The Science of Nursing: Current Issues and Dilemmas

The question regarding the nature and direction o f nursing science, how it is derived or why and whether nursing is a science is a much debated one. This article focuses on an examination of the literature with regard to conceptualisations of science in general and nursing in particular with special emphasis on the nature, purpose, methods and domain o f science and nursing science. It looks at the various positions taken, examines the consequences o f holding any special position and makes Opsomming Die aard van wetenskapsbeoefening in die verpleegkunde, die rigting wat ditbehoort te volg, diemetodes van kennisversameling en die bestaansreg van die verpleegkunde ofhoekom dit well as wetenskap kwalifiseer, is almal omstrede vraagstukke in die verpleegliteratuur. Die literatuur met betrekking tot bogenoemde aspekte is verken en aspekte ten opsigte van die konseptualisering van die wetenskap in die algemeen en meer speisfiek die verpleegkunde as 'n wetenskap, word bespreek. Daar word veral aandag gegee aan die aard, doel, metodes en domein van die wetenskap en verpleging as 'n wetenskap. Verskillende standpunte rakende hierdie aspekte word onder die loep geneem. Aandag word ook gegee aan gevolge, indien 'n sekere standpunt gehuldig word. Voorstelle hoedate uitmuntendheid in verpleegkunde bereik kan word, word gemaak.


INTRODUCTION
Nursing has long been considered as an art, whereas nursing as a science is a relatively recent development.Other than Nightingale who in 1860 identified nursing as both an art and science not valuing one more than the other, (Nightingale reprinted 1969) it was not until the late 1950's that serious attention w as given to nursing as a science.Since that time nursing increasingly has become concerned about its knowledge base for practice.Today the term n u r s in g s c ie n c e is f a m il ia r to n u r s e s .C o n te m p o ra ry li te r a tu r e a b o u n d s w ith strategies for building a nursing science (Chinn & Jacobs 1987;Jacox 1974;W atson 1985).There are Departments o f Nursing Science and the South African Nursing Council (SANC) describes nursing as a human clinical health science.
There are, however, critics w ho challenge the view that nursing is a science, and nurses are not always able to present convincing argum ents that nursing in fact is a science.Even among nurses themselves there isnot alw ays agreem ent on the nature and direction o f nursing science or how it is derived, or why nursing is a science.For close on thirty years this has been a subject o f debate among nurse scholars, and contrary positions still are being explicated.
In order to be able to participate meaningfully in such debates or defend their view s when challenged, it is essential for nurses to have an understanding o f the nature o f nursing science and how it relates to the larger body of science, to be exposed to different viewpoints and to be able to judge the relative merits o f arguments related to nursing as a science.
This article seeks to examine conceptualisations o f science in general and nursing science in particular, as presented in the literature, with regard to its nature, purpose, m ethods and domain.It will also look at the various positions taken, exami ne the consequences o f holding any s p e c ia l p o s itio n , m a k e s u g g e s tio n s for achieving excellence in nursing science and thereby try to clarify the issues relating to nursing as a science.

W IIAT IS SCIENCE?
The question "W hat exactly is science?" is not easy to answer.Many and varied ideas, attitudes and conceptualisations on the exact nature of science and know ing can be found in the literature, each reflecting a specific world view.Science has been defined as a product, a process or both.As a product, science represents the e v e rg ro w in g , e v e rc h a n g in g a c c u m u la te d knowledge o f a particular discipline (Abdellah 1969;Downs 1979;Einstein 1950;Hinshaw 1989;M oody 1990). H inshaw (1989: 162) states: "The sciences are defined as bodies of human knowledge based on general principles about a delim ited range o f phenomena derived from empirical observation".The product or body o f knowledge is the outcom e or result of sc ie n tific in q u iry (P arse 1987; Silva a n ^ R o th b a rt 1 9 8 4 ) a n d in c lu d e s s c i e n t i f i ^ te r m in o lo g y , d e f i n it io n s , p r o p o s itio n s , hypotheses, theories and laws (Rudner 1966).As defined by Moody (1990:19) it is a body of knowledge w hich includes facts and theories generated by the use o f systematic, controlled and precise methods within a defined area of concern.
