There is another subject of concern to those who are inquisitive about the development of knowl- edge in nursing. What criteria has nursing used to accept or reject its theoretical notions? What concepts of truth should it use in the future? When do experiences become knowledge, and when does knowledge become truth? Does reality exist or appear?
Philosophers since Plato have addressed these epistemological questions. Over the centuries, three views have emerged: correspondence, coherence, and pragmatism (Armour, 1969; Kaplan, 1964).
Correspondence Theory
Correspondence, with its careful rules, calls for sensory data, very small variables, and opera- tional definitions. For generations, this view has dominated science, research, and theory construc- tion in the physical and natural sciences. It is the method of truth on which the received or scientific view is based. Indeed, many philosophers of science consider truth by correspondence and the received view one and the same (Table 8-3). Nevertheless, the received view and truth represent
CHAPTER 8 Our Syntax: An Epistemological Analysis 151
two different processes. The received view addresses the process of research, the methodology by which data are collected and theories are developed; truth attends to examining realities, the results of the findings. Whereas the received view asks what to do to know, truth asks how to know (see Table 8-1, and Table 8-3).
Empiricists, such as Bertrand Russell, and rationalists, such as J.E. McTaggart, preferring to view truth through correspondence, have designed a set of rules and norms against which they expect theory development and research to be analyzed. The most significant norm is that of tru- ism of facts and their correspondence with their encompassing theories. One of the most signifi- cant correspondence norms is total objectivity; a separation of the observer from the observed world. Validation is based on congruence between propositions and reality. Reality means one reality, an existing reality, and not reality as it may appear to different viewers. The theorist’s role is to match the world with assertions and match the facts with concepts.
The positivists assert that correspondence truth is achieved through corroboration by verifica- tion. Popper (1959) modified the positivist view and developed the argument for falsification. He asserted that the central concept in scientific discovery is “marcation.” Demarcation criteria require that we consider a proposition scientific only if it has the potential to be falsified. Verifica- tion of the opposite statement occurs with multiple incidents of falsification of the statement through experience. Once a single falsifying instance counters a proposition, the proposition should be rejected. On the other hand, a proposition is not scientific if it does not have the poten- tial for falsification. Continuous attempts to falsify statements make the scientific process rigor- ous. Truth is achieved when we have exhausted all attempts at falsifying a proposition.
Although Popper warns against the potential for any entirely conclusive statement due to problems of reliability in testing, we nevertheless come closer to the truth by testing and retesting,
TABLE 8-3 COMPARISON OF DIFFERENT THEORIES OF TRUTH
Analytical Unit Correspondence Coherence Pragmatism Integration
Norms Corroboration Logic Experience Experience and
utility illumination
Contexts Justification Experience Discovery and Justification
justification
Goals Acceptance/rejection Support Understanding Uncovering patterns
Reality One Pattern Multiple Diversity of views
Clicks into a structure
Role of theorist Match world with Match with Match with users Openness to
assertions assertions Humanness multiplicity
Distance Involvement
Evaluation Verification Simplicity Utility Validation
Falsification Beauty Problem solving Verification
Logic Utility multiple
Process End Process Process
Validation Congruence between Endurance of Consensus of Use patterns of
propositions and ideas users understanding
reality Restructuring Number of solved
New techniques problems
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with the objective of attempting to nullify and falsify the proposition under exploration. To the correspondence theorists, whether verification or falsification is the focus, truth is achieved through sensory data and controlled experiments. The correspondence of existing reality, of facts and propositions, is the goal. No room exists for metaphysics, conceptual truths, multiple realities, or for perceptions of reality. Other problems arise when viewing truth in mainly correspondence terms. If facts exist, are not facts already affected by the concepts introduced to explain them?
There are other ways by which we can corroborate theoretical developments that may be more congruent with epistemic diversity in our discipline. The “warrantable evidence” criteria proposed by Forbes, King, Kushner, Letourneau, Myrick, and Profetto-McGrath (1999) for reviews in nursing science could be utilized for the evaluation of theoretical formulations. The
“warrants” common to pluralistic nursing scholarship are:
1. Critical scrutiny of rigor by a community of scientists 2. Use of intersubjectivity
3. Wider scope of the evidence
One approach to establishing corroboration is to use critical reflection among scholars or among participants (e.g., Gibson, 1999).
