sign in sign up
<<
Home , Applied science

REVIEW THE OF NURSING: CURRENT ISSUES AND DILEMMAS

H. Brink

WIIAT IS SCIENCE? Abstract The question "What exactly is science?" is not The question regarding the nature and direction of nursing science, how it is derived easy to answer. Many and varied ideas, attitudes or why and whether nursing is a science is a much debated one. This article focuses and conceptualisations on the exact nature of on an examination of the literature with regard to conceptualisations of science in science and knowing can be found in the general and nursing in particular with special emphasis on the nature, purpose, literature, each reflecting a specific world view. methods and domain of science and nursing science. It looks at the various positions Science has been defined as a product, a process or both. As a product, science represents the taken, examines the consequences of holding any special position and makes evergrowing, everchanging accumulated knowledge of a particular discipline (Abdellah Opsomming 1969; Downs 1979; Einstein 1950; Hinshaw 1989; Moody 1990). Hinshaw (1989: 162) Die aard van wetenskapsbeoefening in die verpleegkunde, die rigting wat ditbehoort states: "The are defined as bodies of knowledge based on general principles te volg, diemetodes van kennisversameling en die bestaansreg van die verpleegkunde about a delimited range of phenomena derived ofhoekom dit well as wetenskap kwalifiseer, is almal omstrede vraagstukke in die from empirical observation". The product or verpleegliteratuur. Die literatuur met betrekking tot bogenoemde aspekte is verken body of knowledge is the outcome or result of en aspekte ten opsigte van die konseptualisering van die wetenskap in die algemeen scientific inquiry (Parse 1987; Silva an^ en meer speisfiek die verpleegkunde as 'n wetenskap, word bespreek. Daar word Rothbart 1984) and includes scientifi^ veral aandag gegee aan die aard, doel, metodes en domein van die wetenskap en terminology, definitions, propositions, verpleging as ’n wetenskap. Verskillende standpunte rakende hierdie aspekte word hypotheses, theories and laws (Rudner 1966). onder die loep geneem. Aandag word ook gegee aan gevolge, indien 'n sekere As defined by Moody (1990:19) it is a body of standpunt gehuldig word. Voorstelle hoedate uitmuntendheid in verpleegkunde knowledge which includes facts and theories bereik kan word, word gemaak. generated by the use of systematic, controlled and precise methods within a defined area of concern.

As a process science refers to a method of INTRODUCTION on the nature and direction of nursing science or inquiry or the means by which a body of how it is derived, or why nursing is a science. knowledge evolves and progresses (Beckwith Nursing has long been considered as an art, For close on thirty years this has been a subject and Miller 1976; Bronowski 1965; Harrison whereas nursing as a science is a relatively of debate among nurse scholars, and contrary 1984). Bronowski (1965:16) describes science positions still are being explicated. recent development. Other than Nightingale as an intellectual activity and states "Science is who in 1860 identified nursing as both an art and nothing else than the search to discover unity in science not valuing one more than the other, In order to be able to participate meaningfully the wild variety of nature, o r... in the variety of (Nightingale reprinted 1969) it was not until the in such debates or defend their views when our experience". late 1950’s that serious attention was given to challenged, it is essential for nurses to have an nursing as a science. Since that time nursing understanding of the nature of nursing science WIIAT IS THE NATURE OF increasingly has become concerned about its and how it relates to the larger body of science, SCIENCE? knowledge base for practice. Today the term to be exposed to different viewpoints and to be nursing science is familiar to nurses. able to judge the relative merits of The nature of science is a controversial issue. Contemporary literature abounds with related to nursing as a science. Conceptualisations vary according to the world strategies for building a nursing science (Chinn view or philosophical orientation of the & Jacobs 1987; Jacox 1974; Watson 1985). . Two dominant world views of science There are Departments of Nursing Science and This article seeks to examine conceptualisations are reflected in the literature, namely the the South African Nursing Council (SANC) of science in general and nursing science in "received view" and the "perceived view" of describes nursing as a human clinical health particular, as presented in the literature, with science. For decades the received view, also science. regard to its nature, purpose, methods and known as logical or , was domain. It will also look at the various positions the predominantly accepted world view of There are, however, critics who challenge the taken, exami ne the consequences of holding any science. In the literature it is frequently referred view that nursing is a science, and nurses are not special position, make suggestions for to as traditional science or pure science. always able to present convincing arguments achieving excellence in nursing science and that nursing in fact is a science. Even among thereby try to clarify the issues relating to Proponents of the traditional view or logical nurses themselves there isnot always agreement nursing as a science. positivism operate on strict rules of logic, truth,

