693313

research-article2017
NSQXXX10.1177/0894318417693313Nursing Science QuarterlyBarrett

Article

Nursing Science Quarterly

Again, What Is Nursing Science?

2017, Vol. 30(2) 129­–133
© The Author(s) 2017
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DOI: 10.1177/0894318417693313
https://doi.org/10.1177/0894318417693313
journals.sagepub.com/home/nsq

Elizabeth Ann Manhart Barrett, RN; PhD; FAAN1

Abstract
This article again asks, What is nursing science? Who knows? Who cares? The author describes the threat to the survival of
nursing science grounded in nursing frameworks and theories. This threat is magnified by the proposal of the Council for the
Advancement of Nursing Science (CANS) to change the curricula of PhD education. The aim of CANS is to prepare nurse
scientists for lifelong competitive careers in interdisciplinary research, often focused on funding priorities of the National
Institute of Nursing Research (NINR). Curricula would include preparation for conducting research in topics such as omics,
e-science, translation science, biobehavioral science, symptom science, and team science. How can this be nursing science?
It is argued that this focus might obliterate nursing’s discipline-specific phenomenon of concern, the human-universe-health
process.

Keywords
Council for the Advancement of Nursing Science, discipline-specific knowledge, e-science, nursing as a basic or applied
science, nursing frameworks and theories, PhD education

