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Received: 3 May 2018    Revised: 4 September 2018    Accepted: 4 September 2018

DOI: 10.1111/nup.12228

ORIGINAL ARTICLE

The central question and the scope of nursing research

Elizabeth Moulton1  | Rosemary Wilson2  | Pilar Camargo Plazas1  | 

Kathryn Halverson3

1
Queen's University School of Nursing,
Kingston, Ontario, Canada Abstract
2
Department of Anesthesiology and As nursing continues to develop as a professional discipline, it is important for nurses
Perioperative Medicine, Queen's University
to have a central question to guide their research. Since the 1800s, nursing practice
School of Nursing, Kingston, Ontario,
Canada and research have covered a wide scope in cooperation with other disciplines. This
3
Lakehead University School of Nursing, wide area of nursing practice and research has led to the proposal that the central
Thunder Bay, Ontario, Canada
question be: How can the well‐being of a person, family, community, or population be
Correspondence improved? The proposed question must remain flexible and open to revision because
Elizabeth Moulton, Queen's University
nurses will continue to adapt to the changing needs of their patients and populations
School of Nursing, Kingston, ON, Canada.
Email: 43eam@queensu.ca and to their complex and evolving work environments.

KEYWORDS
nursing practice, nursing research, professional practice, science development

1 |  I NTRO D U C TI O N
“So you’re not a nurse anymore?” is the most common question I
(EM) get when explaining that my field of study includes biomechan‐
ics, which is a branch of engineering, and neurology as well as nurs‐
ing. This question comes not only from the general public but also
from other scientists and nurses. Given the difficulty nurses have
in defining our practice, it is no surprise that we also have difficulty
explaining the scope of nursing research to others. Clinical practice
is the predominant source of questions for nursing researchers since
practicing nurses are the primary consumers of nursing knowledge,
though nursing shares its research with the many fields that it bor‐
rows from.
In the modern era, one of nursing’s primary goals is the de‐
velopment and recognition of nursing as a professional discipline
(Smith & McCarthy, 2010). A professional discipline is defined
as a unique perspective with a distinct, identifiable body of
knowledge that developed, researched, advanced and passed
on by its members (Flexner, 2001; Meleis, 2012). In order to
provide knowledgeable service to a society, a professional dis‐
cipline should be dynamic, ready to respond to the changing
needs of individuals, societies and healthcare systems (Meleis,
2012; Smith & McCarthy, 2010). However, dynamic professional
disciplines have core values, assumptions, perspectives and mis‐
sions that remain stable and effective throughout time (Meleis,
2012). As such, recognizing that nursing is a professional disci‐
pline, it is vital to create a central question for nursing research.
This question should provide guidance for nursing’s unique
body of knowledge, but also take into account the philosophies,
ethics, theories, research and art of the discipline (M. Smith &
McCarthy, 2010).
In this paper, we will begin with an overview of the development
of nursing practice and research, from the late 1800s to the present
day. This exploration will allow us to understand the difficulties that
have limited nursing research that is relevant for practice with a view
to future avoidance. The purpose of this paper, therefore, was to pro‐
pose the central question that all nursing research aims to answer
and to use the proposed question in the context of nursing practice
to outline the scope of nursing research. To do this, we will first ex‐
plain the reason that nursing needs a central question to guide its
efforts. We will then discuss how nursing research can be concep‐
tualized within the context of the developed central question. We
will propose a vision for the presentation of nursing among the other
sciences, the worldviews that should be accepted, the flexibility of
the scope of nursing research and the evidence‐informed relation‐
ship between nurse and patient.

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2 |  H I S TO R I C A L PE R S PEC TI V E O F
N U R S I N G R E S E A RC H
Nursing practice and, as a result, nursing research have varied greatly
since their conception. Beginning 180 years ago, in the Nightingale
era, attention was oriented towards the need to properly educate
nurses as a way of increasing the quality of care that the sick received
(Gortner, 1983). Interestingly, Nightingale (Nightingale, 1860) warns
in the preface of her Notes on Nursing that the purpose of the text
is not to teach a nurse to nurse. Rather, it was her intent to provide
“hints” to women who have the responsibility for providing personal
care to a family member: considering this to be knowledge that eve‐
ryone ought to have. Nightingale’s perspective may be interpreted
as a valuing of accessible and widely disseminated nursing knowl‐
edge not simply designed to inform the profession of nursing, but of
the society within which we are all nurses. A quick glance at the table
of contents supports this. The subjects covered are as follows: venti‐
lation and warming, health of houses, petty management, noise, variety,
taking food, what food, bed and bedding, light, cleanliness of rooms and
walls, personal cleanliness, chattering hopes and advices and observa‐
tion of the sick. In the final section of her work, Nightingale cautions
against losing sight of the purpose of observation and, possibly in‐
advertently, provides us with a preliminary purpose for nursing re‐
search: “It is not for the sake of piling up miscellaneous information
or curious facts, but for the sake of saving life and increasing health
and comfort” (Nightingale, 1860). The link that was developed be‐
tween early nursing research and the education of care providers
in the Nightingale era was key to increasing the quality of care the
sick received and was maintained for over a century (Gortner, 1983).
