Debunking Myths in Nursing Theory and Research*

Peggy L. Chinn, RN., Ph.D., F.A.A.N.

* This essay, in modified form, is reprinted by permission of Image: The Journal of Nursing Scholarship.

Abstract

This article examines myths that persist in the traditional male-defined scientific enterprise. Science per se is not rejected, but specific ways of confronting the myths are explored. The methods for debunking the myths derive from the concept of future search, wherein health and the values of nursing for the future direct the discovery of knowledge. The alternatives include a more ethical and responsible use of the methods of science as well as specific alternatives to science derived from Carper's1 patterns of knowing in nursing.

The nursing literature has reflected growing recognition of the limitations of the scientific method in addressing problems in nursing.2-7 Taken together, the literature leaves the impression that we should perhaps forsake the scientific method; alternatives for acquiring knowledge in nursing are not adequately described, and the alternatives that arc suggested are not clearly alternatives to the traditional scientific method.

Most critiques of the scientific method fail to recognize that traditional science is based on a male world view and that the myths sustained by this partial world view have perpetuated erroneous knowledge about the world. The purposes of this article are (a) to present an analysis of myths of science that arise from the partial male world view, (b) to propose methods for debunking these myths to attain a more whole science consistent with the essence of nursing, and (c) to propose alternative approaches to science where an alternative is indicated.

Myths

The concept of "myth" carries many meanings. Two dictionary definitions focus attention on the meanings that are relevant to the focus of this article: "a traditional story of ostensibly historical events that serves to unfold part of the world view of a people, or explain a practice, belief, or natural phenomenon" and "an ill-founded belief held uncritically, especially by an interested group."8

Myths remain a powerful force in the creation of sociocultural patterns, and science and scientists are equally subject to their influence. Myths are not entirely false and in fact contain an element of reality. This is why they are so seductive and difficult to recognize. Since myths are based on a particular world view, they function actually to shape and create reality. Until we examine myths critically, we are not able to sort out what is ill-founded from that which is well-founded, or whose interest are served.

Traditional science has created beliefs about reality that are taken to be "true." Current scientific enterprise, however, rests on a white, upper-class male view of the world.9 This view is not necessarily wrong or bad, but it is not universal. Regardless of the actual origins of the prevailing world view or whether it arose from the maleness per se, it focuses on attributes and phenomena traditionally considered "male": power, control, instrumentation, technology, competition, rationality, logic, objectivity, hard data. Not only does this view rest on the superiority of male-assigned traits, but it also disdains concepts that are consistent with that which is assigned as being "feminine": soft data, subjectivity, feeling, emotion, intuition, and so forth. This arbitrary value assignment clearly does not serve the interests of nursing or the best interest of humanity. Spender discussed the myth of the superiority of that which is masculine in language:

The myth was made a long time ago and for centuries it has been fostered by women and men so that now it is deeply embedded in virtually every aspect of our existence. It is a myth which may be attacked but one which is not easy to eradicate, for all myths still have a hold over us long after they have been intellectually repudiated, and this one, which is fundamental to our social order, is particularly pervasive and particularly hard to dislodge. The fabric of our social organization has been woven to support and substantiate it and nothing less than a restructuring of our beliefs and values is necessary, if it is to be laid to rest.10

Future Search

Just as language is a powerful tool for conveying the prevailing world view, an examination of new meanings for language can be used to create a shift. The word "research" is a useful starting point. The activities that happen under the name of research are often literally re-searching what has been done over and over again. Usually the hypotheses shift from project to project, but there is seldom any creativity in the conceptualizations or methods used primarily because credibility depends on doing the same thing (or close to it) in the same way. What this does is perpetuate the status quo -- a past-oriented perspective.

Heide11 proposes that we shift our focus to future search. Future search requires that we envision the world as it could be, or as we want it to be -- a healthy, productive, peaceful, enduring, nurturing environment and society. Once we have this vision, we can begin to discover knowledge that is required to create this world. As nursing scholars, we can end the perpetuation of a status quo that values illness more than health; we can enact what we know in our practice by focusing our scholarly energies in the direction of health for all. In short, we can be change agents.12

Future-search methods that serve to debunk myths in nursing science rests on the following assumptions:

The Myths of Re-Search

There are several ways to approach a movement toward future search. The movement begins with debunking myths of the scientific enterprise. In considering the myths, I am not suggesting that we eliminate the concepts entirely; I am suggesting that we debunk these ideas as sacred truths, examine the dimensions of these ideas that are partial or false, and move in a direction of wholeness consistent with our world view.

