Nursing and the philosophy

of science

Lovemore Nyatanga

Throughout its history, nursing has struggled with definitional issues. Embedded firmly in tradition mothering roles according to McCloskey and Grace (1985), nursing has found it difficult to make transitions into the professional and scientific realms. The professional and scientific status of nursing may not be as gloomy as McCloskey and Grace put it. Leddy and Pepper (1989) for instance claim that nursing has, since the 1960s. dramatically evolved into a scientific discipline. The purpose of this paper is to: 1. redefine

science in order to establish the basis of the debate on nursing as a science; position in science and examine how nursing 2. outline at least one philosophical might benefit from it; 3. assess or evaluate, in the light of the above points the possible usefulness of nursing science especially the use of paradigm concepts in nursing; 4. finally question whether nursing wants to work towards paradigm status. to the debate on the nuture of science as In a small way this paper contributes applied to nursing. It reflects on the progress being made through nursing models paradigm concepts. The conclusion suggests that the concept of paradigm as used in nursing is in keeping with Kuhn’s and therefore can be adopted as a potentially useful framework.

‘Sincr

the

evolved accepted

1960’s

nursing

as a scientific that

nursing

science

and

the

findings

to practice’

has

discipline. has

science

itself

which

assume

1989 p

The

critical

evolving

as this invite

critical

issue is not so much into

a

scientific

that

discipline

appraisal. nursing but

as

is the

on. Each

rational of these

MEANING Science

knowledge

for instance.

positions

But first, what

while

and individusub-divisions

falsificationism, (logical)

relative

positivism, would

debate but because of scope relativism (in particular Kuhn’s be pursued.

Lovemore Nyatanga MSc PGD(Psychology) Dip/N (London) Cert Ed RGN RMN Senior Lecturer, Derbyshire Institute of Health and Community Studies, Derbyshire College of Higher Education, Kedleston Road, Derby DE3 1 GB (Requests for offprints to LN) Manuscript accepted 4 July 1990

Positivism

inductivism,

positivism,

positions

their

building

& Pepper

strategies.

in

quite different from naturalism alism, has within it philosophical

scientific

such such

philosophical

variations

dimensions:

11.5). Assertions

has many

of

two

applications (Leddy

dramatically It is generally

and

require

so

some

and space historicism)

only will

is sciencr?

OF SCIENCE

is a disciplined

and systematic

attempt

of

I3

14

NURSE EDUCATION

TODAY

the human mind that aims at genuine (Mohr,

1977).

expressed

Genuine

scientific

as true propositions:

knowledge

knowledge

singular

meaning. is

propo-

sitions, data or facts in keeping with general laws.

science,

It can therefore

trative

be argued

that science

royal road to true knowledge enon.

The

theories

tools

is the

of real phenom-

of science

are concepts

and

logically constructed

for scientific

pur-

For instance

would all the follow-

ing labels carry the same scientific essence: forest science, Christian speech science, meat and animal science, adminisdiary science, science, library

science, mortuary

science (Chalmers,

medical

science,

nursing

science,

social science,

1982),

science,

physical

behavioural

science,

poses. In the scientific tradition

a theory (Greek;

and domestic

theo ria = vision) is a scientific

conjecture

ably not. As can be seen almost anything

ogous

to a searchlight

specific empirical

in the beam

observations

and propositions

of which

definitions,

that present

a systematic

by specifying

relation-

key variables for the purpose

of explaining

and predicting

world (Wilson

a part of the

1985);

b) nets cast to catch what we call the world, to rationalise

it, understand

it, and master

it,

we endeavour

to make the mesh finer and

finer (Popper

1968).

tive

Science

(operationally

discover ledge.

uses constitu-

defined)

theories

the truth or obtain genuine So far

outlined

the

meaning

here has portrayed

that science is infallible knowledge. because humans

are

principles

to

know-

of science

as

the impression

if not the goddess of

This of course is strictly not true

science is a human fallible.

endeavour

Despite

and conventions

and

all scientific

this human falli-

bility is always in the background,

and with

The

positivistic

example

argue

objective

and

Knowledge Popper

body’s claim

and

validity

of observations

restill

depend to a large extent on the expertise and theoretical orientations of the scientist (Davies, 1965). Perhaps the truth about science

is that it minimises

maximises

objectivity.

