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Intermodernism

A Philosophical Perspective for Development of Scientific Nursing Theory

Reed, Pamela G., PhD, RN, FAAN

doi: 10.1097/ANS.0000000000000249
The Focus of the Discipline

Nursing is not only a professional practice, it is a scientific practice as well. One aspect of this practice involves development of scientific theory. In this article, I present a philosophical perspective called intermodernism for considering the content, structure, and process of scientific theory. Three types of theory structure are reviewed along with descriptions of the use of models and mechanisms in knowledge development. Practice is championed as a context that informs theory development as well as a context of theory validation and application.

College of Nursing, The University of Arizona, Tucson.

Correspondence: Pamela G. Reed, PhD, RN, FAAN, College of Nursing, The University of Arizona, 1305 N. Martin St, Tucson, AZ 85721 (preed@email.arizona.edu).

The author has no disclosures to report.

A philosophy of nursing science must be judged by its capacity to help nurse scholars create better nursing knowledge.1 (p224)

IT is readily accepted that nursing is a professional practice focused on promoting human health and well-being across the life span. It is less intuitive, though, to consider that nursing is a scientific practice and perhaps also that “nursing” proper is a real entity, a complex and dynamic pattern of well-being with underlying regularities of nature that can be investigated in building knowledge and scientific theory. Elsewhere, I have described intermodernism as a philosophical perspective for nursing science including a tenet about the “inherent nursing processes of well-being within and among human systems”2 (p29) and the role of practice in knowledge development and discovery. I revisit these themes in this article and outline some philosophical perspectives of intermodernism as related to the content, structure, and process of nursing scientific theory in the 21st century.

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INTERMODERNISM

Intermodernism is so named because it stands in the middle of modern and postmodern perspectives on science as a post-postmodern philosophy of nursing science.2 , 3 Traditionally, modern science emphasized value-free objectivity and authority of science and the universal truths and permanent nature of its theories and laws. Postmodernism raised awareness of nonepistemic contextual values in scientific practices and the feminist and social theories that informed views of reality. Intermodernism builds on intersections of modernism and postmodernism that have relevance in our post-postmodern era of science. Beyond the logical and empirical dimensions of science, both modernism and postmodernism share values for critique, reason and rational thought, skepticism, creativity, reflectivity, and sense of community in knowledge development.4

From the late 20th century to now, our philosophical era can be described as a post-postmodern period.5 Post-postmodern philosophers tend to uphold science as the preferred means for building knowledge but reject both foundationalism and relativism; that is, a rejection of (a) the positivist notion that there is one stable Truth to be found through scientific theorizing and mathematical logic, devoid of values and metaphysical abstract concepts, and where scientific explanations are ultimately reducible to physics; and (b) relativism, which claims truth is constructed only as relative to the context, language, culture, or mind. In the chronology of ideas, intermodernism is a post-postmodern philosophical perspective that supplants 3 traditional scientific goals for knowledge that is objective, universal, and permanent with scientific goals for knowledge that is “plural, partial, and provisional.”6 (p207)

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Statements of Significance

What is known, or assumed to be true, about this topic:

  • For several decades, nursing has had used a variety of philosophical worldviews and paradigms that broadly guide knowledge development and the substantive focus of the discipline.
  • Theory development in nursing has proceeded typically as a scientific practice separate from a professional practice.
  • While many disciplines incorporate models and mechanisms into their science, nursing's extant philosophy of science has not yet embraced or encouraged these strategies for theory and knowledge development.

What this article adds:

  • Discusses a contemporary philosophical perspective for nursing science called intermodernism, and its implications, for the content and structure of scientific theory and for the process of theorizing that incorporates new strategies for knowledge development.
  • Describes a form of scientific realism within this new philosophical perspective of nursing science.
  • Proposes nursing pattern as an entity for investigation and a substantive focus of theory.
  • Discusses 3 types of scientific theory structure from philosophy of science with a focus on the pragmatic approach for nursing.
  • Elaborates how models and mechanisms are relevant to nursing knowledge development.
  • Highlights a more inclusive view of knowledge development that incorporates both scientific and professional practices, with nursing practice as a context for theory discovery and theory validation.
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SCIENTIFIC REALISM AND NURSING THEORY

A central concern in philosophy of science that relates to philosophical underpinnings of nursing science and theory has to do with scientific realism, what really exists independent of and as influenced by our constructions from culture, language, and our mental apparatus, and whether it can be detected through scientific methods.7 Realism as a metaphysical belief is keenly relevant to scientific theorizing in nursing because nurses often deal with what seems like intangibles of human existence and because nursing theories subsequently include such concepts in their descriptions and explanations of nursing phenomena. The nature of nursing is such that our philosophical practices must attend to ontological concerns about what exists, mind-independent or interdependent reality, and how we come to understand it.

