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NSQXXX10.1177/0894318418807945Nursing Science QuarterlyThoun et al.
Article
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)
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