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NSQXXX10.1177/0894318418807945Nursing Science QuarterlyThoun et al.

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Nursing Science Quarterly

Philosophical Theories of Truth and


2019, Vol. 32(1) 43­–48
© The Author(s) 2018
Article reuse guidelines:
Nursing: Exploring the Tensions sagepub.com/journals-permissions
DOI: 10.1177/0894318418807945
https://doi.org/10.1177/0894318418807945
journals.sagepub.com/home/nsq

Deborah S. Thoun, RN; PhD,1 Megan Kirk, RN; BScN, MSc,2


Esther Sangster-Gormley, PhD,1 and James O. Young, PhD3

Abstract
In this paper, the authors explore three philosophical theories of truth and offer a critique of this foundational area of
scholarship for nursing. A brief summary of key ideas related to the three substantial philosophical theories of truth—that
is, correspondence, pragmatism, and coherence—serves to highlight various convictions and commitments that facilitate or
discourage the growth of nursing knowledge in particular ways. The authors conclude that the coherence theory of truth
offers a more inclusive view of truth and best captures and supports the diversity that exists within nursing knowledge and
the regulative ideal to which nursing aspires.

Keywords
nursing knowledge, nursing practice, philosophy, truth

The greatest of all evils is when the young start taking seriously as one aligns one’s practice with particular theories of nurs-
what they read in books. ing and their philosophical underpinnings, aligning one’s
practice with a particular theory of truth provides further jus-
(Ignazio Silone, 1949, p. 145) tification for one’s choice of knowledge bases that guide
practice, which in turn provides good reason for or defense
As nursing advances as an academic discipline and learned of one’s approach to practice, which ultimately is based on
profession, its foundations require greater exploration and personal values and beliefs (Cody, 2013). In this paper, the
scrutiny. As a profession, nursing has certain regulative stan- authors posit that the coherence theory of truth best captures
dards and corresponding competencies to which its members the regulative ideal to which the nursing discipline and pro-
must aspire. In Canada, these include but are not limited to fession aspires and offers a platform from which nurses can
knowledge-based and ethical practice, service to the public articulate their distinct and vital contribution to humankind.
or client-focused provision of service, and responsibility and Although a theory of knowledge may seem adequate for
accountability (College and Association of Registered the development of nursing, the authors contend that it is not
Nurses of Alberta, 2013; College of Registered Nurses of enough: It also is important for nursing to explore various
British Columbia, 2012). Further, these standards generate a theories of truth, to align with a preferred theory, and to
discourse of regulative ideals based on a host of values and understand the implications of this alignment. To be sure,
beliefs, such as client-centered care, compassion, human truth is a very provocative and daring area of exploration,
holism, preeminence of personal beliefs and human living and some would argue that we should leave philosophizing
experience, and primacy of personal choice, that pervade the (exploring theories of truth) to philosophers. However, the
nursing literature. notion of truth, once thought to be the exclusive purview of
As an academic discipline, nursing now has another regu- philosophers, holds vital importance for professional prac-
lative ideal, described as truth. The regulative ideal of a dis- tice decisions and the defense of such decisions as well as the
cipline is the goal toward which it is directed and the way one chooses to generate and extend what qualifies as
standards by which its propositions are judged. Accordingly, nursing knowledge and to live nursing practice. In this vein,
an examination of the foundations of the nursing discipline Anderson (1995) writes, “We are charging headlong into a
requires us to ask whether, and in what sense, truths are new era: a time of rethinking and rebuilding in which beliefs
established or proven. To be sure, such truths live within the about belief are shaken as never before, a time in which
knowledge base or nursing theories that guide the generation
of knowledge (inquiry) and professional practice of nursing. 1
Associate Professor, University of Victoria, Victoria, BC, Canada
Accordingly, goals of practice are intricately embedded 2
Doctoral Student, University of Victoria, Victoria, BC, Canada
within theories of truth, whether implicitly or explicitly. Just 3
Professor, University of Victoria, Victoria, BC, Canada
44 Nursing Science Quarterly 32(1)