Intermodernism subscribes to a form of realism facilitative of the scientific practices as well as professional practices of nursing. This philosophical view of realism is pragmatic, perspectival, and naturalized realism.8–10 The pragmatic qualifier is based upon the desire that our theories be meaningful and useful, as Charles Peirce believed that “the content of a proposition should be understood in terms of (among other things) its ‘practical consequences’ for human experience, such as implications for observation or problem-solving.”7 It is perspectival in acknowledging that scientists' perspectives operate between the context-free reality of enlightenment science and value-laden reality of social theorists to capture partial but relevant aspects of reality in their theories.8 , 9 , 11 It is naturalized in the belief that theoretical terms indicate properties that are not only meaningful and real but also empirical and can be studied scientifically. According to intermodernism, nursing scientific theories and models aim to and potentially can provide accurate representations of aspects of reality, including those currently considered to be unobservable. Disciplinary knowledge is developed by the failures and successes of scientific theories. Three philosophical components of this form of realism as related to nursing theory are as follow:

  1. Ontologic, a metaphysical belief that we live in a reality that has structure independent of ourselves except as reality is mind- and culture-interdependent in ways that have been or may be uncovered by science.
  2. Epistemologic, where theories yield at least partial knowledge about aspects of the world (from cytokines and cells to spiritual beliefs and social interactions). Knowledge of reality encoded in theories may be influenced by scientific practices, assumptions, perspectives, and perceptions scientists bring to their investigations, but engagement in a scientific community and scientific methods to control or otherwise account for these influences help maintain needed objectivity.6
  3. Semantic, our theoretical terms are truth apt and potentially can provide accurate descriptions and representations of aspects of the world (objects, events, processes, relations), including those currently considered unobservable. In addition, a pragmatic view acknowledges that the user and her context influence the meanings of theoretical terms.
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INSTRUMENTALISM AND CONSTRUCTIVE EMPIRICISM

Instrumentalism and constructive empiricism are 2 empiricist philosophical views that are incongruent with the form of realism espoused in intermodernism. Scientific theories according to instrumentalism are merely tools for categorizing or predicting observable phenomena but hold no underlying meaning or truth in their content. The logical empiricists were strong advocates of this view. Instrumentalism was present at least as far back as the 16th century. In a preface added to Copernicus' 1543 book On the Revolutions of the Celestial Spheres, by clergyman Andreas Osiander, readers were instructed to think of theories “only as predictive tools rather than as attempts to describe the hidden structure of nature.”10 (p15)

Van Fraassen's12 constructive empiricism expresses similar views about scientific theories in his emphasis on belief only in what is observable to the naked eye. Because theories include unobservables, they can be “accepted” solely for their empirical adequacy or heuristic value in categorizing and predicting but not for any truths they may reveal. Van Fraassen claims that use of scientific instruments to ‘observe’ phenomena does not qualify as observation because “observation is perception, and perception is something that is possible for us without instruments.”12 (p154) However, discoveries in cognitive science, neuroscience, and psychology have expanded our understanding of human perception to where we can be quite sure there is no immaculate perception. Furthermore, in reference to a strict empiricist view of observability, it seems “epistemologically perverse and rather chauvinistic to seek to restrict the knowledge claims of science solely to the stretches of nature within the unaided ranges of those receptor systems. There are so many other regions of nature to which our receptors do not have direct access.”13 (p231) Germs, once mystical to Nightingale, became empirical entities with assistance from the microscope and relevant background knowledge. Similarly, the dark matter in nursing's reality simply may not yet interact with standard apparatus of observation for us to ‘see’ it.

Intermodernism rejects dichotomizing observables and unobservables since all terms are theory-laden14 and interact with the ever-changing scientific capacity to observe and measure phenomena. Realism allows for theoretical terms that seem intangible but that scientific investigations may reveal as manifestations of human existence. These include suffering, self-transcendence, hope, resilience, healing, caring, meaning-making, moral reckoning, and many other concepts nurses often deal with that seem intangible but nevertheless can be theorized, measured, and studied.

