8/3/2019 1994 Mitchell Nursing Research

1/5

Nursing ResearchGail J. Mitchell, RN,pha

If nurses aspire to establish a scientificknowledge &ae that can guide anau&xmmous practice, disc~p&xbspecificinquiry that expmds extant nursingtheory must be recognized as intgral tothat process.

adamerian hermeneutics (thatis, hermeneutics as a process of

understanding, rather than a method)sheds light on the inherent role of the-ory in scientific inquiry. l, 2 Inquiry innursing is increasingly acknowledgedas a theory-driven, value-laden enter-prise, yet the full impact of nursing re-search as a process of understandingfueled by a particular disciplinary per-spective has not been fully explicated.If nurses aspire to establish a scientificknowledge base that can guide an au-tonomous practice, discipline-specificresearch that expands extant theorymust be recognized as being integral tothat process. The purpose of this articleis twofold: first, to explore the meaningof discipline-specific inquiry; second,to consider the implications of herme-neutics for nursing science.

Nuts &ITLOOK 1994;42:224-8.CopyriQtrt * 1994 by h&by-Year Bo&, inc.0029.6554/94/$3.00 + 0 35/l/52707

DWWU?dE-Discipline is defined in the EighthEdition of the Concise Oxford Dictionary as a branch of instruction orlearning. The idea of a branch or areasuggests that there are distinctionsamong branches or disciplines, an ideathat remains obscure in nursing despiterecent claims in the literature that allresearchers have a belief system thatguides their activities. It is, in fact, dif-ferent belief systems, and their relatedvalues and actions, that distinguish in-dividuals, groups, or disciplines3-s Dis-ciplines house belief systems and val-ues in theoretical structures dissemi-nated through formal education andused to guide professional activit ies.The suggestion that all research is the-ory-driven (and, thus, discipline spe-cif ic) although viewed as undesirablein the past, is regarded here as desire-able, necessary for knowledge develop-ment and open to public scrutiny.In contrast to those who believe that

the tenets of truth with observables,reductionism, verificat ion, and bias-free science offer the most hope foradvancing nursing knowledge, I be-lieve there is only value-laden science.Science is knowledge about particularphenomena of concern created by hu-man beings and stored in discipline-specific belief systems. How! then, doesa researchers disciplinary perspectiveand process of inquiry fit together!

Methods of inquiry themselves flowfrom some theoretical perspective. It isforthisreasonthatthetermsqu&at&eand quantitative are inherently ob-scure when it comes to identifying thevalues and purposes embedded in re-search activi ties. One cannot assumethat a method of inquiry is automati-cally linked with a particular paradig-matic tradition until the guiding the-ory is examined. For example, quanti-tative researchers aligned with theoriesconsistent with the natural science tra-dition may search for variables throughqualitative methods. In contrast, thereare qualitative researchers-whose theo-ries are aligned with the human sci-ence tradition. The point is that allmodes of inquiry and the findings gen-erated ultimately flow from the re-searchers theoretical perspective.What methods of inquiry do provideare theoretically consistent processesfor data gathering and analysis. This~ iswhy Parse*~ l and Phillips2 havecalled for nurses to develop methods ofinquiry that flow from nursing theory.

224 Mitchel l VOLUfutE 42 0 MUM l3ER 5 NURS ING OUTLOOK

8/3/2019 1994 Mitchell Nursing Research

2/5

Proceeding on the belief that differ-ent disciplines require distinct theoriesto guide methods of inquiry, it is sug-gested that inquiry without a specificlink to nursing ,theory, while it maycontribute to the knowledge of anotherdiscipline, does n.ot contribute to mu-s-ing knowledge. Morsel3 presents anopposing view on nursing theory andprovides an example of beliefs that areinconsistent with those proffered here.Morse is accurat:e when she suggeststhat when one embraces a theoretical

All researchers aresituated in a reality,through educationand membership insome discipline.perspective, one l.oses he ability to seethings another way. This is preciselythe point! A point that cannot be over-emphasized. Nurses need to see thingsin a nursing way so that understandingabout human-health phenomena maybe enhanced from a disciplinary per-spective.