subjectivity

Maximum

and

objectivity

justifies the claim that science is about true or .genuine knowledge. This then helps separate genuine science from pseudoscience or no science at all. Science has become such an appealling label that its use has from time to time carried no specific

Objective

The obvious problem

harnessed

In

is

words,

without

a

a knowing

with positivism is knowledge

can be

on a ‘tabula rasa’ (blank state). Else-

where Popper

has referred

to this ‘tabula rasa’

ideal as the ‘bucket theory of knowledge’ 1965). The bucket

analogy

assumes

ledge streams into us through

completely

to

or belief to

other

without

scientific

is

of any-

knowledge

is knowledge

subject).

strictly

to, the

sense according

(it is knowledge

that it presupposes

will for

accordingly.

independent

knower

methods

adhered

be verified

or to act.

knowledge

introducing

scientific

some

knowledge

of anybody’s disposition

to assert,

objective

of science

scientific

is totally to know.

independent assent,

that

in this objective

(1972)

1969).

liability

positions in science will

philosophy should

(Hampshire,

where

can

a few

The philosophy of positivism

avoid distorting

are

describing

of these labels.

some of us, on some topics, it has to be in the when we claim to know foreground Even

prob-

give a yardstick with which to measure

ships amongst empirical

(housewifery);

Perhaps

of the philosophical

as:

constructs,

view of phenomena

be called science.

can take place.

A theory may also be defined a) a set of interrelated

anal-

science

our senses, and to

such knowledge,

error,

(Davies

that know-

the scientist

passive but receptive.

and thereby should

remain

It also assumes

that knowledge and meaning are enshrined in the observed phenomenon. But how do the observers choose what to observe if they have not established a tentative theory (vision) or parameters for the observation? Establishing or building a body of scientific knowledge it would seem can not be left to subjective perceptions and interpretations. Unless there are clear rules for self verification this aspect of positivism can lead to confusion and chaos as it would have to rely heavily on the individual’s account of what has been observed. It has been established

(Chalmers,

1982) that individualistic

knowledge

are most problematic

lead to the ‘infinite everyjustificatory fication.

regress

as pure

the other claims

of reasons’

account requires

Individualism

problems

accounts

hand

about

some

the

or serendipity.

positivists

context

to

readers

darkened

will

room

pictures

for purposes

knowledge, be

initial

lung

intestinal

organs, information

probably

still took a few attempts

of

seemed

Therefore

and

so obvious

context

are

learned

concept

scientists judgements

all the

enced

experts.

‘I‘he main protagonist

of historicism

trained as a physicist but later became interested in the history of science. lind that traditional of science evidence.

bore

or threats.

to

of the philosophy

no comparison

with historical

The

The

of science

evidence

historicism).

of

be competent

these worthwhile

scientific

from

challenges

paradigm

seemingly

questioning seemingly

has outlined can

It

workers in the scientific things

let alone

radical and progressive

to this

and

the para-

of dogma and rigidity.

almost seems to prohibit

paradigms

community

as well as internal

rigid

changes. impression

the process

change.

He

by which

presents

the

as follows: ccience-+crisis-+revol-

-pre-science--+normal ution+new

normal

science4

to Kuhn

(1970)

science

progresses

along the above continuum.

Before

a scientific

in keeping

with his-

Pre-science:

as he saw it (hence

the term

According

Like

Kuhn although

many

himself

critics

of

a relative

positivism,

positivist

was

community

can evolve it is presumably

unhappy with the idea of objective knowledge whether arrived at by inductivism (from obser-

by a pre-science

vation to theory) or by deductivism

(from theory

over fundamentals.

to observation), or by retroductivism (a combination of+inductivism and deductivism). Accord-

as many competing

ing

within the pre-science

to

should

recepted

an impression

sequence

and uni-

He then set out to establish a theory of

the philosophy torical

Kuhn was dismayed

accounts

knowledge

rules help to protect

digm from external

Kuhn (1970)

is Kuhn. He

pro-

but also for guiding the less experi-

contemplating

Historicism as a sound alternative

agreed

implies that some members

members.