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PATTERN: REGULARITIES, PROCESSES, AND MECHANISMS

A philosophical assumption of realism is that there are stable (in contrast to strict) regularities in human beings and nature that are discoverable through scientific inquiry into circumscribed situations in the world.15 This assumption underlies a key ontological concept in intermodernism, the nursing pattern, as manifested in regularities of interest to nursing. Pattern is an abstract idea and placeholder for discoveries of regularities associated with life processes and mechanisms of human healing, health, and well-being as they occur within many contexts, from individual and biological to social and cultural.

Homeodynamic principles of unitary nursing science and principles of life span developmental and systems sciences indicate that this pattern is evident in the form of a dynamic diversity and complexity balanced by organization, occurring within human systems in interaction with their environment.16 , 17 A basic tenet of living systems is that they maintain their organization amidst tendencies toward disorder and decay by taking in materials of lower organization as sources of energy to sustain the system and facilitate organization (growth, healing).

Pattern can be manifested in countless regularities that are relevant content for nursing theories, for example, ranging from biologically based mechanisms inherent within human systems to socially based processes inherent in nurse-patient interactions as extensions of this ontological process called nursing. If we consider as real the nursing phenomena represented in our theories, then a necessary next step is to pursue empirical study of how they function. An epistemological claim (for building scientific knowledge) is that regularities in phenomena may be studied and depicted in models of mechanisms and other processes. Nursing theory, evolving in structure and process, may be able to accommodate epistemological views such as this.

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STRUCTURE AND PROCESS OF SCIENTIFIC THEORY

Theories have long been recognized by philosophers of science as carriers of scientific knowledge.18 Theories “magnify understanding, help supply legitimate explanations, and assist in formulating predictions.”19 Scientific theories' wide reach spans from knowledge production to interventions. They are mediators between targets (objects, events, processes) of investigation and the methods of investigating phenomena. A key role of theory is in the representation and scientific explanation of reality—the objects, events, relations, and processes not directly accessible by our senses—through its structure of theoretical terms and proposed relationships. At bottom, all theorizing faces the challenge of making reliable and valid connections between abstract structures and concrete phenomena or empirical data about some aspect of the world.

Changes in the structure of scientific theories over the past century are reflective of 3 major philosophical perspectives from theories about language and logic used in philosophy of science. These 3 approaches to theory structure are as follow: (1) Syntactic, focused on syntax (grammar, logic, abstract structure); (2) Semantic, concerned with meaning and representation in theoretical terms; and (3) Pragmatic, which emphasizes the user (the theorist's context of and purposes for the theory).

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Syntactic theory structure

Syntactic theory, evident in the logical empiricist deontological-deductive (D-N) form of theory, was dominant during the logical empiricist era of science until the mid-20th century. This theorizing employed deduction from universal law (a “covering” law) and relevant conditions to generate propositions. The D-N view was mostly an argument of logic, inferring that rather than explaining why something existed the way it did. It was the logic of sentences in syntactic theory sentences, not the meanings of the theoretical terms, that warranted truth. This axiomatic form of syntactic theorizing proved incompatible with scientific practice, particularly its requirement of universal law, which most disciplines other than physics lacked, and its restriction from the study of so-called unobservable entities of increasing interest to scientists—entities too small, too fast, too slow, or too large to directly observe or entities beyond the normal range of human senses.19 , 20

Philosophers Bluhm21 and Risjord1 identify logical positivist influences in the hierarchical structure of nursing knowledge where theories are organized by levels of abstraction and particularly where there are rules about deducing or deriving middle-range theories from more abstract nursing conceptual models. They endorse an alternative to this rules-based deductive process between conceptual models and theories—an alternative that is consistent with intermodernism and has been active among many nurse theorists: Instead of functioning as sources for deriving nursing theories, nursing conceptual models (and similar theoretical systems including social theory) function more broadly and importantly to provide philosophical groundings, background assumptions, and values for theory development.

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Semantic theory structure

By the mid-1960s, philosophers of science had widely rejected the syntactic view of theory and supplanted it with the semantic approach to theorizing, as logical empiricism gave way to post-positivism in philosophical perspectives of scientific knowledge, lasting into the 21st century. Semantic theory structure emphasized the meaning and content of theories and focused on ways to represent reality through families of models that modeled the real world, data, or hypothetical systems. Philosophers of the physical sciences particularly embraced this approach to theory, which often employed mathematical models. Some eschewed standard theories in favor of models as the conceptual structure for representing and explaining phenomena.15 The semantic view improved on the syntactic approach in part by acknowledging theory as a partial structure of the world and providing a structure that links theories, models, and data in “natural fashion” to build scientific knowledge.8 (p187)

In addition to this semantic approach to theorizing, scientists including nurses used standard hypothetico-deductive reasoning, deducing hypotheses or research questions from law-like generalizations embedded in theoretical frameworks. Instead of seeking verification of universal truths, scientists justified their theories through Popper's falsification. Probabilistic thinking replaced determinism in understandings of causes and necessary relations among phenomena.

