Nursing Epistemology: Traditions, Insights,
Questions
Phyllis R. Schultz and Afaf I. Meleis
Epistemology i the study of what human beings know, haw they come to know
what they think they knew and what the rita are for evaluating knowledge
claims. Nursing epistemology sth study of knowledge shared emang the mem
bers ofthe discipline, the patcns of knowing and knoteedge that develops fom
‘them, and teeter for accepting krowldgeclaime, Three yes of kneeledge
‘specie to nursing asa discipline are described here: clinical knowledge, con
eptual knowledge and empirical kncwledge. Diferent criteria for evaluating
(ach pe ae suggested,
‘using epistemology is the study of the origins of nurs:
ing knowledge, its structure and methods, the patterns
‘of knowing ofits members, and the erteria for valida:
ing its knowledge claims, Just ax women are aware
increasingly that their perceptions, observations and reasoning
about the world contribute understandings that are unique, so too
rurses, as members ofa discipline and profession made up mostly of
women, are changing in consciousness as knowledge for and from
the practice of nursing continues to grow. This paper explores the
epistemology of nursing; it grows out of the belief that, a8 nurses,
‘our ways of knowing have not yet been fully articulated but that
they will emerge if we allow ourselves to sce the world through the
yes of practicing nurses and their cient,
‘The term “‘epistemology”” comes from philosophy, where it is
defined as the study of knowledge, or theory of knowledge (Flew,
1984). As a practice discipline and profestion, nursing is often
described as both an “art” and a “science.” Articulating ite episte-
mology it therefore a complex task: The study of nursing know!
edge must range from the seemingly intuitive “-knowing’” of the
‘experienced and expert nurses to the systematically verified knowl:
‘edge of empirical researchers,
The epistemology of any field of inquiry depends on the nature of
the phenomena studied and on the propensities of the inquirers who
are developing knowledge in the field. ‘Nursing epiatemology, then,
is the study of how nurses come to know what they think they know,
what exactly nurses do know, how nursing knowledge is structured
and on what basis knowledge claims are made.
What is Knowing/What is Known?
For any person, knowing begins with the processes of obterva-
tion, perception and experience in encountering the world and
Volume 20, Number 4, Winter 1988
being in the world. These processes give rite to describing and inter
preting phenomena, including anticipating, with some degree of
accuracy, what is likely to happen at some future time. Tt is helpful
to think of “knowing” as a process and the knowledge that comes
from that process as the product (Bencliel, 1987; Chinn & Jacobs,
1987)
‘According to Benoliel, “Knowing can be viewed as an indivi
ual's perceptual awareness of the complexities of a particular situa
tion and draws on inner knowledge resources that have been ga
nnered through experience in living” (p. 181). It rarely can be
expressed through discourse but is experienced through the acts of
persons (Benner, 1983; Chinn & Jacobs, 1987). By contrast, know!
fdge as product is often expressed in some form of communication
such as informal conversations, formal oral presentations, written,
articles and texts or art forms such as paintings, poetry, novels or
In a practice discipline, knowing is also working on solutions to
problems that are important for the welfare of clients, It includes the
ability to identify the questions at the forefront of inquiry in the
field, the issues involved in answering these questions, the Ways to
go about answering the answerable questions and the ways to han
dle the unanswerable questions. Knowing is aleo having the wisdom
to recognize which questions have top priority, which are secondary
and which are trivial; it is recognizing which questions can be
answered in the near furure and which have to be deferred,
In epistemology, Chisholm (1982) formulated the questions about
knowing
PHYLLIS R. SCHULTZ, RN, Ph.D, Alona Kappa, is Assistant Professor
{at the University of Colorado Heath Scences Center, Schoo! of
Nursing, Denver. AFAF I. MELEIS, RN. PhD, FAAN, Alpha Eta 6
Professor atthe University of California School of Nursing. San Fran:
‘seo. Correspondence to Box C-288, £200 East Ninth Avenue, Univer
sity of Colorado Health Sciences Center, School oF Nursing, Denver,
cosons2,
Or. Schutz ratefuly acknowledges the opportunity to exolare with
Dr. Meets several ideas on nursing enstemology during portdoctoral
study at UCSF in Spring 1986 and 1987. This caper Is an adaptation of
a Keynote address presented by Professor Melels at the Fourth
“Annual Nursing Science Colloquium on Strategies for Theory Develop
‘ment in Nursing v, Philosophy oF Science ana the Develooment Nurs
ing Science, Boston University School of Nursing, March 19-20, 1987,
‘Accepted for oubication February 17, 1988,
271, “What do we know? What isthe extent of our knowledge?”