Due to the mortality rates associated with communicable
diseases, attention turned to public health in the early 1900s.
Professional literature produced during that time was focused on
public health measures surrounding the prevention, detection and
treatment of tuberculosis, meningitis, scarlet fever and other simi‐
lar illnesses (Gortner, 1983). In the 1920s literature, there began to
appear care plans for specific groups of patients, and over the next
30 years, there was a push for the systematic evaluation of nurs‐
ing techniques. The content of nursing work over the first half of
the 1900s was highly systematic and had at its core a theoretical
basis in germ theory and the use of standardization in institutional
settings that resulted from the application of industrial practices
(McPherson, 2003). The push towards mass production of healthy
patients was the result. Research into the organization and deliv‐
ery of health care, with attempts made to link nursing staff and
unit arrangements to patient outcomes, was a focus of the late
1950s (Gortner, 1983). It was not until the 1960s when nursing
research shifted its focus from the nurse to the patient, leading
nurse researchers to consider not only practice processes but also
the effect on patient outcomes.
As the scope of nursing research grew, there was the creation
of alliances with other disciplines that had similar scopes. These
included medicine, biology, epidemiology, psychology, education,
anthropology and sociology (Gortner, 1983; Weaver & Mitcham,
2008). These alliances were facilitated by research programmes
that the United States established in the 1970s to allow nurses to
pursue graduate education in the aforementioned fields (Weaver
& Mitcham, 2008). As a result, nurses brought the concepts, meth‐
odologies and technologies of these fields to the nursing discipline
(Gortner, 1983; Weaver & Mitcham, 2008). The migration of research
techniques from the social sciences resulted in an increased capacity
to describe phenomenon but also in the need to navigate method‐
ological pluralism (Gortner, 1983). To what extent Nightingale would
consider the expansion of nursing research as being enhanced by
the influence of other disciplines, and whether or not she would
consider this growth a threat to the integrity and purity of nursing
knowledge are questions that remain.
The transition from empiricism to rationalism that character‐
ized the development of broad healthcare research (Gadamer,
Weinsheimer, & Marshall, 2004) was also evident in the develop‐
ment of research within the nursing discipline (Gortner, 1983). The
shift in paradigms leads to the challenge of marrying professional
values with research methodology. The rational hermeneutical ap‐
proach to understanding the question behind text permits a deeper
understanding of any phenomenon of interest (Gadamer et al.,
2004). There remains then, the development of a central question
for nursing research if we are to understand the true location of our
findings in the context of this practice discipline.
3 | S H A PI N G TH E Q U E S TI O N
What then is the ultimate goal of nursing research? Packard &
Polifroni, (1991) describe the historical view of nursing as an “emerg‐
ing science,” whereas other recently established research disciplines,
such as education and sociology, are considered fully emerged. The
difference between nursing and emerged scientific disciplines is
the identification of a central question towards which the field is
directed (Packard & Polifroni, 1991). In the study of sociology, for
example, the fundamental questions to be answered are as follows:
What holds society together? What breaks society apart? In educa‐
tion, the questions are as follows: What is thinking? What is learn‐
ing? (Packard & Polifroni, 1991).
Despite the apparent simplicity of fundamental questions,
there is an irony to the creation of an emerged science. The dis‐
cipline’s science requires a body of well‐defined concepts to set
itself apart (Weaver & Mitcham, 2008). In order to determine what
concepts are of interest to the field, there must be some sort of
stated goal, such as a central question to be answered. The chal‐
lenge lies in developing such a question without a set of concepts
to use within the question. The set of concepts must be phenom‐
ena that are of key interest to the profession, and they must be
used clearly and consistently in research, theory, practice and pol‐
icy (Weaver & Mitcham, 2008). Unfortunately, nursing has been
challenged to develop concepts (Weaver & Mitcham, 2008) and
derive raw material from science that is profession‐specific in order
to be considered a profession that is distinct from others (Flexner,
MOULTON et al.
2001). Given this stalemate, it is important to see the process as
cyclical. A preliminary question will set a direction for concept de‐
velopment and analysis, which will in turn improve the question.
Over time, both sides of the equation are strengthened. Packard
& Polifroni, (1991) argue that while all sciences are, by their very
nature, evolving and emerging in a process similar to the one de‐
scribed above, the presence of a central question gives purpose
and reason to the science.