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Pragmatic theory structure

Increasingly, philosophers of science and scientists found the logic and formalization in both the syntactic and standard semantic approaches to scientific theory too restrictive—criticizing their “tedious deduction or clever approximation.”15 (p185), 22 This motivated movement during the 21st century toward the pragmatic perspective of theory structure and process,19 the approach most congruent with intermodernism.

Pragmatic theory embraces creative strategies in exploration and experimentation that theorists may use in developing scientific knowledge and recognizes the immense variety of purposes and approaches to theory development and the forms that scientific theories may take. For example, in addition to hypothesis (theory)-driven research, scientists in the omics and other disciplines are engaging in a form of exploratory experimentation to analyze large data sets for potential theoretical ideas and explanations. Models are still very much a part of this view, but without the formal elements philosophers objected to as much too restrictive in the semantic approach to theorizing.15 , 23 The focus of pragmatic theory is on more circumscribed situations, whether real-world or hypothesized systems. Its restricted scope is reflective of its underlying philosophy emphasizing partial and local truths, usefulness of knowledge, and diversity in theoretical views in representing and explaining reality.

Importantly, the pragmatic approach does not preclude use of more standard theory development tools (eg, deduction, induction, and, more often, abduction). But standard empirical evidence is no longer sufficient for developing scientific knowledge. The takeaway point is that pragmatic theories are both sensitive to the pragmatic elements (context and practices of the theorist) and committed to maintaining standard elements of science (methods, objectivity, and structure).6 , 24 A necessary role of the scientific community, then, is to bring social values and emancipatory knowing,25 as well as epistemic standards, into consideration for critiquing and eventually accepting or rejecting a theory. This expanded boundary of scientific knowledge strengthens rather than threatens scientific endeavors.

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PRECISION NURSING AND THEORY: MODELS AND MECHANISMS

The intermodern perspective regards theory development as deeply challenging, particularly in striving for theories that explain the why of things, and are more than just “empirically adequate” in overall empirical content. Pragmatic theory (as well as some semantic theory) accommodates a diversity of strategies, particularly including models and mechanisms, to meet the challenges of developing scientific knowledge about complex and dynamic phenomena. Models and mechanisms, and also for us in nursing, middle-range theories, provide for a “much more textured” but also labor-intensive account of the empirical processes underlying our phenomena.15 (p185) Theories can be warranted by the empirical successes of models and the mechanisms they explain. Given this, plus other advantages of models in scientific practice, it is prudent for the future of nursing theory to include models and mechanisms in our repertoire of knowledge development tools and strategies.1 , 26

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Mechanisms

The mechanist movement in philosophy of science emerged in the 1990s, reinforcing the shift in discovery and theoretical explanation away from universal law to mechanisms.27–29 Bechtel and Richardson's 1993 Discovering Complexity initiated the movement with their interest in developing a post-logical positivist view on scientific theorizing about the “behavior of complex systems in biology and psychology.”27 (p17) This mechanist perspective is embraced by many disciplines from the social sciences, medicine, and physics in studies focused on local contexts of various types of mechanisms in their interactions and regularities.27 , 29–31 In an interest to apply mechanism more widely across disciplines, Illari and Williamson proposed what has become the consensus definition of a mechanism as a phenomenon consisting of “entities and activities organized in such a way that they are responsible for the phenomenon.”32 (p123)

While the term “mechanism” clanks too much for some of us who have distinguished nursing from other disciplines by a holistic and humanistic philosophy, its meaning in contemporary science has moved far beyond the 17th-century perspective of physical phenomena and Stephen Pepper's33 mechanistic worldview to where they can be comfortably incorporated into nursing science and theory. Mechanisms are organized complex systems of dispositions or functions and activities that manifest stable regularities of nature. Mechanisms are not necessarily reductionistic or deterministic and may be described holistically. They are not machines but are products of nature, evolution, and ongoing change. They are not necessarily linear but may undergo nonlinear change. Finally, mechanisms are neither metaphor nor fiction; they produce measurable effects or outcomes.34 In addition, there is increasing attention to using mechanisms in a way that accounts for biological systems' capacity to actively adapt and thrive in their organization and functioning instead of degrade overtime as their “dissipative energy flows in the environment and within themselves.”35 (p162),36

