Nursing Science

The Philosophy of Science from a Nursing-Scientific Perspective

Barbro Gustafsson, RNT; PhD, university senior lecturer,Karolinska Institute, Department o f Nursing and Department o f Public Health Sciences, Stockholm,

Sweden

The purpose o f this article concerning philosophy o f science is to increase fam iliarity with different traditions o f science and theories o f knowledge viewed from a nursing-scientific perspective. The science o f sciences is seen as a philosophical discipline fo r investigating fundam ental questions concerning methodology and theory-development. Our fundam ental assumptions in basic nursing science are the view o f human being and the conception o f health. These assumptions have consequences with regard to how nursing research shall be performed, which questions we regard as research questions, what we consider is relevant research, our choice o f methodology, and what we consider is the substantial contribution o f nursing knowledge in the nursing theories. The discipline o f nursing is viewed as an autonomous science with its own theoretical perspective 'good nursing ', with practicable scientific methods and with practicable nursing theories developedfrom its own fie ld and with its own scientific ideal. A health conception without any reference to disease is the foundation fo r nursing science understood as an autonomous science.

Keywords: philosophy o f science, discipline o f nursing, ontology, epistemology, methodology.Reprint - previously published in Theoria, Journal o f Nursing Theory, 2002, (2), 3-13.

I. Introduction and aim1. Scientific exploration

SCIENTIFIC WORK IS A question o f investigating the nature o f phenomena and how such phenomena are

related to each other, which involves finding out the nature o f every possible w ay in which these can be described, understood and explained (Kjorup, 1999; Newton-Smith, 2000). A ll scientific w ork is born out o f curiosity, and research is basically about m aking discoveries. To discover may imply demonstrating new, not earlier known phenomena or deepening knowledge and understanding o f familiar phenomena (Taylor, 1978; von Wright, 1975).

The prim ary goal o f science includes truth, simplicity and explanatory pow er (Newton-Sm ith, 2000). W ithin the nursing area it is a question o f understanding the unique person 's m eaning-field, for exam ple o f living with chronic illness.

The scientific investigation is done on the basis o f different norm s, beliefs and values, w ith specific dem ands that involve com plying w ith specific criteria o f reliability and authenticity (M olander, 1988). M any researchers have strongly stressed that the aim o f scientific work is

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Nursing Scienceto explain phenomena and that scientists create theories for the purpose o f explanation. According to Kvernbekk (1994, p. 29) “theories are applied to the real systems for a variety o f purposes: for instance description, prediction and explanation o f phenomena, testing o f theory - and modification o f the world.” Within nursing science nursing theories are developed for explaining different types of data, both subjective and objective, which are considered as relevant for the developm ent o f knowledge within nursing (G ustafsson and A ndersson 2001a; Pörn and Gustafsson, 2002). ‘Good nursing’ could be looked upon as the theoretical perspective o f nursing research, which implies that nursing research has as scientific ideal “being better able to m eet the requirements o f persons who seek nursing through the m apping out o f nursing actions which result in good nursing” (G ustafsson, Pörn and Norberg, 1993, p. 10). Different forms o f knowledge such as knowledge involving judgement, meaning and virtue can be elucidated for attaining this goal (Pörn, 1990). (Cf Benner's (1984), C arper's (1978), Sarvim äki's (1988) systematization o f forms o f nursing knowledge).

2. Theory-building in nursingThe development o f theories has importance for articula­tion o f the discipline o f nursing, for providing descriptions

o f how to support patients' health and well-being, and for offering a common language for different views and philosophical underpinnings in nursing. The purpose of theory-building in nursing is to provide a substantial knowledge basis for the discipline o f nursing involving system atic developm en t from d ifferen t fram ew orks involving respectively facts (Fawcett, 1995;Meleis, 1997; Rooke, 1997). This substantial contribution o f nursing knowledge could be understood as related to three levels o f know ledge according to “T he-N ine-F ield-M odel” elaborated by Gustafsson and Andersson (2001a), inspired by W ulff, Pedersen and Rosengren (1990, pp. 40-45) and A ristotle's virtues o f knowledge (Flyvbjerg, 1994). On the scientific level it is a question of ‘theories o f ’ (scientific maps) and knowledge o f episteme type, on the technological level it is a question o f ‘theories for’ (means and methods) and knowledge o f techne type, and on the technical level it is a question o f ‘theories in ’ (skills and techniques) and knowledge o fphronesis type (Gustafsson,1996). The scientific level concerns basic nursing research with ‘knowing what’ and ‘knowing why’-questions, the technological level clinical nursing research with ‘knowing how’-questions and the technical level concerns clinical practice with ‘knowing that’-questions (cf Suppe, 1977) (for an overview, see Table 1).