A s a process science refers to a method of inquiry or the m eans by w hich a body of knowledge evolves and progresses (Beckwith and M iller 1976;Bronowski 1965;Harrison 1984).Bronowski (1965:16) describes science as an intellectual activity and states "Science is nothing else than the search to discover unity in the wild variety o f nature, o r ... in the variety of our experience".

W IIAT IS THE NATURE OF SCIENCE?
The nature o f science is a controversial issue.Conceptualisations vary according to the world v ie w or p h ilo so p h ic a l o rie n ta tio n o f the scientist.T w o dominant world views o f science are reflected in the literature, nam ely the "received view" and the "perceived view" of science.For decades the received view, also known as logical empiricism or positivism, was the predom inantly accepted w orld view of science.In the literature it is frequently referred to as traditional science or pure science.
Proponents of the traditional view or logical positivism operate on strict rules of logic, truth, laws, axioms, predictions and reductionism.
They believ e that all hum an behaviour is objective, purposeful and measurable.Only what can be seen, sensed and m easured is worthy of pursuing.Predictive statem ents that have no sensory data corroboration are not scientific.They hold the position that "truth" is absolute and there is a single reality.True statements are based on experience and known from experience.In order to find truth one must be com pletely objective, w hich m eans that values, feelings and personal perceptionscannot e n te r in to th e m e a s u re m e n t o f re a lity .Accordi ng to logical positivists there is only one method for science.This method is detached o b s e r v a tio n , c o n tr o lle d e x p e rim e n t and m athem atical or quantitative m easurem ent (Van Manen, 1990:4) and incorporates logistic and deductive reasoning.
Facts from research are systematically linked to each other in a way that seem s best to explain our empirical world; such linkages are called laws, principles or axioms depending on the certainty of the facts and relationship within the linkage.The emphasis of logical positivists is one of theory validation, not theory discovery (Rudner 1966).
L o g ic a l p o s i ti v is t s d o n o t a d d re s s th e application of science and therefore are accused of erecting barriers between the pure scientist and the scientific practitioner.
The perceived view of science, also known as h isto ricism or p o stp o sitiv ism , ev o lv ed in reaction to the rather obvious limitations o f traditional science or logical positivism and has gained increasing prominence since the 1960s.Historicists maintai n that there is more to people than that w hich can be seen , sen sed and measured.They believe it equally important to stu d y and d o c u m e n t w h a t p e o p le know , e x p e r ie n c e a n d g iv e m e a n in g to b o th subjectively (internal reality) and objectively (external reality).Science is view ed as a process of understanding human behaviour."Understanding human expressions, knowing contextual experiences, and grasping the world view of people open the door to new and more meaningful insights about people" (Leininger 1985:23).
Historicists claim no access to certain truth or knowledge but rather accept certain knowledge to be "true", if it withstands practical tests of reason and utility.They do not cling to any one method of science but in fact encourage the use o f the most appropriate method for the particular research question (De Groot 1988:8).Either qualitative or quantitative methods are seen as effective tools for the developm ent o f science and unlike traditional scientists, historicists hold values, aesthetics and ethics as an integral im p o rtan t part o f the re se a rc h tra d itio n .According to this view legitimate knowledge can incorporate w hatever is germane to the d is c ip lin e , be it s u b je c tiv e , d e sc rip tiv e , normative, evaluative or objective.
Despite the differences in the conceptualisation o f science by proponents of the received and perceived view of science, common threads in the characteristics, criteria and norm s o f science can be identified.Gortncr and Schultz (1988) provide a list o f w ell-accepted criteria for judging excellence in science which include significance, theory-observation, congruency, gcneralisability, reproducibility, precision and intcrsubjectivity.These criteria are applicable r e g a r d le s s o f th e m e th o d o lo g ic a l o r philosophical approach used in developing the knowledge.A number of criteria which arc interdisciplinary across the social sciences are often used as norms to judge the merit o f the enquiry process and resultant knowledge base (M erton 1979;B arber 1952;Storer 1966).T h e s e c r i t e r i a in c lu d e u n iv e r s a li s m , com m onality, disinterestness and organised scepticism.Hinshaw (1989) suggests that two additional criteria need to be used in judging excellence in science -the developm ent or existence o f substantiated bodies o f knowledge specific to areas o f critical concern in the profession, and the evolving information base on the "cutting edge" of science -are both characteristics crucial to developinga creditable and usable science base.
