The nursing profession has a long history of advocating for social justice and health equity, and both values profoundly infuse nursing ethics, theory, and education. Homecare nursing occurs between the patient's daily life at home and the public health care system. Therefore, homecare nurses ideally possess insight into the living conditions and social determinants of health that their patients experience. This interpretive phenomenological study explores the strategies employed by homecare nurses to fight health inequity and advance social justice. Data were (...) collected through participant observations, situational interviews, and small group interviews with 12 homecare nurses from two municipalities. Three analytical approaches were used: paradigm cases, exemplars, and thematic analysis. The data identified two primary strategies homecare nurses use to circumvent, solve, and mitigate the negative consequences of social determinants of health on patients' care and treatment: “Negotiating practice” and “Aligning practice.” “Negotiating practice” ensures that care and treatment are delivered in a way acceptable to all involved. “Aligning practice” ensures cohesion, progression in the treatment and care trajectory, and support for patients and relatives in navigating the system. Both strategies are part of nurses' largely hidden work, reflecting the nursing profession's position as nested between the individual patient and the system. (shrink)

This article presents a study of how co-present individuals work out the nature of embodied engagement and disengagement displays by individuals with dementia in a Danish public care facility. Research has found that moderate to severe dementia may result, for example, in a lack of social engagement, apathy and problems in maintaining conversations. Research has, however, also found that co-present individuals indicate their right to unavailability for social interaction. This is accomplished through details of embodied and multimodal conduct such as (...) gaze behavior, which includes practices of glancing and gazing at co-present individuals or practices of gazing into space. These practices may coincide with indications of ‘lack of social engagement’ and ‘apathy’. This study falls within the framework of ethnomethodology and employs multimodal conversation analytic methods to show how co-present individuals monitor residents’ displays of engagement and disengagement, primarily gaze behavior and how they respond to them. The study is based on 20 hours of video-recordings. (shrink)

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching Embase, Medline, Scopus and PsycINFO. The quality (...) of the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here. (shrink)

BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced (...) philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. (shrink)

Slurs are rhetorically insidious and theoretically interesting because they communicate something above and beyond the truth-conditional predication of group membership, something which typically though not always projects across 'blocking' constructions like negation, conditionals, and indirect quotation, and which is exceptionally resistant to direct challenge. I argue that neither pure expressivism nor straightforward truth-conditionalism can account for the sort of commitment that speakers undertake by using slurs. Instead, I claim, users of slurs endorse a denigrating perspective on the targeted group.

The objective of this paper is to characterize the rich interplay between automatic and cognitive control processes that we propose is the hallmark of skill, in contrast to habit, and what accounts for its flexibility. We argue that this interplay isn't entirely hierarchical and static, but rather heterarchical and dynamic. We further argue that it crucially depends on the acquisition of detailed and well-structured action representations and internal models, as well as the concomitant development of metacontrol processes that can be (...) used to shape and balance it. (shrink)

According to the Stoics, ordinary unified bodies—animals, plants, and inanimate natural bodies—each have a single cause of unity and being: pneuma. Pneuma itself has no distinct cause of unity; on the contrary, it acts as a cause of unity and being for itself. In this paper, I show how pneuma is supposed to be able to unify itself and other bodies in virtue of its characteristic tensile motion (τονικὴ κίνησις). Thus, we will see how the Stoics could have hoped to (...) account for corporeal unity by positing another body (pneuma) apparently itself in need of unification. (shrink)

Recent philosophical attention to climate models has highlighted their weaknesses and uncertainties. Here I address the ways that models gain support through observational data. I review examples of model fit, variety of evidence, and independent support for aspects of the models, contrasting my analysis with that of other philosophers. I also investigate model robustness, which often emerges when comparing climate models simulating the same time period or set of conditions. Starting from Michael Weisberg’s analysis of robustness, I conclude that his (...) approach involves a version of reasoning from variety of evidence, enabling this robustness to be a confirmatory virtue.. (shrink)