12 Curationis, Vol. 15, No. 2, 1992 laws, axioms, predictions and reductionism. Despite the differences in the conceptualisation represents a shared belief among its members They believe that all human behaviour is of science by proponents of the received and regarding its reason for being. For example, the objective, purposeful and measurable. Only perceived view of science, common threads in domain of enquiry for physiology is the study what can be seen, sensed and measured is the characteristics, criteria and norms of science of the function of living systems, and for worthy of pursuing. Predictive statements that can be identified. Gortncr and Schultz (1988) sociology it is the study of principles and have no sensory data corroboration are not provide a list of well-accepted criteria for processes governing human society. The focus scientific. They hold the position that "truth" is judging excellence in science which include for law is injustice and grievance and the focus absolute and there is a single reality. True significance, theory-observation, congruency, for architecture is the form and function of statements are based on experience and known gcneralisability, reproducibility, precision and buildings. All in these disciplines is from experience. In order to find truth one must intcrsubjectivity. These criteria are applicable directed towards addressing this focus in some be completely objective, which means that regardless of the methodological or small part. Each discipline thus has a central values, feelings and personal perceptionscannot philosophical approach used in developing the focus which influences the perspective of that enter into the measurement of reality. knowledge. A number of criteria which arc field, the way i t conceptualises the world and the Accordi ng to logical positivists there is only one interdisciplinary across the social sciences are question it poses for investigation. Donaldson method for science. This method is detached often used as norms to judge the merit of the and Crowley (1978:418) draw attention to the observation, controlled and enquiry process and resultant knowledge base fact that even though each discipline is unique, mathematical or quantitative measurement (Merton 1979; Barber 1952; Storer 1966). they are not totally independent of each other. (Van Manen, 1990:4) and incorporates logistic These criteria include universalism, The quality of theories, research designs and and deductive reasoning. commonality, disinterestness and organised validity of conclusions drawn within one scepticism. Hinshaw (1989) suggests that two discipline are dependent upon their congruence Facts from research are systematically linked to additional criteria need to be used in judging with all of knowledge. Therefore knowledge in each other in a way that seems best to explain excellence in science - the development or one discipline may constrain or enhance the our empirical world; such linkages are called existence of substantiated bodies of knowledge process of enquiry in another and no discipline laws, principles or axioms depending on the specific to areas of critical concern in the should function in isolation. Donaldson and certainty of the facts and relationship within the , and the evolving information base Crowley (1978:418) further distinguish linkage. The emphasis of logical positivists is on the "cutting edge" of science - are both between academic and professional disciplines. one of theory validation, not theory discovery characteristics crucial to developinga creditable A professional discipline in addition to its area (Rudner 1966). and usable science base. of study is defined by social relevance and value orientations. The focus is derived from a belief Logical positivists do not address the These criteria may be useful in exploring and value system about the profession’s social application of science and therefore are accused whether or not and to what extent a science of commitment, nature of its service and area of of erecting barriers between the pure scientist nursing exists. responsibility for knowledge development. and the scientific practitioner. These requisites need expression in the focus WIIAT IS TIIE PURPOSE, GOAL statement. For example, while the central focus The perceived view of science, also known as OR AIM OF SCIENCE? in is disease, defect and physiological historicism or , evolved in deficits, the social and value orientations of reaction to the rather obvious limitations of For Kerlinger (1973) the major aim of science medicine as a professional discipline is traditional science or logical positivism and has is to evolve theory which is conceptualised as conveyed by the commitment to alleviate gained increasing prominence since the 1960s. a coherent set of verified relations useful for disease. Historicists maintai n that there is more to people explanation and prediction, and consequently for control. Professional disciplines, however, than that which can be seen, sensed and CONCEPTS RELEVANT TO TIIE measured. They believe it equally important to expand on this and believe that the aim of FOCUS OF NURSING study and document what people know, science includes the development of experience and give meaning to both prescriptive theory i ,e. theory to guide practice. N ursing has defi ned itself as a discipli ne in order subjectively (internal reality) and objectively to establish identity separate from medicine (external reality). Science is viewed as a WIIAT IS A DISCIPLINE? (Murphy and Hoeffer 1983). Nurse theorists process of understanding human behaviour. however, have not reached consensus yet on a "Understanding human expressions, knowing Most of the definitions of science are posed in central focus of enquiry clearly distinguishing it contextual experiences, and grasping the world the context of the discipline from which they from other disciplines. view of people open the door to new and more arise (Moody 1990:18). It therefore stands to meaningful insights about people" (Leininger reason that a consideration of science should 1985:23). include a consideration of the discipline from The domain of nursing was addressed by Yura which it arises. and Torres in 1975 when they described the Historicists claim no access to certain truth or major concepts or the domain of nursing as knowledge but rather accept certain knowledge The Oxford dictionary defines discipline as "a being man, society, health