477151
477151Nursing Science QuarterlyDoucet
NSQXXX10.1177/0894318413
Book Reviews and New Media
Philosophical and Theoretical
Perspectives for Advanced
Nursing Practice (5th ed.), by
W. K. Cody (Ed.). (Burlington,
MA: Jones and Bartlett, 2013)
Reviewed by: Thomas Doucet, RN; PhD1
DOI: 10.1177/0894318413477151
When reviewing an article for publication, this reviewer
pays very close attention to the words the author is using to
describe the theoretical work of his/her choice. As one stum-
bles over some parochial expressions used to convey the
conceptual meaning intended by the theorist, one wonders if
the author in an attempt to render accessible to readers the
basis of the theoretical work is not actually blurring the con-
cepts. In the pursuit of scholarliness: to what extent must a
reviewer show flexibility or maintain rigidity in the use of
conceptual language in the pursuit of knowledge. What is
evoked that is not intended? What is said that is not uttered?
Remember, words, words, words, meanings, meanings,
meanings (Parse, 2002)!
In the preface of the 5th edition of Philosophical and
Theoretical Perspectives for Advanced Nursing Practice,
Cody (2013a) posits that in service to humankind advanced
nurse practitioners and nurse scholars must possess deep
understandings of philosophical and theoretical nursing
knowledge that can only be acquired through formal study of
the discipline. This five-part, 31-chapter book carries a dis-
tinction between practice and care “construing practice as
values based and practitioner driven and care as evidence
based and consumer driven” (Cody, 2013a, p. 301). In prepar-
ing professionals for practice, Cody (2013a) invites readers to
dialogue about the ontological-epistemological-methodological
link underpinning nursing science. It is a privilege to be asked
to write a review of this book.
Cody (2013a) introduces the first part of the book, The
nursing discipline and the development of nursing knowl-
edge, by giving a brief historical overview of the emergence
of philosophy and theory as fundamental to nursing scholar-
ship. While Nightingale viewed nursing as a vocation and
the performance of applied skills rather than a basic science
and a learned discipline, her writings and endeavorings pro-
moted a system for delivering effective care. Yet, it was not
until Peplau’s work that nursing scholarship began to appear,
grounding the importance of philosophy and theories for the
advancement of nursing as a learned discipline. Henceforth,
in view of its social mandate for human betterment, the
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Nursing Science Quarterly
26(2) 193­–198
© The Author(s) 2013
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nursing theory-based practice movement evolved from either
the totality or simultaneity paradigmatic perspective (Parse,
1987). Furthermore, notwithstanding philosophical debates
in the past decade, nursing service is discussed in view of the
relationship surrounding practice and research.
While Cody in chapter 1 posits that pursuit of scientific
endeavors cannot be value free and that practitioners choose
how to practice based on personal values, Carper in chapter
3 proposes that fundamental patterns of knowing in nursing
exemplify characteristic ways of thinking about nursing
phenomena. Cody in chapter 6 and Fawcett in chapter 4
argue that it is nursing theory supported by evidence that
advances the knowledge of the discipline by providing
direction for practice, whereas Schlotfeldt (2013) in chap-
ter 2, states that evidence arising from nursing science and
other disciplinary extant theories allows “to appraise and
assist human beings in their quest to optimize their health
status” (p. 17). Yet, Schlotfeldt (2013) advocates that given
personal knowledge of the recipient of care, “there can be
no prescriptive nursing practice theories or professional
approaches to nursing care that are universally generaliz-
able” (p. 20). Phillips, in chapter 5 explicitly states that it is
the pattern of knowledge embedded with coherent philo-
sophical and theoretical foundations that gives unity to
nursing science. The philosophical postures of these nurse
scholars set the stage for dialogue in preparing advanced
nurse practitioners in light of the nursing discipline and the
development of nursing knowledge.
First, this reviewer thinks that incarnating personal val-
ues congruent with a theoretical nursing perspective bridges
debates that maintain a split between personal and profes-
sional values and, more so, fosters accountability for
advanced nursing practice. Simply put, Cody (2013b) asks
1
Professor, University of Moncton, New Brunswick
Contributing Editor:
Mary R. Morrow, RN, PhD,Vice President of Nursing, Loyola Gottlieb
Memorial Hospital, 701 W. North Avenue, Melrose Park, Illinois 60160
Email: mmorrow626@comcast.net
194 Nursing Science Quarterly 26(2)
that advanced nurses reflect on “What guides my practice?”
