A Philosophy of Nursing Forum
Thursday, October 08, 2009

Ok now that Professor Newsom has kicked off our discussion on realism, let's keep it going.

Realism versus anti-realism

Revolutionary ideas


Read: Rosenberg C 6.

Bergin, M., Wells, J., & Owen, S. (2008, July). Critical realism: a philosophical framework for the study of gender and mental health. Nursing Philosophy, 9(3), 169-179.

Hansen-Ketchum, P., & Myrick, F. (2008, July). Photo methods for qualitative research in nursing: an ontological and epistemological perspective. Nursing Philosophy, 9(3), 205-213.

1. Based on your understanding of Kuhn’s assertion that “we are no nearer the truth about the nature of things nowadays than we were in Aristotle’s times,” (pp 145-146) what are some examples from our profession of accepted paradigms? In applied disciplines, this usually relates to generally accepted practice guidelines.

2. What is your definition of realism as compared to anti realism? In your own words…

3. How do Hansen-Ketchum and Myrick justify the use of photography as a research method based on ontology and epistemology?

4. Select an article in nursing scholarship, which reflects or refutes Kuhn’s ideas. Share your critical assessment of author’s perspective.

1.Based on your understanding of Kuhn’s assertion that “we are no nearer the truth about the nature of things nowadays than we were in Aristotle’s times,” (pp 145-146) what are some examples from our profession of accepted paradigms? In applied disciplines, this usually relates to generally accepted practice guidelines. Barker (1992) states that paradigms are sets of rules and regulations that establish or define boundaries, and direct behavior in order to ensure success. The current health care system is facing a transformation that is more comprehensive and revolutionary than ever before. Nurses are being forced to ensure survival and strengthen the discipline and to fit the current nursing paradigm and the need for a paradigm shift. Part of the impetus for change is the result of technology .Clients may become increasingly knowledgeable reading health problems and acquire consultation from agents all over the world. This can turn data management in the health care system into a critical element to the client, system and the interaction between them. The problem with the current nursing paradigm is that we can no longer define what we do as being different from other health care professionals. Nursing is conflicted. We train our master prepared nurses in the medical model to become nurse practitioners who focus on disease states. Failure of nursing to clearly indicate the relationship between nursing interventions and patient outcomes is another difficulty. According to Spitzer, students are coached to perform a role which is virtually nonexistent within the framework of today’s health care system-hence the amount of frustration among students and practicing nurses. Finally, students and practicing nurses alike cannot possibly meet their patient’s emotional, social and managerial needs. The average stay in a hospital is about 5 days so it is unrealistic to expect clients to disclose their desires, values ,motivation, believes an emotion to their nurses. In summary, nursing has a problem identifying its declared core. In addition, the acting scope of nursing is so limited in terms of authority and independence that prohibit the profession from ensuring quality care managed exclusively by nurses. In conclusion, the current nursing paradigm cannot consolidate the economic and quality issues into theory of nursing. A new paradigm is needed.
Spitzer, A (1997).Moving into the information era: does the current nursing paradigm still hold? Journal of Advanced Nursing, 28, (4), 786-793.
3. How do Hansen-Ketchum and Myrick justify the use of photography as a research method based on ontology and epistemology? According to Hansen-Ketchum and Myrick,(2008),Ontology is our understanding of existence. Epistemology is our set of beliefs about the nature of knowledge. Harrison (2002) claims that visual components of knowledge continue to be marginalized and undervalued in research .Photo research methods build on the value of the visual to capture and use visual data. The design of photo methods affords participants the opportunity to take or select their own photographs based on what is meaningful to them. Photo elicitation is a term used to describe the process of using photographs to stimulate dialogue during individual or group interviews. Collier and Collier suggest there is an opportunity to use photography as a research tool not only to augment and validate what we know through other means, but to ascertain more about nursing and health related problems in ways that matter to participants and inform practice.
Select an article in nursing scholarship, which reflects or refutes Kuhn’s ideas. Share your critical assessment of author’s perspective.
Spitzer,(1997) states that nursing paradigms needs to change because we can no longer address the emotional, social and managerial aspects of care of our patients.The inability of the profession to define its unique product in the health producing process raises a dilemma regarding the unique contribution of nursing.Nursing is being challenged by the paradigm of the changing health care system.The entrance of nurse -replacement health allied professonals to the stystem of care question the existence of nursing in the future.
A very thoughtful posting. I would like to pose a couple of questions for you. Do you think this need for a new paradigm is a new issue in nursing? Do you think that we have ever had a paradigm that was working for us? How do you think that photography adds or does it add to our ontological and epistemological knowledge?
Response to question one:
The nursing profession is still evolving, since it is thought to be a relatively new profession. The essence of the profession is progressing yet remains grounded in the history of Nightingale. The major accepted paradigm of nursing is considered to be a meta-paradigm that encompasses the interrelatedness of nurse-health-environment-person.
In some circles, this is generalized as a holistic approach to nursing with caring being a major exemplar. Each specialty within the nursing profession seems to be embracing a paradigm that focuses on the uniqueness of that area of nursing practice. Thus, there is a lot of miss-communication, fragmentation or lack of cohesiveness among the concepts/theories that support the ‘paradigms’ in each specialty. The one thread that ties many of nursing ‘paradigms’ together seems to be focus on ‘person’, the recipient of nursing practice.