The emphasis on the limitations of objectivity, in specific guises and networks, has been a continuing theme of contemporary analytic philosophy for the past few decades. The popular sport of baiting feminist philosophers — into pointing to what's left out of objective knowledge, or into describing what methods, exactly, they would offer to replace the powerful objective methods grounding scientific knowledge — embodies a blatant double standard which has the effect of constantly putting feminist epistemologists on the defensive, on the (...) fringes, on the run.This strategy can only work if objectivity is transparent, simple, stable, and clear in its meaning. It most certainly is not. In fact, taking objectivity as a sort of beautiful primitive, self-evident in its value, and all-powerful in its revelatory power, requires careless philosophy, and the best workers in metaphysics, epistemology, and philosophy of science have made reworked definitions of objectivity absolutely central to their own projects. In fact, classic feminist concerns with exploring the impact of sex and gender on knowledge, understanding, and other relations between human beings and the rest of the world fall squarely within the sort of human and social settings thatare already considered central in most current analytic metaphysics, epistemology, and philosophy of science. I argue that the burden of proof is clearly on those who wish toreject the centrality and relevance of sex and gender to our most fundamental philosophical work on knowledge and reality. (shrink)

Our ordinary and theoretical talk are rife with “framing devices”: expressions that function, not just to communicate factual information, but to suggest an intuitive way of thinking about their subjects. Framing devices can also play an important role in individual cognition, as slogans, precepts, and models that guide inquiry, explanation, and memory. At the same time, however, framing devices are double-edged swords. Communicatively, they can mold our minds into a shared pattern, even when we would rather resist. Cognitively, the intuitive (...) power of a frame can blind us both to known features that don’t fit easily within the frame, and also to “unknown unknowns” we have not yet encountered. Thus, perhaps Locke is right to disavow such “eloquent inventions” as “perfect cheats” that “insinuate wrong ideas, move the passions, and thereby mislead the judgment.” Against this, I argue that while the metaphor of double-edged swords is indeed apt, this is because frames are tools for thought. Like any tool, they can be used well or badly; but they do not fall outside the realm of rationality altogether. I describe how framing devices express open-ended perspectives, which produce structured intuitive characterizations of particular subjects. I argue that frames can make effective, distinctive epistemic contributions in the course of inquiry, and that the cognitive structures that frames produce can contribute to, and constitute, epistemic achievements in their own right, even in highly idealized circumstances at the nominal end of inquiry. Throughout, I focus especially on scientific understanding, because it serves as a paradigm case of rational inquiry, from which frames and perspectives are most likely to be excluded. (shrink)

I argue that we can reconcile two seemingly incompatible traditions for thinking about concepts. On the one hand, many cognitive scientists assume that the systematic redeployment of representational abilities suffices for having concepts. On the other hand, a long philosophical tradition maintains that language is necessary for genuinely conceptual thought. I argue that on a theoretically useful and empirically plausible concept of 'concept', it is necessary and sufficient for conceptual thought that a thinker be able to entertain many of the (...) potential thoughts produced by recombining her representational abilities apart from a direct confrontation with the states of affairs being represented. Such representational abilities support a cognitive engagement with the world that is flexible, abstract, and active. (shrink)

Widmer sheds light on a neglected aspect of the Western philosophical tradition. Following an era of Hegelianism, the members of the neo-Kantian "Marburg School," such as Friedrich Albert Lange, Hermann Cohen, Rudolf Stammler, Paul Natorp, and Ernst Cassirer defended socialism or left-wing ideals on Kantian principles. In doing so, Widmer breaks with two mistaken assumptions. First, Widmer demonstrates that the left-Hegelian and Marxist traditions were not the only significant philosophical sources of socialist critique in nineteenth-century Germany, as the left-Kantians identified (...) problems of normativity that the left-Hegelians could not adequately address. Second, Widmer challenges the prevailing assumption that the political philosophies developed in the Marburg School can be comprehensively characterized as a unified school of "ethical socialism." By showing that they varied fundamentally regarding their political views and their philosophical foundations of socialism, Widmer fills a gap in the studies of neo-Kantianism that is long overdue. (shrink)

