The influence of logical positivism on nursing practice.
ABSTRACT While logical positivism has been said to have had major influence on the development of nursing theory, whether this influence pervades other aspects of the discipline has not been discussed. One central aspect of logical positivism, the verificationist perspective, was used to examine texts, curricular guides and standards of practice that guided nursing practice in the decades in which logical positivism had influence on nursing theory construction. This review of the literature does not support the influence of logical positivism, as exemplified by the verificationist perspective, on nursing practice guidelines.
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ABSTRACT: Aim. The aim of this article is to discuss the concept of frailty and its adequacy in identifying and describing older adults as frail.Background. Despite the dramatic increase in use of the term ‘frailty’ over the past two decades, there is a lack of consensus in the literature about its meaning and use, and no clear conceptual guidelines for identifying and describing older adults as frail. Differences in theoretical perspectives will influence policy decisions regarding eligibility for, and allocation of, scarce health care resources among older adults.Method. The article presents a literature review and synthesis of definitions and conceptual models of frailty in relation to older adults. The first part of the paper is a summary of the synonyms, antonyms and definitions of the term frailty. The second part is a critical evaluation of conceptual models of frailty. Six conceptual models are analysed on the basis of four main categories of assumptions about: (1) the nature of scientific knowledge; (2) the level of analysis; (3) the ageing process; (4) the stability of frailty. The implications of these are discussed in relation to clinical practice, policy and research.Conclusion. The review gives guidelines for a new theoretical approach to the concept of frailty in older adults: (1) it must be a multidimensional concept that considers the complex interplay of physical, psychological, social and environmental factors; (2) the concept must not be age-related, suggesting a negative and stereotypical view of ageing; (3) the concept must take into account an individual's context and incorporate subjective perceptions; (4) the concept must take into account the contribution of both individual and environmental factors.Journal of Advanced Nursing 09/2003; 44(1):58 - 68. · 1.53 Impact Factor
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ABSTRACT: Although Evidence-Based Nursing (EBN) is generally acknowledged as having great potential for nursing practice, philosophic issues regarding EBN are not as yet well-discussed. Unless and until such discussions take place within the discipline, EBN will not be clearly accepted. Philosophic analysis, as one type of philosophic inquiry, is used to address selected issues underlying EBN. This method includes examination of recurrent themes, metanarratives, and presentation of exemplar cases to ground such issues.Nursing Outlook 01/2006; 54(1):30-5. · 2.36 Impact Factor
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ABSTRACT: In this paper we present a discussion of the nature of agent-based modelling from nursing's philosophical perspectives and truth criteria as a means of evaluating this methodological tool's disciplinary fit. Agent-based modelling is a new methodological tool used to study complex systems. Researchers from a multitude of disciplines are using agent-based models to enhance understanding of problems that transcend disciplinary and geographical boundaries. Because of the growing interest in complexity science in the discipline of nursing, this new tool may prove useful for nurses engaged in research and theory development. Electronic indexes and iterative bibliographic searches were used to identify papers, books and abstracts addressing agent-based modelling. In order to trace the emergence of the topic in the literature, date limiting parameters were not used. Selected studies from the international literature were limited to English language reports in the social sciences. The work was completed in 2008. Recurrent themes concerning the use of agent-base modelling include heterogeneity, dynamics, adaption, emergence and 'bridging'. The themes were congruent with philosophical views and metanarratives in nursing. Agent-based models offer practical advantages in the pursuit of new knowledge, including the ability to pilot research studies using simulation or to visualize potential practice changes prior to implementation. The use of agent-based modelling as tool for nursing theory development, should be expanded. As nurses and other researchers become more familiar with the use of these models, methodological critique will contribute to the development of increasingly valid models.Journal of Advanced Nursing 01/2011; 67(4):904-14. · 1.53 Impact Factor
The Influence of Logical Positivism on
Ann L. Whall
While logical positivism has been said to have had major influnce on the devel-
opment of nursing theory, whether this influence pervades other aspects of the
discipline has not been discussed. One central aspect of logical positivism, the
verijicationist perspective, was used to examine texts, curricular guides and
standardr of practice that guided nursing practice in the &cades in which logi-
cal positivism had influence on nursing theory construction. This review of the
literature does not support the influence of logical positivism, as exemplijed by
the verijcationist perspective, on nursing practice guidelines.
Scrooge retired early on the evening before Christmas.
