Nightingales Realist Philosophy of Science,

Nightingales realist philosophy of science," Sam Porter discusses the philosophy of science of Florence Nightingale, in terms of her adherence to positivism and scientism, determinism, naturalism, and epistemological absolutism (2001). Porter concludes Nightingale's views, while stemming from the positivist tradition, did not adhere solely to those principles (2001). This paper will examine Porter's analysis of Nightingale's philosophy, and will discuss each issue in relation to modern nursing practice.

In order to analyze Porter's arguments, it is important to understand the term 'positivism.' Positivism, developed by Auguste Comte, is a system of philosophy based on the concept that only true and reliable knowledge is scientific knowledge. This knowledge, according to true positivists, is gained only through methodical observation of external phenomena and causal relationships (Porter, 2001). Within this basic premise also lie other tenets of positivism, such as the belief in phenomenalism, rejection of speculative philosophy, and other issues (Porter, 2001).

Porter (2001) concludes in his article that Nightingale's philosophy of science was positivist in terms of scientism. Scientism, the central component to positivism, stresses the importance of knowledge as gained through methodical observation of causal relationships. Porter notes Nightingale's use of statistics in her practice, and her firm belief that such information was vital to the field of medicine (Porter, 2001). As a member of the Statistical Society and the American Statistical Association, Nightingale clearly placed much emphasis on such factual information (Porter, 2001). This practice of using methodical research strategies to show patterns of causation supports Porter's conclusion that Nightingale showed a distinctively positivist approach in terms of scientism. Through careful methods and recording practices, Nightingale studied the cause and effect relationships between phenomena, rather than relying on internal and therefore unreliable information.

Scientism is clearly in use in modern nursing practices. There is a heavily reliance in hospital and clinic staff, as well as in emergency health care technicians, on the basic scientific information gathered by nursing staff in relation to patient health. Information gathered by nursing staff, such as weight, height, blood pressure, and temperature, are often the basis for any physician examination. Further, in hospital settings, the use of scientific principles to maintain a healthy environment by nursing staff is vital to patient health. The monitoring of fluid and medication levels, the patient response to various forms of treatment, and an overall reliance on the scientific method are the basis for modern nursing (Lawler, 1997). Even modern nursing texts promote the concept of scientism in nursing, stressing the need for an acceptance of 'instrumental rationality' as the basis for nursing practice (Lawler, 1997).

Porter (2001) also supported the concept that Nightingale showed a propensity for positivism in terms of determinism, as well. According to Nightingale, every action and situation has a specific set of causes and uniformities (Porter, 2001). In other words, every event is caused by a specific set of casual processes, and is therefore uniform in result. This again is supported in the philosophy of positivism, as such, causes can be easily identified and catalogued with methodical observation of events and outcomes.

Determinism, while softer than in Nightingale's time, is still in high practice in nursing today (Tebes, 2005). For example, in poverty-stricken areas of the world, nursing staff have seen consistent issues with illnesses due to contaminated water, such as typhoid, polio, cholera, and other illnesses. In many cases, the drinking of such contaminated waters will cause similar effects in patients, and each disease reacts similarly in each patient. The symptoms of each disease are the same in each patient, and each patient react similarly to each symptom. The disease its self is directly caused by the intake of contaminated water. Nursing staff, using this deterministic view, can easily recognize and treat these types of illnesses through an understanding that each illness is caused directly by a specific event (Tebes, 2005).

In terms of naturalism, Porter (2001) ascertains Nightingale again shows a positivist stance, and this is supported by Nightingale's own words on the topic of man and his actions. The naturalist approach assumes that natural and social sciences are one, since social circumstances and events are subject to causation in the same manner as natural phenomenon (Porter, 2001). Nightingale propounds that if the social actions of man were random, he would not discover any certainty. Thus, she supposes, man is and does what he is and does due to a specific set of causal relationships and circumstances (Porter, 2001). In other words, the social actions of individuals and the social characters of individuals are caused by a set of specific circumstances and causations, just as natural events are caused by the same. This viewpoint supports positivism, in that again, if such a concept is factual, such circumstances and causations can be methodically recorded, organized, and examined from an external viewpoint.

Furthermore, Nightingale shows a propensity for positivism in her viewpoint of free will and naturalism. Nightingale recognized the argument that in her viewpoint, one has no free will, and is simply a byproduct of circumstances and situations. She responds, however, to note that while man can will anything, man's will to do specific things or act in specific ways is predetermined by circumstance and natural law (Porter, 2001). This stance again supports positivism in terms of naturalism, in that the assumption that man acts, even in social circumstances, according to predetermined sets of causation, shows a clear belief in the concept of external causation.

This concept of naturalism, however, has been shown to be somewhat misleading. While in certain circumstances, specific events or circumstances do cause the same results each instance, there are many instances in the nursing profession in which this is not the case. An example of such a concept can be seen in the psychiatric nursing staff. The naturalistic viewpoint is clearly rejected by these staff members, in their clear focus on biological and social processes as reasons for behavioral actions, and in the expectation of nursing staff in mental health facilities to participate in the diagnosis of schizophrenia and other illnesses. By observing the outward actions of patients, nurses in many areas are a source of vital behavioral information, in the context of either a social or a biological determination of causation. Each is trained specifically on external behaviors fitting specific physiological disorders, or causes (Barker, Reynolds, & Stevenson, 1997). This stress on the importance of understanding the causal relationship between the illness and the action, and the differences in social and biological reasons for mental disorder, shows a clear break from the naturalistic perspective. Whereas one patient may exhibit catatonic behaviors due to schizophrenia, another may exhibit violent behavior due to the same illness. Clearly, not all situations or circumstances evoke the same response in all individuals.

