Nursing scholars continuously refine nursing knowledge and the philosophical foundations of nursing practice. They advance nursing knowledge by creating new knowledge and weighing the relevance of developments in cognate sciences. Nurse philosophers go further by providing epistemological and ontological arguments for explanations of nursing phenomena. In this article, I engage with Bender's arguments about why mechanisms should have more primacy as carriers of nursing knowledge. Despite the careful scholarship involved, Bender's arguments need to be more convincing. Accordingly, this article encourages (...) debate about Bender's arguments for reorientating nursing science to mechanisms. I begin by suggesting that the claim that the theory‐practice divide can be overcome by reorientating to mechanisms is acceptable only if we accept Bender's depiction of the challenge. Then I question the ontology Bender relies on to justify reorientating nursing science. After that, I argue that mechanisms in models that parallel analytical sociology undermine the kind of nursing science Bender advocates. I illustrate my arguments with a social mechanism thought experiment. Then I explain why Bender's arguments cannot escape the received view of science or inform emancipatory nursing action without theory. Finally, I mention some caveats and implications for nursing science. (shrink)

Outcomes research is topical in discussions about health-related research. Its emphasis on effectiveness creates an important opportunity for nurse researchers to strengthen the linkages between theory, outcomes research and nursing practice but, before care can be more effective, it is logical to establish patients’ desired outcomes. A thorough review of the implications of this requirement for the care of hospice patients is needed, but is lacking in the literature. Therefore, the literature on a ‘good death’ is reviewed as a step (...) towards assisting hospice patients to achieve what they regard as an acceptable death. The starting point is to define more clearly what it means to die a good death. The relationship between hospice care and achieving a good death is then examined. (shrink)

Attendance at 12-step programs has become part of the orthodoxy of treating clients with substance abuse disorders. However, concerns have been raised about the assumptions on which 12-step programs are based. I argue that antirepresentationalism is the moral principle that underpins such concerns. After clarifying the principle of antirepresentationalism, I explore strategies for reconciling antirepresentationalism with 12-step programs. However, all the strategies I try fail. Consequently, I adopt an alternative way of thinking about antirepresentationalism that leaves mental health professionals free (...) to refer clients to 12-step programs. However, such referrals can continue only at the cost of accepting objectionable assumptions about motivation, spirituality and human agency. Therefore, it might well be time to find an alternative to 12-step programs. (shrink)