CONFRONTING CONCEPTUAL CHALLENGES IN NURSING SCHOLARSHIP
Advancing the science of nursing requires a variety of forms of inquiry and also a clear understanding of what constitutes nursing as a discipline. Neither of these is possible without meaningful conceptual work. Science is, after all, a conceptual enterprise. Everything we learn involves refinement and development of concepts that give us more clear, specific, and effective ways to think about the world around us.
The need for quality conceptual work is particularly evident in nursing. Many of the things that nurses describe as crucial to the discipline and that capture the purportedly unique position of nursing are understood primarily on the conceptual level. Think about how often in nursing we reference abstract ideas such as presence, justice, dignity, personhood, caring, and holism. Although conceptual work is critical to nursing, and to science in general, rarely is it given the specific attention that is necessary to move our science forward. Even more disturbing, much of the work identified as conceptual lacks the rigor and meaningfulness we expect in our scientific endeavors overall.1 As a result, it may be tempting to abandon such work. But abandoning an approach is not the solution for flawed applications; what is needed in nursing (and in other disciplines) is renewed understanding of the importance of conceptual work and the development of alternatives so that work can proceed at a high level.
Several initiatives are crucial at this stage. First, nurse scholars must move beyond the long-standing obsession with literature-based concept analysis and expand the array and quality of conceptual work. The focus should be on the development of concepts using methods appropriate to the conceptual problems and the phenomena being conceptualized. Existing research methods can be used for concept development and new methods of inquiry based on expressive and aesthetic forms can be created to expand the types of inquiry done to enhance our conceptual foundations. An important part of such change in our inquiry is the explicit recognition and emphasis on creating better concepts as a part of scientific progress. Second, such work must be tied to a clear and delineated conceptual problem. The need for the inquiry as well as how the work will contribute to science should be explicit. Third, such work must involve the methodological rigor that is appropriate to any quality inquiry, with rigor evident in every aspect from problem delineation to sampling and data analysis techniques. The overemphasis on literature-based analysis, and lack of attention to concept development overall, is a clear hindrance to scientific progress.1 Fourth, nurses must recognize that philosophy and methodology change over time and embrace changes in methodology rather than rely on decades-old viewpoints because they are the most prevalent. Finally, advancing nursing science on the conceptual level requires awareness of the contributions that all scientific work makes to concept development and building on that development across an area of science. As a simple example, consider the evolving concept of fat based on new insights about types of fat and the roles of different adipose tissues in the body. Empirical studies have advanced the understanding of physiology, but that understanding persists in a radically reshaped concept of fat.2,3 We grow science conceptually even if we do not recognize that connection. Imagine the possibilities if we make that connection explicit and directly confront conceptual problems with sound methods.
A clear challenge in the path forward concerns inquiry known as “concept analysis.” More than one-half century of conduct and critique of this work have resulted in little change and the oversaturation of the literature with studies that often are of poor quality, duplicative of previous work, or that offer little link to scientific progress.1,4 Rigorous analysis does have a role, however, and is useful to answer questions such as: When, and why, did this concept emerge? What real-world phenomenon does this concept capture? How does the use of the concept reflect current thinking compared with its historical use? How do we distinguish phenomena using an array of similar concepts? What conceptual problems are addressed by variations? What is the current conceptualization of some phenomena and does that capture the situation well? How can we conceptualize a new situation effectively? If we cannot conceptualize something, we cannot study it; and if we do not address the conceptual aspects of a situation of interest, we lose the ability to think clearly and communicate about it. An example of the contribution of analysis to new ways of thinking can be found in Westra and Rodgers'5 work on the concept of integration that offered an alternative to dominant ideology concerning “adaptation” or “adjustment,” neither of which reflected what they were seeing in their older adult population upon discharge from the hospital. Such insights have important implications for those in practice as they can shape thinking and also interventions to support people during such experiences.
Systematic and expedient growth in our science can come from an explicit focus on concept development. Nurses at all levels need to understand the critical role of concepts in our knowledge base well beyond any connection they may have with theory, and nurse scientists can work to ensure those concepts are useful. We have immense opportunities for improving our conceptual repertoire if those invested in the science of nursing confront conceptual problems with quality inquiry and with the creativity that is needed to continue the advance of nursing science.
—Beth L. Rodgers, PhD, RN, FAAN
1. Rodgers BL, Jacelon CS, Knafl KA. Concept analysis and the advance of nursing knowledge: state of the science. J Nurs Scholarsh. 2018;50(4):451–459.
2. Giralt M, Villarroya F. White, brown, beige/brite: different adipose cells for different functions? Endocrinology. 2013;154(9):2992–3000.
3. Marlatt KL, Ravussin E. Brown adipose tissue: an update on recent findings. Curr Obes Rep. 2017;6(4):389–396.
4. Beecher C, Devane E, White M, Greene MB, Dowling M. Concept development in nursing and midwifery: an overview of methodological approaches. Int J Nurs Pract. 2019;25(1):e12702.
5. Westra BL, Rodgers BL. The concept of integration: a foundation for evaluating outcomes of nursing care. J Prof Nurs. 1991;7(5):277–282.