ENTRAR            

THEORETICAL

Influence of positivism on nursing research and practice

Erick Landeros-Olvera,¹ Bertha C. Salazar-González,² Edith Cruz-Quevedo^3
1Nursing Sciences Ph degree student at UANL. ²Ph in Phylosophy. UANL Nursing School. ³Ph in Nursing Sciences. UANL Nursing School researcher. Monterrey, México

Mail delivery: Erick Landeros-Olvera. Nursing School Ph programs secretariate, Autonomous Nuevo León University. Av. Gonzalitos Norte 1500 Norte, colonia Mitras Centro, Monterrey Nuevo León, 64460 México

Manuscript received by 20.4.2009
Manuscript accepted by 28.7.2009

Index de Enfermería [Index Enferm] 2009; 18(4): 263-266

How to cite this document

 Abstract

Purpose: To describe the corresponding parto to positivism as one of the mainstream thoughs influencing nursing research and practice. Positivism characteristics assert that knowledge is concrete and phenomena are feasible to measure. For nursing this translates into keeping privilege for that what is organic; indirectly denying the subjective part, what matters is the clinical data that can be verified using concrete technology or techniques such as physical exploration. Regarding research, replication of nursing care interventions in different samples serves the goal to accumulate enough specific evidence (mathematically significant) as to be useful in practice. In conclusion the links between practice and research based under this thought have generated most of nursing knowledge and remains foundational to nursing practice in hospital and communities as well.
Key-words: Philosophy/ Positivism/ Nursing/ Practice/ Research.

Introduction

    The way to acquire knowledge could be explained form different thought phylosophycal perspective currents such as empirism, pragmatism, realism, and prisitivism among others. The phylosophycal perspective of any of them implicates advocating -using their own arguments- the concepts they develop to acquire new knowledge. Positivism states knowledge comes from the observable, that it is objective; from this perspective phenomena are feasible of measurement and count and can, therefore, be researched and contribute to science. The so called "hard sciences" (mathematics, phisics, chemistry, etc.) have guided themselves by the positivist perspective in order to develop knowledge, and its influence has spread onto biological sciences such as medicine and nurisng which traditionally have been configured under this phylosophycal paradigm.¹
    Positivism sciences main trait lies on the scientific explanation where research otucomes can be contrasted by the number of favourable events, that is, evidence accumulated in specific situations that underpin the generation of hypotheses, laws, and universal generalizations as well.^2,3 Consequently, it describes relations among phenomena in terms of succesion, resemblance, coexistency. Its explanations are characterized by the use of mathematics, logic, observation, experimentation, and control.
    The scientific explanation is precisely one of the nursing research goals regarding care practice; within our discipline one tends ideally to obtain accumulated evidence to make it usefull in practice so its concrete outcomes could be verified by quantitative indicators.⁴ This type of action is the product of positivism influence; to nursing, accumulated evidence means health caring with a scientific support and not only routinary practice.^5,6
    Due the nursing discipline nature -a biological and psycho-social stands combination- it can be influenced by diverse phylosophycal currents; however, the purpose of this paper is describing the part corresponding to positivism as one of the main currents that influence nursing research and practice.

Postulados fundamentales del positivismo

    The term "positivism" was set at the end of the 19th century by Auguste Comte to point out to the scientific knowledge as the human knowledge climax. Positivism boom goes back to 1907 when the Viena Circle was formed. It was represented mainly by the physicist Philipp Frank, the mathematic Hans Hahn, and the economist Otto Neurath. Their meetings aimed discussing science phylosophy themes, originating a new movement called "logical positivism".⁷ The name "logical" was added to indicate the support for new forms of scientific explanation based on the formal logic. Traditionally under this current the researcher (the nurse) has to rely on what he/she can measure and count; everything that can not be explained by a mathematical language does not exist to science and, therefore, is left on the metaphysics realm.^7,8
   Logical positivism built its doctrine over the norms that guide scientific knowledge and highlights that everything lacking an empirical character and everything that can not be submited to the contrast process is not science. Following these premises, according to Katouzian,⁹ positivism foundamantal postulates are: 1) scientific research starts with personal observations or experience; 2) observations are formultated by primary hypotheses or singular statements completely free of prejudice and describing a determined event or state of things in a prefixed place and moment; 3) singular statements came from universal (general) statements; 4) by the concepts development procedure one arrives to general theories elaboration that are subjected to contrast using an adecuate observation method including the experimentation and verification of its implications. If contrast is successful the theory is accepted, otherwise it is rejected.