T hese criteria may be useful in exploring w hether or not and to what extent a science of nursing exists.

W IIAT IS TIIE PURPOSE, GOAL OR AIM OF SCIENCE?
For Kerlinger (1973) the major aim of science is to evolve theory which is conceptualised as a coherent set o f verified relations useful for explanation and prediction, and consequently for control.Professional disciplines, however, expand on this and believe that the aim of s c ie n c e in c lu d e s th e d e v e lo p m e n t o f prescriptive theory i ,e.theory to guide practice.

W IIAT IS A DISCIPLINE?
Most of the definitions o f science are posed in the context o f the discipline from which they arise (Moody 1990:18).It therefore stands to reason that a consideration o f science should include a consideration of the discipline from which it arises.
The Oxford dictionary defines discipline as "a branch o f instruction or education; a department of learning or knowledge".represents a shared belief among its members regarding its reason for being.For example, the domain o f enquiry for physiology is the study o f the function o f living system s, and for sociology it is the study o f principles and processes governing human society.The focus for law is injustice and grievance and the focus for architecture is the form and function of buildings.All research in these disciplines is directed towards addressing this focus in some small part.Each discipline thus has a central focus w hich influences the perspective of that field, the way i t conceptualises the world and the question it poses for investigation.Donaldson and Crowley (1978:418) draw attention to the fact that even though each discipline is unique, they are not totally independent o f each other.The quality o f theories, research designs and v alid ity o f co n clu sio n s draw n w ithin one discipline are dependent upon their congruence with all o f knowledge.Therefore knowledge in one discipline may constrain or enhance the process o f enquiry in another and no discipline should function in isolation.Donaldson and C ro w le y (1 9 7 8 :4 1 8 ) fu rth e r d is tin g u is h between academ ic and professional disciplines.A professional discipline in addition to its area o f study is defined by social relevance and value orientations.The focus is derived from a belief and value system about the profession's social comm itment, nature o f its service and area of responsibility for know ledge developm ent.These requisites need expression in the focus statement.For example, while the central focus in medicine is disease, defect and physiological deficits, the social and value orientations of m e d ic in e a s a p ro fe ssio n a l d is c ip lin e is co n v ey ed by the co m m itm ent to alleviate disease.

CONCEPTS RELEVANT TO TIIE FOCUS OF NURSING
N ursing has defi ned itself as a discipli ne in order to establish identity separate from medicine (M urphy and Hoeffer 1983).Nurse theorists however, have not reached consensus yet on a central focus o f enquiry clearly distinguishing it from other disciplines.
The domain o f nursing w as addressed by Yura and Torres in 1975 when they described the major concepts or the domain o f nursing as b e in g m an , so c ie ty , h e a lth an d n u rsin g .A lth o u g h th e re a re s lig h t v a ria tio n s in terminology am ong theorists, there appears to be general agreem ent at present, at least in the USA and Canada, that the domain o f nursing is p e rso n , e n v iro n m en t, health and nursing.Fawcett (1984) and Jennings (1987) regard this a s an im p o rta n t s te p in n u rs in g th eo ry developm ent because it signifies that nursing has developed to the stage o f identifying major id e a s g u id in g co m m o n lin e s o f enquiry. H ow ever, H inshaw (1989:164) argues that "even with the com m itm ent to and consensus c o n c e rn in g th ese fo u r b ro ad phenom ena, kno w led g e to be developed and useful in Curationis, Vol. 15, No. 2, 1992 practice will need to be much more specific in nature ". Newman et al (1991) concur.