2, “How are we to decide whether we know? What are the criteria
‘of knowledge?” (p. $0) Chisholm identified three epistemological
positions a possible answers to these questions: skepticism, method
fm and particulariem. Skeptics say that these are unanswerable
questions because we cannot answer either set without presupposing
fan answer to the other. This position is untenable for a practice dis-
cipline beeatie we have to take care of real people with real health
problen
By ‘"methodism,”” Chisholm (1982) meant that to have know!
‘edge is to have a preferred method of inguiry and procedures for
Fecognizing reliable oF credible knowledge (ie., one begins by
answering the second set of questions (set 2). Chisholm explicitly
identified empiriciem as a “type of ‘methodist’ ” (p. 67)
‘debates ia nursing about qualitative and quantitative daa col
‘with their corresponding metaphysical and epistemological founda:
tions reflect a type of methodivi in nursing (Schultz, 1987). This
Imethodism has led some nurse inguirers to subscribe to science in
general and to empiricist science in particular as the preferable epis-
{emological positon in nursing.
“The allegiance to empiricism can explain some ofthe sense of sep-
aration that has arisen among nurse inguirers who hold different
epistemological positions and use different methods of inquiry
Some rely on reflection and reasoning; others lect structured obser
vation and hypothesis testing; still others prefer phenomenological
dialogue and reflective interpretation. Academicians tend to insist
fon knowledge that is formal, orderly, validated and communicable.
Practitioners trust knoveledge that results in appropriate ations with
clients in specific situations. To espouse the methodist’s epistemo-
logical postion is to fail to recognize the legitimacy of these multi-
ple ways of knowing; itis to resist accepting the complexity and
holistic character of nursing (Benoliel, 1987; Chinn & Jacobs, 1987;
Visintainer, 1986)
By “particularism,"” Chisholm (1982) meant “We an know and
nove that we know some particular thing at a particular point in
ime” (p. 74). This position starts from the premise that there are
tome things we know, whether or not we agree on the methods and
procedures for knowing (Chisholm, 1982; Schultz, 1987). Philoso-
phers begin with rather ordinary, everyday cates of knowledge such
fs “I know how to drive a ear” and “T know that seven plus five
Cquals twelve.” Similarly, “T know that the sentence, Some mush:
rooms are poitonous, is true” (Lehrer, 1974). These three state-
ments can be classed as (a) recounting a practical skill, (b) com-
Imunicating a conceptual insight and (c) articulating an’ empirical
hypothe
’As nurses, we begin with particular cates of knowledge from (a)
‘our practice, (b) our theories, or (¢) our research. Statements about
What we “know” are reflected implicitly or explicitly in the writings
of our clinicians, theorists and researchers, for example:
1, ‘The experiences of pertons in health and illness are revealed in
characteristic patterns, These patterns tend to be repetitive, orderly,
predictable, and unified; they rlleet organization
2. Some individuals have health and iliness experiences that do not
fit the general pattern, Thus another case of what we “know” in
nursing is that itis predictable that individuals may be unpredict-
ale in thei health and illness experiences.
5. Human health and illness can be perceived and understood
through uncovering the meanings that individuals, groups and soci=
ties derive from their experiences.
44. The health and illness of persons are interactive with environ-
5. Nursing acts influence the responses of persons in health and ill-
ness; nursing and the experiences of persons with health and illness
‘Statements such as these about what we “know” in nursing are
what we want to begin with in formulating the criteria of knowledge
in our discipline. But before we explore auch criteria, we will discuss
patterns of knowing revealed in the nursing literature, and those
from a study of women (Belenky eta, 1986), which may contribute
218
[Nutting Epistemology: Traditions, Init, Questions
to our understanding of the types of knowledge in present-day nurs
ing.