Table I. The development o f nursing knowledge in nursing theories (Modification o f original model in Gustafsson and Andersson, 2001a, p. 14).

LEVELS QUESTIONS THEORIES VIRTUE OF KNOWLEDGE

S a s ic nu rs in g r e s e a r c hthe scientific level ’knowing w hat’ and ’theories o f’ episteme type

’knowing w hy’ questions

N ursing r e s e a r c hthe technological level ’knowing how’-questions ’theories fo r’ techne type

N ursing p r a c t i c ethe technical level ’knowing that’-questions ’theories in ’ phronesis type

The developm ent o f nursing know ledge starts a t all levels based on models, whose characteristics are given by defin itions and rela tions betw een these, and the theories make use o f the models for the development of hypotheses (Giere, 1984; Hausman, 1981; Pörn, 1985).

The developm ent o f a discipline is closely related to the generation o f theories and m odels out o f its own field o f knowledge. The purpose o f nursing theories is to give guiding principles for good nursing (Kirkcvold, 2000).

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Rooke (1997) has found that the development o f nursing knowledge in Sweden successfully could be interpreted in relation to Henderson's fourteen needs. Nursing research (Heyman, 1995; Rinell Hermansson, 1993; 1999) could, in relation to “The N ine-F ield-M odel”, belong to the technological level with classification o f nursing actions and to the technical level with use o f the nursing process and the hermeneutic circle for understanding the patient as a unique human being. But there is also a lot o f concept- and theory-building, i.e. basic nursing research, going on. Rooke (1997) has pointed out that the SAUC model for confirm ing nursing developed by G ustafsson and Pörn (1994; G ustafsson 2000) has contributed to the developm ent o f the d iscip line o f nursing in Sweden (cf Willman and Stoltz, 2002). The model has given a theoretical framework and identity to the discipline o f nursing. Willman and Stoltz (2002) have analyzed Swedish nursing science both from a natural science and human science approach and found that the development today is moving to a development based on human science.

3. The science o f nursingThe m ultip lic ity o f science w hich w e have today is characterised by a gradual process in which new and often highly specialized sciences are established (Newton- Sm ith, 2000). A science o f a m ore recent date is the science o f nursing (Fawcett, 1995; Meleis, 1997; Pörn, 1984). The purpose o f nursing research is to contribute to a humanistic and wholeness-directed nursing through an increased understanding o f the hum an being and her experiential m eaning o f her present life-situation (Barrett, 2002). In this way nursing science is clearly defined against traditional medicine. Gustafsson, Pörn and Norberg (1993) have done an agent-causal interpretation o f the concept o f care. This definition emanated from care actions which result in improvement or which prevent deterioration or preserve the status quo in the region of hum an good in term s o f health, adequacy, well-being o r m eaningful life. N ursing is defined as care on the person level. The nursing actions are complex and involve emotional, attitudinal and epistemic categories and are in the nursing theories spelled out in different ways.

The aim o f this article is to increase fam iliarity with different traditions o f science and theories o f knowledge v iew ed from a n u rs in g -sc ie n tif ic p e rsp ec tiv e . The p h ilo sophy o f sc ience has specia l re fe ren ce to the philosophy o f nursing and involves a ph ilosophical analysis o f the nature, conditions and status o f scientific knowledge.

Nursing ScienceII. The philosophy o f science/. The science o f sciencesThe philosophy o f science may be regarded as a branch o f the science o f sciences; the latter is broad in its scope. In this extensive sense the science o f sciences includes for example the history o f science and the sociology of science (Rosing, 1991; Wallén, 1996). An essential sub­discipline within the science o f sciences is philosophical in nature. As a matter o f fact the science o f sciences is patterned on the philosophy o f science. The science of sciences has been defined as a philosophical discipline which investigates fundam ental questions concerning m ethodology and theory-developm ent (M arc-W ogau, 1967; N ew ton-Sm ith, 2000). By that is m eant partly a ph ilo soph ica l ana ly sis o f the concep ts w hich are common to all sciences, partly a philosophical analysis o f standpoints and prerequisites in particular sciences or fam ilies o f sciences, fo r exam ple the philosophy o f social science or the philosophy o f nursing science (Pörn, 1984; 1985). The standpoints in particular sciences are often the basic research. The philosophy o f science seeks to understand the aim, methods, tools and products o f sc ience (B arbosa da S ilva and A ndersson , 1993; Newton-Smith, 2000).

