NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Case Study

A nurse on a medical/surgical floor is treating a 62 year old patient with an initial diagnosis of colitis. The patient has been in the inpatient setting for 11 days, which is far longer than the normal length of stay for this diagnosis. This patient also has a comorbidity of seizure disorder. He has not been compliant with daily ambulation orders, and acts largely helpless when asked to independently perform activities of daily living. Upon assessment at the beginning of the shift, the patient is alert and oriented.

He has no complaints of pain. His lungs sounds are clear but diminished in the bases. Breathing is even and regular at this time. His oxygen saturation via pulse oximetry is 94% on room air. The patient has sequential compression devices on his bed, but they are not applied. When the patient is asked why they are not on, he states that they were annoying him so he took them off earlier in the day. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

They are reapplied at this time. The patient is without further complaints. His evening medications are administered, including 30 mg of Phenobarbital, 100 mg of Dilantin, and 10 mg of Valium, which is his normal regimen of medications for his seizure disorder. Later in the shift, the certified nurse’s aide takes his routine vital signs. The aid reports an oxygen saturation of 76% on room air. The patient is easily aroused and oriented with no signs of over sedation. No cyanosis is noted at this time. The patient’s breathing pattern is shallow, and he states that is feels like he cannot catch his breath. The patient’s telemetry shows that he is in sinus tachycardia with a rate of 110 to 140. The patient is place on 2 liters of oxygen via nasal canula. After several minutes, the patient’s saturation is at 80%.

The oxygen level is titrated, and the patient achieves a saturation of 90% at 4.5 liter of oxygen. The nurse removes the sequential compression devices from the patient, assigns the aid to monitor the patient’s oxygen saturation and calls the physician for further orders. The stat D-Dimer ordered is positive, and the subsequent V-Q scan shows the presence of a pulmonary embolism. The patient is transferred to the Critical Care Unit for anticoagulation therapy and monitoring.

NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Empirical Knowledge

Empirical knowledge is scientific, objective and quantifiable knowledge that can be used to explain things that are observable and verifiable (McGovern, Lapum, Clune, & Martin, 2012). In this case, empirical knowledge allows the nurse to know that an oxygen saturation of 76% is dangerous to the patient, and an abnormal finding based on previous experimentation and observable phenomena. Another piece of empirical knowledge is that a positive D-dimer can be indicative the presence of a blood clot, which also poses a danger to the patient’s safety.

Ethical Knowledge

Ethical knowledge refers to the moral component of nursing. This way of knowing is manifested by the choices that nurses make, and judgment on which actions to take in any given situation (McGovern, Lapum, Clune, & Schindel-Martin, 2012). The nurse in this case, regardless of any possible personal feelings related to the patient’s non-compliance and perceived helplessness, did everything possible to ensure timely delivery of treatment for this patient to reduce the risk of death or permanent damage because it was the morally right thing to do. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Clinical Knowledge

Clinical knowledge is the way of knowing that comes from nursing experience. It is a combination of empirical knowledge, personal knowledge, intuition, and subjective knowing (McEwen & Wills, 2011). Clinical knowledge is what appears to guide most clinical decision-making skills (Lake, Moss, & Duke, 2009). In this case, the nurse’s clinical knowledge, gathered from what was learned in textbooks, previous experiences, and the “feel” of the situation, guided the response to this situation. The knowledge that the patient had been sedentary for 11 days combined with the lack of compliance with deep vein thrombosis prophylaxis put this patient at a high risk for a blood clot.

Shallow breathing and low oxygen saturations could have been caused by the relatively large doses of barbiturates and diazepam that the patient had been given, but the nurse was aware of the patient response to these medications on previous shifts, which did not result in over sedation. The nurse was also aware that the lack of a significant increase in oxygen saturations after administration of supplemental oxygen was also indicative of a possible pulmonary embolism, which led to the action of removing the sequential compression devices to prevent the mobilization of any further clots that may have been present. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Nurses use multiple ways of knowing on a daily basis without conscious thought of how they know what they know. The four basic patterns of knowledge combine almost seamlessly into everyday decision making in the clinical setting. By analyzing the actions and the sources of knowledge, nursing can encourage the use of different types of knowledge in practice, education, and research, as well as help to develop the knowledge base for nurses with less clinical experience and judgment (McEwen & Wills, 2011).

