Comparison of the Received, Perceived, and Postmodern Views of Science
Prediction and control Description and understanding Metanarrative analysis One truth Multiple truths Different views Validation and replication Trends and patterns Uncovering opposing views Reductionism Constructivism/holism Macrorelationship;
microstructures Quantitative research Qualitative research methods Methodologic pluralism methods
Sources: Meleis (2012); Moody (1990).
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing The terms nursing philosophy, nursing science, and philosophy of science in nursing are sometimes used interchangeably. The differences, however, in the general meaning of these concepts are important to
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recognize.
Nursing Philosophy Nursing philosophy has been described as “a statement of foundational and universal assumptions, beliefs and principles about the nature of knowledge and thought (epistemology) and about the nature of the entities represented in the metaparadigm (i.e., nursing practice and human health processes [ontology])” (Reed, 1995, p. 76). Nursing philosophy, then, refers to the belief system or worldview of the profession and provides perspectives for practice, scholarship, and research.
No single dominant philosophy has prevailed in the discipline of nursing. Many nursing scholars and nursing theorists have written extensively in an attempt to identify the overriding belief system, but to date, none has been universally successful. Most would agree then that nursing is increasingly recognized as a “multiparadigm discipline” (Powers & Knapp, 2011, p. 129), in which using multiple perspectives or worldviews in a “unified” way is valuable and even necessary for knowledge development (Giuliano, Tyer- Viola, & Lopez, 2005).
Nursing Science Parse (2016) defined nursing science as “the substantive, discipline-specific knowledge that focuses on the human-universe-health process articulated in the nursing frameworks and theories” (p. 101). To develop and apply the discipline-specific knowledge, nursing science recognizes the relationships of human responses in health and illness and addresses biologic, behavioral, social, and cultural domains. The goal of nursing science is to represent the nature of nursing—to understand it, to explain it, and to use it for the benefit of humankind. It is nursing science that gives direction to the future generation of substantive nursing knowledge, and it is nursing science that provides the knowledge for all aspects of nursing (Holzemer, 2007; Parse, 2016).
Philosophy of Science in Nursing Philosophy of science in nursing helps to establish the meaning of science through an understanding and examination of nursing concepts, theories, laws, and aims as they relate to nursing practice. It seeks to understand truth; to describe nursing; to examine prediction and causality; to critically relate theories, models, and scientific systems; and to explore determinism and free will (Nyatanga, 2005; Polifroni, 2015).
Knowledge Development and Nursing Science Development of nursing knowledge reflects the interface between nursing science and research. The ultimate purpose of knowledge development is to improve nursing practice. Approaches to knowledge development have three facets: ontology, epistemology, and methodology. Ontology refers to the study of being: what is or what exists. Epistemology refers to the study of knowledge or ways of knowing. Methodology is the means of acquiring knowledge (Powers & Knapp, 2011). The following sections discuss nursing epistemology and issues related to methods of acquiring knowledge.
Epistemology Epistemology is the study of the theory of knowledge. Epistemologic questions include: What do we know? What is the extent of our knowledge? How do we decide whether we know? and What are the criteria of knowledge? (Schultz & Meleis, 1988).
According to Streubert and Carpenter (2011), it is important to understand the way in which nursing knowledge develops to provide a context in which to judge the appropriateness of nursing knowledge and methods that nurses use to develop that knowledge. This in turn will refocus methods for gaining knowledge as well as establishing the legitimacy or quality of the knowledge gained.
Ways of Knowing In epistemology, there are several basic types of knowledge. These include the following:
Empirics—the scientific form of knowing. Empirical knowledge comes from observation, testing, and
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replication. Personal knowledge—a priori knowledge. Personal knowledge pertains to knowledge gained from
thought alone. Intuitive knowledge—includes feelings and hunches. Intuitive knowledge is not guessing but relies on
nonconscious pattern recognition and experience. Somatic knowledge—knowledge of the body in relation to physical movement. Somatic knowledge
includes experiential use of muscles and balance to perform a physical task. Metaphysical (spiritual) knowledge—seeking the presence of a higher power. Aspects of spiritual
knowing include magic, miracles, psychokinesis, extrasensory perception, and near-death experiences. Esthetics—knowledge related to beauty, harmony, and expression. Esthetic knowledge incorporates art,
creativity, and values. Moral or ethical knowledge—knowledge of what is right and wrong. Values and social and cultural
norms of behavior are components of ethical knowledge.
