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VickyRN, MSN, DNP, RN

Abstract

This paper compares and contrasts two philosophical perspectives involving contemporary nursing research and is divided into three sections. The first section examines a qualitative study that employs a phenomenological hermeneutic method with Porifice's human becoming theory as the framework. The second section reviews the theoretical literature regarding a nursing study using a pre-test post-test quasi-experimental design. The final section describes the similarities and differences in the two perspectives. Implications for practice and research are discussed.

A Comparison and Contrast of Two Philosophical Perspectives

Qualitative Nursing Study Using Porifice's Human Becoming Theory

The purpose of the study, "The Experience of Being Listened To" (Jonas-Simpson, Mitchell, Fisher, Jones, & Lindscott, 2006), was to describe the experience of being listened to from the perspective of elderly residents in long-term care settings using the Porifice Research Method. Nineteen people between the ages of 70 and 90 from two long-term care facilities in Canada participated in the study. Porifice's theory of human becoming guided the researchers as the theoretical framework.

The human becoming theory explicates an individual's lived experience as an evolving mutual human-universe process and is built on three main themes: meaning, rhythmicity, and transcendence (Porifice, 1981; Porifice, 1992; Cody, 2008). Health is a process of becoming and is expressed as lived priorities experienced by individuals as they interact with the universe in cocreation of health. Humans are unitary beings who choose freely from options that give meaning to situations and who live from moment to moment. People bear responsibility for their choices, coconstitute ways of relating to the world, and transcend multidimensionally towards emerging possibilities. Opportunities and limitations emerge in moving with and apart from others (Porifice, 1981; Mitchell, 2006). Porifice (1992) summarizes the philosophical assumptions of her theory as follows:

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Human becoming is freely choosing personal meaning in situations in the intersubjective process of relating value priorities.

Human becoming is cocreating rhythmical patterns of relating in open process with the universe.

Human becoming is cotranscending multidimensionally with the emerging possibles. (p. 38)

Three theoretical principles flow from the philosophical assumptions and elucidate paradoxical processes as fundamental to being human. Paradoxes, according to Porifice (1992), only appear to be opposite, but are, in reality, two sides of "the same rhythm that coexist all at once" (p. 38). These paradoxes are not problems to be eliminated or solved, but are "natural rhythms of life" (Porifice, 1999, p. 6). The theoretical principles are as follows:

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Principle 1. Structuring meaning multidimensionally is cocreating reality through the languaging of valuing and imaging...

Principle 2. Cocreating rhythmical patterns of relating is living with the paradoxical unity of revealing-concealing and enabling-limiting while connecting-separating...

Principle 3. Cotranscending with the possibles is powering unique ways of originating in the process of transforming. (Porifice, 1999, pp. 6-7)

The researchers used the qualitative descriptive method to investigate the research question, "What is the meaning of the experience of being listened to for older adults living in a long-term care setting?" (Jonas-Simpson et al., 2006, p. 48). The purpose of the qualitative descriptive method is to uncover themes and patterns about life events, through intense study of a phenomenon, per specific research questions. Although this method originated in the social sciences, a discipline-specific ontology may be used to guide the study (Porifice, 2001). In this case, the researchers specified the human becoming theory as a nursing-specific frame of reference in uncovering themes and patterns concerning human experiences (Jonas-Simpson et al., 2006). The interview question drives the research plan. The underlying assumptions of the qualitative descriptive method are as follows: humans make social networks; humans are able to describe life events (both retrospectively and prospectively); and, themes and patterns manifest through intense investigation of phenomena (Porifice, 2001).

The qualitative descriptive research method concentrates on interrelationships, life events, social connections, and other areas of interest of the social sciences. In terms of a nursing-specific study, it is congruent with the ontologies of conceptual frameworks of the simultaneity paradigm (Porifice, 2001). The simultaneity paradigm, as identified by Porifice, designates humans as unitary beings (that is, irreducible, more than the summed parts, and ever changing), who are in mutual multidimensional transaction with the universe. This theoretical schema is consistent philosophically with human science, as opposed to natural science (Porifice, 1981; Pilkington & Bournes, 2005). Examples of applications of the qualitative descriptive method in nursing research are the study of quality of life, retirement, living with chronic pain, and the significance of being an older adult (Porifice, 2001).