issues once left to philosophers—such as the nature of An overview of three substantial theories of truth (corre-
truth—become matters of vital importance to ordinary peo- spondence, pragmatism, and coherence) and their competing
ple” (p. 3). accounts of the sort of conditions under which propositions
Being aware of the philosophical dimensions and impli- are true is presented. An exploration of the manifestation of
cations of various theories of truth enables members of the each theory in nursing, with particular attention on the use-
nursing discipline and profession to think carefully about the fulness of each for nursing, follows.
underpinnings of nursing models, theories, and affiliated
research and to engage in necessary critique of this important
Correspondence
area of scholarship. While it is acknowledged that there are
numerous theories of truth, such as deflationary theories The correspondence theory of truth dates back to the ancient
(including the redundancy and disquotational theories), and Greek philosophers Plato and Aristotle. These scholars pro-
the identity theory, to name a few, the authors chose to posed the reality of a material world and offered divergent
explore the three substantial theories of truth in this paper. A epistemologies that would garner knowledge of an external
review of the nursing literature reveals that while the dis- world. According to Plato, truth or knowledge of the world
course related to truth is quite limited, the substantial theo- lay in an acquaintance with preexisting ideal Forms, a tran-
ries (correspondence, pragmatism, coherence) appear most scendent or divine aspect of reality that could be apprehended
often in discussion and critique, although often times only through rigorous philosophic inquiry. Like his prede-
obliquely referenced. In view of this, a brief summary of key cessor Parmenides, Plato maintained that knowledge of the
ideas related to correspondence, pragmatism, and coherence world outside of rational thought was illogical. Aristotle
is presented. Further, the authors identify differences that argued that knowledge lay in universal categories that char-
guide the growth of nursing in particular ways and raise criti- acterized the distinct substances or essences of the material
cal questions about the shifting realities of practice with a world. He declared the externality of knowledge as an event
view to the most suitable theory of truth for nursing. or object of discovery/inquiry.
The dualistic legacy of Greek philosophy and the search
Three Theories of Truth: Summaries for one absolute (Plato) or empiric (Aristotle) truth contin-
ues to inform and provide metaphysical bases for the cor-
and Implications for Nursing respondence theory of truth upon which the vast corpus of
Various theories of truth are predicated upon the belief that scientific theories has been conceived throughout Western
truth is a property that propositions can have and every sen- thought. According to David (2016) in the Stanford
tence is made true by certain conditions. When specific con- Encyclopedia of Philosophy, correspondence theory is a
ditions prevail or obtain, a sentence is true. Thus, each theory way of relating a fact or proposition if there are facts in
of truth explores and posits the conditions upon which a existence to support or correspond to it. Similarly, Patterson
proposition is considered to be true. One can characterize the (2003) contends that propositions must correspond to the
debate between competing theories of truth as a dispute world in which they are made in order to explain meaning.
about the nature of truth conditions. As such, the idea of an external reality is said to reflect a
Within nursing, diverse manifestations of practice world independent of minds, concepts, language, where
approaches, knowledge generation, and pedagogical deci- true beliefs represent facts out there—a perspective com-
sions reveal complex, multilayered differences that are monly referred to as realism (Young, 2007). Hence, the
underscored by the impact of divergent theories of truth. In identified property of truth is a relation between a proposi-
other words, each theory contains distinct conceptualiza- tion and objective features of an external world. Sentences
tions of truth that both establish and sustain a commitment therefore are true when they offer an accurate representa-
to various research methodologies, standards of scientific tion of external reality or when certain conditions are
rigor, and practice approaches. Although not always appar- obtained. Correspondence theory therefore advances the
ent, these differences have fueled controversy over the preeminence of objective and discovered truth wherein
most appropriate way to grow the discipline of nursing. inquiry seeks to determine which propositions (truths) cor-
Tape (2009) argued that reframing the debate as one of respond to facts (reality) (Newman, 2004).
truth distinctions rather than adequacy of actions would In nursing, the evidence of correspondence theory can be
help professionals to understand better the tensions seen clearly in the generation and use of reliable determinis-
between and among various points of view. While each tic data and strategies that guide highly prized evidence-
theory of truth can support nursing in different and useful based or -informed systems of practice (EBP). Such data
ways, it is our contention that only coherence supports a emanate from the search for facts, which we all can agree are
holism that honors human indivisibility, respects conflict- true. These facts give rise to best practices or the dominance
ing statements about reality, and engenders openness to of one acceptable approach to practice. Although proponents
competing narratives such as new paradigms in physics, of EBP claim that it includes “the conscientious, explicit, and
genetics, and indeed, nursing. judicious use of current best evidence in making decisions
Thoun et al. 45