Myth #1: The Myth of the Ultimate Truth

The myth of the ultimate truth leads us to think that science represents some absolute reality. Scientific theory is supposed to represent reality, and reality is supposed to be truth. Truth, as it is conceptualized in the traditional scientific enterprise, is represented in the assumptions of theories and research. For the most part, the assumptions are rarely recognized much less questioned. By subscribing to the assumptions as "truth," we seek data that conform to our view and ignore contrary evidence that does not support the underlying assumption of what is true. We ignore as being idiosyncratic (insignificant) data that do not conform to our preconceived beliefs.

The method for debunking this myth is to identify existing assumptions. Once existing assumptions are identified, contrary evidence will not be automatically dismissed, but will simply be incorporated into an enlarged viewpoint.

The work of Gilligan14 demonstrates the importance of questioning underlying "truths" and unstated assumptions. Gilligan studied with Kohlberg and learned his theory of moral development. Later, she realized there was important information that had not been disclosed in final reports of the research or integrated into the theory. Kohlberg's theory is based on all-male research. When the theory and tools derived from it were used with women, women were found not to achieve development beyond the third state of a 10-stage process and were assumed to be inferior to men.14 Gilligan reexamined the theory and questioned the assumption that failing to be "10" represents an inferiority. Using methods of traditional science, she demonstrated contrary evidence required to debunk the myth of the universality of Kohlberg's theory, revealing that women are not inferior; the theory is inferior. In a very fundamental way, Kohlberg's theory does not withstand the test of universality, as Kohlberg has claimed. In the process ol discovering contrary evidence, Gilligan also contributed knowledge that has begun to change how women are viewed -- a hallmark of the future search enterprise.15

Myth #2: The Myth of Objectivity

Traditional science prides itself on being "value-free" and therefore objective and not subjective. Intellectually, some traditional scientists recognize that no science is value-free; nor is it free from subjective influence. However, it is not the value laden bias of the scientific enterprise that is the problem; it is the continuing failure to acknowledge and take seriously the nature of the values and subjective interpretations that are imposed on the so-called "objective" ideas, methods, and designs.

One of the dictionary meanings of "objective" is particularly enlightening: "methods that eliminate the subjective by limiting choices to fixed alternatives requiring a minimum of creative interpretation (e.g., tests of personality)."8 Of course, the dictionary does not ask, "Who determined the alternatives? What values influenced their choice of the 'fixed alternatives?' Who decided that it was desirable to eliminate the 'subjective' and 'creative' in the testing of personality?"

The most insidious technique used to perpetrate the myth of objectivity is the erasure, abdication, and obfuscation of responsibility, thereby obscuring the subjective influence. The scientific literature, including that of nursing, is abundant with such phrases as "research results show" (What research? What kind of research? By whom?), and "it is generally known that" (By whom?). This is a tradition that works well to obscure responsibility and should be a major ethical concern for all scientists of our day. It is both an individual and a collective problem.

The method for debunking the myth of objectivity is to name the responsible agent, and to demystify the assumptions, the motives, the values, and the processes that were used to arrive at the definition of what is purported to be objective. We have a wonderful example in our own history of a nursing scholar who recognized this problem and took a strong stand opposing it. Writing in the American Journal of Nursing in 1915, Lavinia Dock stated:

As a result of the European war, there are reappearances of ailments that were practically non-existent. Gaseous gangrene, never seen in surgery now-a-days, has come again. . . . When we know how surely and certainly these diseases are caused by men's own acts and deeds, does it not seem as if we should say, "Man's actions have produced gas-gangrene and typhus;" instead of the flabby statement, "Typhus is prevalent; gas-gangrene is developing." Seeing such ruthless and dastardly energies at work, does one not understand Florence Nightingale's impatient contempt for the germ theory, and comprehend her insistence that it was the things people did that caused disease?16

Exposing responsibility exposes underlying assumptions and myths and creates a new view of reality. For example, Florence Nightingale experienced the horrors of war and the destruction of human life and health; she refused to accept that the unsanitary conditions that she witnessed were "natural."

Her personal and subjective response to these conditions created an awareness of reality that was not generally accessible to other scholars of her day. Margaret Sanger grieved for the waste of human life and human potential that was created by the uncontrolled frequency of pregnancy, and she refused to assume that this condition was "natural." Her subjective, self-acknowledged response created the motive to seek the knowledge that would create health.

Myth #3: The Myth of the Perfect Method

The myth of the perfect method results in compulsive orderliness, repetition, and a fixation on minute details. It encourages us toward mental laziness in envisioning alternative methods, alternative approaches, and alternative assumptions. We re-search and re-search to the point that we know more and more about less and less, failing to recognize the relevance or irrelevance of what we are studying. The perfect method, by definition, leads us on a path of examining small segments and parts of reality apart from the whole and is based on the assumption that a segmented analysis of the parts will yield knowledge of the whole.