Of particular relevance for theory is that mechanisms are explanatory; they assist researchers in explaining the why behind an event or process, beyond the what. They accomplish this not by referring to or describing regularities—nursing has described many regularities in human-environment processes—but instead by revealing what is produced by the mechanism's activities or functions.29 Pattern in nursing, then, is discoverable through empirically based regularities manifested through models that researchers create, construct, test, revise, refine, and so on, in a self-correcting process that serves the development of scientific theories.37

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Models: Description and strategy

Creating and then manipulating models in research are often central to scientific practice and theory development. A model is a simplified description or representation of certain regularities governing a natural process or real-world system and is designed intentionally for the purpose of representing and understanding a certain aspect of reality.18 , 38 Some models incorporate mechanisms. Models of mechanisms in research span various levels of living systems, from the molecular and cellular to the whole organism. Examples of systems that are modeled to understand underlying mechanisms range from cell biology to astrophysics, from cognitive to social sciences, from organic chemistry to behavioral genetics.34 Furthermore, investigators suggest a mixed-mechanisms approach that integrates microbiological, socioeconomic, and environmental mechanisms of health and disease.35 , 39

Godfrey-Smith's38 model-based science approach to model construction provides a creative strategy for theorizing that is distinct from the standard philosophical semantic approach to models. Overall, it involves constructing a simplified model that is similar to its target (real-world) system in key aspects and then studying and experimenting with the model to formulate potential theoretical explanations about the real situation. Research questions and hypotheses are then derived from the theoretical model for investigation, using the findings to further develop and refine theoretical ideas.

The theorist's strategy for constructing a model, as Godfrey-Smith38 adapted it from Giere's earlier work, involves 2 basic steps. These steps address relationships between the Model Description and the Model System, and then between the Model System and the Target System, respectively: (1) investigate and specify what the hypothetical model system is; and (2) incorporate the similarities or resemblances (relations among and organization of the components) between the model's hypothetical system and the real-world “target system” to be explained. Through this procedure, the model's description specifies a model, which, in turn, is made to accurately and adequately resemble the aspect of reality of scientific interest. By their resemblances, models provide a partial representation of some regularity derived from the real system or theory about the system. The user must take care to ensure that there are relevant similarities between elements in the model and features in the real world. To accomplish this, the user employs strategies of model construction, for example, idealization (by deliberate simplifications and distortions of a real system in the target) and analogies (by creating sameness or similarities between the real system and its model in their properties, parts, or arrangement of parts).18

Model-based science is relevant to nursing science because it is more compatible overall with knowledge development and theories in the life sciences than other modeling strategies related to philosophical theories of logic, mathematics, and physics. For example, the resemblances required in the model-target relation are less strict than those required by isomorphism. Also, the model is less abstract than the mathematical structures used in modeling strategies of other disciplines. This approach, whether based upon synthesis of actual data or hypothesized systems, allows for creativity and close connection to the situation.

Scientists work with a diversity of models; models may be composed of a variety of elements, linguistic, nonlinguistic, or both, and they may be physical, material, or conceptual structures,39 including words, mathematical equations, pictures, diagrams, computer-generated images, and simulations. (See Effken and colleagues40 for an example of simulations in computer-based modelling of complex systems such as the dynamics and levels of nursing units to study hospital safety.) Overall, the pragmatic nature of model-based science accounts for not only the model as it represents reality but also the user's inventiveness in building knowledge—the theorist's specific purposes relative to delimited aspects of the world.41 , 42

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Relationship between theories and models

Including models in theory development raises issues about the relationship between theories and models debated widely among philosophers and scientists.15 , 23 , 43 Opinions vary. A model may be derived from theory or it may function independently of any theory. The perspective of intermodernism on this matter stands in between these positions to regard models as never completely untethered from theory. While models may seem functionally autonomous, they nevertheless are linked to theory in a variety of important ways. Most basically, they stimulate inventive theoretical thinking about a local situation. Models may also be used to modify or refine theories.38 , 44 Overall, models function as mediators between theory and the world to enable or directly contribute to development of scientific knowledge.45 , 46 Models function to represent what the user identifies as the target—theoretical ideas, sets of data, or particular phenomena.45

Similar to semantic-based philosophers, some scholars in nursing have recommended using models over theories in nursing knowledge development.1 , 47 Instead, from a pragmatic-based approach to theory, I suggest, as have other philosophers,38 , 42 , 46 that we not abandon theories and also include models in our repertoire of conceptual structures as useful in inquiry. In addition, we can revisit and make more purposeful use of the theoretical model in knowledge development practices. Models have scientific content,40 not unlike the theories familiar in nursing; they display relationships between concepts that have meaning, are testable, and can represent real-world situations. Accepting models and theories as legitimate truth bearers in nursing enriches scientific practice by providing a diversity of processes and structures for exploring and representing reality.