and nursing. to be "true", if it withstands practical tests of branch of instruction or ; a department Although there are slight variations in reason and utility. They do not cling to any one of learning or knowledge". In their now classic terminology among theorists, there appears to method of science but in fact encourage the use article "The discipline of nursing", Donaldson be general agreement at present, at least in the of the most appropriate method for the particular and Crowley (1978:414) maintain that USA and Canada, that the domain of nursing is (De Groot 1988:8). Either disciplines have evolved as a consequence of a person, environment, health and nursing. qualitative or quantitative methods are seen as distinct perspective and syntax which Fawcett (1984) and Jennings (1987) regard this effective tools for the development of science determines what phenomena are to be viewed, as an important step in nursing theory and unlike traditional , historicists hold what questions are to be raised scientifically, development because it signifies that nursing values, aesthetics and ethics as an integral what methods of study are to be used and what has developed to the stage of identifying major important part of the research tradition. evidence of proof is required. ideas guiding common lines of enquiry. According to this view legitimate knowledge However, Hinshaw (1989:164) argues that can incorporate whatever is germane to the According to Newman, Sime and "even with the commitment to and consensus discipline, be it subjective, descriptive, Corcoran-Perry (1991:1) a discipline is concerning these four broad phenomena, normative, evaluative or objective. distinguished by a domain of enquiry that knowledge to be developed and useful in

Curationis, Vol. 15, No. 2, 1992 13 practice will need to be much more specific in arguments are equally applicable to the focus of relating to lack of clarity and specificity would nature”. Newman et al (1991) concur. concern defined by the other national bodies to be applicable here too. What are nursing which reference has been made. activities? How are they distinguished from medical or other health related activities? This In recent years concepts of concern central to nursing have been defined or suggested by a The SANC has attempted to distinguish the view furthermore limits the scope of scientific number of professional nursing bodies in domain of nursing from the domain of medicine inquiry of nursing; for example, historical different parts of the world in their position or by adding "within the parameters of nursing studies of the evaluation of nursing practice or studies on the meaning of phenomena of policy statements, and also by several nurse philosophy and ethics ... and developing concern to nursing are excluded. So far, the scholars who work mainly in the USA. For knowledge for nursing diagnosis" - but did not example, according to the position papers on elucidate these concepts. It is generally suggestion made by Newman et al (1991) seems nursing of the Royal College of Nursing(RCN), espoused that nursing adheres to a humanistic one of the most meaningful regarding the focus "caring", is the core of nursing. "The nursing philosophy so it is not clear in which way of concern for nursing. The task remains to examine and explicate the meaning of caring in system must acknowledge the centrality of care nursing philosophy isaphilosophyspecificonly the human health experience in order to in the overall delivery of service... it is the skill to nursing and neither is it clear in which way ascertain the adequacy of this focus for nursing, and art of caring for another person that nursing ethics are distinctive. and to examine the philosophic and scientific transforms the action from a technique to a questions provoked by the focus statements. nursing intervention" (1987:11). The American Either health or care or both feature prominently Until such time, the issue of the central concern Nursing Association (ANA) in its posi tion paper as the central focus of nursing in all the of nursing will remain unresolved. The position on nursing regards the diagnosis and treatment definitions referred to so far, as well as in current is taken that despite this shortcoming, great of human response to actual and potential health definitions of many nurse theorists and strides have been made in developing the problems as the central phenomenon of concern researchers. It can be argued that health has disci pi ine of nursing. As an evolving disci pi ine, in nursing (1980:2). The Nordic Nurses been heralded as the center piece of nursing nursing is developing an organised body of Federation in theirethical guidelines for nursing knowledge since the days of Florence knowledge, composed of specialised concepts research acknowledge nurses’ responsibility to Nightingale and continues to be viewed as such and terminology used in education, practice and "promote health, to prevent illness, to restore by many nurse theorists and researchers (Meleis research. It has identified credible research health, to prevent death, and to assist to a 1990; Newman 1986; Pender 1987). Caring, methods, acceptable standards of practice, and comfortable death". Further there is a clear too, (both the concept and the process) has criteria for educating practitioners in the field. expectation for renewing personal knowledge occupied a prominent position in nursing and skills (1987:7). The SANC (1988) in its literature and has been suggested as the essence DEFINITIONS OF NURSING Philosophy and Policy statement on both or central core of nursing, not only by the RCN SCIENCE professional basic and postbasic training state: but also by several nurse scholars (Benner and "Within the parameters of nursing philosophy Wrubel 1989; Bottorf 1991; Leininger 1984; Nursing Science, like science in general has and ethics, nursing science is concerned wi th the Watson 1985). The question which needs to be been defined