2. Basic nursing researchAccording to Niiniluoto (1993, p. 3) “the primary task of basic science is cognitive: the so far best results o f science give us elements o f a dynamically developing worldview. Knowledge about the current state and the regularities o f the world also allows us to explain and understand reality.” Basic research within nursing research takes into account the problems concerning views o f human being. The different views presuppose different theories o f the nature o f hum an being. The perspective w e choose is o f importance for how the conception o f health will be spelled out, involving what we consider nursing is and how good nursing ought to be manifested, and regarding which characteristics are desirable for a good caregiver (G ustafsson, 2000). The view o f w hat good nursing and a good caregiver is can be the basis o f policies and guidelines for nursing practice (Kirkevold, 2000).

The nature o f human beings may for example be spelled out in the fo llow ing way, bu t it seem s im portan t to point out that the views o f human nature (ontological assumptions; see Gustafsson, Pörn and Norberg, 1993, p. 8) often are different kinds o f combination or development o f a view , and no t so c lea rly spelled o u t as in th is presentation, (i) The mechanical and materialistic view oj

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Nursing Sciencehuman nature is based on the approach o f natural sciences including behaviorism. This includes the conception o f the human being as a biological creature with her system and apparatus attributes (categorical assumptions) in focus concerning human development. These attributes can be m anipulated (Kjorup, 1999; Hospers, 1987; Wedberg, 1966). The understanding o f the hum an being sought by a reductionistic method which implies that the parts constitute the whole, (ii) The mechanical and idealistic view o f human nature is based on a hum an-scientific approach and the human being is seen as a religious being with her spiritual attributes (categorical assumptions) in focus concerning human development. Some o f the traits o f character and salient features are inherited and run in families. The human being may be understood from a religious view as a “marionette” guided, directed and governed by the god, deity, divinity, (iii) According to the dialectical and materialistic view o f human nature based on a social-scientific approach the human being's consciousness is determined by material circumstances (categorical assum ptions) such as social class, culture and the oppositions between different material entities, which influence the human being and contribute to human developm ent and occur in relation to different factors in society (e f Andersson, 1997). (iv) In the dialectical and idealistic view o f human nature based on human science the subject is assigned a crucial role, with subject entities such as intentions, plans, projects, motives, wills, desires, abilities, reflections, environm ent (categorical assumptions) with the acting and reflecting attributes in focus concerning human development. Self-consciousness originates from the reflections we have o f our actions and o f ourselves in other human beings (Jacobs, 1989). The human developm ent may be understood as an infinite chain o f interactions, and this developm ent is coupled with the oppositions which are in the m ental entities such as thoughts, em otions, feelings and perceptions (H ospers, 1987; M arc-W ogau, 1967). The view s o f human nature could also be understood in a framework of reductionalization and personalization.

It is apparent that the problems concerning the view o f human being concern basic nursing research (Fawcett, 1995; Meleis, 1997). The view o f human being is related to what are considered as beneficial properties in nursing. For exam ple, if the hum an being is understood as an acting subject with the ability to initiate actions based on her own ideality, good nursing practice has to contribute to pa tien ts ' increased possib ilities o f self-realization linked to their own ideality (Pörn and Gustafsson, 2002).

I f mental entities are in focus the enhancement o f patients' consciouness by different means and methods is related to good nursing practice.

3. The philosophy o f science and epistemologyThe philosophy o f science, as a philosophical discipline, interfaces with the theoiy o f knowledge in philosophy, also designated epistemology (Molander, 1993; Nordenfeit, 1982; W edberg, 1966). E p istem io logy is described generally as the doctrine o f the sources, reliability and boundaries o f human knowledge. In the light o f this we can say that the science o f sciences in relation to epistemology is concen tra ted on scien tific o rgan ized know ledge. For exam ple, the question concerning sensations and perceptions as a source o f reliable knowledge belongs to the general epistemiology, but questions concerning sen­sations and perceptions for the development o f scientific knowledge belong to the science o f sciences. Another example that nursing science as practical/empirical know­ledge, transferred from ‘m aster’ to ‘apprentice’, handed down from one caregiver generation to another, belongs to general epistem ology, but the scientific/theoretical know ledge be longs to the sc ience o f sc iences. The rela tionsh ip betw een an em pirical and a theoretical discipline belongs also to the latter. Pörn (1984) states that nursing science is both an empirical and a theoretical discipline (c f Benner, 1984; Carper, 1978). Sarvimäki (1988) means that nursing is viewed as a manifestation o f a conception o f the good life, and therefore nursing is a moral, practical, communicative and creative activity.