It has been 25 years since Packard and Polifroni (Packard &
Polifroni, 1991) identified the need for a central question of nursing
science. A pragmatic search of the literature identified 19 articles
that cited Packard and Polifroni. Of the 19 articles, 10 mention that
Packard & Polifroni, (1991) suggest the development of a central
question; however, no question has been developed (Hemsley, 2003;
Jacobs, 2001; LeVasseur, 1998; LeVasseur, 1999; Mitchell, 1994, 2001;
Mulhall, 1996; Spenceley, 2004; Thorne et al., 1998; Willis, Grace,
& Roy, 2008) despite the recommendation for appropriate research
methodologies (Broussard, 2006; Carboni, 1995; Im & Chee, 2001;
Iphofen & Poland, 1997; Shih, 1998) and forwarding the notion that
nursing is an applied science (Edwards, 2013; Schick Makaroff, 2005)
with theoretical constructs that need to be applicable to the real
world (Packard & Polifroni, 1999). Supporting the need for a central
question in our discipline, Smith, (2000) defended the notion that too
much energy is spent testing non‐nursing theories resulting from the
engagement with multiple worldviews required for nursing to function
in interdisciplinary environments and within a broad scope of practice.
While no central question has yet to be proposed for nursing
science, Clements & Averill, (2006) highlight the type of ques‐
tions that are associated with the six types of nursing knowl‐
edge proposed by Carper, (1978), White, (1995), Munhall, (1993)
and Heath, (1998). Adding to Carper’s four fundamental patterns
of knowing in nursing: empirics, aesthetics, ethics and personal
knowledge (Carper, 1978), White proposed sociopolitical know‐
ing and Munhall and Heath advocated for unknowing. In empir‐
ical knowledge development, the questions posed are What is it
and how does it work? In aesthetic knowledge development, the
questions are What does this mean? and How is this significant? In
ethical knowledge development, the questions are Is this right?
and Is this responsible? In personal knowledge development, the
questions are Do I know what I do? and Do I do what I know? In
sociopolitical knowledge development, the questions are Whose
voice is heard? and Whose voice is silenced? Unknowing is unique in
that it is an awareness of what one does not know and that one
cannot understand a person they have just met, and therefore, no
question is proposed (Clements & Averill, 2006; Munhall, 1993).
Of special importance is the link made by Clements and Averil be‐
tween each of these types of knowing to passages of Nightingale’s
writing in order to demonstrate her use of each type of knowl‐
edge, although she did not explicitly name them. The challenge is
to propose a question that does justice to the scope of knowledge
that nurses use and which contains the essence of a hermeneu‐
tic question, namely that it opens up possibilities and keeps them
open (Gadamer et al., 2004).
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We propose therefore that the fundamental question of nursing
research ought to be:
How can the well‐being of a person, family, commu‐
nity or population be improved?
4 | I N D E FE N C E O F TH E Q U E S TI O N
In proposing the question, how can the well‐being of a person, fam‐
ily, community or population be improved? as the central question
of nursing research, we accept that the concept of well‐being and
the outcome of improvement are nebulous and that they are used
differently in different contexts. In proposing a question, this is not
problematic. Gadamer states, “the art of questioning is the art of
questioning even further” (Gadamer et al., 2004). We will clarify
well‐being, person/population and improvement in the context of
this proposed question and expose the question to the dialectic:
questioning and truth‐seeking, not arguing.
Health, wellness and well‐being are closely related concepts,
and use varies according to time period, context and personal
preference and, at times used interchangeably. In 1947, the World
Health Organization (WHO) defined health not only as the absence
of problems but also as “the state of complete physical, mental and
social well‐being” (World Health Organization, 2015a). The idea of
health continued to grow, and in 1968, Dubos expanded the defini‐
tion by proposing that health is a quality of life that involves social,
emotional, mental, spiritual and biological fitness, and that this fit‐
ness is based on adaptation to the environment (Dubos, 1968). The
types of health have continued to evolve and now often include
the following: physical health, social health, mental health, occupa‐
tional health, emotional health, environmental health and spiritual
health. Eventually, the idea of health and wellness began to be used
interchangeably (Donatelle, 2008). Recently, the idea of health has
also been challenged to consider that societal participation may be
more important than survival years and that coping capacity may
be more important than complete recovery, a shift that emphasizes
an individual’s sense of well‐being over health status (Huber et al.,
2011).
Though these terms are in constant evolution, they have also
been used in combination. For example, a press release from the
WHO (World Health Organization, 2000) stated that their re‐
port discusses the health and well‐being of people around the
world, offering the impression that health and well‐being are
separate yet similar concepts. However, consider the following
definitions:
Well‐being: the state of being happy, healthy or pros‐
perous (Merriam‐Webster, 2015).
Wellness: the quality or state of being in good health
especially as an actively sought goal (Merriam‐
Webster, 2018).
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4 of 7       MOULTON et al.
