Journal of Psychiatric and Mental Health Nursing, 2011, 18, 403–410

So what exactly is nursing knowledge? jpm_1685 403..410

L. CLARKE dip nurs dip theol dip med phil ba msc ma phd
Reader in Mental Health School of Nursing and Midwifery University of Brighton, Eastbourne, UK

Keywords: nursing models, nursing Accessible summary

role, nursing theory, philosophy

Correspondence:
• Definitions of nursing knowledge are ill thought through and confusing.

L. Clarke
• That which adds uniqueness to nursing is typically confused in argument to the
extent that argument is presented.
Robert Dodd Building
49 Darley Road • The persistence of a medical base for theory, although highly prevalent, albeit
Eastbourne
justified via a linguistic turn, as in ‘advanced practitioner’.
BN20 7UR • Implicit, in my argument, is that there exist, among journals and their authors,
UK denials of what (practically) nursing is, forcing instead a counterfeit nursing
E-mail: w.f.clarke@bton.ac.uk language that stems from either medical or unworkable, non-propositional, philo-
sophical sources.
Accepted for publication: 27 November
2010
Abstract
doi: 10.1111/j.1365-2850.2010.01685.x
This paper aims to present a discussion about intrinsic nursing knowledge. The paper
stems from the author’s study of knowledge claims enshrined in nursing journal
articles, books and conference speeches. It is argued that claims by academic nurses
have largely depended on principles drawn from continental and not Analytic (British-
American) philosophy. Thus, claims are credible only insofar as they defer proposi-
tional logic. This is problematic inasmuch as nursing is a practice-based activity usually
carried out in medical settings. Transpersonal nursing models are particularly critici-
zable in respect of their unworldly character as are also concepts based on shallow
usages of physics or mathematics. I argue that sensible measurements of the ‘real
world’ are possible – without endorsing positivism – and that nursing requires little
recourse to logically unsustainable claims. The paper concludes with an analysis of a
recent review of nursing knowledge, which analysis indicates the circularity that
attends many discussions on the topic.

something real, something that operated ‘out there’, a

Introduction
March Hare: Then you should say what you mean.
Alice: I do: at least – at least I mean what I say – that’s
the same thing you know.
Mad Hatter: Not the same thing a bit! You might just as
well say that I see what I eat is the same thing as I eat
what I see!
March Hare: You might just as well say that I like what
I get is the same thing as I get what I like.
Dormouse: You might just as well say that I breathe
when I sleep is the same as I sleep when I breathe.
Recently, musing on the phrase ‘nursing knowledge’, I
began to think how, for many, it had come to denote
descriptor both meaningful and instrumental. Dismissing
any idea that it meant knowledge that nurses have, for
instance about anatomy and physiology, I surmised that
more was intended, perhaps an intrinsic ‘nursing knowl-
edge’ that separated nursing from other disciplines, some-
thing universally applicable without limitation of national
boundary or cultural inference. The latter supposition –
that one could discuss nursing without recourse to particu-
larized cultures is, of course, improbable but nevertheless
something that is done.
Keith Cash (2009) asks: ‘what is the additional bit’ that
makes nursing what it is. One response is that nursing is
a mixture of things, its ‘uniqueness lying in the mix’. But

© 2011 Blackwell Publishing 403

L. Clarke
perhaps matters become clearer if ‘uniqueness’ is substi-
tuted with ‘usefulness’. Nursing literature contains many
such formulations, from David Towel’s (1975) ‘nurse as
intermediary’ to a text (Forster 2001) whose various chap-
ters list ‘the nurse’ as ‘manager’, ‘supervisor’, ‘educator’,
‘researcher’, ‘clinician’, assessor’ but not as ‘nurse’! These
definitions – the nursing imperative to embrace other
roles – reinforces nurses as all things to all people with a
consequent avoidance of what to distil as ‘the additional
bit’; in effect, to declare nursing’s knowledge. The confu-
sion seems markedly noticeable in respect of medicine
and recently so given the predilection of some nurses
for evidence-based, testable practice. This paper mainly
addresses the use of continental philosophy in generat-
ing ideas of nursing knowledge. Therefore, I will focus
only briefly, but necessarily, on the alternate method of
claiming a knowledge base through an appropriation of
medicine.
