Philosophical underpinnings of an emergent methodology for nursing as caring inquiry

Two research approaches congruent with the theory of nursing as caring are described: group interpretive phenomenology and nursing as caring research as praxis. The idea of praxis and the theory of communicative action are explored for congruence as philosophical underpinnings of a possible eventual methodology for developing knowledge of nursing as caring.     

Emancipatory physiotherapy practice

In physiotherapy, as with many other health-care practices, therapeutic interventions, based on scientific knowledge, may be at odds with patient experiences. Patients may understand what they need to do to improve their health condition, but feel that these requirements may be emotionally, socially, or culturally incompatible with their lifestyles, social behavior, or personal choices. To work in the best interest of their patients, physiotherapists need to engage with the tensions that exist between scientific reason and social reality to offer a meaningful and relevant service for their patients. The challenge for physiotherapists is to arrive at decisions and interventions together with their patients that enhance, for example, mobility, social function, and well-being. To achieve this, physiotherapists need to rethink their professional role and translate their technical knowledge and goals into the patient's 'lifeworld', and patients--for their part--need to engage with physiotherapy professional knowledge. Often, the most commonly used strategy for facilitating this reciprocal engagement is open dialogue between patients and therapists. Habermas, a prominent contemporary philosopher and critical theorist, has developed a communicative theory that may support physiotherapists in their efforts to arrive at more sustainable and shared decisions with their patients. In this paper, I examine what constitutes physiotherapists' practice knowledge and how Habermas's theory of knowledge, interest, and communication strengthens shared decision-making and can be used as a vehicle toward emancipatory practice. Drawing on data generated in an action research project, I examine how Habermas's ideas can be applied in emancipatory physiotherapy practice. The paper concludes that emancipatory practice is meaningful because it creates opportunities for reflection, evaluation, and choice for future physiotherapy practice.     

Philosophy of science in doctoral nursing education revisited

Because every scientific theory and all research methods are tied to some philosophical framework, it is important that scientists within a given discipline be aware of the philosophical orientations that serve as the basis for developing theory and advancing knowledge. Nurse scientists have been challenged recently to examine the discipline's philosophical underpinnings in order to understand the evolutionary process of nursing science. The inclusion of the study of philosophy of science in doctoral nursing curriculum has remained a topic of periodic discourse. Whereas some assert that it promotes the essential process of philosophical reflection necessary for scientific exploration of relevant phenomenon, others contend that nurse scientists' preoccupation with this issue has diverted their attention from the real business of nursing science—that of knowledge development that will lead to legitimization of nursing as a discipline. Philosophy of science provides a useful frame of reference in which to appreciate the unfolding of nursing as a discipline. It should not be viewed as a distraction but rather a critical step in the transformation of the doctoral student into a productive nurse scientist. Doctoral programs remain the most logical place in which to educate future scholars regarding nursing's unique philosophical foundations and their implications for scientific inquiry and continued knowledge development. Creating and maintaining liaisons between nursing and philosophy departments—as well as requiring courses that emphasize the interrelationships among philosophy of science, nursing theory, and nursing research—are just a few of the strategies whereby doctoral programs can actively promote advancement of the discipline.     

The current status and future significance of nursing as a discipline

The nature of nursing and the need for knowledge distinct from medicine was first spoken of by Florence Nightingale in 1859. Her notions may be regarded as the earliest formations of nursing as a discipline. Since that time there has been substantial effort committed to the development of a distinct theory base for nursing. Increased interest in nursing's unique body of knowledge has been particularly evident in the last decade, as seen by the growth in research undertaken from a nursing perspective, and by the numbers of publications which focus on the nature of knowledge and theory in nursing. These efforts have served not only to advance the discipline of nursing but also to challenge all nurses to articulate for themselves the theoretical foundations of their own practice. The main thesis of this paper is that nursing is an evolving discipline. Aspects of its evolution will be discussed using the four characteristics of a discipline; domain, syntax, history, and output of knowledge.     

Ambiguous opportunity: toiling for truth of nursing art and science

This article questions traditional boundaries between nursing art and nursing science and explores how nurses build knowledge and truth. A brief overview of familiar notions about nursing art is followed by questions that are meant to deepen understanding about nursing and the knowledge required for a discipline. Authors describe understanding as an event that heralds human creation of meaning and potential action. Art is then shown to be a way to enhance understanding and meaningful knowledge when woven with nursing theory to guide practice. Findings from Parse's research method are described as artistic expressions, and borders that have served to separate notions about nursing art and science are challenged. The hermeneutics of human becoming are presented as beacons for truth and understanding. Authors call for tolerance of ambiguity and openness to support dialogue and discovery.     

Tobacco control in the 21st century: a critical issue for the nursing profession

Tobacco control is central to reducing death and disability and improving quality of life worldwide and nursing action is imperative. This article addresses tobacco as a global health issue with implications for nursing practice, education, research, and policy development. The lack of knowledge and skills, lack of expectation for clinical intervention, limited research, an absence of professional policies, and minimal nursing leadership have diminished the critical role that nurses can play in confronting this epidemic. Swift action is needed to ensure that all nurses are prepared to effectively engage in activities to prevent tobacco use, provide evidence-based cessation interventions, and support efforts to prevent exposure to secondhand smoke. Increased opportunities are needed to support creative nursing research efforts that test interventions and strategies to reduce barriers to tobacco control within different cultures, subcultures, and countries.     