Morses skepticism about discipline-specific theoretical inquiry is evidentlylinked to a belief in an objective real-ity. A reality that already exists outthere and that may be discoveredthrough value-free, inductive inquiryconducted by researchers who canbracket all prior knowledge, values,and purposes. But reality is constructedand interpreted by human beings whoare already embedded in a world ofmeaning, language, culture, and histo-ry. 216f 4 Gadame:r2 proposed that it isnot possible to have objective knowl-edge of reality since all persons are al-ready situated in it.

Al l researchers are situated, througheducation and membership in somediscipline. The knowledge of a disc i-pline provides a theoretical horizonthat is enlarged or expanded throughinquiry. Gadamer2 proposed that in-quiry is in essence a hermeneutical

process of understanding, a process thatmediates the familiar and the unfamil-iar. The hermeneutical process then,represents the movement of insightand discovery as researchers come tounderstand something familiar in anew way. If the discipline of a re-searcher does not contribute to theprocess of inquiry, then what is thepurpose of having different disciplines?What is the purpose of doctoral educa-tion in nursing if there is no discipline-specific inquiry! It is hoped that schol-arly dialogue about the different ap-proaches to inquiry will help to clarifyand propel further debate. An examplefrom the literature on quality of lifemay help to clari fy issues related todiscipline-specific inquiry.DISCIPLINE SPECIFICITY ANDQUALITY OF LIFEThe literature on quality of life begsthe question: Do researchers of differ-ent disciplines require distinct views ofhuman phenomena to guide inquirythat enhances understanding and thedevelopment of meaningful knowl-edge? An analysis of the literature onquality of life sheds light on the re-strict ions of atheoretical, or generic,inquiry. Generic inquiry is not guidedby an expl icit theory from the re-searchers discipline, and, thus, find-ings are sweepingly dispersed acrossdiscip lines without integration into aspecific theoretical framework. Ge-neric, or non-discipline-specific, in-quiry only contributes to the ever ex-panding quagmire about the meaningof human phenomena, like health andquality of life. 15, 6 A synthesis of find-ings is not possible because generic re-searchers mix languages (theories) thathave different meanings and assump-tions.

Generic inquiry about quality of lifehas generated more than 800 indica-tors, and researchers, including nurses,have resorted to creating hundreds ofad hoc definitions to guide re-search.151 7 The search for the one def-inition of quality of life that is free oftheoretical bias has only served to sus-pend findings in a bottomless well of

NURSING OUTLOOK SEPTEMBER/OCTOBER 1994

possible interpretations. Quality of lifeis a concept that is value-laden, and at-tempts to define it in a sterile, genericway have failed.

A frustration with the generic appreach has led some scholars to suggestthat researchers from different disc i-plines need to know different thingsabout health and human experience.For example, Aaronson17 proposed thatmedical researchers should limit qual-ity-of-l ife definitions to those that gen-erate data that may have a direct im-pact on the treatment of, for instance,toxic side effects. In contrast, sociolo-gists prefer to study global indicators oflife quality and their relationshipswith roles and social processes.18, 9 Al-though the logic of the discipline-spe-cifi c approach seems evident, there arethose who continue to advocate for theopposing position, that the minimallyacceptable definition of quality of lifein any study must include multiple di-mensions incorporating all life do-mains. Proponents of this latter posi-tion, like Morsel3 in nursing, contendthat there should be a gold standard,

Generic researchersmix languages thathave differentmeanings andassumptions.

some operational definition that willincorporate all dimensions and provideguidance for all researchers, for all dis-ciplines.