Coherence Theory
Truth through coherence differs considerably from truth through correspondence. Truth through coherence is manifested by the logical way in which relationships and judgments relate.
Whereas the norms for correspondence are verification and falsification using sensory data, the norms for coherence are an integration of relationships, simplicity of presentation, and a certain beauty of propositions (Table 8-3). When separate components of a phenomenon “suddenly fall into a pattern of relatedness, when they click into position,” then truth has been achieved (Kaplan, 1964, p. 314). Truth according to this theory endures, but perhaps in a more transitory fashion or in ways that may not be reproducible but are no less recognizable. If the proposition is sufficient for today, there is truth in it.
The coherence norms of logic, simplicity, and aesthetic presentation appear to be norms to be used in both the context of discovery and the context of justification. They are most suitable, how- ever, for the discovery of apparent realities. They lend themselves more to the evaluation of con- cepts that are in the process of development than to those in the process of testing. Although norms of correspondence and coherence may appear contradictory, it is nonetheless possible to consider them as complementary. While using the coherence norms to judge and evaluate theo- ries, we can also use correspondence norms to judge propositions that evolve out of research.
Pragmatism Theory
In the 1930s, a group of American philosophers, called pragmatists, advanced a third type of theory about truth. In fact, according to Leslie Armour (1969), there are two types of pragmatic theories of truth. First, an assertion is true if it produces the right type of influence on its follow- ers. In other words, a proposition is declared to be true when its users determine its usefulness.
Experience and the ability to solve problems are two of the norms considered in this view of truth.
Second, a proposition or any theorized relationship is true if it receives confirmation from a person or persons who have conducted the right investigations or who are designated as significant by the community of scholars. Pierce (cited in Kaplan, 1964) suggests that, according to this theory, a consensus between significant theoreticians or investigators is what constitutes truth.
Pragmatic truth depends less on evidence than on observations––on a declaration of effec- tiveness by whatever methods the significant members of a community of scholars use. These measures of effectiveness may be subjective, political, social, or objective. To the proponents of this view, “a theory is validated, not by showing it to be invulnerable to criticism, but by putting it to good use, in one’s own problems or in those problems of coworkers” (Kaplan, 1964).
A pragmatic theory of truth allows for the validation of theories through restructuring, use of new techniques, or even better awareness and realizations of the meanings of old relationships.
CHAPTER 8 Our Syntax: An Epistemological Analysis 153 The value of these new relationships lies not in the answers they may provide as much as in the new questions they may ask and the consequences that result from their use (Kaplan, 1964).
Humanity, tentativeness, subjectivity, collectivity, and usefulness are all qualities attached to this concept of pragmatic truth, which evolved out of the Chicago school of thought (Table 8-3).
Integrative Theory
A tension continues to exist between using a single paradigm, a pluralistic approach to para- digms, or no paradigm to guide the development of nursing knowledge. Weaver and Olson (2006) examined a number of paradigms in terms of their philosophical underpinnings and effectiveness and concluded that no single paradigm emerged as superior for nursing research. The complexity of human health experience and illness responses may require the use of all of them, or on a more integrative approach as proposed by others (Aranda 2006, Ali, 2007), and in offering integrative theory as an approach to discerning “truth” in the knowledge that is developed.
Furthermore, some conceptual problems are not as well addressed by any one of the theories of truth in isolation. Laudan (1977, p. 54) identified three. The first of these problems is an intra- scientific problem, which results from two theories representing two inconsistent domains. An example is Rogers’ (1970) view of a unitary human being as an energy field and of behavior as the manifestation of the pattern and organization of the energy field. This view presupposes a method- ological approach to the study of a human being and his or her energy field as a whole. Con- versely, Johnson (1974) views a social behavioral system, with seven subsystems revolving around subsystem goals and manifested in observable behavior. Johnson presupposes a study of humans by reducing humans to their behaviors (Table 8-3).