We address the controversy in the literature concerning the definition of holobionts and the apparent constraints on their evolution using concepts from community population genetics. The genetics of holobionts, consisting of a host and diverse microbial symbionts, has been neglected in many discussions of the topic, and, where it has been discussed, a gene-centric, species-centric view, based in genomic conflict, has been predominant. Because coevolution takes place between traits or genes in two or more species and not, strictly speaking, between (...) species, it may affect some traits but not others in either host or symbiont. Moreover, when interacting species pairs are embedded in a larger community, indirect ecological effects can alter the expected pairwise dynamics. Mode of symbiont transmission and the degree of host inbreeding both affect the extent of microbial mixing across host lineages and thereby the degree to which selection on one trait of either partner affects other aspects of a holobiont phenotype. We discuss several potential defining criteria for holobionts using community genetics and population genetics models, suggesting their application and limitations. Using community genetics models, we show how conflict between genomes can be self-limiting, while cooperation and mutualism tend to be self-accelerating. It is likely that this bias in the evolutionary dynamics of interaction between hosts and symbionts is an important feature of holobionts. This bias in the evolutionary dynamic could contribute to explaining the absence of cheaters from natural mutualisms, although cheaters are predicted by gene-centered conflict theory to cause the evolutionary instability of mutualisms. Additionally, it may help explain the more frequent origin of mutualisms from parasitic than from free-living systems, an evolutionary trajectory opposite to that predicted by genome conflict theory. (shrink)

Many philosophers have offered accounts of shared actions aimed at capturing what makes joint actions intentionally joint. I first discuss two leading accounts of shared intentions, proposed by Michael Bratman and Margaret Gilbert. I argue that Gilbert’s account imposes more normativity on shared intentions than is strictly needed and that Bratman’s account requires too much cognitive sophistication on the part of agents. I then turn to the team-agency theory developed by economists that I see as offering an alternative route to (...) shared intention. I concentrate on Michael Bacharach’s version of team-agency theory, according to which shared agency is a matter of team-reasoning, team-reasoning depends on group identification and group identification is the result of processes of self-framing. I argue that it can yield an account of shared intention that is less normatively loaded and less cognitively demanding. (shrink)

This paper considers what function—if any—colocation of bodies may have in the Stoic theory of blending (κρᾶσις), by examining (1) whether colocation is part of the definition of what blending is; and (2) whether colocation is posited by the Stoics as a requirement necessary for the definition to be satisfied. I reconstruct the standard, Chrysippean definition of blending, and I show that the answer to (1) is ‘no’; further, I argue that the evidence gives no reason to affirm (2). Thus, (...) it appears that colocation does not have a central function in the Stoic theory of blending. (shrink)

I distinguish among a range of distinct representational devices, which I call "frames", all of which have the function of providing a perspective on a subject: an overarching intuitive principle or for noticing, explaining, and responding to it. Starting with Max Black's metaphor of metaphor as etched lines on smoked glass, I explain what makes frames in general powerful cognitive tools. I distinguish metaphor from some of its close cousins, especially telling details, just-so stories, and analogies, in ordinary cognition and (...) communication. And I use these distinctions to illustrate different sorts of gaps that frames or models can open up between representation and reality. (shrink)

We should not admit categorial restrictions on the significance of syntactically well formed strings. Syntactically well formed but semantically absurd strings, such as ‘Life’s but a walking shadow’ and ‘Caesar is a prime number’, can express thoughts; and competent thinkers both are able to grasp these and ought to be able to. Gareth Evans’ generality constraint, though Evans himself restricted it, should be viewed as a fully general constraint on concept possession and propositional thought. For (a) even well formed but (...) semantically cross-categorial strings often do possess substantive inferential roles; (b) hearers exploit these inferential roles in interpreting such strings metaphorically; (c) there is no good reason to deny truth-conditions to strings with inferential roles. (shrink)