Recently I received a fundraising letter from a major,
renowned medical institution located in a large metropolitan
area. The letter remarked that patients have benefitted from
skilled nurses providing “personal care and concern” and
doctors providing “medical knowledge and expertise.” Of
course, personal care and concern and skills are necessary
but not sufficient, and what about nurses’ knowledge and
expertise? There is nothing distinctively nursing about being
skilled and providing personal care and concern. Should not
all healthcare personnel provide personal care and concern?
Ironically, as a former patient in that institution, I was given
safe, courteous, proficient care by baccalaureate- and mas-
ter’s-educated nurses—care that reflected a wide range of
both nursing and general knowledge learned from college
professors and not through “apprenticeship” or “on the job
training.” However, what was noticeably missing was a
nursing theory-guided practice approach. I was still
responded to as a bundle of parts without a substantive, dis-
tinct, coherent, meaningful nursing context. How different,
I wondered, was that letter from what I, as a new baccalaure-
ate graduate 46 years ago, might have read coming from my
well-respected local hospital in a different part of the coun-
try. Nursing education, research, and practice have pro-
gressed monumentally during that time, and yet even in
2017, it is not always acknowledged!
Now as I write, another fund-raising letter arrived from a
nationally known institution. No mention of nursing, only of
“dedicated professionals,” along with “medical expertise,”
“medical treatments,” and “medical discoveries.” Yes, there
are many professionals who are dedicated, yet they remain
nameless in this message to the public.
Unless nursing is recognized as a basic science, how will
the public differentiate nursing from other health disciplines?
Communicating a clear definition of nursing science to the
public will change how society thinks about nursing, and that
change will reverberate. Perhaps, this is what we want the
public to know: Nursing is a basic science and the art of nurs-
ing is using that knowledge for the wellbecoming of people
(Phillips, 2016; Rogers, 1992). As Malinski (2017, p. 38)
lamented, nursing frameworks and theories have been “preg-
nant with promise far too long: time to deliver.”
Rogers (1992) wrote and numerous others have agreed,
nursing has been viewed as a verb meaning to do and not as a
noun meaning to know. It is time to claim that what nurses do
is based on what nurses know, and the essence of this broad
knowledge is education in discipline-specific nursing knowl-
edge. Fortunately, patients usually experience that nurses
know as well as do even though they often will describe an
undifferentiated view acquired through socialization as mem-
bers of society and that view is often misunderstood and absent
of a nursing science perspective. There is still more that nurses
need to know. There is still more that nurses need to do. Will it
be nursing theory-based, or will it be knowledge reflecting
other disciplines? Who knows? Who cares? Can we sidestep
the hegemony of the opposition and advocate for nursing the-
ory-based knowledge directly with our consumers? Will we?
So, with a somewhat heavy heart and a determined spirit,
I ask again, What is nursing science? This haunting question
rumbles from a disquieting voice in the distance. Another
1
Professor Emerita, Hunter College, CUNY, New York, NY, USA
130 Nursing Science Quarterly 30(2)
voice, coming from a different direction, roars back, “Haven’t
you heard, it is passé to even ask the question—again.” Yet I
must! So I search to know how the two voices can talk to
each other. Meanwhile, in the distance, the disquieting rum-
ble continues.
New questions of critical importance need attention. Do
nursing science definitions require knowledge that is disci-
pline-specific? What defines discipline-specific? Are extant
nursing frameworks and theories essential to the definition
of nursing science? Is nursing a basic or applied science—or
both? These questions are the crux of why some of us are
asking again, What is nursing science? Primarily, it depends
on who is answering the questions. Nevertheless, the voices
of nurse scholars around the world have offered descriptions
of nursing science that require, implicitly or explicitly, that
nursing frameworks or nursing theories form the substantive
sine qua non content of definitions (Barrett et al., 1997, pp.
10-13). For 30 years Nursing Science Quarterly has pub-
lished only content that speaks to the cumulative substance
of this type of nursing knowledge. Other nursing science
journals have likewise made significant contributions.
Opposing groups as important in our history cannot dismiss
these advancements yet claim they are now ancient history.
Gowan (as cited in Johnson, 1959a, p. 199) defined nurs-
ing as an art and science involving the whole person, and
Dorothy Johnson (1959a, 1959b) claimed that nursing was
an applied science laying historical groundwork by using the
terminology primarily of “science of nursing,” which on
occasion was and is interchanged with “nursing science.”
