Philosophical and Theoretical Perspectives for Advanced Nursing Practice (5 th ed.),by W. K. Cody (Ed.). (Burlington,MA: Jones and Bartlett,2013)

When reviewing an article for publication, this reviewer pays very close attention to the words the author is using to describe the theoretical work of his/her choice. As one stumbles over some parochial expressions used to convey the conceptual meaning intended by the theorist, one wonders if the author in an attempt to render accessible to readers the basis of the theoretical work is not actually blurring the concepts. In the pursuit of scholarliness: to what extent must a reviewer show flexibility or maintain rigidity in the use of conceptual language in the pursuit of knowledge. What is evoked that is not intended? What is said that is not uttered? Remember, words, words, words, meanings, meanings, meanings (Parse, 2002)!

In the preface of the 5^th edition of Philosophical and Theoretical Perspectives for Advanced Nursing Practice, Cody (2013a) posits that in service to humankind advanced nurse practitioners and nurse scholars must possess deep understandings of philosophical and theoretical nursing knowledge that can only be acquired through formal study of the discipline. This five-part, 31-chapter book carries a distinction between practice and care “construing practice as values based and practitioner driven and care as evidence based and consumer driven” (Cody, 2013a, p. 301). In preparing professionals for practice, Cody (2013a) invites readers to dialogue about the ontological-epistemological-methodological link underpinning nursing science. It is a privilege to be asked to write a review of this book.

Cody (2013a) introduces the first part of the book, The nursing discipline and the development of nursing knowledge, by giving a brief historical overview of the emergence of philosophy and theory as fundamental to nursing scholarship. While Nightingale viewed nursing as a vocation and the performance of applied skills rather than a basic science and a learned discipline, her writings and endeavorings promoted a system for delivering effective care. Yet, it was not until Peplau’s work that nursing scholarship began to appear, grounding the importance of philosophy and theories for the advancement of nursing as a learned discipline. Henceforth, in view of its social mandate for human betterment, the nursing theory-based practice movement evolved from either the totality or simultaneity paradigmatic perspective (Parse, 1987). Furthermore, notwithstanding philosophical debates in the past decade, nursing service is discussed in view of the relationship surrounding practice and research.

While Cody in chapter 1 posits that pursuit of scientific endeavors cannot be value free and that practitioners choose how to practice based on personal values, Carper in chapter 3 proposes that fundamental patterns of knowing in nursing exemplify characteristic ways of thinking about nursing phenomena. Cody in chapter 6 and Fawcett in chapter 4 argue that it is nursing theory supported by evidence that advances the knowledge of the discipline by providing direction for practice, whereas Schlotfeldt (2013) in chapter 2, states that evidence arising from nursing science and other disciplinary extant theories allows “to appraise and assist human beings in their quest to optimize their health status” (p. 17). Yet, Schlotfeldt (2013) advocates that given personal knowledge of the recipient of care, “there can be no prescriptive nursing practice theories or professional approaches to nursing care that are universally generalizable” (p. 20). Phillips, in chapter 5 explicitly states that it is the pattern of knowledge embedded with coherent philosophical and theoretical foundations that gives unity to nursing science. The philosophical postures of these nurse scholars set the stage for dialogue in preparing advanced nurse practitioners in light of the nursing discipline and the development of nursing knowledge.

First, this reviewer thinks that incarnating personal values congruent with a theoretical nursing perspective bridges debates that maintain a split between personal and professional values and, more so, fosters accountability for advanced nursing practice. Simply put, Cody (2013b) asks that advanced nurses reflect on “What guides my practice?” (p. 5). Secondly, this writer strongly agrees with Cody, Carper, Fawcett, and Phillips that development of nursing knowledge ought to be steeped in the discipline and not into other disciplinary extant theories; otherwise there is sufficient concerns to be “troubled by the state of our science” (Fawcett, 2013, p. 35). Isn’t a view of the focus of the nursing discipline and its practice the humanness of health circumstance for which nurses “advocate the humanness of people’s experience in the strategizing for service development and in community development” (Litchfield & Jónsdóttir, 2013, p. 63)?

Conceptualizations of human beings, health, environment, and nursing practice are reported in the second part of the book. Cody (2013a) begins with Reed’s (2013) conceptualization of nursing as the ontology of the discipline. Reed (2013) posits that the complexity of human experiences and the integration of qualitative changes of ongoing life events “can be learned and knowingly deployed to facilitate well-being” (p. 75). After rereading this section of the book, it became apparent to this reviewer that it might have been Cody’s intention to first present nursing as the ontology of the discipline in view of discussing the aforementioned metaconcepts in the following articles in light of relational propositions.