Butler20 proposed that the meaningassigned to any phenomenon ulti-mately depends on the values and pur-poses of the researcher or group. Shouldnot researchers be expected to identifytheir group and its values and purposesin order to advance discipline-specificknowledge? If what distinguishesone discipline from another is theknowledge base used by group mem-bers 6 10,21-23hen researchers from dif-ferent discipl ines wil l be guided by and

Mitchel l 225

8/3/2019 1994 Mitchell Nursing Research

3/5

dedicated to expanding distinc t bodiesof knowledge. The socio logis ts globalindicato rs of life quality and the on-cologists explication of morbidity andtoxic side effects should be differentfrom nursing s area of concern,

The advancement of nursing knowl-edge has been hindered not on ly bynurse researchers who borrow theory,but also by those who espouse value-free, generic research. It remains amystery why nursing scholars want toconduct value-free inquiry when it isthe values of a discip line that guide thethoughts and actions of its members.The belief that researchers can bracketprejudices is itself just a theoretical he-lief, a belief called into serious ques-tion by the recent disclosure of theintegral nature of science and val-ues. J2, J 22 And even when research-ers suggest that they bracket theoreti-cal presuppositions, the language usedto interpret findings reveals their viewsand biases about human beings andhea1th.l As noted by Gadamer, lan-guage is the living out of what is withus -not only in the concrete interrela-tionships of work and poli tics but in allthe other relationships and dependen-cies that comprise our world.NURSING-SPECIFIC INQUIRYNursing as a discipline is interested inthe human-health interrelationship ,but not in the same ways as medicineor sociology. Like other disciplines,nursing has its theories that guidepractice and research. It is generallyagreed in nursing that the discip line iscommitted to providing care that re-spects the uniqueness of each humanbeing and family in ways that promotehealth. The dive rsity of theoreticalframeworks within the nursing disci-pline will eventually generate an ex-tensive knowledge base about human-health phenomena as viewed fromspecific perspectives. For instance, theway grieving is viewed in Rogerssframework2 is different from the wayNewman, Orem, or l?arse6, s viewthe phenomenon. Each view of thephenomenon wil l be linked to theunity of understanding about the

226 Mttchel l

human-health lnterrelatlonship that t:>specified in the theory.

There is a growing recognition ;r~lc !commitment to the helief that if nur~ing is to continue tti develop a scientlfiiknowledge has

8/3/2019 1994 Mitchell Nursing Research

4/5

pose of theory in any discipline is todescribe a meaningful reality about aparticula r phenomenon of concern in aunique language. In nursing, the lan-guage of different theories describesdifferent realitie s about the human-universe-health interrelationship.

Gadamer describes a process of in-quiry whereby the researcher and par-ticipant come together to have a dia-logue about the meaning of some phe-nomenon. Both ,parties are concernedabout the subject matter and bothexperience a buoyancy in the transmis -sion of meaning that leads them toplaces beyond their original horizons.Understanding is an event, a happen-ing that happens ,through language. Fornurses conducting qualitative inquiry,the findings represent the researchersunderstanding, the fusion of horizonsthat i s disclosed by the researcher inthe light of a theoretical prejudice, orperspective. The example below servesto illustra te the power of the herme-neutic process in nursing science.THE HERMENEUTICS OFPARSES RESEARCH METHODParses research method was structuredto flow from the assumptions and prin-ciples of her hum.an becoming nursingtheory. ior l1 Researchers have beenguided by Parses theory in the study ofuniversal lived experiences like hope,grieving, aging, and struggling througha difficu lt time, to name several. Thehuman becoming theory represents theresearchers preexisting nursing frame-work. A researcher guided by Parsestheory of human becoming holds cer-tain views or prejudices that createunique openings or questions abouthuman beings and health. The open-ness defined by the preexisting frame-work is circumscribed and, yet, waiting to be filled. Scientific inquiry, then,is a process of gath.ering specific knowl-edge to fill the openness circumscribedby theory.

For example, IV5tche1135 recorded 12discussions with persons over the age of75 about their e-xperience of restric-tion-freedom in later life. Three coreconcepts emerged in the structure of

the experience as described by studyparticipants, anticipating limita-tions, unencumbered self-direct ion,and yielding to change fortifies resolvefor moving beyond. One of the threecore concepts, anticipating limitations,will serve to guide this discussion ofthe hermeneutical process.

