The CAEN curriculum is informed by a number of philosophical perspectives or “worldviews” that shape understanding of the program’s core concepts as well as the traditions and trends of nursing research, knowledge and practice. The values and beliefs inherent in each worldview form a complimentary, reciprocal discourse that enriches the breadth and depth of critical reflective and reflexive practice and holistic care, resulting in a greater appreciation of diversity, and tolerance of ambiguity. Certain perspectives are discussed in the following paragraphs:
An empiricist approach values observables and “careful scientific strategies that bear results that can be corroborated if not confirmed” (Im & Meleis, 1999, p.14). Empirico-analytic perspectives may include positivism, logical positivism, logical realism, scientism, and more recently, post positivism and post empiricism. Empirico-analytic or positivist perspectives are grounded in a belief that data collected through the senses is the only valid form of information. Key to the empirico-analytic tradition is the idea of objectivity as central to the judgment of truth claims and rationality.
The scientific approach whereby data is collected in controlled situations in order to demonstrate a hypothesis and hence develop knowledge has informed the evolution of both the natural and social sciences. During the early years of the development of nursing as a discipline, this perspective influenced the evolution of thought about nursing science and what constitutes valid knowledge in the discipline. The development of nursing theories and models followed.
A post empiricist perspective accepts the emphasis on collecting information through careful scientific processes but proposes that “no common pattern is rigidly viewed as having relevance for every individual or situation and no universal laws governing all of health are believed to exist.” (Im & Meleis, 1999, p.14). Within post empiricism, situation-specific theories can be developed to assist in linking the observable to the “unobservables” (Im & Meleis, 1999). Within nursing, post empiricist thought allows for theorizing the responses of certain groups of persons under certain health and illness conditions, but denies universal application. It is important to acknowledge that empirical knowledge gained through the scientific approach can add to nursing understanding, but not at the expense of other traditions.
Postmodernism refers to a variety of different traditions that together reject modernist ideas about universal truths and grand narratives that endorse singular versions of knowledge produced and exhorted by positivism. Instead, postmodernisms see the social world as fluid, evolving and changing. In this environment culture can be made explicit, the person or self reflects an identity made visible through language (speech acts), ways of acting (one's agency) and other forms of disclosure, especially in relationships with others. Discourse plays a major role in mediating the social, political, and cultural understandings (Lyotard, 1984) that underpin one's engagement in the world. Postmodern perspectives include the following:
Phenomenology is both a philosophy and a method of inquiry and is informed by several philosophical traditions, including Hegel (c. 1807, phenomenology), Husserl (1964, phenomenology), Merleau-Ponty (1962, existentialism), Heidegger (1962, hermeneutics), and Gadamer (1976, hermeneutics). These philosophers extended the branches of phenomenology from the position of the individual perception of their world to areas such as uncovering meaning and gaining understanding in everyday reality. As a philosophy, phenomenology is concerned with the nature of human experience as it is lived day-to-day. It attempts to grapple with the interplay of one's existence within one's context or reality (Van Manen, 1997, 1995). From a phenomenological perspective, reality exists only as an embodied experience. Not only is one conscious of one's world, but one also engages with the world as a self-interpreting being. Language is the medium through which one comes to understand one's reality, often after the event and frequently in different circumstances. Each person’s reality is therefore a unique subjective process of being and becoming (Paterson & Zderad, 1976). The notion of being and becoming emphasizes the idea that one's interpretation of a given reality underpins their action. Knowledge of reality is therefore created by reflecting, interpreting and illuminating meaning contained within one's lived experience that in turn informs action (Heidegger, 1962).
In phenomenology the knower and the known are one in a given moment in time (Heidegger, 1962). Leonard (1999) suggests that one's knowing occurs from being there, or being present. The knowing that occurs is understood in one's mind, body and environment, the knowing is not separate from the experience because the person/self is situated within it and therefore the experience is also constituted by the person experiencing the situation in that moment in time. Phenomenological inquiry methods focus on the study and analysis of how phenomena present themselves to individuals as lived and embodied experiences as well as how these experiences are assigned meaning, or what the essence of experience might be.