Wellness is then the level of health that an individual has with the
goal for each type of health being the highest possible level of well‐
ness. However, individuals also have an overall level of well‐being
which includes not only the types of health but also related concepts
such as happiness and quality of life. Quality of life has the distinctions
of referring to the level of satisfaction that an individual has with their
life, including the types of health, and it contributes to overall well‐
being (Dignani, Toccaceli, Guarinoni, Petrucci, & Lancia, 2015). The
broad state of well‐being is the goal of all people and populations, and
it represents the end that nurses are trying to achieve.
The central question focuses on patients, whether it be a person,
family, community or population, because all nursing knowledge is
developed for practice (Higgins & Shirley, 2000). This means that all
nursing research should eventually impact patients in the practice
setting. This does not mean that all research must be directed at a
patient. For example, the goal of studying how we train new nurses
is not to ensure that the nurses are competent enough to bring home
a pay cheque or for the pure understanding of the educational pro‐
cess. Rather, it is so that we can produce nurses who are up to the
challenge of providing quality care for patients.
Often the concepts of health, wellness and well‐being are used
in the context of an individual (Dubos, 1968). However, the health of
the public has had nurses’ attention since the early 1900s, (Gortner,
1983) and given that people rarely live in isolation, it is important to
consider both in tandem. Whether we are discussing the observa‐
tion of the sick described by Nightingale (Nightingale, 1860), the in‐
dustrialization of the hospital environment in the 1950s (McPherson,
2003) or the complex techniques used in hospitals today, the focus
of nursing has always been the patient.
The final concept to be discussed is the idea of improvement.
How does a nurse know that a person’s well‐being has improved?
We propose a simple and patient‐centred definition: Improvement is
whatever the person perceives it to be. It is subjective, and it will vary
from person to person and population to population. Fortunately,
the majority of the time finding out if a person has experienced im‐
provement is simple: you ask them.
5 |  TH E S CO PE O F N U R S I N G R E S E A RC H
Some may argue that the proposed question is too broad, thus too
much for a single profession. We would argue that the scope of nurs‐
ing practice is broad and that the scope of nursing research must
match it. While defining and discussing the particulars of nursing
practice and research would take many books, the scope of nursing
research can be approached from three questions: What affects a
person's, a family's, a community's or a population's well‐being? What do
nurses do to promote and preserve this well‐being? and How do nurses
do what they do? These questions will be explored in order to explore
the scope of nursing research, starting with what affects a person’s
or population’s well‐being.
According to the WHO (World Health Organization, 2015b),
there are a variety of determinants of health that can affect a
person’s or population’s well‐being. These include the following: in‐
come and social status, education, physical environment, social‐sup‐
port networks, genetics, health services and gender (World Health
Organization, 2015b). Some of these determinants are easy to un‐
derstand in relation to nursing research. Nurses need to understand
the effect of gender on their patients so that they can provide ap‐
propriate care. Furthermore, genetics plays a heavy role in the de‐
velopment of illness and personal behaviours. There has also been
a fair amount of attention on helping patients build social‐support
networks, which could be specific to building strength in families
with newborns, or it could mean altering the culture of a country so
that public places are accepted as non‐smoking. Discussion of physi‐
cal environment started with Nightingale’s (Nightingale, 1860) focus
on the cleanliness of an environment and now includes aspects such
as air pollution and access to safe water.
Discussing what nurses do to promote and preserve well‐being
is challenging because nurses take on a variety of tasks. Part of the
variety comes from the settings within which nurses work (emer‐
gency rooms, operating rooms, public health, teaching and politics
to name a few) as well as the number of positions that nurses can
hold in an area (such as a frontline worker or a manager). Denzin
and Lincoln (Denzin & Lincoln, 2005) describe qualitative research‐
ers as “jacks of all trades.” Nurses, who use and generate both qual‐
itative and quantitative research, are also aptly described by this
turn of phrase. Though, we would alter the popular saying and fur‐
ther describe nurses as “jacks of all trades and masters of some.”
Trained as generalists in their undergraduate degree, most nurses
then go on to become masters of the area in which they chose to
work.
There is also the phenomenon of nurses plugging the gaps in pa‐
tient care (Allen, 2004). This occurs when the nurse takes on tasks
which either no other profession has claimed or which is claimed by
another profession but is not being performed by that profession
due to a lack of manpower (Allen, 2004). Allen, (2004) argues that
this leads to a blurring of professional jurisdictions. We would argue
that since nurses are likely to continue to do such work in order to
improve the well‐being of their patients, this type of work should be
accepted as a part of the practice, and thus be addressed by nursing
research’s central question.
In addition to basic nursing care, nurses are expected to admin‐
ister medications that they may not have the authority to prescribe,
take patients through physiotherapy routines and collaborate in the
implementation of plans constructed by professional social workers.