Since then, there has been no shortage of using these terms,
although rarely differentiated.
Parse (2015b, p. 101) called these differences to our atten-
tion when she noted that “science of nursing rarely includes
conceptualization within a nursing framework or theory”
while “nursing science describes the frameworks and theo-
ries of the discipline.” One wonders if the term “nursing sci-
ence” is becoming a euphemism coopted to replace the more
inclusive science of nursing. Is nursing science, as many
scholars define it, including the “American Academy of
Nursing’s Expert Panel on Nursing Theory-Guided Practice”
(Parse, 2016, p. 101), being sacrificed on the altar of other
disciplines’ needs? Many nurse scholars avoid definitions
entirely and others maintain that they are “grounded in the
recognition that nursing science is the science of health”
(Henly, McCarthy, Wyman, Alt-White et al., 2015, p. 440). If
that is not discipline-specific to nursing frameworks and
theories, is use of the term nursing science appropriate?
The fact that many definitions do not include nursing
frameworks and theories is the source of my rumbling, disqui-
eting discomfort with a foreboding that the answer to Parse’s
(2016, p. 101) question, “Where have all the nursing theories
gone?” has already been answered. “Stop teaching them, and
they will become a relic of a bygone age.” Watson (1999)
warned that without a language, we are invisible. I suggest that
nursing frameworks and theories, as they have been defined
by their creators and further developed by others, are the
unique language of nursing education, research, and practice.
This premise is open for respectful debate with those who pre-
fer terminology that amalgamates with other disciplines.
The Nature of Nursing Science
Speaking up regarding the nature of nursing science is essen-
tial if we are to protect our phenomenon of concern—the
human as a whole being, the environment, and health—con-
sidered as a unity, not independently as parts. The phenom-
enon of concern, which distinguishes our uniqueness as a
discipline, is appropriately expressed somewhat differently
reflecting various worldviews within the nursing discipline.
Is it not time to further claim our territory? Fawcett (2000)
asked, “Where is the nursing in the science?” (p. 3). This
may be the single most relevant question of all.
In 2002, I explored and defined nursing science. Fifteen
years later in 2017, I again propose these definitions for
consideration.
“Nursing is a basic science and the practice of nursing is
the scientific art of using knowledge of unitary human beings
who are in mutual process with their environments for the
well-being of people)” (Barrett, 2002, p. 51). Note that well-
being has been updated to wellbecoming (Phillips, 2016).
“Science, as scientific knowledge, represents best efforts
toward discovering truth. It is open-ended, evolving, and subject
to revision and occasionally unfolds in dramatic shifts in thought.
Research is how we create science” (Barrett, 2002, p. 51).
“Nursing science, a basic science, is the substantive disci-
pline-specific knowledge that focuses on the human-uni-
verse-health process articulated in the nursing frameworks
and theories. The discipline-specific knowledge resides
within schools of thought that reflect different philosophical
perspectives that give rise to ontological, epistemological,
and methodological processes for the development and use
of knowledge concerning nursing’s unique phenomenon of
concern” (Barrett, 2002, p. 51).
I am aware that some definitions cannot be universally
defined (Munhall, 1997), although the underlying philoso-
phy and belief systems can be compared. I respect the opin-
ions of those who define nursing science by excluding
nursing frameworks and theories, if that is a freely made
choice. However, can nurse scholars make an informed
choice if there is no opportunity for substantive study of
nursing frameworks and theories with follow-through in
research and practice? How will nursing research distinguish
itself from contributions of the biological, biobehavioral,
medical sciences, and others? Or do nurse policy makers
consider that an outmoded belief?
The Crossroads
Indeed, as Grace, Willis, Roy, and Jones (2016) warned, the
nursing profession is at a crossroads. They discussed PhD
Barrett 131
preparation of nurse scholars in current doctoral programs.
They point out that there are many issues that determine
nurse scholars’ choices for lifelong research topics. “When
what is fundable drives the discipline’s scholarly activities,
there is a danger that substantive disciplinary questions
grounded in nursing’s conceptual and theoretical understand-
ings of disciplinary goals and ways to meet these, will be
neglected” (Grace et al., 2016, p. 66). They identified chal-
lenges and responsibilities of scholars and proposed strate-
gies to address complex situations.
The Council for the Advancement of
Nursing Science (CANS)
I was alarmed to read the articles in Nursing Outlook (July/
August, 2015, pp. 390-445) “Special Issue: Council for the
Advancement of Nursing Science: PhD Education.” I won-
dered if I was looking back into the future when I read,
“nursing science overlaps with the biological, behavioral,