Patterns of Knowing in Nursing
‘The complexity of nursing’s epistemology was clearly demon:
strated by Carper's (1978) delineation of four fundamental patterns
of knowing in nursing: empires, ethics, esthetics and personal
Knowledge. Each of these four patterns has recently been specified
epistemologically by Chinn and Jacobs (1987). Here we will elabo-
rate only on personal knowledge, beeause of our belief in the impor-
tance of the practitioner asthe knower in nursing’s development of
knowledge,
Personal knowledge was described by Carper (1978) as selF
knowledge, or awareness of the self. This description seems to leave
tout the knowledge from practice that Benner (1983) termed “prac
fal knowledge," following the reasoning of Polanyi (1964) in his Pr-
tonal Krowoledge. For Polanyi, “personal” referred to a characteristic
of the knower; “knowledge,” co a mental process
1 regard knowing at an active comprehension of the things known, a
faction that requires dill... Comprehension ie either an arbitrary
Skinor a pasive experience, buts fesponnible act claiming universal
valny
‘Thus to know the self is part of comprehending “the things
known.” Knowing what one knows is also part of comprehending
Polanyi (1964) distinguished between Knowledge as theory and
knowledge as practical shill, He termed knovledge that may not be
articulated through language as “tacit knowing"; knowledge chat is
‘communicable through discourse he termed ‘explicit knowing,”
‘Another way to phrase this distinction is “knowing how'” and
“knowing that,” which Benner (1983) found useful in explaining
what expert nurses know. Expert nurses may enter a caring encoun-
ter with awareness of the self as therapeutic agent (Carper, 1978)
and with a foundation of formal concepts, theories, facts and skills
learned in their education (the knowing that). According to Benner
(1903), as the encounter, or event, unfolds, they refine, elaborate or
dlisconfirm this “foreknowledge”; the encounter then deserves to be
termed “experience” and contributes to the knowing how. These
three aspects of personal knowledge—knowing the self, knowing
that and knowing how-—are the sum of what one knows” All three
fare brought to the caring situation and are used to identify and
solve the problems of the discipline
‘Unfortunately, we know very litle about personal knowing, espe
cially about knowing the self and knowing how, in part because they
tan only be articulated retrospectively (Chinn & Jacobs, 1987). The
knowing how from practice may, however, be brought ¢o conscious
ness and made ‘communicable through innovative methods of
inquiry such as interpretive, grounded theory or phenomenological
research (Benner, 1983; 1985; Pyles & Stern, 1983, Ray, 1987). For
example, using ® grounded theory approach, Pyles’ and Stern
described the “nursing gestalt," by which exper’ critical care nurses
identify impending cardiogenic shock and prevent untimely death
‘They learned that novice nurses must work with expert critical care
nurses (the Gray Gorilla concept) to acquire their know how for
practice. Their findings corroborated those of Benner’s (1983) study
fof the knowledge embedded in clinical practice
Alto, in a study of critical care nursing using phenomenology a
method, Ray (1987) discovered thatthe essence of nursing in critical
care involves technological and ethical caring; itis an experiential
ialectie between technical competence (doing no harm) and com
passion (in response to sufering), which are mediated through ethi-
fal choice (preserving autonomy and ensuring justice)
Efforts to bring to consciousness the self-knowledge and knowing
how of nursing practice may be aided by examination of women’s
ways of knowing identified by Belenky et al. (1986). The patterns
they discovered were not supposed to be hierarchical, although
unfortunately their descriptions appear to be so. In applying their
framework to nurses, we will artume that diffrent patterns of know=
ing exist simultaneously. The five patterns of women’s knowing that
IMAGE: Journal of Nursing ScholarshipNonsing Epistemology: Traditions, asighs, Queto
[Belenky etal identified are silence, received knowledge, subjective
knowedge, procedural knowledge and constructed knowledge, Each
ofthe five patterns is explained in the following:
Silene. Persons "experience themselves as mindless and voiceless
and subject to the whims of external authority" (p.16). Belenky et
Al. add that silent women know at the "gut level” but have not cule
tivated their eapacity for abstract thought; nor do they attempt to
articulate why they do what they do. They accept the voices of
authority for direction in their work and life because of others’
power, not necessarily expertise. Others are ‘right the silent one
is “wrong” and dumb."
According to Colliere (1986) silent nurses may not know how to
conceptualize their daily experiences; they follow the voices of others
because of fear of others’ power. They do not have the language to
{generalize from what they know so that their knowledge can be com:
‘municated. They have learned to be silent. Their work, their pat
tems of knowing and their knowledge are invisible,
Recived knowledge. Persons “perceive themselves as capable of
receiving, even reproducing, knowledge from all-knowing external
authorities but not capable of creating knowledge on their own” (p.