As a result, it is only reasonable that these areas are included in nurs‐
ing research so that nurses can prove for themselves that the steps
they are taking on behalf of their patients are in their patients’ best
interest.
Nursing care, and thus research, must not be constrained by
tradition or convention. In hermeneutics, questions are considered
to have openness because the answer is not yet settled. Openness
does not imply that the scope of nursing research should be bound‐
less; it means that the limits set should not be based on false presup‐
positions (Gadamer et al., 2004). Keeping the end state of improved
MOULTON et al.
well‐being in mind, nurses should feel free to explore and embrace
alternative interventions as they question their scope. Cognitive
training and certain types of biofeedback are within the nursing
scope of practice. If changes to city infrastructure or access to edu‐
cation might benefit the population for which a nurse cares, it is only
reasonable that the nurse researches these approaches and uses
them as a nursing intervention.
The final question is how do nurses do what they do to improve
the well‐being of those in their care? Nurses are able to assist their
patients, families, communities and populations when they have the
interventions they know will work. This leads us to ask: what meth‐
odologies are used in the development of the nursing knowledge that
informs and tests nursing interventions?
Nursing research has its roots in the use of methodologies from
other fields of science including medicine, biology, epidemiology,
psychology, education, anthropology and sociology (Gortner, 1983;
Weaver & Mitcham, 2008). Historically, the discipline lacked its
own methodologies and traditionally used those developed in other
fields: a practice consistent with nursing activity in the clinical set‐
ting. This can be taken not as a complete lack of direction with regard
to a central question, but a sensitivity to the notion that the central
question of nursing makes use of other fields.
When the types of nursing knowledge are compared to the
fields of study nursing borrows from, there are overlaps. Empiric
knowledge, defined by Carper, (1978) as systematic knowledge of
the empirical world, frequently builds on knowledge from medicine,
biology, epidemiology and sometimes psychology. Aesthetic knowl‐
edge, what is considered the art of nursing and is often developed
by apprenticeship (Carper, 1978), can be developed out of psychol‐
ogy, education and anthropology. Sociopolitical knowledge, which is
based on disparities of power and health (Clements & Averill, 2006),
draws on anthropology and sociology. Ethical knowledge, which
deals with moral ambiguity and uncertainty (Carper, 1978), is devel‐
oped from logic, philosophy and/or religion. Personal knowledge,
which is about knowing the self (Carper, 1978), is built on psychology
as well as self‐reflection. The nurse is as concerned with their pa‐
tient’s cell structure as they are with their patient’s social activities
(Gortner, 1993). Ultimately, the nurse is concerned with what affects
their patient’s well‐being.
6 | FU T U R E CO N C E P T UA LIZ ATI O N O F
N U R S I N G R E S E A RC H
The definition of such a broad question and scope for nursing re‐
search lead to the problem of how we should conceptualize nursing
research. There are different mechanics for incorporating a larger
scope into nursing research. For example, the Canadian Common
Curriculum Vita (CCCV) (Canadian Common Curriculum Vita, 2013)
website arranges areas of research as sectors of discipline (Arts and
Literature, Health Sciences, Human and Social Sciences, and Natural
Sciences and Engineering), which each has a number of fields.
Medical Sciences, Nursing, and Physical Education and Rehabilitation
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are the three fields that fall under Health Sciences. Under the field
of Medical Sciences, there are 42 disciplines, ranging from Anatomy
to Virology. In the field of Physical Education and Rehabilitation,
there are nine disciplines listed. Nursing has one—Nursing. Of all
the fields, Nursing is the only one with a single discipline. The next
lowest are Mathematical Sciences and Natural Sciences, both with
five disciplines. Nursing research needs to be reconceptualized to
include the number of disciplines that are covered by its scope. For
example, disciplines that could be listed on the CCCV under the field
of nursing could include, but not be limited to, Aboriginal Nursing,
Cardiology, Case Management, Home Health Care Nursing, Mental
Health Nursing, Neurosciences, Parish Nursing, Pediatrics, Primary
Care Nursing, School Nursing, Surgery and Outpost Nursing. This
will help articulate to the scientific community, the complexity,
breadth and depth of nursing research. It will also help funding agen‐
cies to see that the discipline of nursing covers a variety of fields and
has a wide area of interest.
The philosophical conceptualization of the science is complex.
Gadamer et al., (2004) describe two types of sciences: natural sci‐
ences—which are concerned with the development of laws that ex‐
plain and predict natural phenomena—and human sciences—which
seek to predict social phenomena, a process which is much more
complicated given that it includes unique individuals and occurs in
a historical context (Gadamer et al., 2004). Nursing’s position in the
sciences is interesting, given that it uses philosophies and method‐
ologies from both types of science. Due to the fact that both per‐
spectives are important in nursing science, we agree with Gortner’s,
(1993) argument that no single worldview should dominate the prac‐
tice and science of nursing. Unless nursing makes a radical shift in
practice towards one of the types of science described by Gadamer,
nursing must be willing to incorporate the different worldviews into
their research (Gadamer et al., 2004; Gortner, 1993).