Because of the theoretical incompatibility between these two fundamental views of the nurs- ing client, the nursing community may attempt (perhaps prematurely) to accept one in favor of the other. The theorist’s commitment to adequacy and effectiveness may also prompt one to concede to the other. Either of these alternatives to resolving the problem may fail because of the level of conceptual and methodological knowledge. To reject Rogers’ conception of a unitary human being as an energy field and behavior as a manifestation of pattern and organization of the energy field will either create a reductionist scientific school of thought in nursing or will prompt Rogers, a committed theorist, to continue to work on developing a more adequate theory of the unitary human being. The latter option is acceptable for scientific development, but the former may impede development because of its prematurity.
It is also possible that the newness of nursing as a discipline makes it easier to reject both competing views in favor of another, more established view of a human being (such as one that holds a person to be a biologic system), to the detriment of solving the central problem. Neither correspondence nor coherence criteria could solve this issue; it is best addressed through a prag- matic approach to truth.
Nursing, historically, has also been beset by other philosophical inconsistencies (Munhall, 1982). Existential and pragmatic philosophies have dominated clinical nursing, and positivistic, empirical philosophies have attempted to dominate the academic discipline. This theoretical con- fusion has managed only to temporarily impede nursing’s theoretical development. Laudan refers to such conflict between emerging conflicting theoretical and methodological paradigms as nor- mative difficulties. Those who believe that the correspondence norm has dominated nursing would attribute the early rejection of nursing theories to this paradox.
It was once believed that the only credible theories in nursing were those inferred from observable data. Others asserted that a nursing philosophy that espoused holism, integration, and health was in direct conflict with its methodology of reductionism, objectivity, logic, measure- ment, verification, and falsification. Where does the truth lie? Which of the two options should nursing follow––the methodological view or the philosophical premise? Who determines the truth––the methodologists or the theoreticians? None of the norms in isolation would provide us with the truth. A combination of all may bring us closer.
A third difficulty that confronts theorists, and one that cannot be resolved by any one of the theories, Laudan calls “prevalent world view difficulties” (Laudan, 1977, p. 61). This phenomenon
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is observed when myths, beliefs, history, and practice are in opposition with developing theories.
The prevalent nursing view ascribed to by clinicians is that nursing is practical and skill- oriented and that its principles, as well as its skills, are derived from other disciplines. Nursing is neither theoretical, says this worldview, nor academic.
Tension also exists between the researchers, who hold the belief that theories develop only from research, and the theoreticians, who believe that theories are culminations of experience, his- tory, and intuition, as well as research findings. There have been many “world views” in nursing, with very few ascribing to a theoretical worldview. Weltanschauung attempts to address the many problems that none of the truth theories can address in isolation.
The scope of meanings of responses, sense data, and findings is wide, and requires hetero- geneity for different evolving “truths.” Judgment about the “truth” can depend not only on one source of legitimacy (Clarke, 1999). In the face of relativism, subjectivism, postmodernism, and deconstructionism and their ideas, truth still matters (Lynch, 2005). However:
People never think there is no truth of the matter; rather they think the other side is wrong.
(Gottlieb, 2005)
Therefore, there are diverse ways to establish truth, and one is by offering alternatives to cor- respondence norms and to the received view. Suppe (1977) suggested that what is needed is a dif- ferent way to analyze theories. He called this new way Weltanschauung and defined it as “a comprehensive world view, especially from a specified standpoint.” According to Suppe, Weltan- schauung is:
[an] analysis of theories which concerns itself with the epistemic factors governing the discov- ery, development, and acceptance or rejecting of theories; such an analysis must give serious attention to the idea that science is done from within a conceptual perspective which deter- mines in large part which questions are worth investigating and what sorts of answers are acceptable; the perspective provides a way of thinking about a class of phenomena which define[s] the class of legitimate problems and delimits the standards for their acceptable solu- tion. Such a perspective is intimately tied to one’s language which conceptually shapes the way one experiences the world. (p. 126)
A Weltanschauung, an integrative worldview, of truth in theoretical nursing includes an inte- gration of norms emanating from different theories of truth. It combines rigor and intuition, sen- sory data as they exist and as they appear, perceptions of the subject and of the theoretician, and logic with observable clinical data. What different theorists and researchers have advocated merely as norms for the acceptance of propositions are not contradictory, because in some situa- tions, events, and experiences, one set of norms is more appropriate than another. Some research in nursing has been guided by the positivists’ views and by correspondence. Some theory develop- ment has been guided by these norms as well. For example, Orlando and Johnson focused on observ- able, verifiable behavior in developing theories (Johnson, 1974; Orlando, 1961). Rogers spoke of experiences beyond the five senses (1970).