In chapter 9, Banfield explicates Orem’s understanding of human beings as foundational to nursing practice. Banfield clarifies Orem’s conceptualization of human beings from a moderate realist perspective. She argues that Orem views human beings as unitary; that is, a unity of structural and functional differentiations in an ongoing process of concrete existence. This relational proposition links Orem’s view of person with environment. In practice, according to Banfield (2013) nurses attend to the humanness of persons with human love, “an integral component of the nurse’s ability to help others” (p. 89). Boykin and Schoenhofer (2013) claim that the outcome of the “artistry of nursing” (p. 101) is nursing’s contribution to healthcare. The authors’ (Boykin & Schoenhofer, 2013) caring philosophical and theoretical perspective highlights personhood as “a living grounded in caring . . .nurtured in relationship with caring others” (p. 97). Boykin and Schoenhofer argue that in practice nursing’s intention and language are to nurture the person’s wholeness through deliberate presence and reflective practice, knowing the other as a caring person. This draws attention to the relational proposition between person and nurse. By using a dialectical approach to systematically analyze distinct conceptualizations concerning the art of nursing, Johnston’s outstanding in-depth review of nursing literature in chapter 16 identifies five meanings which serve to delineate the relation between person and practice. These are a) grasping meaning in patient encounters, b) establishing a meaningful connection with the patient, c) skillfully performing nursing activities, d) rationally determining an appropriate course of nursing action, and e) morally conducting one’s nursing practice. Doane and Varcoe (2013) in chapter 18 continue the discussion by stating nursing’s ethical obligation in practice, which is “to be reflexive and intentional, [to] open a relational space, and to act at all levels to effect potential health and healing” (p. 211). Doane and Varcoe (2013) conclude that, “a relational inquiry directs a more in-depth look at the values, experiences, goals, and concerns shaping [nursing] action within particular moments of practice and a conscious consideration of possibilities and intentional responsive action” (p. 210).

In chapter 11, Pender (2013) questions, “What are the varying human patterns most indicative of health . . . viewed as a lived experience (p. 109)?” The question underscores the proposition relating person with health. The theorist inquires about health from a human approach; indeed “a unitary phenomenon” (Pender, 2013, p. 108). Based on research, Pender proposes five dimensions of health expressions, organized into 15 subcategories with several respective potential indicators. In view of moving nursing forward, Pender invites nurse scientists to expand a humanistic understanding of factors affecting health that is distinct from the absence of disease. In chapter 13, Butterfield addresses the health-person-environment relational proposition in view of complex social, political, and economic factors, whereas Kleffel in chapter 14 reflects on its distinct ethical perspectives. Butterfield contends that promoting individual change based on perceived personal benefits and barriers or by identifying personal variables to stimulate health action is placing a burden on the individual rather than considering health deficits from both micro and macro perspectives. One could apprehend Kleffel’s (2013) description of the egocentric approach from a micro perspective “grounded at the personal level [where…] what is best for the individual is best for society” (p. 150), whereas a homocentric approach, a meso perspective, reflects “the utilitarian ethic . . . grounded at the social level” (p. 151). An ecocentric approach would delineate a macro perspective with the necessity of holistic values grounded in the cosmos. In pursuit of collaborative actions, Kleffel (2013) suggests to “think globally, act locally” (p. 157). Cowling in chapter 12 furthers the discussion in view of the theoretical principles of unitary science by emphasizing the health-person-environment-practice relation through praxis. This scholar (Cowling, 2013) posits that healing as appreciating wholeness is a “process of pattern appreciation [that is] a synoptic stance toward pattern information, a participatory engagement with people in exploration of wholeness, and a transformation process that illuminate the possibilities in wholeness—the embodiment of healing” (p. 136).

In light of nursing practice based on values and beliefs for person-centered care, Cody suggests McCormack’s conceptual framework, which arises from the totality perspective, and Parse’s humanbecoming theory, which emerges from a simultaneity perspective. McCormack identifies patient’s values, nurse’s values, and context of the care environment as central to nursing practice. According to McCormack (2013) through caring in a therapeutic nurse-patient partnership, the nurse is able to facilitate authentic consciousness by “enabling the patient [‘s autonomy] to follow the path of their own choosing and in their own way” (p. 192). Autonomy as defined and used in common parlance is not consistent with Parse’s view. Parse notes that the transformation of practice is grounded on knowledge of basic-science nursing. Parse (2013) posits,

“What one believes about human beings and health permeates one’s actions . . . people know the way and choose their health situation and their quality of life …. The form of nursing in the transformational practice guided by the human becoming principles is true presence: a non-routinized way of being with others that honor others’ views and choices on changing health patterns and quality of life” (pp. 164, 166).