Here, for example, there is professed, as an exemplar,
a new middle-ground theory called ‘Flight Nursing
Expertise’:
An example of flight nursing knowledge is the decision
to place a chest tube in a trauma patient in a referring
emergency department with a 15% pneumothorax prior
to transport. If this same patient was to remain at the
referring hospital, the pneumothorax would be moni-
tored and not include intervention. The flight nurse, in
placing the chest tube, does so realizing there is an
inability to auscultate breath sounds during transport,
and that fluctuation in barometric pressure because of
altitude changes may worsen the pneumothorax. Such
a situation is specific to flight nursing experience [my
italics] and illustrates how flight-nurse knowledge can
guide decision-making differently from hospital based
nursing (Reimer & Moore 2010, pp. 1188–1189).
The above might count as an adjunctive skill (to some
nursing): that it constitutes a nursing exclusivity of any sort
is questionable.
On the cusp of English nursing becoming an all-degree
profession, it seems apposite to question what some of
the above might mean. To begin, we can concede that
knowledge, from whatever sources, sociology, physiology
and so on, is necessary to nursing and that, as well, there
are few professions which do not utilize material external
to their base. However, the question then becomes
which of these ‘knowledges’ predominates; for example,
although medicine may draw from sociology, its practice
remains governed by medical theory. So, unless there is a
nursing knowledge, those elements that are external to it,
sociology, medicine, etc. become more instrumental, if not
intrinsic, to its practice than whatever its own theory
might be.
404
Higher education
Prior to English nursing entering higher education, the
question of nursing knowledge was quickly dispensed with
by academic establishments. Significantly, nursing did not
enter the university system until recently: this points to
both the conservatism of English higher education (histori-
cally) but, as well, the widespread notion of nursing as a
practical undertaking, a view retained by some. For
example, the Open University refused credit transfer to
nursing qualifications (as did other universities) because
nurse teaching was (in)famously (seen as) based on received
ideas, routinized in content and delivery. Since entering
higher education, nursing knowledge has been discussed
at conference, in journals and textbooks. However, these
discussions typically set aside propositional knowledge,
embracing instead relativist inquiries whose heartland is
subjectivity. This fosters confusion through co-opting terms
purporting to demonstrate a caring perspective that is
simultaneously denoted as ‘science’. Witness, for example,
the Report: Nursing and Caring Sciences (Academy of
Finland 2003) which sustains these conflations with insuf-
ficiently analysed claims about nursing knowledge, and
science, carried through from non-deductive principles.
A chief spokesperson for this relativism is the French
charismatic Michel Foucault (1982, p. 210) who has said
(not untypically): ‘shall we try reason? To my mind,
nothing would be more sterile’. Foucault is one of several
continental writers difficult to place intellectually. This is
because their ‘method’ proceeds from a meta-critique (of
reason) and with a literary style that blends independent
disciplines of inquiry. As such, Foucault’s writing com-
prises philosophy, history, social criticism, literary criticism
and sociology. Although experts from these disciplines
identify deficiencies of rigour in his work, Foucault retains
a large following within nursing and is frequently sourced
in support of ‘multiple ways of seeing’, usually deployed in
critiquing justifications of scientific/medicine’s supposed
dominance.
Knowing
Philosophy is about differentiating between concepts: the
methods by which we do this are fundamental. For
example, one view, essential to scientific inquiry, is falsifi-
cation (Popper 1990) wherein a theory is experimentally
disproved by another which both accounts for the theory
and that which falsifies it. So for instance, in a qualitative
study, encountering unanticipated data contrary to my
expectations, [and I find it psychologically implausible
that qualitative researchers do not possess some research
‘expectations’] for example that ethnic group members are
© 2011 Blackwell Publishing

prejudiced towards some of their own group, I incorporate
this into my expanding concept of prejudice. Had I
embarked non-qualitatively with an experimental hypoth-
esis that such prejudice existed – on the basis of earlier
studies – but found no evidence for it, this would falsify
extant findings as well as contest the methods originally
used. This is not solely a distinction between methods: the
qualitative enterprise feeds a knowledge base that differs
from traditions of empirical testing whilst yet claiming
scientific credibility. Socrates, separating knowledge from
opinion, stated that knowledge is:
‘Tied down’ by the ability to give a reason for what we
know, and this makes it, unlike opinion, something
abiding which will not run away. This demand for a
‘reckoning of the reason’ or ‘account of the explanation’
or ‘definition of the cause’ or ‘explicit answer to the
question why’ is Socrates and Plato’s most seminal idea
(in Hare 1982, p. 18).