in several ways, which leads to development of knowledge for the nursing answered is whether either of these two confusion and may impede argumentation. In diagnosis, treatment and personalised health concepts - health or caring, represents the 1969 Abdellah described nursing science as "a care of persons exposed to, suffering or central focus of the discipline of nursing. body of cumulati vescientific knowledge, drawn recovering from physical or mental illness. It According to Peplau (in Smith 1988:82) we from the physical, biological and behavioural encompasses the study of preventive, cannot say health is a central focus, because sciences that is uniquely nursing: (p.339). promotive, curative and rehabilitative health health is a goal, an outcome. In a recent editorial Almost a decade later Jacobs and Huether care for individuals, families, groups and Diers (1988) disagrees with the premise of (1978:66) described nursing science as "the communities and covers man’s life span from caring as the central focus, stating it is process and the result of ordering and pattemi ng before birth". The International Council of presumptuous of nurses to assume that only they the events and phenomena of concern to Nurses (ICN) in a revised position paper on care. Packard and Polifroni (1991) pose the nursing". nursing research (1987) first specify a clear question "If the aims of nursing science are expectation for a constant generation of directed towards the phenomena of caring, how More recently Bottorf provided the following up-to-date organised nursing knowledge, and is nursing different from other helping definition: "The term science of nursing refers then state: "Nursing as an integral part of the ?". Newman et al (1991:2) argue to that branch or body of knowledge that is health care system, encompasses the promotion that neither concept (i.e. health or caring) alone characteristically different from the knowledge of health, prevention of illness and care of the meets the criteria for the focus of the nursing that is aimed at and achieved by other physically ill, mentally ill and disabled people discipline. For example, knowledge about discipline" (1991:28). Bottorf then emphasises of all ages in all health care and other health without consideration of cari ng, would be that the science of nursing does not comprise all community settings. Within this broad knowledge of a discipline of health and the knowledge that nurses need in order to spectrum of health care, the phenomena of similarly, knowledge of personalised health practice (e.g. physiology, sociology) but rather, particular concern to nurses are individual, care of persons exposed to suffering or onl y that knowledge that is particular to nursing. fami ly and group responses to actual or potential recovering from illness would be knowledge of These three writers thus all view nursing science health problems". Tlie ICN thus concurs with a discipline of health. These writers therefore differently. While Abdellah and Bottorf both the ANA regarding the phenomena of concern suggest that the concepts, caring, health and agree that science is a body of knowledge - the for nursing. health experience should be related to each focus of concern for accumulating this body of other, to identify the domain of inquiry for knowledge differs. On the other hand Jacobs nursing and submit that nursing is the study of Allen (1987) has criticised the lack of clarity in and Huether support the viewpoint that science caring in the human health experience (1991:3). the definition statement of the ANA, and is a product created by a process "that is directly suggests that rather than providing clarity, the related". These variations in the statement may well serve to blur the direction of In a recent article B otes(1991:20) identifies the conceptualisation of nursing science can cause nursing science through a superficial definition domain of nursing enquiry as "die mens considerable confusion to those wanting to of the scope of nursing. Packard and Polifroni betrokke by ecn of ander defend nursing as a science. (1991) are of the opinion that the defined focus verplegingshandelinge". Translated, this does not distinguish clearly the domain of would be man involved in one or other nursing The definition of nursing science by the SANC nursing from the domain of medicine. These activity. Similar arguments already voiced with its many labels for the term nursing

14 Curationis, Vol. 15, No. 2, 1992 science, further adds to this confusion. In its caring or the historical evolution of holistic by other disciplines. If nurses pursue nursing policy and philosophy on professional basic health care). However, if nursing science is science as an applied science, nurse scientists training the SANC describes nursing science as pursued only as a basic science, nursing practicc may be forced to wait indefinitely for a human clinical health science that constitutes will be without the scientific understanding of development of scientific principles that can be a body of knowledge ... is concerned with the nursing means. Without scientific knowledge tested and applied to nursing practice. development of knowledge... is an area of study of nursing, the nurse is left to her or his own ... and the scientific approach is also referred to resources and to using trial and error to The third conceptualisation of nursing science as the nursing process. Nursing science can thus determine how descriptive knowledge should to be considered is that of nursing as a practical refer to any of five phenomena. be applied in a particular situation. Basic science. In recent literature Orem (1988) and scientific knowledge does not provide the nurse Schlotfeld (1988) argued that the science of Carper (1978) described a convenient way of with the necessary knowledge to make nursing must be practical. Scientific inquiry in viewing the kind of knowledge necessary in decisions about the most effective course to nursing