13). Individuals who use this way of knowing rely on others for the
words to communicate what they know. For this type of knower,
knowledge is observable; there is no ambiguity init, and it depends
fn the expertise of others,
Many nurses bave contented themselves with using the words of
others to express and guide their knowing. American nurses have
used medical knowledge, psychological and sociological knowledge,
philosophical knowledge and administrative knowledge to comrnus
niicate what they know. Following the same pattern, nurses in other
countries have used nursing theories developed in the United States
(communicate the nature of their practice
Subjective iowledge. Knowledge is “conceived of as personal, pri-
vate, and subjectively known and intuited" (p, 15). The subjective
pattcrn of women’s knowing reminds us of the debates in nursing
foday about the usefulness and reliability of experiential knowing
(ice, knowledge from practice). Knowers such as this in nursing
offer us their subjective wisdom from their own inner voices, which
‘may enhance our understanding of complex situations, but their
knowledge is transient, and not cumulative. Such knowers may find
ie dificult to articulate the processes that they have gone through in
knowing because knowing for them is intuitive, experienced, not
thought out and something felt rather than cognitively appraised or
constructed
‘Procedural knowledge, These knowers depend on careful abserva-
tion, structured procedures and systematic analyses. In short, they
are rationalists. They use objectivity as a measure of what can be
known as well a repeated observations under controlled situations
for corroboration. ‘They distance themaclves from experience in
order to know. Though they use subjective awareness to provide
insights, they adhere to the idea that objectivity yields the know!
crige that is most reliable,
‘Nurse researchers and academicians are the strongest adherents
of this way of knowing. Following strict procedures for inquiry is
considered the way to secure reliable knowledge for teaching the
principles and practices of nursing and for further inquiry. Ax we
‘emphasize increasingly research-based practice, clinicians are join
ing the ranks of the rational, procedural knowers in nursing.
onstraced tnowiedge. A pattern of knowing in which persons
“view all knowledge as contextual, experience themselves as ere
ators of knowledge, and value both subjective and objective strate
gies of knowing’ (p. 15). These knowers integrate the different
ways of knowing and the differenc voices (including the silent voice).
To them, “all knowledge is constructed, and the knower is an int
smate part ofthe known'"(p. 37),
Nurses who subscribe to this view of knowing see theories ax
approximations of realty that are ongoing and always in process;
their frames of reference are constructed and reconstructed
(Visintaines, 1986), and posing questions is as important as
attempting to answer questions, These nurses believe that knowing
Volume 20, Number 4, Winter 1988
is achieved as much through openness and curiosity and through
examination ofthe assumptions and context within which questions
are posed as through adherence to procedures or systematic observa-
tion and replication.
For nurses who subscribe 1o this view of knowing, the develop:
ment of knowledge is a never-ending process. There are glimmers of
certain knowledge if one understands the whole of a. situation
including formal knowledge of the phenomenon, Experts (i.e, expe:
rienced knowers) develop a connected knowing through conversing
with each other and through identifying pattern, consistencies and
corder in the evidence provided by the various ways of knowing
(Benoliel, 1987; Schultz, 1987). Their knowledge is corroborated by
knowledge from other disciplines
‘Types of Nursing Knowledge and Criteria of
Credibility
From our reflections on the traditional patterns of knowing in
nursing and on worncn’s ways of knowing, we have identified three
types of knowledge specific to nursing as a discipline: clinical know-
cdge, conceptual knowledge and empirical knowledge, Discussed
below are their relationships co the diferent patterns of knowing and
possible eiteria of eredibilty fo each type.
Clinical Knowledge
inical knowledge results from engaging in the gestalt of caring,
from bringing to bear multiple ways of knowing in order to solve the
problems of patient care. Florence Nightingale knew the needs of
the soldiers who fought in the Crimean War because she worked
with them day and might; she was able to see the results of limited
resources and exposure tothe uahygienie environment, She realized
that not only were diseases aflieting the soldiers, but the care they
failed to receive affected thei recovery.
Clinical knowledge is manifested primarily in the acts of practi
ing nurses; i is incividval and perzonal. Historically, ic has often
been voiceless except in descriptions of the art of nursing, which
have come to be viewed as less important and eredible since nursing
has been developing formal empirical foundations for practic. Cl
niicians experience patients’ situations and “do!” (je., they act
based on these experiences).