Nursing ‘paradigms’ that I found interesting:
“Psychological, social, cultural, environmental, biological, and experience-based problems are the root of mental illness. Mental health nursing must have a comprehensive paradigm that honors the relational nature of the nurse-patient relationship, the critical influence of environment, the importance of biological factors, and the way that narrative understanding and history shape behavior.”
Bonnie Raingruber (2003).Nurture: The Fundamental Significance of Relationship as a Paradigm for Mental Health Nursing. Perspectives in Psychiatric Care, Vol. 39 excerpt.
URL is http://www.questia.com/googleScholar.qst?docId=5002041776

Another interesting nursing ‘paradigm’:
“A Complexity Integration Nursing Theory presents…an integrated and comprehensive philosophical and practical imagery guide within a world of complex phenomena and remarkably interconnectedness.” “In part of the book, we discuss about the Evolution of Nursing Essence in the context of philosophical, scientific, cultural, metaphysical and social analysis. Specifically, we highlight the Platonic thought of the real and objective world, based upon Plato’s Allegory of the Cave. We emphasize in the Complexity and Chaos theory presenting the Human Being as an open complex self-organizing system incorporating four fundamental concepts (Philosophy, Science, Civilization incorporated in Culture and the Being).” “The Evolving Essence of the Science of Nursing: A Complexity Integration Nursing Theory. Authors: Dr. Sharon L. Van Sell and Mr. Ioannis A. Kalofissudis, Bsc URL is http://www.nursing.gr/theory/

Another interesting ‘paradigm’:
“ In a Hellenic CCU, somebody (RN or MD) instead of receiving medicine for his headache, asks for acolleague to “break up” the “evil eye” by saying a pray. Continuing to observe the situation, the neutral observer will hear a dialogue, with the victim of the malign influence thanking the colleague for helping to set him free from the “evil eye”, because already he feels better.” I. A, Kalofissudis Evil Eye, Creative Metaphors and the Postmodern Nursing Paradigm. ICUS NURS WEB J │ ISSUE 13│JANUARY - MARCH 2003 (NURSING.GR) pp.1-4.