References

Lake, S., Moss, C., & Duke, J. (2009). Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision-making literature. International Journal of Nursing Practice, 15(5), 376-388. doi:10.1111/j.1440-172X.2009.01778.x McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia: Lippincott. McGovern, B., Lapum, J., Clune, L., & Schindel- Martin, L. (2013). Theoretical framing of high-fidelity simulation with carper’s fundamental patterns of knowing in nursing. Journal of Nursing Education, 52(1), 46-9. doi:http://dx.doi.org/10.3928/01484834-20121217-02

NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Nursing Philosophy, Nursing Science, and Philosophy of Science

Nursing philosophy, nursing science, and philosophy of science in nursing are three interrelated but separate concepts. Nursing philosophy is the foundational and universal assumptions, belief system and principles of the profession of nursing (McEwen & Wills, 2011). Nursing science is discipline specific knowledge that is used in nursing theory and practice (McEwen & Wills, 2011). The philosophy of science in nursing helps to establish the meaning of science as it relates to nursing practice (McEwen & Wills, 2011). While these terms are sometimes used interchangeably, each is an important part of understanding the discipline and theoretical foundation of nursing. Nursing Philosophy

A nursing philosophy states the thoughts on what is believed to be true about the nature of the profession of nursing and provides a basis for nursing activities. Nursing philosophy encompasses beliefs about the epistemology, or nature of knowledge and thought, as well as the ontology, or the nature of what exists concerning nursing practice or human health practices (McEwen & Wills, 2011). It examines the relationship between the truths and ideals in nursing. Many nursing philosophies exist on the individual, facility, and group levels, and philosophies have been proposed on the national and discipline level, but nursing, as a discipline or profession, has no single nursing philosophy that overrides all others (Meehan, 2012). This means that there is no universal basis for all nursing practice, processes, or research. This can be considered a part of the reason for division about nursing’s status as a profession (Meehan, 2012). NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

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Nursing Science

Nursing science is considered to be among the human sciences, as well as an applied science (Logan & Angel, 2011). It is not a hard science, characterized by sole empirical and quantitative experimentation. It is not a soft science, focusing on the subjective experiences of individuals, groups, or cultures. A human science combines the objective with the subjective, the biological aspects with the psychological aspects of human response, while considering cultural differentiation and the role of the nurse in creating positive responses (Logan & Angel, 2011). Nursing science is responsible for the generation of new knowledge in the domain of human responses to health and illness. The purpose of nursing science is to understand, explain, and represent the nature of nursing and to use this information for the benefit of all (McEwen & Wills, 2011).

Philosophy of Science in Nursing

Philosophy of science in nursing is basically the combination of nursing philosophy and nursing science, or the point in which the two distinct entities intersect. Philosophy of science is a separate perspective that examines the body of knowledge and the approaches to the study of the knowledge (Porter, 2013). While philosophy is concerned with thoughts and beliefs about the nature of nursing, and science is concerned with the generation and analysis of nursing knowledge, philosophy of science seeks to establish the meaning of science by understanding, relating, exploring, and examining nursing concepts, theories, and laws as they relate to nursing practice (McEwen & Wills, 2011). NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

While nursing philosophy, nursing science, and philosophy of science in nursing are three separate concepts, they are interrelated. In order to understand one concept, there must be an understanding of the others. In order for nursing to continue to grow as a discipline and a profession, the philosophy of nursing needs to be better defined, and continued growth is needed in the science of nursing.