Critical action research applied in clinical placement development in aged care facilities

XIAO LD, KELTON M and PATERSON J. Nursing Inquiry 2012; 19 : 322–333
Critical action research applied in clinical placement development in aged care facilities The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas’ communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year‐levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities.     

The Nature of Knowledge and Theory in Nursing

The formulation of nursing as a discipline is under way. Work on theory development, concept clarification and the development of a knowledge base is spurred by the creation of new doctoral programs and the emphasis on nursing research. As nursing establishes itself as an inventor of theory, the contrasts and similarities between its existence as both a practice profession and academic discipline come into sharp focus. As nursing strives to understand itself both as a user-applier and discoverer-inventor of knowledge and theory, it provides a model for other practice professions and academic disciplines to explore such questions as, What is the nature of theory in practice? What is the role of application in the formulation of theory? This paper examines the characteristics of theoretical constructs as they apply to the practice of nursing, the use of theory in that practice and the limitations of theory in application.     

Developing specialty knowledge: the case of Australian critical care nursing.

The generation of new knowledge is important to the evolution of the nursing profession and its specialties and is a fundamental requirement for the development of the discipline. This study documents the growth of empirical knowledge in Australian critical care nursing by examining the research published in one critical care specialty journal and a second generalized nursing research journal between 1994 and 1998. The proportion of research published in the specialty journal increased from 25 to 69%, with almost one-half focusing on patient therapies and treatments. The proportion of research in the general journal was consistently high, approximately 80 to 90%, with one to two critical care research articles per year. Nurses were first authors on the vast majority of these research articles. Approximately half of the critical care research focused on patient care. The results support the claim that Australian critical care nurses are conducting research to promote best practice in patient care and are thus contributing to the development of the discipline of nursing.     

Developing critical reflection for professional practice through problem-based learning

AIMS: To explore the influence of current learning traditions in nursing on the development of reflection and critical reflection as professional practice skills and to offer suggestions for nursing education that will specifically facilitate the development of critical reflection. ORGANIZATIONAL CONSTRUCTS: Mezirow's transformative learning theory, Barrows conceptualization of problem-based learning (PBL). METHODS: Integrative literature review of published literature related to nursing, health science education and professional education from 1983-2000. FINDINGS: Professional education scholars concur that specialized knowledge is clearly essential for professional practice, however, they also suggest that self-consciousness (reflection) and continual self-critique (critical reflection) are crucial to continued competence. While strategies to facilitate reflection have been outlined in the literature, specific strategies to facilitate the development of critical reflection and implications for nursing education are much less clear. Advocates of reflective and critically reflective practice suggest that the development of these abilities should be inextricably linked to professional development and can be developed through active repeated guided practice. In health care, PBL based on constructivism, has been identified as one way to facilitate the development of these skills. CONCLUSIONS: Nursing learners exposed to PBL develop the ability to be reflective and critically reflective in their learning and acquire the knowledge and skill within the discipline of nursing by encountering key professional practice situations as the stimulus and focus of their classroom learning. The learners' ability to be both reflective and critically reflective in their learning is developed by critical questioning of the faculty tutor during situational analysis, learning need determination, application of knowledge, critique of resources and personal problem-solving processes, and summarization of what was learned.     

Thoughts on the discipline of nursing as we approach the year 2000

A discipline is 'characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry' (Donaldson & Crowley 1978). Further, Chinn & Jacobs (1987) define discipline as a 'branch of instruction; a body of knowledge and of systematizing that knowledge within an area of concern or domain of inquiry'. The position taken in this paper is that nursing, as it approaches the year 2000, is an evolving discipline that is 'dedicated to the advancement of knowledge which contributes to the pursuit of excellence of care' (AARN 1985). The writer agrees with Jennings' (1987) position that theory gives definition to nursing's body of knowledge, and direction to research and practice. This paper addresses some of the issues and concerns related to the development of nursing knowledge which serves as a cornerstone for the discipline. It goes on to consider briefly a few tasks that face nursing as it approaches the year 2000.     

The rhetoric of nursing theory

Skeptics who question the validity and relevance of nursing theory in the nursing curriculum demonstrate the failure to persuade nurses of the importance of theory. Attempts to justify theory by forcing its use in contexts where it barely fits have contributed to the increasing disenchantment. But however misused and misunderstood, theory is nevertheless a lasting and essential part of nursing knowledge. Theory is the intellectual life of nursing. To further research, experiment, and insight in nursing as a discipline, theorizing must be encouraged–subject as all intellectual efforts must be–to honest critique and a healthy willingness to acknowledge success or failure.     