Historically, clinical knowledge has been the product of s combi-
nation of personal knowing and empirics, It has usually involved
intuition and subjective knowing, although these have tended to be
ignored, denigrated or denied (Rew & Barrow, 1987). In the past,
the empirical base was often “received empiries” from medicine of
the social and behavioral sciences. Increasingly, however, empirical
studies by nurses inform clinical practice. Further, intuition and
subjective knowing are regaining ther legitimacy as necessary com-
ponents of humane care (Watson, 1985). The acathetic and ethical
patterns of knowing are also contributing to the development of clin-
ical knowledge in response to the changing needs of persons inter-
acting with technological and organizational environments.
Traditionally, clinical knowledge has been communicated retro-
spectively, through the publication of articles on specific client prob-
Jems. These accounts, in national journals of nursing and increas
ingly in international journals, report individual case descriptions ot
summaries of multiple cases that provide antwers for questions and
problems in practice. These published accounts often reflect
received knowledge and procedural knowledge and are character-
ized by prescriptions for practic,
The credibility of clinical knowledge has been based on the useful
‘ness of its communicated wisdom-—"Tt works.”” This criterion
meets the requirement of purposefulness of a practice discipline
(Chinn & Jacabs, 1987). De we nced other modes of corroboration?
Can the art of nursing yield as reliable and reproducible knowledge
a does the “science’” of nursing? Should it? Perhaps models of
practice, the discovery of patterns within and across clients and tes
timonials of subjective knowledge might be appropriate criteria for
the credibility of clinical knowledge. These are unanswered
‘questions.
219‘Nursing Epistemology: Tradition, Insights, Questions
Conceptual Knowledge
Conceptual knovledge is abstracted and generalized beyond per-
sonal experiences, itexplicates the patterns revealed in multiple cli-
‘ent experiences in multiple situations and articulates them as models
fo theories. Concepts are defined, and statements about the rela-
tionships among them are formulated, ‘These propositions are sup-
ported by empirical and/or anecdotal evidence or defended by infer-
‘ences and logical reasoning. This type of knowledge is manifested in
the works of nurse theorists who seck answers to questions such a8,
Who is our client? What is i¢ that nurses do that influences persons"
health (Meleis, 1985)? These theorists develop comprehensive for-
rmulations of the nursing world, They use knowledge from other
disciplines but through reflection and imagination evolve perspec:
tives on that knowledge that are unique to nursing. They are influ-
fenced by procedures followed in the development of other fields but
adhere to procedures supportive of the values and purpose of nurs-
ing.
Conceptual knowledge is the product of reflection on nursing phe-
nomena. Tt emanates from curiosity and evolves from innovation
‘and imagination in inquiry, along with persistence and commitment
to the accumulation of facts and reliable generalizations. This type
‘of nursing knowledge requires logical reasoning and comes primar
ily Trom individuals who take the position that knowledge is con:
structed within a context, and its development is a never-ending
process
‘Empirical knowing has influenced the development of conceptual
knowledge in nursing through a dynamic interplay between system-
atic observation (empiric) and theorizing (reflecting, describing,
tynthesizing) (Weekes, 1986). The results of an inguirer’s own
research and that of others are used to support the propositional
‘ructure of frameworks or theories. But imagination and risk taking
are important in ther origination,
Will aesthetic knowing lead to formal conceptualizations of nurs
ing that reflect its ar? Will conceptual frameworks and models
emerge from ethics as pattern of knowing to describe this dimen-
tion of nursing? The answers to these questions depend on the
degree to which nurse inguirers can view multiple ways of knowing
‘a equally valuable in contributing tothe mission of nursing.