Anticipating limitations was de-scribed by participants as a process ofreflecting on restrict ions in the now, aswell as how restrictions might be ex-perienced in time to come. Olderpersons expected that painful arthritis ,poor vision, and hearing loss wouldcontinue to present restrictions in laterlife. Falls were pictured as possiblehappenings, as was the eventual relin-quishment of caring for self and livingindependently, unless death came first.Some participants spoke about antici-pated limitat ions in a matter-of-factway and in the context of the opportu-

Understanding is anevent, a happeningthat happensthrough language.nities that would accompany them. Forexample, a participant described thatthe restriction of less privacy mightlead to more time to do what is wantedwith friends and family. Persons antic-ipated gains and losses n later life. Lossof activ ity, strength, and loved ones, forexample, were expected to coexist withthe freedom to laugh and be withfriends, the freedom to decide how tobe with frustrations, and the freedomto keep going until the end was insight.

The core concept, anticipating limi-tations, was synthesized from partic i-pant descriptions about what they pic-tured as possible happenings. The de-scriptions, when interpreted in thelight of Parses theoretical concepts,clearly linked to the concept imaging.Imaging is one of nine concepts speci -fied in the theory of human becoming.

NURSING OUTLOOK SEPTEMBER/OCTOBER 1994

It is the way persons construct reality,according to Parse.

Participant descriptions directed theresearcher to Parses concept, imaging.The researchers bias before the studywas that all human beings image, whatthey imaged about the lived experi-ence of restriction-freedom was discov-ered in the inquiry. The anticipatedlimitations described by participantswere not known before inquiry. In thisway Parsesabstract concept of imagingwas filled out, expanded, and furtherdefined with substantive content at thelevel of lived experience.

The researcher gained understand-ing, not only about what kinds of lim-itations were imaged in later life, butalso how persons saw themselves in re-lation to the limitations. The researcherdiscovered how persons were alreadytrying out and planning ways to bewith the anticipated limitations. Theolder persons spoke about choosinghow to be with frustrations, upsets, andlosses. Personal descriptions inter-preted in the light of Parses theory in-cluded not only what is, but what willbe. This understanding is profound inthat nurses aspire to conduct inquirythat depicts health as a process. Inquiryguided by Parses theory captured theprocess of how persons experiencehealth, not only in the now moment,but health as it wil l be lived in time tocome.

All research is theory driven, and allresearch findings are weaved into sometheoretical belief system that is inher-ently philosophical; this is what makesfindings meaningful. Rather than be-ing an embarrassment, theoretical in-terpretation is prized as the essence ofknowledge expansion. If researchersdesire discipline-specific inquiry, re-search must be performed in the lightof a spec ific theory that houses theknowledge of the researchers disci-pline. It is evident in the language ofParses theory that it represents a cer-tain way of thinking and speakingabout human experience. Other re-searchers, who have different preexist -ing theoretical frameworks would nothave conceptualized the inquiry or in-

Mitchel l 227

8/3/2019 1994 Mitchell Nursing Research

5/5

tcrpreted findings about restriction.freedom in the way described above,This is the beauty, and the value, oftheory-guided research. Findings fromMitchells study on restriction-free-dom arc uniquely discipline specific,and they represent nursing knowl-edge:SUMMARYGadamers insights into the herme-neutical process contribute a great dealto the understanding that may accom-pany scientific inquiry, if preexistingprejudices are respected for their con-tribution to discipline-specific knowl-edge. Heidegger3 said that languagespeaks for us in what has been spo-ken. This means that the way nursesuse language signif ies who they are asa group of health professiona ls. Lan-guage is the vehicle that discloses nurs-es values and beliefs. Parses theory isone framework among many that pro-vides nurse researchers with a coherentlanguage of the human-health interre-lationship for guiding inquiry. Theprejudices of the theory are clearlyspecified and they circum scribe uniquearenas for knowledge development.The language of the theory describeshuman becoming from a nursing per-spective. It is complex, process ori-ented, and abstract, just like thehuman-health phenomena it repre-sents. It is precis ely the unique under-standing and knowledge of nursingtheories that may direct further disc i-pline-specific inquiry and structure ac-tivit ies for an autonomous nursingpractice. Ultimately, knowledge gen-erated from discipline-specific inquirywill expand theories for guiding cre-ative and meaningful practice withpersons, families, and groups that seekprofessional engagements. n

REFERENCES1

2

3

4

5

6.7.

8.

9.

10 .

11 .

12

13 .14

IS.

16 .17 .