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THE NURSING PRACTICE TURN IN KNOWLEDGE DEVELOPMENT

In theorizing about knowledge and contexts where science is practiced, scholars outside of nursing have not much considered contexts where nursing is practiced. Social theories and philosophy of science have reformulated traditional views about the practice of science that motivate new thinking about nursing theory. As a nursing philosophy of science, intermodernism inserts into scientific knowledge development another kind of social practice—that of professional nursing practice. Building on the practice turn initiated in the last century that informed us of the human practices of scientists, there is yet another turn to be taken. And that is to more deliberately include professional practice in our scientific practices.

The pragmatic movement in theory construction along with post-postmodern views expanding understandings and standards of scientific knowledge have paved the way for more inclusive and creative approaches in science. Among the conditions stipulated for a dynamic and productive scientific community was a “tempered equality of intellectual authority.”6 (p206) This condition necessitates purposeful inclusion of practicing nurses in knowledge development. Nurse practice actions and interactions with patients are constitutive, not contextual components of theory development. Historically, noted nursing scholars promoted practice as a place for theory generation: Hildegard Peplau and her cycle of inquiry and peeling out concepts in practice where knowledge becomes nursing knowledge, Rosemary Ellis' practitioner as theorist, and Donna Diers' clinical scholarship. More recently, scholars have argued for an emancipatory understanding of the knowledge embedded in and traditionally associated with certain occupational groups dominated by one gender or class or other factor to better understand their “knowing practices” and contributions to knowledge.48 By this perspective of knowledge, the focus is not practitioners per se but their practices in direct involvement with patients, families, and communities. It is this focus that characterizes the fullest turn toward practice.

Nursing practice falls within the ontological domain of natural processes of healing and well-being within and among human systems. Nursing practice is not just an aesthetic pattern; it is an epistemic practice and a critical source of knowledge for theory development. Nursing theory is informed by as well as a guide for practice. In vivo investigations of nursing practices in direct involvement with patients and families may lead to discoveries in healing processes that occur not only between the nurse and the patient and family but also within the patients themselves—patients qua persons. Patients are understood not as passive recipients of the knowledge of “knowers” in nursing practice but as active participants.

Mechanisms and processes gleaned from these practice-based insights may be theorized and modeled for investigation and eventually explained for real-world applications. Practice is a context for both discovering and validating scientific theories that explain processes of well-being. This entails practice-based science and theorizing that not only include but also extend beyond Bender and Elias'49 compelling proposal for the scientific study of aesthetic knowing. Nursing needs scientific theory that elucidates not only knowing-how but also knowing-why.

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CONCLUSIONS: THE SHAPE OF NURSING KNOWLEDGE

What might nursing theory and theorizing look like in our post-postmodern era? I presented intermodernism as a philosophy of nursing science, which included a form of scientific realism. This philosophical view has several implications for the content, structure, and process of scientific theory in nursing.

In terms of content, there is an ontological claim for a nursing pattern of inherent capacities for healing and well-being within individual human beings and among various types of human-environment systems (including the family, community, nurse-patient relationship). An epistemological claim is that this pattern is manifested in regularities of healing and well-being that occur within and among human systems, detectable in scientific investigation of mechanisms and processes. In terms of structure and process, the pragmatic approach to developing scientific theories includes use of models of mechanisms and other processes, and integrating relevant social practices and values into traditional scientific standards. In sum, scientific theories about nursing pattern arise from nursing practices—personal and professional wherever human-environment processes of health and well-being are happening. These scientific theories also are grounded in values, perspectives, and principles clarified by philosophical views of nursing found in metaparadigmatic statements, worldviews, conceptual models, grand theory, and social theory.

A key tenet of intermodernism is that professional nursing practice is a context where theories are not only justified but also discovered. It is a more inclusive view of knowledge development, with essential contributions from participants of scientific practice and professional practice. The dual nature of nursing as a discipline and a profession provides a fertile environment for development of knowledge. Theory, as it evolves through new structures and strategies, endures as the shape of nursing scientific knowledge.

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Keywords:

intermodernism; philosophy of science; practice; theory structure

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