Several authors have commented on my reductionist account of spirituality in nursing, describing it variously as naïve, disrespectful, demeaning, paternalistic, arrogant, reifying, indicative of a closed mind, akin to positivism, a procrustean bed, a perpetuation of fraud, a matter of faith, an attempt to secure ideological power, and a perspective that puritanically forbids interesting philosophical topics. In responding to this list of felonies and misdemeanours, I try to justify my excesses by arguing that the critics have not really understood what (...) reductionism involves; that rejecting reductionism is not the same as providing arguments against it; that the ethical dilemmas allegedly associated with reductionist views are endemic to health care; that 'reifying' is what believers in the spiritual realm do; and that the closed minds belong to those who dismiss reductionist science without having studied its achievements. (shrink)

Amedeo Giorgi has published a review article devoted to Phenomenology as Qualitative Research: A Critical Analysis of Meaning Attribution. However, anyone reading this article, but unfamiliar with the book, will get a distorted view of what it is about, whom it is addressed to, what it seeks to achieve and how it goes about presenting its arguments. Not mildly distorted, in need of the odd correction here and there, but systematically misrepresented. The article is a study in misreading. Giorgi misreads (...) the book's mise en scène; he misreads its narrative arc; he misreads individual arguments; he misreads short, simple passages; he misreads the philosophy of the science literature; he misreads his own data; he misreads the title; he misreads the blurb; he misreads the acknowledgements. In addition, there are serious failures of scholarship (ironically, he demonstrates how unacquainted he is with the relevant literature at the very moment he is accusing me of being ill‐informed). In this reply, I provide several examples of these errors, but my primary aim is to understand why Giorgi's misreading is as ubiquitous as it is. To this end, I explain his mistakes by reference to the hermetic epistemology within which he is confined. (shrink)

This paper evaluates attempts to defend established concepts of expertise and clinical judgement against the incursions of evidence‐based practice. Two related arguments are considered. The first suggests that standard accounts of evidence‐based practice imply an overly narrow view of ‘evidence’, and that a more inclusive concept, incorporating ‘patterns of knowing’ not recognised by the familiar evidence hierarchies, should be adopted. The second suggests that statistical generalisations cannot be applied non‐problematically to individual patients in specific contexts, and points out that this (...) is why we need clinical judgement. In evaluating the first argument, I propose a criterion for what counts as evidence. It is a minimalist criterion but the ‘patterns of knowing’, referred to in the literature, still fail to meet it. In evaluating the second argument, I will outline the powerful empirical reasons we have for thinking that decisions based on research evidence are usually better than decisions based on clinical judgement; and show that current efforts to rehabilitate clinical judgement seriously underestimate the strength of these reasons. By way of conclusion, I will sketch the ways in which the concept of expertise will have to be modified if we accept evidence‐based practice as a template for health‐care. (shrink)

The use of correlational probability values (p‐values) as a means of evaluating evidence in nursing and health care has largely been accepted uncritically. There are reasons to be concerned about an uncritical adherence to the use of significance testing, which has been located in the natural science paradigm. p‐values have served in hypothesis and statistical testing, such as in randomized controlled trials and meta‐analyses to support what has been portrayed as the highest levels of evidence in the framework of evidence‐based (...) practice. Nursing has been minimally involved in the rich debate about the controversies of treating significance testing as evidentiary in the health and social sciences. In this paper, we join the dialogue by examining how and why this statistical mechanism has become entrenched as the gold standard for determining what constitutes legitimate scientific knowledge in the postpositivistic paradigm. We argue that nursing needs to critically reflect on the limitations associated with this tool of the evidence‐based movement, given the complexities and contextual factors that are inherent to nursing epistemology. Such reflection will inform our thinking about what constitutes substantive knowledge for the nursing discipline. (shrink)