Nursing Epistemology Nursing epistemology has been defined as “the study of the origins of nursing knowledge, its structure and methods, the patterns of knowing of its members, and the criteria for validating its knowledge claims” (Schultz & Meleis, 1988, p. 217). Like most disciplines, nursing has both scientific knowledge and knowledge that can be termed conventional wisdom (knowledge that has not been empirically tested).
Traditionally, only what stands the test of repeated measures constitutes truth or knowledge. Classical scientific processes (i.e., experimentation), however, are not suitable for creating and describing all types of knowledge. Social sciences, behavioral sciences, and the arts rely on other methods to establish knowledge. Because it has characteristics of social and behavioral sciences, as well as biologic sciences, nursing must rely on multiple ways of knowing.
In a classic work, Carper (1978) identified four fundamental patterns for nursing knowledge: (1) empirics —the science of nursing, (2) esthetics—the art of nursing, (3) personal knowledge in nursing, and (4) ethics— moral knowledge in nursing.
Empirical knowledge is objective, abstract, generally quantifiable, exemplary, discursively formulated, and verifiable. When verified through repeated testing over time, it is formulated into scientific generalizations, laws, theories, and principles that explain and predict (Carper, 1978, 1992). It draws on traditional ideas that can be verified through observation and proved by hypothesis testing.
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Empirical knowledge tends to be the most emphasized way of knowing in nursing because there is a need to know how knowledge can be organized into laws and theories for the purpose of describing, explaining, and predicting phenomena of concern to nurses. Most theory development and research efforts are engaged in seeking and generating explanations that are systematic and controllable by factual evidence (Carper, 1978, 1992).
Esthetic knowledge is expressive, subjective, unique, and experiential rather than formal or descriptive. Esthetics includes sensing the meaning of a moment. It is evident through actions, conduct, attitudes, and interactions of the nurse in response to another. It is not expressed in language (Carper, 1978).
Esthetic knowledge relies on perception. It is creative and incorporates empathy and understanding. It is interpretive, contextual, intuitive, and subjective and requires synthesis rather than analysis. Furthermore, esthetics goes beyond what is explained by principles and creates values and meaning to account for variables that cannot be quantitatively formulated (Carper, 1978, 1992).
Personal knowledge refers to the way in which nurses view themselves and the client. Personal knowledge is subjective and promotes wholeness and integrity in personal encounters. Engagement, rather than detachment, is a component of personal knowledge.
Personal knowledge incorporates experience, knowing, encountering, and actualizing the self within the practice. Personal maturity and freedom are components of personal knowledge, which may include spiritual and metaphysical forms of knowing. Because personal knowledge is difficult to express linguistically, it is largely expressed in personality (Carper, 1978, 1992).
Ethics refers to the moral code for nursing and is based on obligation to service and respect for human life. Ethical knowledge occurs as moral dilemmas arise in situations of ambiguity and uncertainty and when
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consequences are difficult to predict. Ethical knowledge requires rational and deliberate examination and evaluation of what is good, valuable, and desirable as goals, motives, or characteristics (Carper, 1978, 1992). Ethics must address conflicting norms, interests, and principles and provide insight into areas that cannot be tested.
Fawcett, Watson, Neuman, Walkers, and Fitzpatrick (2001) stress that integration of all patterns of knowing is essential for professional nursing practice and that no one pattern should be used in isolation from others. Indeed, they are interrelated and interdependent because there are multiple points of contact between and among them (Carper, 1992). Thus, nurses should view nursing practice from a broadened perspective that places value on ways of knowing beyond the empirical (Silva, Sorrell, & Sorrell, 1995). Table 1-4 summarizes selected characteristics of Carper’s patterns of knowing in nursing.