must yield findings directly useful and nursing by identifying fundamental patterns of follow in meeting a goal. Some scholars have relevant to nursing practice. Practical nursing. The four fundamental patterns she argued that nurses should not impose their own knowledge presupposes theoretic knowledge. identified are: views on their clients and limit knowledge As Wallace (1983:277) stated "Sciences are claims to those which are purely descriptive. said to be practical because their knower intends (1) Empirics - the science of nursing Moccia, for example argued that the use of operation, while they are also said to be knowledge that is predictive strips individuals theoretical because their knower intends truth (2) Aesthetics - the art of nursing of their potential for autonomous and proceeds analytically, even though the (3) Personal knowledge - interpersonal self-determination and reduces them to objects. science as such is concerned with something knowing concerned with the kind of She expresses concern regarding the view that doable". When nursing science is knowing that promotes wholeness and science should guide practicc and asks whether conceptualised as a practical science, it is clear integrity in the personal encounter and it is not immoral to impose a belief system on that nursing’s ultimate goal is to use knowledge the achievement of engagement rather another individual. However, in retaliation the of principles and causes in the development of than detachment, and question of whether it is immoral to subject specific nursing means that can achieve nursing to a trial and error practice in nursing ends and thereby the overall end of nursing. A (4) Ethics - the component of moral also needs to be addressed. practical science generates descriptive, knowledge in nursing explanatory, predictive and prescriptive theory In reaction to the apparent inconsistencies and and therefore can be considered suitable to These patterns are useful for structuring inadequacies of nursing as a basic science, meeting nursing’s needs. Botes (1991) knowledge in nursing and indicate areas for nursing is regarded by many as an applied advocates the use of the functional approach in establishing a useful body of knowledge for science. Questions however, arise in respect to nursing science. Except for the terminology her ^^iursing. Chinn (1985) wrote extensively in a common determination of what is really meant explication of the functional approach appears ^Pupport of Carper’s patterns of knowing and by the term applied science. In the nursing to be more or less equivalent to descriptions of refuted the superiority of empirical knowledge literature it has been given a variety of practical science in the American and Canadian as the only relevant science. It would appear meanings. Some view applied science as literature. that the non-restrictive definition of science answering questions related lo the applicability suggested by Moody (1990:19), but substituting of basic theories in practical situations, rather The implication of calling nursing a practice Carper’s four fundamental patterns of nursing than questions related lo how basic theories are science is that the focus of nursing, in providing for Moody’s defined area of concern, could to be applied (Donaldson and Crowley 1978). a particular service, should be a special serve as an excellent guideline for nurses. Some suggest that an applied science is one that consideration in the development of nursing uses the knowledge of basic sciences for some knowledge. While this observation is obvious, TIIE ISSUE OF NURSING AS A practical end (Wallace 1983). Some refer to there is reason to question the utility and BASIC VS APPLIED OR PRACTICE applied science as theories derived from the appropriateness of advancing arguments SCIENCE scientific theories of other disciplines that arc pertaining to basic vs practice science. applicable to nursing (Meleis 1988). In the light The question whether nursing is a basic, applied of the ambiguity surrounding the term Toulmin (1972) pointed out that all scientific or practice science is a further issue of frequent "applied" science, the term as related to nursing enterprises are made up of two components, controversy and confusion. Currently three is in need of clarification. On the other hand, viz.: posi tions regardi ng the nature of nursing science there remains the question of "applying what" can be found in the nursing literature. It held - only nursing theories or theories from other (1) the body of knowledge that nursing is a basic science, an applied disciplines? And also, there is the question as science or a practical science. Arguments can (2) the group of individuals who work to to whether being an applied science eliminates be advanced for and against each of these three apply, develop and evaluate that the potentialities of basic science. positions. knowledge

The basic sciences generally are distinguished History demonstrates that some of the most The notion of a practical discipline might be from other sciences on the basis of their goal or important scientific discoveries come about considered universal, for even historians and end. The goal of basic science is theory or inadvertently and not as a direct result of mathematicians have a "practice" component as knowledge for the sake of knowledge. Basic specific research aims. Further, theory hasoflcn they work to apply the knowledge in their science serves as a pool of knowledge and does preceded application by many years, as for respective fields. It is difficult to argue against not offer guidance perse. Proponentsof nursing example in the case of nuclear and Toulmin’s view of science because a body of as a basic science limit scientific enquiry in M endel's law. In labelling nursing as an applied knowledge must be knowledge for some group nursing to description, explanation and science and limiting scientific inquiry to the of people. Consequently following Toulmin’s understanding (Gortner and Schultz 1988; application of basic sciences to nursing practicc, view, the distinction between a basic and Moccia 1988; Parse 1981; Pcplau 1988; Rogers the science of nursing is made dependent on applied or practice discipline offers little 1988). Scientific effort should be focused on advancements in other disciplines. It is contribution to understanding the nature of abstract knowledge that clarifies the domain of however, unlikely that all scientific knowledge nursing. All disciplines must have an associated nursing (e.g. what is the meaning of health or csscniial for nursing practice will be developed group of persons who use and develop the