about the care of individual patients” (Sackett, Rosenberg, Best Practice, Correspondence, and
Gray, & Haynes, 1996, p. 71), this approach “de-emphasizes Pragmatism
intuition, unsystematic clinical experience” (Guyatt, 1992, p.
2420), distinct “epistemic authority” (Reed, 2016, p. 241), Numerous illustrations of guidelines/directives, once
and professional autonomy, while accepting the authority of thought to delineate best practice and to highlight success-
scientific facts as truth and eagerly relying on them as the ful interventions, pervade the nursing literature. The fol-
bases for accurate decision making, often without regard for lowing examples are proffered simply to establish that all
the level of evidence used to establish EBP. This view is sentences, propositions, theories, protocols, guidelines,
underscored by the notion of “correspondence competence,” and successes are subject to doubt, interpretation, and
which focuses directly on consequences related to empirical revision, as well as the myriad conditions that may con-
standards and the empirical accuracy of judgments (Shaffer flict with said protocols at the time nurses must make
& Hulsey, 2009, p. 141; Weiss, Brennan, Thomas, Kirlik, & practice decisions. For example, in the 1960s, medical
Miller, 2009, p. 164). imperatives confined women and newborns to hospitals in
separate locations for 1 to 2 weeks following delivery
(Mehl, Peterson, Sokolosky, & Whitt, 1976). This guide-
Pragmatism line, based on a host of medical, economic, and cultural
Pragmatism is a philosophy with distinctly American roots, factors, informed nursing practice. Over time, psychologi-
born from work by 19th century American philosophers cal and social science research determined that lengthy
Charles Sanders Peirce (1839-1914), William James (1842- hospitalization after childbirth and the use of nurseries to
1910), and John Dewey (1859-1952). Neopragmatic think- house healthy newborns hindered maternal-child attach-
ers include Richard Rorty and Hilary Putnam (Hookway, ment and was not in the best interest of either mother or
2016). infant (De Chateau, 1976). Consequently, shortened hos-
Of the classical pragmatists, only James considered prag- pital stays, rooming-in, family presence in delivery rooms,
matism a theory of truth. and birthing rooms became common practice, and nursing
According to Hookway (2016), James’s writings on truth practice was adjusted according to the evidence garnered
were some of his most lively and also his most criticized. from these disciplines.
For example, he wrote, “The true is the name of whatever Similarly, in the 1970s and well into the 1980s, it was
proves itself to be good in the way of belief, and good, too, common practice for public health nurses to teach new moth-
for definite assignable reasons” (as cited in Hookway, sec- ers to lay babies on their abdomens at bedtime. This was
tion 3.2, para. 1). James expanded on things being true only thought to prevent babies from choking, to reduce visual
insofar as they are expedient or instrumental—that is, if they stimulation, and to promote strengthening of neck and upper
prove useful or practical in particular cases. In other words, body muscles. However, a growing number of medical and
this system of beliefs favors utility or goal acquisition above social science research studies linked this practice with an
all else and identifies success as the harbinger of truth. Thus, increased risk for Sudden Infant Death Syndrome (SIDS)
if it works, it is true: A position wherein the greater the suc- (Beal, 1998; Fleming et al., 1990; Hogberg & Bergstrom,
cess, the greater the belief in the accuracy of a statement and 2000). As a result, a national agenda titled “Back to Sleep
subsequent actions. In short, the property of truth is useful- Campaign” was initiated during the 1990s, wherein the cam-
ness that guides us to particular actions that have beneficial paign message was to place babies on their backs for sleep-
outcomes. ing. Public health nurses accepted the evidence as presented,
Although James contrasted pragmatism with correspon- altered practice, and provided client teaching that aligned
dence theory and maintained that truth resided in commu- with this new directive. While this shift in practice is thought
nity agreement wherein one’s beliefs must be consistent to be responsible for a successful decrease in the incidence of
with the beliefs of the wider community, he asserted that SIDS, it is also linked to plagiocephaly (flat head). Again,
the pragmatist “clings to facts and concreteness, observes responsive action was taken and public health nurses began
truth at its work in particular cases, and generalizes” (as teaching the significance of tummy time for babies, while
cited in Menand, 1997, p. 105). Such assertions engender continuing to stress the importance of placing babies in a
the propagation of empiric and normative data and models supine position for sleep.
that adhere to the standards and tenets of normative scien- Such examples, replete within the literature, shed light on
tific rigor: validity, reliability, and generalizability. It is the dubious position of correspondence and pragmatism as
important to recognize, therefore, that pragmatism can be adequate theories of truth for nursing and, hopefully, serve to
considered a variant of correspondence (Young, 2001), open a dialogue about what constitutes best practice. Indeed,
wherein EBP, best practice guidelines, and a preponderance how should we determine best practice? On what bases are
of data and direction from a variety of disciplines outside of choices explored? Is there room for supposition, conjecture,
nursing offer an instrumentalist approach to knowledge patient values, and personal beliefs, in light of empirical
generation and practice. data, institutional policies, and past successes?
46 Nursing Science Quarterly 32(1)

