A dialogical paradigm for holistic discourse in nursing

This work sets forth a dialogical paradigm for nursing. This paradigm is articulated in terms of the theoretical orientations of constructivism and hermeneutics. Piaget, as a principal architect of constructivism, provides the foundational work for understanding the construction of cognitive realities. Heidegger's hermeneutical method allows an approach to examine the construction of human experience, particularly the construction of understanding that supports and complements the Piagetian interpretation.

These perspectives are defined and related to the theory and practice of nursing with particlar focus on the continuing debate between scientific-medicine and holistic-health paradigms. The 17th Century roots of present-day science are traced and compared with the ancient beliefs in holism.

Dialogue, not dialectics, is proposed as the preferred method for nursing discourse. In order to understand the background and evolution of discourse in nursing literature, a thematic synthesis was performed. Three journals were selected as being representative of the nursing discourse. All items published in Advances in Nursing Science, Nursing Outlook, and Nursing Research, from 1978-1986 were categorized according to thematic presentation. The sample was further enlarged by including items referenced by the original sample. The total sample of 1500 articles was reduced to 240 items that were found to express two major themes: l) Inconsistency in the use of the word, science, and 2) The dichotomy between the holistic belief that nursing theory supports and the quantitative/reductionistic approaches evidenced in nursing research. Implications of these findings and directions for constructing and understanding holistic discourse in nursing are developed.