Curationis, Vol. 15, No. 2, 1992 15 knowledge base, whether their "practice" realm Hinshaw (1989:169) to judge excellence in not inclined to confine themselves to a limited is in a laboratory or in a community with human nursing science, namely depth i n the knowledge context and solve problems locally without recipients (Rodgers 1991:180). Debates on base and studies which are on the "cutting edge" extracting principles which may hold nursing as a basic or applied or practice science of knowledge frontiers, will be examined in universally? Another vital component of thus appear to offer little contribution to ielation to the present state of nursing science. science is scepticism - the recognition that all supporting the view that nursing is a science. knowledge is uncertain and therefore the ability Depth in the knowledge base refers to a series to suspend judgment and to feel and express of studies in the same or common areas of doubt is important. Are nurses perhaps still too NURSING SCIENCE METHODS investigation which provide evidence of similar eager to hold their findings as facts regardless results. Only if replicated findings are present of whether they can justify their credibility, across several studies under di fferent as well as rather than welcome criticism about them, and The decision regarding an acceptable method to similar conditions, can professionals be criticise then themselves? Science is also be used in the conduct of scientific enquiry in reassured that the information is credible and characterised by accuracy and precision and nursing has been subject to considerable debate. useful, and only if the findings have been terms specific to the system are defined for Some writers believe that empiricism if not publicised and criticised and consensus has clarity and precision. Uniformity of usage quanti fication is the most appropriate avenue for been reached by a community of scholars can provides for . In nursing there research endeavours (Clarke and Yaros 1988; professionalsbe reassured that their information is still room for much improvement regarding Moccia 1988; Norbeck 1987). Others (Field and is significant. The historical pattern in nursing these criteria. We have so many terms to cover Morse 1985; Leininger 1985) maintain that the research both here and abroad has been a more exactly the same concept. We coin new terms qualitative approach holds the greatest promise. shotgun approach - one study in an area of to cover what has previously been discussed in Several writers have advocated the use of both interest followed by one in another area of another setting and in another field and do not qualitative and quantitative approaches within investigation. With very few exceptions there define them adequately. We almost have the same study and for the same questions is no series of nursing studies in the same or reached a stage where nobody is understanding (Duffy 1987; Gortner and Schultz 1988; Porter common areas of investigation. If there are anybody. 1989). In response, a number of writers more than two or three studies in the same area including Moccia (1988) and Phillips (1988) they generally were all done in isolation and do CONCLUSION address the overall loss of integrity inherent in not link with each other. Nurses are not yet using opposing methods. Proponents of the dedicated to basing new research efforts on The nursing scienti fie community is confronted quantitative methods seem to agree that is is not previous knowledge, yet a cumulative body of the only way to go about research, but it is knowledge includes building on colleagues as with the challenge of developing knowledge for important in that statistical data allow us to see well as one’s own research. With regard to the discipline with scientific rigor and integrity what portion of the dependent variable is publicising and criticising, more nurses are and to defend its position in relation to other disciplines. So far it has grappled with many explained by the identified independent coming forth and publishing their research - variables. Those who favour qualitative peers however, are not forthcoming in issues - confusion regarding terminology, it^ methods believe that first hand experience criticising and with a few exceptions researchers central focus of concern, diversity regarding the provides the most meaningful data for nursing. and writers are not yet ready to accpet criticism, nature and purpose of nursing, methods to be or otherwise are oversensitive to it. used in developing nursing science and the Leininger (1985:2) encapsulates the views of question of sustaining excellence in nursing the proponents of this approach in stating "the science. Valid arguments for and against the is far too narow, reductionistic Being on the cutting edge of knowledge positions taken have been advanced. In the eyes and controlled to let one know human beings in frontiers requires that nurse researchers be in the of purists i.e. adherents of traditional science or their totality and help them in times of wellness forefront with their knowledge of the logical positivism nursing will not qualify as a and illness”. Those theorists and scholars who substantive area as well as the methods needed science, as nursing knowledge is not consistent support