References

Logan, P. A., & Angel, L. (2011). Nursing as a scientific undertaking and the intersection with science in undergraduate studies: implications for nursing management. Journal Of Nursing Management, 19(3), 407-417. doi:10.1111/j.1365-2834.2011.01247.x McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia: Lippincott. Meehan, T. C. (2012). The Careful Nursing philosophy and professional
practice model. Journal Of Clinical Nursing,21(19/20), 2905-2916. doi:10.1111/j.1365-2702.2012.04214.x Porter, S. (2013). Philosophy of science for nursing practice: Concepts and applications. Nursing Philosophy, 14(1), 66-69. doi:10.1111/j.1466-769X.2011.00517.x

Nursing as a Profession

A long-standing debate exists regarding the status of nursing as a profession versus an occupation. Nursing is an occupation, since all professions are in fact occupations, but not all occupations are professions. A profession is defined as an occupation that meets specified criteria beyond that of an occupation (Creasia & Friberg, 2011). A profession has seven characteristics. These include a defined knowledge base or theoretical framework for practice, a required education, altruistic service, a defined code of ethics, socialization, autonomy, and self-regulation (McEwen & Wills, 2011). Nursing provides an altruistic service, a defined code of ethics, socialization, and self-regulation. While nursing embodies some of these characteristics, in order for nursing to be universally accepted as a profession, some areas, such as the knowledge base, education requirements, and autonomy, need to be better defined. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Defined Knowledge Base

Nursing as a discipline does possess its own knowledge base that is derived from theoretical formulations and scientific research. Also included in the realm of nursing knowledge are personal experiences that contribute to clinical knowledge and expertise (Creasia & Friberg, 2011). One of the things that nursing is lacking is a defined philosophy or universal base for nursing practice, processes, or research. Nursing also lacks a defined theoretical framework, but instead relies on many, sometimes conflicting, frameworks for the basis of research and knowledge generation (Parker & Smith, 2010). This lack of cohesion is one of the arguments against nursing’s status as a profession. Nurses in advanced practice can help to advance the professional status of nursing by participating in research for knowledge generation and expansion of the nursing knowledge base, as well as working to develop a cohesive nursing philosophy (Sabatino, Stievano, Rocco, Kallio, Pietila, & Kangasniemi, 2014).

Required Education

The varying education requirements for nursing are another area of contention regarding status as a profession. An argument against the acceptance of nursing as a profession is the lack of required university level training to achieve licensure. There are three different entry levels for a Registered Nurse, including diploma programs, Associates Degree programs, and Bachelors Degree programs. All three entry levels take the same test administered by the National Council Licensure Exam (NCLEX) that is developed by the Nation Council of State Boards of Nursing. Each state Board of Nursing sets the requirements for education programs and licensure within that state, leading to differences in education standards across the nation (Creasia & Friberg, 2011). NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

In order to advance nursing’s professional status, it has been proposed that new Registered Nurses should be required to be trained to the Bachelors Degree level before achieving licensure, although in 2011 only 40% of those applying to take the NCLEX were from Bachelor’s programs (McEwen, Pullis, White, & Krawtz, 2013) . While this would help promote the professionalism of the field, it is not deemed to be a feasible option at this time with ongoing nursing shortages, especially in underserved areas.

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Autonomy

Autonomy is a key issue to the professionalism of nursing. Autonomy is the freedom to act within a specified scope of practice (Creasia & Friberg, 2011). The autonomy of nurses is limited by facilities and actions of nurses are simply carrying out the orders of a physician, even though the methods in which the orders are carried out are directed by nursing knowledge. For many, nursing is still viewed as a lower level of medical knowledge that is directed by the profession of medicine (McEwen & Wills, 2011).