To honor the works of the nurse scholars cited, it is imperative to illuminate the philosophical underpinnings that guide their theoretical perspectives or their accounts of the metaconcepts human beings, health, and environment in light of possibilities for nursing practice. Words such as unitary, wholeness, healing, or therapeutic are used indiscriminately and tend to obfuscate worldviews offered from either the totality or simultaneity paradigmatic perspective and confound the richness of nursing’s heritage and future in preparing nurses for advanced nursing practice.

Contemporary perspectives on nursing is the topic addressed in the third part of the book. Mitchell and Cody, in chapter 19, question if human science is a distinctive philosophical foundation for science. Given its mission to explore and understand the meaning and values of humanly lived experiences, the authors identify wholeness, intentionality and free will, and the nature of reality as attributes that constitute the ontological and epistemological foundations of human science—which is distinct from humanism. For the sake of conceptual clarity in view of nursing practice and research, Mitchell and Cody point out the consistencies and inconsistencies related to human science attributes in several nursing theoretical works. In pursuit of nursing knowledge, the authors state that Parse’s work offers a congruent ontological-epistemological-methodological (research and practice) link which is consistent with and moves beyond human science. In chapter 20, Wuest argues that from both a liberal feminist perspective that seeks equal opportunity and a social feminist perspective that seeks social change, development of nursing science maintains a status quo steeped in patriarchal professionalism by upholding research and practice based on logical positivism. Wuest calls for a contemporary theoretical framework based on a social feminist perspective to value caring in nursing practice and foster nursing knowledge development to alter public policy and thereby confirm nursing’s social contribution in a unique way. Locsin and Purnell in chapter 21, address contemporary nursing practice in view of the human-technology interface. Beside Heidegger’s philosophical view regarding this dialectical tension, Lonergan’s (1957) conceptualization of isomorphism could possibly enrich Orem’s previously discussed relational proposition between person and environment and illuminate Parse’s (2013) view related to the transformation of nursing practice.

While metaphorical language is pervasive in everyday language, Mitchell, Ferguson-Paré, and Richards (2013), in chapter 22, suggest that the frontier, “an open place of exploration and discovery” (p. 275), would better convey contemporary nursing practice rather than military language and images. For these authors, frontier, described as presence, community, discovery, knowledge, and possibility (Mitchell et al., 2013, pp. 269-270), better translates nursing’s relationship with patient, family, community, and other health professionals. Ketefian and Redman in chapter 23 further the discussion surrounding nursing practice in view of the global community. The authors question the ontological, epistemological, and methodological foundations that would capture the nature of theory, research, education and practice to ground nursing science as globally relevant, while honoring the diversity of varying human needs. This reviewer wonders if culture, viewed as a symbolate (Parse, 2009; White, 1973) embedded with value, conceptualized as that by which one defines good (Gillet, 1978), might not open venues by illuminating attributes of human science and help bridge differing intercultural beliefs. For example, Arnold and Bruce in chapter 24 propose that Parse’s humanbecoming theory honors aboriginal ways of constituting health and reality by considering knowledge and actions arising from a distinct worldview.

Anchoring contemporary perspectives of nursing solely in logical positivism highlights a partial view of the value of the discipline in its social mandate. While some nursing theories lack clarity in positing human science as foundational to their works, only Parse’s congruent ontological-epistemological-methodological link is argued to move beyond this specific philosophical perspective. The humanbecoming theory is acknowledged as a viable alternative in nursing practice. In view of the advancement of nursing science, this school of thought welcomes dialogue in a unique way related to concerns pertaining to the global community.

Interrelationships among nursing theory, research, and practice is the topic addressed in part four of the book. Mitchell in chapter 27 eloquently and compellingly explicates the close knit relations among theory, research, and practice that grounds nursing science. Mitchell (2013) states that while evidence might help people make a decision about available care options, “evidence will not build a knowledge base for nursing practice . . . evidence is value laden and theoretically driven” (pp. 322-323). Mitchell (2013) contends that evidence understood as “menu-driven directives” (p. 324) or “presentation of data” (p. 328) obscures the theory-practice link and leads to “prescriptive interventions aimed at managing patients” (p. 328). Mitchell (2013) said, “If research expands and informs the guiding theory, then findings must be considered in light of the practice prescribed by the theory” (p. 328). Fawcett, Watson, Neuman, Walker, and Fitzpatrick (2013) in chapter 26 concur with Mitchell that general literature supporting evidence-based practice “obstructs the nursing process, human care, and professional accountability” (p. 321). Fawcett and colleagues (2013) posit that, rather than focusing evidence-based nursing practice on the prevalent atheoretical medical empirical model of evidence, diverse patterns of knowing could potentially be viewed as theory-guided, evidence-based nursing practice. Specific modes of inquiry would then need discrete expressions of evidence to build such theories that would “Collectively . . . constitute the ontological and epistemological foundations of the discipline of nursing” (Fawcett, et al., 2013, p. 315). In chapter 25, Pipe describes how the use of a nursing leadership model to integrate evidence-based practice simultaneously facilitates the transition to theory-driven practice. Pipe, Wellik, Hansen, and Martyn (2005) demonstrate how a change implementing Watson’s theory of human caring in nursing practice empowered nurses’ behaviors for ensuring patient safety and optimizing health outcomes.