a position which espouses the values of for their field of study. To remain on the with these views. Nursing has humanistic or both , particularly in "cutting edge" of any scientific field requires naturalistic components that are incompatible combination, seem to believe that it is too early continual learning and relearning. Nurses are with such a conception of science. Recent in the development of nursing to put closure on aware of this and are paying active attention to writings in philosophy have provided a any type of . improving themselves continuously. A second substantial basis for the rejection of such views, strategy for staying on the forefront of the but nevertheless current writers support an I would support this latter view. Nursing is a developing scientific body of knowledge is expanding view of science allowing for the complex and diverse phenomenon and has a maintaining strong relationships with introduction of naturalistic orientation with a great variety of questions confronting it today. interdisciplinary colleagues in relevant fields of wider range of methods, a more flexible The many types of qualitative and quantitative study. Hinshaw (1990:23) states "nursing conception of theory, and in general a broader methods all have valuable and unique research cannot afford to be developed in a view of what science is. This form contributions to make. All methods should be vacuum only to discover that valuable resources accommodates the previously debatable forms given equal respect and support by all members such as ti me, energy and money have been spent of nursing science and enables attention to be of the discipline of nursing. The purpose of the in recreating information already known by given to many forms and methods of enquiry. research should dictate the approach to be used. other disciplines". Commonality or the sharing With the multiplicity and diversity of of ideas and research endeavours is one of the phenomena in nursing, it is imperative to use IS EXCELLENCE IN NURSING major criteria to judge the merit of science more than one method of approaching and SCIENCE SUSTAINED? which is interdisciplinary across the social understanding them. Anything that values sciences. Do nurses in this country collaborate exclusively one standard as superior (whether a Gortner and Schultz (1988) believe the sufficiently with colleagues from other language, race gender or science) restricts its emphasis in debates on nursing as a science disciplines when doing research? Not much ability to progress behond the boundaries it should be on standards of "good science" in evidence exists at present to provide an answer. self-imposes. There is always growth and nursing regardless of technique. Thus the issue Universalism which is another criterion discovery beyond the boundaries and there ofconcern is to what extent does nursing science advocated for judging the merit of science cannot be only one best view or one best method meet the accepted criteria forjudging scientific requires that knowledge be generalisable to indevelopingascience. Thereshouldhowever, merit? To answer this, the criteria advanced by more and more of the universe. Yet are nurses be one central focus of concern to direct nurse

16 Curationis, Vol. 15, No. 2,1992 researchers and nurses should reach consensus DIERS, D. 1988. On clinical scholarship. LEININGER, M.M. (ed). 1984. Care: The about this. It is also important to re-examine Image 20 (no. 1): 2. essence o f Nursing and Health. Thorofare, continually our scientific progress and to N.J.: Slack. evaluate the scientific merit of our developing DONALDSON, S.K. & CROWLEY, D M. LEININNGER, M.M. 1985. Qualitative body of knowledge. Nurses need to deal with 1978. The discipline of nursing. Nursing Outlook 26 (no. 2): 113-120. Research Methods in Nursing. Orlando: the challenge to assure excellence in nursing Grune and Stratton. science. To accumulate knowledge which is DOWNS, F. 1979. Clinical and theoretical creditable and usable, nurse scientists need to research in F.S. Downs & J.W. Fleming MELEIS, A.I. 1990. Being and becoming build on colleague’s as well as their own (eds) Issues in nursing research 67-89. New healthy: The care of nursing knowledge. research. They need to generate multiple York: Appleton-Century Crofts. Nursing Science Quarterly 3 (n o . 3): studies in specific content areas and they need 107-114. to publicise, criticise and question ideas and to DUFFY, M.E. 1987. Methodological strive to extend each others endeavours. They triangulation: A for merging MERTON, R.K. 1979. The sociology of need to keep in step with developments in the quantitative and science: An episodic memoir. Cartondale: and their subject area as methods. Image 19 (no.2): 130-132. Southern Illinois. University Press. well as to maintain strong relationships with EINSTEIN, A. 1950. Out of my later years. MOCCIA, P. 1988. A critique of compromise: interdisciplinary colleagues in relevant fields. New York: Philosophical library. Beyond the methods debate. Advances in Above all they need to ensure that the science Nursing Science 10 (no. 4): 1-9. of nursing is rel levant to the art of nursing. FAWCETT, J. 1984. The metaparadigm of nursing: Present status and future MOODY, L.E. 1990. Advancing Nursing REFERENCES refinements. Image 16 (no. 2): 84-87. Science through Research. Vol. 1. Newbury Park: Sage Publications. ABDELLAH, F.G. 1969. The nature of nursing FIELD, P.A. AND MORSE, J. 1985. Nursing science. Nursing Research 18 (no.5): Research: The application of qualitative MUNHALL, P.L. AND OILER, CJ. 1986. 393-399. approaches. Rockville, M.D. Aspen Nursing Research: A qualitative ALLEN, D.G. 1987. The social policy Systems. perspective. Norwalk/Connecticut: statement: A reappraisal. Advances in Appleton Century Croft. GORTNER, S. (ed). 1987. Nursing science Nursing Science 10(no.l): 39-48. methods: A reader. San Francisco: MURPHY, S. AND HOEFFER, B. 1983. Role AMERICAN NURSES ASSOCIATION. 