Positivism in the nursing science

    The first nursing conception within positivism alludes Nightingale due the historical moment lived at the end of the 19^th century.⁷ Positivism creation coincides with Nightingale's nursing movement with her trascendent publication Notes on Nursing,¹⁰ ich started the evironment hygienist current with the principles of cleanness, space, light, and air. Nightingale registerd her interventions which contributed to diminish infections and death for the soldiers in the nursing room at Crimea. Her records were the concrete evidence, the observable data that served nursing to formally enter into the health sciences, likewise Nightingale to become an honorary member of the American Statistical Association in 1847 for his contribution to evidence-based practice.
    With Nightingale's contributions on positivism ground plus the nurses formative tradition under the biomedical current, the nursing in charge of patient's care is shaped on the qualitative paradigm.¹¹ Nowadays in many high level education institutions and health institutions in Mexico -where nurses are educated- maintain a prinvilege toward the organic, indirectly denying the subjective or emotional part that without doubt helps in patient's recovery; however, what matters is the clinical data. This means that students upbringing bases its practice on biological issues that can be measured, that render outcomes verifiable using technology or the concrete empirical techniques such as physical exploration. Some examples are: taking arterial pressure with a esfingmomanometer, count and traits of heart frequency by palpation, verifying arterial gases to adjust ventilation parameters in an artificial respiratory device, specifying hemo-dnamic profile using a Swan Ganz catheter to adjust cardiac expense, identifying cardiac arrhythmia caused by electrolites deficit, a neurological exploration using a Glasgow scale, hyperthermia caused by a bacteria infection and verified with a cultivation, haemoglobin low concentration in the face of nutrients deficit, among a never ending clinical data. All these parameters are feasible to mathematical verification, meaning they can be measured, and the concrete data indicates the nurse what he/she has to do to maintain or recover normal levels, although the patient's emotional needs are not taken in consideration; for what matters is his/her organic stability, anything else lacks importance. This is a clear example of positivism objectivity that is required by the labor market within the hospital scope.

Positivism: from nursing research to nursing practice

    Positivism has a clear influence not only on the clinical area; this current clear influence is reflected in most nursing research when the positivism method is used through the inductive reasoning characterized by the observations or particular experiences processes arrivng to a result that can be generalized.¹² Under this logical reasoning, nursing research as well as several disciplines uses the scientific method -a positivism method "per excellence". For example, in nursing, the main instrument derived directly from the scienctific method is the Applying Nurses Process (ANP). In research, however, other instruments or questionnaires with quantitative scales are used and constructed for measuring concepts transformed to variables (through concept's abstract concretion processes).¹³ Concepts represent particular units from where the inductive reasoning starts; in order to be subject to measurement they are transformed into reactives or indicators that accompany numbers or scales so they can be translated into a statistical representation.⁴ The result or datum is then interpreted on a mathematical basis and this last determines if it is, or not, significant to the research sample. When the research protocol is replied under specific conditions on different samples, one can arrive to its results generalization depending on the number of favourable events, measuring under what specific conditions the phenomenon should be replied; for example: once seen the result of certain physical exercise intervention that was successful in normalize adeponectin level in a group of women with obesity (adeponectin is a hormone related to ateriosclerosis processes, arterial hypertension and diabetes),¹⁴ we might ask: "can this exercise dose be useful in all women with obesity within the clinical practice?" In answering this question, research has to go through a replying process with populations that have similar characteristics in different geographical areas; in such way we can learn under which specific conditions the phenomenon studied will be replicated. Therefore, knowledge derived from research are numerical data suggesting rising interventions or actions in replicating the physical excercise dose in women with obesity is under a scientific foundation. Clarifying, to achieve a nursing care under a scientific foundation is necessary to verify several previous results that can be contrasted, and it is done by a systematic review of published research results. In Hempel's words,¹⁵ "contrasting shows empirical data and can explain under what specific conditions the phenomenon will be replicated; statements constitute a scientific explanation that requires empirical contrast. Therefore, science gives meanings to the phenomenon that is explained by the verification method; when the phenomenon is repited under certain conditions its veracity is proven and thus scientific postulates, laws, and generalizations arise.³ Reasoning is as follows: "nursing theory (as a biological science) has the purpose to explain or describe health care phenomena through postulates, statements, and hypotheses formulatiion,¹³ and these should be contrasted by means of theoretical support and number of favourable events; that is, evidence accumulates, is contrasted and verified in different scenarios.¹⁶
    The objective of each research carried out in nursing is to give a contributing fraction to explain or describe scientifically the phenomena around health care; the combined results evidence has the potential -among others- to modify clinical and community practice techincal procedures, modify diseases and risk prevention ways, propose innovative techniques for determinated group of patients with a particular nurse.
    On the other hand, research positivism trend in North America has influenced on Latin-American research since this last tendency for using nursing models and theories,^6,17 which concepts can be subjected to verification; and although laws are not generated there is an aproximation to supported by mathematical logic shown -in an objective way- in the statistics for knowledge poroduction and advance. According to Galvez,¹¹ "nursing scientific evidence is developed on the deepest positivism ground, the patient's criterion and the profesional's experience are advocated but, actually, all its support is on the statistical realm and on what is quantitative, on what is controlled random". The use of descriptive designs and the trend for using correlational, experimental, and quasi-experimental designs is most frequently used to answer a research question which answer would generate knowledge that can verify the relatiionship of concepts derived from nursing theoretical postulates, thus getting closer to the human groups health care reality explanation.

Conclusion

    Nursing is neither a hard science nor a totally biological science because it deals with the person's wholeness and so, ti has not the necessary structure to establish human health care universal law. The quite deep abstract nature represented by the care phenomenon and its multiple variables around the human response pose over the prediction of conducts a series of limitations. We consider that not any phylosophical current has the absolute truth nor the best way for generating knowledge; however, is positivism the one that prevails in nursing, and its influence is totally marked in the hospital practice that uses scientific evidence based on the quantiiable clinical datum, and thus traditionally, what matters in the nursing care result is the numerical data. Finally, positivism is used in research through the nursing theoretical models use, making obvious its concrete usefulness in clinical practice by showing a circle between practice and research in order to generate and apply knowledge.

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