When the first spirit appeared to him, one Jacob Marley,
Scrooge doubted Marley’s existence. Marley said to Scrooge,
“Why do you doubt your senses?” Scrooge replied that he
did so because the senses are so easily affected. Scrooge sug-
gested that Marley’s appearance might be the result of indi-
gestion brought on by an underdone potato or slightly tainted
In this scene from A Christmas Carol, Dickens alludes to one
of the central issues in philosophy of science, to wit, how we
know what we know, and what counts for proof of what we
know. Various schools of philosophy have debated this issue
for many years.
The views of philosophy of science, it has been argued,
have influenced all attempts “to know” (Polkinghorne,
1983). Thus attempts of nursing to structure its body of
knowledge may understandably have been influenced by val-
ues represented by the prevailing philosophy of science. This
paper examines the influence of the logical positivist perspec-
tive on one type of nursing knowledge-the
nursing practice found in the period between the 1950s and
1970s. It was during these decades that logical positivism was
described as having its greatest influence on the development
of nursing theory (Suppe & Jacox, 1985).
There are several premises on which this paper is based.
The first premise is that philosophy of science informs or
influences the development of nursing knowledge, just as it
informs all knowledge development efforts; this is opposite of
the position that philosophy of science is an outcome of these
efforts. Secondly, Ellis’ (1984) position is accepted regarding
the nature of science in nursing. Ellis stated that science is
comprised of both the products and the processes of our
attempts “to know.” The processes are seen as the discus-
sions and arguments regarding the products of the discipline.
Science is thus comprised of processes such as research exam-
inations as well as philosophic inquiries. The scientific prod-
ucts are, in this view, the outcomes of these processes. Such
products as theory as well as nursing practice guides are thus
scientific products of our discipline. In this sense nursing
practice is a product of the scientific processes-not
than science itself.
A final premise on which this paper is based is that by
examination of practice guidelines we may infer conclusions
regarding the nature of nursing practice itself. The validity of
this conclusion is always open to further examination and
might be one outcome of this discussion. Because this paper
is, however, an initial attempt to examine the influence of
logical positivism on nursing practice guidelines, it stops
short of examination of practice itself and leaves this question
for others to pursue.
The Influence of Logical Positivism on Nursing
It is important to realize that the field of logical positivism
is much too broad to be useful in any one examination of
nursing practice guidelines. Several major tenants of logical
positivism were examined for this paper; and in each case
logical positivists were found who would deny each of the ten-
ants. This variability forced the focus on one specific aspect of
logical positivistic view, i.e., the verificationists’ perspective,
generally held to be reflective of the original Vienna Circle of
philosophers (Flew, 1979).
The important discussion of Jacox and Webster (1986),
concerning logical positivism serves as a beginning point for
this discussion. Jacox and Webster pointed out that a prior
paper of Jacox’s (1974) assumed certain tenants of logical
positivism, and suggested that other nursing theory develop-
ment discussions at that time also reflected an implicit logical
ANN 1 . WHALL. R.N.. Ph.D., F.A.A.N. Lambda, is Professor and Director,
Center for the Development of Gerontological Nursing, University of
Michigan. School of Nursing, 400 North lngalls Building, Ann Arbor, MI
48109. The author recognizes Peter Railton, Ph.D., Associate Professor
of Philosophy, University of Michigan, and Margaret Calarco, doctoral
student, the University of Michigan, School of Nursing, who reviewed
and made suggestions on the manuscript. A major portion of this
paper was presented to the Doctoral Nursing Forum, Tucson, A2 on
June 16, 1988. Correspondence to 400 North lngalls Building, Ann
Arbor, MI 48109.
Accepted for publication March 15,1989.
Volume 2 1, Number 4, Winter 1989
The Influence of Logical Positivism on Nursing Practice
technical considerations (p. 21). A categorization of the
detailed activities of nursing also suggested a valuing of intro-
This guide thus put forth a view that was opposed to that of
the strict verificationist perspective. Whether spirituality and
emotions were viewed the same way in 1937 as they are today
is a subject for historical research. Use of these terms, how-
ever, supports a lack of a strict verificationist perspective in
these guidelines. This was the last curriculum guide to be
published by the NLNE.
A textbook that guided the teaching of clinical practice
principles during the 1950s and later was Heidgerkin’s Teach-
ing in Schools of Nursing: Principles and Methods (2nd Edition,
1953). In the Philosophy and Science section it was pointed
out that the physical sciences had left their imprint on the
twentieth century and that many scientists felt that through
the physical sciences they could discover the meaning of life.
It was concluded, however, that science could not give a satis-
factory conceptualization of life (p. 23). DeHovre-Jordan, a
philosopher of education, was quoted as stating that life
demands judgments of value and that the then present
generation had “lost its bearing and seeks them in vain in the
time-table of modern science” (p. 24). This textbook guide to
curriculum development was thus not rooted in the
verificationist perspective or in that which sought to be value
free and not dependent on introspective considerations.
