing and therefore might reflect a more arbitrary decision than we felt comfortable with. As a result, the operationalization of these traditions has been integrated into the chapters describing these philosophies.

    Section II focuses on the schools of thought that were the first to challenge the traditional views of science. These schools of thought are classified in this text as revolutionary/evolutionary. Thomas Kuhn's scientific revolution and Larry Laudan's science as problem solving are highlighted in this section.

    Section III introduces those schools of thought that are sometimes classified as postmodern. Postmodern thought most directly challenges the objectification of science. The schools presented in this text are feminism, phenomenology, critical theory, and poststructuralism.

    The tension that exists in the relationship between science and practice is unique, yet fundamentally critical to professional disciplines such as nursing. Any book exploring the development of knowledge in a professional discipline would be incomplete if these tensions were not addressed. Such is the intent of Section IV. The chapters in this final section explore some of the possible relationships between science and nursing practice.

    We wish to acknowledge that this book is not an isolated effort; many other fellow travelers have assisted us. As suggested by Sage, each chapter was internally reviewed by other contributors with expertise in the topic. We also wish to thank Christine Smedley, our editor at Sage, whose patience with us was beyond notable, bordering on the heroic.

    We also wish to conclude the beginning with this thought. Knowledge development is always an adventure. For nursing, that adventure has only just begun.

    AnnaOmery, Christine E.Kasper, GayleGiboney Page
  • Epilogue: The Journey Continues

    At this point, it is important to reassess where the ideas presented in this book have led us. In the Preface, we identified our belief that a plurality of philosophies may be necessary to reflect the many facets of nursing science, that no one view may be sufficient to embrace or drive nursing knowledge in all of its diversity. It is time to question whether this belief can still be supported. Further, if such a belief can be supported, can there be any unity in nursing science?

    More than any other content presented, the application chapters support the ongoing need for diversity in belief systems, for it is only through that diversity that the discipline of nursing will be able to support knowledge development, scientific knowledge development in particular. The application content ranged from the further development of a philosophy of science for the discipline of nursing (Chapter 5) to the presentation of a clinical research study that had its method of inquiry firmly founded in a particular view of scientific method and knowledge (Chapter 12). Each of these contributions adds its own unique perspective to the totality that is this discipline nursing. Each of these contributions is founded within a unique school of thought. To deny one of these belief systems at the expense of another is to deny a specific and unique contribution to our discipline.

    We believe that such a denial would have a catastrophic effect on the continuing development of nursing knowledge. It would be as if on our journey through the terrain that is nursing we tried to climb a mountain with only one rope. Despite such a limitation, we might be able to scale a significant portion of the peak. Certainly, the empiricist and pragmatic terrains have contributed greatly to the development of nursing science; yet, as those proponents of alternative belief systems have identified, there are significant parts of the mountain that cannot be traversed if we are limited to a single rope. Thus many significant ideas would be rejected as directions in knowledge development for the discipline if empiricism were the only legitimate school of thought driving knowledge development.

    Rather, it seems that we need to be open to diverse schools of thought. We must acknowledge the contributions that the empiricist belief system make possible. But as Gayle Page indicated, we may never scale the pain peak; we may never resolve the pain questions in science until we recognize the biases and potential for oppression that can present themselves within the context of the traditional belief systems of science and scientific knowledge.

    If such diversity of belief is tolerated in our discipline, will the inevitable outcome be a lack of unity in nursing? Can there be any unity if such diversity is accepted as the norm? Will members of the discipline be forced to travel forever on discrete trails on our discipline's journey, never to merge, never to converge? Sue Donaldson's and Hannah Dean's contributions lead us to the premise that such a conclusion, while possible, does not have to become a reality. Both of these authors noted that the discipline of nursing, as a practice discipline, is linked completely and absolutely to the recipients of our knowledge, that these recipients, through their societal mandate, justify the ongoing existence of any discipline. When and if a discipline fails that mandate, its own existence will be called into question.

    Unity in and for nursing science then comes from society's mandate. This social mandate not only directs our discipline but also charges our diversity in that same direction. If nursing science is to meet its challenge, it will need many tools, tools that are best founded in our diversity. There may be schools of thought that do not serve in meeting our mandate or some aspect thereof, but we should not rush to abandon any school of thought until it can be clearly established that such a belief system makes no contribution to nursing's effort to meet its societal mandate.

    Increasingly, the discipline has come to understand that the public mandate to nurses is the diagnosis and treatment of human responses to health (American Nurses' Association, 1980, 1994). This mandate can be met only through gaining the scientific knowledge that directs the nurse in caring for and treating human responses to health. Some of the knowledge required to treat these responses, especially those that are physiological, is best developed using empirical methods founded in the school of empiricist thought, whereas knowledge required for the care and treatment of psychological or social responses may best be developed within a postmodern belief system.