The particular significance of this worldview for nursing is the understanding it reveals about the unique nature of the client’s experience of health and healing. Practical action can be client-centred and not solely based on instrumental or prescriptive reasoning and methods of practice. Understanding experience precedes the nurses' engagement with the client in the enactment of nursing care. Actions are specifically aimed at promoting that individual’s health and healing. The nurse's agency is therefore expressed in a form of praxis (informed action), that has its roots in wise choices of action, prudently chosen through value commitments and informed decision making or phronesis (Gadamer, 1975; Carr & Kemmis, 1986).
The phenomenological perspective underscores the moral nature of nursing whereby ‘right action’ of care is determined by the client’s lived and embodied experience – an experience that cannot be fully accessed outside of relational caring practice. Caring, which is central to nursing’s role and responsibility, is also rooted in existential and phenomenological worldviews (Watson, 1988; Bowden, 1997). It is understood broadly and embraces multiple ways of knowing, being and doing.
The development of critical social science emerged through critiques of Positivist Science, Marxism, and Interpretive perspectives in the early 20th Century (Hamilton, 1994). The perspective of Positivist Science that developed as part of the enlightenment project, considered object reality and rationality from the position of the disinterested observer. From this vantage point, rules, are used to signify cause-effect relationships and facts direct action. The empirico-analytic view offered little to understanding the social realm. Likewise even the branches of phenomenology including hermeneutics offered limited understanding of the human condition with descriptions of one's everyday experience as a self-interpreting being within a particular situation. What was omitted from these traditions was the politicization of reality and the extent to which one's reality could mask distorted understandings lived out in the taken-for-granted discourses, practices and social relationships that mediate power. The task for Critical Social Theory was to realign values, judgments, intentions, and human interests into a coherent theoretical perspective that raised questions about the practice world politicizing its tensions, complexities, understandings, meanings and forms of action.
One of the prominent intellectuals in this tradition is Habermas (1972) and his theory of knowledge constitutive interests. The theory distinguishes between the technical knowledge constitutive interest (causal explanation for phenomena), the practical knowledge constitutive interest (understanding), and the emancipatory knowledge (reflection, insight and freedom) (Carr & Kemmis, 1986). Technical knowledge is associated with empirical knowledge. Grundy (1987) states that technical knowledge is a “fundamental interest in controlling the environment through rules following action based upon empirically generated laws” (p. 12). In the early years of the nursing profession much of nursing knowledge followed the technical-interest approach to nursing education, research, and practice.
The basic orientation of practical knowledge is toward understanding that humans can live within and as part of the world. The practical interest is a “fundamental interest in understanding the environment through interaction-based agreement and consensual interpretation of meaning” (Grundy, 1987, p.14). Knowledge development occurs through the making of meaning. The underlying assumption of practical knowing attends to the everyday nursing practices and understanding. Such knowledge development is closely aligned with Heidegger’s (1962) view of understanding human experience as being-in-the-world.
Emancipatory knowing is concerned with empowerment, that is, the ability of individuals and groups to take charge of their own lives in autonomous and responsible ways. Grundy defines emancipatory knowledge as “a fundamental interest in emancipation and empowerment to engage in autonomous action arising out of authentic, critical insights into the social construction of human society” (1990, p.19). The curriculum pays close attention to the three ways of knowing suggested by Habermas.
Together, Habermas' knowledge constitutive interests enable nurses to raise questions about practice by asking, for example, 'whose interests are served by practicing in particular ways', highlighting the ideologies underpinning practice. This question politicizes understandings that nurses have a tendency to take for granted, exposing the underlying ideologies. A central value of critical social theory is a commitment to penetrate the world of objective appearances in order to expose social relationships that are often concealed. From this perspective, knowledge cannot be separated from the knower. Critical theorists believe that knowledge should be used for emancipatory political aims. At the heart of critical theory is its criticism of ideology. The overall goal of critical theory is to address the effects of ideology so that people's perceptions are freed or emancipated and they are able to see beyond the taken-for-granted reality that oppresses them.
