Paradigm Shift or Paradigm Drift? A Meditation on Commitment and Transcendence

Discourse about a paradigm shift in nursing has appeared with increasing frequency in the literature for 30 years (Fawcett, 1993; Hardy, 1978; M. Newman, 1992; Parse, 1987; Tinkle & Beaton, 1983; Watson, 1999), sparked, as in other disciplines, by Kuhn’s landmark book, The Structure of Scientific Revolutions, published in 1962 with a second edition in 1970. Prior to that time nursing science progressed largely in accord with the positivistic/postpositivistic philosophy of science, the perspective driving the “normal science” of the era, to use Kuhn’s term. The central theme of the paradigm discourse in nursing is that this scientific worldview, or paradigm, has been displaced, is on the verge of being displaced, or will eventually be displaced by a new paradigm arising in the discipline. In the 1950s, 1960s, and 1970s, as a new science that was subjugated to medicine and led by women, nursing was doubly dominated, and the literature provides ample evidence that conventional medical science was the primary guide to nursing practice. Nursing did not have the standing to pose a major challenge to conventional science or medicine as the guides for its own conduct and progress, though the future eruption of philosophy and theory specific to nursing was brewing even then (M. Rogers, 1964). Given this start, the proliferation of theory development in nursing over the past 30 years is a remarkable achievement. As of December 1999, a search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on the term nursing theory yielded 2,965 entries. A search on the term paradigm yielded 2,435 entries. Of course, the existence of these papers does not necessarily mean that they influenced practice, education, or research. The purpose of this article is to examine whether, over the years that this discourse has unfolded, a paradigm shift has actually occurred in nursing, and, if so, what has its impact on the discipline been, and what may it be in the future? An advantage of nursing’s late arrival as a scientific discipline was the wide availability of discourses on philosophy of science, theory-building, research methods, and humanistic alternatives to the received view. The successes of the physical sciences and the excesses of positivism and modernity were profusely documented and debated. These discourses informed and supported nursing science as it progressed, with a self-consciousness unique among disciplines, through (a) the use of borrowed theories, to (b) the use of theories specific to nursing, commensurate with the received view, to (c) the use of theories specific to nursing and challenging the received view—that is, the emergence of an alternative paradigm, a new and distinct perspective on the phenomena of concern to nurses. From 1970 onward, the coexistence of nurse leaders in diverse phases of these overlapping developments—in combination with the fragmentation of nursing by multiple entry levels, variations in scope of practice, narrow specialties defined by medical categories, and leaders educated in other disciplines—has meant that nursing science has been an extremely multifarious endeavor. Although a common scientific worldview (positivism/postpositivism) has been shared by the majority of nurses throughout the modern scientific era, theories in use among nurses have spanned medicine, biology, psychology, sociology, business and management, philosophy, and education. The variety of scholarly and practice activities carried out within the context of the received view, along with numerous critiques and proposals counter to the received view from the new paradigm proponents and others, have made it difficult for scholars to be consistent and clear about what constitutes the new (or the old) paradigm. Editor’s Note: Send comments, reflective responses, suggestions, or query letters about ideas for this column to William K. Cody, RN, PhD, Associate Professor and Chairperson, Family and Community Nursing, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223; phone: (704) 547-4729; fax: (704) 547-3180; E-mail: wkcody@email.uncc.edu.