    However, the development of our social mandate, the scientific and practice knowledge regarding the diagnosis and treatment of human responses, is a different journey. If we are to embark upon this journey, we must first understand the many pathways we will need to explore. We must come to understand the strengths and limitations of each belief system and where each school of thought will lead us in our science and our practice within society's mandate for the care and treatment of human responses to health.

    References
    American Nurses' Association. (1980). Nursing: A social policy statement. Kansas City, MO: Author.
    American Nurses' Association. (1994). Nursing: A nursing policy statement (Revision/draft). Washington, DC: Author.

    About the Contributors

    Anne H. Bishop, Ed.D, M.N., R.N., is Professor of Nursing at Lynchburg College, where she teaches psychiatric-mental health nursing and a senior seminar that deals with philosophy, ethics, legalities of nursing, and trends and issues. She is currently Project Director of the Nursing Center for Health Promotion, which is supported by a grant from the Division of Nursing. Through the Center, faculty in the Department of Nursing at Lynchburg College are developing health education/health promotion teaching materials at a fourth-grade level to be used in conjunction with the programs for clients at the Free Clinic of Central Virginia. She has been recognized by her colleagues with the Outstanding Member Award of the Virginia Nurses' Association (1976) and the Nancy Vance Award (1990). She was selected as Outstanding Faculty Scholar at Lynchburg College in 1992. For 15 years, she and John R. Scudder, Jr. have been engaged in developing a philosophy of nursing that to date has produced four books: Caring, Curing, Coping: Nurse, Physician, Patient Relationships (Alabama, 1985), Nursing: The Practical, Moral and Personal Sense Nursing (SUNY, 1990), Nursing: The Practice of Caring (NLN, 1991), and a recently completed book on nursing ethics.

    Evelyn Calvillo, D.N.Sc., R.N., was an Associate Professor in the School of Nursing at California State University, Los Angeles, at the time of her collaboration with Barbara Riegel and others on the chapter focusing on a generative philosophy of science.

    Luther Christman, Ph.D., R.N., F.A.A.N., is Dean Emeritus of Rush University, President of Christman, Cornesky, and Associates, and an Adjunct Professor at Vanderbilt University.

    Marlene Zichi Cohen, Ph.D., R.N., is Associate Professor and Director, Office of Nursing Research, University of Southern California, Department of Nursing, and USC/Norris Comprehensive Cancer Center, Los Angeles, California.

    Hannah Dean, Ph.D., R.N., is Associate Chief of Nursing Service/Research at the Veterans Administration Medical Center in Sepulveda, California. She has held faculty positions at California State University at Dominguez Hills, the University of North Dakota, Sonoma State University, and St. Xavier University. She was Director of the School of Nursing at Southern Oregon University in Ashland, Oregon, from 1985 to 1987.

    Sue Karen Donaldson, Ph.D, R.N., F.A.A.N., is Dean of and Professor in the School of Nursing and Professor of Physiology in the School of Medicine at The Johns Hopkins University in Baltimore. She has held faculty positions in nursing and physiology at the University of Washington, Rush University in Chicago, and the University of Minnesota at Minneapolis. She occupied the first endowed chair for nursing research in the nation, the Cora Meidl Siehl Chair at the University of Minnesota. Her basic research is in the area of striated muscle physiology, and she established the multidisciplinary Research Center for Long Term Care of the Elderly in the School of Nursing at the University of Minnesota. She is an elected member of the American Academy of Nursing and the Institute of Medicine, National Academy of Science.

    Laura Cox Dzurec, Ph.D., R.N., is an Associate Professor at the University of Maine in Orono and Clinical Specialist in Psychopharmacology Service at Acadia Hospital in Bangor, Maine.

    Naiema Gaber Elsayed, Ph.D., R.N., is a faculty member of the School of Nursing at the University of Alexandria in Egypt.

    Sara T. Fry, Ph.D., R.N., is Henry R. Luce Professor of Nursing Ethics at Boston College School of Nursing, where she teaches the philosophy of nursing, nursing ethics, and conducts clinical nursing research.

    Ruth Ginzberg, Ph.D., is Assistant Professor in the Philosophy Department at Weslyan University in Middletown, Connecticut.

    Sandra Harding, Ph.D., is Professor of Philosophy and Women's Studies at UCLA and the University of Delaware. She is author and editor of many books on science, epistemology, feminism, and postcolonialism, including Whose Science? Whose Knowledge? Thinking From Women's Lives, The Science Question in Feminism, Feminism and Methodology, Sex and Scientific Inquiry, and The “Racial” Economy of Science: Towards a Democratic Future.

    Inger Margrethe Holter, Ph.D., R.N., is an Associate Professor at the University of Oslo, Institute for Nursing Science in Norway. She received the basic nursing education for diploma from Deaconess Hospital School of Nursing in Oslo and her M.S. and Ph.D. in nursing from the University of Rhode Island. She is author of several articles in English and Norwegian on critical philosophy and action research.