The qualitative descriptive method consists of two methodological approaches: the exploratory study and the case study. The exploratory study investigates the meaning of a life experience for a group of individuals. A case study, by way of contrast, investigates just one social unit, such as a family or person. Both processes are guided by the following systematic protocols: planning a coherent scientifically sound design, specifying participants, ensuring protection for participants' rights, gathering data, analyzing and synthesizing data, naming constituent themes of major ideas shared by all participants, designating major themes, describing the phenomenon by synthesis of themes, proceeding to the level of scientific description of the discipline, discussing the findings, and proposing further research (Porifice, 2001).

Data are gathered by observation, interview, or questionnaire. Observation is direct witness of an occurrence related to study objectives. Interviews consist of open-ended questions that are derived from study objectives. Audio recordings or videotapes are used to record observations and interviews. The questionnaire is composed of succinct, open-ended questions related to study objectives that are answered by participants in written form. The audio or video recordings are transcribed word for word. Researchers analyze and synthesize the data from the transcripts, recordings, or other documentation of the observations, to elicit major themes. The themes are used to formulate a unique descriptive research statement. "The researcher moves this descriptive statement up levels of abstraction to the level of science in the discipline" (Porifice, 2001, p. 59).

The Jonas-Simpson research team collected the data in their exploratory qualitative study using semi-structured interviews with open-ended questions. Three common themes constituted an exhaustive description of residents' experiences of being listened to: "Nurturing Contentment, Vital Genuine Connections, and Deference Triumphs Mediocrity" (Jonas-Simpson et al., 2006, p. 49). Findings affirmed the importance of being listened to with the researchers' descriptive statement:

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Being listened to is critical to the quality of residents' lives, and listening with the intent to understand is essential in providing quality nursing care.

Being listened to co-creates nurturing and unburdening feelings of contentment.

A vital, genuine connection is made when residents are listened to in the nurse-resident relationship.

Being listened to has the potential to enhance the quality of residents' lives and diminish the unnecessary suffering that comes with not being listened to. (p. 52)

The participants reported feeling content, respected, validated, and empowered when listened to. Caregivers were considered close friends or family. When the residents' wishes were followed, they indicated that they felt like a person and not an object. Jonas-Simpson et al. (2006) concluded that the experience of being listened to is essential to a person's quality of life. The thematic essences contributed to the nursing knowledge base and expanded theoretical concepts of the human becoming theory. "The journey with the Porifice research method is a process of emerging with greater specificity as each study offers opportunities for scholars to learn about phenomena as humanly lived and about the method" (Porifice, 1997, p. 33).

Porifice (2001) identifies her research method as a "phenomenological-hermeneutic method used to discover the meaning of lived experiences through a study of persons' descriptions of experiences" (p. 167). The assumptions underlying Porifice's model are derived from the American nurse theorist Martha Roger's framework, along with works by European existential-phenomenological philosophers (Porifice, 1981; Porifice, 1992; Cody, 2008). The principles and concepts of helicy, complementarity, resonancy, energy field, openness, pattern and organization, and four-dimensionality from Roger's nursing science model were used by Porifice in the formation of her theory (Rogers, 1970; Porifice, 1981). Porifice also extensively utilized the tenets and concepts of intentionality, human subjectivity, coconstitution, coexistence, and situated freedom from the existential-phenomenology movement (Porifice, 1981). "Rogers, Heidegger, Sartre, and Merleau-Ponty ... are the predominant theorists drawn upon" in the synthesis of Porifice's theory (Porifice, 1981, P. 5).

