741101
research-article2017
NSQXXX10.1177/0894318417741101Nursing Science QuarterlyReed / Philosophical Issues
Philosophical Issues
Philosophical Issues and Nursing Science
Pamela G. Reed, RN; PhD; FAAN1
Abstract
The author of this article introduces a new column that will explore philosophical issues of concern to nurse scientists. In this
initial column, I review the general terrain of philosophy in nursing science and explore some philosophical issues relevant to
theory development. One conclusion is that inquiry into philosophical issues may help expand our repertoire of conceptual
tools useful in building scientific knowledge and facilitating theoretical progress.
Keywords
nursing knowledge, philosophy of science, theory development
[O]ur knowledge development has proceeded backwards—we
have been attempting to conduct our science without first
defining the fundamental perspectives from which we approach
reality, the methods of knowing we believe to be appropriate to
that perspective, and the values inherent in it. Such is the task of
philosophy. (Barbara Sarter, 1988, p. 2)
Philosophical Issues and Nursing
Science
Sarter’s words remain relevant 30 years later. The attention
needed to advance philosophical knowledge is competing
with the action-laden practices of research and patient care.
Technological and scientific progress, advanced and dynamic
roles in practice, burgeoning content in educational curricula,
and diversity of human health problems and potential solu-
tions—all point to an urgency in knowledge production.
Nevertheless, inquiry into philosophical issues of a discipline
enhances capacity for generating scientific knowledge. My
purpose in this article as it initiates a new column is to lay out
introductory comments about the general terrain of philosophy
in nursing science and explore a philosophical issue or two
concerning theory development. My hope is that this stimu-
lates new thinking or questions and motivates increased atten-
tion to philosophy’s potential in our knowledge enterprise.
Current trends in nursing and related sciences reflect the
significance of scientific inquiry in understanding and facili-
tating the welfare of human beings and the environment.
Together, two recent publications about doctoral nursing edu-
cation highlight trends in research and corresponding philo-
sophical issues for knowledge development (Grace, Willis,
Roy, & Jones, 2016; Wyman & Henly, 2015). Scholarly
inquiry in a science, and particularly in the science of a profes-
sional discipline, must include conceptual as well as empirical
tools and expertise. Historically, nursing has produced an
impressive repertoire of philosophical and metatheoretical
Nursing Science Quarterly
2018, Vol. 31(1) 31­–35
© The Author(s) 2017
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DOI: 10.1177/0894318417741101
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writings. This is due in part to nursing’s roots in scholarly dis-
ciplines and visionary thought leaders. Further, the nature of
professional nursing and its focus on emergent problems has
compelled deep philosophical thinking.
There is continuing need to balance the philosophical and
empirical in development of scientific knowledge. The nature
of doctoral-level learning helps students acquire the conceptual
tools along with the empirical tools of inquiry. The table below
compares the tools of inquiry for philosophy and science.
Wrestling with philosophical issues is not unique to nurs-
ing, the humanities, or the social and human sciences more
broadly. In his essay on the history and philosophy of chem-
istry, DeLanda (2017) examined the “disputes and controver-
sies” within chemistry concerning various ontological and
methodological positions that have shaped and continue to
influence theory development and knowledge in chemistry.
The philosophical debates he explored in chemistry are not
unfamiliar to nursing; these included the realism versus
social constructivism debate, clarifying part-whole relation-
ships and other properties of chemical substances, and
revealing the sociohistorical influences on knowledge devel-
opment. Many scholarly disciplines address philosophical
issues as integral to their scientific progress.
Branches of Philosophy and Related
Issues for Inquiry
Major areas of inquiry in philosophy include metaphysics
and ontology, epistemology, ethics, logic, and aesthetics. In
1
Professor, University of Arizona College of Nursing, Tucson, AZ, USA
Contributing Editor:
Pamela G. Reed, RN; PhD; FAAN, Professor, University of Arizona
College of Nursing, 1305 N. Martin St., Tucson, AZ 85721-0203, USA.