One more interesting nursing ‘paradigm’:
“Ejournals are explored within the traditional context of scholarship and a discussion of the "serials crisis" that promoted the inception of ejournals is presented. After laying the groundwork for discussing scholarship in this new age of dissemination of scholarly information, the article discusses whether this digital form of publication can be called a "paradigm shift" in Kuhn's (1970) traditional sense of the word.” Citation: Jones, S., Cook, C. (January 31, 2000) "Electronic Journals: Are They A Paradigm Shift?" Online Journal of Issues in Nursing. Vol. 5, No. 1, Manuscript 1.
URL is www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume52000/No1Jan00/ElectronicJournalsAreTheyAParadigmShift.aspx

Conclusion is that nursing is clearly nowhere nearer the truth than in Aristotle times…nursing is still in the early stage of its journey.
Hansen-Ketchum and Myrick point out the fact that nurses carefully and purposely use language to express our concepts- "the building blocks of theories (Walker & Avant, 2004)"- taking vision for granted. Ontologically Hansen-Ketchum and Myrick use photo's as an expression of self or person. Epistemologically they demonstrate personal experience by allowing participants to interpret (and in some cases take and interpret) pictures. To me this as another dimension of the interview process. Perhaps even more distinct and personal than language. Similarly to words- the pictures can be evaluated be for content, context, and participant assigned meaning. This seems to be an innovative way to illicit information, especially concerning difficult phenomena.
Based on your understanding of Kuhn's assertion that "we are no closer to the truth about the nature of things nowadays than we were in Aristotle's time. What are some examples of nursing's accepted paradigms.

I believe our 'meta-paradigm' of the interrelatedness of nurse-health-environment-person is our major paradigm. I agree with Sandra on the ideas concerning this paradigm. Particularly that this has changed to 'holistic' care. No revolution or reduction, just a name change and maybe an improved understanding of the concepts involved.
In response to this question I offer my selected article "Social Justice and Human Caring" by Jean Watson. In this article Dr. Watson establishes excellent points concerning both the injustices of society and the concept of caring. Dr. Watson emphasizes that this 'new' paradigm (model) goes "beyond intellectualization". She bases this model on the nurse-health-person-environment paradigm (model) and includes the human-human and human-environment relationships as well.
This is a very beautifully written work. The article is much like poetry with some song lyrics and descriptive writings, however this new- 2008 paradigm reflects Kuhns ideas that by his own parameters- we are no nearer the truth.

My thoughts are that by Kuhn's parameters- can we ever be any nearer to the truth? For instance we are actively pursuing a new or all encompassing nursing paradigm- but according to Kuhn can one paradign 'encompass' others? I believe he says they incommensurable. Also concerning the building of knowledge- (although I can understand the concept of a Kuhn Revolution) but if pre and early science was frequently accepted by educated people and is now considered false or myth to us- then should we consider our current knowledge the future myths of the ages?

Watson, J. (2008). Social justice and human caring: a model of caring science as a hopeful paradigm for moral justice for humanity. Creative Nursing, 14(2), 54-61. http://search.ebscohost.com
Question 3.
How do Hansen-Ketchum and Myrick justify the use of photography as a research method based on ontology and epistemology?

I support Melissa's response to this questions...
The authors suggested photo methods, rather than methodology, to be appropriate for qualitative nursing research since it focuses on modes of engagement.
A research participant may be engaged in viewing photograph images and the researcher may determine realism and relativism epistemological influences based on the participant’s descriptive discussion.
Some suggest that photographs can be used to explore social reality--An exemplar of the realism photo method is a group of seniors that took pictures of the barriers and facilitators of walking in their community.
A relativists’ exemplar has participants using a self-selected photo to aid in descriptive dialogue about their preceived serenity.
The photo method supports ontological and epistemologic perspectives. It adds a dimension to the exploration of phenomena but there are short-comings to this. It may be influenced by the photographer and researchers' own interpretation of reality.