Of course, experimental designs do not yield absolute
truth but their conceptual approximations do incremen-
tally increase testable knowledge by way of observation
and test. Whilst accepting the uniformity of nature and
causal laws, experimental design takes nothing for
granted, nothing is straightforwardly asserted. Continen-
tal philosophy, alternatively, is assertion and often formed
of determinately convoluted ideas enriched by an often
difficult to decipher syntax. Thus, the density of, say,
Heideggerian writing, becomes a problematic labyrinth to
anyone unskilled in lateral thinking. As Ernest Gellner
(1959, p. 258) puts it:
On the side of continental philosophy a greater and
greater cult of paradox and obscurity, an appetite which
feeds on what it consumes and, as with a galloping
illness, hardly allows the imagination to conceive its
end: who can outdo Heidegger?
Unlike Western (Anglo-American) philosophy (and
omitting continental logicians such as Gottlob Frege 1848–
1925) with his emphasis on logic, the continental variety
disavows deduction and experiment. On occasion, even the
normative rules of academia are abandoned:
Sometimes I quote someone without using quotation
marks or a footnote to give the name of the source. It
seems like I’m just supposed to prove that I’ve read this
famous scholar, and I say why should I have to put
quotes around it if you can’t even recognize who it
comes from? (Foucault 1980, p. 5).
In addition, this declarative philosophy will utilize
mathematical equations to make its case [see Sokal &
Bricmont’s (1998) essay on the logical peculiarities this can
lead to]. This is not to deny that ‘the subjective’ is unim-
portant to philosophical knowledge construction and
deployment, nor does one restrict (the word) ‘science’ to
© 2011 Blackwell Publishing
So what exactly is nursing knowledge?
physical investigations. Social sciences too employ investi-
gative methods that can be unambiguous and productive of
verifiable findings. Rather is the objection to (1) aligning a
vaguely defined ‘science’ with nursing as a putative way of
justifying being with patients and (2) discussions on ‘scien-
tific knowledge’ when they evolve from none too rigorous
analyses of subjectivism.
Here is an example: Bonis (2009) distinguishes subjec-
tive from objective knowing (p. 1329), the subjective, she
states being:
Shaped through an individual’s engagement with the
environment, or personal experience. This subjective
type of knowledge gained through personal experience
is effected by how the individual perceives these
experiences.
She quotes Chinn & Kramer (1999, p. 1) who describe
such knowledge as ‘knowing, or a way of perceiving and
understanding the self and the world’ before concluding
(p. 1329) that:
Subjective knowledge is in a continual process of change
through each new experience that is encountered.
Support for this ‘position’ is taken from Immanuel Kant
but in a manner that moderates Kant’s view of experience
as dependant on a priori mental states that structure one’s
surroundings. It’s an understandable error that flows less
from how much Kant one reads and more about how one
reads Kant, his actual view being that we do have concepts
of the world and, as well, that the achievements of natural
sciences are of the highest intellectual order. So that whilst
knowledge may derive from experience, this does not pre-
clude factors of time and space, inherently possessed. It
follows that there is no bar to empirical testing, collecting
measureable evidence, formulating logical arguments. That
there exists a fixed reality is born out by perceptions of its
primary factors of objects, their density, length, volume,
movement.
Utilizing Kant to displace objectivity may be seen as
obliqueness of style, but its affirmation that matters (are
better) engaged with subjectively makes for circuitous
thinking. Kant’s latter work did fashion a meta-critique of
reason which does philosophically advantage theory-
building but, taken to conclusions, results in a scepticism
an unworkable in practice-based contexts. The problem
is that critiquing deductive reasoning undermines the
medical/psychological status of patients. Proffering help
that is untested, that relies upon supposition – counselling
and complementary therapies are of this type – requires a
confidence that disdains potential negative consequences.
What is required are verifiable arguments to justify and
defend nurses in light of harmful outcomes and this is
where writers like Foucault fail to deliver. Formulating a
social constructivism (a nuanced relativism) in which that
405
L. Clarke
social control (via medical language) determines all, omits
the requirement of an over-arching ethics negating the
capacity to appraise the moral status of competing claims:
so is a nursing ethics that claims uniqueness, a power play.
Yet the profession does this, its constructivism failing to
acknowledge that all claims are ultimately subjective.