Email: preed@arizona.edu
32 Nursing Science Quarterly 31(1)

Table.  Comparison of Philosophical Inquiry & Scientific Inquiry. well as nursing theories and concepts. Characteristics of
nursing practice such as specialties, educational focuses,
Philosophy Science
areas of credentialing, and so on may also reflect our nursing
Methods of Inquiry: ontology.
Conceptual Empirical Ontological issues address debate as to whether certain
Reason, dialogue, critique, Instruments, questionnaires, disciplinary concepts are real, as defined in the philosophical
systematic reflection, systematic observation, and perspective of scientific realism (Chakravartty, 2014). By
argument, speculation measurement, interviews
this philosophical perspective, real means that the entity or
Armchair work Fieldwork
process exists in the universe, independent of the contents
Exposes values and examines Accepts assumptions and
assumptions; poses proceeds to study an
(beliefs, perceptions, attitudes) of our minds, and perhaps
problems in life or practice assumed problem even if the entities or processes are not observable at present.
Evidence consists of reasoned Evidence consists of empirical An alternative approach is to regard these entities as purely
ideas data conceptual, constructed for use in an instrumental way to
Focus: organize observations and make theoretical predictions.
Eye on the whole Eye on the parts An expression that is ubiquitous in nursing but has not
Substantive change Accidental change garnered adequate philosophical discussion is the concept of
Infers what ought to be Describes what is; proposes spirit. What exactly do we mean by spirit in body-mind-
what may be spirit? Are spirit and mind real entities distinct from the
Goals: body? What about caring, inner healing, and transcendence
Seeks meaning Seeks measurement as commonly accepted concepts promoted in nursing theo-
Seeks understanding why Seeks knowing how and what ries and applied in practice: Do these processes really exist?
Keeps questions open with Closes questions with answers Moreover, might some of the concepts embedded in nursing
new questions (then identifies new empirical
questions for empirical study)
theories represent what philosophers of science have desig-
nated to be “natural kinds”—real entities that carve nature at
Compiled by P. G. Reed from various sources. its joints (see Bird & Tobin, 2017)? Or if not natural kinds,
might nursing concepts be “social kinds,” which philoso-
phers recently have proposed to describe mind-dependent
addition, axiology (regarding the nature and role of values in entities that nonetheless are of nature and real (Khalidi,
scientific inquiry) may be included. Philosophy of science 2015; Mason, 2016).
focuses on metaphysics and epistemology. Conceptual prac-
tices and conceptual tools of a discipline that are relevant to Epistemology
ontological or epistemological inquiry include concept anal- Epistemology addresses the nature of knowledge, how it is
ysis and development; theory development and evaluation formed and warranted in a given discipline. It asks questions
strategies; philosophical assumptions and views underlying about the types of knowledge considered to be relevant,
nursing conceptual structures (theories and models); and respected, and legitimate. Epistemological perspectives or
structures of knowledge (from broad philosophies to various worldviews, sometimes referred to in short as “isms,” are
levels and types of theories). Next, I will elaborate on two also content in this branch of philosophy as they influence
major branches, metaphysics and epistemology. knowledge and theory development and research methods.
These isms include postpositivism and realism (including
Metaphysics critical and other forms of realism) and the various philo-
sophical views that generally represent antirealism: histori-
Metaphysics refers to the nature of reality and theories about cism and social constructionism; postmodernism and
truth. One philosophical issue, for example, concerns whether poststructuralism; critical theory and related feminism and
the scheme of our scientific theories is one of corresponding postcolonialism; and a philosophical perspective for nursing
(vertically) to a stable, unchanging reality independent of our that I have labeled as intermodernism (Reed, 2011). [I did
perceptions, values, and beliefs, or one of relating (horizon- not list logical positivism or logical empiricism as contem-
tally) in a coherent way with other accepted theories of simi- porary perspectives—although vestiges of these views exist
lar focus. The first is more reflective of logical empiricist in our scientific practices—since philosophers generally
views and the second of postempiricist perspectives. have rejected these as tenable philosophies of science today;
Ontology is included within metaphysics and refers to the scientific practices go beyond the strictly empirical to also
nature of being and what exists and to the substantive focus include measures of difficult-to-observe or theoretical
or fundamental areas of inquiry in a discipline. Components entities.]
