Advances in Nursing Science

Vol. 42, No. 1, pp. 17–27

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Intermodernism
A Philosophical Perspective
for Development of Scientific
Nursing Theory
Pamela G. Reed, PhD, RN, FAAN

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. Key words: intermodernism, philosophy of science, practice, theory structure

A philosophy of nursing science must be judged perspectives of intermodernism as related to

by its capacity to help nurse scholars create better the content, structure, and process of nursing
nursing knowledge.1(p224) scientific theory in the 21st century.

I T is readily accepted that nursing is a pro-

fessional practice focused on promoting
human health and well-being across the life INTERMODERNISM
span. It is less intuitive, though, to consider
that nursing is a scientific practice and per- Intermodernism is so named because it
haps also that “nursing” proper is a real entity, stands in the middle of modern and post-
a complex and dynamic pattern of well-being modern perspectives on science as a post-
with underlying regularities of nature that can postmodern philosophy of nursing science.2,3
be investigated in building knowledge and sci- Traditionally, modern science emphasized
entific theory. Elsewhere, I have described in- value-free objectivity and authority of science
termodernism as a philosophical perspective and the universal truths and permanent na-
for nursing science including a tenet about ture of its theories and laws. Postmodernism
the “inherent nursing processes of well-being raised awareness of nonepistemic contextual
within and among human systems”2(p29) and values in scientific practices and the feminist
the role of practice in knowledge develop- and social theories that informed views of re-
ment and discovery. I revisit these themes ality. Intermodernism builds on intersections
in this article and outline some philosophical of modernism and postmodernism that have
relevance in our post-postmodern era of sci-
ence. Beyond the logical and empirical dimen-
Author Affiliation: College of Nursing, The sions of science, both modernism and post-
University of Arizona, Tucson. modernism share values for critique, reason
The author has no disclosures to report. and rational thought, skepticism, creativity,
reflectivity, and sense of community in knowl-
Correspondence: Pamela G. Reed, PhD, RN, FAAN,
College of Nursing, The University of Arizona, 1305 edge development.4
N. Martin St, Tucson, AZ 85721 ([email protected] From the late 20th century to now, our
.edu). philosophical era can be described as a
DOI: 10.1097/ANS.0000000000000249 post-postmodern period.5 Post-postmodern
17

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 18 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2019

Statements of Significance • Highlights a more inclusive view

What is known, or assumed to be of knowledge development that
true, about this topic: incorporates both scientific and
• For several decades, nursing has professional practices, with
had used a variety of nursing practice as a context for
philosophical worldviews and theory discovery and theory
paradigms that broadly guide validation.
knowledge development and the
substantive focus of the
discipline. philosophers tend to uphold science as the
• Theory development in nursing preferred means for building knowledge but
has proceeded typically as a reject both foundationalism and relativism;
scientific practice separate from that is, a rejection of (a) the positivist no-
a professional practice. tion that there is one stable Truth to be found
• While many disciplines through scientific theorizing and mathemati-
incorporate models and cal logic, devoid of values and metaphysical
mechanisms into their science, abstract concepts, and where scientific expla-
nursing’s extant philosophy of nations are ultimately reducible to physics;
science has not yet embraced or and (b) relativism, which claims truth is con-
encouraged these strategies for structed only as relative to the context, lan-
theory and knowledge guage, culture, or mind. In the chronology of
development. ideas, intermodernism is a post-postmodern
What this article adds: philosophical perspective that supplants 3 tra-
• Discusses a contemporary ditional scientific goals for knowledge that is
philosophical perspective for objective, universal, and permanent with sci-
nursing science called entific goals for knowledge that is “plural, par-
intermodernism, and its tial, and provisional.”6(p207)
implications, for the content and
structure of scientific theory and
for the process of theorizing that SCIENTIFIC REALISM AND NURSING
incorporates new strategies for THEORY
knowledge development.
• Describes a form of scientific A central concern in philosophy of sci-
realism within this new ence that relates to philosophical underpin-
philosophical perspective of nings of nursing science and theory has to
nursing science. do with scientific realism, what really ex-
• Proposes nursing pattern as an ists independent of and as influenced by our
entity for investigation and a constructions from culture, language, and our
substantive focus of theory. mental apparatus, and whether it can be de-
• Discusses 3 types of scientific tected through scientific methods.7 Realism
theory structure from philosophy as a metaphysical belief is keenly relevant to
of science with a focus on the scientific theorizing in nursing because nurses
pragmatic approach for nursing. often deal with what seems like intangibles
• Elaborates how models and of human existence and because nursing the-
mechanisms are relevant to ories subsequently include such concepts in
nursing knowledge their descriptions and explanations of nursing
development. phenomena. The nature of nursing is such
that our philosophical practices must attend