This is key: science is subjective, for instance, when
scientists choose what to research and where topics of
interest stem from fashionability (whether of topicality
or outcome). But to argue that science is subjective in its
statistical analyses of (randomly selected) data – certainly
above the level of sub-atomic physics – is mistaken: the
scientific method is anti-human, its tools applied to what
can be known by means of excluding human preferment.
In these cases, knowledge recognizes fallibility not as an
end in itself – as would the humanist – but as something
to be corrected as a means to an end.
Medical settings
Nurses working in medical settings may experience
difficulty in resisting the premises of medical practice.
They may, of course, act pastorally so as to imbue the
culture of a treatment centre and so augmenting its medi-
cal efficiency. What concerns however are dissociations
from medicine on assumptions of nursing uniqueness,
assumptions that can drift towards other-worldliness or
improbability, where, for instance, illness is viewed as
transpersonal. This usually results in excess of metaphor:
these are useful in nursing when amplifying what is
already known: used creatively and/or definitively and
they camouflage, possibly distort, illness. At best, meta-
phor is a literary annoyance: at worst and however well
meant, it trivializes distress. Whatever it’s utility as an
interpretative device – and it is widely used in psycho-
therapy – ‘defining illness as something else’ (Fox 1993),
as abstraction, promotes formulaic responses: why, asks
Susan Sontag (1983) ‘can’t illness just be illness?’ Carson
& Arnold’s (2000) text Mental Health Nursing is
emblematic; it posits a veneer of ‘journey’ and ‘traveller’,
its chapter headings: ‘the journey marked by Aids’ or
‘getting to know the traveller’, typifying its orientation.
Of course, its chapters quickly collapse into quasi-medical
descriptions and the journey-metaphor becomes mere
sophistry where it both sidesteps patient’s talk and
imposes terms that leave practitioners befuddled. In con-
sequence, the terminology of nurse-philosophers Martha
Rogers and Rosemarie Parse (see Metzger McQuiston &
Webb 1995) with their respective rhetoric, ‘infinite energy
fields’ and ‘totality paradigms’, generate distance oblivi-
ous to clarity. Primo Levi (1990, p. 158) states the clarity
need so well:
406
In my opinion one should not write in an obscure
manner, because a piece of writing has all the more value
and all the more hope of diffusion and permanence, the
better it is understood and the less it lends itself to
equivocal interpretations.
The transpersonal
Albert Ellis (Edwards 1992) states that transpersonal
practitioners have strong beliefs in Godlike intuition,
higher powers, elevated consciousness and the ability to
cure the self and others. This evolves into holism where
everything is (seen as) inter-related, where subsets of
knowledge are inexplicable without recourse to the whole
of which they are part. This is normally read in two
ways: (1) the manner in which a patient’s life impacts on
his illness and (2) interventions that regard science as one
option amongst many. For some, the transfer is from a
nursing whose responses are to physical and psychologi-
cal distress into something bordering on the ethereal. But
this induces the holistic problem: perceiving matters as
illimitable forces an intellectualism that constantly
‘sounds off about abstract problems that are plainly
insoluble’ (Carey 2010, p. 41) and whose utility may
smack of professional power.
Noteworthy in respect of the transpersonal is Professor
of Nursing Jean Watson who states:
The nurse has a human responsibility to move beyond
the patient’s immediate specific needs and help the
patient reach his or her highest level of growth, maturity
and health. Nursing’s most important goal is the pro-
motion of self-actualization (in Elliott 1997, pp. 81–82).
In Fawcett’s view (1993, p. 218) Watson’s theory:
Goes beyond the existential-phenomenological app-
roach to, perhaps, a higher level of abstraction and sense
of personhood, incorporating concepts of the soul and
transcendence, reaching towards a metaphysical world
where nothing is random or meaningless’.
Professor Margaret Newman (1993) advises that
nursing must proceed from an expanding consciousness
where ‘all opposites are reconciled’ and where ‘experiences
of all kinds are equal and unconditional, pain as well as
pleasure, failure as well as success, ugliness as well as
beauty, disease as well as non-disease’. Because, she states,
the soul:
Moves directly in circular reasonings, where retreats are
as important as advances, preferring labyrinth and
corners, giving a metaphorical sense to life. Soul is
vulnerable and suffers; it is passive and remembers’.
Spiritually, these sentiments are fine: however, one
doubts their applicability within settings where people seek
recovery from illness. It reminds one that pure theory unen-
© 2011 Blackwell Publishing

cumbered by facts can drift into private reverie. Yet, as
Professor of Nursing Trevor Hussey (2008, p. 286) affirms:
Many nurses and even nurse philosophers appear
willing to embrace practices and theories that are little
removed from medieval magic. They favour . . . the
modern equivalent of the laying on of hands.