4. The philosophy o f nursingThe philosophy o f nursing science includes the basic research, the standpoints for this particular science with its own special features, its own theoretical perspective spelled out as ‘good nursing’ and its own scientific ideal: a wish “being better able to meet the requirem ents o f persons who seek nursing through the m apping out o f nursing actions which result in good nursing” (Gustafsson, Pörn and Norberg, 1993, p. 10). The discipline o f nursing can be divided in the following sub-disciplines: nursing philosophy, nursing history, nursing metaphysics, nursing knowledge theories, nursing logic, nursing epistemology, nursing methodology (methods used in nursing practice), nursing ethics, and nursing aesthetics. In the curriculum building in nursing science I feel it important to stress that the sub-disciplines are a central basis for students' deve­lopment o f nursing knowledge to become a “competent and reflective practitioner” in order to m anifest “good nursing” based on the real complexity and individuality in

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the life-worlds o f human beings. Cody (2001) stresses the importance o f and demands that nurses shall articulate nursing as a distinct discipline with philosophies, goals, theories and methods in education (c f Willman, 2000).

III. Views o f knowledgeThe different views o f knowledge can be differentiated on the basis o f how they are connected to: (i) the source o f know ledge (rationalism and em piricism ), (ii) the reliability o f knowledge (reality and consciousness), and (iii) the boundaries o f knowledge (evidence and claim to knowledge).

1.The source o f knowledgeFirstly, the source o f knowledge has the relation between rationalism and em piricism as the basis o f division (H ospers, 1987; W edberg, 1966). W ith reference to the source o f know ledge we have tw o w ell-defined positions: (i) The ra tionalists consider that logical- conceptual thinking, with given numerical systems, based on theoretical analysis is the m ost important source o f knowledge and their methodical ideals are deductions (Follesdal, Walloe and Elster, 1993; Nordenfeit, 1982). (ii) The empiricists argue that knowledge is based on human experiences and that the concepts, the meaning o f words, are reflections o f observations, the sensory impressions are the real research object (Molander, 1993). The aim o f traditional epistem iology w as to defend science against sceptical doubts by showing how it can be derived from a secure foundation - for example, from clear and distinct ideas (rationalism) or from immediate sensory evidence (empiricism) (Newton-Smith, 2000). In the Western countries magical-spiritual thinking has been replaced by scientific thinking, but for many persons with other cultural backgrounds the magical-spiritual thinking can have m ore influence for their own experiences o f health and unhealth.

The source o f knowledge can also be divided in terms o f ‘a p rio ri’ and ‘a posterio ri’ know ledge (H ospers, 1987; Wedberg, 1966). By knowledge ‘a priori’ is meant knowledge that is independent o f our experiences, for example 2 + 2 = 4, that every cause has an effect and that every thing has an extension. By know ledge ‘a posteriori’ is meant knowledge that is dependent on our experiences, for example that “All nurses on this ward are confirming.”

2. The reliability o f knowledgeSecondly, the reliability o f knowledge has the relation

Nursing Sciencebetween reality and consciousness as the basis o f division (W edberg, 1966). W ith reference to the re liab ility of knowledge we have two focus concerning development of knowledge: (i) realism, reality and the material world, and(ii) idealism, consciousness and the immaterial world. The realism and idealism depends on whether or not there is a reality which is dependent on a “knowledge-searching” subject. For exam ple, the proponents o f m aterialism argue that existence is material. From that stand-point rea lity governs w hat we a re th ink ing . A ccord ing to that m echanical and material view the developm ent of existence occurs passively by different processes. I f the essence o f existence is immaterial, idealistic, our thoughts govern reality. In relation to idealism the development o f ex istence is active. D ialectic is a question o f the development o f thought and existence that occurs through oppositions, tensions betw een d ifferen t interests and opinions, i.e. a play o f contrasts (cf Andersson, 1997). The reliability in the development o f knowledge in different nursing theo ries is based both on a m ateria l and an immaterial perspective.

3. The boundaries o f knowledge Thirdly, the boundaries o f knowledge have the relation between evidence and claim to knowledge as the basis of division (Pörn 1985; Wedberg, 1966). Here we have a lot o f different scientific views when it comes to justification o f the development o f knowledge and beliefs. For example, scepticism , dogm atism , apriorism , vcrificationism and red u c tio n ism (K jo rup , 1999; N ew ton-S m ith , 2000; Wedberg, 1966).