(p. 5). Secondly, this writer strongly agrees with Cody,
Carper, Fawcett, and Phillips that development of nursing
knowledge ought to be steeped in the discipline and not
into other disciplinary extant theories; otherwise there is
sufficient concerns to be “troubled by the state of our sci-
ence” (Fawcett, 2013, p. 35). Isn’t a view of the focus of the
nursing discipline and its practice the humanness of health
circumstance for which nurses “advocate the humanness of
people’s experience in the strategizing for service develop-
ment and in community development” (Litchfield &
Jónsdóttir, 2013, p. 63)?
Conceptualizations of human beings, health, environ-
ment, and nursing practice are reported in the second part of
the book. Cody (2013a) begins with Reed’s (2013) conceptu-
alization of nursing as the ontology of the discipline. Reed
(2013) posits that the complexity of human experiences and
the integration of qualitative changes of ongoing life events
“can be learned and knowingly deployed to facilitate well-
being” (p. 75). After rereading this section of the book, it
became apparent to this reviewer that it might have been
Cody’s intention to first present nursing as the ontology of
the discipline in view of discussing the aforementioned
metaconcepts in the following articles in light of relational
propositions.
In chapter 9, Banfield explicates Orem’s understanding of
human beings as foundational to nursing practice. Banfield
clarifies Orem’s conceptualization of human beings from a
moderate realist perspective. She argues that Orem views
human beings as unitary; that is, a unity of structural and
functional differentiations in an ongoing process of concrete
existence. This relational proposition links Orem’s view of
person with environment. In practice, according to Banfield
(2013) nurses attend to the humanness of persons with
human love, “an integral component of the nurse’s ability to
help others” (p. 89). Boykin and Schoenhofer (2013) claim
that the outcome of the “artistry of nursing” (p. 101) is nurs-
ing’s contribution to healthcare. The authors’ (Boykin &
Schoenhofer, 2013) caring philosophical and theoretical per-
spective highlights personhood as “a living grounded in car-
ing . . .nurtured in relationship with caring others” (p. 97).
Boykin and Schoenhofer argue that in practice nursing’s
intention and language are to nurture the person’s wholeness
through deliberate presence and reflective practice, knowing
the other as a caring person. This draws attention to the rela-
tional proposition between person and nurse. By using a dia-
lectical approach to systematically analyze distinct
conceptualizations concerning the art of nursing, Johnston’s
outstanding in-depth review of nursing literature in chapter
16 identifies five meanings which serve to delineate the rela-
tion between person and practice. These are a) grasping
meaning in patient encounters, b) establishing a meaningful
connection with the patient, c) skillfully performing nursing
activities, d) rationally determining an appropriate course of
nursing action, and e) morally conducting one’s nursing
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practice. Doane and Varcoe (2013) in chapter 18 continue the
discussion by stating nursing’s ethical obligation in practice,
which is “to be reflexive and intentional, [to] open a rela-
tional space, and to act at all levels to effect potential health
and healing” (p. 211). Doane and Varcoe (2013) conclude
that, “a relational inquiry directs a more in-depth look at the
values, experiences, goals, and concerns shaping [nursing]
action within particular moments of practice and a conscious
consideration of possibilities and intentional responsive
action” (p. 210).
