Paradigm shifts are often not easy, but here's the thing[horizontal ellipsis]after more than 25 years as nurse scientists, the current potential modification of our scientific paradigm has left us somewhat confused and worried. At the same time, we also have interest and commitment to the goals of inclusive nursing science that improves health for all. Let's start at the beginning.
First, let us be clear about what we mean by a paradigm. Although often used to describe a type of thought or behavior, as originally used in 1962 by Thomas Kuhn and as many of us learned during our doctoral training, a paradigm is a set of concepts and practices that define a scientific discipline at a particular point in time. Kuhn (1962) noted that a discipline's paradigm focuses on the "problems" and solutions for scientists within that discipline. That is, a paradigm directs scientists to study particular problems, ask particular questions, study those problems and questions in particular ways, interpret the results of studies within disciplinary theories, and continue to build and develop theoretical knowledge to define the discipline and field. According to Kuhn, a paradigm shift is a fundamental change in the basic concepts and experimental practices of a scientific discipline. In short, a paradigm shift occurs when the dominant paradigm under which the "normal science" of a discipline functions ceases to be compatible with new phenomena, thus requiring a new theory or paradigm. Again, according to Kuhn, paradigm shifts occur when a new paradigm is needed because there are new scientific problems that cannot be addressed with the existing paradigm.
Now, we could argue about the validity of Kuhn's work, and we could argue about the nature of nursing's scientific paradigm or even if we have one. For the sake of this editorial, we will affirm our general acceptance of Kuhn's argument about scientific revolutions. We will also affirm our understanding that nursing's paradigm consists of person, health, environment, and nursing and that there are many theories used within nursing's paradigm to solve problems important to the discipline and problems focused on improving health outcomes for all individuals and specifically for those to whom we (nurses) provide care.
Nursing science, in fact, has many phenomena of interest, including: wellness promotion in diverse communities, management of illness conditions and troubling symptoms, development and implementation of technology to address health problems and improve health outcomes, mechanisms to improve understanding of the biology or psychology or social factors that underlie disease or disease- or treatment-related complications, and end-of-life comfort and care. Moreover, nursing science is not limited to a particular setting; it takes place and is being used in hospitals, homes, communities, schools, and all other places where humans live and interact with each other and the environment in ways that affect health. Critically, nursing science links research to practice; science provides the evidence for care that is designed to promote the most optimal health outcomes for all persons. For many nursing scientists, the last few years have been a period of normal science during which great progress was made to solve complex problems. Many thought we might really have mature science making important scientific progress. Thus, it is surprising to think that we may be on the verge of a paradigm shift.
Nursing science has experienced paradigm adjustments in the past. For example, the increased focus on mechanism-based biological explanations for health and illness, symptom experience, and long-term outcomes began during the 1990s and gained prominence during the early part of this century. Although many nurses were initially uncomfortable with the increased use of biological measures, including multiomics methods applied to our science, over time, a large portion of the community of nursing scientists have embraced the necessary inclusion of these measures within our existing paradigmatic theories and have received advanced training in these methods. The same is also true of the paradigm adjustments that occurred as part of the movement toward more "qualitative," understanding-focused research that gained momentum in the 1980s and 1990s. These and other adjustments, though difficult for some nursing scientists, have been largely accepted because the work within these areas has further advanced nursing science, the focus of which is to improve human health. Moreover, both the National Institute of Nursing Research (NINR) and the academic community responded to these adjustments in paradigm with significant infrastructure, resources, expertise, and training opportunities, which greatly contributed to the acceptance of the work and the adjustments. In short, there was much involvement of the community of nursing scientists in managing these shifts in a way that did not abandon the work that had previously occurred. These shifts were embraced because they improved nursing science and because they had widespread scientific support from the community of scholars.