A ccording to scepticism the uniform observation o f a limited/finite number o f different cases does not provide sufficient evidence for generalization. For example, from the observation that “ All patients I have met have felt confirmed,” the conclusion cannot be that “All patients w ho receive care have been confirm ed.” The sceptic considers that the evidence o f our senses and memories never can contribute to reliability. On the contrary, sceptics consider it can be a question o f accidental occurences which influence the result. The dogmatist considers that the reliability o f know ledge can be based on regular, uniform knowledge. The apriorist considers that evidence is definitive because there is an overriding principle which has reference to nature's uniformity, i.e. that it is correct to move from limited observations to an open class, for example, that “All patients who receive care have been confirmed.” The apriorist says that wc have the right to generalize. The verificationist considers it is a question

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Nursing Scienceo f hypotheses, which is to say that “All patients who receive care have been confirmed” is a hypothesis which has to be proved by evidence before it can be accepted (cf Follesdal, Walloe and Elster, 1993). By use o f theoretical constructs, for example nursing theories, this hypothesis can also be given a specification and theoretical reliability. Fawcett et.al. (2002) argue that different kinds o f nursing theo ries prov ide d ifferen t lenses fo r c ritiq u in g and in terpreting the different kinds o f evidence essential for theory-guided, evidence-based holistic nursing (cf W illman and Stoltz, 2002b). The reductionist answers questions concerning evidence from the starting point that different behaviours can be interpreted as reflecting the individual's mental state and there is thus a connection between m ental state and behaviours. A m ental state is defined by reductionism as a pattern o f behaviours which can be observed. The term “holism” refers to a variety o f positions which have in common a resistance to understand ing larger un ities as m erely the parts without treating them as belonging to such larger wholes (Newton-Smith, 2000).

Edw ards (2001, p. 9) po in ts out the fo llow ing three problem s concerning nursing know ledge: “ First, the problem o f establishing a criterion for knowledge, for example, in order to distinguish knowledge from belief. Second, the problem relating to sources o f knowledge, for example, can the senses or reason, or intuition provide knowledge? And third, can we distinguish differing types o f know ledge, for exam ple practical and theoretical knowledge, moral, aesthetic and others?”

IV. The scientific paradigm1. The perspectives on scientific work In the same way that we within general epistemiology can distinguish different views o f knowledge - such as rationalism and empiricism (the source o f knowledge), reality and consciousness (the reliability o f knowledge), and evidence and claim to knowledge (the boundaries o f knowledge) - we can within the science o f sciences d istinguish different ways o f looking upon scientific work often verbalized in terms o f (i) positivism (natural science and quantita tive data) and (ii) herm eneutics (human science and qualitative data) including meaning interpretation (Follesdal, W alloe and Elster, 1993). In this context we often talk about paradigms. A paradigm is often defined as a set o f norms and ideas which in a certain research comm unity influence the researchers’ notions o f what the research shall be about, and how it shall be done (Kjorup, 1999; Nordenfelt, 1982). Kuhn

(1962) suggested tha t the defin ing ch arac te ris tic o f a scientific tradition is its “ com m itm ent” to a shared “paradigm.” A paradigm is “the source o f the methods, problem -field, and standards o f solution accepted by m ature scien tific com m unity at any g iven tim e” (p. 102). W hen questions arise in this connection, it is o f interest to note (i) the way o f asking the questions, (ii) the way o f answering them, and (iii) the consequences o f the answers.

(i) A ccord ing to p o sitiv ism scien tific w ork is about m easurable and quantita tive data and the ideal is to elaborate theories as mathematical connections between such data (Newton-Smith, 2000). The theories are also in a further sense expected to be used in causal explanations (W allén, 1996). T his scientific trad ition tries to get answers to ‘W hy-questions’. This positivistic scientific ideal has its ‘home base’ in natural science. Positivism involved»originally knowledge which is real, true, useful, secure, precise and positive (Molander, 1988). This true, positive knowledge is designed to discover laws which govern phenomena and facts, and to detect permanent relationships prevailing between these.

(ii) In the herm eneutic tradition scientific w ork will become interesting when it is based on qualitative data, for example texts, and when the aim is to get answers to questions concerning the importance, understanding and experiential m eaning o f data (Taylor, 1978). The theories shall be, according to the herm eneutic view, useful for essence explanations, w hich are based on ‘W hat-questions’ (Gustafsson and Andersson, 2001a). The hermeneutic scientific ideal belongs to human science. For this knowledge to be designated as scientific knowledge, its development must be based on certain assumptions and follow certain accepted principles and methods.