In chapter 11, Pender (2013) questions, “What are the
varying human patterns most indicative of health . . . viewed
as a lived experience (p. 109)?” The question underscores
the proposition relating person with health. The theorist
inquires about health from a human approach; indeed “a
unitary phenomenon” (Pender, 2013, p. 108). Based on
research, Pender proposes five dimensions of health expres-
sions, organized into 15 subcategories with several respec-
tive potential indicators. In view of moving nursing forward,
Pender invites nurse scientists to expand a humanistic
understanding of factors affecting health that is distinct
from the absence of disease. In chapter 13, Butterfield
addresses the health-person-environment relational proposi-
tion in view of complex social, political, and economic fac-
tors, whereas Kleffel in chapter 14 reflects on its distinct
ethical perspectives. Butterfield contends that promoting
individual change based on perceived personal benefits and
barriers or by identifying personal variables to stimulate
health action is placing a burden on the individual rather
than considering health deficits from both micro and macro
perspectives. One could apprehend Kleffel’s (2013) descrip-
tion of the egocentric approach from a micro perspective
“grounded at the personal level [where…] what is best for
the individual is best for society” (p. 150), whereas a homo-
centric approach, a meso perspective, reflects “the utilitar-
ian ethic . . . grounded at the social level” (p. 151). An
ecocentric approach would delineate a macro perspective
with the necessity of holistic values grounded in the cos-
mos. In pursuit of collaborative actions, Kleffel (2013) sug-
gests to “think globally, act locally” (p. 157). Cowling in
chapter 12 furthers the discussion in view of the theoretical
principles of unitary science by emphasizing the health-per-
son-environment-practice relation through praxis. This
scholar (Cowling, 2013) posits that healing as appreciating
wholeness is a “process of pattern appreciation [that is] a
synoptic stance toward pattern information, a participatory
engagement with people in exploration of wholeness, and a
transformation process that illuminate the possibilities in
wholeness—the embodiment of healing” (p. 136).
In light of nursing practice based on values and beliefs for
person-centered care, Cody suggests McCormack’s concep-
tual framework, which arises from the totality perspective,
and Parse’s humanbecoming theory, which emerges from a
simultaneity perspective. McCormack identifies patient’s
values, nurse’s values, and context of the care environment
Doucet 195
as central to nursing practice. According to McCormack
(2013) through caring in a therapeutic nurse-patient partner-
ship, the nurse is able to facilitate authentic consciousness by
“enabling the patient [‘s autonomy] to follow the path of
their own choosing and in their own way” (p. 192). Autonomy
as defined and used in common parlance is not consistent
with Parse’s view. Parse notes that the transformation of
practice is grounded on knowledge of basic-science nursing.
Parse (2013) posits,
“What one believes about human beings and health
permeates one’s actions . . . people know the way and
choose their health situation and their quality of life
. . .. The form of nursing in the transformational prac-
tice guided by the human becoming principles is true
presence: a non-routinized way of being with others
that honor others’ views and choices on changing
health patterns and quality of life” (pp. 164, 166).
To honor the works of the nurse scholars cited, it is impera-
tive to illuminate the philosophical underpinnings that guide
their theoretical perspectives or their accounts of the
metaconcepts human beings, health, and environment in
light of possibilities for nursing practice. Words such as uni-
tary, wholeness, healing, or therapeutic are used indiscrimi-
nately and tend to obfuscate worldviews offered from either
the totality or simultaneity paradigmatic perspective and
confound the richness of nursing’s heritage and future in pre-
paring nurses for advanced nursing practice.
Contemporary perspectives on nursing is the topic
addressed in the third part of the book. Mitchell and Cody, in
chapter 19, question if human science is a distinctive philo-
sophical foundation for science. Given its mission to explore
and understand the meaning and values of humanly lived
experiences, the authors identify wholeness, intentionality
and free will, and the nature of reality as attributes that con-
stitute the ontological and epistemological foundations of
human science—which is distinct from humanism. For the
sake of conceptual clarity in view of nursing practice and
research, Mitchell and Cody point out the consistencies and
inconsistencies related to human science attributes in several
nursing theoretical works. In pursuit of nursing knowledge,
the authors state that Parse’s work offers a congruent onto-
logical-epistemological-methodological (research and prac-
tice) link which is consistent with and moves beyond human
science. In chapter 20, Wuest argues that from both a liberal
feminist perspective that seeks equal opportunity and a social
feminist perspective that seeks social change, development
of nursing science maintains a status quo steeped in patriar-
chal professionalism by upholding research and practice
based on logical positivism. Wuest calls for a contemporary
theoretical framework based on a social feminist perspective
to value caring in nursing practice and foster nursing knowl-
edge development to alter public policy and thereby confirm
nursing’s social contribution in a unique way. Locsin and
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Purnell in chapter 21, address contemporary nursing practice
in view of the human-technology interface. Beside
Heidegger’s philosophical view regarding this dialectical
tension, Lonergan’s (1957) conceptualization of isomor-
phism could possibly enrich Orem’s previously discussed
relational proposition between person and environment and
illuminate Parse’s (2013) view related to the transformation
of nursing practice.
