Nursing Research

Gail J. Mitchell, RN,pha

the tenets of truth with observables, reductionism, verification, and biasIf nurses aspire to establish a scientific free science offer the most hope for knowledge &ae that can guide an advancing nursing knowledge, I beau&xmmous practice, disc~p&xbspecific lieve there is only value-laden science. Science is knowledge about particular inquiry that expmds extant nursing phenomena of concern created by hutheory must be recognized as intgral to man beings and stored in disciplinethat process. specific belief systems. How! then, does a researchers disciplinary perspective and process of inquiry fit together! Methods of inquiry themselves flow from some theoretical perspective. It is adamerian hermeneutics (that DWWU?dEforthisreasonthatthetermsqu&at&e is, hermeneutics as a process of Discipline is defined in the Eighth and quantitative are inherently obunderstanding, rather than a method) Edition of the Concise Oxford Dictio scure when it comes to identifying the sheds light on the inherent role of the- nary as a branch of instruction or values and purposes embedded in reory in scientific inquiry. l, 2 Inquiry in learning. The idea of a branch or area search activities. One cannot assume nursing is increasingly acknowledged suggests that there are distinctions that a method of inquiry is automatias a theory-driven, value-laden enter- among branches or disciplines, an idea cally linked with a particular paradigprise, yet the full impact of nursing re- that remains obscure in nursing despite matic tradition until the guiding thesearch as a process of understanding recent claims in the literature that all ory is examined. For example, quantifueled by a particular disciplinary per- researchers have a belief system that tative researchers aligned with theories spective has not been fully explicated. guides their activities. It is, in fact, dif- consistent with the natural science traIf nurses aspire to establish a scientific ferent belief systems, and their related dition may search for variables through knowledge base that can guide an au- values and actions, that distinguish in- qualitative methods. In contrast, there tonomous practice, discipline-specific dividuals, groups, or disciplines3-s Dis- are qualitative researchers-whose theoresearch that expands extant theory ciplines house belief systems and val- ries are aligned with the human scimust be recognized as being integral to ues in theoretical structures dissemi- ence tradition. The point is that all that process. The purpose of this article nated through formal education and modes of inquiry and the findings genis twofold: first, to explore the meaning used to guide professional activities. erated ultimately flow from the reof discipline-specific inquiry; second, The suggestion that all research is the- searchers theoretical perspective. to consider the implications of herme- ory-driven (and, thus, discipline spe- What methods of inquiry do provide neutics for nursing science. cific) although viewed as undesirable are theoretically consistent processes in the past, is regarded here as desire- for data gathering and analysis. This~is able, necessary for knowledge develop- why Parse*~i l and Phillips2 have Nuts &ITLOOK 1994;42:224-8. ment and open to public scrutiny. called for nurses to develop methods of CopyriQtrt * 1994 by h&by-Year Bo&, inc. In contrast to those who believe that inquiry that flow from nursing theory. 0029.6554/94/$3.00 + 0 35/l/52707
224 Mitchell VOLUfutE 42 0 MUMl3ER 5 NURSING OUTLOOK

process of understanding, a process that Proceeding on the belief that different disciplines require distinct theories mediates the familiar and the unfamilto guide methods of inquiry, it is sug- iar. The hermeneutical process then, gested that inquiry without a specific represents the movement of insight link to nursing ,theory, while it may and discovery as researchers come to understand something familiar in a contribute to the knowledge of another discipline, does n.ot contribute to mu-s- new way. If the discipline of a reing knowledge. Morsel3 presents an searcher does not contribute to the opposing view on nursing theory and process of inquiry, then what is the provides an example of beliefs that are purpose of having different disciplines? inconsistent with those proffered here. What is the purpose of doctoral educaMorse is accurat:e when she suggests tion in nursing if there is no disciplinespecific inquiry! It is hoped that scholthat when one embraces a theoretical arly dialogue about the different approaches to inquiry will help to clarify and propel further debate. An example All researchers are from the literature on quality of life situated in a reality, may help to clarify issues related to through education discipline-specific inquiry.