Pragmatism emphasizes practical consequences and empirical explanations rather than introspective contemplations. However, the arguments of pragmatists are not uniform, as shown by the four prominent pragmatists presented in this article. The major difference between them is that Peirce and Haack acknowledge an objective truth, whereas James and Rorty do not. Thus, for a fuller understanding of the pragmatist view of our knowledge, both camps must be consulted. In the nursing field, pragmatism is occasionally referred to as a guiding philosophy. However, (...) the influence of James and Rorty has been greater than that of Peirce and Haack on pragmatists, which may risk leading to a skewed understanding of pragmatism by nursing scholars. Still, the four pragmatists share naturalism, which rejects a metaphysics that defines the nature of knowledge before our enquiry and emphasizes experience and practice. Pragmatic naturalism can help ensure that nursing theory does not deviate from clinical practice. This article also explores the broad adaptability of the ideas of all four pragmatists to philosophical issues in nursing, such as mixed‐methods research, epistemic relativism and realism. By showing that pragmatism can be relevant and stimulating to each of these topics, the article demonstrates that the different approaches to pragmatism can provide more inspiration for nurses and nursing researchers in the future. (shrink)

Reasons for the limited uptake of the clinician–scientist role within nursing are examined, specifically: the lack of consensus about the nature of nursing science; the varying approaches to epistemology; and the influence of post-modern thought on knowledge development in nursing. It is suggested that under-development of this role may be remedied by achieving agreement that science is a necessary, worthy pursuit for nursing, and that rigorous science conducted from a clinical perspective serves nursing well. Straddling practice and research is a (...) powerful strategy for ensuring relevant research while forging strong links with practice. The clinician–scientist role, typically requiring a 75:25 ratio between research and clinical activities, is well established in medicine. Nursing, however, has been slow to institute the role; it is rare within North America, Australia, and western European countries, and almost non-existent outside those areas. Beyond structural obstacles, philosophical issues may explain nursing's reluctance to implement the role. Following a survey of clinician–scientist roles throughout the world, the nature of nursing science and epistemology, and the influence of post-modern thought on nursing attitudes to research are examined with respect to their influence on this role. The nurse clinician–scientist role holds promise for making strides in clinically relevant research, and for accelerating the knowledge cycle from clinical problem to research question to change in clinical practice. (shrink)

In the present paper we empirically investigate the psychometric properties of some of the most famous statistical and logical cognitive illusions from the “heuristics and biases” research program by Daniel Kahneman and Amos Tversky, who nearly 50 years ago introduced fascinating brain teasers such as the famous Linda problem, the Wason card selection task, and so-called Bayesian reasoning problems (e.g., the mammography task). In the meantime, a great number of articles has been published that empirically examine single cognitive illusions, theoretically (...) explaining people’s faulty thinking, or proposing and experimentally implementing measures to foster insight and to make these problems accessible to the human mind. Yet these problems have thus far usually been empirically analyzed on an individual-item level only (e.g., by experimentally comparing participants’ performance on various versions of one of these problems). In this paper, by contrast, we examine these illusions as a group and look at the ability to solve them as a psychological construct. Based on an sample ofN= 2,643 Luxembourgian school students of age 16–18 we investigate the internal psychometric structure of these illusions (i.e., Are they substantially correlated? Do they form a reflexive or a formative construct?), their connection to related constructs (e.g., Are they distinguishable from intelligence or mathematical competence in a confirmatory factor analysis?), and the question of which of a person’s abilities can predict the correct solution of these brain teasers (by means of a regression analysis). (shrink)

In nursing today, it remains unclear what constitutes a good foundation for qualitative scientific inquiry. There is a tendency to define qualitative research as a form of inductive inquiry; deductive practice is seldom discussed, and when it is, this usually occurs in the context of data analysis. We will look at how the terms ‘induction’ and ‘deduction’ are used in qualitative nursing science and by qualitative research theorists, and relate these uses to the traditional definitions of these terms by Popper (...) and other philosophers of science. We will also question the assertion that qualitative research is or should be inductive. The position we defend here is that qualitative research should use deductive methods. We also see a need to understand the difference between the creative process needed to create theory and the justification of a theory. Our position is that misunderstandings regarding the philosophy of science and the role of inductive and deductive logic and science are still harming the development of nursing theory and science. The purpose of this article is to discuss and reflect upon inductive and deductive views of science as well as inductive and deductive analyses in qualitative research. We start by describing inductive and deductive methods and logic from a philosophy of science perspective, and we examine how the concepts of induction and deduction are often described and used in qualitative methods and nursing research. Finally, we attempt to provide a theoretical perspective that reconciles the misunderstandings regarding induction and deduction. Our conclusion is that openness towards deductive thinking and testing hypotheses is needed in qualitative nursing research. We must also realize that strict induction will not create theory; to generate theory, a creative leap is needed. (shrink)