In hermeneutics I also include postmodernism in nursing, which does not accept the “natural scientific narratives” but has a desire to create own narratives based on a person and holistic perspective o f hum an being and thereby recreate the lost identity in nursing. Postm odernism in nursing also has a will to create debates by asking questions that are taken for granted (Bumard, 1999). The postmodern analysis o f narratives about different nursing problems does not focus on facts, but on the hidden and concealed, and the complexity in the narratives. When the narratives are deconstructed possibilities open up for new insights in nursing practice and new questions may be asked (M cA llister, 2 0 0 1; Robinson Wolfe, Lagner

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and Jeffersson, 2000). The development o f the concept o f caring has in a sim ilar way, within postmodernism in nursing, desired to alienate from natural sciences and also to detect new methods and new definitions, which are not related to positivism (Kikuchi and Simmons, 1992).

2. Scientific methodologyIn the case o f scientific exploration the demand is to use the right methodology in relation to the phenomenon which shall be investigated. Q uantitative research m ethods, which focus on m easuring, describing and explaining phenomena, are used within positivism (Follesdal, Walloe and Elster, 1993; Kjorup, 1999). The qualitative research methods w ithin the hermeneutic tradition are used for mapping, interpretation and understanding o f phenomena by m eans o f verbal descrip tion and textual analysis (Palmer, 1988). The demands concerning reliability and validity in scientific methods, techniques and instruments o f measurement in qualitative research are as rigorous as in quantitative research.

The scientific conclusions are divided into deductive and inductive (Toulmin, 1964). (i) The deductive research way is about derivations, because the purpose is to prove that the assumptions, the hypotheses, are deduced from the chosen theory and are true or false. It is a question o f verification or falsification. By verification is meant that hypotheses agree with reality by falsification is m eant that they do not. Falsification is im portant in all scientific work. Gustafsson and Andersson (2001a) argue that falcification is central in the development o f nursing theories. It has to be possible to falsify such theories, otherwise there can be problems, for example “The circularity o f descriptions and explanations makes it difficult to follow the theory's logic” (Kirkevold, 2000, p. 227). The deductive way is from theory to reality. Within positivism the hypothetical-deductive method is intended for creating connection explanations, often causal, i.e. ‘cause - effect’ explanations. But the same method can be used within the hermeneutic tradition in order to create essence explanations o f meaning-bearing texts (Follesdal, Walloe and Elster, 1993; Rosing, 1999).

The research methods in the (ii) inductive approch way have not had the sam e prom inent position as in the deductive approach, but there has always been the same demand that the work shall be regarded as scientific. The credibility in the presentation o f the research results has to be based on intelligible language and the different stages in the interpretation and analysis o f data have to

Nursing Sciencebe clearly shown (Follesdal, Walloe and Elster, 1993). By induction is meant that the starting-point is based on reality, which may result in theory-building. The reliability o f knowledge is closely related to the scientific methods used w ith in a field o f know ledge. The quan itita tive methods with large volume o f data have often been found to have a high reliability.

The researcher’s pre-understanding has also been discus­sed. For example, are there scientific research methods where the researcher’s pre-understanding is ‘bracketed’ (Kjorup, 1999) and thereby not influence the research results? Is the research dependent or independent o f the researcher? In that nurses entered the research community a new knowledge-seeking started within care, with the focus on exploration o f patients’ meaning-field and world o f experiences and with interest in acquiring wholeness- c re a tin g kn o w led g e based on d iffe re n t q u a lita tiv e m ethods (H eym an, 1995; R inell H erm ansson, 1993; 1999; Rooke, 1997; W illman and Stoltz, 2002a). This individual-specific knowledge basis is seen as important fo r m an ifesting nu rsing w hich suppo rts pa tien ts as resourceful individuals.

The question also concerns i f the results w ithin nursing research are representative and generalizable. For example, can individual-specific data be used for generalization and can general data be used for individualization? Is there in nursing research a main interest in trying to find general laws for nursing, a ‘generalized nursing’, i.e. a nomotetic nursing practice? O r is the main purpose to try to develop knowledge with the goal o f ‘individualized nursing’, i.e. an idiographic nursing practice? For these questions the directions have to be based on nursing science’s own theoretical perspective ‘good nursing’ and on the fact that nursing research has in its scientific ideal a w ish “being better able to m eet the requirem ents of persons who seek nursing through the m apping out of nursing actions which result in good nursing” (Gustafs­son, Pörn and Norberg, 1993, p. 10). Another question concerns how nursing-theoretical constructs can increase re liab ility in the developm ent o f individual-specific nursing knowledge. See Gustafsson and Willman (1999) fo r specific n u rs in g as d ise a se -d iv id e d n u rs in g or individual-divided nursing.

