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Convention dictates that qualitative nursing inquiries ought to be firmly positioned within a theoretical framework.1 The rationale for this convention derives from an understanding of general science, wherein observations must be sequentially aligned with prior observations along stepwise theoretical lines in order to credibly contribute to the discovery of new truths. Qualitative methods primarily came to us from the social sciences, whose intellectual projects were oriented around theorising rather than truth discovery per se. However, in the social science context, each new study did have to signal which ongoing theoretical conversation it was intending to join. So in adapting qualitative technique to the business of knowledge-building in nursing, we absorbed the idea that a study must be positioned within an explicit theoretical framework as a hallmark of good social science practice. And although some of the problems with that practice have been acknowledged in our literature,2 we have rarely tackled the issue squarely and asked ourselves why we continue to expect all nursing qualitative work to conform to this tradition.
Readers of qualitative health research will recognise that uncritical adherence to the idea that all such studies must locate themselves by naming an explicit theoretical framework has led to some rather illogical and counterproductive practices. Since very few nursing scholars explicitly locate themselves within a particular disciplinary metaparadigm theory at this stage in our history,3 nurses typically draw on the most neutral or innocuous social ones they can find to fulfil this obligatory requirement. And all too often, they use them in ways that seem counter to the interior logic of the disciplinary knowledge they claim to be seeking. We see studies in which a theoretical framework is so solidly defended at the outset that the investigator's capacity for inductive analysis seems to have been overwhelmed from the start, such that the ‘findings’ become the subset of observations that happen to conform to what was anticipated by the framework. We see other studies in which a theoretical framework is politely named in the introductory material, and then somehow disappears from sight for the remainder of the process, such that the findings bear no relationship to the theoretical structure within which they were to have made sense. And we see variations on these themes, such as the hollow nod to the framework that sneaks its way into the conclusions, despite having been missing in action throughout the entire analytic process. The frequency with which disjunctures between the theoretical forestructuring claims and the apparent actual analytic practice can be detected in our qualitative literature should tell us that there is a problem in how we are thinking about the role and function of theory in the knowledge generation that nurses do.
I think that where we went off the rails was in assuming that nursing disciplinary thinking itself was insufficient as an epistemological grounding for scholarly inquiry and discovery. Because we assumed that you had to select ‘a nursing theory’ rather than working within the foundational principles that are common across all nursing thought, we have fallen into the pattern of relying on borrowed social theories as the ritual offering that must be made before we are entitled to deeply reflect on the substance of our practice. However, when we allow ourselves to consider the common understandings nurses have when they enter a field of clinical study, we recognise a set of ideas that seem far more relevant to our knowledge needs than are the frameworks we commonly borrow. For example, nurses will always assume variation within pattern. We are less concerned about whether there are deep organising structures explaining patient behaviour than we are with ensuring that each variation upon a theme is well served in the practice setting. Similarly, we conduct our studies in the moment, but always recognise that clinical material is understandable only in dynamic processual context. So we extend our thinking beyond the horizons of what is immediately observable to encompass what has come before and what is likely to follow. These are just examples of what I would consider fundamental epistemological nursing grounding. Rather than sustaining hollow theoretical practices that are not serving the conceptual integrity of our qualitative scholarship, it seems high time we reclaimed the discipline itself as an appropriate and worthy theoretical foundation upon which to build our qualitative explorations.
Competing interests None.