The epistomology and ontology of nursing from varying philosophical traditions: A.

critical social theory Critical social theory refers to the study of differences between people as related to socially determined status, such as socioeconomics. As applied to the medical world, this social theory speculates about why certain groups of people are predisposed to physical ailments and deficiencies. The goal of critical social theory within nursing teaching and practice is to identify and reduce socially related health disparities between patients (Horkheimer 1993). The origin of critical social theory can be traced to the 1920s and 1930s in Germany. Researchers and theorists at the Institute of Social Research in Frankfurt began to posit the idea that societal divisions and classes is not a naturally occurring structure, but rather historically based. In other words, social class is determined and set by events that have happened in the past. The assumption of these critical social theory researchers was that these divisions were kept in place to support the dominant group of any given society (Horkheimer 1982, 244). The ideas at the origin of critical social theory can be connected to the medical field in different ways. In nursing science, the divisions between classes as described by critical social theory are expanded to include health problems, or vulnerabilities to health problems, that specific groups exhibit. Critical social theory in nursing does not attribute health vulnerabilities to the internal characteristics of a specific group, such as ethnicity, and rather attributes these vulnerabilities to external social factors (Lindlof & Taylor, 2002, p. 53) Eliminating socially derived assumptions about people groups within nursing science involves looking at the broader picture of health care and access to health care. An inability to access regular health care as a result of socioeconomic status can mean a lack of access to preventative measures. This can result in the onset of preventable disease and sickness at higher rates for specific demographics. For instance, many health difficulties can be traced back to a lack of access to good nutrition, which can be directly related to socioeconomic status (Mohammed, 2006) The goal of critical social theory in nursing science education, practice and research is to establish a clear distinction between the false, socially derived assumptions that often are attached to marginalized groups and the real disadvantages and class structure that exists as a result of societal hierarchies. Once this distinction is established, nurses can work toward an actionable solution to amend these disparities. The theory also provides a framework for nursing science professionals to investigate any practices of inequality within the health care system that result from embedded assumptions. Through critical social theory, assumptions and stereotypes can be shattered and practices that reinforce inequality can be eliminated (Mohammed, 2006).

Nurses can use critical social theory to expose and reduce communication failures that result from assumptions and cultural misunderstandings between health care staff and patients. Reducing these communication breakdowns is a large part of building capacity for the equitable treatment of all patients, regardless of social status related to socioeconomics, ethnicity, age or gender. B. holism and human science Holism is the concept that represents how professional can think of people as a body-mind-spirit unit. It is a concept created to advance understanding of whole human beings and their complex interactions in light of a belief in an orderly, predictable, manageable view of human beings and their environments. The concept of holism created a world of opportunity for thinkers and researches that saw and dreamed about the potential discoveries that could enlighten and liberate humankind. There were many important discoveries and advancements made within the clockwork view of reality. But for some scholars, it also became clear that the clockwork model and its related concept of holism could not fulfill dreams in all of the life sciences such as biology (Cooper, 1996) and nursing (Parse, 1981, 1987, 1998; Rogers, 1970, 1990). In nursing, some authors propose that dividing people into bio-psycho-socio-spiritual or body-mind-spirit parts, in order to define and assess how the parts function and contribute to the working of the whole human, has detracted from practices concerned with irreducible persons and their experiences of health (Hagey & McDonough, 1983; McHugh, 1987; Mitchel, 1991, 1995; Takemura & Kanda, 2003). The dissatisfaction with holism and the mechanistic paradigm helped fuel the desire for new ways of thinking about human beings and their relationships in the world. The twentieth century was a time of accelerated, out-of-the-box thinking. Many scholars in various disciplines searched for more unitary accounts of reality into which human existence is integrated (Cooper, 1996, p. 410), and which is known for its continuous growth, change, and unpredictability. The later twentieth century scholars were not he first to ponder the possibilities of a more unified and dynamic world view. For instance, Cooper (1996) wrote about Henri Bergson (1859-1941), a celebrated philosopher, who spoke of a seamless flux of experience, a conscious force that gallops through time, and of a unified consciousness that could not be contained in a clockwork universe. Cooper quotes Bergson who stated, Science and intellect carve up the world for our convenience and then promptly forget that they have done so (p.412). Bergson proposed that science can show how to make things and how to act on things to achieve goals. However, science does not disclose the nature of reality of the nature of human life, which he thought was a continuity in which memories, moods, perceptions, flow into and give shape to one another (Cooper, 1996, p. 413). Bersons contemporaries, Alfred North Whitehead (1861 -1947) and Wilhelm Dilthey (1833-1911), also worked to develop different philosophies of science that were more human, coherent, meaningful, and unified (Dilthey, 1988; Ermarth, 1978). Whitehead wanted a world view that could provide meaning for the aesthetic and the moral, as well as the empirical and mathematical. Cooper (1996) suggests that

Whitehead was encouraged by new physics and its reliance on process as the ultimate route to understanding. He, too, saw life as vibrant and pulsating, full of emotion and enjoyment. Dilthey (1998), known by some as the thinker that coined the term human science, worked to create a philosophical system of thought that elevated human life out of the objective, sterile world of the mechanistic universe. Phenomenological philosophers proposed that the essences of life could be studied in systematic and rigorous ways such that the unity of lived experience could be preserved, and meaningful knowledge generated, that could add to the betterment of humankind. Gradually, ideas about meanings, values, understanding, history, experience, essence, the arts, and unity began to shape and give form to a different view of the human-worlduniverse. This new view has various streams of thinking in nursing including simultaneity (Parse, 1987) and the unitary-transformative (Newman, 1992). Such is the purpose of philosophy: to create worlds of meaning and space for new worlds to emerge.

Reference: Horkheimer, M., 1972. Bemerkungen zur Religion. Frankfurt: Fisher Verlag. , 1982. Critical Theory, New York: Seabury Press. , 1993. Between Philosophy and Social Science, Cambridge: MIT Press.

All Business: "(Re)examing Health Disparties: Critical Social Theory in Pediatric Nursing"; Selena A. Mohammed; Jan. 1, 2006 Lindlof, T. R., & Taylor, B. C. (2002). Qualitative Communication Research Methods, 2nd Edition. Thousand Oaks, CA: Sage.

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