possible interpretations. Quality of life is a concept that is value-laden, and attempts to define it in a sterile, generic way have failed. A frustration with the generic ap preach has led some scholars to suggest that researchers from different disciplines need to know different things about health and human experience. For example, Aaronson17 proposed that medical researchers should limit quality-of-life definitions to those that generate data that may have a direct impact on the treatment of, for instance, toxic side effects. In contrast, sociologists prefer to study global indicators of life quality and their relationships with roles and social processes.18,l9 Although the logic of the discipline-specific approach seems evident, there are and membership in those who continue to advocate for the DISCIPLINE SPECIFICITY AND some discipline. opposing position, that the minimally QUALITY OF LIFE The literature on quality of life begs acceptable definition of quality of life in any study must include multiple dithe question: Do researchers of differperspective, one l.osesthe ability to see ent disciplines require distinct views of mensions incorporating all life domains. Proponents of this latter posithings another way. This is precisely human phenomena to guide inquiry the point! A point that cannot be over- that enhances understanding and the tion, like Morsel3 in nursing, contend that there should be a gold standard, emphasized. Nurses need to see things development of meaningful knowlin a nursing way so that understanding edge? An analysis of the literature on about human-health phenomena may quality of life sheds light on the rebe enhanced from a disciplinary per- strictions of atheoretical, or generic, Generic researchers spective. inquiry. Generic inquiry is not guided mix languages that Morses skepticism about disciplineby an explicit theory from the respecific theoretical inquiry is evidently searchers discipline, and, thus, findhave different linked to a belief in an objective real- ings are sweepingly dispersed across meanings and ity. A reality that already exists out disciplines without integration into a assumptions. there and that may be discovered specific theoretical framework. Gethrough value-free, inductive inquiry neric, or non-discipline-specific, inconducted by researchers who can quiry only contributes to the ever exbracket all prior knowledge, values, panding quagmire about the meaning some operational definition that will and purposes. But reality is constructed of human phenomena, like health and incorporate all dimensions and provide and interpreted by human beings who quality of life. 15,l6 A synthesis of find- guidance for all researchers, for all disare already embedded in a world of ings is not possible because generic re- ciplines. meaning, language, culture, and histo- searchers mix languages (theories) that Butler20 proposed that the meaning 216fl4 Gadame:r2 proposed that it is have different meanings and assump- assigned to any phenomenon ultiry. not possible to have objective knowltions. mately depends on the values and puredge of reality since all persons are alGeneric inquiry about quality of life poses of the researcher or group. Should ready situated in it. has generated more than 800 indica- not researchers be expected to identify All researchers are situated, through tors, and researchers, including nurses, their group and its values and purposes education and membership in some have resorted to creating hundreds of in order to advance discipline-specific discipline. The knowledge of a disci- ad hoc definitions to guide re- knowledge? If what distinguishes pline provides a theoretical horizon search.151l7 The search for the one def- one discipline from another is the that is enlarged or expanded through inition of quality of life that is free of knowledge base used by group meminquiry. Gadamer2 proposed that in- theoretical bias has only served to sus- bers 6 10,21-23 then researchers from difquiry is in essence a hermeneutical pend findings in a bottomless well of ferent disciplines will be guided by and
NURSING OUTLOOK SEPTEMBER/OCTOBER 1994 Mitchell 225