In Stoic physics, blending (κρᾶσις) is the relation between active pneuma and passive matter; natural bodies from rocks and logs to plants, animals and the cosmos itself are blends of pneuma and matter. Blending structures the Stoic cosmos. I develop a new interpretation of the Stoic theory of blending, based on passages from Hierocles. The theory of blending, I argue, has been misunderstood. Hierocles allows us to see in detail how the theory is supposed to work and how it fits (...) into Stoic physics. (shrink)

In Spanish (and other Romance languages) certain predicates select the subjunctive mood in the embedded clause, while others select the indicative mood. In this paper, I present a new analysis for the predicates that select the subjunctive mood in Spanish that is based on a semantics of comparison. The main generalization proposed here is the following: in Spanish, a predicate selects the subjunctive mood in its embedded proposition if the proposition is compared to its contextual alternatives on a scale introduced (...) by the predicate. In this proposal, predicates that select the subjunctive mood are thus analyzed as gradable predicates. Furthermore, the subjunctive mood morpheme is claimed to make a semantic contribution, namely to evaluate the contextual alternatives that are compared by the predicate. In comparing this proposal to other approaches, I show that it can more straightforwardly account for a number of properties of these predicates (entailment relations, practical inferences, and contexts with more than two alternatives). New empirical evidence for two crucial properties of the predicates that select the subjunctive mood is provided: these predicates are focus sensitive and they are gradable, two properties that follow directly from the proposal developed here. In the vast literature on mood, the link between the appearance of the subjunctive mood and these important properties has never been made before. (shrink)

Zusammenfassung Das German Diagnosis Related Groups (G-DRG)-System hat zu einem weitgehend erlösorientierten Krankenhausfinanzierungssystem geführt. Im vorliegenden Beitrag werden die ethischen Implikationen und Folgen dieses Systems am Beispiel rekonstruktiver Maßnahmen (Defektversorgung) bei Patient*innen mit Mundhöhlenkarzinomen herausgearbeitet. Dabei gilt es zugleich, das Wechselspiel von G‑DRG-System und Leitlinienentwicklung zu beleuchten. Vorangestellt werden einführende Angaben zum Mundhöhlenkarzinom und den bestehenden Behandlungsoptionen: konventionelle Rekonstruktionstechnik versus kostenintensive High-End-Chirurgie. Methodische Grundlage und argumentativer Bezugspunkt der Arbeit ist das theoretische Fallszenario „Versorgung mittelgroßer Defekte nach Tumorresektion“. Das G‑DRG-System und (...) die dadurch geschaffenen ökonomischen Anreize haben weitreichende ethische Implikationen in der bedarfsorientierten Behandlung von Patient*innen und führen zu mehrdimensionalen Wechselwirkungen. Die bestehende Tendenz zur High-End-Chirurgie birgt das Risiko der Über- und Fehlversorgung und läuft demnach den Prinzipien Benefizienz und Nonmalefizienz zuwider. Die einseitige Indikationsstellung zugunsten der High-End-Chirurgie lässt zudem auf eine direktive Patientenaufklärung schließen (Verstoß gegen das Prinzip des Respekts der Patientenautonomie). Kostspielige High-End-Verfahren konterkarieren überdies das Wirtschaftlichkeitsgebot und berühren somit zugleich Fragen der Verteilungsgerechtigkeit. Schließlich wirkt die klinische Bevorzugung von High-End-Verfahren auch auf die innermedizinische Logik, namentlich auf die Publikationslandschaft (publication bias), die Ausgestaltung der betreffenden Leitlinien sowie auf die chirurgische Expertise. Zu fordern ist eine Sensibilisierung aller in der Chirurgie tätigen Akteur*innen (Chirurg*innen; Leitlinienexpert*innen, Gutachter*innen). (shrink)

I argue that four of the fundamental claims of those calling themselves `genic pluralists'Philip Kitcher, Kim Sterelny, and Ken Watersare defective. First, they claim that once genic selectionism is recognized, the units of selection problems will be dissolved. Second, Sterelny and Kitcher claim that there are no targets of selection. Third, Sterelny, Kitcher, and Waters claim that they have a concept of genic causation that allows them to give independent genic causal accounts of all selection processes. I argue that each (...) one of these claims is either false or misleading. Moreover, the challenge that arises from the availability of genic causal accounts, namely, the inability to choose on rational grounds among genic and higher-level accounts, is unsupported. (shrink)