In recent years concepts o f concern central to nursing have been defined or suggested by a num ber o f professional n ursing bo d ies in different parts o f the world in their position or policy statements, and also by several nurse scholars w ho work mainly in the USA.For example, according to the position papers on nursing of the Royal College o f N ursing(RCN ), "caring", is the core o f nursing."The nursing system must acknowledge the centrality of care in the overall delivery o f se rv ic e ... it is the skill and art o f carin g for ano th er person that transforms the action from a technique to a nursing intervention" (1987:11).The American Nursing Association (ANA) in its posi tion paper on nursing regards the diagnosis and treatment of human response to actual and potential health problems as the central phenomenon of concern in nursing (1 9 8 0 :2 ).T he N o rd ic N urses Federation in theirethical guidelines for nursing research acknowledge nurses' responsibility to "promote health, to prevent illness, to restore health, to prevent death, and to assist to a comfortable death".Further there is a clear expectation for renewing personal knowledge and skills (1987:7).The SANC (1988)  The SANC has attempted to distinguish the domain o f nursing from the domain of medicine by adding "within the parameters o f nursing p h ilo so p h y and eth ic s ... and d ev elo p in g knowledge for nursing diagnosis" -but did not elu c id a te these co n cep ts.It is g en erally espoused that nursing adheres to a humanistic philosophy so it is not clear in which way nursing philosophy isaphilosophyspecificonly to nursing and neither is it clear in which way nursing ethics are distinctive.
Either health or care or both feature prominently as the central focus o f n ursing in all the definitions referred to so far, as well as in current d e fin itio n s o f m any n u rse th e o ris ts and researchers.It can be argued that health has been heralded as the center piece of nursing k n o w le d g e s in c e th e d a y s o f F lo re n c e Nightingale and continues to be viewed as such by many nurse theorists and researchers (M eleis 1990; Newman 1986; Pender 1987).Caring, too, (both the concept and the process) has occu p ied a prom inent p osition in n u rsing literature and has been suggested as the essence or central core o f nursing, not only by the RCN but also by several nurse scholars (Benner and Wrubel 1989;Bottorf 1991;Leininger 1984;W atson 1985).The question which needs to be a n sw ered is w h eth e r e ith e r o f th ese tw o concepts -health or caring, represents the central focus o f the discipline o f nursing.According to Peplau (in Smith 1988:82) we cannot say health is a central focus, because health is a goal, an outcome.In a recent editorial Diers (1988) disagrees with the prem ise of c a rin g as the c en tral fo cu s, sta tin g it is presumptuous o f nurses to assume that only they care.Packard and Polifroni (1991)

DEFINITIONS OF NURSING SCIENCE
Nursing Science, like science in general has been defined in several ways, w hich leads to confusion and may impede argumentation.In 1969 Abdellah described nursing science as "a body o f cumulati vescientific knowledge, drawn from the physical, biological and behavioural scien ces that is uniquely nursing: (p.339).A lm ost a decade later Jacobs and Huether (1978:66) described nursing science as "the process and the result o f ordering and pattemi ng the ev en ts and ph en o m en a o f concern to nursing".
More recently B ottorf provided the following definition: "The term science o f nursing refers to that branch or body of knowledge that is characteristically different from the knowledge th a t is a im e d a t an d a c h ie v e d by o th er discipline" (1991:28).B ottorf then emphasises that the science o f nursing does not comprise all the know ledge that nurses need in order to practice (e.g.physiology, sociology) but rather, onl y that knowledge that is particular to nursing.These three w riters thus all view nursing science differently.W hile Abdellah and B ottorf both agree that science is a body o f knowledge -the focus o f concern for accum ulating this body of knowledge differs.On the other hand Jacobs and Huether support the view point that science is a product created by a process "that is directly r e l a te d " .
T h e s e v a r i a t i o n s in th e conceptualisation o f nursing science can cause considerable confusion to those w anting to defend nursing as a science.