Clinical research methods in the nursing discipline framework

Within the nursing discipline, the research helps or should help to develop and assess the theories related to the relevant phenomena. A professional discipline such as ours determines the relevant phenomena through its sphere of activity and the priorities of the society in general. With time, the disciplines develop a preference in the way of thinking about their discipline. At that point, there is no singular approach to the development of knowledge inside the nursing discipline, and no consensus either on the way of carrying out nursing research, whether it is applied or not. From time immemorial, the logical and systematic chain of reasoning coupled with the minute observation, the reflection and the intuition have built up the processes essential to the understanding of the human natural phenomena. Thus, the nursing research was mainly influenced by the two prevailing approaches (quantitative and qualitative) both focused on the experience, but using different strategies to get in touch with reality. Recently, the triangulation of the research elements seems more frequent, whether it is the combination of theories, of methods or of researchers of different disciplines with different perspectives. Each approach has its own methods and criteria to collect and analyse the data, then to interpret and check the results. The reproduction and the confirmation of this knowledge through additional and critical research are essential if we want this knowledge to be recognized by this discipline.     

Too busy to think?

A synthesis of current nursing knowledge by means of nursing theory construction is missing in German speaking countries. Unfortunately, due to this the nursing discipline cannot counterbalance the influence of other scientific disciplines with a self-created nursing specific theory. The level of theory construction in a discipline serves as sensitive indicator of intellectual state in this discipline. After the fruitful period from 1980 to 1990, the theoretical discourse in nursing almost disrupted while the number of empirical studies is increasing. This deserves to be discussed thoroughly with respect to further development of nursing theory. The theoretical discourse in nursing should generalise research findings in order to develop nursing theory in an inductive way - combined with a focus on patient's perspective in research and theory construction. New aspects and themes in health care as the demographical development and its epidemiological consequences, the increase and transformation of chronic illness as well as the changing role of the patient (participation, self-management) should be considered. The reanimation of a culture of discussion is only possible if scholars can dedicate time to it. Only under this condition reading and discussing research findings of other disciplines will be again on the agenda of scientific working and will - last but not least - inspire the construction of a nursing specific theory.     

Re-thinking representations, re-writing nursing texts: possibilities through feminist and Foucauldian thought

FOCUS: Critical approaches are increasingly being used to inform theory and research within the discipline of nursing. In this paper we discuss the work of feminist writers, particularly those located within the postmodern, and Michel Foucault. Their work, although having significant points of difference, can be viewed as complementary and our engagement with these ideas has led us to re-think nursing knowledge. RATIONALE: Using ideas from Foucault and postmodern feminism foregrounds critical questions such as whose knowledge is visible in nursing literature, whose is suppressed, and the power relationships reflected in representations of knowledge. Our exploration of representations of knowledge has led us to review fundamental nursing texts that we consider to be important political and ideological artefacts in the enculturation of student nurses. The dominant position of medical knowledge in the texts reviewed continues to position this 'voice' as primary in nursing literature. DISCUSSION: Drawing on our current research on endometriosis to illustrate the potential inherent in rewriting such texts, we argue for a repositioning of knowledge related to the illness experience. Privileging the voices of people who are the focus of our clinical care reflects the reality of nurses' work; the embodied experience of the person is made visible rather than marginalized in the illness discourse.     

Nursing theory and practice: connecting the dots

The authors propose connecting the dots among theory, practice, and research by adopting an expanded conceptual-theoretical-empirical structure of nursing knowledge and matrix process to guide the placement of nursing knowledge in a contextual whole. An overview of the theoretical journey of nursing knowledge development is contrasted with the journey from practice resulting in a theory-practice disconnect. Both approaches are united to present an integrated view of the dimensions of the knowledge development of nursing as a professional discipline.     

Foucault and nursing: a history of the present

While a commitment to the development of nursing theory has been a significant force in nursing scholarship, particularly in the US, the authors have noted a recent trend among nurses in different countries to develop Foucauldian interpretations of nursing. The objective of this paper is to identify those publications by nurses that employ a Foucauldian perspective and to provide a useful summative review of these works to date, which illustrate the potential contribution of a Foucauldian reading of nursing. The authors have reviewed 27 publications written by nurses which present a Foucauldian analysis. These publications were issued between 1987 and 1998 in English, Portuguese and German. The most frequent concepts treated in the literature reviewed are power/knowledge, surveillance, discourse, discipline, resistance, docile bodies, clinical gaze, and panopticon. The literature reviewed illustrates that Foucault's concepts can have a profound impact on the way we conceive of nursing as a discipline and as a profession. Nursing care becomes a political event, nursing knowledge contributes to the dissemination of regimes of truth, and nurses, rather than being powerless, are perceived as professionals who exercise power over life in society. A Foucauldian reading of nursing enables nurses to move into a broader interdisciplinary and critical scholarship.     

A comparison of action research, participatory research, and participatory action research and their applications in nursing research

Action research, participatory research, and participatory action research methodology adopting critical theory as epistemology for knowledge development have been applied in diverse nursing specialties. They share similar research principles and values, and employ the same data collection methods. For these many scholars use the terms interchangeably. However, their developmental origins and ideological backgrounds are different, as are their expected outcomes and research methods. The terms have therefore been misused. This paper is intended to enhance researchers' ability to distinguish between the similar methodologies and to apply research methodology and related terms appropriately to the relevant issues of health care.