In order for nursing to been viewed by all as a profession as opposed to an occupation, there needs to be cohesive action by all nurses to change its image. By investing in education and working to change the entry level of nurses to a university level education, nurses can gain more prestige. By investing in, and actively engaging in nursing research, the defined nursing knowledge base can grow. Showing competence in nursing judgment, and working with physicians as opposed to under physicians may help elevate the status of nursing to a profession in the eyes of the whole world, not just the nursing world. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

References

Cresia, J., & Friberg. (2011). Conceptual foundations: The bridge to professional nursing practice (5th ed.). St. Louis: Mosby. McEwen, M., Pullis, B., White, M., & Krawtz, S. (2013). Eighty percent by 2020: The present and future of RN-to-BSN education. Journal of Nursing Education, 52(10), 549-557. doi:http://dx.doi.org/10.3928/01484834-20130913-01 McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia: Lippincott. Parker, M. E. & Smith, M. C. (2010). Nursing theories and nursing practice (3rd ed.). Philadelphia, PA: FA Davis Sabatino, L., Stievano, A., Rocco, G., Kallio, H., Pietila, A., & Kangasniemi, M. K. (2014). The dignity of the nursing profession: A meta-synthesis of qualitative research. Nursing Ethics, 21(6), 659-672. doi:10.1177/0969733013513215

Introduction Philosophy originates with the Greek word philosophia, which translates as “the love of wisdom”. Philosophers are engaged in inquiry concerning the search for truth, the nature of universe and the meaning of human experience. Welch& Polifroni(1999). The aim of this paper is to compare and contrast the philosophical paradigms of Realism, Antirealism, Phenomenology , Postmodernism. To relate the Empiricism, Positivism, Historicism, and Relativism to the nature of scientific truth. Moreover, to discuss the significance of truth for nursing as a profession and as a science.

The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Weaver, and Olson. (2006). Table 1 illustrate theses differences between these philosophical paradigms. Realism and Antirealism Realism has an ontology which states that the structures creating the world cannot be directly observed. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Its epistemology is that appearances do not necessarily reveal the mechanisms which cause these appearances, and its methodology therefore involves the construction of theories which can account for these appearances.

Wainwright,S. ( 1997). Realism, in the Aristotelian, holds that things and individuals have existence independent of human thought and that this extra-mental world is intelligible and forms a basis for evaluating propositions about the world.

Whelton,B. (2002) 2 Philosophy course –First Assignment Positivism collapses the world into a single plane of events. In contrast, realism recovers the ontological depth between the three stratified domains and thereby establishes relations of natural necessity rather than the relations of logical necessity (universality). Wainwright,S. ( 1997). Relevance of Realism to Nursing Realism proposes a common ontology and epistemology for the natural and social sciences. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Realism enables the traditional natural and social science division in subjects like geography, psychology, medicine and nursing to be bridged. Realism can therefore provide ontological and epistemological basis for nursing. Wainwrigh( 1997). On the other hand, the interest her in the causal and epistemological ingredients of scientific realism because they support the claim that explanations are important in nursing science and practice and that the aim of scientist is to discover better and better explanations. Gortner, and Schumacher,(1992).

Relevance of Antirealism to Nursing It the positivist antirealism that make their views inappropriate for nursing science. It is not possible in positivism to deal with subjective aspects of person, nor with perceived relational processes, nor with explanations without translating them into physiological states or behaviors. One of the most serious consequences of an antilrealist construction of theories is that theories cannot explain.

One of the major distinction between scientific realism and antirealism is the way in which “theoretical entities” are understood. In the language of scientific realism the term “theoretical entities” usually means unobservable entities, states, or processes. The antirealists deny the existence of 3 Philosophy course –First Assignment unobservable entities or process. Antirealist assert that the notion of truth or falsity is relevant to observation even though it is not relevant to theory. Gortner, and Schumacher,(1992). NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Phenomenology For Edmund Husserl, phenomenology is “the reflective study of the essence of consciousness as experienced from the first-person point of view” Phenomenology, founded by Edmund Husserl, promotes the idea that the natural world is largely shaped by the human mind. Wikipedia, (2007). Phenomenology is philosophical movement whose primary objective is the direct investigation and description of phenomena as consciously experienced. It remains different from and in opposition to positivism because it is a theoretical, non causal, and attempts to be free of supposition. Welch(1999) P243).

