Doctoral programmes in nursing are charged with developing the next generation of nurse scholars, scientists, and healthcare leaders. The American Association of Colleges of Nursing (AACN) endorses the inclusion of philosophy of science content in research‐focused doctoral programmes. Because a philosophy course circumscribed to the natural or social sciences does not address the broad forms of knowledge that are relevant to nursing practice, we have developed and co‐taught a course on the philosophy of knowledge that introduces students to competing claims (...) regarding the nature of knowledge, truth, and rationality. In addressing broad themes related to science and knowledge of the body, health and illness, and ethics, the course equips students to tread the rough and shifting ground of nursing scholarship and practice. Providing doctoral students with this philosophical footing is intended to give future scholars, researchers, and healthcare leaders the intellectual skills to critically reflect on knowledge claims, to challenge the hegemony of science, and to recognize the disciplinary forms of knowledge that are left out or trivialized. Our pedagogical approach to knowledge development does not denigrate scientific knowledge, but elevates forms of inquiry and notions of clinical knowledge that are too often marginalized in doctoral education and the academy in general. (shrink)

Although the positive outcomes achieved in home‐visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse–family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic of techne. After (...) describing how a scientific–clinical gaze misrepresents teen mothers and contributes to a rational–technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life‐world. Dialogical understanding also disrupts the scientific–clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers’ long‐term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know‐how that ‘strays’ from protocol‐driven care is addressed. (shrink)

Phenomenological researchers are obliged to grasp the epistemological and ontological differences between the Husserlian and Heideggerian branches of phenomenology to avoid misappropriating phenomenological terms or mischaracterizing study design. To that end, we spell out the key differences between both phenomenological traditions as background for describing the indelible role that the researcher's background assumptions, or fore‐structure, play in interpretive studies. We draw on our four studies to illustrate how we traversed the hermeneutic circle to disclose, challenge, and refine the personal, cultural, (...) clinical, and scientific assumptions hidden in our fore‐structures. Our reflections highlight how understanding evolves, not by bracketing or disengaging ourselves from the phenomena we study, but by engaging in an open dialog that seeks understanding as lived by patients and families. (shrink)

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

Qualitative longitudinal research (QLR) provides temporal understanding of the human response to health, illness, and the life course. However, little guidance is available for conducting QLR in the nursing literature. The purpose of this review is to describe the methodological status of QLR in nursing. With the assistance of a medical librarian, we conducted a thorough search circumscribed to qualitative, longitudinal nursing studies of patients’ and care‐givers’ experiences published between 2006 and 2016. The methodological quality of the 74 reviewed studies (...) varied tremendously; many reports lacked sufficient detail in reporting on sampling and attrition, retention strategies, and data collection and analysis, making it difficult for readers to evaluate the credibility and transferability of study findings. Based on the strengths and limitations of the studies reviewed and findings in the literature, we provide recommendations for enhancing the reporting of the research process as a supplement to the standards for qualitative research more broadly. These recommendations are offered in the spirit of encouraging dialogue among colleagues and assisting journal reviewers and editors in their evaluation of QLR. (shrink)

Effective public health nursing relies on the development of responsive and collaborative relationships with families. While nurse–family relationships are endorsed by home visitation programs, training nurses to follow visit‐to‐visit protocols may unintentionally undermine these relationships and may also obscure nurses’ clinical understanding and situated knowledge. With these issues in mind, we designed a home‐visiting intervention, titled Listening with Care, to cultivate nurses’ relationships with teen mothers and nurses’ clinical judgment and reasoning. Rather than using protocols, the training for the intervention (...) introduced nurses to narrative methods and therapeutic tools. This mixed‐method pilot study included a quasi‐experimental design to examine the effect of the intervention on teen mothers’ depressive symptoms, self‐silencing, repeat pregnancy, and educational progress compared to teens who received usual care. Qualitative data were collected from the nurses to evaluate the feasibility and acceptability of the intervention and therapeutic tools. The nurses endorsed the therapeutic tools and expected to continue using them in their practice. Despite the lack of statistically significant differences in outcomes between groups, findings suggest that further study of the intervention is warranted. Future studies may have implications for strengthening hidden aspects of nursing that make a difference in the lives of teen mothers. (shrink)