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 Intermodernism 19

to ontological concerns about what exists, in a scientific community and scientific

mind-independent or interdependent reality, methods to control or otherwise ac-
and how we come to understand it. count for these influences help maintain
Intermodernism subscribes to a form of re- needed objectivity.6
alism facilitative of the scientific practices as c. Semantic, our theoretical terms are
well as professional practices of nursing. This truth apt and potentially can provide
philosophical view of realism is pragmatic, accurate descriptions and representa-
perspectival, and naturalized realism.8–10 tions of aspects of the world (objects,
The pragmatic qualifier is based upon the de- events, processes, relations), including
sire that our theories be meaningful and use- those currently considered unobserv-
ful, as Charles Peirce believed that “the con- able. In addition, a pragmatic view
tent of a proposition should be understood acknowledges that the user and her
in terms of (among other things) its ‘practical context influence the meanings of the-
consequences’ for human experience, such oretical terms.
as implications for observation or problem-
solving.”7 It is perspectival in acknowledging
that scientists’ perspectives operate between INSTRUMENTALISM AND
the context-free reality of enlightenment sci- CONSTRUCTIVE EMPIRICISM
ence and value-laden reality of social theorists
to capture partial but relevant aspects of real- Instrumentalism and constructive empiri-
ity in their theories.8,9,11 It is naturalized in cism are 2 empiricist philosophical views that
the belief that theoretical terms indicate prop- are incongruent with the form of realism es-
erties that are not only meaningful and real poused in intermodernism. Scientific theories
but also empirical and can be studied scientif- according to instrumentalism are merely tools
ically. According to intermodernism, nursing for categorizing or predicting observable phe-
scientific theories and models aim to and po- nomena but hold no underlying meaning or
tentially can provide accurate representations truth in their content. The logical empiricists
of aspects of reality, including those currently were strong advocates of this view. Instru-
considered to be unobservable. Disciplinary mentalism was present at least as far back as
knowledge is developed by the failures and the 16th century. In a preface added to Coper-
successes of scientific theories. Three philo- nicus’ 1543 book On the Revolutions of the
sophical components of this form of realism Celestial Spheres, by clergyman Andreas Os-
as related to nursing theory are as follow: iander, readers were instructed to think of
theories “only as predictive tools rather than
a. Ontologic, a metaphysical belief that we as attempts to describe the hidden structure
live in a reality that has structure inde- of nature.”10(p15)
pendent of ourselves except as reality Van Fraassen’s12 constructive empiricism
is mind- and culture-interdependent in expresses similar views about scientific the-
ways that have been or may be uncov- ories in his emphasis on belief only in what
ered by science. is observable to the naked eye. Because the-
b. Epistemologic, where theories yield at ories include unobservables, they can be “ac-
least partial knowledge about aspects cepted” solely for their empirical adequacy
of the world (from cytokines and cells or heuristic value in categorizing and predict-
to spiritual beliefs and social interac- ing but not for any truths they may reveal.
tions). Knowledge of reality encoded Van Fraassen claims that use of scientific
in theories may be influenced by sci- instruments to ‘observe’ phenomena does
entific practices, assumptions, perspec- not qualify as observation because “ob-
tives, and perceptions scientists bring servation is perception, and perception is
to their investigations, but engagement something that is possible for us without