The definition o f nursing science by the SANC w ith its many labels for the term nursing science, further adds to this confusion.In its policy and philosophy on professional basic training the SANC describes nursing science as a human clinical health science that constitutes a body of knowledge ... is concerned with the development of know ledge... is an area o f study ... and the scientific approach is also referred to as the nursing process.Nursing science can thus refer to any o f five phenomena.Carper (1978)

TIIE ISSUE OF NURSING AS A BASIC VS APPLIED OR PRACTICE SCIENCE
The question w hether nursing is a basic, applied or practice science is a further issue o f frequent controversy and confusion.Currently three posi tions regardi ng the nature of nursing science can be found in the nursing literature.It held that nursing is a basic science, an applied science or a practical science.Arguments can be advanced for and against each of these three positions.
The basic sciences generally are distinguished from other sciences on the basis o f their goal or end.The goal of basic science is theory or knowledge for the sake of knowledge caring or the historical evolution of holistic health care).However, if nursing science is pursued only as a basic science, nursing practicc will be without the scientific understanding of nursing means.Without scientific knowledge o f nursing, the nurse is left to her or his own re so u rces and to using trial and erro r to determine how descriptive knowledge should be applied in a particular situation.Basic scientific knowledge does not provide the nurse w ith th e n e c e s s a ry k n o w le d g e to m ake decisions about the most effective course to follow in meeting a goal.Some scholars have argued that nurses should not impose their own views on their clients and limit knowledge claims to those which are purely descriptive.
Moccia, for example argued that the use of knowledge that is predictive strips individuals o f th e ir p o te n tia l fo r a u to n o m o u s self-determination and reduces them to objects.She expresses concern regarding the view that science should guide practicc and asks whether it is not immoral to impose a belief system on another individual.However, in retaliation the question o f whether it is immoral to subject humans to a trial and error practice in nursing also needs to be addressed.
In reaction to the apparent inconsistencies and inadequacies o f nursing as a basic science, nursing is regarded by many as an applied science.Questions however, arise in respect to a common determination o f what is really meant by the term applied science.In the nursing lite ra tu re it has been g iven a v ariety of m eanings.Some view applied science as answering questions related lo the applicability of basic theories in practical situations, rather than questions related lo how basic theories are to be applied (Donaldson and Crowley 1978).Some suggest that an applied science is one that uses the knowledge o f basic sciences for some practical end (Wallace 1983).Some refer to applied science as theories derived from the scientific theories of other disciplines that arc applicable to nursing (M eleis 1988).In the light o f th e a m b ig u ity s u rro u n d in g th e te rm "applied" science, the term as related to nursing is in need of clarification.On the other hand, there remains the question of "applying what" -only nursing theories or theories from other disciplines?And also, there is the question as to whether being an applied science eliminates the potentialities of basic science.
History demonstrates that some of the most im portant scientific discoveries come about inadvertently and not as a direct result of specific research aims.Further, theory hasoflcn preceded application by many years, as for example in the case of nuclear physics and M endel's law.In labelling nursing as an applied science and limiting scientific inquiry to the application of basic sciences to nursing practicc, the science of nursing is made dependent on a d v an cem en ts in o th e r d isc ip lin e s.It is however, unlikely that all scientific knowledge csscniial for nursing practice will be developed by other disciplines.If nurses pursue nursing science as an applied science, nurse scientists m ay be fo rc e d to w a it in d e f in ite ly for development of scientific principles that can be tested and applied to nursing practice.
The third conceptualisation o f nursing science to be considered is that o f nursing as a practical science.In recent literature Orem (1988) and Schlotfeld (1988) argued that the science of nursing must be practical.Scientific inquiry in nursing must yield findings directly useful and re le v a n t to n u rs in g p ra c tic e .P ra c tic a l knowledge presupposes theoretic knowledge.
As W allace (1983:277) stated "Sciences are said to be practical because their knower intends o p eratio n , w hile they are also said to be theoretical because their knower intends truth and proceeds analytically, even though the science as such is concerned with something d o a b le " .