and social sciences” (Henly, McCarthy, Wyman, Heitkemper
et al., 2015b, p. 399). Perhaps that explains the focus of sev-
eral articles on the need to prepare PhD students for lifelong,
“competitive” careers with the interdisciplinary team.
“Competitive” along with “team science” seemed to be the
recommended approach to the dominant themes of “symp-
tom science” and “omics.” Would nurse scientists need to
compete if their societal contributions were clearly distinct?
Can nurse scientists meaningfully study topics under investi-
gation, such as NINR funding priorities, using a nursing
framework or theory? It seems unlikely if there is no oppor-
tunity for substantive study of nursing frameworks and theo-
ries in PhD programs.
There are two perspectives regarding whether nursing is a
basic science or an applied science. Perhaps this is at the
heart of the matter. Parse’s (2015a) editorial differentiates
them: “A basic science is a unique body of knowledge … a
knowledge-specific recognizable entity. It has more than one
worldview. … Each worldview espouses a specific ontologi-
cal-epistemological-methodological congruence. … It
reflects the phenomenon of concern to the specific basic sci-
ence. … An applied science is an amalgamation of concepts
from various sciences and the humanities, with no consistent
recognizable unique discipline-specific theories, ethos, or
methodologies.” Council, Who decides?
The CANS group is adopting an applied science view for
PhD education. Henly, McCarthy, Wyman, Heitkemper and
colleagues (2015, p. 440) encouraged doctoral curricula to
reflect the “biological underpinnings of human disease and
behavior” while noting that nursing students have been
exposed to the biopsychosocial view since entering nursing.
Conley and colleagues claimed, “Nursing scientists appreci-
ate the interplay between biology, behavior, environment,
and health, a unique view that differs from other scientific
investigators” (p. 425). What is uniquely nursing about
appreciating this interplay? Where is the person?
Emerging and priority areas are “informatics and physiol-
ogy (symptom science foundation), other biology, biophysi-
cal instrumentation and measurement, and genetics and
genomics which includes omics” (Wyman & Henly, 2015, p.
395). There seems to be at least seven types of omics science
(Henly, McCarthy, Wyman, Stone et al., 2015, p. 410).
Henly, McCarthy, Wyman, Heitkemper and colleagues
(2015) viewed the emergent priorities as “omics and the
microbiome; health behavior, behavior change, and bio-
behavioral science; patient-reported outcomes; big data,
e-science, and informatics; quantitative sciences; translation
science; and health economics” (p. 399). Does this sound
like learning more and more about less and less with every-
one competing for research funds? Of note, NINR has funded
15 omics-based studies (Conley et al., 2015, pp. 419, 421,
422, 423).
Yes, this is a new twist, perhaps, on looking back into the
future. In years past, there was nursing science. Yet before
the nursing theory movement had come into its own with its
corresponding bases for research, there were few nursing
doctoral programs. Some thought it was appropriate that
nursing borrowed theories from other disciplines and nurses
obtained PhDs, primarily in the biological or social sciences.
Other programs remained true to doctorates in nursing. In
1970, there were 20 research-focused doctoral programs
(AACN, 2001), and in 2013, there were 132 (www.aacn.
nche.edu/research-data/doc.pdf, AACN, 2015). Then, we
borrowed from other disciplines and now it seems CANS is
recommending contributing to other disciplines through par-
ticipating in team science. Can simply saying “that was then
and this is now” dismiss this? What is the story in this
picture?
Of course, we can all benefit from the discovery of new
knowledge. The topics that have been deemed emergent
priorities for study are important for nurse scientists to
understand. That is not the issue. The issue is why do we
want to prepare PhD nurse scientists to compete with other
disciplines to grow knowledge that is not structured to con-
tribute to the basic science of nursing? Again, what is nurs-
ing science?
What price will nursing pay if research endeavors are
strongly influenced by adopting a different approach to PhD
curricula, interdisciplinary competition, funding priorities,
institutional pressure, prestige, recognition, and not by fol-
lowing one’s “must” as Nightingale encouraged? Of course,
many will be choosing to do just that, I realize. What will be
the price if there is no opportunity for PhD students and fac-
ulty to learn nursing frameworks and theories that are critical
to the view of nursing as a basic science?
Henly, McCarthy, Wyman, Alt-White and colleagues
(2015) raised one critical question: “What is the place of
nursing theory in the emerging areas of nursing science?” (p.
406). While recognizing the importance of “theory” in devel-
oping the nursing discipline, the authors maintain it was not
often used to guide research studies. Years ago, yes; now, no!
132 Nursing Science Quarterly 30(2)
They argue for the development of “nursing as a science and
for development of its research-based disciplinary knowl-