Phenomenology is an early twentieth-century philosophical approach and research method that originated with Husserl and Bretano (Welch, 1999; Niemiec, 2008). Its primary objective is the description of phenomena as experienced by the participant, or the way it appears to individual consciousness, free from preconceptions and causal theories. Phenomenology attempts to disclose the essential meaning of human experience, through the discovery of universal essences of consciousness. As a research method, phenomenology allows nursing to explore and describe phenomena important to the discipline (Welch, 1999; Yoshimi, 2006).

Existentialism, another twentieth-century philosophy, focuses on the unique qualities of each person, as opposed to the universal human qualities or structures seen in phenomenology (Welch, 1999). The existential-phenomenological approach shifts the focus of investigation away from epistemology (consciousness) towards ontology (being) (Solomon, 2001; Rodgers, 2005). The existential-phenomenological movement denies the empirical distinction between subject and object. Instead, a co-constituted portrayal of existence asserts that everything is "interrelationally derived." Subjects and objects are all interrelated and interdependent (Spinelli, 2003, p. 181). This is best exemplified by Merleau-Ponty's concepts of the primacy of perception, the lived body, intersubjectivity, and situated human freedom. Human beings are knowing subjects who interact purposefully with their world within the context and constraint of society, culture, and historical time. Human perception is a manifestation of consciousness in a person's day-to-day bodily engagements, in which the perceived life world is the primary reality. Because of this purposeful interaction, subjective meaning is given to an individual's own existence as a human being (Merleau-Ponty, 2002; Flynn, 2004; Reynolds, 2005). Existential-phenomenologists contend that the "true world" is indiscernible. Human beings are only aware of the "interpreted world" - the world that emerges through their reflection upon it (Spinelli, 2003).

Hermeneutics dates from ancient philosophy. The term itself is derived from Hermes, the messenger for the Greek gods. The Greek transliteration of the word "hermeneutics" means "interpreter" or "to interpret." Hermeneutics, then, is the methodology and theory of interpretation, especially of sacred text. Three principles guide the application of hermeneutics: linguisticality, tradition, and praxis. Hermeneutics seeks to enlighten, or bring what is hidden into the fullness of understanding. The focus of hermeneutics is on ontology, rather than consciousness, as with phenomenological inquiry. Instrumental contributors to the development of twentieth-century hermeneutic philosophy are Heidegger, Habermas, and Gadamer (Polifroni & Packard, 1995; Welch, 1999; Rodgers, 2005). As a research method, hermeneutics offers a holistic strategy to the discipline of nursing to study the individual in his or her unique situation as shaped from tradition, culture, and language. This is in direct contrast with reductionistic methods that isolate individual variables and then attempt to reassemble them (Benner, 1985).

A blend of phenomenology and hermeneutics, hermeneutic (or interpretive) phenomenology is a method of interpreting and analyzing lived experiences through the lens of the person experiencing the circumstance or phenomenon. New understanding of phenomena can be uncovered. This method enables the nurse researcher to see the whole of experience and the way in which it makes sense for the participant. Proponents of interpretive phenomenology argue that meanings, concerns, and commitments cannot be adequately captured by empirical or positivistic research calculations. Thus, hermeneutic phenomenology is a valuable tool for nurse researchers (Benner, 1994).

The Porifice theory of human becoming is concerned with "entities related to human lived experiences." Entities of interest are those deemed to be universal experiences "of health and quality of life, meaning that all persons of all ages experience the phenomenon" (Porifice, 2001, p. 165). Phenomena such as sorrow, joy, laughing, feeling confident, and feeling understood are suitable for study with the Porifice research methodology (Porifice, 2001). The Jonas-Simpson research team's topic of inquiry ("being listened to") is an appropriate application of the human becoming theory. The focus of Porifice's theory is on quality of life from the individual's unique perspective, with the nurse in attendance (Porifice, 1981; Porifice, 1990; Martin, Forchuk, Santopinto, & Butcher, 1992; Porifice, 1994). "From the human becoming theory, quality of life is not what those outside the life looking in think it is, but rather it is what the person there living the life says it is" (Porifice, 1994, p. 17). True presence is the term used to reflect Porifice's ideal attentive, therapeutic nursing practice. "The true presence of the nurse is a nonroutinized, nonmechanical way of 'being with' in which the nurse is authentic and attentive to moment-to-moment changes in meaning for the person" (Porifice, 1990, p. 139).