At face value, nurses offering patients spiritual support
is acceptable although when Nurse Caroline Petrie
(Gledhill 2009) suggested to a patient that they pray
together she discovered this was not to her National
Health Service Trust’s liking. She was occupationally
dismissed although subsequently re-instated. The patient,
although not offended, was said to be ‘taken aback’ at
Petrie’s suggestion, reporting her to another carer. Petrie
has defined her Christian faith as inseparable from her
nursing which is, she says, ‘all about loving and caring’.
Her National Health Service Trust confesses no objection
to giving spiritual support but states that the initiative
must come from the patient. It’s a dilemma. On the one
hand, asking someone to pray seems innocuous, the
patient simply says ‘yes’ or ‘no’ and that is that. Yet cul-
turally, faith is, for some, a private affair: one can be both
religious and private in its expression. Also, a familiarity
with Fawcett and Newman (above) might, in zealous
hands, provoke activities not conducive to well-being.
Christians themselves, worldwide, differ considerably in
the details of their faith. Some assert the redemptive value
of pain, others proclaim homosexuality an abomination.
In other words what counts are the consequences of
beliefs: intending benevolence and non-maleficence, one
may still, in practice, induce harm. As an instance, offer-
ing prayer might lead a patient to think they are more ill
than they are; transpersonalism might also distance prob-
lems from actual aetiology and prognosis. More generally,
I reiterate the necessity to see matters in culturally
informed ways: propounding internationalism is question-
able in terms of human response be it illness or cure.
Two editorials
Two editorials (Kalofissudis 2007, Norman 2009) demon-
strate the fine line by which knowledge/identity questions
are managed. Norman draws attention to an ‘interpersonal
relations’ model that he contrasts with a scientific, ‘evi-
denced based’ approach. The former, he says, is well estab-
lished but the latter now has pride of place because of
demonstrating effectiveness. However, he says, combining
the art and science of nursing is only achievable at a level of
interaction with people, whether through recovery models
or preventative interventions. This is true: but regrettably
takes us nowhere towards knowledge of what and why we
do things: his articulation of sensibility in respect of lived
© 2011 Blackwell Publishing
So what exactly is nursing knowledge?
problems works from a moral imperative to help but it
lacks theoretical explication.
Kalofissudis (p. 1) states that a: ‘theory of nursing
knowledge’ (called NKW) is:
{IB} = P
Where {IB} is the individual nurses’ synthesis of nurs-
ing knowledge through cognitive, psychomotor, and
affective/spiritual domains of self. P represents the depth
and breath of nursing praxis as determined by the
nurses’ Being {IB}.
The integration of this yields the equation: If P = Y, and
{IB} equals X, then the greater the X the greater the Y.
The writer states later (p. 3):
The only consistency in nursing is the inconsistency or
diversity and fluidity of change.
The intention, it seems, is to provide a logical definition
of nursing uniqueness, a (new) domain of knowledge.
Bonis (2009) too attempts this. When performing a litera-
ture search, she inserts the word ‘knowing’ into a database.
This retrieves little of usefulness until, typing in ‘personal’
and ‘experience’, the floodgates open and she is enabled to
conclude (p. 1332):
That although another individual can be part of the
same experience, the perspective for each individual is
unique.
But then, she says:
Being aware of a patient’s unique perspective of the
health experience [four citations are listed here] enables
a nurse to understand the individual reality for that
patient.
The contradiction in these two quotes negates a centu-
ries old debate: how do we have knowledge that we exist?
Later, again with a selective literature, Bonis avows that
knowledge is about recognizing disease processes but, as
well, requires a distinction:
Between the scientific facts about a disease process and
the personal experience of living with that disease
process.
Through understanding these, she asserts (p. 1335),
nurses acquire:
A new kind of knowledge that interfaces objective
empirical knowledge with the subjective reality that is
uniquely theirs as they live and interact with the world.
Let us be clear: nurses do not have any special pur-
chase on intuitive, empathic, tacit or other kinds of
non-propositional ‘knowing’. When Bonis contrasts two
sets of investigations, the medical being concerned with
biology and the nursing with patient’s experiences, she
rightly defines a qualitative orientation that many nurses
subscribe to. However, in doing so they must also
concede that intuiting other people’s distress is not their
407
L. Clarke
exclusive domain although many of my students, influ-
enced by others, insist it is, arguing that medics, for
instance, ‘don’t see the patients long enough’, an impres-
sive idea that fails to explain how ‘familiarity’ can so
quickly ‘breed contempt’, that a good heart is not con-
strained by time.