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 20 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2019

instruments.”12(p154) However, discoveries in human healing, health, and well-being as they

cognitive science, neuroscience, and psychol- occur within many contexts, from individual
ogy have expanded our understanding of hu- and biological to social and cultural.
man perception to where we can be quite Homeodynamic principles of unitary nurs-
sure there is no immaculate perception. Fur- ing science and principles of life span devel-
thermore, in reference to a strict empiricist opmental and systems sciences indicate that
view of observability, it seems “epistemo- this pattern is evident in the form of a dynamic
logically perverse and rather chauvinistic to diversity and complexity balanced by organi-
seek to restrict the knowledge claims of sci- zation, occurring within human systems in in-
ence solely to the stretches of nature within teraction with their environment.16,17 A basic
the unaided ranges of those receptor sys- tenet of living systems is that they maintain
tems. There are so many other regions of na- their organization amidst tendencies toward
ture to which our receptors do not have di- disorder and decay by taking in materials of
rect access.”13(p231) Germs, once mystical to lower organization as sources of energy to
Nightingale, became empirical entities with sustain the system and facilitate organization
assistance from the microscope and relevant (growth, healing).
background knowledge. Similarly, the dark Pattern can be manifested in countless reg-
matter in nursing’s reality simply may not yet ularities that are relevant content for nursing
interact with standard apparatus of observa- theories, for example, ranging from biolog-
tion for us to ‘see’ it. ically based mechanisms inherent within hu-
Intermodernism rejects dichotomizing ob- man systems to socially based processes inher-
servables and unobservables since all terms ent in nurse-patient interactions as extensions
are theory-laden14 and interact with the ever- of this ontological process called nursing. If
changing scientific capacity to observe and we consider as real the nursing phenomena
measure phenomena. Realism allows for the- represented in our theories, then a necessary
oretical terms that seem intangible but that next step is to pursue empirical study of how
scientific investigations may reveal as manifes- they function. An epistemological claim (for
tations of human existence. These include suf- building scientific knowledge) is that regular-
fering, self-transcendence, hope, resilience, ities in phenomena may be studied and de-
healing, caring, meaning-making, moral reck- picted in models of mechanisms and other
oning, and many other concepts nurses often processes. Nursing theory, evolving in struc-
deal with that seem intangible but neverthe- ture and process, may be able to accommo-
less can be theorized, measured, and studied. date epistemological views such as this.

PATTERN: REGULARITIES, PROCESSES, STRUCTURE AND PROCESS OF

AND MECHANISMS SCIENTIFIC THEORY

A philosophical assumption of realism is Theories have long been recognized by

that there are stable (in contrast to strict) reg- philosophers of science as carriers of scien-
ularities in human beings and nature that are tific knowledge.18 Theories “magnify under-
discoverable through scientific inquiry into standing, help supply legitimate explanations,
circumscribed situations in the world.15 This and assist in formulating predictions.”19 Scien-
assumption underlies a key ontological con- tific theories’ wide reach spans from knowl-
cept in intermodernism, the nursing pattern, edge production to interventions. They are
as manifested in regularities of interest to mediators between targets (objects, events,
nursing. Pattern is an abstract idea and place- processes) of investigation and the methods
holder for discoveries of regularities associ- of investigating phenomena. A key role of
ated with life processes and mechanisms of theory is in the representation and scientific

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 Intermodernism 21

explanation of reality—the objects, events, cal structure of nursing knowledge where