While metaphorical language is pervasive in everyday
language, Mitchell, Ferguson-Paré, and Richards (2013), in
chapter 22, suggest that the frontier, “an open place of explo-
ration and discovery” (p. 275), would better convey contem-
porary nursing practice rather than military language and
images. For these authors, frontier, described as presence,
community, discovery, knowledge, and possibility (Mitchell
et al., 2013, pp. 269-270), better translates nursing’s relation-
ship with patient, family, community, and other health pro-
fessionals. Ketefian and Redman in chapter 23 further the
discussion surrounding nursing practice in view of the global
community. The authors question the ontological, epistemo-
logical, and methodological foundations that would capture
the nature of theory, research, education and practice to
ground nursing science as globally relevant, while honoring
the diversity of varying human needs. This reviewer won-
ders if culture, viewed as a symbolate (Parse, 2009; White,
1973) embedded with value, conceptualized as that by which
one defines good (Gillet, 1978), might not open venues by
illuminating attributes of human science and help bridge dif-
fering intercultural beliefs. For example, Arnold and Bruce
in chapter 24 propose that Parse’s humanbecoming theory
honors aboriginal ways of constituting health and reality by
considering knowledge and actions arising from a distinct
worldview.
Anchoring contemporary perspectives of nursing solely
in logical positivism highlights a partial view of the value of
the discipline in its social mandate. While some nursing the-
ories lack clarity in positing human science as foundational
to their works, only Parse’s congruent ontological-epistemo-
logical-methodological link is argued to move beyond this
specific philosophical perspective. The humanbecoming
theory is acknowledged as a viable alternative in nursing
practice. In view of the advancement of nursing science, this
school of thought welcomes dialogue in a unique way related
to concerns pertaining to the global community.
Interrelationships among nursing theory, research, and
practice is the topic addressed in part four of the book.
Mitchell in chapter 27 eloquently and compellingly expli-
cates the close knit relations among theory, research, and
practice that grounds nursing science. Mitchell (2013) states
that while evidence might help people make a decision about
available care options, “evidence will not build a knowledge
base for nursing practice . . . evidence is value laden and
theoretically driven” (pp. 322-323). Mitchell (2013) con-
tends that evidence understood as “menu-driven directives”
(p. 324) or “presentation of data” (p. 328) obscures the
196 Nursing Science Quarterly 26(2)
theory-practice link and leads to “prescriptive interventions
aimed at managing patients” (p. 328). Mitchell (2013) said,
“If research expands and informs the guiding theory, then
findings must be considered in light of the practice pre-
scribed by the theory” (p. 328). Fawcett, Watson, Neuman,
Walker, and Fitzpatrick (2013) in chapter 26 concur with
Mitchell that general literature supporting evidence-based
practice “obstructs the nursing process, human care, and pro-
fessional accountability” (p. 321). Fawcett and colleagues
(2013) posit that, rather than focusing evidence-based nurs-
ing practice on the prevalent atheoretical medical empirical
model of evidence, diverse patterns of knowing could poten-
tially be viewed as theory-guided, evidence-based nursing
practice. Specific modes of inquiry would then need discrete
expressions of evidence to build such theories that would
“Collectively . . . constitute the ontological and epistemo-
logical foundations of the discipline of nursing” (Fawcett,
et al., 2013, p. 315). In chapter 25, Pipe describes how the
use of a nursing leadership model to integrate evidence-
based practice simultaneously facilitates the transition to
theory-driven practice. Pipe, Wellik, Hansen, and Martyn
(2005) demonstrate how a change implementing Watson’s
theory of human caring in nursing practice empowered
nurses’ behaviors for ensuring patient safety and optimizing
health outcomes.
The final part of this book addresses the future of
advanced nursing practice. Kenney’s thought-provoking
and well-informed article in chapter 28, addresses the rele-
vance of nursing knowledge and use of eclectic models and
theories in nursing centers. Indeed theory guides practice.