V. MetaphysicsI. Onto logyM etaphysics concerns the m ost fundamental questions concerning existence and existential conditions (Wedberg,

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Nursing Science1966), and trad itionally m etaphysics is regarded as the study o f w hat lies behind the world o f apparence (Newton-Sm ith, 2000). For exam ple, are there in the world only concrete things such as nurses, or are there also abstract things such as the class o f all nurses? This is a question for ontology. Pörn (1984; 1985) has described ontology as the doctrine o f the nature o f being, i.e. how existence is constitued and how things that exist can be related to each other. To this area belong questions concern ing how know ledge is related to reality and consciousness (N ew ton-Sm ith , 2000). The question whether there is a reality which is independent o f the researcher often is treated in terms o f correspondence between consciousness and reality. By epistemic realism is considered that reality is independent o f the researcher’s abilities to understand and to think. By epistemic idealism is meant that things which are real always are real for the researcher, i.e. w hat is real for the researcher is dependent on the researcher’s mental efforts and capacity to apprehend the world.

2. The view o f human being and nursing research Our fundamental assumptions concerning existence are o f importance when it comes to starting-points and concepts in the particular sciences (Pörn, 1984; 1985). One can say for example that in physics the fundamental questions and basic research concern cells and molecules, in economics products and trade, in medicine tissues and organs, in physiotherapy movements and in occupational therapy activities. In nursing science the fundamental assumption concerns the view o f human being with the concept o f the person as the most central consensus concept, because the concept o f health is built on the concept o f the person, and the concept o f nursing on the concept o f health (Gustafsson and Pörn, 1994; 2U02).

Often attention is paid to the role o f the view o f human nature in respect o f the design o f nursing and valuations in different systems within health care (Barbosa da Silva and Andersson, 1993). This discussion seems to have played as great role in scientific discussion about the conceptual foundations o f health and nursing (Fawcett, 1995). Since the concept o f the person has a central position, the view o f human being and the consequences o f this for nursing constitute an important factor in the study o f the foundations o f nursing science (Gustafsson, 1996).

Our basic assumptions about existence also have conse­quences with regard to how nursing research shall be performed. This is, for example, connected with questions

about w hat w e regard as nursing research problem s and nursing research questions, w hat we consider are relevant research questions within nursing, which o f these problems we consider possible to investigate and whether there is clarity and lack o f ambiguity in relation to the problem in question (Follesdal, Walloe and Elster, 1993). At different departments o f nursing within universities, different nursing research questions are asked and thereby different research interests and areas are in focus (Heyman, 1995; Rinell Herm ansson, 1993; 1999; Rooke, 1997; Willman and Stoltz, 2002a).

3. The view o f human being and nursing theories The developm ent o f nursing theories and thereby the development o f nursing knowledge is based on different scientific perspectives and views o f human being. Some examples o f these are (i) the reductionistic view o f the human being as a biological creature (cf the mechanical and materialistic view of human nature), (ii) the action- theoretic view o f the human being as an acting subject (c f the dialectical and idealistic view o f human nature),(iii) the ideal-relativistic view with the human being as a mental being (c f the dialectical and idealistic view o f human nature), (iv) the religious view o f the human being as a spiritual being (c f the mechanical and idealistic view o f human nature), and (v) the cultural view o f the human being as a cultural being (c f dialectical and materialistic human nature).

I suggest that the nursing theories may be systematized in term s o f these perspectives on hum an being. For example:(i) th e need, a c tiv itie s a n d b eh a v io ra l m odels can be understood from a theo ry -bu ild ing based on the reduction istic view o f hum an being as the basis for hum an developm ent and “good nursing,” for example H enderson’s “ D efinition o f N ursing ,” N ig h tin g a le ’s “Modern Nursing,” Roper’s, Logan’s and Tierney’s “A Model o f Nursing based on Model o f Living” (Marriner Tomey and Raile Alligood, 1998), (ii) the interaction, self-relation and self-care models from an action-theoretic view o f human being as the basis for human development and “good nursing”, for example Gustafsson’s and Pörn’s “ SAUC Model for Confirm ing N ursing” (Gustafsson, 2000), K ing’s “Theory o f Goal-Attainment” and Orem ’s “Self-Care Theory o f Nursing,” (iii) the human becoming models from an ideal-relativistic view o f human being as the basis for human development and “good nursing,” fo r exam p le P a rse ’s “H um an B eco m in g ,” R o g e r’s “Unitary Human Beings,” Travelbee’s “Human-to-Human