This paper defends a ‘noetic’ conception of aesthetic experience whereby such experience is best conceived as a kind of explorative thought process. Although not directly aimed at acquiring knowledge, this process often leads to an enhanced understanding or improved epistemic grasp of the object of appreciation itself and the world. On this conception, aesthetic value acts as an invitation to engage in a series of contemplative and reflective processes during which we rely not only on the perceptual, imaginative, and affective (...) abilities which have occupied such a central role in aesthetic theory, but also on our capacities for sense-making, problem-solving and theory-building. Cases of intelligible beauty or aesthetic value should thus lie at the heart of accounts of aesthetic experience. (shrink)

The discovery of mirror neurons has given rise to a number of interpretations of their functions together with speculations on their potential role in the evolution of specifically human capacities. Thus, mirror neurons have been thought to ground many aspects of human social cognition, including the capacity to engage in cooperative collective actions and to understand them. We propose an evaluation of this latter claim. On the one hand, we will argue that mirror neurons do not by themselves provide a (...) sufficient basis for the forms of agentive understanding and shared intentionality involved in cooperative collective actions. On the other hand, we will also argue that mirror neurons can nevertheless play an important role in an account of the production and understanding of joint action, insofar as they provide the basic constituents of implicit agent-neutral representations and are useful elements in a process of online mutual adjustment of participants' actions. (shrink)

In this article, I offer a literary-critical reading of Modernity and the Holocaust, arguing that Bauman’s non-Hobbesian ethics is linked to a form of Orphic authorship. I contextualize this reading with a study of three literary authors: W.G. Sebald, Peter Weiss and Janina Bauman, and their respective versions of this post-Holocaust authorship. At stake is the drama of the forbidden gaze, the moment when Orpheus turns to look at Eurydice, killing her a second time. Using Levinas’ ethics and his scenario (...) of recognition, Bauman re-writes this fateful gaze as a loving gaze, implicitly proposing a counter-model to the Schmittian gaze — always ready to recognize the enemy, always ready to kill. (shrink)

In this paper I distinguish various ways in which empirical claims about evolutionary and ecological models can be supported by data. I describe three basic factors bearing on confirmation of empirical claims: fit of the model to data; independent testing of various aspects of the model, and variety of evident. A brief description of the kinds of confirmation is followed by examples of each kind, drawn from a range of evolutionary and ecological theories. I conclude that the greater complexity and (...) precision of my approach, as compared to, for instance, a Popperian approach, can facilitate detailed analysis and comparison of empirical claims. (shrink)

climate scientists have been engaged in a decades-long debate over the standing of satellite measurements of the temperature trends of the atmosphere above the surface of the earth. This is especially significant because skeptics of global warming and the greenhouse effect have utilized this debate to spread doubt about global climate models used to predict future states of climate. I use this case from an under-studied science to illustrate two distinct philosophical approaches to the relation among data, scientists, measurement, models, (...) and theory. I argue that distinguishing between 'direct' empiricist and 'complex' empiricist approaches helps us understand and analyze this important scientific episode. I also introduce a complex empiricist account of testing and evaluation, and contrast it with the basic Hypothetico-Deductive approach to the climate models used by the direct empiricists. This more developed complex empiricist apporach will serve philosophy of science well, as computational models become more wide-spread in the sciences. (shrink)

We first describe how the concept of “fringe consciousness” can characterise gradations of consciousness between the extremes of implicit and explicit learning. We then show that the NEO-PI-R personality measure of openness to feelings, chosen to reflect the ability to introspect on fringe feelings, influences both learning and awareness in the serial reaction time task under conditions that have previously been associated with implicit learning . This provides empirical evidence for the proposed phenomenology and functional role of fringe consciousness in (...) so-called implicit learning paradigms . Introducing an individual difference variable also helped to identify possible limitations of the exclusion task as a measure of conscious sequence knowledge. Further exploration of individual differences in fringe awareness may help to avoid polarity in the implicit learning debate, and to resolve apparent inconsistencies between previous SRT studies. (shrink)