Postmodernism The essence of truth lies within the individual and the individual may change or later alter that view dependent on the context and the circumstances. Thus, the postmodern worldview is that truth neither singular nor multiple; it is personal and highly individualized and contextually driven. Welch & Polifoni (1999)p-58) The Significance of Truth for Nursing as a Profession and as a Science. Science, philosophy and philosophy of science are all topics of great significance to nursing…the need to examine issues of what it means to know, what truth is, how we know and what can be learned from science and philosophy is central to growth in the 4 Philosophy course –First Assignment discipline. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Simultaneously, it is imperative that nurse scholars gain understanding of the divers scientific and philosophic traditions that have influenced the development of nursing knowledge in order to develop and enhance our science, our discipline and our profession. ”. Welch and Polifroni (1999(p-1)) Philosophy of science in nursing seeks to understand truth, to examine prediction, causality and law, to critically relate theories, models and scientific systems. Theses goals are accomplished through the methods of philosophic inquiry of reflection and dialogue. Welch& Polifroni(1999(p-5)).

In order to understand what truth is, Welch& Polifroni(1999) discussed the sources of truth ( Intuition, Authority, Tradition, Common Sense and Science)as well as the theories of truth such as correspondence theory; coherence theory; pragmatic theory; semantic and performative theory. These theories gave different interpretations for truth, for instance, correspondence theory suggests that truth is related to and correspond with reality, the truth is achieved through perceptions of the world, on the other hand for coherence theory, the truth is true if it is coherent while for the pragmatic theory the truth is relative and related to the practicality and workableness of a solution. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

According to Newman, Sime and Corcoran-Perry(1991):’’ Nursing is the study of caring in the human health experience…nursing body of knowledge includes caring and human health experience. A body of knowledge that does not include caring and human health experience is not nursing knowledge. ”. Truth can be achieved through knowing principles and causes of the natural kind behind phenomena. It is proposed that humans are the natural kind behind nursing phenomena.

Thus, human nature provides proper principles (the truth) of nursing 5 Philosophy course –First Assignment practice…. It is proposed that it is knowledge of human nature that provides principles of human action, and thus human nature is a source of practical truth in nursing. Whelton . (2002). The realist ontological position assumes that an objective world exists independently of our knowledge, beliefs , theories or descriptions about it.

This reality exists whether or not we can experience it or have conceptions of its nature. In contrast, several nonrealist positions have also been advanced, incorporating a wide variety of philosophical views pertaining to truth. These positions reject ontological and/or epistemological realism, and therefore truth cannot be related to an external reality . Lomborg and Kirkevold (2003).

However, Gortner and Schumacher (1992 )stated that ‘’ Nursing scholars can explore scientific realism for the insights it may provide for nursing science “. Moreover, Gortner and Schumacher (1992) proposed that “ Scientific realism is relevant to nursing science in the following ways: (1) It supports the full range of nursing theory; (2) It affirms the importance of including subjective client states in nursing theory and refutes the claim of the positivists that if it is not observable, it does.

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not exist. ;(3) It adds the idea of the substantive content of explanations to discussion about forms of explanation;(4) It includes the notion of truth as a regulative ideal in science and claims that better theories are theories that are closer to the truth”. 6 Philosophy course –First Assignment Relate the Empiricism, Positivism, Historicism, and Relativism to the nature of scientific truth Positivism Positivist approaches are founded on an ontology that the things we experience are things that exist. NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Its epistemology requires that this experience is verified through the deductive methodology of the `scientific method’ Wainwright,S. ( 1997). The positivistic philosophy of science will for example argue that scientific knowledge is objective and should be verified accordingly. Nyatanga(2005). The Relevance of Positivism to Nursing : It the positivist antirealism that make their views inappropriate for nursing science. It is not possible in positivism to deal with subjective aspects of person, nor with perceived relational processes, nor with explanations without translating them into physiological states or behaviors.

One of the most serious consequences of an antilrealist construction of theories is that theories cannot explain. Gortner, and Schumacher, (1992). EMPIRICISM Empiricism in its classical sense was a philosophical doctrine that considered observation to be the foundation of knowledge. Gortner and Schumacher(1992). Contemporary empiricism is a paradigm that has the ability to facilitate the application of the scientific facts learned from empirical methods within the appropriate context by taking interpretative knowledge into account…

It thus seems apparent that a broader view of scientific knowledge is required, and this is where contemporary views of 7 Philosophy course –First Assignment empiricism are more applicable to the practice of nursing. However, before reviewing the basic tenets of contemporary empiricism, there is a need to provide an overview of interpretive methods and their ability to provide a context or structure for the use of empirical knowledge.