‘The credibility of conceptual knowledge rests, in part, on the
‘extent to which nurses find ureful models and theories in communi
‘ating what they know. Whether or not a particular conceptual for
‘mulation holds up to critical appraisal depends also on its coher-
fence and logical integrity—two criteria for evaluating theories
(Meleis, 1985; Chinn & Jacobs, 1987),
‘Conceptual knowledge is often communicated in the form of
propositional sentences. ‘Thus itis the propositions and their rela
tionships to each other that are evaluated for credibility, Chisholm's
six levels of epistemic preferability illustrate the criteria for evaluat:
ing propositional credibility. Schultz (1987) explicated these levels
with a proposition exemplifying a nursing knowledge claim:
Nursing acts influence persons’ energy exchange for healing and
Iealh, For the person wh believer this aon the statement fa (1) sc
presenting to him or her at «particular point in time; (2) the claim hat
ome presumption in its favor because tis not contradicted by other
indie (2) the dain i judged vo be acceptable because it not discon
frmed by the st of propositions having some presuoption in their
favor: (4) the claim i epistemically in the dear because is noe incon
firmed by the set of acceptable propositions and therefore (5) the claim
is beyond reasonable doubt, Having met these conditions, the claim it
Judged tobe (6) evident orceresin (p14).
These are stringent criteria, Since nurses attend to individual expe-
riences as well as to general patterns of experience, we may need to
formulate differen criteria of eredibilty forthe conceptualization of
nursing phenomena
Empirical Knowledge
‘Empirical knowledge results from research. By research, we do
‘not mean simply the empiricist approach per se but also historical,
phenomenological, interpretive and critical theory approaches
220
(Chinn, 1986). Empirical knowledge is manifest in published
reports and is often used to justly actions and procedures in prac
tice, It forms the basis for new studies and thereby contributes to the
cumulative body of knowledge of a discipline. It often stimulates
theoretical coneeptualizations.
‘Retearchers rely, in part, on received and procedural knowledge
to inform their inquiries, but the hypotheses they test may originate
in subjective knowledge; that is, their experiences with and reflec
tions on nursing phenomena may give rise to hunches that lead t0
innovative methods or approaches to inquiry. If the empirical
inquirer is also a practitioner, sel-knowledge and practical know!
‘edge may be brought to bear on the methods of inquiry. It is less
‘lear how the aesthetic or ethieal patterns of knowing contribute to
the development of empirical knowledge except that unually (8)
researchers adhere to ethical precepts in the conduct oftheir studies
and (b) nurse inguirers are turning to the arts and humanities for
approaches to systematic inquiry.
‘Advocates of different types of research approaches and methods
have carved out criteria to validate their findings that are congruent
with the particular designs and epistemological orientations that
they follow (Gortner, 1984; Sandelowski, 1986). For all, however,
the credibility of empirical knowledge rests on the degree to which
the researcher has followed procedures accepted by the community
of researchers and on the logieal derivation of conclusions from the
fevidence without bias or prejudice (Schultz, 1987; Gortner &
Schultz, 1987), Of particular importance is whether or not the
researcher is cognizant of previous research findings, knowledgeable
shout the procedures by which they were discovered, and dedicated
to basing new research efforts on previous knowledge (Benoliel,
1987),
In addition to the procedural criteria accompanying various
research designs and methods, the credibility of empirical know!
tilge is assessed by the systematic review and critique of research
published in annual reviews (Werley & Fitzpatrick, 1983-1986;
Fitepatrick & Taunton, 1987), by consensus conferences focused on
corroborating what is known about specifie phenomena (e.g., pain)
(National Institute of Health, 1987), and by invitational conferences
{o clarify the state-of-the-art on a topic and suggest new directions (0
be taken (Duly & Pender, 1987). The epistemic preferabilty cr
teria enumerated above for conceptual knowledge claims may also
be useful for assessing the credibility of empirical knowledge claims.
‘Ukimately credibility erteria must be consistent with nurses’ var-
‘ous ways of knowing and types of knowledge. Can criteria be devel:
‘oped to accommodate the epistemological plurality of nursing, its
complexity and holism? Is there one set of criteria or are there Sev-
eral? These are unanswered questions, but let us consider the poss
bility tha the criteria for accepting knowledge vary for each type of
knowledge.
Conclusion
‘Throughout this paper, we have deliberately avoided using the
concept of “truth.”” Unfortunately inquirers from difering and con-
tradictory perspectives have a propensity to put forth the view that
their way of knowing yields she truth rather than a truth. Perhaps it
is inappropriate to use the language of truth in nursing or in any
practice discipline chat deals with complex human experiences. Per
haps comprehending the context and patterns of human experi
fences, adjusted for individual differences, is more appropriate for
claiming universal validity (Polanyi, 1964; Visintainer, 1986). Per-
hhaps it is not sufficient to speak of facts alone, rather we should
ion and facts. Pethape it is not enough 10
research as the medium for knowledge development; concep:
jon and expert knowledge from clinical practice may be
equally powerful and credible
Tf we agree that there are different ways of knowing, dillerent
unknowns to be known, different propensities of knowers for know-
ing and different aspects to be known about the same phenomenon,
then perhaps we can develop appropriate eriteia for knowing from
‘what we do know and, then, for knowing what we want to know. 73.