This integration of worldviews can be aided by Gadamer’s defini‐
tion of understanding and interpretation. For him, the two concepts
are bound together. Interpretation is an always‐evolving process,
and as a result, is never certain (Laverty, 2003). By constantly ques‐
tioning the worldviews and paradigms associated with natural and
human science, we maintain a process of continual re‐evaluation and
refinement.
The constant evolution of the nursing sciences is necessary,
given that the focus of nursing is on the patient. The non‐realist
perspective argues that the people whom nurses care for are not
immutable, rather they are fluid (Flaming, 2004). Nursing practice
and research are reaction to the needs of the people. It is then rea‐
sonable to assume that practice and research must remain as fluid
as the people that nurses serve and that the boundaries of nursing
research will shift over time.
7 | CO N C LU S I O N
Nursing history shows us that science has long been a part of the pro‐
fession of nursing. However, despite the call 25 years ago for a central
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6 of 7       MOULTON et al.
question of nursing science, none have been proposed. This paper
proposes “how can the well‐being of a person, family, community
or population be improved?” as a central question for nursing. This
question also takes into account the various types of health and well‐
ness that affect people, and it is focused on patients, who have always
been the focus of nursing work. This question allows for a broad range
of nursing research, which complements nursing practice. Adopting
this central question will mean accepting the various worldviews,
methodologies and philosophies that have informed nursing over the
years. Defining what drives nursing research will make it easier to ex‐
plain nursing research to the scientific community and will help situate
nursing within interdisciplinary practice and research.
C O N FL I C T O F I N T E R E S T
There are no conflicts of interests to report.
ORCID
Elizabeth Moulton  http://orcid.org/0000-0002-7885-8686
Rosemary Wilson  https://orcid.org/0000-0003-3262-243X
Pilar Camargo Plazas  https://orcid.org/0000-0002-8349-7723
Kathryn Halverson  http://orcid.org/0000-0002-1844-9733
REFERENCES
Allen, D. (2004). Re‐reading nursing and re‐writing practice: Towards an em‐
pirically based reformulation of the nursing mandate. Nursing Inquiry,
11(4), 271–283. https://doi.org/10.1111/j.1440-1800.2004.00234.x
Broussard, L. (2006). Understanding qualitative research: A school nurse
perspective. The Journal of School Nursing, 22(4), 212–218. https://
doi.org/10.1177/10598405050220040501
Canadian Common Curriculum Vita. (2013). Research classification sys‐
tem [Data file]. Retrieved from https://ccv-cvc.ca/indexresearch‐
er-eng.frm
Carboni, J. T. (1995). A Rogerian process of inquiry. Nursing Science Quarterly,
8(1), 22–37. https://doi.org/10.1177/089431849500800107
Carper, B. (1978). Fundamental patterns of knowing in nurs‐
ing. Advances in Nursing Science, 1(1), 13. https://doi.
org/10.1097/00012272-197810000-00004
Clements, P. T., & Averill, J. B. (2006). Finding patterns of knowing in
the work of Florence Nightingale. Nursing Outlook, 54(5), 268–274.
https://doi.org/10.1016/j.outlook.2006.06.003
Denzin, N. K., & Lincoln, Y. S. (2005). The Sage handbook of qualitative
research, 3rd edn. Thousand Oaks, CA: Sage Publications.
Dignani, L., Toccaceli, A., Guarinoni, M. G., Petrucci, C., & Lancia, L.
(2015). Quality of life in chronic obstructive pulmonary disease:
An evolutionary concept analysis: Quality of life in COPD. Nursing
Forum, 50(3), 201–213. https://doi.org/10.1111/nuf.12110
Donatelle, R. J. (2008). Health: The basics, 4th Canadian edn. Toronto,
ON: Pearson Benjamin Cummings.
Dubos, R. J. (1968). So human an animal. New York, NY: Scribner.
Edwards, S. L. (2013). Learning from practice: the value of story in nurse
education. (Dissertation/Thesis), ProQuest Dissertations Publishing,
Retrieved from http://queensu.summon.serialssolutions.com/2.0.0/
link /0/eLvHCXMwpV1L SwMxEB6 0 Uh AParX4 qDDQ89pNN‐
rvZCCJiLf6A3pdsNlt62a22PfTf68REpYVePAfCQMJHMvM9ABJ‐
H0dbmEBPfWWNKIVMM6O4rFPDLctMLUxaym1R_3OQxvjjD
i j p o L t q DX X N R y zL pW T 0 QX h av Ee U I 0 X z V h ‐ q c Q h H T M j EyX
95vAO 0 D j w n p x AG _ N ‐ c E Z 8 v s e vJ ‐ K 9 S z u B k _ G e 2 f g 4 H t u l B
13cDLuDRO6nOkBQlGNRRD_j1AkSy_LbY1khcyQ3OG3TkDrSB_
nE Jw8nr9OUtCoUV_hIui9‐qkj50 mraxV4BaV Y YccHTFlUgqpt
M6L zO pTa5KoY W6hsG ‐nW 72L9_CMXd5EdSjGEBn9bG2dz_
BHZ8uXqSX
Flaming, D. (2004). Nursing theories as nursing ontologies. Nursing
Philosophy, 5(3), 224–229. https://doi.org/10.1111/j.1466-769X.