W h e n n u r s in g s c ie n c e is conceptualised as a practical science, it is clear that nursing's ultimate goal is to use knowledge o f principles and causes in the development of specific nursing means that can achieve nursing ends and thereby the overall end of nursing.A p ra c tic a l s c ie n c e g e n e ra te s d e s c rip tiv e , explanatory, predictive and prescriptive theory and therefore can be considered suitable to m e e tin g n u rs in g 's n e ed s.B o tes (1 9 9 1 ) advocates the use o f the functional approach in nursing science.Except for the terminology her explication o f the functional approach appears to be more or less equivalent to descriptions of practical science in the American and Canadian literature.
The implication of calling nursing a practice science is that the focus o f nursing, in providing a p a rtic u la r se rv ic e , sh o u ld be a special consideration in the development of nursing knowledge.W hile this observation is obvious, there is reason to question the utility and a p p ro p ria te n e s s o f a d v a n c in g arg u m en ts pertaining to basic vs practice science.Toulmin (1972) pointed out that all scientific enterprises are made up of two components, viz.: (1) the body of knowledge (2) the group o f individuals who work to apply, develop and evaluate that knowledge The notion o f a practical discipline might be considered universal, for even historians and m athem aticians have a "practice" component as they w ork to apply the knowledge in their respective fields.It is difficult to argue against T oulm in's view of science because a body of knowledge must be knowledge for some group o f people.Consequently following Toulm in's view , the d istinction betw een a basic and ap p lied o r practice d iscip line offers little contribution to understanding the nature of nursing.All disciplines must have an associated group o f persons w ho use and develop the knowledge base, w hether their "practice" realm is in a laboratory or in a comm unity with human recipients (R odgers 1991:180).Debates on nursing as a basic or applied or practice science thus app ear to o ffe r little co n trib u tio n to supporting the view that nursing is a science.

NURSING SCIENCE M ETHODS
The decision regarding an acceptable method to be used in the conduct o f scientific enquiry in nursing has been subject to considerable debate.Some w riters believe that empiricism if not quanti fication is the most appropriate avenue for research endeavours (Clarke and Yaros 1988;Moccia 1988;Norbeck 1987).O thers (Field and Morse 1985;Leininger 1985) maintain that the qualitative approach holds the greatest promise.
Several w riters have advocated the use o f both qualitative and quantitative approaches within the sam e study and for the sam e questions (Duffy 1987;G ortner and Schultz 1988;Porter 1989).In resp o n se, a n u m b er o f w rite rs including Moccia (1988) and Phillips (1988) address the overall loss o f integrity inherent in using opposing methods.Proponents o f the quantitative methods seem to agree that is is not the only way to go about research, but it is important in that statistical data allow us to see w hat portion o f the dependent variable is e x p la in e d by th e id e n tifie d in d e p e n d e n t v a ria b le s .T h o se w h o fa v o u r q u a lita tiv e m ethods believe that first hand experience provides the most meaningful data for nursing.Leininger (1985:2) encapsulates the view s o f the proponents of this approach in stating "the scientific method is far too narow, reductionistic and controlled to let one know human beings in their totality and help them in times o f wellness and illness".

IS EXCELLENCE IN NURSING SCIENCE SUSTAINED?
G o rtn e r and S c h u ltz (1 9 8 8 ) b e lie v e the emphasis in debates on nursing as a science should be on standards of "good science" in nursing regardless of technique.Thus the issue ofconcern is to what extent does nursing science meet the accepted criteria forjudging scientific merit?To answer this, the criteria advanced by Hinshaw (1989:169) to judge excellence in nursing science, namely depth i n the knowledge base and studies which are on the "cutting edge" o f knowledge frontiers, will be examined in ielation to the present state o f nursing science.
