Book review: Nursing Knowledge: Science, Practice, and Philosophy

Searching for an up-to-date nursing theory book I wanted something different from the usual fare. The usual fare being a description of the various nursing theories, models and frameworks to date. I needed a text that would help me in two ways: firstly, deal with and critique the foundations of nursing theory; secondly, to provide some insights that would inform my own study into Hodges' model. I quickly found a book with a bonus: it is written by a philosopher.

Mark Risjord's - Nursing Knowledge: Science, Practice, and Philosophy (Wiley-Blackwell, 2010).

This is not a large book considering the literature within its potential purview at just 246 pages in total. The text is very readable both visually and in style. Even if points need to be re-read this isn't a chore. Evidence of structure and discipline runs from paragraphs to the overall division into seven parts, with the usual reference listing and index. As a nursing student of the late 70s and early 80s this book needed to reframe this subject for lifelong learning student of the 2010s. Risjord starts by examining the history - prehistory no less - of the problem. 

Key questions that have arisen in nursing and directed thought are discussed. The influence of what was happening simultaneously in the philosophy of science and culture is also related. The writing is succinct (as already suggested) on page 18 we have an explanation for the appearance of the relevance gap, how this gap endures and how it might be closed.

Central to the demographic, media and political challenges that nursing faces part II covers values. This brings in nursing's standpoint and more direct reference to cultural influences on nursing knowledge in particular feminism. This discussion is again brief, standpoints are very relevant for me. The combination of depth of analysis, brevity with a clear focus are a great achievement. A lesson in how to write, how to argue, how to communicate. You can only do this if you know your subject.

If I missed anything it is technology and information, but the book is probably all the better for this whether considered an omission or diversion. Seeing specific reference to multidisciplinary in the index and a discussion of nursing knowledge in relation to other disciplines would be helpful. Risjord's purpose for this book is however, clear from start to finish. It's there in the title. The book is no glossary, or dictionary, and yet the treatment of many concepts here, such as; axioms, borrowed theory, coherence, context, grand theory, and paradigm (a chapter)... will help reader's appreciate their definition and use. Seminal papers from the literature are identified and re-examined. Much of the book is devoted to research and methods with illustrative examples.

There is much to inform my studies, in particular chapter 15: Conceptual models and the fate of grand theory. Here I can conclude from Risjord that Hodges' model creates an orientation picture rather than an abstraction picture:

On this understanding, nursing models are expressions of the philosophical background to nursing research. Conceptual models orient research and practice by guiding the selection of problems or making phenomena salient. They make no theoretical pronouncements. A conceptual model can guide research and practice only in the light of some values and goals. Nursing values and goals are thus crucial components of the conceptual model on the orientation picture. They set the agenda for nursing research by articulating what is important. p.173.  

I've long considered Hodges' model to be a map. Initially, a blank map - a space within which values can be deliberated. In pedalling this particular bike since 1998 I know how tired nursing theory is. Now students don't need to get on the bike, they stand on one pedal and freewheel the short distance that represents the curricula space devoted to nursing theory (and philosophy). A packed curriculum provides the momentum for the (values) by-pass. Mark Risjord concludes with new questions about nursing theory, new maps and new directions. I've outlined other points from the text for future reference. This book will remain a companion for quite some time: a great compass.

Acknowledgement: Many thanks to Wiley-Blackwell for the review copy.