The discipline of nursing has long maintained that is has a unique contribution to make within the health care arena. This assertion of uniqueness lies in great part in the discipline's claim to a distinct body of knowledge. Nursing knowledge is characterized by diverse and multiple forms of knowing and underpins the work of all nurses, regardless of field of practice. Unfortunately, it has been challenging for the discipline to take full ownership of its epistemological diversity, largely due to factors (...) such as competing worldviews, and ideological and binary positioning. A philosophical middle ground stance is proposed as a way for the discipline to contemplate, discuss and develop nursing knowledge; a middle space that provides the freedom to consider competing worldviews while still allowing for the discipline to fully express itself in all of its epistemological diversity. In being able to enact its multiple forms of knowledge in a creative and open space that is open to different ideas and worldviews, not only can nursing take full ownership of its practice and its unique knowledge, it can also demonstrate how best to navigate an increasingly polarized world. In a world that is increasingly fixated on binary solutions and dualistic points of view, it is time for nursing to celebrate its epistemological diversity. (shrink)

As a system of knowledge, nursing has utilized a range of subjects and reconstituted them to reflect the thinking and practice of health care. Often drawn to a holistic model, nursing finds it difficult to resist the reductionist tendencies in biological and medical thinking. In this paper I will propose a relational approach to knowledge that is able to address this issue. The paper argues that biology is not characterized by one stable theory but is often a contentious topic and (...) employs philosophically diverse models in its scientific research. Biology need not be seen as a reductionist science, but reductionism is nonetheless an important current within biological thinking. These reductionist currents can undermine nursing knowledge in four main ways. Firstly, that the conclusions drawn from reductionism go far beyond their data based on an approach that prioritizes biological explanations and eliminates others. Secondly, that the methods employed by biologists are sometimes weak, and the limitations are insufficiently acknowledged. Thirdly, that the assumptions that drive the research agenda are problematic, and finally that uncritical application of these ideas can be potentially disastrous for nursing practice. These issues are explored through an examination of the problems reductionism poses for the issue of gender, mental health, and altruism. I then propose an approach based on critical realism that adopts an anti‐reductionist philosophy that utilizes the conceptual tools of emergence and a relational ontology. (shrink)

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral (...) constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

“Doing Gender,” Candance West and Don Zimmerman’s famous 1987 article, has become a folk concept—a trope or commonsense resource within the sociology of gender. Yet at the same time, most gender scholars overlook its ethnomethodological premise, visible in both poststructuralist misunderstandings of its argument outside the discipline of sociology and what I term a realist misunderstanding of it in the study of structures and identities within the discipline. Reading West and Zimmerman queerly while clarifying ethnomethodology’s ontology, I refocus attention for (...) critical scholarship on ethnomethodology’s analytic sensibilities for research on gender, race, and sexuality, among other embodiments. Specifically, ethnomethodology reframes a vision of actors as relational, practical actors; repositions gender as accountable, jointly produced social relations, not individual identity; and foregrounds resistance in addition to conformity. Hence, my gender is not mine; it is ours. Ethnomethodology’s ontological shift in temporality to reality-in-production enables interpretive-materialism: a queer, anti-racist, intersectional sociology that is future-facing and in motion. (shrink)