Pluralism supports the assumption of contemporary empiricism that human responses can be identified, measured and understood even considering their complex nature. Therefore, an important part of nursing knowledge acquisition includes a synthesis of the data in order to better understand the synergistic effects of the whole, which cannot be learned simply by studying its parts. Traditional empiricism provides a basis for the study of certain types of knowledge that have made important contributions to the science of nursing. Giuliano,K. ( 2003). NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

The strength of contemporary empiricism is that it values traditional empirical knowledge but takes interpretive knowledge into account in order to provide a context for the appropriate application of that knowledge. The pluralistic nature of contemporary empiricism gives it the ability to bridge the gap between the facts of scientific knowledge and the use of scientific knowledge in order to facilitate the application of all types of nursing knowledge. Giuliano,K. ( 2003).

HISTORICISM The main protagonist of historicism is Kuhn. He was dismayed to find that traditional accounts of the philosophy of science bore no comparison with historical 8 Philosophy course –First Assignment evidence. He then set out to establish a theory of the philosophy of science in keeping with historical evidence as he saw it (hence the term historicism). Nyatanga (2005). Relativism Epistemological relativism view of truth and falsity in general are relative.

An epistemological relativist denies that anything at all can be known with certainty. According to hard core epistemological relativism, everything is a matter of opinion, including science. In this view of truth, nursing science has much knowledge that is derived from opinion and personal experience and consequently it is relative knowledge. Summary The importance and significance of the philosophical world views of realism, antirealism, phenomenology , postmodernism, positivism, empiricism, relativism and historicism for nursing science and profession were explored in this paper.

However, this area need more detailed exploration through our philosophy course in order to understand the similarities and differences between these philosophical worldviews and how we can integrate this knowledge in our practice and education. 9 Philosophy course –First Assignment References Giuliano,K. (2003). Expanding the use of empiricism in nursing: can we bridge the gap between knowledge and clinical practice? Nursing Philosophy. 2003,4, pp. 44–52. Gortner,S. and Schumacher,K. (1992). (Mis)conception and Reconceptions about Traditional Science. Advances in Nursing Science, 1992, 14(4):1-11 Lomborg,K. and Kirkevold,M.(2003).

Truth and validity in grounded theory – a reconsidered realist interpretation of the criteria: fit, work, relevance and modifiability. Nursing Philosophy, 2003,4, pp. 189–200. Newman,M. , Sime, A. , and Cororan-Perry. .(1991)The Focus of the Discipline of Nursing. Advances in Nursing Science,(1991),14(1)1-6. Nyatanga, L. (2005). Nursing and the philosophy of science. Nurse Education Today (2005) 25, 670–674 Wainwright, S. ( 1997). A new paradigm for nursing: the potential of realism. Journal of Advanced Nursing, 1997, 26, 1262-1271 Weaver, K. and Olson, J. (2006). NURS 8110 Assignments: Theoretical and Scientific Foundations of Nursing

Understanding paradigms used for nursing research. Journal of Advanced Nursing 2006 – Vol. 53 Issue 4 pages 459–469 10 Philosophy course –First Assignment Welch,M. and Polifoni,E. (1999) . Perspectives on Philosophy of Science in Nursing. An Historical and Contemporary Anthology. Copyright 1999. Lippincott Williams & Wilkins . Whelton,B. (2002) Human nature as a source of practical truth: Aristotelian–Thomistic realism and the practical science of nursing. Nursing Philosophy,2002, 3, pp. 35–46 Wikipedia, (2007). Phenomenology. Wikipedia the free encyclopedia. Retrieved October 15, 2007, from http://en. wikipedia. org/wiki/Phenomenology. N