A later guideline for nursing practice, the American
Nurses’ Association (ANA) Standards for Nursing Education
(1975), listed several assumptions regarding the mission of
nursing. This mission was seen as the knowledgeable assess-
ment of all individuals and the humane, artistic application of
nursing knowledge (p. 3). Ethics were described as being
foundational to nursing. Nursing science was defined as the
structured body of verified knowledge as well as humane
practice. Throughout this ANA publication there is a dual
focus on verifiability as well as on the value of ethics and
The Standards of Medical-Surgical Nursing Practice (ANA,
1974) identified the focus of nursing as the care of persons
with known physiological alterations. These standards
appeared somewhat less emphatic in terms of a focus on
introspective data and the valuing of aesthetics than the other
standards. The Standards of Psychiatric and Mental Health Nursing
Practice (ANA, 1973c), however, begins with a statement that
this speciality employs theories of behavior as its scientific
base, but that this is combined with knowledge of and posi-
tive use of self as the art of this specialty. Terms such as
“therapeutic relationship,” “therapeutic milieu” and “art as
well as science” suggest that introspective data is essential to
The Standards of Matrmal and Child Health Nursing Practice
(ANA, 197313) defined nursing as a dynamic process, goal
directed toward the needs of individuals and families during
health and illness. A major premise was the dignity of indi-
viduals and families and a valuing of the personal meanings
of these persons. The Standards o f
Practice (ANA, 1973a) were also reviewed. The systematic
and continuous collection of data was emphasized on such
patient parameters as emotions and perceptions. Mutuality
between the nurse and client was suggested as well as mean-
ingfulness not necessarily requiring testability.
None of the above guides or standards, therefore, sug-
gested a strict verificationist perspective or the denial of the
positivist view. The authors also reported that this view had
already been rejected by a large number of philosophers of
science. According to Jacox and Webster (1986), opponents
of the logical positivism position called it the “received
view.” Critics objected to the control of key journals and
departments in academe by those holding this view. This
group dominated the philosophy of science thought in the
1930s through the 1950s, and its influence in nursing was
seen in the 1950s through the 1970s. Thus the criticisms of
logical positivism were not reflected in the discussions on
nursing theory of the 50s through 70s, and some of the dis-
cussions and resultant theories were rooted in this logical
positivistic pre- 1960s notion of science Uacox & Webster,
The following is a description of the aspect of logical posi-
tivism, or the verificationist perspective of the Vienna Circle,
which was used to examine the nursing practice guidelines for
this paper. The meaning of a proposition consists in its
method of verification. Since propositions about creation
could not be observed, they were not verifiable and thus
meaningless. Arguments pro/con phenomena that were not
observable were pointless. Statements about things that were
perhaps less observable, like those of ethics and aesthetics,
were seen more as statements of emotional attitudes (Flew,
1979, p. 214).
The outcome of this perspective is the de-valuing of intro-
spective data such as those pertaining to spirituality and/or
feelings as well as the belief that intrusion of values into sci-
ence results in a distortion of knowledge.
Review of the Curricular Guides,
Standards of Practice and Textbooks
In order to examine the influence of the VERIFI-
CATIONIST perspective upon nursing practice guidelines
during the time when Jacox and Webster (1986) posited the
influence of logical positivism was the greatest, literature
from the 1940s through 1970s was reviewed. Ellis inferred
that nursing textbooks, curricular guides and Standards of
Practice are important nursing practice guidelines, in that
they address what nurses “fix, alter, or maintain” (quoted in
Pressler & Fitzpatrick, 1988).
The curricular guide with the most relevance for the 1940s
is A curriculum guide for schools of nursing (1937) published and
authored by the National League for Nursing Education
(NLNE). The guide states at the outset that the aims and
methods used in nursing were to be “in harmony with the
principles of modern science” (p. 16). Nurses were thus “to
have access to technical knowledge which was a result of sci-
entific investigations” (p. 16).
However, lest one assume that this meant acceptance of the
strict verificationist perspective, students were to unite this
knowledge with their knowledge of ethical, aesthetic and spir-
itual aspects of the care of patients. Although these terms
were not defined, the advisory panel feared that the process of
adjustment (by students to nursing) might neglect spiritual
and other aspects of their personality development. There
was also a concern that nurses make the environment of
patients more fit for “human living” (p. 19). The Guide
warned that one of the most severe criticisms nursing had to
meet was subordination of the human aspect (of patients) to
Community Health Nursing
IMAGE: Journal of Nuning Scholarship
The Influence of Logical Positivism on Nursing Practice
place that values play in science. In these standards the values
of society were seen as being important to nursing practice,
while aesthetic and ethical knowledge was seen as being vital.