Defending ‘new’ nursing’s realm
A moment’s thought reveals that most argument represents
something of the desire and socialization of persons
arguing: even a cursory glance at some of the major writers/
theorists of the past or one’s own consciousness, will
yield this observation. It is disingenuous therefore, that in
defending ‘nursing theories’ – again, without defining what
these are – critics of nursing theories are accused of not
trying to understand, of perpetrating hidden motives. State
Cody & Mitchell (2002, p. 8):
To claim that the language of human science nursing is
too removed from conventional scientific language to be
useful, to claim that nursing theory is not necessary to
have sufficient knowledge to guide nursing practice, and
to take action to limit the diversity of views expressed in
nursing all constitute ways of exerting political power in
nursing to shape the practice application of knowledge
in the provision of nursing services.
Within a feminist perspective, there is a case to answer
here where the desire to see nursing ‘return to the
bedside’ harbours a political agenda intent on demoting
female occupational statuses within society overall.
However, celebrating the nobility of nursing, as well as its
cultural standing, needs little recourse to ersatz theories
whose resemblance to real world communication or sen-
sibility is weak. This is not to discredit nursing but to call
attention to its misrepresentation as an abstruse activity
which, at worst, denies the pathology of illness whilst, at
best, mimics – quite effectively as such – the practice of
medicine.
A prosaic approach
In The Construction of Social Reality, John Searle (1996)
uses three markers by which we view the world.
1. Physical structures acquire a (functional) status posi-
tion. A piece of metal becomes a wedding ring.
2. Systems/rules allow for institutional facts derived from
the status function. So the wedding ring requires a mar-
riage ceremony presided over by someone licensed by
society to perform it.
3. A mechanism which accords universal recognition of
what is entailed within the rules by which physical
objects are processed, for example, societies acknowl-
408
edging what marriage means, its evolution within a
culture in terms of that meaning.
Jim Baggott (2005, p. 43) quotes Searle thus:
A whole vocabulary of success and failure is now appro-
priate that is not appropriate to simple brute facts of
nature. Thus we can speak of ‘malfunction’, heart
disease’, and better or worse hearts. We do not speak of
better or worse stones, unless of course we have assigned
a function to them.
So that we do consciously work on our surroundings,
giving rise to their commonly attested elements. This does
not disqualify individual mental experience but it affords us
ways of talking about things in decently sensible patterns,
attesting what may be publicly known. If you substitute,
for wedding rings, some object within a treatment centre,
agreement can then stem from shared beliefs about its
meanings and functions. Of course, the rules may alternate
between community (nursing) and hospital, or types of
nursing but, given agreed systems, there will emerge rules
about how things happen and why.
Bryan Magee (1998) says that what knowledge is and
how we come to it is the central question of philosophy
[it always has been]. Unsurprisingly, we celebrate intellect
and its nourishment from primary school upwards. When
someone inquired of the late philosopher, A.J. Ayer about
the meaning of Eastern philosophy, he dismissed the ques-
tion ‘with Hegelian vehemence’ (Tynan 1979). So likewise
do philosophy historians give short shrift to their con-
tinental and Eastern varieties. So the Western regard for
knowledge as precious, hard won, not coming naturally.
Whilst not the sum-total of what can be known, posi-
tivism does, nevertheless, yield a peculiarly testable way
of knowing. Given nursing’s roots – whether choosing
Nightingale, Sarah Gamp or Grace Poole – it is, indelibly,
a practical affair. But in terms of practice informing
theory, the essential of ‘tacit knowing’, this is akin to
saying:
That driving buses brings a unique perspective to the
theory of internal combustion (Allmark (1995, p. 22).
How true: although questions remain as to the depth
of knowledge that nurses require. In terms of material
issues, it is not too difficult a question, for example
the physiology governing muscular injections. Defining
claims to tacit nursing understandings derived from prac-
tice, alternatively, is a more uncomfortable intellectual
effort.
Addendum
In a major text, Mark Risjord (2010) investigates
knowledge comprehensively, philosophically. According to
Risjord:
© 2011 Blackwell Publishing

1. Nursing can not have a strict distinction between
scientific knowledge and ethical/political knowledge.