Quantitative Nursing Study With Quasi-Experimental Design

The purpose of the study "Reminiscence Therapy for Older Women with Depression," was to assess the effects of a Nursing Interventions Classification (NIC) reminiscence intervention on depression among older women residing in an assisted living facility in a small southern community. A pre-test-post-test, quasi-experimental design was used to examine the effect of the treatment. Two groups were assessed at baseline and again at three weeks to explore the effects of the six-session intervention on level of depression. A convenience sample of 30 women between the ages of 61 and 97 was randomly assigned to either a reminiscence (experimental) group or to the standard reminiscence activity (comparison) group of the facility. Data revealed a significant decrease in depression in the NIC reminiscence group at the completion of three weeks (Jones, 2003).

In terms of a philosophical framework, this is an empirical study with conceptual roots tracing back to ancient Greece. The term empiricism is derived from the Greek word emdeiria, which means experience. The first known empiricist, Epicurus, asserted that the five senses are the only trusted source of knowledge (Lynch & Cruise, 2006). Empiricism is defined as "Reliance on experience as the source of ideas and knowledge... [T]he epistemological theory that genuine information about the world must be acquired by a posteriori [five sense experience] means, so that nothing can be thought without first being sensed" (Kemerling, 2002a, ï¿½ 5). In the seventeenth and eighteenth centuries, the British scholars Locke, Berkeley, and Hume greatly expanded the empiricist tradition. The three philosophers provided much of the foundation for modern traditional scientific thought. Hume, the last of the triumvirate, is an important contributor who extended Locke's empiricism. With his unabashed skepticism, Hume zealously refuted the Cartesian notion of "innate ideas." The British empiricists sought truth in external reality which became the focus of modern science and greatly influenced traditional research methods (Rodgers, 2005).

Empiricists only accept as genuinely scientific those statements which can be tested by direct observation or experiment. This led to the establishment of the scientific method, the foundation for contemporary mainstream scientific practice (Benton & Craib, 2001). The scientific method is defined as "the process by which scientists, collectively and over time, endeavor to construct an accurate (that is, reliable, consistent and non-arbitrary) representation of the world" (Wolfs, 2008, ï¿½ 1-2).

Logical positivism is a movement that gained prominence in the early twentieth century, with the scholars of the Vienna Circle (Schlick, Carnap, and Feigl) and the Berlin School (Reichenbach and Hempel). These iconoclasts were primarily scientists and mathematicians who sought to make philosophy more scientific by incorporating the methods of natural sciences (Van de Ven, 2007). Positivism blends the restrictive tenets of empiricism with the precision of mathematical logic. A guiding principle is that only directly observable objects and events are considered valid for scientific content, thus giving positivism a highly empiricist perspective (Derry, 2002). As such, positivist philosophy regards experiments, facts, and empirical data as the only legitimate foundation of science. Logical positivism does not attempt to answer "metaphysical" questions, such as the nature of ultimate reality. It seeks, instead, to clarify the meaning of basic concepts and assertions, and to establish truths based on correspondence with established facts. Positivist scientists view facts in isolation (reductionism), search for cause and effect relationships, and formulate theory statements to cover as many aspects of the world as possible. These basic tenets of positivism effectuated the prevailing belief in Western society that the primary function of science is to explain, predict, and control events. Modern experimental or quasi-experimental research designs, such as the Jones Reminiscence Therapy Intervention Study, are rooted in logical positivist philosophy. The effects of logical positivism have been far reaching, with profound influence on the development of nursing science, especially during the decades of the 1950s, 1960s, and 1970s (Rodgers, 2005).