Nursing theoreticians, however, would not have developed their theories if they adhered to corre- spondence norms. Numerous examples have shown that nursing has used a pragmatic theory of truth.
Johnson (1974) spoke about criteria for acceptance of knowledge as based on social responsibility and about how knowledge and nursing action should make a valuable difference in the people’s lives.
Whether the model guiding nursing is right or wrong is a social decision and not exclusively a theo- rist’s or researcher’s decision. Rogers (1970), in conceptualizing a unitary man as an energy field, spoke of experiences beyond the five senses and therefore could not use correspondence norms to ver- ify her conceptualization, but instead used coherence norms. Many others supported the necessity of considering coherence norms in conceptualizing nursing and suggested that truth emanated from logic (Batey, 1977; Beckstrand, 1978a, 1978b; Dickoff, James, and Wiedenbach, 1968).
The integrative truth in nursing theory utilizes a diversity of views about truth. It uses validation, verification, simplicity, logic, consequences, clients, theorists, and actual or potential experiences as norms against which to compare the truth of the theory. It reflects a broader notion of evidence
CHAPTER 8 Our Syntax: An Epistemological Analysis 155 that relates to multiple sources of knowledge, particularly knowledge that has been marginalized due to its softness (Kirkham, Baumbusch, Schultz, and Anderson, 2007). It accepts multiple reali- ties and “a composite of realities” (Oiler, 1982). It accepts different expressions, different sources, and criteria such as the number of solved problems within a discipline (Laudan, 1977).
CONCLUSION
Our syntax includes ways of knowing in nursing and approaches by which truth has been defined. The received, perceived, interpretive, and critical patterns of knowing are more congru- ent with the nature of nursing as a human science. The received view provided the canons for acceptance and rejection of the road that nurses have taken in theory development. However, it is a more acceptable approach to analysis and evolution of knowing within the context of justifica- tion. The perceived view of knowing that guided nursing practice, nursing theory, and nursing education historically has been more open, variable, relativistic, and subject to experience and personal interpretations. It is holistic in approach and based on the perceptions of both the client and the theoretician. The perceived view is more appropriate to the context of discovery. The interpretive approach to knowing honors diversity and socioeconomic variations and provides a view that is critical of gender inequity, as well as of power differentials due to social class, race, and colonialism.
ing a theoretical framework for a research question within your field of practice. What are the most significant properties that distinguish the process you have selected?
7. What are the weaknesses and strengths of each approach to truth discussed in this chapter?
8. Discuss some of the values nurse scien- tists hold that may support or negate each of the ways of knowing and mod- els of truth discussed in this chapter.
9. In what ways do values about knowing in the United States, as well as in other parts of the world, correspond or negate each way of knowing discussed in this chapter?
10. In what ways do major funding sources for nursing research shape patterns of knowing and models of truths in the discipline of nursing? Take a pro or con stand and defend it with evidence.
11. Discuss an Eastern philosophical way of knowing (e.g., Buddhism) and critically consider how it could enrich or constrain knowledge development in nursing.
REFLECTIVE QUESTIONS
1. Discuss epistemic diversity and its potential outcomes on practice that is based on evidence (mostly defined from a received view and correspondence theory of truth).
2. Critically analyze the progress in the discipline of nursing within the differ- ent views of knowing. What criteria are you using to arrive at your conclusion?
3. Identify ways of knowing within your field of interest. Compare and contrast ways of knowing in your field of interest with those discussed in this chapter. In what ways are they different or similar, and why?
4. Which one of our discipline’s epistemo- logical traditions is likely to produce the evidence needed for quality care outcomes? Identify and define nursing discipline-driven quality care outcomes.
5. Compare and contrast the strengths of the different ways of knowing discussed in this chapter. What other approaches to knowing would you add to those dis- cussed in this chapter?
6. Select one pattern of knowing and dis- cuss how you would go about develop-
(Continued on page 156)
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