IMAGE: Journal of Nursing ScholarshipNanving Epnemology: Trains, nvighs, Questions —_
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“Gritiat Care Nursing, 60), 165-178
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IMAGE ANNUAL INDEX
Alerander, Mary A. and Blank, Jacqueline di, “Factors Reltied to Obey in
Mover Ameran Preschool Chiren" Vol 20:2, p. 79-82, 1088.
‘Andersen, Joan E. and Briggs, Lyne L., “Nursing Diagnose: A Study of Quay
‘and Supportve Evidence" Val. 20:3. p” 141-144, 1988
‘Ammon Gabercon, Kathleen B. and Piantanida, Maria, “Generating Ressks
trom Qualtative Bal Vol 20:2, p. 159-161 1388,
‘Avant, Kay ., "Book Review Cose Sues Nursing Theory,” Vel 20:1. 56,
"588
‘Baggs, Judith C. and Schmit, Madeline H.,"Colaboraton Betwoen Nurses and
ican," Vl. 20:39. 145.199, 1988,
‘Baranowsk, Madelon Vsintainer, “Book Review: The Primacy of Caring —Siress
‘nd Coping in Heath and Bincss "Vol 80°. p. 113-114, 1088
Brgoten, Dorothy, Brown, Linda P:, Munro, Barbara, York, Ruth, Cohen,
‘Susan M., Roncol, Marianne and Holimgeworth, Andrea. “Ear Dscorge
and Spocnit Tansonal Care” al 20:2. 64-68, 1988,
Camille Rosemary, "On Elegant Weng” Vol 20° p. 169-171, 1988
Cannon, Barbara, and Brow, Julia S.,“Norees Atitudes Tosurd Impaired
‘Coleaguer” Vol 30:2, p, 96-101, 1988
Ccason, Caroin L. Cason, Gerald J. and Redland, Alice R, “Peer Review of
everch Abaracis “Vol 20:2. i210 1988,
Chins, Peggy I, Book Revew: Nkne Chovee, Taking Chances: Nurse Lead
ts Tel Ther Storie,” Vol 20:3 p. 178-174, 1588,
Clinton, Jacqualine, “ejected Proposal: What Nex?” Vol. 20:1, p. $4, 1988
Constaitina, Rose E., “Comparcon of Two Group Interventions for the
Bereaved" Vol 20:2 p, 85-89, 1988
Davi, Tey and Jensen, Louie, “Ideaslyng Depresion in Medial Patents,”
Val 20-4.p. 191-195, i988,
‘el Bueno, Dorothy, "The Promise and the Realty of Cetin,” Vol 204
2-311, 1988
Donovan, Consianee 7, Book Review: The Profesional Commitment: ees
nd Ecsin Nerang Vo 2011, p. 56-57. 1988,
Drake, Mary Louie, Verhulst, Diana, Fawcett, Jacqueline and Barger, Diane
ager, “Spouses Body image Changes During and Aer Pragnancy. A Repes
‘ton n Canada" Vat 20°29. 8895, 1988
Drew, Barbara J. "Devaluaton of Bologes! Knowledge,” Vol. 20°, p. 25-27,
"se,
Gaffney. Kathleen Flynn, “Prenatal Maternal Attachment,” Vol
103-209, 1988
GGttaroth, Sister Lucia, "Long-Term Care Resource Requirements Before and
‘Alte theProspecve Payment System, Vel 20 iep. 7-11, 988,
Germain, Cara P. and Nemchik, Ria M.,"Dibeien Sell Management and Ho
pialeaon" Vol 20:29. 78-75, 1988
Gartner, Susan Rand Schult, Phyl
Methods Val 20:1, 22-24, 1988,
Hamilton, Diane, "Faih and inence,” Vo. 203, p. 126-127, 1988
Hezekiah, Jocelyn, “Colonal Hersage ond Nursing Lendership in Tnided and
“Tatas,” Val 203, p. 198-158, 1088
‘Ons of Nusng Kaswledge" Vol. 20:4 p, 223, 1988,
id Morrison, Eileen F. The Progresion of Knowledge 9 Nurs
Ing: A'Seorch for Meaning Wol 208 p 282-22, 1988
"Approaches fo Nursing Scence
‘Volume 20, Number 4, Winter 1988
Volume 20, 1988
Lund, Ulla, Sader, Marten and Waerners, Karl, “Nursing Theoses: A Creal
Mtl 20. pS, 1388 = i,
{Uymaugh, Joan E.'and Fagin, Clave M., “Nursing Comet of Age.” Val. 20;
184° 190, 1988)
Méfirie, Angela Barron, “Mental Heal Elects of Women's Mutiple Roles.”