Porter (2001) also notes Nightingale's propensity for positivism in terms of epistemological absolutism. According to Porter, Nightingale showed, through her acceptance that her own research could be susceptible to future discovery (Porter, 2001). Since epistemological absolutism refers to the idea that there is but one truth, such a statement by Nightingale would lend to the conclusion that she rejects such an absolutist view. In terms of positivism, this rejection would agree, since to assume one's research is the absolute and final truth, one would be denying the ability of future research to study the same methodical research methods to study additional forms of causation to conclude different results. Since positivism is firm in the belief that such causations exist universally and uniformly, to accept that one set of circumstances is the only causal factor for a specific event would be to deny the methods of positivism. Thus, Porter's analysis of Nightingale's position is accurate.

The rejection of absolutism is a vital component to modern nursing. In general, the practice of nursing combines traditions of care, nurture, healing, listening, simple presence, understanding, and concern. These outward expressions are underlain by a combination of biological, psychological, social, theological, philosophical, and socioeconomic perspectives, each of which plays a vital role in patient care. Through a holistic care paradigm, modern nursing staff are not only partially responsible for curing disease and prolonging human life, but also for doing so in a manner that recognizes equality, potential, integrity, spirituality, and social acceptance (Santos, 2001). In their struggle to encompass all aspects of the human condition, modern nurses clearly reject the principles of epistemological absolutism. In their use of multiple paradigms to treat patients from various cultures, backgrounds, statuses, and medical histories, modern nurses clearly admit that any or all care techniques may be the method required. In choosing not to focus solely on a single aspect of care, but displaying proficiency in all areas, nursing staff show a rejection of the absolutist principle.

Porter (2001) also maintains that Nightingale's realistic view differs from that of modern realism. These differences are apparent on several levels. First, both Nightingale and contemporary realists believe firmly in a rejection of phenomenalism, or the idea that only observable phenomenon should be pursued to discover causation (Porter, 2001). However, whereas Nightingale believed any phenomena must be examined in terms of underlying reality and causation, contemporary realists believe such actions, while necessary, are not sufficient to gain full knowledge (Porter, 2001).

More importantly, however, contemporary realists differ from Nightingale in four main areas, those of theistic assumption, methods of research, determinism, and naturalism. While contemporary realists certainly agree with Nightingale's position that simply realizing fact is not enough, and that actions based on findings is important (Porter, 2001), Nightingale inserted a certain assumption of God into her realistic viewpoints that modern realism avoids. Whereas Nightingale supported the concept that man's actions were dictated by God, modern realists recognize specific non-theistic causes for behaviors.

Secondly, Nightingale relied solely on quantitative method of research, since such methods were most available in her period. Such methods, involving the scientific, external, specific identification of patterns of events, are useful, but modern realists understand the need for individualistic understanding of information. Whereas Nightingale's focus was on identifying the patterns of relationships, modern realists focus more on understanding those relationships (Porter, 2001).

Third, modern realists differ slightly from Nightingale in their views on determinism. As discussed, Nightingale believed firmly in determinism, and believed no true free will of behavior existed (Porter, 2001). Modern realists, however, focus not only on the tendencies for patterns, rather than inevitable patterns of relationships (Porter, 2001). In this way, modern realists allow for flexibility in causation, whereas nightingale's hard deterministic stance did not.

Finally, modern realists recognize a unity between causation of social structure and natural structure. Whereas Nightingale held a naturalistic belief that social and natural events occur due to the same causation factors, modern realists see the two independently, in that social structures are the result of human action, while natural events occur due to natural law (Porter, 2001). Since human action is interpretable, such a belief breaks the naturalistic viewpoint.

Understanding these differences in realism views is vital to nursing practice. While Nightingale's harsh realism was acceptable in her time period, due to a reliance on theology and quantitative methods, such concepts are outdated, and should be rejected in modern nursing. While theological perspectives are important, understanding the basis of causation outside such a doctrine is vital to understanding modern causation of events, and thus, modern nursing concepts. The interpretable actions of individuals, outside of deterministic viewpoints, is vital to understanding human beings in the modern age, and is thus necessary to understanding the structures, norms, diseases, and atmospheres of modern man. Further, the break between social and natural law is necessary, in that natural law is not subjective. In order to fully comprehend causes and effects of specific nursing concepts, such an understanding of different levels of causation is necessary.

Porter (2001) concludes his article by noting the influence Nightingale's philosophy has had on modern nursing. While some critics have downplayed this influence, Porter is accurate in his analysis. He stresses the admitted limitations of her philosophy, such as her reliance on theological and religious aspects and quantitative research methods, due to the time period in which she lived, but also stresses the importance of her focus on the beginnings of a realistic approach to nursing and medicine. He points to Nightingale's insistence on deeper causes of illness and health, her focus on statistics as a means of measurement, and her linkage of fact and value. In this, Porter refers to the concept of understanding not only the disease and the etiology of disease, but also the experiences of those with disease and the social belief systems of the population. In other words, according to Porter, Nightingale's philosophy not only stresses the importance of health, but also of the social and personal ramifications of health on each individual (Porter, 2001).