Neither can it claim objectivity by including essentially
evaluative procedures.
2. Nursing possesses moral and political values within its
topics of inquiry.
3. Nurses’ knowledge of human health is in virtue of their
role in health care: nursing knowledge is an outgrowth
of the nursing (practical) standpoint.
4. A discipline that is a basic science should have its own
corpus of (unique) laws, its theories allowing predic-
tions to be tested by experimentation.
5. We need to understand why the received view (of
science) (as in 4 above) represents a particular view of
what science is.
6. Discarding material originating within other disciplines
weakens nursing scholarship.
I will now critique these points. Risjord (p. 109) notes
that scientists draw from theory originating within other
domains; therefore, he suggests, nursing can do the same
and he gives, as an example, the ‘theory of planned behav-
iour’ which comes from social psychology.
To insist, he says, that. . . . [this theory] be reformulated
in novel nursing terms would be to cut off the support
available from existing texts in a variety of domains.
But if scientists (one of the other domains) do this – and
he means physical scientists – they still test what they
borrow using methods which transform what is borrowed
into factually measurable data. For nurses to ‘borrow’, let’s
say, behaviour therapy, as an additional element to nursing,
does not make the former nursing: its still behaviour
therapy. There is no nursing method that will alter what it
is. Yet Professor Risjord argues that sharing theory with
other disciplines will strengthen nursing’s hand, increase its
knowledge.
Further, in playing ‘the uncertainty principle’ (a
concept from subatomic physics often transferred, by
subjectivists, into social settings to show the non-stability
of science, and it, follows positivism), he refers to
observed differences of things at different levels. Acknow-
ledging that Boyle’s Law of Gasses fits the scientific view
nicely, he says that this is not the full truth because dif-
ferent instruments produce dissimilar effects. That is, I
can feel hot water with my hand but a thermometer
will express this feeling mathematically. Risjord concludes
that philosophers of science, neglecting the sensual
modality, amplified the scientific, in effect, medical view.
Nursing he alleges must reject the latter whilst acknowl-
edging its biological, psychological and social elements:
this will move matters nearer a knowledge-based disci-
pline. The following text (from Meleis 1991, p. 115) is
then land-marked:
© 2011 Blackwell Publishing
So what exactly is nursing knowledge?
As nurses and societies become comfortable with the
uniqueness of what nurses can offer [my italics] knowl-
edge for nursing will then be knowledge health care in
general. It will be knowledge developed and utilized
collaboratively by members of a number of a number of
disciplines. Therefore, nursing theories will become theo-
ries for health care, developed by nurses, physicians,
occupational therapists and others. There will no longer
be nursing theories. There will be theories about health
care, some of which are developed by nurses (in Risjord,
p. 123).
Professor Risjord comments favourably on this before
declaring nursing a ‘patchwork profession’ – the ‘jack of all
trades’ with which I began this paper. However, other
disciplines – medicine included – also borrow: ‘no disci-
pline’, we are told, ‘owns a theory’. Amongst the patch-
work lies nursing, as one of many, and the:
Domain of nursing science is the science that makes
explicit the nursing standpoint (p. 140)
Although previously Risjord has stated contradictorily
that there can be no such thing in and of itself.
Almost finally, two writers (Reed & Lawrence 2008,
p. 423) are quoted:
Nursing knowledge refers to knowledge warranted as
useful and significant to nurses and patients in under-
standing and facilitating human health processes (in
Risjord, p. 221).
Being thus, it can not be unique to nurses in epistemo-
logical terms. But yet is it argued that this is a ‘radical
definition perspective’ on health and which:
[gives] nursing knowledge its identity and unique char-
acter (p. 221).
Finally, he argues, the conclusive problem for nursing
knowledge and practice rests on a misinterpretation
of knowledge derived from the template of science.
Unfortunately, this misreads what the scientific method
is but what matter if ‘new kinds of philosophy’
(p. 222) redefine science, which takes us to where
we began.
Conclusion
The professional knowledge base is unique to its function.
The crisis for nursing is that having annexed continental
thinking first, and then medicine second, it still has no
firm knowledge base. It can not have medicine since
another profession already has that; continental philoso-
phy invites intellectual chaos uncomfortable in any
practice-based setting. Therefore, we either accept that
nursing is a multifaceted skill set delivered under physi-
cian guidance or we work more transparently towards
stating what it otherwise is.