Coherence previously, such consistency is revealed clearly when prac-


tice decisions/judgments made by persons/nurses align with
While correspondence and pragmatist theories function the beliefs held by the persons/nurses. For example, from a
within the constraints of a material world, coherentism has coherence perspective, nurses who believe in the preemi-
the consequence that reality does not constrain what is true. nence of empirical knowledge and the plethora of best prac-
This view of truth “emerged in the work of Immanuel Kant tice and EBP guidelines, as well as professional expertise,
at the end of the eighteenth century” (Dawson & Gregory, ability, and authority, will make decisions/judgments that
2009, p. 127) and has been advanced by early 20th century reflect and align with these beliefs. It is one’s belief in such
idealists (Blanshard, 1939; Bradley, 1893; Ewing, 1934), things/ideas that form the bases upon which judgments are
some members of the Vienna Circle (Neurath, among them), made. Thus, meaning and truth are derived from these
and Lacan, to name a few. The central coherentist doctrine semantic conditions, not an external reality.
holds that a proposition is true when it coheres (that is, is In contrast to using correspondence and pragmatist theo-
entailed by) a system of beliefs (that is, propositions held to ries of truth that adhere to an objectivist view of the world,
be true by a community of inquirers). nurses can address ontological questions, such as “What are
According to Young (2001, 2009), the coherence theory we supposed to do?” or “How is practice lived, within a phil-
of truth entails that truth is relative, constructed, mind- osophical foundation of beliefs rather than institutional poli-
dependent, and internal to a system of beliefs, which is deter- cies and guidelines?” The relevance of this distinction is
mined by how well our individual beliefs hang together to particularly important when linguistic variation and diverse
form our worldview. Rather than being objective, the truth contextual bases for theory development and use engender
conditions of a proposition are provided by other proposi- disparate interpretations of a situation, suggesting that people
tions, those that entail it. In this vein, coherentists have been can, and do indeed, see things differently (Popper, 1972). In
charged with presuming the truth of a correspondence theory other words, nurses who choose different approaches to and
when they assert the rightness of their theory. This, however, goals of practice can provide justification for practice deci-
is a groundless charge. Coherentists can apply their theory of sions/judgments based on logical consistency in judgments
truth to itself: It too is true because it coheres with a system and decisions rather than on correspondence with an external
of beliefs. In other words, one can only say something is true reality or past successes. It is important to note that such con-
against a background of beliefs that supports the statement or sistency calls into question the beliefs upon which judgments
proposition, which also applies to coherence theory. are made and the articulated goals of one’s practice. Hence, it
Coherentism leaves open the possibility that there can be is imperative that one is capable of recognizing and articulat-
competing systems of beliefs and that propositions that cohere ing one’s system of beliefs (ontology, epistemology, and
with each, though inconsistent with each other, have equal methodology) that aligns with a community of inquirers and
claims to be true. Young (2001) claimed that coherentists can the knowledge base generated within that community. As
be metaphysically neutral, meaning they need not dismiss the such, the coherentist theory of truth also has the capacity to
existence of objective conditions but urge that speakers can- shed light on the philosophy-theory-practice nexus and the
not establish semantic relations with these conditions, and specious notion of a theory-practice gap (Parse, 2008).
thus derive meaning and truth from them. In contrast to logi- In contrast to the virtually universal acceptance of corre-
cal positivists who insist “that all knowledge has a foundation spondence as the unqualified harbinger of truth and pragma-
in experience” (Young, 1991, p. 472), coherentists emphasize tism’s propensity to justify beliefs in terms of their practical
that beliefs rather than experience provide the evidence upon effects and successes, coherence theory enables nurses to
which we make judgments. Accordingly, one must have a rethink the limitations of the normative, traditional metanar-
belief that what one sees is what is seen. Or, said differently, rative of healthcare; to question the authority of those narra-
what we see is evidence of our beliefs, not our experiences. tives; and to advance and adhere to nursing disciplinary
Although seemingly convoluted, the view that what we knowledge and values that offer distinct approaches for pro-
believe determines what we see is considered to be the fessional practice. While this has implications for honoring
essence of coherence (Hempel, as cited in Young, 1991). diversity within the profession, it also has implications for
Within nursing disciplinary development, coherence the- emancipation from the prevailing hegemony of health care in
ory lives in the congruence and consistency between and general and medicine specifically. To be sure, from this per-
among metaphysical, epistemological, and methodological spective, we can “critique claims from any one discipline
choices that researchers and teachers make in the generation that it holds the dominant truth or standard for practice and
and use of knowledge (Parse, 2008). Within professional policy” (Reed, 2016, p. 244).
practice, coherence theory is expressed in consistency When nurses adhere to the coherence theory of truth and
between the judgments and decisions nurses make and the subsequent standards of competence, they are necessarily
identified goals of practice. Mosier (2009) referred to “coher- drawn to knowledge that is consistent with the beliefs they
ence competence [as] the ability to maintain logical consis- hold. Clearly, nurses who subscribe to the prevailing material-
tency in judgments and decisions” (p. 155). As discussed ist hegemony within healthcare have a plethora of knowledge
Thoun et al. 47

