Abduction, deduction and induction describe forms of reasoning. Deduction and induction are discussed in the nursing literature. However, abduction has been largely neglected by nurse scholars. In this paper it is proposed that abduction may play a part in qualitative data analysis – specifically, in the identification of themes, codes, and categories. Abduction is not, in research, restricted to or associated with any particular methodology. Nevertheless, situating abduction in qualitative research facilitates the identification of three interlinked issues. First, it is (...) suggested that abductively derived claims require support from deductive and inductively sourced evidence if they are to ‘hold’ and, yet, in qualitative research this is clearly problematic. Second, difficulties in choosing between alternative plausible hypotheses are explored through an examination of the ‘generality problem’. Third, the role of background and auxiliary theories in adjudicating between hypothesis options is discussed. It is argued that if qualitative researchers utilize abductive inference in the manner suggested, then the peculiarly fallible nature of abduction must be acknowledged and, in consequence, the action guiding potential of qualitative research findings is compromised. (shrink)

The placebo effect is a common phenomenon in therapy and research but has received very little attention as such in nursing research. This article reviews some of the literature which shows the placebo effect, which can be positive or negative, is a significant force. Then it is argued that, while all health professionals have a general obligation to benefit their patients, nursing has a special, specific obligation to enhance the placebo effect, to maximize a positive effect and minimize a negative (...) effect. Nursing education, current policy statements, and circumstances of clinical practice explain this obligation. Nursing research is needed to clarify the multiple ways in which the social and physical environment can trigger a placebo effect. As nursing expands its knowledge of this effect, it can begin to educate patients to the self-care implications of this pervasive but misunderstood phenomenon. Keywords: ethics, placebo, placebo effect, self care CiteULike Connotea Del.icio.us What's this? (shrink)

This study addresses the question of normative analysis of the value‐based aspects of nursing. In our perspective, values in science may be distinguished into (i) epistemic when related to the goals of truth and objectivity and (ii) non‐epistemic when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysis of the roles of the various forms of values and models of knowledge translation provides (...) the ground to understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. It follows that adopting a normative perspective in the analysis of nursing knowledge provides key elements to identify its proper dimension. (shrink)

Debates about the ethics and effects of placebos and whether ‘placebos’ in clinical trials of complex treatments such as acupuncture are adequate rage. Yet there is currently no widely accepted definition of the ‘placebo’. A definition of the placebo is likely to inform these controversies. Grünbaum’s characterization of placebos and placebo effects has been touted by some authors as the best attempt thus far, but has not won widespread acceptance largely because Grünbaum failed to specify what he means by a (...) therapeutic theory and because he does not stipulate a special role for expectation effects. Grünbaum claims that placebos are treatments whose ‘characteristic features’ do not have therapeutic effects on the target disorder. I show that with four modifications, Grünbaum’s definition provides a defensible account of placebos for the purpose of constructing placebo controls within clinical trials. The modifications I introduce are: adding a special role for expectations, insisting that placebo controls control for all and only the effects of the incidental treatment features, relativizing the definition of placebos to patients, and introducing harmful interventions and nocebos to the definitional scheme. I also provide guidance for classifying treatment features as characteristic or incidental. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related to (...) ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

Mediating the meaning of evidence through epistemological diversity Nursing's disciplinary recognition of ‘multiple ways of knowing’ reflects an epistemological diversity that supports nursing praxis. Nursing as praxis offers a conceptual way to explore what it is about the interface of practice, knowledge and evidence in nursing that distinguishes us as a discipline. I suggest that the relationship between evidence and knowledge is defined and mediated by the same epistemological diversity that supports nursing as praxis. Just as the meaning and truth‐value (...) of evidence is evaluated from within the body of existing disciplinary knowledge, new evidence may prompt an evaluation of the meaning and truth‐value of extant nursing knowledge. Nursing practice that relies on scientific evidence as a singular basis of practice knowledge is susceptible to exploitation by the diverse agendas operating within an ideology of evidence‐based practice and the healthcare system. Mediating the meaning of evidence for nursing practice through acknowledgement of the diverse epistemologies that underpin nursing knowledge will contribute to a disciplinary‐specific definition of what constitutes evidence for nursing, and will better direct how evidence is integrated into a disciplinary body of knowledge. (shrink)