409
L. Clarke
References
Academy of Finland (2003) Nursing and Caring
Science. Academy of Finland, Helsinki.
Allmark P. (1995) A classical view of the theory-
practice gap in nursing. Journal of Advanced
Nursing 22, 18–23.
Baggott J. (2005) A Beginner’s Guide to Reality.
Penguin Books, London.
Bonis S. (2009) Knowing in nursing: a concept
analysis. Journal of Advanced Nursing 65,
1328–1338.
Carey J. (2010) Blackguard and genius. The
Sunday Times Culture 7th February, pp. 40–41.
Carson V. & Arnold E. (2000) Mental Health
Nursing: The Nurse-Patient Journey. W.B.
Saunders Co., London.
Cash K. (2009) Clinical autonomy and contractual
space. Nursing Philosophy 2, 36–41.
Chinn P. & Kramer M. (1999) Theory and
Nursing: Integrated Knowledge Development.
Mosby, London.
Cody W. & Mitchell G. (2002) Nursing Science
Quarterly 15, 4–13.
Edwards G. (1992) Does psychotherapy need a
soul? In: Psychotherapy and Its Discontents
(eds Dryden, W. & Feltham, C.), pp. 194–224.
Open University Press, London.
Elliott H. (1997) Holistic nursing and the thera-
peutic use of self. Complementary Therapies in
Nursing and Midwifery 3, 81–82.
410
Fawcett J. (1993) Analysis and Evaluation of
Nursing Theories. F.A. Davis and Co., Philadel-
phia, PA.
Forster S. (2001) The Role of the Mental Health
Nurse. Nelson Thornes, Cheltenham.
Foucault M. (1980) Prison talk. In: Power/
Knowledge: Selected Interviews and Other
Writings 1972–1977 (ed Gordon, C.), pp.
37–54. Harvester, Brighton.
Foucault M. (1982) Afterword: the subject and
power. In: Michel Foucault: Beyond Structural-
ism and Hermeneutics (eds Dreyfus, H. &
Rabinow, P.), pp. 210–220. University of
Chicago Press, Chicago, IL.
Fox N. (1993) Postmodernism: Sociology
and Health. The Open University Press,
Buckingham.
Gellner E. (1959) Words and Things. Routledge,
London.
Gledhill R. (2009) Victory for suspended Christian
nurse. The Times. February 7th.
Hare R. (1982) Plato. Oxford University Press,
Oxford.
Hussey T. (2008) Book review: beyond the hoax:
science, philosophy and culture. Nursing Phi-
losophy 9, 285–286.
Kalofissudis I. (2007) The theory of nursing
knowledge. Health Science Journal 1, 1–4.
Levi P. (1990) Other People’s Trades. Sphere
Books, London.
Magee B. (1998) The Story of Philosophy.
Dorling-Kindersley, London.
Meleis A.I. (1991) Theoretical Nursing: Develop-
ment and Progress. Lippincott, Philadelphia.
Metzger McQuiston C. & Webb A. (1995)
Foundations of Nursing Theory. Sage, London.
Newman M. (1993) Health As Expanding Con-
sciousness. C.V. Mosby, St. Louis, MO.
Norman I. (2009) The art and science of mental
health nursing: reconciliation of two traditions
in the cause of public health. International
Journal of Nursing Studies 46, 1537–1540.
Popper K. (1990) The Logic of Scientific Discov-
ery. Unwin Hyman, London.
Reed P.G. & Lawrence L.A. (2008) A paradigm for
the production of practice based knowledge.
Journal of Nursing Management 16, 422–432.
Reimer A.S. & Moore S.M. (2010) Flight-nursing
expertise: towards a middle ground theory.
Journal of Advanced Nursing 66, 1183–
1191.
Risjord M. (2010) Nursing Knowledge, Science,
Practice and Philosophy. Wiley-Blackwell,
Chichester.
Searle J. (1996) The Construction of Social
Reality. Penguin, London.
Sokal A. & Bricmont J. (1998) Intellectual Impos-
tures. Profile Books, London.
Sontag S. (1983) Illness As Metaphor. Penguin
Books, Harmondsworth.
Towell D. (1975) Understanding the Psychiatric
Nurse. RCN Publications, London.
Tynan K. (1979) Show People. Weidenfeld &
Nicolson, London.
© 2011 Blackwell Publishing
Copyright of Journal of Psychiatric & Mental Health Nursing is the property of Wiley-Blackwell and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.