relations, and processes not directly accessi- theories are organized by levels of abstraction
ble by our senses—through its structure of and particularly where there are rules about
theoretical terms and proposed relationships. deducing or deriving middle-range theories
At bottom, all theorizing faces the challenge from more abstract nursing conceptual
of making reliable and valid connections be- models. They endorse an alternative to this
tween abstract structures and concrete phe- rules-based deductive process between con-
nomena or empirical data about some aspect ceptual models and theories—an alternative
of the world. that is consistent with intermodernism and
Changes in the structure of scientific the- has been active among many nurse theorists:
ories over the past century are reflective of Instead of functioning as sources for deriving
3 major philosophical perspectives from the- nursing theories, nursing conceptual models
ories about language and logic used in philoso- (and similar theoretical systems including
phy of science. These 3 approaches to theory social theory) function more broadly and
structure are as follow: (1) Syntactic, focused importantly to provide philosophical ground-
on syntax (grammar, logic, abstract struc- ings, background assumptions, and values for
ture); (2) Semantic, concerned with meaning theory development.
and representation in theoretical terms; and
(3) Pragmatic, which emphasizes the user
(the theorist’s context of and purposes for Semantic theory structure
the theory). By the mid-1960s, philosophers of science
had widely rejected the syntactic view of the-
ory and supplanted it with the semantic ap-
Syntactic theory structure proach to theorizing, as logical empiricism
Syntactic theory, evident in the logical em- gave way to post-positivism in philosophical
piricist deontological-deductive (D-N) form perspectives of scientific knowledge, lasting
of theory, was dominant during the logical into the 21st century. Semantic theory struc-
empiricist era of science until the mid-20th ture emphasized the meaning and content of
century. This theorizing employed deduction theories and focused on ways to represent re-
from universal law (a “covering” law) and ality through families of models that modeled
relevant conditions to generate propositions. the real world, data, or hypothetical systems.
The D-N view was mostly an argument of Philosophers of the physical sciences par-
logic, inferring that rather than explaining ticularly embraced this approach to theory,
why something existed the way it did. It which often employed mathematical models.
was the logic of sentences in syntactic the- Some eschewed standard theories in favor of
ory sentences, not the meanings of the the- models as the conceptual structure for rep-
oretical terms, that warranted truth. This ax- resenting and explaining phenomena.15 The
iomatic form of syntactic theorizing proved semantic view improved on the syntactic ap-
incompatible with scientific practice, partic- proach in part by acknowledging theory as a
ularly its requirement of universal law, which partial structure of the world and providing
most disciplines other than physics lacked, a structure that links theories, models, and
and its restriction from the study of so-called data in “natural fashion” to build scientific
unobservable entities of increasing interest knowledge.8(p187)
to scientists—entities too small, too fast, too In addition to this semantic approach to
slow, or too large to directly observe or en- theorizing, scientists including nurses used
tities beyond the normal range of human standard hypothetico-deductive reasoning,
senses.19,20 deducing hypotheses or research questions
Philosophers Bluhm21 and Risjord1 identify from law-like generalizations embedded in
logical positivist influences in the hierarchi- theoretical frameworks. Instead of seeking

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 22 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2019

verification of universal truths, scientists and practices of the theorist) and committed
justified their theories through Popper’s to maintaining standard elements of science
falsification. Probabilistic thinking replaced (methods, objectivity, and structure).6,24 A
determinism in understandings of causes and necessary role of the scientific community,
necessary relations among phenomena. then, is to bring social values and emanci-
patory knowing,25 as well as epistemic stan-
dards, into consideration for critiquing and
Pragmatic theory structure eventually accepting or rejecting a theory.
Increasingly, philosophers of science and This expanded boundary of scientific knowl-
scientists found the logic and formaliza- edge strengthens rather than threatens scien-
tion in both the syntactic and standard se- tific endeavors.
mantic approaches to scientific theory too
restrictive—criticizing their “tedious deduc-
PRECISION NURSING AND THEORY:
tion or clever approximation.”15(p185),22 This
MODELS AND MECHANISMS
motivated movement during the 21st century
toward the pragmatic perspective of theory
The intermodern perspective regards the-
structure and process,19 the approach most
ory development as deeply challenging, par-
congruent with intermodernism.
ticularly in striving for theories that explain
Pragmatic theory embraces creative strate-
the why of things, and are more than just
gies in exploration and experimentation that
“empirically adequate” in overall empirical
theorists may use in developing scientific
content. Pragmatic theory (as well as some
knowledge and recognizes the immense va-
semantic theory) accommodates a diversity
riety of purposes and approaches to theory
of strategies, particularly including models
development and the forms that scientific the-
and mechanisms, to meet the challenges of
ories may take. For example, in addition to hy-
developing scientific knowledge about com-
pothesis (theory)-driven research, scientists
plex and dynamic phenomena. Models and
in the omics and other disciplines are engag-
mechanisms, and also for us in nursing,
ing in a form of exploratory experimentation
middle-range theories, provide for a “much
to analyze large data sets for potential theo-
more textured” but also labor-intensive ac-
retical ideas and explanations. Models are still
count of the empirical processes underlying
very much a part of this view, but without
our phenomena.15(p185) Theories can be war-
the formal elements philosophers objected to
ranted by the empirical successes of models
as much too restrictive in the semantic ap-
and the mechanisms they explain. Given this,
proach to theorizing.15,23 The focus of prag-
plus other advantages of models in scientific
matic theory is on more circumscribed situ-
practice, it is prudent for the future of nurs-
ations, whether real-world or hypothesized
ing theory to include models and mechanisms
systems. Its restricted scope is reflective of
in our repertoire of knowledge development
its underlying philosophy emphasizing partial
tools and strategies.1,26
and local truths, usefulness of knowledge, and
diversity in theoretical views in representing
and explaining reality. Mechanisms
Importantly, the pragmatic approach does The mechanist movement in philosophy of
not preclude use of more standard theory de- science emerged in the 1990s, reinforcing the
velopment tools (eg, deduction, induction, shift in discovery and theoretical explanation
and, more often, abduction). But standard em- away from universal law to mechanisms.27–29
pirical evidence is no longer sufficient for Bechtel and Richardson’s 1993 Discovering
developing scientific knowledge. The take- Complexity initiated the movement with their
away point is that pragmatic theories are both interest in developing a post-logical posi-
sensitive to the pragmatic elements (context tivist view on scientific theorizing about the