edge” (Henly, McCarthy, Wyman, Alt-White et al., 2015, p.
407). Nursing frameworks and theories add the missing com-
ponent with its focus on nursing’s phenomenon of concern.
The authors continue, “Academicians in nursing have long
argued for the unique contribution of the nursing perspec-
tive. Can this unique contribution be articulated and effec-
tively communicated to scientists in related fields, so their
work can be enriched by nursing science?” (Henly, McCarthy,
Wyman, Alt-White et al., 2015, p. 406).
Yes, it can, and yes, it has been effectively communicated,
including the economic value (Ericsson, 2013, pp. 5, 11, 12;
Ericsson, Jones, & Ditomassi, 2013; Fawcett & DeSanto-
Medeya, 2013; Nickitis & Frederickson, 2015; Parse, 2016,
p. 101; Smith & Parker, 2015). Scientists of other disciplines
can grasp that nursing is a basic science of whole person
unity known by its unique discipline-specific knowledge that
arises from postulates and principles of the discipline’s vari-
ous worldviews and often accompanied by research method-
ologies and practice models. Throughout the past century,
extensive literature in nursing provides evidence that nursing
science can stand on its own, while collaborating and coop-
erating with other disciplines. “Nursing science nursing is a
recognizable entity” (Parse, 2015a, p. 181). How can we
communicate what “nursing science nursing” is and to what
audiences?
The National Research Council of the National Academies
challenged nursing “to reengineer some [emphasis added] of
its doctoral programs to exclusively meet the goals of pro-
ducing scientists … for development of its research-based
disciplinary knowledge” (as cited in Henly, McCarthy,
Wyman, Heitkemper et al., 2015, p. 74). If CANS proceeds
in its efforts to pursue this applied science approach, then
“some” other doctoral programs can continue to pursue the
basic science approach. Nursing frameworks and theories
cannot be “a come before or an add on later” in cursory class-
room acknowledgement prior to returning to the historical
archives.
The Survival of Nursing Frameworks
and Theories
Despite what appears as a major disconnect between basic
and applied science perspectives, without question, nursing
will survive. However, the extant nursing theories and frame-
works are in danger of extinction! Let’s wake up and get the
elephant out of the closet before nursing theories are silently
erased from the blackboard of nursing science.
Nursing is not a weak group that might tend to destroy
itself by attacking its own members. Opposing views are not
an enemy within. However, are we willing to reach out to
both groups who ascribe to different positions regarding
nursing frameworks and theories? The issue will not go away
by ignoring it.
That leads me to another critical issue for the survival of
“traditional” nursing science that is alive, but how well is a
matter deserving further attention. A discussion of philosophy,
power, politics, and policy focused on the disciplinary dilemma
discussed in this paper is urgent. That is a topic for another
essay, full article, or letter to the editor. Please consider con-
tributing. Only a brief introduction is presented here.
Power (Barrett, 1986, 2010, 2015) is the capacity to par-
ticipate knowingly in change by being aware, making choices,
feeling free to act on intentions, and involving oneself in cre-
ating change. In other words, power is being aware of what
one is choosing to do, feeling free to do it, and doing it inten-
tionally. There are two types: power-as-control and power-
as-freedom. Both options are continuously available. This
view can provide a structure to frame an approach for strate-
gic planning. If we choose to participate knowingly in change,
we can use our power—not to control; instead, using it in the
service of freedom—freedom to participate knowingly, not
competitively, in dialogue with those who take the position
to exclude nursing frameworks and theories and discipline-
specific knowledge from nursing science endeavors. Why
not have a face-to-face dialogue among PhD students, PhD
faculty, and other nurse scholars who represent the two major
perspectives regarding “What is nursing science?”
Consider Robert Frost’s (1967, p. 181) traveler who
comes to a fork in the road. Except there are two travelers. So
can there be two viable paths? Can two distinct but legiti-
mate paths in PhD education coexist without compromise or
capitulation of either? In the distance, the disquieting voice
continues to rumble.
Isn’t it time to stop tiptoeing through the tulips and start
recognizing we are in a patch of thorny rose bushes? If we
can remove the thorns, beautiful roses of different colors will
safely remain, yet all will be roses. The revolutionary cre-
ators of the nursing theory movement did not tiptoe. They
marched! When we have the courage to do what we need to
do, and we do it, the rest will, most likely, take care of itself.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the authorship and/or publication of this review.
Funding
The author received no financial support for the authorship and/or
publication of this review.
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