The final part of this book addresses the future of advanced nursing practice. Kenney’s thought-provoking and well-informed article in chapter 28, addresses the relevance of nursing knowledge and use of eclectic models and theories in nursing centers. Indeed theory guides practice. Kenney asserts that all professional disciplines have their own knowledge base, yet she advocates that nurses use shared relevant models and theories. This reviewer questions if nursing needs to revisit Johnson’s (1968) “inquiries into the nature of knowledge required for nursing practice and . . . the problem of nursing’s objects in scientific investigation” (p. 207)? Rather, one would hope that nursing honors the works of its predecessors and contemporaries given the current nursing paradigmatic perspectives and the focus of the discipline. With Meleis (1993) this reviewer ponders if education of advanced nursing practice forms junior doctors, psychologists, sociologists, or pastors instead of senior nurses. As a process of coming to know and in light of the advancement of nursing science, is the discipline better off to duplicate or to innovate? Simply put, Parse (2001) advocates for innovation through “inquiry as sciencing . . . that purports to study human experiences (p. 1), whereas Johnson (1968) says,

In the sciences that deal with man’s interactions, we still have unburned witches to deal with. There are many wrong turns ahead in these sciences—but it is an essential of science to blunder down some of these wrong turns, to develop and test hypotheses. That is the way we get ahead. [Nursing science] must not be thrown down the drain because of some of the essential blundering that will make real progress possible. (p. 209)

In chapter 30, Arslanian-Engoren, Hicks, Whall, and Algase (2013) concur by explicitly stating, “nursing’s unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge” (p. 361). While one might agree with the authors’ (Arslanian-Engoren et al., 2013) assertion that “to ignore nursing’s scholarship is to deprive an emerging generation of practitioners and scientists of nursing’s foundational knowledge and to impair the further building of knowledge” (p. 364), this reviewer queries the authors choice advocating Reed’s “ontological perspective that synthesizes and unites […] various views” (p. 364). While Parse (1987) clearly delineates two major paradigms in light of assumptions about person and health, goals of nursing, and implications for research and practice, Adam (1983) reports criteria related to social congruence, signification, and utility of the nursing profession. For example, in light of pursuing disciplinary knowledge in service to humankind, this writer questions, What are the values underpinning the philosophical and theoretical perspective guiding advanced nursing practice?

In chapter 29, Reeder posits that inquiries conducted from a positivist science perspective isolates perceptible sense entities of the physical world from the lived world context, whereas knowledge arising from a unitary perspective grounded in a phenomenological view provides different access and exploration of the life-world. Reeder (2013) states that evidence in the year 2050 will call for knowledge related to “cosmic patterns of change in the life world . . . [that] could be achieved through the process of pattern recognition” (p. 353). Reeder advocates that evidence that reflects the tenets of intentionality and choice grounded in human sciences contributes to the education of advanced nursing practice. Bunkers in chapter 31 posits foundational tenets in guiding the framing of nursing knowledge for the nurse scholar of the 21^st century. These tenets highlight three essentials processes: perpetual curiosity, a focused commitment, and a willingness to risk challenge (Parse, 1994).

Cody’s (2013a) 5^th edition of Philosophical and Theoretical Perspectives for Advanced Nursing Practice offers teachers of advanced nursing practice an opportunity to engage with students in a rich dialogue in “potentiating integrity [in] . . . strengthening a oneness of purpose” (Parse, 2004, p. 35) based on a congruent ontological-epistemological-methodological link to further the advancement of nursing science. It is incumbent on nursing educators to address the diversity and richness of the work done by their predecessors, envisaged by contemporary scholars, and the yet to be revealed successors in light of the discipline’s service to humankind. While evidence based on logical positivism does not convey the value of nursing in its social mandate, a deep understanding of human science will guide advanced nursing practitioners to propel the transformation of nursing practice in any locale where humans freely choose to cocreate health. For the survival of the discipline of nursing, philosophical and theoretical nursing knowledge can only be acquired through formal study of the discipline.