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 Intermodernism 23

“behavior of complex systems in biology and by the mechanism’s activities or functions.29

psychology.”27(p17) This mechanist perspec- Pattern in nursing, then, is discoverable
tive is embraced by many disciplines from through empirically based regularities mani-
the social sciences, medicine, and physics fested through models that researchers cre-
in studies focused on local contexts of var- ate, construct, test, revise, refine, and so on,
ious types of mechanisms in their interac- in a self-correcting process that serves the de-
tions and regularities.27,29–31 In an interest to velopment of scientific theories.37
apply mechanism more widely across disci-
plines, Illari and Williamson proposed what
has become the consensus definition of a Models: Description and strategy
mechanism as a phenomenon consisting of Creating and then manipulating models in
“entities and activities organized in such research are often central to scientific prac-
a way that they are responsible for the tice and theory development. A model is a sim-
phenomenon.”32(p123) plified description or representation of cer-
While the term “mechanism” clanks too tain regularities governing a natural process
much for some of us who have distinguished or real-world system and is designed inten-
nursing from other disciplines by a holistic tionally for the purpose of representing and
and humanistic philosophy, its meaning in understanding a certain aspect of reality.18,38
contemporary science has moved far beyond Some models incorporate mechanisms. Mod-
the 17th-century perspective of physical phe- els of mechanisms in research span various
nomena and Stephen Pepper’s33 mechanistic levels of living systems, from the molecular
worldview to where they can be comfortably and cellular to the whole organism. Examples
incorporated into nursing science and theory. of systems that are modeled to understand un-
Mechanisms are organized complex systems derlying mechanisms range from cell biology
of dispositions or functions and activities that to astrophysics, from cognitive to social sci-
manifest stable regularities of nature. Mech- ences, from organic chemistry to behavioral
anisms are not necessarily reductionistic or genetics.34 Furthermore, investigators sug-
deterministic and may be described holisti- gest a mixed-mechanisms approach that in-
cally. They are not machines but are products tegrates microbiological, socioeconomic, and
of nature, evolution, and ongoing change. environmental mechanisms of health and
They are not necessarily linear but may un- disease.35,39
dergo nonlinear change. Finally, mechanisms Godfrey-Smith’s38 model-based science ap-
are neither metaphor nor fiction; they pro- proach to model construction provides a cre-
duce measurable effects or outcomes.34 In ad- ative strategy for theorizing that is distinct
dition, there is increasing attention to using from the standard philosophical semantic ap-
mechanisms in a way that accounts for bio- proach to models. Overall, it involves con-
logical systems’ capacity to actively adapt and structing a simplified model that is similar
thrive in their organization and functioning in- to its target (real-world) system in key as-
stead of degrade overtime as their “dissipative pects and then studying and experimenting
energy flows in the environment and within with the model to formulate potential theo-
themselves.”35(p162),36 retical explanations about the real situation.
Of particular relevance for theory is that Research questions and hypotheses are then
mechanisms are explanatory; they assist re- derived from the theoretical model for inves-
searchers in explaining the why behind an tigation, using the findings to further develop
event or process, beyond the what. They ac- and refine theoretical ideas.
complish this not by referring to or describing The theorist’s strategy for constructing a
regularities—nursing has described many reg- model, as Godfrey-Smith38 adapted it from
ularities in human-environment processes— Giere’s earlier work, involves 2 basic steps.
but instead by revealing what is produced These steps address relationships between