Kenney asserts that all professional disciplines have their
own knowledge base, yet she advocates that nurses use
shared relevant models and theories. This reviewer ques-
tions if nursing needs to revisit Johnson’s (1968) “inquiries
into the nature of knowledge required for nursing practice
and . . . the problem of nursing’s objects in scientific inves-
tigation” (p. 207)? Rather, one would hope that nursing hon-
ors the works of its predecessors and contemporaries given
the current nursing paradigmatic perspectives and the focus
of the discipline. With Meleis (1993) this reviewer ponders
if education of advanced nursing practice forms junior doc-
tors, psychologists, sociologists, or pastors instead of senior
nurses. As a process of coming to know and in light of the
advancement of nursing science, is the discipline better off
to duplicate or to innovate? Simply put, Parse (2001) advo-
cates for innovation through “inquiry as sciencing . . . that
purports to study human experiences (p. 1), whereas Johnson
(1968) says,
In the sciences that deal with man’s interactions, we still
have unburned witches to deal with. There are many
wrong turns ahead in these sciences—but it is an essen-
tial of science to blunder down some of these wrong
turns, to develop and test hypotheses. That is the way
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we get ahead. [Nursing science] must not be thrown
down the drain because of some of the essential blun-
dering that will make real progress possible. (p. 209)
In chapter 30, Arslanian-Engoren, Hicks, Whall, and Algase
(2013) concur by explicitly stating, “nursing’s unique onto-
logical and epistemological perspective into advanced prac-
tice nursing practice places priority on delivering care based
on research-derived knowledge” (p. 361). While one might
agree with the authors’ (Arslanian-Engoren et al., 2013)
assertion that “to ignore nursing’s scholarship is to deprive
an emerging generation of practitioners and scientists of
nursing’s foundational knowledge and to impair the further
building of knowledge” (p. 364), this reviewer queries the
authors choice advocating Reed’s “ontological perspective
that synthesizes and unites […] various views” (p. 364).
While Parse (1987) clearly delineates two major paradigms
in light of assumptions about person and health, goals of
nursing, and implications for research and practice, Adam
(1983) reports criteria related to social congruence, signifi-
cation, and utility of the nursing profession. For example, in
light of pursuing disciplinary knowledge in service to
humankind, this writer questions, What are the values under-
pinning the philosophical and theoretical perspective guid-
ing advanced nursing practice?
In chapter 29, Reeder posits that inquiries conducted
from a positivist science perspective isolates perceptible
sense entities of the physical world from the lived world
context, whereas knowledge arising from a unitary per-
spective grounded in a phenomenological view provides
different access and exploration of the life-world. Reeder
(2013) states that evidence in the year 2050 will call for
knowledge related to “cosmic patterns of change in the life
world . . . [that] could be achieved through the process of
pattern recognition” (p. 353). Reeder advocates that evi-
dence that reflects the tenets of intentionality and choice
grounded in human sciences contributes to the education of
advanced nursing practice. Bunkers in chapter 31 posits
foundational tenets in guiding the framing of nursing
knowledge for the nurse scholar of the 21st century. These
tenets highlight three essentials processes: perpetual curi-
osity, a focused commitment, and a willingness to risk chal-
lenge (Parse, 1994).
Cody’s (2013a) 5th edition of Philosophical and
Theoretical Perspectives for Advanced Nursing Practice
offers teachers of advanced nursing practice an opportunity
to engage with students in a rich dialogue in “potentiating
integrity [in] . . . strengthening a oneness of purpose”
(Parse, 2004, p. 35) based on a congruent ontological-
epistemological-methodological link to further the
advancement of nursing science. It is incumbent on nursing
educators to address the diversity and richness of the work
done by their predecessors, envisaged by contemporary
scholars, and the yet to be revealed successors in light of
Doucet 197
the discipline’s service to humankind. While evidence
based on logical positivism does not convey the value of
nursing in its social mandate, a deep understanding of
human science will guide advanced nursing practitioners to
propel the transformation of nursing practice in any locale
where humans freely choose to cocreate health. For the sur-
vival of the discipline of nursing, philosophical and theo-
retical nursing knowledge can only be acquired through
formal study of the discipline.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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