Foundational Perspectives
The CAEN curriculum is informed by a number of philosophical perspectives or "world views" 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.
Empiricist Perspectives
An empiricist approach values observables and "careful scientific strategies that bear results that can be corroborated if not confirmed" (Im and 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.
Post Empiricist Perspectives
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 and Meleis, 1999, p.14). Within post empiricism situation-specific theories can be developed to assist in linking the observable to the "unobservables" (Im and 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.
Post Modern Perspectives
Post modernism 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:
Phenomenological Perspectives
Phenomenology is both a philosophy and a method of inquiry and is informed by several philosophical traditions through the writings of late 18th and early 19th Century writings of Hegel, more recently Husserl (1964) and existential philosophers such a Merleau-Ponty (1962), and the hermeneutical perspectives of Heidegger (1962), and Gadamer (1976). These latter 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 experienced. 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 emphasises 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).
Critical Perspectives
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.
Of important significance to nursing, critical theoretical 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 this perspective, 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, to be an advocate for the tolerance of diversity and support for social justice. Thus Critical Social Theorists are concerned with inequalities perpetuated through for example class, race, gender, colour, and labour. Critical approaches include but are not limited to:
Feminist Perspectives
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. 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: liberal, socialist, cultural, radical and post-modern feminism (Chinn, (1989). 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
Postcolonial perspectives bring our attention to the social conditions related to colonization and racism (Doane and 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 and 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. Said for example argued that colonizing ideologies were implicit in language (1978). 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.
Intersection of Perspectives
The Positivist tradition in nursing has given way to a post-empiricist view that stands alongside interpretive and post-modern 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 lead nursing scholars to use ideas from phenomenology, existentialism including ideas drawn from the work of existential philosophers such as Buber, Sartre, 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 short comings of earlier interpretive traditions 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 have all been acted to inform nursing's epistemology or ways of knowing in nursing.
Ways of Knowing and Nursing
The early work on nursing knowledge followed the traditions of Positivism. It was not until the late 1960's that alternative perspectives began to emerge for example in the theoretical work of Paterson and Zderad (1976). In 1978 Carper's thesis on fundamental patterns of knowing in nursing was published paving the way to rethinking nursing's epistemology.
Carper (1978) identifies four ways of knowing in nursing: (1) empirics, the science of nursing; (2) aesthetics, the art of nursing; (3) the component of personal knowledge in nursing, and (4) ethics, or moral knowledge in nursing. The empirics of nursing include the proliferation of nursing theory and research and the advancements nursing has made in the scientific realm. Traditional ways of knowing and culturally relevant ways of knowing are also important and inform nursing practice in Canada and the global context.