in our discipline that reflect our ontology are the nursing These philosophies of science inform empirical practices of
metaparadigm, and nursing worldviews and paradigms, as nursing science and suggest strategies and insights about how
Reed / Philosophical Issues 33
we study nursing phenomena. Further, they are not necessarily
mutually exclusive categories. A critical theory perspective,
for example, may be combined with some postpositivist
research approaches. And while social constructionism is
listed as a philosophical perspective distinct from postpositiv-
ism, social constructionism may include realist conceptions of
the world. Sveinsdóttir (2015) applied the work of two notable
philosophers of science, Ian Hacking and Sally Haslanger, in
arguing for a social constructionism that avoids the complete
collapse of all its phenomena of interest “into language, text,
or discourse” (p. 889) and allows for social phenomena to be
studied as effecting change in the natural world.
Example of a Philosophical Issue:
Scientific Explanation and Laws of
Nature
A philosophical issue related to both ontology and epistemol-
ogy concerns the scientific explanations of events and phe-
nomena of interest in a discipline. Explanation in the form of
laws is typically associated with logical empiricism. By this
philosophical view, laws are universal in scope, stable, true,
and natural, and corresponding necessarily with empirical
observations. Physics is the prototypical discipline that has
established laws of nature (laws of physics) to explain its phe-
nomena and how its science works. Whether there are laws of
biology or laws of psychology is a philosophical issue debated
among the scholars in these disciplines.
Nurse scholars also have employed the term laws in semi-
nal writings about the form and focus of nursing knowledge.
In her writings about the knowledge bases for nursing sick and
well individuals, Nightingale (for example, 1893/1949)
referred to laws of nature, laws of life, laws of health, and even
“laws of nursing”—which Barritt (1973) suggested marked
the moment when nursing became a science. Nightingale’s
laws were expressed in the form of empirical generalizations,
experimental laws that link together observed regularities in
generalizations, at least at the local level. For example, this
experimental law or empirical generalization is from her Notes
on Nursing (Nightingale, 1859/1969): “Unnecessary noise, or
noise that creates an expectation in the mind [such as whis-
pered conversations or rustling dresses], is that which hurts a
patient” (p. 44). The table of contents listing the chapters in
her Notes on Nursing identifies several of these laws of nurs-
ing. (It is worth noting that while Nightingale held strong reli-
gious beliefs, her use of “laws” was distinct from “natural
law,” historically regarded first as instinctively known, and
then by Thomas Aquinas as known through reason, later
rejected as a form of scientific explanation by 18th-century
philosophers. However, see Nolan’s [1992] discussion of the
use of natural law in the nursing ethic of caring.)
Another source where the term laws is used is found in one
of the most well-known articles cited for its succinct yet com-
prehensive description of three themes that represent inquiry in
nursing science—Donaldson and Crowley’s (1978) Discipline
of Nursing article. Their first theme is the “concern with prin-
ciples and laws that govern the life processes, well-being, and
optimum functioning of human beings—sick or well” (p. 113).
Further, the authors refer specifically to Nightingale’s and
Rogers’ “concern with laws” in discussing this theme.
More recently, as if responding to a philosophical ques-
tion about whether nursing has laws, Webber (2008) pro-
claimed that yes, indeed, “nursing does have laws.” She
elaborates on how the interrelationships among the compo-
nents in nursing’s structure of knowledge (theory, research,
practice, and reasoning) generate principles and laws that
can attain logical adequacy and epistemic status in nursing.
I raise this idea of laws in scientific explanation as a phil-
osophical issue because it seems there is a philosophical
reluctance to speak in terms of laws of nature in reference to
our nursing theories. If we do not gloss over these historical
statements about nursing knowledge as merely conventional
ideas of their time but instead inquire further into this issue,
we may gain new insights about theorizing and nursing
knowledge. For example, in examining the laws-of-biology
debate in reference to biological knowledge and the unpre-
dictable nature of biological systems, Hamilton (2007) pro-
posed some ways to revise the logical empiricist notion of
laws to (a) consider development of explanatory laws that
hold under a smaller range of conditions or (b) specify how a
generalization works within a narrower scope of explana-
tion—strategies remarkably similar to nursing’s focus on
midrange and situation-specific theories!