    David L. Kahn, Ph.D., R.N., is an Assistant Professor and Luci Baines Johnson Fellow at the University of Texas at Austin School of Nursing.

    Christine E. Kasper, Ph.D., R.N., F.A.A.N., is an Assistant Professor in the School of Nursing at the University of California at Los Angeles. Her research focuses on the effects of atrophy on skeletal muscle function and on the adaptation of skeletal muscle to microgravity environments, which has been studied during NASA shuttle missions. She has authored over 40 research publications in this area. The recipient of multiple grants from the National Institutes of Health, NASA, and the American Nurses' Foundation for studies in skeletal muscle physiology, she has been nationally honored for her research and work with students and has been elected a Fellow in the American Academy of Nursing.

    Jacquelyn Ann K. Kegley, Ph.D., is CSU Outstanding Professor of Philosophy at California State University at Bakersfield.

    Hesook Suzie Kim, Ph.D., R.N., is a Professor at the University of Rhode Island College of Nursing. She is author of a theoretical treatise, The Nature of Theoretical Thinking in Nursing, and has published several articles and book chapters on the nature of nursing knowledge development.

    Patricia Lee, M.N., R.N., is a Family Nurse Practitioner at the Veterans Administration Medical Center in West Los Angeles and a doctoral student in the UCLA School of Nursing.

    Carol Mack, M.N., R.N., is a doctoral student at UCLA School of Nursing.

    Anna Omery, D.N.Sc., R.N., is Assistant Director of the Dumont-UCLA Transplant Center and Director, for Nursing and Clinical Research. She is an Assistant Clinical Professor at the UCLA School of Nursing. Her research focus is on bioethics and qualitative research, especially phenomenology. She continues to be an active participant in the debates regarding the philosophical foundations of and for the discipline of nursing.

    Gayle Giboney Page, D.N.Sc., R.N., is an Assistant Professor of Nursing at Ohio State University. The focus of her program of research is the immune and metastatic consequences of postoperative pain. Throughout her clinical practice of caring for critically ill infants recovering from surgery, she has sought to deal with the many issues associated with attaining adequate pain control for these patients and to demonstrate that there is a biological consequence for experiencing unrelieved postoperative pain.

    Francelyn Reeder, Ph.D., R.N., is an Associate Professor at the Center for Human Caring in the School of Nursing at the University of Colorado. She is author of several articles and book chapters on nursing science development.

    Barbara Riegel, D.N.Sc., R.N., F.A.A.N., is Clinical Researcher and Coordinator in the Clinical Research Program at Sharp Memorial Hospital in San Diego.

    John R. Scudder, Jr., Ph.D., is Professor of Philosophy at Lynchburg College in Lynchburg, Virginia. He began bringing his understanding of phenomenology and the human sciences, focused on history and education, to bear on nursing in the early 1980s when he and Anne Bishop began developing a philosophy of nursing. Their research to date has produced four books: Caring, Curing, Coping: Nurse, Physician, Patient Relationships, The Practical, Moral, and Personal Sense of Nursing: A Phenomenological Philosophy of Practice, and Nursing: The Practice of Caring. In 1986, he received both the T. A. Abbott Award for Faculty Excellence, given annually to one faculty member of the 17 colleges and universities related to the Disciples of Christ, and the Outstanding Faculty Scholar Award from Lynchburg College.

    Pamela Shuler, D.N.Sc., R.N., is an Assistant Professor in the School of Nursing at the University of Kentucky in Hazard.

    Bonnie Ellen Siegel, D.N.Sc., R.N., is a private consultant in nursing administration in Los Angeles.

    Richard H. Steeves, Ph.D., R.N., is an Associate Professor in the School of Nursing at the University of Virginia.

    Cathy Rodgers Ward, D.N.Sc.(C.), R.N., C.N. A. A., is Assistant Director of Nursing at the UCLA Medical Center and Assistant Clinical Professor in the UCLA School of Nursing.

    Sandra J. Weiss, Ph.D., D.N.Sc., F.A.A.N., is a Professor in the School of Nursing at the University of California at San Francisco. She is currently Director of the Center for Family Health Studies and Chair of the Academic Senate for all sciences faculty at UCSF. She has received the UCSF Distinction in Teaching Award twice as well as the Helen Nahn Research Lecture Award. She has been actively involved with professional organizations, including the Governing Board of the American Academy of Nursing and the American Heart Association in San Francisco as both its Vice President for Research and Chair of the Board. Prior to coming to UCSF, she was Executive Director of the Health Care Consortium, a nonprofit research and educational institute.

    Her scientific preparation is in two fields: child and family mental health nursing and biological and developmental psychology. Her program of research focuses on sensory vulnerability due to genetic predisposition or disease and the ways in which caregiving can influence health, development and recovery form illness through modulation of sensory stimulation. She has published extensively in this area, especially regarding measurement of interpersonal touch, vulnerability to touch, and the effects of touch on neurobehavioral response.


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