2004.00191.x.
Flexner, A. (2001). Is social work a profession? Research on Social
Work Practice, 11(2), 152–165. https://doi.org/10.1177/104973
150101100202
Gadamer, H. G., Weinsheimer, J., & Marshall, D. G. (2004). Truth and
method, 2nd rev edn. New York, NY: Continuum.
Gortner, S. R. (1983). The history and philosophy of nursing science
and research. Advances in Nursing Science, 5(2), 1–8. https://doi.
org/10.1097/00012272-198301000-00005
Gortner, S. R. (1993). Nursing's syntax revisited: A critique of philosophies
said to influence nursing theories. International Journal of Nursing Studies,
30(6), 477–488. https://doi.org/10.1016/0020-7489(93)90019-Q
Heath, H. (1998). Reflection and patterns of knowing in nurs‐
ing. Journal of Advanced Nursing, 27(5), 1054–1059. https://doi.
org/10.1046/j.1365-2648.1998.00593.x
Hemsley, M. (2003). Walking two worlds: transformational journals
of nurse healers, a hermeneutic phenomenological investigation.
(Doctor of Philosophy), Southern Cross University, Australia.
Higgins, P. A., & Shirley, M. M. (2000). Levels of theoretical thinking in
nursing. Nursing Outlook, 48(4), 179–183. https://doi.org/10.1067/
mno.2000.105248
Huber, M., Knottnerus, J. A., Green, L., Horst, H. v. d., Jadad, A. R.,
Kromhout, D., … Smid, H. (2011). How should we define health? BMJ,
343(7817), d4163–d4237. https://doi.org/10.1136/bmj.d4163
Im, E.‐O., & Chee, W. (2001). A feminist critique of research on cancer
pain. Western Journal of Nursing Research, 23(7), 726–752. https://doi.
org/10.1177/01939450122045519
Iphofen, R., & Poland, F. (1997). Professional empowerment and teach‐
ing sociology to health care professionals. Teaching Sociology, 25(1),
44–56. https://doi.org/10.2307/1319110
Jacobs, B. B. (2001). Respect for human dignity: A central phenome‐
non to philosophically unite nursing theory and practice through
consilience of knowledge. Advances in Nursing Science, 24(1), 17–35.
https://doi.org/10.1097/00012272-200109000-00005
Laverty, S. M. (2003). Hermeneutic phenomenology and phenomenol‐
ogy: A comparison of historical and methodological considerations.
International Journal of Qualitative Methods, 2(3), 21–35. https://doi.
org/10.1177/160940690300200303
LeVasseur, J. (1998). Plato, Nightingale, and contemporary nursing.
Image – The Journal of Nursing Scholarship, 30(3), 281. https://doi.
org/10.1111/j.1547-5069.1998.tb01306.x
LeVasseur, J. J. (1999). Toward an understanding of art in nurs‐
ing. Advances in Nursing Science, 21(4), 48–63. https://doi.
org/10.1097/00012272-199906000-00009
McPherson, K. M. (2003). Bedside matters: The transformation of Canadian
nursing, 1900–1990, 2nd edn. Toronto, ON: University of Toronto
Press. https://doi.org/10.3138/9781442627987
Meleis, A. I. (2012). Positioning for the Journey. In C. Brandon (Ed.),
Theoretical nursing, development and progress (pp. 2–6). Philadelphia,
PA: Lippincott Williams & Wilkins.
Merriam‐Webster. (2015). Well‐being. Merriam‐Webster.com. Retrieved
from http://www.merriam‐webster.com/dictionary/well‐being
Merriam‐Webster. (2018). Wellness. Merriam‐Webster.com. Retrieved
from https://www.merriam‐webster.com/dictionary/wellness
Mitchell, G. J. (1994). Discipline‐specific inquiry: The hermeneutics of
theory‐guided nursing research. Nursing Outlook, 42(5), 224–228.
https://doi.org/10.1016/0029-6554(94)90023-X
MOULTON et al.