In their now classic article "The discipline o f nursing", Donaldson a n d C ro w le y ( 1 9 7 8 :4 1 4 ) m a in ta in th a t disciplines have evolved as a consequence of a d is ti n c t p e rs p e c tiv e an d s y n ta x w h ic h determines what phenomena are to be viewed, what questions are to be raised scientifically, what methods of study are to be used and what evidence o f proof is required.A c c o r d in g to N e w m a n , S im e an d C o rc o ra n -P e rry (1 9 9 1 :1 ) a d is c ip lin e is distinguished by a dom ain o f enquiry that in its Philosophy and P olicy statem en t on both professional basic and postbasic training state: "Within the parameters o f nursing philosophy and ethics, nursing science is concerned wi th the developm ent o f know ledge for the nursing diagnosis, treatment and personalised health care o f p erso n s ex p o sed to, su ffe rin g or recovering from physical or mental illness.It e n c o m p a s s e s th e s tu d y o f p r e v e n t iv e , promotive, curative and rehabilitative health care for individu als, fam ilies, g roups and communities and covers m an's life span from before birth".The International Council of Nurses (ICN) in a revised position paper on nursing research (1987) first specify a clear e x p e c ta tio n fo r a c o n sta n t g e n e ra tio n o f up-to-date organised nursing knowledge, and then state: "Nursing as an integral part o f the health care system, encompasses the promotion o f health, prevention o f illness and care of the physically ill, mentally ill and disabled people o f all ag e s in all h ealth c a re an d o th e r co m m u n ity se ttin g s .W ith in th is b ro ad spectrum o f health care, the phenomena of particular concern to nurses are individual, fami ly and group responses to actual or potential health problems".Tlie ICN thus concurs with the ANA regarding the phenomena o f concern for nursing.Allen (1987) has criticised the lack o f clarity in the definition statem ent o f the A NA , and suggests that rather than providing clarity, the statement may well serve to blur the direction o f nursing science through a superficial definition of the scope o f nursing.Packard and Polifroni(1991)  are o f the opinion that the defined focus does not distinguish clearly the dom ain of nursing from the domain o f medicine.These argum ents are equally applicable to the focus of concern defined by the other national bodies to w hich reference has been made.
pose the question "If the aims of nursing science are directed towards the phenomena o f caring, how is n u rs in g d iffe re n t fro m o th e r h e lp in g professions?".Newman et al (1991:2) argue that neither concept (i.e.health or caring) alone meets the criteria for the focus o f the nursing discipline.For exam ple, know ledge about health without consideration o f cari ng, would be k n o w le d g e o f a d isc ip lin e o f h ealth and sim ilarly, know ledge o f personalised health c a re o f p e rs o n s e x p o se d to su ffe rin g or recovering from illness would be knowledge of a discipline o f health.These writers therefore suggest that the concepts, caring, health and health experience should be related to each other, to identify the domain of inquiry for nursing and submit that nursing is the study o f caring in the human health experience (1991:3).In a recent article B o tes(1991:20) identifies the dom ain o f nursing enquiry as "die m ens b e tr o k k e by e c n o f a n d e r v erp leg in g sh a n d elin g e".T ran slated , this would be man involved in one or other nursing activity.Sim ilar argum ents already voiced relating to lack o f clarity and specificity would be applicable here too.W hat are nursing activities?How are they distinguished from medical or other health related activities?This view furtherm ore limits the scope of scientific inquiry o f nursing; for exam ple, historical studies o f the evaluation o f nursing practice or stu d ie s on th e m ean in g o f phenom ena o f concern to nursing are excluded.So far, the suggestion made byNewman et al (1991)  seems one o f the most meaningful regarding the focus o f concern for nursing.The task remains to examine and explicate the meaning o f caring in th e h um an h ealth e x p e rien ce in o rd er to ascertain the adequacy of this focus for nursing, and to examine the philosophic and scientific questions provoked by the focus statements.Until such time, the issue o f the central concern o f nursing will remain unresolved.The position is taken that despite this shortcoming, great strid es have been m ade in developing the disci pi ine o f nursing.As an evolving disci pi ine, nursing is developing an organised body of knowledge, composed o f specialised concepts and terminology used in education, practice and research.It has identified credible research methods, acceptable standards of practice, and criteria for educating practitioners in the field.