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 24 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2019

the Model Description and the Model System, of simulations in computer-based modelling
and then between the Model System and the of complex systems such as the dynamics
Target System, respectively: (1) investigate and levels of nursing units to study hospital
and specify what the hypothetical model sys- safety.) Overall, the pragmatic nature of
tem is; and (2) incorporate the similarities or model-based science accounts for not only
resemblances (relations among and organiza- the model as it represents reality but also the
tion of the components) between the model’s user’s inventiveness in building knowledge—
hypothetical system and the real-world “tar- the theorist’s specific purposes relative to
get system” to be explained. Through this delimited aspects of the world.41,42
procedure, the model’s description specifies
a model, which, in turn, is made to accurately
and adequately resemble the aspect of reality Relationship between theories
of scientific interest. By their resemblances, and models
models provide a partial representation of Including models in theory development
some regularity derived from the real system raises issues about the relationship between
or theory about the system. The user must theories and models debated widely among
take care to ensure that there are relevant sim- philosophers and scientists.15,23,43 Opinions
ilarities between elements in the model and vary. A model may be derived from theory
features in the real world. To accomplish this, or it may function independently of any the-
the user employs strategies of model construc- ory. The perspective of intermodernism on
tion, for example, idealization (by deliberate this matter stands in between these positions
simplifications and distortions of a real sys- to regard models as never completely unteth-
tem in the target) and analogies (by creating ered from theory. While models may seem
sameness or similarities between the real sys- functionally autonomous, they nevertheless
tem and its model in their properties, parts, are linked to theory in a variety of impor-
or arrangement of parts).18 tant ways. Most basically, they stimulate in-
Model-based science is relevant to nursing ventive theoretical thinking about a local sit-
science because it is more compatible over- uation. Models may also be used to modify or
all with knowledge development and theo- refine theories.38,44 Overall, models function
ries in the life sciences than other modeling as mediators between theory and the world to
strategies related to philosophical theories of enable or directly contribute to development
logic, mathematics, and physics. For example, of scientific knowledge.45,46 Models function
the resemblances required in the model-target to represent what the user identifies as the
relation are less strict than those required target—theoretical ideas, sets of data, or par-
by isomorphism. Also, the model is less ab- ticular phenomena.45
stract than the mathematical structures used Similar to semantic-based philosophers,
in modeling strategies of other disciplines. some scholars in nursing have recommended
This approach, whether based upon synthe- using models over theories in nursing
sis of actual data or hypothesized systems, al- knowledge development.1,47 Instead, from a
lows for creativity and close connection to the pragmatic-based approach to theory, I sug-
situation. gest, as have other philosophers,38,42,46 that
Scientists work with a diversity of models; we not abandon theories and also include
models may be composed of a variety of models in our repertoire of conceptual struc-
elements, linguistic, nonlinguistic, or both, tures as useful in inquiry. In addition, we
and they may be physical, material, or can revisit and make more purposeful use
conceptual structures,39 including words, of the theoretical model in knowledge de-
mathematical equations, pictures, diagrams, velopment practices. Models have scientific
computer-generated images, and simulations. content,40 not unlike the theories familiar in
(See Effken and colleagues40 for an example nursing; they display relationships between