The method for debunking this myth begins with the recognition that there is no one perfect method and that various methods must be used in relation to each question that is asked. Most important, this shift requires valuing alternative methods in a fundamental way. It requires refusing to apologize for what is presumed to be inadequate when contrasted with the "perfect method." It also requires that we cease to view alternative methods as merely stepping stones to the "perfect method" or entirely different approaches (such as those I will describe in the following section), are to be used and developed for their own worth and value.

Nursing is faced with what might be called an imperative to debunk this myth arising from the nature of the work we do, what we have identified as important, and how we view our goals. In conceptualizing health, the client, the environment, and the nurse-client interactions, a clear holistic view has emerged. If we remain committed to this foundational view, then the traditional method, which requires studying parts or segments of things or people, is simply not adequate.4 A segmented, partial approach might serve to enlighten or might serve some limited pragmatic purpose; it might be preferable to adapt the traditional methods to complex problems rather than to do nothing; however, as new methods emerge, they must be judged on their own merits, not against the false "standard" of the perfect method.

Myth #4: The Myth of Scientific Supremacy

The myth of scientific supremacy focuses on the religious-like quality of traditional science as the means for delineating truth, knowledge, and reality -- and as an end in and of itself. A critical component of this myth is the rejection of any other possibility for creating knowledge. Traditional science, which is based on the notion of empirical validation, is thought to result in true knowledge; all other forms of knowledge are judged as being merely speculation, opinion, or not what can be conceptualized as knowledge. If this myth did not have a strong hold on us, we would long ago have begun serious work to develop other ways of knowing.

Traditional science has served well to debunk myths perpetuated by the ancient philosophies and religions, and it is undoubtedly an effective way to obtain knowledge. However, science as the supreme end in and of itself has produced knowledge that has not turned out to be in the best human interest; indeed it has been used to create planet-wide contamination and has brought us to the brink of world-wide destruction.

The method for debunking the myth of scientific supremacy is to insist on the integration of the different patterns of knowing. The patterns of knowing described by Carper1 derive from the nursing literature and serve well as a basis for envisioning that which is possible. Any one pattern of knowing used in isolation of the others is an incomplete, partial form of knowing. All patterns must be integrated to create what I would call Knowledge. Each pattern requires its own process of discovery and its own method for determining what is credible, as distinguished from isolated fantasy:

Myth #5: The Myth of Empirical Evidence

The myth of empirical evidence is the belief that "what is" is observable through sensory experience, and whatever is not observable through sensory experience does not exist. Furthermore, whatever is observable is measurable; it is quantifiable. The fundamental usefulness of empirical validation of phenomena is not to be rejected, but the myth represents a good idea gone wild. The myth extends the value of empirical validation of phenomena to encompass the belief that, if something cannot be empirically validated, it does not exist or is not worth pursuing. Further, the myth sustains the tendency to proclaim that something either is or is not empirically accessible when in reality phenomena are relatively accessible to empirical knowing. Science has stimulated ideas that give rise to possibilities for empirical validation long before empirical validation is possible; we call this the discovery of instrumentation, or methods for empirical observations. As we have moved into areas of knowledge that are relatively inaccessible, we create methods that are increasingly indirect in relations to the phenomena, still naming the indirect measure "empirical evidence" to justify the scientific nature of our enterprise. Once this is done, we call the phenomenon empirically validated: it exists.

As we leap through these mental exercises, we fail to seriously confront the artifacts that are created in the process of "empirical validation." I am not arguing that highly abstract phenomena (e.g., health or motive) cannot and should not be empirically validated; nor do I reject scholarly work in this direction; but I reject the assumption that empirical tools or observations are adequate to create comprehensive knowledge of these phenomena. I also question the assumption that empirical evidence itself will produce accurate knowledge.

The method for confronting the myth of empirical evidence is to recognize the limitations of empirical evidence in relation to developing knowledge and to value other ways of knowing related to the phenomena that we are exploring. As we recognize the limitations of empirical evidence, we can begin to untangle distortions that are created by artifacts of empirical validation. The untangling process will include improvements in our approaches to obtain empirical evidence as well as open possibilities for knowledge that do not derive from empirical evidence. I submit that our body of knowledge of a phenomenon such as "motive" in relation to health will ultimately require strong, sound empirical evidence free of artifacts. But the complex keys to understanding this and other phenomena do not reside solely with the scope of empirical validation. The key to understanding these complex phenomena requires integration of the methods of justification, criticism, and introspection.