Vol 2-1 p 41-7 1068,
“McCloskey; Jonnne Coml and McCain, Bruce, "Varbes Related to Nurse Per
formance" Vol. 2034, p. 203.207, 1988
Medait-Cooper, Barbara, “The Elects of Handing cn Preterm Infants with Bron
hopulmonary Dysplea" Vol.20°3, p. 132-134, 1988
Mercer, Ramona T., "Book Review: Gay ond Lesbion Parents,” Vo. 20:
D, 234.235, 1988
Mist, Merle H., "Uncertainty nies,” Vol. 20:4, p, 225-292, 1988,
Norris, Anne IE, “Comnive Analy of Contactptive Behavior,” Vol. 20:3,
135-140, 1588,
Oshansy, Elen Frances, “Rezpones to High Technology Inertity Treatment,
Vol 2035, p. 128-181, 1988,
Podeadky, Debra L. asd Serion, Dorothy 1,
Paton” Vol 20:1, 16-21, 1988,
Presale, Jana Land Fitpatrick, Joyce J, "Contabutons of Rosemary Eis to
‘Rrowledge Development for uring Val 20:1, p. 28-90, 1388
Redeker, Naney Schmieder, "Hess Baits and’ Adherence in Chron ness”
Val. 26-1,p. 31-35, 1588
Rew, Lyn, “ftuon ip Decson Making "Vol 20:3, p. 190-154, 1988
Richard, dudith A, “Congruence Betwcan Ineehit Reports and Patents! Acta
‘Condicnn" Val 20-1, p. 4-6, 1988,
Schmelzer, Marilee and. Anema, Marion G., “Should Nuses Ever Lie to
Paton?" Val 20:2,p. 110-112, 1988
Schulte, Phylis Rand’ Mele, Alt 1, “Nursing Epistemology
Tisghis, Questions," Wal 20:8, p, 217-231, 1988
‘Smith, Shela Kx "An Anais the Bherismenon of Deterioration i the Cit
“al Val. 26-1, p. 12-15, 1988
Steinke, Elaine F.'Oker Adula Knowledge and Artudes about Senusiy and
“agin” Vol 20:3, . 93-9, 1988,
nt, Patricia E. and Hall Joanne M., "Sigma, Heath Belels and Exper
‘shee wth Heath Caren Leshan Women,” Vol 30:2 p 69.72, 1988,
Thompson, Joh D., ack Review [Hae Done My Duy Flaence Mghingole
Ime Crimean We 1854-1880," Vol. 20:3,» 172, 1988
Warner, Sandra L. Rose, M. Candice and Clark, Lr, An Analy of Entry
Info Proce Argument: * Vol 20:4 . 212-216, 196,
Wiiamson, Kenny Mallow, Selleck, Cynthia S., Turner, John G., Brown,
Kathleen C, Newman, Karen Davideon and Sis, Ann Travis, Occup
anal Health Hazrds lor Nurser: nection * Vol, 20:1. 4-53, 1688,
Wiltameon, Kenny Mallow, Turner, Joan G.,.Brown, Kathleen Cov Newman,
Karen Davidion, Sires, Ann Travia and Selec Cynthia SCs)
Health Hazards fo Nuts Part > Val 20-3, p. 162108, 1988,
‘Young, Jane Coolidge, “Ratonsle for Cinican Sei Dscosure and Research
“Agenda,” Vol 20-4.p" 196-199, 1988,
‘ake, Lina Kardahi, Khoury, Mey and Nugent, Kevin, “Neonatal Behavior of
PrensalySrestd Lebanese Infant" Vol 20'4 p, 200-202, 1988,
‘Nurses! Reactions to Dil
rations,
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