dedicated to expanding distinct bodies human-health lnterrelatlonship that t:> of knowledge. The sociologists global specified in the theory. indicators of life quality and the onThere is a growing recognition ;r~lc! cologists explication of morbidity and commitment to the helief that if nur~ toxic side effects should be different ing is to continue tti develop a scientlfii from nursings area of concern, knowledge has<, II- Inquiry must I:Y The advancement of nursing knowlpand nursing theorv.: x 21-33 Currunt edge has been hindered not only by research in uclrsi!lg 1s restrrctlvel\, nurse researchers who borrow theory, bound by an unacknowledged, mcd; but also by those who espouse value- tally dominatt~l, multidisciplinary free, generic research. It remains a framework and 3 generic mode r)t in mystery why nursing scholars want to conduct value-free inquiry when it is the values of a discipline that guide the is thoughts and actions of its members. The belief that researchers can bracket prejudices is itself just a theoretical helief, a belief called into serious question by the recent disclosure of the integral nature of science and values. J 2, J 22 And even when researchers suggest that they bracket theoretical presuppositions, the language used to interpret findings reveals their views and biases about human beings and hea1th.l As noted by Gadamer, lan- yuiry that does not advance nursing guage is the living out of what is with science. The trend toward generic, mulus -not only in the concrete interrelatidisciplinary inquiry, which does not tionships of work and politics but in all distinguish the theoretical perspectives the other relationships and dependenof participating members, only serves cies that comprise our world. to blur and level differences that need to be developed and sharpened. Discipline-specific inquiry has the potential NURSING-SPECIFIC INQUIRY Nursing as a discipline is interested in to clarify the uniqueness of each discithe human-health interrelationship, plines knowledge and, thus, its contribut not in the same ways as medicine bution to society or sociology. Like other disciplines, Nursings distinct concern with the nursing has its theories that guide human-health interrelationship demands unique modes of inquiry that practice and research. It is generally agreed in nursing that the discipline is are guided by nursing theory., I2 Parse committed to providing care that re- has specified a qualitative mode of inspects the uniqueness of each human quiry that guides researchers to explore being and family in ways that promote meanings, patterns, and relationships related to universal lived experiences. health. The diversity of theoretical frameworks within the nursing disci- Most qualitative methods require the pline will eventually generate an ex- recording of descriptions about lived tensive knowledge base about humanexperiences that are gathered by a huhealth phenomena as viewed from man researcher who belongs to a parspecific perspectives. For instance, the ticular discipline and who has a particway grieving is viewed in Rogerss ular perspective within that discipline. framework2 is different from the way It is in this arena, where researcher Newman, Orem, or l?arse6,s view meets participant description in words, the phenomenon. Each view of the texts, or art work, that Cadamers inphenomenon will be linked to the sights about the hermeneutical process unity of understanding about the become especially meaningful. There

GADAMERIAN HER~WUTICS AND NURSING SCIENCft

Gadamer s Insights into the ilature of understanding as a process of interprrtation. rather than a reenactment, haa far-reaching itnplications tar scientific development, including nursing sciem.* 4ccording to Gadamer, the hermcneutical phenomenon is a proccss of interpretation or mediation that brings the familiar and the unfamiliar together in a 11ew way. In the arena of qualitative inquiry, the familiar may be regarded as the researchers theoretical perspective, the unfamiliar as the heretoiore unknown aspccrs &crib& by research participants ;rbwt~ a particular phenomenon under study. Gadamer suggests that theoretical preiudices, rather than representing harriers to understanding, are the hiascs of the researchers openness 10 the world. This means that a researcher cannot attend to all the phenomena that are present in the stream of ;I lived cxpenencc. All persons give attention to certain aspects of experience according to values, beliefs, and purposes. For a disciplinc, and a researcher wlthin a discipline, the way a researcher attends to a phenomenon should he guided by some theory that identifies the rcsearcher as part of a group. And the group s realities arc made explicit in the language of its theories. Language discloses different realities; that is its power., 2 I. , Gadamer might ask, How do the unique prcjudices of the nursing discipline represent an openness to the world? And what IS the phenomenon that nursing is open to? Further, How is the phenomenon disclosed in the different languages of the discipline? The pur42 NUMBER 5 NlJRStNC OUTLOOK

Nursing interested in the human-health in terreia tionship, but not in the same ways as medicine or sociology.

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Mttchell

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pose of theory in any discipline is to describe a meaningful reality about a particular phenomenon of concern in a unique language. In nursing, the language of different theories describes different realities about the humanuniverse-health interrelationship. Gadamer describes a process of inquiry whereby the researcher and participant come together to have a dialogue about the meaning of some phenomenon. Both ,parties are concerned about the subject matter and both experience a buoyancy in the transmission of meaning that leads them to places beyond their original horizons. Understanding is an event, a happening that happens ,through language. For nurses conducting qualitative inquiry, the findings represent the researchers understanding, the fusion of horizons that is disclosed by the researcher in the light of a theoretical prejudice, or perspective. The example below serves to illustrate the power of the hermeneutic process in nursing science.

the experience as described by study anticipating limitaparticipants, tions, unencumbered self-direction, and yielding to change fortifies resolve for moving beyond. One of the three core concepts, anticipating limitations, will serve to guide this discussion of the hermeneutical process. Anticipating limitations was described by participants as a process of reflecting on restrictions in the now, as well as how restrictions might be experienced in time to come. Older persons expected that painful arthritis, poor vision, and hearing loss would continue to present restrictions in later life. Falls were pictured as possible happenings, as was the eventual relinquishment of caring for self and living independently, unless death came first. Some participants spoke about anticipated limitations in a matter-of-fact way and in the context of the opportu-