Question two asks for a personalized definition of realism as compared to anti-realism...For me, realism is the world (internal and external) in which I am contained and interact with. For me, anti-realism is opposing force that may attempt to impinge upon the realism in which I exist.
Kuhn stated in his famous book ,"A scientific theory is usually felt to be better than its predecessors not only in the sense that it is a better instrument for discovering and solving puzzles but also because it is somehow a better representation of what nature is really like. One often hears that successive theories grow ever closer to, or approximate more and more closely to, the truth. Apparently generalizations like that refer not to the puzzle-solutions and the concrete predictions derived from a theory but rather to its ontology, to the match, that is, between the entities with which the theory populates nature and what is "really there. ""

Did Kuhn mean that the reason that one paradigm survives and another dies is because one solves puzzles better, not because it is a more accurate representation of reality or closer to the 'truth'??
Response to Dr. Story,
I apologize for the late response to your questions. I believe that there have been times before when nursing has required a new paradigm. For example, when nursing was viewed as nothing more than a supporting profession for medicine, the exodus from hospital based programs to academic programs occurred. This was done in order to afford more resources and authority to nursing education. I believe that today we face the very same problems of little power and little differentiation from the medical model. In addition,we can no longer continue to ignore the problems that our current paradigm does not address. In other words, we must be able to prove our worth in order to survive. The question remains, what is the unique contribution of nursing? We continue to state that we are different from the medical model and yet our advanced practice nurses specialize based on the medical model. What is it exactly that we currently contribute that cannot be done by medical assistants? How can we convince policy makers that we are a necessary component of health care when our voices are not heard even during the current debate regarding health care reform?
Yes, I believe that photography adds to our ontological and epistemological knowledge. The study by Lockett et al seemed particularly useful because the participants were actively involved in the study. This would seem to empower this group who are often marginalized. The use of photography would be very interesting in the field of abuse. The legal system of course utilizes pictures to document physical abuse, but what about the effects that go unseen? Perhaps photography could even be used as a form of therapy for victims of abuse. I believe this is a creative and exciting method by which to conduct research and perhaps will be a way that nursing can help to form its unique contribution.
Hello professor Newsom. I did not get an opportunity to introduce myself the previours week. My name is Charlotte Gore and I am faculty at USM Gulfpark Campus. I live in Gulfport and teach in the undergraduate program. My BSN degree is from William Carey University and my MSN is from LSU Health Science Center. I completed two years at UMC for my PhD and transferred to USM to finish. I have a love/hate relationship with philosophy. I love the way it makes me think but hate feeling unsure about a lot of it. Below are my answers to this week’s questions posed by Dr Lundy and Dr Story.
1. Based on your understanding of Kuhn’s assertion that “we are no nearer the truth about the nature of things nowadays than we were in Aristotle’s times,” (pp 145-146) what are some examples from our profession of accepted paradigms? In applied disciplines, this usually relates to generally accepted practice guidelines.

Thomas Kuhn was one of the persons responsible for bringing the term paradigm to awareness. From his time to now we are still try to figure out how things are and how things work. Those like Kuhn and Descartes began the process of pondering these questions of ontology and epistemology related to paradigms of inquiry. Some accepted paradigms in the field of inquiry include positivism (after Descartes), postpositivism, critical theory, and constructivism.

The positivist ontological view is considered “naïve” but still asked the questions we continue to ask about the nature of reality. Positivists believe that there is a reality out there driven by natural laws. The next paradigm is the postpositivist view.

The postpositivism is a modified version of positivism. Ontologically there is a move from realist view to critical realist view. Critical realists believe that although a there is knowledge out there and a real world exist, we cannot comprehend it with our imperfect senses. This is still the basic concept of realism. Another paradigm that is rooted in the same ontological views as postpositivism is critical theory.

The paradigm of critical theory encompasses neo-Marxism, materialism, feminism, Freireism and participatory inquiry. They also have the critical realist view but believe that the inquiry is value laden instead of value free. They believe that the paradigm holds the values of the constructors.

Lastly you have the constructivist paradigm who thinks there are many flaws in the preceding paradigms. As we move to the constructivist paradigm we move from realist ontology to relativist ontology whose belief is that there are multiple realities that exist in people’s minds and that realities are co constructed.

Epistemologically we move for objective inquiry in positivism, postpositivism and critical theory to subjective inquiry in constructivism. This is just four paradigms outlined by Guba (1990). There is still strong discussion about which paradigm is “the one.” It does appears we are no nearer to the reality of nature than in Aristotle’s time.