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 Intermodernism 25

concepts that have meaning, are testable, and an emancipatory understanding of the knowl-
can represent real-world situations. Accepting edge embedded in and traditionally associated
models and theories as legitimate truth bear- with certain occupational groups dominated
ers in nursing enriches scientific practice by by one gender or class or other factor to bet-
providing a diversity of processes and struc- ter understand their “knowing practices” and
tures for exploring and representing reality. contributions to knowledge.48 By this per-
spective of knowledge, the focus is not prac-
titioners per se but their practices in direct
THE NURSING PRACTICE TURN IN involvement with patients, families, and com-
KNOWLEDGE DEVELOPMENT munities. It is this focus that characterizes the
fullest turn toward practice.
In theorizing about knowledge and con- Nursing practice falls within the ontologi-
texts where science is practiced, scholars out- cal domain of natural processes of healing and
side of nursing have not much considered well-being within and among human systems.
contexts where nursing is practiced. Social Nursing practice is not just an aesthetic pat-
theories and philosophy of science have re- tern; it is an epistemic practice and a critical
formulated traditional views about the prac- source of knowledge for theory development.
tice of science that motivate new thinking Nursing theory is informed by as well as a
about nursing theory. As a nursing philosophy guide for practice. In vivo investigations of
of science, intermodernism inserts into scien- nursing practices in direct involvement with
tific knowledge development another kind of patients and families may lead to discover-
social practice—that of professional nursing ies in healing processes that occur not only
practice. Building on the practice turn initi- between the nurse and the patient and fam-
ated in the last century that informed us of ily but also within the patients themselves—
the human practices of scientists, there is yet patients qua persons. Patients are understood
another turn to be taken. And that is to more not as passive recipients of the knowledge of
deliberately include professional practice in “knowers” in nursing practice but as active
our scientific practices. participants.
The pragmatic movement in theory con- Mechanisms and processes gleaned from
struction along with post-postmodern views these practice-based insights may be the-
expanding understandings and standards of orized and modeled for investigation and
scientific knowledge have paved the way for eventually explained for real-world applica-
more inclusive and creative approaches in tions. Practice is a context for both discov-
science. Among the conditions stipulated for ering and validating scientific theories that
a dynamic and productive scientific commu- explain processes of well-being. This entails
nity was a “tempered equality of intellectual practice-based science and theorizing that not
authority.”6(p206) This condition necessitates only include but also extend beyond Ben-
purposeful inclusion of practicing nurses in der and Elias’49 compelling proposal for the
knowledge development. Nurse practice ac- scientific study of aesthetic knowing. Nurs-
tions and interactions with patients are con- ing needs scientific theory that elucidates not
stitutive, not contextual components of the- only knowing-how but also knowing-why.
ory development. Historically, noted nursing
scholars promoted practice as a place for the-
ory generation: Hildegard Peplau and her cy- CONCLUSIONS: THE SHAPE OF NURSING
cle of inquiry and peeling out concepts in KNOWLEDGE
practice where knowledge becomes nursing
knowledge, Rosemary Ellis’ practitioner as What might nursing theory and theoriz-
theorist, and Donna Diers’ clinical scholar- ing look like in our post-postmodern era?
ship. More recently, scholars have argued for I presented intermodernism as a philosophy

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 26 ADVANCES IN NURSING SCIENCE/JANUARY–MARCH 2019

of nursing science, which included a form sum, scientific theories about nursing pattern
of scientific realism. This philosophical view arise from nursing practices—personal and
has several implications for the content, professional wherever human-environment
structure, and process of scientific theory in processes of health and well-being are
nursing. happening. These scientific theories also
In terms of content, there is an ontological are grounded in values, perspectives, and
claim for a nursing pattern of inherent principles clarified by philosophical views
capacities for healing and well-being within of nursing found in metaparadigmatic state-
individual human beings and among various ments, worldviews, conceptual models,
types of human-environment systems (in- grand theory, and social theory.
cluding the family, community, nurse-patient A key tenet of intermodernism is that pro-
relationship). An epistemological claim is fessional nursing practice is a context where
that this pattern is manifested in regularities theories are not only justified but also discov-
of healing and well-being that occur within ered. It is a more inclusive view of knowl-
and among human systems, detectable in edge development, with essential contribu-
scientific investigation of mechanisms and tions from participants of scientific practice
processes. In terms of structure and pro- and professional practice. The dual nature of
cess, the pragmatic approach to developing nursing as a discipline and a profession pro-
scientific theories includes use of models vides a fertile environment for development
of mechanisms and other processes, and of knowledge. Theory, as it evolves through
integrating relevant social practices and new structures and strategies, endures as the
values into traditional scientific standards. In shape of nursing scientific knowledge.

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