Myth #6: The Myth of Higher Authority

The myth of higher authority governs the scientific enterprise in a number of ways. It perpetuates ethical, empirical, and moral dishonesty. Most scholarly work begins with a review of "authoritative" literature, and we use the authority of existing literature to justify everything we do. The halo effect that an idea or a belief acquires by being published is a remarkable transition that I can only perceive as being magic.

The very fact of being engaged in the academic/scientific enterprise confers a socially sanctioned aura of authority. We are in a position to give or withhold information at will; to use, coerce, and manipulate people with little if any challenge to our authority. Even the language we use in research communicates authority -- control, manipulation (of variables, conditions, numbers, people), inference, standardization, operationalization, subjects, instruments.

Being a scientist also confers the authority to assign value judgments and worth to phenomena, ideas, or things. The act of measuring produces dichotomous thinking, or hierarchical assignment of value. We speak of high and low, we rank order things and assign values to those things without questioning the meaning of the valuing or the contextual possibilities that might exist or be created by our valuing. This myth has made it possible for male scientists to assign the value of "the norm" to maleness. Simply assigning a value does not make a thing true or right, but assigning a value of "ten" creates the illusion of truth or rightness.

The method for debunking the myth of higher authority is to place ourselves in the position of the grass-roots people with whom we work, or for whom our knowledge might have the most direct effect. In essence, this strategy is one of ethical justification, esthetic criticism, and personal introspection. We must discard the myth that the scientific enterprise is by definition a higher authority and that the scientist by definition has rights or authorities that are different from those of any other individual. Once we make this shift in our thinking, we can examine how well our approaches, our methods, and our conclusions are consistent with experiential reality.

Myth #7: The Myth of Significance

The myth of significance is most clearly recognized by examining the statistical concept of significance. When we are told that something is "significant" at the .01 level of probability, it assumes a halo effect of significance far beyond the strictly technical and statistical meaning of the term. The statistician and the researcher (hopefully) know the limitations and restrictive meaning of the term "significance" in a statistical sense. However, scientists rarely adhere to the strict statistical meaning in interpreting their results. As long as the results reach statistical significance, the findings have meaning. If the results do not reach statistical significance, the findings must be explained and have little meaning. The "significance" of the results of studies is used to imply not the statistical concept but the more common language understanding of the term: that it is important. Rarely does anyone ask, "Significant for what? For whom? In what context?" We seldom ask for what purpose, or in whose interest, a scientific enterprise has been undertaken. These factors are critical in determining how much importance we attach to the results of our research -- those that are statistically significant as well as those that are not.

The method for debunking the myth of significance is to apply the test of importance in relation to future search purposes and goals, regardless of the statistical findings. By shifting our attention to the importance of the research, we can detect ways in which the research may or may not contribute to knowledge that can create the kind of world in which we wish to live and work.

We will discover many subtle ways in which our scientific enterprise limits the universality of the theories and the generalizability of the research. A statistically significant study that is based on white, male, middle-class values, that draws on a white, male, middle-class population (as in much nursing research), probably has little or no meaning, much less importance, for the majority of people in this world who are not white, middle-class, or male.

Why Debunk Myths?

In conclusion, I want to acknowledge that there are pitfalls in taking a skeptical view of the status quo, even though scientists are by definition supposed to be skeptical. My interpretations of the myths of the scientific enterprise are deliberately severe to stimulate awareness of the actual behavioral practices of many scientists and the flaws in that which we take to be truth. I have not recommended the abandonment of traditional science, but I do recommend that we equally credit the limitations of this method. By debunking the myths of scientific enterprise, we will find critical areas for new applications of that which is valuable in the scientific method and ways of integrating other patterns of knowing.

The fundamental question is not why we should question and challenge the myths of the scientific enterprise, but why not? Why not conceptualize the purposes and the goals of our research and theory in terms of the world that we want to create? Why not seriously value other ways of knowing? Why not value nursing and health? Why not identify actions, behaviors, and assumptions that we know to be consistent with health and behave as scientists in ways that are consistent with our vision? I believe that we are already beginning to do this; and if we choose to, we will increasingly focus our energies in this direction.

Acknowledgements

This article is adapted from a presentation given at the Research Day sponsored by Sigma Theta Tau Alpha Nu Chapter, Villanova University, Villanova, Pennsylvania, November 2, 1984. The author wishes to acknowledge the contributions of Charlene Eldridge Wheeler in conceptualizing the myths; of Barbara Carper in critiquing the methods for determining credibility of ethical, esthetic, and personal knowledge; and of the members of the Nursing Theory Think Tank for discussion that prompted the development of this article.


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