1980. University of California. of the specialities in nursing science. Nursing: A social policy statement. Kansas Advances in Nursing Science 5 (no. 4): GORTNER S.R. AND SCHULTZ, P.R. 1988. City M.O.: ANA 31-39. Approaches to nursing science methods. 3ARBER, B. 1952. Science anti the Social Image 20 (no. 1): 22-27. NEWMAN, M.A. 1986. Health as Expanding Order. New York: Collies. Consciousness. St. Louis: Mosby. GORTNER, S.R. 1990. Nursing values and BECKWICK, J. AND MILLER, L. 1976. science: Toward a science philosophy. NEWMAN, M.A. 1991. Health • Behind the mask of objective science. The Image 22 (no. 2): 101-105. conceptualisations and related research. Sciences 16: 16-19. Anm al Review of Nursing Research 1991: GREENE, J. 1979. Science, nursing and 9. BENNER, P. AND WRUBEL, J. 1989. The nursing science: A conceptual analysis. Primacy of Caring. Menlo Park. Advances in Nursing Science 2 (no. 4): NEWMAN, M.A., SIME, M. AND California: Addison-Wesley. 57-64. CORCORAN-PERRY, S.A. 1991. The focus of the discipline of nursing. Advances BOTES, A. 1991. ’n Funksionele HARRISON, A.J. 1984. Science, in Nursing Science. 14 (no. 1): 1-6. denkbenadering in die verpleegkunde. and . Science: 223-543. Curationis. 14 (no. 1): 19-23. NIGHTINGALE, F. Reprint 1969. Notes on HINSHAW, A.S. 1989. Nursing science: The nursing: What it is and what it is not. New BOTTORF, J.L. 1991. Nursing: A practical challenges to develop knowledge. Nursing York: Dover Publications. science of caring. Advances in Nursing Science Quarterly 2 (no. 4): 162-171. Science 14 (no. 1): 26-39. NORBECK, J.S. 1987. In defense of JACOBS, M. AND HUETHER, S. 1978. empiricism. Image 19 (no. 1): 28-30. BRONOWSKI, J. 1965. Science and Human Nursing science: The theory practice Values. New York: Julia Messner. linkage. Advances in Nursing Science 1 (no. NORDIC NURSES FEDERATION. 1987. CARPER, B.A. 1978. Fundamental patterns of 1): 63-73. Ethical guideli nes for nursi ng research i n the Nordic countries. Aurskog, Norway: knowing in nursing. Advaitces in Nursing JACOX, A. 1974. Theory construction in Printing Data Center. Science 1 (no. 1): 13-23. nursing: An overview. Nursing Research CHINN, P.L. 1985. Debunking myths in 12: (no. 1): 6-8. OREM, D.E. 1988. The form of nursing nursing theory and research. Image 17 (no. science. Nursing Science Quarterly 1 9no. JENNINGS, B.M. 1987. Nursing theory 2): 75-79. 2): 45-49. development, successes and challenges. CHINN, P.L. & JACOBS, M.K. 1987. Theory Journal of Advanced Nursing 12: (no. PACKARD, S.A. AND POLIFRONI, C. 1991. aiulNursing. 2nd Edition. St Louis: Mosby. l):63-69. The dilemma of nursing science: Current quandaries and lack of direction. Nursing KERLINGER, F. 1973. Foundations of CLARKE, P.N. AND YAROS, P.S. 1988. Science Quarterly 4 (no. 1): 7-13. Commentary: Transitions to new Behavioural Research. N.Y.: Holt, Rinehart methodologies in nursing science. Nursing & Winston. PARSE, P.R. 1981. Man-living-hcalth: A Science Quarterly 3:147-151. theory of nursing. New York: Wiley. KLEMKE, E.D., HOLLINGER, R. AND DE GROOT, H. 1988. Scientific enquiry in KLINE, A.D. 1980. Introductory readings PARSE R. 1987. Nursing Science: Major nursing: A model for a new age. Advances in the Philosophy of Science. Buffalo: paradigms, theories and critiques. in Nursing Science 10 (no. 3): 1-21. Prometheus. Philadelphia: W.B. Saunders.

Curationis, Vol. 15, No. 2, 1992 17 PENDER, N.J. 1987. Health promotion in SARNECKI, M.T. 1990. : A science. 2nd edition. Washington. D.C: nursing practice. Norwalk/Connecticut: legitimate research methodology for University Press of America. Appleton-Lange. nursing. Ach’ances in Nursing Science 12 WATSON, J. 1981. Nursing’s scientific quest. (no. 4): 1-9. PHILLIPS, J R. 1988. Research Blenders. Nursing Outlook. 29 (no. 7): 413-416. Nursing Science Quarterly. 1: (no. 1): 4-6. SCHLOTFELD, R.M. 1988. Structuring WATSON, J. 1985. Nursing: The philosophy nursing knowledge: A priority for creating and science of caring. Boulder: Colarado POLKINGHORNE, D. 1983. Methodology for nursing’s future. Nursing Science Quarterly Associated University Press. the human scienccs: Systems of enquiry. 1 (no. 1): 35-38. Albany: New York State, University of VAN MANEN, M. 1990. Researching lived SILVA, M.C. 1977. Philosophy, science, New York Press. experience. New York: The State theory: Interrelation-ships and implications University of New York. PORTER, E.J. 1989. The for nursing research. Image 9 (no. 3): 59-63. qualitative-quantitative dualism. Image 21 YURA, H. AND TORRES C. 1975. Today’s SILVA, M.S. AND ROTHBART, D. 1984. An (no. 2): 98-102. with the analysis of changing trends in philosophies baccalaureate nursing programs. (N.L.N. RODGERS, B.L. 1991. Deconstructing the of science on nursing theory development Publication No. 15-1558 pp. 17-75). New dogma in nursing knowledge and practice. and testing. Advances in Nursing Science 6 York: National League for Nursing. Image 23 (no. 3): 177-181. (no. 2): 1-13.

ROGERS, M.E. 1988. Nursing Science and art: SMITH, M.J. 1988. Perspectives on nursing A perspective. Nursing Science Quarterly 1 science. Nursing Science Quarterly. 1 (no. (no. 3): 99-102. 3): 80-85.

ROYAL COLLEGE OF NURSING 1987. In STORER, N.W. 1966. The social system of pursuit of excellence. A position statement science. New York: Holt, Rinehart, on nursing. London: RCN. Winston. SUPPE, F. 1977. The structure of scientific RUDNER, R.S. 1966. Philosophy of social theories. 2nd edition. Chicago: University science. Englewood Cliffs: N.J. of Illinois. Prentice-Hall. TOULMIN, S. 1972. Human understanding. Hilla Brink D Lilt, et Phil. R.N. RM. R.T. SANC. 1988. Guidelines for the course R.NA. R.C.H.N. Princeton: Princeton University. leading to registration as a nurse (general, Professor in Nursing Science psychiatric and community) and midwife WALLACE, W.A. 1983. From a realist point University of South Africa 55/M88. Pretoria: SANC. of view. Essays on the philosophy of Pretoria.

18 Curationis, Vol. 15, No. 2, 1992