nurses should reach consensus about this.It is also important to re-examine c o ntinually our scien tific progress and to evaluate the scientific merit o f our developing body of knowledge.Nurses need to deal with the challenge to assure excellence in nursing science.To accumulate knowledge which is creditable and usable, nurse scientists need to build on co lleag u e's as well as their own research.They need to generate multiple studies in specific content areas and they need to publicise, criticise and question ideas and to strive to extend each others endeavours.They need to keep in step with developm ents in the philosophy of science and their subject area as well as to maintain strong relationships with interdisciplinary colleagues in relevant fields.Above all they need to ensure that the science o f nursing is rel levant to the art o f nursing.PENDER,N.J. 1987.Healthprom otion in nursing practice.N orw alk /C o n n ecticu t: Appleton-Lange.PHILLIPS, J R. 1988.Research Blenders.N ursing Science Quarterly.1: (no.1): 4-6.POLKINGHORNE, D. 1983.M ethodology for the human scienccs: Systems o f enquiry., B.L. 1991.Deconstructing the dogma in nursing knowledge and practice.Im age 23 (no.3): 177-181.ROGERS, M.E.1988.Nursing Science and art: A perspective.N ursing Science Quarterly 1 (no.3): 99-102.ROYAL COLLEGE O F NURSING 1987.In pursuit of excellence.A position statement on nursing.London: RCN.RUDNER, R.S. 1966.Philosophy of social s c ie n c e .E n g le w o o d C li f f s : N .J. Prentice-Hall.SA NC. 1988.G uidelines for the course leading to registration as a nurse (general, psychiatric and comm unity) and midwife 55/M88.Pretoria: SANC.SARNECKI, M.T. 1990.Historiography: A le g itim a te re s e a rc h m e th o d o lo g y fo r nursing.Ach'ances in N ursing Science 12 (no.4): 1-9.S C H L O T F E L D , R.M .1988.S tructuring nursing knowledge: A priority for creating nursing's future.N ursing Science Quarterly 1 (no.1): 35-38.S ILV A , M .C. 1977.P hilosophy, science, theory: Interrelation-ships and implications for nursing research.Im age 9 (no.3): 59-63.SILVA, M.S. AND ROTHBART, D. 1984.An analysis o f changing trends in philosophies o f science on nursing theory developm ent and testing.Advances in N ursing Science 6 (no.2): 1-13.SMITH, M.J. 1988.Perspectives on nursing science.N ursing Science Quarterly. 1 (no.3): 80-85.STORER, N.W. 1966.The social system of sc ie n c e .N ew Y o rk : H o lt, R in e h a rt, Winston.SUPPE, F. 1977.The structure o f scientific theories.2nd edition.Chicago: University o f Illinois.TOULMIN, S. 1972.Human understanding.Princeton: Princeton University.W ALLACE, W.A. 1983.From a realist point o f view.E ssa ys on the p h ilo so p h y o f science.2nd edition.Washington.D.C: University Press o f America.W ATSON, J. 1981.N ursing's scientific quest.N ursing Outlook.29 (no.7): 413-416.W ATSON, J. 1985.Nursing: The philosophy and science o f caring.Boulder: Colarado Associated U niversity Press.VAN MANEN, M. 1990.Researching lived e x p e r i e n c e .N ew Y o rk : T h e S ta te University o f New York.Publication No. 15-1558 pp.17-75).New York: National League for Nursing.Hilla Brink D Lilt, et Phil.R.N. RM.R.T. R.NA.R.C.H.N.Professor in Nursing Science University o f South Africa Pretoria.
sciences.Do nurses in this country collaborate s u f fic ie n tly w ith c o lle a g u e s fro m o th e r disciplines when doing research?Not much evidence exists at present to provide an answer.U n iv e rs a lis m w h ich is a n o th e r c rite rio n advocated for judging the merit o f science requires that know ledge be generalisable to more and more of the universe.Yet are nurses un d erstan d in g them .A n y th ing that values exclusively one standard as superior (whether a language, race gender or science) restricts its ability to progress behond the boundaries it self-im p o ses.T here is alw ays grow th and discovery beyond the boundaries and there cannot be only one best view or one best method in developingascience.Thereshouldhow ever, be one central focus of concern to direct nurse researchers and RODGERS