Philosophers of science explain that there are two ways to
describe laws of nature as used in a discipline. First, there are
laws that govern. Governing laws are ontologically meaning-
ful in that they have “oomph” in pushing and pulling “stuff
around in the universe” (Demarest, 2015, p. 335). These laws
are distinct from but underlie specific phenomena considered
as causing or influencing specific events. Second, laws may be
used to systematize phenomena in a discipline. By this system-
atizing approach, laws “merely summarize the events, proper-
ties, or trajectories a world” (Demarest, 2015, p. 335). The
language used by Donaldson and Crowley (1978), Nightingale
(1893/1949, 1859/1969), and others suggested that they were
using laws in the bolder, first sense where laws are regarded as
having a significant role in what happens in the world.
Might we explore the possibility of law-like relationships
that not only describe but govern events and phenomena of
concern to nursing? These laws need not be universal and
unchanging. After all, Einstein (Schlipp, 1970), whose work
in laws of nature and laws of physics is iconic, encouraged a
philosophical approach that was imaginative and pragmatic
and that avoided a positivist, universalizing stance in devel-
oping scientific theories.
Mechanisms in Theories
To extend our inquiry a bit further, let us consider a related
philosophical issue regarding the use of mechanisms in
34 Nursing Science Quarterly 31(1)
scientific theories. Nurse scientists apply this term in their
work readily, in contrast to nurse educators, theoreticians,
and practitioners who do so reluctantly. On the face of it, the
idea of mechanisms seems to conflict with holistic philo-
sophical views widely held by nurses. But mechanisms, it
turns out, could be an important innovation from philosophy
of science. It is a device for explaining and modeling phe-
nomena and for advancing the quality of scientific theories.
Moreover, philosophers have clarified that mechanisms are
not necessarily deterministic, reductionistic, or linear in cau-
sation, nor are they “just fictions/metaphors” (Craver &
Tabery, 2017). Mechanisms are organized systems or struc-
tures that explain complex, emergent social and biological
processes.
Craver and Tabery (2017) reported that mechanistic theo-
ries of natural kinds involving high individual variability
have been developed in the biology of human emotion. Other
fields such as cell biology, cognitive science, organic chem-
istry, physics, and neuroeconomics have also incorporated
mechanisms into their research. But there is more work to be
done.
The sciences that have employed mechanisms in their
theorizing have made significant scientific achievements in
recent decades, but Risjord (2014) suggested that nursing’s
“insulation” from this strategy may be jeopardizing its theo-
retical progress. This point raises a philosophical issue con-
cerning a potential conflict between ontological views and
theory development methods. Through discussion and
debate, it is possible that nursing may discover innovative
ways to integrate holism and mechanism. See Nairn (2014)
for an example of this integration in knowledge.
Philosophical Inquiry and Our Future
In summary, inquiry into philosophical issues may lead to
the following outcomes:
•• Exposing hidden assumptions and critiquing existing
practices in science
•• Addressing questions that science cannot answer
(epistemological, ontological, ethical)
•• Providing a comprehensive and coherent view of
focuses of the discipline
•• Sustaining the discipline’s openness to change in
knowledge development through reason, reflection,
and debate
•• Stimulating conceptual innovations in the process of
nursing theory development
•• Facilitating generative links among philosophy,
research, and practice dimensions of nursing
Over 30 years ago, Silva and Rothbart (1984) published
an analysis of changing trends in philosophies of science
related to nursing theory development. Philosophy of sci-
ence has continued to change and present new challenges
and opportunities for knowledge development. The rela-
tively recent practice turn in philosophy of science is an
important trend that calls on scientists and philosophers to
attend to the processes—not just the products—of scien-
tific inquiry. The practice turn is evident here in this brief
discussion of the roles of laws and mechanisms in the pro-
cess of theory development. Exploration of philosophical
issues emerging from current trends in philosophy of sci-
ence may help nurses’ expand their repertoire of concep-
tual tools that support nursing’s continuing theoretical
progress.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the authorship and/or publication of this review.
Funding
The author received no financial support for the authorship and/or
publication of this review.
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