Today, we have a different sort of challenge to nursing science. It is found in a number of statements posted on the NINR website and included in statements distributed via funding opportunity announcements and notices of special interest, which appear to be a precursor to a new strategic plan for the institute. The plan, which was not available at the time of this writing, is promised to "present a bold, new research agenda to advance nursing science" that advances "health equity through practice- and policy-relevant research that addresses the realities of people's lives and living conditions" (https://www.ninr.nih.gov/). Although we do not fully understand the meaning of these publicized statements, their release, in conjunction with other statements found on the NINR website, appears to be an effort by NINR leadership to change the nursing science paradigm without first engaging nursing scientists in the discussion.
To be fair, nursing scientists may have become complacent with the current nursing scientific paradigm and the normal science stage in which we have been for the last decade or two. During this time, nursing scientists have developed a set of theories that have usefully provided guidance for practice and for research, especially in the areas of symptom management, palliative/end-of-life care, mechanism-based multiomics methods, health behaviors, and use of technology. Indeed, many nurse scientists were trained using a clear set of tools to study important problems; this training led to successful programs of research involving both nursing and interdisciplinary scientists. Nursing science further expanded during this time, encompassing different populations in different settings, using different tools of discovery.
If our predominant paradigm needed adjusting, we would generally expect that we would have uncovered "anomalies" or questions that could not be explained by our existing paradigm; this need, however, was not apparent to many nursing scientists. Thus, although we have many more questions to answer, including questions about health equity, the current paradigm does not seem exhausted. We are not yet in crisis or in need of what Kuhn called "extraordinary research," which is characterized by a period of research conducted without use of the structures of the dominant paradigm. During a time of extraordinary research, we would expect a proliferation of competing theories, a willingness to try anything, and a debate over the fundamental nature of nursing science. Eventually, we would have a new paradigm, one with its own followers, as current scientists adapt to change or withdraw from the discipline.
Changing paradigms can be difficult (Younas & Parsons, 2019). The new paradigm has to explain or predict nursing science phenomena better than the existing paradigm, and it has to be "good" for the future of nursing science, especially because progress can slow down drastically during a shift. Importantly, there cannot, according to Kuhn, be two paradigms in existence for normal science to occur, and normal science is necessary for problems to be solved.
Thus, this has led to our confusion and concern. Are we finished with solving the problems that have been before us for decades? Is a new paradigm needed? Will the new paradigm being promulgated by the NINR leadership work better than out current paradigm to solve human health problems? What will happen to the thousands of nursing scientists who have been trained within the current paradigm? Can nursing science survive the inevitable loss of a current generation of nurse scientists and those potential future nurse scientists who do not "fit" the new paradigm as it has been explicated by NINR leadership?
Importantly, given the potential effects of a paradigm shift, there is a concern that nursing scientists have abdicated their influence, skill, and knowledge to a federal agency to set the research agenda for nursing science. Truth be told, we have in fact done this for years. Many of us "grew up" with NINR, celebrating its early founding in the 1980s as a center and then later, in the 1990s, as an institute; we have largely relied on NINR to provide guidance to our science. However, perhaps now is the time to step back from our reliance on NINR for scientific agenda setting and for leadership, funding, and scientific development. Perhaps it is time to consider a different structure for nursing science, one that encourages input from scientists across experience, focus, and methods (Weaver & Olson, 2006).
Nursing scientists have long embraced inclusivity of thoughts and concepts, methods, and interpretation of scientific results. At the moment, we do not see this inclusivity. We do not hear or see public calls from the scientific community for conversation about the research priorities being set by NINR, an entity many of us have rigorously supported throughout its entire existence. We do not see any recognition of the potential harm that a forced paradigm shift may have on scientific progress.
We do not know how this will be resolved. Certainly more conversation and meaningful dialogue are needed among nursing scientists. We hope this happens. We hope that nursing's scientific societies and the institutions that support the work of nursing science and the training of future nursing scientists will provide the leadership needed to enable continued progress in nursing science.
ORCID iDs
Rita H. Pickler https://orcid.org/0000-0001-9299-5583
Susan G. Dorsey https://orcid.org/0000-0001-7648-1312
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