Related to our practice guidelines most often they are written interpretations of practices nurses have been doing for a long time. Most are not really new ideas, just newly documented. If we look back to Nightingale, most of our practice guidelines are update versions of older practices. Just as with last week’s comments about Dr Semmelweis. He did research on something that was already being done that worked and put up a sign that essentially stated “ do what you have already being doing because it works”.

Guba, E. (Ed.). (1990). The Paradigm Dialog. Newbury Park, CA: Sage Publications, Inc.
2. What is your definition of realism as compared to anti realism? In your own words…
Realism is accepting the fact that there are things or phenomenon in the world that exist even though you cannot actually observe them yourself. For instance like the belief in God or that things that happen in our life could be caused by something or someone other than ourselves. Anti realism is accepting nothing as fact until there is empirical evidence to back it up.
3. How do Hansen-Ketchum and Myrick justify the use of photography as a research method based on ontology and epistemology?
The author justifies photography as a research method by examining photography as a method of developing knowledge and establishing the relationship between the inquirer and the known. The author uses examples of two opposing views of ontology (being) and epistemology (knowing) to show how the use of photography has philosophical underpinnings. He uses an article by Lockett et al. (2005) to look at the pragmatic realist view and another article by Kruse (1999) to look at the constructivist view.
In the article by Lockett the author examines older adults using photography to look at barrier and facilitators to walking. The pragmatic realist view in the article believes that pictures are a representation of the truth. The realist view believe that reality exist separate from the mind. The researcher must practice an objective epistemology – they kept their distance from the participants and did not interfere while the photos were being taken. The photos are used to connect all the realities – the knower, researcher, and the environment.
In the article by Kruse (1999) the author examined serenity in survivors of traumatic events. This author used constructivism which has a relativist ontology with the use photography as a method. According to the Hansen-Ketchum and Myrick the relativist believed “reality is mind-dependent with no universal threads outside of individual construction”. In this study the researcher has a subjectivist epistemology. There was interaction between the researcher and the participants. The authors believed that the photos were outside representations of internal realities of the participant and dependent upon the participant.
Photography can be a great research method for all paradigms. It is dependent upon which paradigm the author supports. Because Hansen-Kethchum and Myrick looked at photography as a method instead of a methodology, it can be examined from the ontological and epistemological stance of any paradigm.
Summary for the week:

There seems to be a concensus of agreement with Kuhn's assertion that "we are no nearer to the truth about the nature of things nowadays than in Aristotle's time".
The questions moved us to focus on the fact that nursing needs a new paradigm or maybe that nursing has never had a all inclusive meta-paradign that functioned in the ways our profession needs it to. However It seems the "old" nurse-health-person-environment, has functioned well for us in the past. But now as nursing evolves as a profession we (nurses) will have to define our own way. And from our discussion it seems we are looking for a "revolution" here.

Concerning the photgraphy as a method of research, there was some agreement that it could be a useful tool ingathering data.

Louanne made a great point concerning nurses functioning under the medical model and the fact that we need to seperate and function under a 'nursing model'.

Sandra offered many interesting nursing paradigms, however in review I don't think we have found new meta-paradigm yet. Sandra also posed a good question "did Kuhn mean a paradigm survives and another dies because it solves puzzles better, not because its closer to the truth?". This question does provoke thought on our perception of truth. Although we are working diligently to find 'truth', if we all agree we have come no closer in over 2000 years of science, then rationally we must are likely replacing paradigms based on its ability to solve problems. More specifically we replace paradigms based on its ability to solve 'current' problems or maybe based on the way problems are currently veiwed.

Charlotte gave a great example positivist- postpositivist- critical theory to constructivist view in relation to paradigms. This expansion of our conversation beyond nursing really gives us example of how much we really 'don't know' about everything in the universe.

Professor Newsome- Thank you for allowing us to have this experience and for sharing your thoughts with us. These assignments have been my only exposure to blogging; but I really understand the expression involved. I have enjoyed this experience greatly. Melissa.
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