The beliefs involved in the placebo effect are often assumed to be self-fulfilling, that is, the truth of these beliefs would merely require the patient to hold them. Such a view is commonly shared in epistemology. Many epistemologists focused, in fact, on the self-fulfilling nature of these beliefs, which have been investigated because they raise some important counterexamples to Nozick’s “tracking theory of knowledge.” We challenge the self-fulfilling nature of placebo-based beliefs in multi-agent contexts, analyzing their deep epistemological nature and (...) the role of higher-order beliefs involved in the placebo effect. (shrink)

This study addresses the question of normative analysis of the value‐based aspects of nursing. In our perspective, values in science may be distinguished into (i) epistemic when related to the goals of truth and objectivity and (ii) non‐epistemic when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysis of the roles of the various forms of values and models of knowledge translation provides (...) the ground to understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. It follows that adopting a normative perspective in the analysis of nursing knowledge provides key elements to identify its proper dimension. (shrink)

While discussions of the ethics of the placebo have usually dealt with their use in a research context, the authors address here the question of the placebo in clinical practice. It is argued, firstly, that the placebo can be an effective treatment. Secondly, it is demonstrated that its use does not always entail deception. Finally guidelines are presented according to which the placebo may be used for clinical purposes. It is suggested that in select cases, use of the placebo may (...) even be morally imperative. The argument is illustrated by three case vignettes. (shrink)

Transdisciplinarity includes the assumption that within new institutional settings, scientific research becomes more closely responsive to practical problems and user needs and is therefore often subject to considerable application pressure. This raises the question whether transdisciplinarity affects the epistemic standards and the fruitfulness of research. Case studies show how user-orientation and epistemic innovativeness can be combined. While the modeling involved in all cases under consideration was local and focused primarily on features of immediate practical relevance, it was informed by theoretical (...) insights from basic research. Conversely, industrial research turns out sometimes to produce theoretical understanding. These findings highlight an interactive relationship between science and technology (moderate emergentism), which is distinct from the traditional view of a one-sided dependence of technology on science (cascade model) and from the newly received independence account (emergentism). (shrink)

Despite strong growth in scientific investigation of the placebo effect, understanding of this phenomenon remains deeply confused. We investigate critically seven common conceptual distinctions that impede clear understanding of the placebo effect: (1) verum/placebo, (2) active/inactive, (3) signal/noise, (4) specific/nonspecific, (5) objective/subjective, (6) disease/illness, and (7) intervention/context. We argue that some of these should be eliminated entirely, whereas others must be used with caution to avoid bias. Clearing away the conceptual underbrush is needed to lay down a path to understanding (...) and harnessing placebo effects in clinical medicine. (shrink)

This paper looks at the implications of contemporary work in philosophy of science for nursing science. Early work on the nature of theories in nursing was strongly influenced by logical empiricism, and this influence remains even long after nurse scholars have come to reject logical empiricism as an adequate philosophy of science. Combined with the need to establish nursing as an autonomous profession, nursing theory's use of logical empiricism has led to serious conceptual problems. Philosophers of science have also rejected (...) many of the central tenets of logical empiricism, including its focus on the logical justification of theories and the idea that science is, or should be, unified. Instead, there has been an increasing focus on the practice of science, which in turn has led to a pluralist understanding of science that emphasizes the construction of scientific models that are appropriate for certain purposes or in certain contexts. I suggest that this approach to philosophy of science may provide better resources for nursing science. (shrink)

POHLMAN S, CIBULKA NJ, PALMER JL, LORENZ RA and SMITHBATTLE L. Nursing Inquiry 2013; 20: 71–81 The placebo puzzle: examining the discordant space between biomedical science and illness/healingThe placebo response presents an enigma to biomedical science: how can ‘inert’ or ‘sham’ procedures reduce symptoms and produce physiological changes that are comparable to prescribed treatments? In this study, we examine this puzzle by explicating the discordant space between the prevailing biomedical paradigm, which focuses on a technical understanding of diagnosis and treatment, (...) and a broader understanding of illness and healing as relational and embodied. Although biomedical achievements are impressive, the knowledge resulting from this paradigm is limited by its ontological and epistemological assumptions. When the body and world are objectified, illness meanings, therapeutic relationships, and healing practices are dismissed or distorted. In spite of a robust critique of the tenets of biomedicine for guiding practice, the biomedical paradigm retains a tenacious hold on evidence-based medicine and nursing, downplaying our clinical understanding of the sentient body, patients’ life-worlds, and illness and healing. In reality, skilled nurses rely on multiple forms of knowledge in providing high-quality care to particular patients. Clinically wise nurses integrate their experience and knowledge of patients’ priorities, fears, and illness trajectories along with biomedical findings to make astute judgments and promote health and healing. (shrink)