Of important significance to nursing, critical perspectives enable nurses to engage in reflective critique of their own practice and the health care cultures in which they work. Through an understanding of these perspectives, nurses can participate with their clients and colleagues in empowering change processes as well as being conscious and active in their everyday practice to prevent the abuse of power, to promote respect, and to be an advocate for the tolerance of diversity and support for social justice. Thus critical theorists are concerned with inequities perpetuated through, for example, class, race, gender, colour, and labour. Critical perspectives include but are not limited to:
Feminism is conceptualized as a dynamic, evolving ideology. Historically, feminism focused on the valuing of women and on confronting the systematic injustices that are based on gender (Harding, 1986, 1991; Lloyd, 1989; Gilligan, 1982). Feminism now values an inclusive model of liberation for all people, with particular attention given to the status of women. Feminism includes a number of perspectives such as liberal, socialist, cultural, radical and postmodern feminism. The common thread running through these perspectives relates to the oppression of women. A feminist perspective is important to nurses because of the gendered history of nursing, nursing knowledge and the gendered perspectives that continue to dominate health care and health care delivery.
Postcolonial perspectives bring our attention to the social conditions related to colonization and racism (Doane & Varcoe, 2005). Colonialism encompasses the process by which a foreign power dominates and exploits indigenous groups and more specifically refers to these processes enacted by European powers between the 16th and 20th centuries (Henry, Taylor, Mattis & Rees, 2000 as cited in Doane & Varcoe, 2005). This attention to the dominance of a “foreign power” and its taken-for-granted cultural norms and mores - enacted as truth and used to sustain power - provides nurses with a metaphor applicable to many experiences and forms of professional and corporate oppression associated with nursing and health care. Edward Said (1990), for example, argued that colonizing ideologies were implicit in language. Processes for dealing with and overcoming the effects of colonialism provide nurses with strengths and strategies essential to their own health and leadership potentials when working under these conditions. The multicultural nature of Canadian society and the importance of the historical experiences of the Indigenous groups in Canada make this an important lens for considering nursing practice.
There are different ways that the ‘post’ of postcolonialism can be understood. Anderson (2004) and Browne, Smye, and Varcoe (2005) refer to Linda Tuhiwai Smith (1999) and Cathryn McConaghy (2000) in holding that post does not represent a period of time after colonialism, or mean that we have moved beyond or past colonialism and colonial practices, but rather, it refers to the idea of working “against and beyond colonialism” (Anderson, p. 240). Neocolonialism is a term that is often used to describe contemporary forms of colonialism (Peters & Self, 2005; Reimer Kirkham & Browne, 2006).
The Positivist tradition in nursing has given way to a post-empiricist view that stands alongside interpretive and postmodern traditions. Critical theory or critical social science, for instance, acknowledges the importance of empirics but not at the expense of other ways of knowing. Recognizing that nursing needs to draw on a variety of philosophical perspectives to inform and enrich nursing's understanding of everyday realities has led nursing scholars to use ideas from phenomenology and existentialism, including ideas drawn from the work of existential philosophers such as Buber, Sartre, and Merleau-Ponty. These philosophers, plus the ideas drawn from the work of Heidegger, Gadamer and Ricoeur, from a hermeneutical perspective, have enabled nursing to focus on social existence, being in the world and making meaning of it. Identifying the shortcomings of the earlier interpretive traditions of Habermas, Adorno and Marcuse, amongst others from the Frankfurt School, plus Friere and Gramsci, sought to critique the historical and contemporary social worlds in the context of everyday cultural practices and social action. Scholars from the feminist traditions have added considerably to the political dimensions of knowing, addressing areas such as inequities and gendered analysis of situations and bringing into the foreground those marginalized by dominant perspectives. These philosophical perspectives all inform nursing's epistemology or ways of knowing in nursing.
Last reviewed 5/24/2012 4:10:41 PM