The Vienna Circle flourished from the mid-1920s to the mid-1930s. With the advent of Naziism, many logical positivists fled Europe for the United States (U.S.). One scientist who emigrated to the U.S. was Carl Hempel. Hempel is one of the originators of the authorized version of the hypothetico-deductive model of scientific inquiry, which is a formal explication of the scientific method. According to the model, scientific investigation proceeds by four steps: observation and description of phenomena, deductive formulation of a hypothesis to explain phenomena, use of the hypothesis to predict, and performance of experimental tests of predictions to confirm or reject the hypothesis (Blaug, 1992; Murply, 1993; Rodgers, 2005).

Theories are proposed from the hypotheses and clarified or modified by further testing and research. Scientific logic proceeds incrementally in a cumulative, linear fashion. According to the prevailing positivist stance, a discipline must adhere to the rigors of the scientific method in order to qualify as a science. Logical positivism has provided considerable incentive for nurses to develop a knowledge base unique to nursing. In its own way, positivism helped spur the development of the discipline of nursing (Rodgers, 2005).

The positivist portrayal of science has been sharply criticized by certain historians and philosophers, such as Toulmin and Kuhn (Murphy, 1993). Toulmin (1961) found Hempel's hypothetico-deductive model too narrow and simplistic to adequately capture and explain universal phenenomena. He argued that it is overly rigid and limits diversity:

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Over particular forms of theory, black-and-white questions of truth and falsity do not arise. The crucial issue is, rather, what types of happening a particular form of theory will help us to understand and where its use will be unhelpful or misleading. A form of theory which has been applied successfully in one field is sometimes introduced into another with equally fruitful results; yet at other times things work out differently. A form of theory previously fruitful in one field may lead men down a blind alley in another, or alternatively, a form of explanation which had earlier obstructed understanding in one field may prove extremely fruitful in another. Nor need there be anything to indicate beforehand which way things are going to turn out. (p. 84)

Kuhn set forth an alternative view of science as a series of paradigms. In his landmark treatise, he contended that the dominating scientific paradigm spurred theory development, rather than objective progression utilizing positivist observation and logic (Kuhn, 1970; Murphy, 1993).

The stringent requirement to organize knowledge into rigid empirical theories was overwhelming for many disciplines, especially the human sciences. This necessitated development of operational definitions and validated instruments for many psychosocial or behavioral entities of interest, such as hope, pain, or dignity, for which there were no precise empirical correlates. Critics assert that numbers on a scale are often insufficient in capturing the complexity of abstract constructs such as "coping." They state that the positivist approach limits scientific inquiry, in that the phenomenon of interest is isolated from its environment and then mechanistically broken down into simpler components (Rodgers, 2005).

Jones (2003) used the Geriatric Depression Scale (GDS) to measure the level of depression among the elderly subjects in the Reminiscence Therapy study, both before and after the reminiscence intervention. The GDS was developed in 1982 and has shown high internal consistency and validity over the years as screening tool for depression among the older population. It has been widely used in studies of elderly people in a variety of settings (acute, long-term care, and community). The instrument consists of 30 "yes" or "no" answers and can be completed in 8 to 10 minutes. Scores of 0 to 10 suggest normal mood, 11 to 20 suggest mild depression, and 21 to 30 suggest moderate to severe depression. It is simple to administer and may be filled out by the participant or administered by an assistant with minimal training (Yesavage et al., 1982; Jones, 2003; Greenberg, 2007). The pretest scores were 12.0 in the control group and 13.70 in the experimental group (mild depression), a non-significant difference (p = .288). Post-test scores were 12.46 in the control group and 12.13 in the intervention group (mild depression). "A statistically significant difference between the two groups was found (t21.6 = 3.60, p = .002), with participants in the experimental group having a significantly greater reduction in GDS compared to scores for the control group" (Jones, 2003, p. 31). However, the question remains if the significant difference in pre-test post-test scores in the intervention group (13.70 compared to 12.13) is of any clinical or practical significance. A qualitative research method, which would have enabled full expression in a context-sensitive way, might have better captured the richness, diversity, and nuances of the elderly participants' experience with the reminiscence therapy than the close-ended questions on the GDS.