Cassirer’s view on ethical objectivity is puzzling. In his scarce comments on Kantian ethics, he defines the “pure will” as a “function of consciousness,” which he considers a prerequisite for the possibility of objective ethical normativity embedded in empirical reality. In the existing body of literature, we find two different interpretations of Cassirer’s account of ethical objectivity. The “meta-philosophical” interpretation takes objectivity as a telos that humanity gradually approaches, thereby emphasizing the historically relative truth standards to which the teleologically-evolving symbolic (...) forms respond. The “Kantian” interpretation takes objectivity as a concept inherent to the conduct of the moral law, highlighting the evaluative and prescriptive aspects of his philosophical method. In this paper, I defend the thesis that, by interpreting Cassirer’s ethics through the lens of Hermann Cohen’s mature ethical theory, we can see that ethical deliberation in Cassirer involves a notion of universality that is a priori and depends on a substantiated concept susceptible to change. The proposed “contingent conception of universality” thesis accounts for both: the evaluative and teleological features of Cassirer’s ethical theory, grounding an a priori account of ethical objectivity conceptualized relative to contingent truth standards that gradually improve. (shrink)

this requirement for adaptations. Emergent characters are always potential adaptations. Not all selection processes produce adaptations, however. The key issue, in delineating a selection process, is the relationship between a character and fitness. The emergent character approach is more restrictive than alternative schemas that delineate selection..

Despite the diversity of ageing, society and academics often describe and label older persons as a vulnerable group. As the term vulnerability is frequently interchangeably used with frailty, dependence, or loss of autonomy, a connection between older age and deficits is promoted. Concerning this, the question arises to what extent it may be helpful to refer to older persons as vulnerable specifically in the context of health care. After analyzing different notions of vulnerability, I argue that it is illegitimate to (...) conclude that older age is related to increased vulnerability. Much more, identifying older adults as a vulnerable group is closely related to ageism and can be associated with paternalistic benevolence and a tendency to overprotection, especially within health care. Additionally, even though older adults are more often in situations of increased vulnerability due to their potentially higher need for health care, I argue further that older adults mainly become a vulnerable group due to ageism. In this way, it can be concluded that the vulnerability of older adults does not originate in certain attributes of the group, but arises from a characteristic of society and, in turn, health personnel, namely ageism. Labeling older adults as vulnerable therefore is only helpful, when it is used to raise awareness of the widespread ageism in society, in this context, especially in the setting of health care, and the negative consequences thereof for older adults. (shrink)

Texts about theory in nursing often refer to theory construction by using inductive methods in a rigid way. In this paper, it is instead argued that theories are created, which is in line with most philosophers of science. Theory creation is regarded as a creative process that does not follow a specific method or logic. As in any creative endeavour, the inspiration for theory creation can come from many sources, including previous research and existing theory. The main idea put forward (...) is that deductive qualitative research approaches should play a key role in theory creation. Furthermore, there is a need to differentiate between theory creation and theory justification. A model that emphasizes the creative aspects of theory creation and theory justification using qualitative approaches is presented. The model suggests that knowledge development is a deductive trial‐and‐error process where theory creation is followed by testing. Scientific theory creation and justification are presented as an iterative process that is deductive in that a testable hypothesis is derived from the theory. If the hypothesis is falsified, then the theory needs modification or might be altogether wrong. Several factors can block the creative process, both in theory development and in finding ways to test a theory in the justification phase. Some of these blockers are the idea of ‘building blocks’ and the inductive view of science often brought forward in nursing. Other blockers include striving for consensus and adherence to existing nursing philosophies and existing theories. Research and knowledge development are creative processes, and following predefined methods is not enough to ensure scientific rigour in qualitative nursing research. (shrink)