from which to draw—a plethora of knowledge that provides Conclusion


justification for practice decisions/judgments. What is not as
clear or, more precisely, what is more difficult to discern are While some readers may wish to object to the idea of a pre-
the circumstances of nurses who find themselves participating ferred theory of truth for nursing, the authors emphasize and
in activities that do not align with their beliefs and values. Far reiterate that coherence is the only theory that does not exclude
too often, a disquieting tension between and among client or dismiss the range of beliefs that can be held by scholars in a
goals, professional goals, organizational goals and priorities, field. Indeed, coherence provides space for scholars who do
and physician directives is neither identified nor addressed. not align with the dominant scientific discourse within health-
Under such conditions, it is vital that nurses are able to defend care while not assuming a bias against those who do. As such,
their actions by articulating their rationale for decisions made the determination and conceptualization of a nursing disciplin-
and judgments employed with clarity and conviction. In other ary goal, such as quality of life (Parse, 2014), and standards by
words, nurses must understand how logical consistency is which nursing propositions are judged, can occur within a
maintained in judgments and decisions. Similarly, nurses who theory of truth wherein diversity is honored. To be sure, this
understand the intricacies of coherence theory are better pre- theory of truth can be extended to all theories of nursing from
pared to reject or modify protocols and best practice guide- which disciplinary goals and propositions can be judged.
lines in light of another system of beliefs or other truths. That Additionally, the coherence theory of truth enables regulative
is to say, nurses are better able to recognize the conditions that ideals of practice, such as client-centered care, human holism,
cohere with their beliefs rather than objective experience (such the preeminence of personal beliefs, and the primacy of per-
as protocols) and thus account for or justify their decisions. sonal choice, to be lived in practice in ways that are recog-
Moreover, one could argue that coherentism, with its nized and prized, rather than dismissed in favor of the realist
emphasis on a system of beliefs forming a coherent whole, is (or monolithic) regulative ideal currently pervading health
the theory of truth least likely to tolerate tension between care. Moreover, the adoption of a more inclusive view of truth
theory and practice. Indeed, coherentism seems to be the creates space for nursing to reconsider standards of nursing
theory of truth that is best compatible with a plurality of practice, competencies, ethics, nursing theories, and curricular
approaches. Coherentism can permit a variety of coherent design and content within coherence-based criteria and to
systems of belief, each of them equally compatible with reflect on the nature and structure of nursing knowledge and
empirical evidence and each of them with an equal claim to the products and processes of inquiry. Providing a philosophi-
truth. To be sure, nurses who understand that practice deci- cal rationale for practice decisions as well as decisions for dis-
sions rest on truth-value and not simply empirical data (no ciplinary development demands that nurse scholars continue
matter how sound), or personal preferences and inclinations, to grapple with this dynamic and spirited area of scholarship.
open the door to greater depth of scholarship in nursing. Our hope is that discussion and awareness of the relation
What does seem important to highlight at this juncture is between philosophical theories of truth, disciplinary develop-
that all theory/knowledge is founded upon assumptions that ment, and professional practice will continue.
are themselves informed by a theory of truth held by research-
ers, educators, and practitioners within a given field. One’s Declaration of Conflicting Interests
theory of truth reflects the reality or worldview within which The authors declared no potential conflicts of interest with respect
one is working. In other words, a philosophical foundation is to the authorship and/or publication of this review.
a precondition for theory development, purposeful research,
and appropriate practice models within a field. Because each Funding
theory of truth contains distinct conditions of truth that both The authors received no financial support for the authorship and/or
establish and sustain a commitment to various research publication of this review.
methodologies, standards of scientific rigor, and practice
approaches, one can say that when a philosophical founda- References
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