Contrary

This

knowledge

of real life situations.

community

community

parameters.

universally

of public

the operational

creates

of the paradigm.

not only for making

gastro-

in specific

and theoretical

The

is

and perpetu-

is in fact scientific

or explanations

the scientific

to make sense

to the

positions

your

to some positivistic accounts

observations

professional

While

build-

activities’ of

Thus science becomes

correction,

which aims to establish

versal agreement

was there in front of you it

contrary

scientific

so on.

to scrutiny,

fam-

of X-ray

disorders,

objective what

Recall

observations

of fractures,

of har-

an example used.

subjected

public knowledge

To

knowledge

a social activity where all the public knowledge ation under the traditions

context

which con-

for the ‘puzzle-solving

grand

can be gained.

parameters

ing methods,

theory

way knowledge

iliar

On

matrix

tains values, rules, regulations,

and

the need for observational

scientific

is a disciplinary

make

free

independent

nessing

A paradigm

that scientific community.

has the same

demonstrate and theoretical

where

furtherjusti-

therefore

intuition

of

as they tend to

Mohr

(1977)

Kuhn’s

account

of

the

stage. This

isied by total disagreement There

rules, puzzle-solving

preceded

stage is characterand constant

debate

are no agreed values,

strategies

and there may be

ideas as there are individuals community.

philosophy of science can be understood through his popular concept of paradigm and scientific community. For instance by having a

Normal science (paradigm): Unlike the individualistic nature

scientific nursing

normal science (paradigm) has shared values, assumptions, knowledge building strategies, and

hecomes

community

(which

could

well be a

community) scientific knowledge public knowledge to members of that

community. Each scientific community according to Kuhn (1970) will adopt a single paradigm.

of’ pre-science.

agreed laws. A paradigm therefore depicts a functional stage of mature science where there is general accord on fundamentals. Paradigm

16

NURSE EDUCATION

workers

tend

TODAY

to support

their own paradigm. normal

rather

than

In other words workers

science do not advertently

their own theories,

propositions,

anomalies

principles,

inconsistencies)

(theoretical

then any such inconsistencies be defended

are to has to

and used by all workers

what separates non-science

Kuhn,

this collective

normal

science

from

in that effort

is

pseudo

or

disciplines.

each

model

-

congruence

be explained principles

away-when

can no longer

the guiding rules and

are no longer

useful

for the puzzle-

to argue

normal

science).

community theories

can

Here members advance

to be scrutinised

lishing a new paradigm

revolution

a new paradigm

(new

of the scientific

new and

science).

New normal science: Revolution

ends with the acceptance

of a single

predominant new paradigm. This like the old paradigm will be defended and utilised by all members

until it too runs into a new crisis.

science: osophy

of

science

identify (Leddy

with Kuhn’s phil& Pepper,

1989;

McCloskey & Grace, 1985). The essence of current nursing theories and models seem to imply the acceptance at least by the authors, of Kuhn’s outline of a disciplinary matrix. Most authors of current conceptual models of nursing appear to accept the convention that:

- each model of nursing

should address the four central concepts (paradigm concepts) namely, person, environment, health/illness, and nursing

paradigm

views, individualistic

ings

as a science,

Dunlop

that nursing Of

stage.

course

so on.

and

Nyatanga

accounts

and

as argued

Cull-Wilby

(1986),

suggest

art,

and divergences

(1987),

(1987),

would seem to

is not

to suggest

is taking the wrong course to

pursue

at

pre-science

It merely

by Jenn-

Pepin

(1990)

of

These

is still at the pre-science

this

that

of action by

paradigm

identifies

Kuhn’s paradigm

status.

seems to be characterised

status

but

(preparadigmatic) where

nursing

is on

continuum.

Implication for the science of nursing: Among the many relevant

themes

that could be

debated

from the above outline only two will be

pursued

in the space provided.

with the equation activity (Mohr,

between

The first is to do

science

as a social

1977) and nursing as essentially

social activity (Chapman,

1976).

This

a

equation

implies that the science of caring is possible and

Current status of the philosophy of nursing Some nurse scientists

has reached

competing

in the hope of estab(new normal

position was shared by

by opposing

nursing

by a scientific for

its

should have logical

position

appearing remaining

is followed

state

and social utility, and so on.

nursing

Revolution: is a search

should

The current

solving activity of the paradigm.

which

nursing

If the above philosophical

stage.