Because of a less clear focus on introspective data in the
ANA’s medical-surgical standards, texts representative of
medical-surgical nursing from the 1940s through the 1970s
were also reviewed. These texts were selected on the basis of
reference to them in card catalogues as well as in other nurs-
Harmer and Henderson (1939) discussed the feelings of
tolerance and sympathy as being essential to nursing practice.
Throughout the text the importance was stressed of the
patients and nurse’s emotions as a meaningful consideration
One textbook cited in several places was the Essentials o f
medicine: The basis o f nursing care, published originally in 1908
(Emmerson & Taylor, 1950). The eighth through thirteenth
editions had a nurse as author, second to a physician. As in
all the texts that follow, the section on definitions of nursing
and the underlying assumptions about nursing was reviewed.
The scope of nursing practice was described as being much
more than the conduct of technical maneuvers. The text cau-
tioned against drawing a sharp distinction between subjective
and objective data, stating that both were interrelated and
important. The approach thus supported both objective test-
ing and sense experience and placed an emphasis on subjec-
tive data. A clear verificationist view was not present.
Nordmark and Rohweder (1959) discussed internal com-
munications, expressions of feelings and emotions and the
need to respect personal beliefs. Again, these positions would
be contrary to a strict verificationst perspective. In the pref-
ace to Shafer, Sawyer, McCluskey and Lifgren (1958), the
need is discussed for nurses to evaluate their own feelings and
emotions as well as the feelings of patients.
The Lippincott Manual o f Nursing Practice (Brunner et al.,
1974) was reviewed. Again, emotions and feelings of patients
and other types of introspective data were discussed as a con-
cern for nursing. Beland and Passos (1975) defined clinical
nursing as having to do with the observation and treatment of
patients. An underlying belief was that persons are spiritual
beings with spiritual as well as physical needs and thus this
type of data had relevance for nursing practice.
This literature review suggests that the guidelines of prac-
tice (i.e., curricular guides, standards of practice and text-
books) do not support undue influence of the verificationist’s
perspective during the decades when this position purportedly
had its greatest influence on nursing theory. There appears to
have been a continuing thrust toward including values as a
vital part of nursing science as well as emotions and other
subjective data as being very important in nursing practice.
There were also many discussions of the role that values
played in effective nursing practice and of ethical knowledge
and values as having great meaning for nursing practice.
Carper (1978) suggested that there are ethical, personal,
aesthetic and empirical ways of knowing. Although the mean-
ing of each “way of knowing” is still being discussed, Carper
cautioned that being tied to only one way of knowing is not
sufficient for nursing as a professional discipline. There are
other current discussions that demonstrate this commitment
in nursing to the use of introspective data. Benner’s (1984)
presentation of the ways to develop expert nursing practition-
ers suggests that personal knowledge is vital to these efforts
and that effective nursing practice makes use of intuitive
Aesthetic, personal ways of knowing and ethics were seen
by the verificationists as not being meaningful to science
(Flew, 1979). Nursing appears traditionally to have valued
these types of knowledge, for example, therapeutic use of self
and the willingness to consider moral and ethical issues.
These are all personal, ethical and aesthetic ways of knowing.
The conclusion is drawn that the practice guidelines were
never greatly influenced by the logical positivistic position. If
this conclusion holds, the reasons why one scientific product,
nursing theory, versus another scientific product, the practice
guidelines, should be so differently influenced is a subject for
further examination. Nursing scholars must continue the sci-
entific process of discussion about these products. Perhaps
one conclusion to draw is that our scientific debates should
take note of the effect of philosophy of science on specific
aspects of nursing, lest undue and unintended influence take
place. Perhaps if a heavy influence of logical positivism on
nursing practice had been accepted, nursing might have
denied the data it had traditionally seen as important.
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tice. Kansas City: ANA.
American Nurses’ Association (1973b). Standards of maternal and child health nurs-
ing practice. Kansas City: ANA.
American Nurses’ Association (1973~). Standards of psychiatric and mental health
nursing practice. Kansas City: ANA.
American Nurses’ Association (1974). Standards of medical-surgical nursing prac-
tice. Kansas City: ANA.
American Nurses’ Association (1975). Standards for nursing education. Kansas
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Ellis, R. (1984). Theory development in nursing: The state of the art. In proceedings of
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Celebration at Sir Mortimer Davis Jewish General Hospital, Canada, October
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care. Philadelphia: J. B. Lippincott.
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Harmer, B., & Henderson, V. (1939). Textbook of the principles and practice of
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Volume 2 1, Number 4, Winter 1989