18 .

19 .

&darner H-G Pfriiosophrcal hermeneutlcs(Linge DE, trans ed I Berkeley, CalitormaLlniversitv of Cahfornra Press, 1976.Gadamer ti-i; 1 I {rib .I& method (Wcrtisheimer J Marshal1 IX tr.ms, cd-, ! &:~~~York Crc)ssro;id, lYl9.Culi-Wilhy BL, Icpt:: 1 1 Towards a coexist-cncc of paradtgms iii nursing knowledge de-velopmen t 1 Adv :Xurs lY87j12,i15-2 1DeGroot HA Screuttfic unLutry in nursmg.I mode l for .r net\ zgc Adv Nurs Sci IYKtl;10(3):1-21Moccia P. A crmqtre ~)t compromtse beyondthe methods debar.< Adv Nurs S ci 1988.10(4):1-Y.Parse RR Man-hvtng-health. a theory ofnursing. N ew York Wiley, 1981.Polkinghorn e D Methodo logy for the buman sciences systems of inquiry. Albany,New York: State University of New YorkPress, 1983.Skinner Q The return of grand theory in thehuman sciences. London : Cambridg e Uruversity Press, 198 5Gortncr SK, Schultz PR. Approaches to nurs-ing science methods lmage J Nurs Sch1988;20:22-4Parse RR. Man-living-he alth theory of nurs-ing. In, Parse RR, ed. Nursing science: majorparadigms, theories and critiques. Philad el-phia. Saunders, 19X 7.Parse RR Parses research methodolo gy withan illustration of the lived experience ofhope. Nurs Sci Q 1Y90,3,9-17Phillips JK. New methods of research, he-yond the shadows of nursing science. NursSci Q 1990&l-2Morse J. If you believe in theories. Qua1Health Res I Y92,2,259-61 .Heideggcr M. Bein g and time. Macquarrre I,Rohinson E, tram t New York, Harper &Row, 1962.Holmes CA Health care and the quality oflife a review. I Adv Nurs 1989,14:83 3-Y.Phillips JR. The looking glass of nursing re-search. Nurs Sci Q 1988;1:96.Aaronson KK. Quality of life research incancer climcal trials: a need for commonrules and langua ge Oncology 1990;4(5):59-66Campbel l A. The sense of wel l-being inAmerica. New York: McGraw Hill, lY81.Flanagan JC. Measurement of quality of life:

LO.

L!.L?

23

24 .

25

26 .

2728 .2).

30

31.32

33.

34

35.

Nrwraan MA. Health as expandm g con-:>c~o~~sn~s~ FL LOUIS. CV MO&~-, 1986Qrcn: DE . Nursing, concepts of praerice 4thcd St Louts MoshyYear Rook, 1 YY 1.!arsc RR Human becomin g. Parses theorvof nursing. Mm-s Sci Q 1992,5,35-42Lcminger MM. Care. The essence of nurstngand bcslth Thorofarr, New lersey Slack,i\i . ?Mahnski VM Explorat ioni on Martha Rog-CIS sctence of unitary human beings Nor-M.A k Cormecticut Appleton-Century-i,r-iifi,, 1986Reed PG. Nursing theorrzing ab an ethicalcndcavor Adv Nurs Sci iYHY;I 1(3):1-Y.Roy C Andrews H. The Roy adaptationmode! the definitive statement Norwalk,Connectrcut: Appleton-L ange, 19Y 1.Struttr MC Nursing practice guide d hy orgenerating theory. Nurs Scr Q 1990;3: 147-H.Herdrgger IM Poetry, language, though t.(Hoiswdtcr 4, Trans.) New York. Harper bKLiW 1975Mitchell i;J. Exploring the paradoxtcal cx-

pertence of restrictton-freedom in later life,Parse s theory-guided research [unpublish eddocto ral dtsscrtatron]. LJniversrtv of Sou th;~rrr~Jma. C olumb ia, S C

GAIL J . MITCH ELL is a nurse scientist gThe Queen El izabeth Hospital and an as-sistant professor at the Uniwts+ty ofToronto, in Toronto, Ontar io, Canada.

22 8 MRc4ell