A crisis

three

and sys-

all or most nurses, then it might have been easier

differences

A crisis occurs when the anomalies

of

each model of nursing

nursing

Crisis:

interactional

values and assumptions

Until

(anomalies)

have a pri-

the present

tems theories

practical

defensible.

should

focus,

being developmental, -

away; that is, the paradigm For

mary (theoretical)

and

is defended

and

are no longer

be explained paradigm.

in

until its values and puzzle-sol-

ving strategies

- each model of nursing

seek to falsify

so on. As far as possible a paradigm against

criticise

that the distinction

between

be ourelv academic

after all. The science and art

view implied Pepper ceptual

in this paper

science and art may and by Leddy

and

(1989) is that science refers to the conbase of nursing and art refers to the

applications of the conceptual base. The second and more obvious theme is nursing’s involvement addition

with paradigm

to abundant

literature

concepts.

on nursing

In as a

science there is sufficient emphasis on nursing having paradigm concepts (Fawcett, 1989; Meleis, 1985; McCloskey &-Grace, 1985). The four paradigm concepts of nursing seem sufficiently agreed in relation to current nursing models. They (the paradigm concepts) can easily form

the disciplinary matrix and provide for the nursing community the relevant puzzle-solving conventions as other paradigms do. The strength of the paradigm approach is its ability to define disciplinary parameters, identify valued knowledge, provide common strategies for further research and best ways of teaching new members of the nursing community. The paradigm approach ensures professional unity through the understanding and sharing of the unique but public knowledge of the discipline. Within the sharing and scrutinising of knowledge, minor differences (anomalies) can be addressed and the core of nursing can be preserved. So far it can be argued the advent of nursing models despite some problems has improved our understanding of what nursing really is about. Practising nurses (as members of the nursing community) therefore, must actively evaluate the utility of nursing models in patient c-are. They must examine the authenticity of theories and research conventions behind the models. They must make informed judgements about the worthwhileness of adhering to paradigm concepts and their potential contribution to better nursing care. The process of scrutinising nursing knowledge in this way makes nursing both a science and a social activity which fits the description of scientific community. This way nursing can be sure among other things, of livourably comparing itself with other true science disciplines. achieving professional status, being responsible for the knowledge that influences its practice, and so on. Of course all this assumes agreement and competence to judge worthwhile knowledge. Perhaps the truth is that nursing as an evolving scientific discipline has not yet delved into the study of science sufficientlv to reach an agreement, and that there is insufficient public knowledge to shed light on rhe core of nursing.

CONCLUSION While the theoretical and scientific essence of nursing remains unclear (at least in the UK) the purpose of this paper has been to review albeit in

a limited way the philosophical ideals and realities surrounding the philosophy of science, and its possible relevance to nursing. Kuhn’s position on paradigms has been highlighted as less problematic and most compatible with the reality that nursing is essentially a social activity. Within the paradigm convention it has been established that nurses will be able to focus, scrutinise, correct, strengthen, teach, and perpetuate those paradigm concepts central to their discipline. For purposes of unity, professional progress, and establishing nursing as science discipline, it seems almost axiomatic that the paradigm philosophy has tremendous appeal. After all nursing appears to have already chosen it. All this should not be seen as advocating uncritical L,~.; of nursing theories or models of nursing. It is merely a plea for nursing to clarifl-: 1. whether or not the four paradigm concepts are useful for understanding the scientific discipline of nursing? ‘1 6. whether or not nursing as a scientific community can operationalise the paradigm concepts for purposes of teaching, research, and practice. 3. that we do not as we did with the nursing process blindly accept or reject theories/ models of nursing. 4. that if we are at the pre-science stage we should be aware of that fact but continue to strive for paradigm status. The scientific approach (Davies, IYciS) requires rlgour of thought as well as methodological competence. If the professionalisation of nursing can be pursued through paradigmatic nursing, then there is a challenge to the profession to identify with the same rigour suitable paradigm concepts (if the above four are not acceptable) and valued theories to influence future nursing. Above all to reassure society of improved care. and the profession ofa secure path to intellectual and scientific status.

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NURSE EDUCATION

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