38 Theoria, Journal o f Nursing Theory. 2006, 15(4)

R elationship M odel” and W atson’s “Philosophy and Science o f Caring,” (iv) the interdependence models from a religious view o f human being as the basis for human development and “good nursing”, for example M artinsen’s “Caring M odel” and Eriksson’s “Caritative Nursing Model” (Kirkevold, 2000), and (v) the cultural models from a cultural view o f human being as the basis for human development and “good nursing,” for example Leininger’s “Culture Care: Diversity and Universality Model.”

The beneficial properties o f nursing theories are based on the scientific perspective and the view o f human being. Also the cultural contexts and laws influence in different w ays w hich qualities w ill be focused on in nursing theories. In Western countries the subject view o f the human being and the ‘I-Thou relationship’ has influenced the theory-build ing in term s o f patienl-involvem cnt, influence, autonomy and creation o f good relationship with the patient and relatives (cf Fawcett, 1995; Meleis,1997). A m ore unifying central phenom enon could be viewed as restoration o f human dignity. The discussion today also concerns a broader approach to aesthetics, a theoretical approach to nursing aesthetics (Wainwright, 2000; c f Carper, 1978).

VI. DiscussionNursing research in Sweden is based on different research traditions, has had an empirical tradition, and has been clin ically focused, or has been based on the nursing process as structure for the development o f new knowledge (Heyman, 1995; Rinell Hermansson, 1993; 1999; Rooke, 1997; Willman and Stoltz, 2002a); also it has involved the exploration o f people’s experiences, which contributes to nursing practice based on patients’ own experiential meaning o f their situation. Today there is an increased theoretical awareness, with nursing theories as theoretical frameworks for logical-conceptual thinking which can contribu te to the developm ent o f individual-specific nursing knowledge.

N ursing know ledge prim arily concerns issues on the agency level o f the patient as emotions, desires, wills, be liefs, atti-tudes etc. (categorical assum ptions) as opposed to issues o f lower levels as cells, organs, tissues etc. (categorical assum ptions). The generalization o f nursing know ledge on agency level is possible if the com plex ity and ind iv id u a lity re la ted to the unique hum an being is taken into account and if hum anistic and wholeness-creating understanding o f individuals is

Nursing Sciencepossible. In the generalization the individual life-worlds should not be allowed to disapper or be distorted by simplification. If the generalization implies that essential elem ents in the com plex ind iv idual life-w orlds are taken into account generalization o f nursing knowledge is possible. The generalization can both be based on knowledge produced by research and biographies written by patients and relatives, but also by literary novels that can help the caregivers to support patients based on an understanding perspective, which implies that the patients are supported in self-recognition, in acquiring life-competence as unique individuals in their specific life- situation. Evidence-based nursing is one way to generalize nursing know ledge (W illman and Stoltz, 2002b). But if ev idence-based nu rsing really shall con tribu te to the improvement o f nursing quality from a person and holistic perspective, the demand is that the evidence of nursing knowledge seriously considers the complexity and individuality in the life-world o f the human being and has an understanding for humanistic and wholeness- creating process. Otherwise there is an obvious danger for simplification and reduction o f the human being.

The discipline o f nursing is today viewed as an autonomous science, related to (i) its own theoretical perspective ‘good nursing’ (ii) nursing research methods for charac­terizing the exploration o f people’s world o f experience,(iii) nursing theories for how ‘good nursing’ shall be manifested, (iv) sanction o f society, (v) own scientific com m unication, and (vi) organization in departm ents o f nursing within universities (cf Gustafsson, Pörn and Norberg, 1993; c f Pörn, 1985). Finally, it seems important to stress that the positive health conception without any link to disease is the basis for interpretation o f nursing as an autonomous science. If the health conception is linked to diseases the nursing science is seen as a complement to medicine (Gustafsson and Willman, 1999; Gustafsson and Andersson, 2001a; Pörn, 1993). Therefore the conception o f the person and the conception o f health are especially important in the philosophy o f science from a nursing- scientific perspective.

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