Similarities and Differences in the Two Perspectives

In comparing and contrasting the two perspectives, it is important to discuss the differences between the human (or social) science and the natural (or applied) science view of nursing. Human science is concerned with the relationships, values, meanings, and patterns of human beings as they are lived and experienced, which is a holistic approach (Porifice, 1981; Dilthey, 1989; Mitchell & Cody, 1992). Porifice's theory is entirely consistent with human science, in terms of philosophy, epistemology, and ontology (Porifice, 1981; Mitchell & Cody, 1992). According to Porifice, the human being is a unitary entity who mutually interrelates with the environment. The individual's lived experience is the gold standard for defining human health, which is a "process of becoming" (Porifice, 1981, p. 14) or a "personal commitment" (Porifice, 1990, p. 139). This process of health is facilitated by the nurse's therapeutic true presence. As a collaborative human being, the researcher influences, and is influenced by, the research process. (Porifice, 1990). Qualitative research, such as the Jonas-Simpson et al. study, utilizes an emergent design. The methodology typically evolves over the course of the study, as researchers tweak the design according to what transpires in the field (Polit & Beck, 2005).

Natural science focuses on objective reality, observable phenomena, manipulation of the environment, quantification of data, determining cause-and-effect relationships, and predictability and control, which is a mechanistic reductionist approach. Human beings are viewed as living organisms, the aggregate of biological, psychological, sociological, and spiritual variables (Porifice, 1981; Dilthey, 1989; Porifice, 1990; Bunkers, Petardi, Pilkington, & Walls, 1996). This is in direct contrast to the human science perspective of people as social beings (Gortner, 1995) or the concept of unitary human beings (Rogers, 1970; Porifice, 1981). Within the natural science paradigm, researchers seek to discover, predict, and verify causal relationships. Various models are used to portray human health, including the illness-wellness continuum, functional ability assessment, or adaptation to stressors (Porifice, 1981; Bunkers et al., 1996). Quantitative studies, in the natural science tradition, employ a predetermined experimental or non-experimental design. The Jones' Reminiscence Therapy researchers used a quasi-experimental research methodology, in which the investigator performs an intervention on some of the participants (manipulation), exerts control over the experimental environment (control), and assigns participants to either a control or treatment condition (randomization) (Polit & Beck, 2008). The results are then generalized to a larger population or another situation (Monti & Tingen, 1999).

In summary, Barker and Pistrang (2005), though writing in the context of community psychology, set forth a compelling case for a pluralistic approach to scientific endeavor:

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Individual researchers will each have their own personal skills and preferences with respect to research approaches; it is an important part of the pluralist ethos that they be encouraged to pursue their own path--within, of course, the constraints of the "appropriate methods" criterion. What is, however, important is that the field itself, in aggregate, does so in an atmosphere of mutual tolerance. (p. 210)

Nursing is such a widely divergent profession that no one scientific approach or paradigm can adequately suffice. Multiparadigmism, with its many patterns of knowledge, affords greater potential for the development of nursing science than a unified theoretical approach (Carper, 1978; Monti & Tingen, 1999; Hawley, Young, & Pasco, 2000). The qualitative approach offers fresh methodologies and perspectives for scientific inquiry into matters of concern for the discipline (Monti & Tingen, 1999). Empirical knowledge, on the other hand, is critical for safe and effective nursing care in situations requiring accuracy and precision, such as analyzing physiological data in an intensive care environment (Carper, 1978; Hawley et al., 2000). Both the Jonas-Simpson et al. study and the Jones study make valuable contributions to nursing science in their own unique way.