THE HERMENEUTICS PARSES RESEARCH

OF METHOD

Parses research method was structured to flow from the assumptions and principles of her hum.an becoming nursing theory. ior l1 Researchers have been guided by Parses theory in the study of universal lived experiences like hope, grieving, aging, and struggling through a difficult time, to name several. The human becoming theory represents the researchers preexisting nursing framework. A researcher guided by Parses theory of human becoming holds certain views or prejudices that create unique openings or questions about human beings and health. The openness defined by the preexisting framework is circumscribed and, yet, wait ing to be filled. Scientific inquiry, then, is a process of gath.ering specific knowledge to fill the openness circumscribed by theory. For example, IV5tche1135 recorded 12 discussions with persons over the age of 75 about their e-xperience of restriction-freedom in later life. Three core concepts emerged in the structure of
NURSING OUTLOOK SEPTEMBER/OCTOBER

Understanding is an event, a happening that happens through language.

nities that would accompany them. For example, a participant described that the restriction of less privacy might lead to more time to do what is wanted with friends and family. Persons anticipated gains and lossesin later life. Loss of activity, strength, and loved ones, for example, were expected to coexist with the freedom to laugh and be with friends, the freedom to decide how to be with frustrations, and the freedom to keep going until the end was in sight. The core concept, anticipating limitations, was synthesized from participant descriptions about what they pictured as possible happenings. The descriptions, when interpreted in the light of Parses theoretical concepts, clearly linked to the concept imaging. Imaging is one of nine concepts specified in the theory of human becoming.
1994

It is the way persons construct reality, according to Parse. Participant descriptions directed the researcher to Parses concept, imaging. The researchers bias before the study was that all human beings image, what they imaged about the lived experience of restriction-freedom was discovered in the inquiry. The anticipated limitations described by participants were not known before inquiry. In this way Parsesabstract concept of imaging was filled out, expanded, and further defined with substantive content at the level of lived experience. The researcher gained understanding, not only about what kinds of limitations were imaged in later life, but also how persons saw themselves in relation to the limitations. The researcher discovered how persons were already trying out and planning ways to be with the anticipated limitations. The older persons spoke about choosing how to be with frustrations, upsets, and losses. Personal descriptions interpreted in the light of Parses theory included not only what is, but what will be. This understanding is profound in that nurses aspire to conduct inquiry that depicts health as a process. Inquiry guided by Parses theory captured the process of how persons experience health, not only in the now moment, but health as it will be lived in time to come. All research is theory driven, and all research findings are weaved into some theoretical belief system that is inherently philosophical; this is what makes findings meaningful. Rather than being an embarrassment, theoretical interpretation is prized as the essence of knowledge expansion. If researchers desire discipline-specific inquiry, research must be performed in the light of a specific theory that houses the knowledge of the researchers discipline. It is evident in the language of Parses theory that it represents a certain way of thinking and speaking about human experience. Other researchers, who have different preexisting theoretical frameworks would not have conceptualized the inquiry or inMitchell 227

tcrpreted findings about restriction. freedom in the way described above, This is the beauty, and the value, of theory-guided research. Findings from Mitchells study on restriction-freedom arc uniquely discipline specific, and they represent nursing knowledge:

REFERENCES
1 &darner H-G Pfriiosophrcal hermeneutlcs (Linge DE, trans ed I Berkeley, Calitorma Llniversitv of Cahfornra Press, 1976. 2 Gadamer ti-i; 1 I {rib .I& method (Wcrti sheimer J Marshal1 IX tr.ms, cd-, ! &:~~~ York Crc)ssro;id, lYl9. I3 Culi-Wilhy BL, Icpt:: 11 Towards a coexistcncc of paradtgms iii nursing knowledge development 1 Adv :Xurs lY87j12,i15-21 4 DeGroot HA Screuttfic unLutry in nursmg .I model for .r net\ zgc Adv Nurs Sci IYKtl; 10(3):1-21 . 5 Moccia P. A crmqtre ~)t compromtse beyond the methods debar.< Adv Nurs Sci 1988. 10(4):1-Y. 6. Parse RR Man-hvtng-health. a theory of nursing. New York Wiley, 1981. 7. Polkinghorne D Methodology for the bu man sciences systems of inquiry. Albany, New York: State University of New York Press, 1983. 8. Skinner Q The return of grand theory in the human sciences. London: Cambridge Uru versity Press, 1985 9. Gortncr SK, Schultz PR. Approaches to nursing science methods lmage J Nurs Sch 1988;20:22-4 10. Parse RR. Man-living-health theory of nursing. In, Parse RR, ed. Nursing science: major paradigms, theories and critiques. Philadelphia. Saunders, 19X 7. 11. Parse RR Parses research methodology with an illustration of the lived experience of hope. Nurs Sci Q 1Y90,3,9-17 12 Phillips JK. New methods of research, heyond the shadows of nursing science. Nurs Sci Q 1990&l-2 13. Morse J. If you believe in theories. Qua1 Health Res I Y92,2,259-61. 14 Heideggcr M. Being and time. Macquarrre I, Rohinson E, tram t New York, Harper & Row, 1962. IS. Holmes CA Health care and the quality of life a review. I Adv Nurs 1989,14:833-Y. re16. Phillips JR. The looking glass of nursing search. Nurs Sci Q 1988;1:96. 17. Aaronson KK. Quality of life research in cancer climcal trials: a need for common rules and language Oncology 1990;4(5):5966 18. Campbell A. The sense of well-being in America. New York: McGraw Hill, lY81. of quality of life: 19. Flanagan JC. Measurement LO.

L! .L?

SUMMARY
Gadamers insights into the hermeneutical process contribute a great deal to the understanding that may accompany scientific inquiry, if preexisting prejudices are respected for their contribution to discipline-specific knowledge. Heidegger3 said that language speaks for us in what has been spoken. This means that the way nurses use language signifies who they are as a group of health professionals. Language is the vehicle that discloses nurses values and beliefs. Parses theory is one framework among many that provides nurse researchers with a coherent language of the human-health interrelationship for guiding inquiry. The prejudices of the theory are clearly specified and they circumscribe unique arenas for knowledge development. The language of the theory describes human becoming from a nursing perspective. It is complex, process oriented, and abstract, just like the human-health phenomena it represents. It is precisely the unique understanding and knowledge of nursing theories that may direct further discipline-specific inquiry and structure activities for an autonomous nursing practice. Ultimately, knowledge generated from discipline-specific inquiry will expand theories for guiding creative and meaningful practice with persons, families, and groups that seek professional engagements. n

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26. Nrwraan MA. Health as expandmg con:>c~o~~sn~s~ FL LOUIS. CV MO&~-, 1986 concepts of praerice 4th 27 Qrcn: DE. Nursing, cd St Louts MoshyYear Rook, 1 YY 1. Parses theorv 28. !arsc RR Human becoming. of nursing. Mm-s Sci Q 1992,5,35-42 2). Lcminger MM. Care. The essence of nurstng and bcslth Thorofarr, New lersey Slack, i\i ? 1. 30 Mahnski VM Explorationi on Martha RogCIS sctence of unitary human beings NorM.A k Cormecticut Appleton-Centuryi,r-iifi,, 1986 31. Reed PG. Nursing theorrzing ab an ethical cndcavor Adv Nurs Sci iYHY;I 1(3):1-Y. 32 Roy C Andrews H. The Roy adaptation mode! the definitive statement Norwalk, Connectrcut: Appleton-Lange, 19Y 1. 33. Struttr MC Nursing practice guided hy or generating theory. Nurs Scr Q 1990;3: 147-H. 34 Herdrgger IM Poetry, language, thought. (Hoiswdtcr 4, Trans.) New York. Harper b KLiW 1975 i;J. Exploring the paradoxtcal cx35. Mitchell pertence of restrictton-freedom in later life, Parse s theory-guided research [unpublished doctoral dtsscrtatron]. LJniversrtv of South ;~rrr~Jma. Columbia, SC

GAIL J. MITCHELL is The Queen Elizabeth sistant professor at Toronto, in Toronto,

a nurse scientist g Hospital and an asthe Uniwts+ty of Ontario, Canada.

228

MRc4ell