Mitchell, G. J. (2001). Prescription, freedom, and participation: Drilling
down into theory‐based nursing practice. Nursing Science Quarterly,
14(3), 205–210. https://doi.org/10.1177/08943180122108445
Mulhall, A. (1996). Cultural discourse and the myth of stress in nursing
and medicine. International Journal of Nursing Studies, 33(5), 455–468.
https://doi.org/10.1016/0020-7489(96)00005-3
Munhall, P. L. (1993). ‘Unknowing’: Toward another pattern of knowing in
nursing. Nursing Outlook, 41(3), 125.
Nightingale, F. (1860). Notes on nursing: What it is, and what it is not.
London, UK: Harrison.
Packard, S. A., & Polifroni, E. C. (1991). The dilemma of nursing science:
Current quandaries and lack of direction. Nursing Science Quarterly,
4(1), 7–13. https://doi.org/10.1177/089431849100400105
Packard, S., & Polifroni, E. (1999). The nature of scientific truth. In M.
Welch (Ed.), Perspectives on philosophy of science in nursing (pp. 126–
134). Philadelphia, PA: Lippincott Williams & Wilkins.
Schick Makaroff, K. L. (2005). The experience of feeling understood for nurses
withdisabilities.(Dissertation/Thesis),ProQuestDissertationsPublishing,
Retrieved from http://queensu.summon.serialssolutions.com/2.0.0/
link/0/eLvHCXMwpV3bTsQgEJ3oGhPjg_eoqwk_UC0wLeXJGHXjB‐
z7hsvw2K6X_X‐hS‐vGjb74SAgJYeAwDDPnAEhxVxY_MCG5‐pocWl‐
RV7bRQoXKCeO0CusqqX4v6s7kHlOyh23cuRc3v405FHgFYPSzfiiQ‐
jlb5bs6bGLuxxVLKv_t30h76f76gxPXdKHFh4cltsg7JIiDs7giFrd‐
J1gksUotgkc_zPvYzh83viHP4Edak9hP0cOzuAxbh5GIwky6wIL‐
1Beus9W6GKbrPIvuLlvngLAUzWU‐0_UmitZzmM9e5k‐vRdZaKJaoy‐
kIZCuQMIfei8bwmMtqjjPcaBUnRB1RWS1vH7oqTiFY0lmQVoh1L‐
HQ0o5AVM2q6lS2BxoEsUO8YLjdJzU4XG1sq4Rls0qK9gOizLIp‐
Xj8W4Jtd_9k7hoKdO7UMgNzD5fF_R7agL8gXDSLpi
Shih, F. J. (1998). Triangulation in nursing research: Issues of conceptual
clarity and purpose. Journal of Advanced Nursing, 28(3), 631–641.
https://doi.org/10.1046/j.1365-2648.1998.00716.x
Smith, L. S. (2000). Said another way: Is nursing an academic discipline? Nursing
Forum, 35(1), 25–29. https://doi.org/10.1111/j.1744-6198.2000.
tb01175.x
Smith, M., & McCarthy, M. P. (2010). Disciplinary knowledge in nursing
education: Going beyond the blueprints. Nursing Outlook, 58(1), 44–
51. https://doi.org/10.1016/j.outlook.2009.09.002
|
      7 of 7
Spenceley, S. M. (2004). Out of fertile muck: The evolving narra‐
tive of nursing. Nursing Philosophy, 5(3), 201–207. https://doi.
org/10.1111/j.1466-769X.2004.00187.x
Thorne, S., Canam, C., Dahinten, S., Hall, W., Henderson, A., & Kirkham,
S. R. (1998). Nursing's metaparadigm concepts: Disimpacting the
debates. Journal of Advanced Nursing, 27(6), 1257–1268. https://doi.
org/10.1046/j.1365-2648.1998.00623.x
Weaver, K., & Mitcham, C. (2008). Nursing concept analysis in North
America: State of the art. Nursing Philosophy, 9(3), 180–194. https://
doi.org/10.1111/j.1466-769X.2008.00359.x
White, J. (1995). Patterns of knowing: Review, critique, and up‐
date. Advances in Nursing Science, 17(4), 73–86. https://doi.
org/10.1097/00012272-199506000-00007
Willis, D. G., Grace, P. J., & Roy, C. (2008). A central unifying focus for
the discipline: Facilitating humanization, meaning, choice, quality of
life, and healing in living and dying. Advances in Nursing Science, 31(1),
E28. https://doi.org/10.1097/01.ANS.0000311534.04059.d9
World Health Organization. (2000). World health organization assesses
the world's health systems [Press release]. Retrieved from http://
www.who.int/whr/2000/media_centre/press_release/en/
World Health Organization. (2015a). Constitution of WHO: principles.
Retrieved from http://www.who.int/about/mission/en/
World Health Organization. (2015b). Health Impact Assessment.
Retrieved from http://www.who.int/hia/evidence/doh/en/
URLHASH;
How to cite this article: Moulton E, Wilson R, Camargo
Plazas P, Halverson K. The central question and the scope of
nursing research. Nurs Philos. 2018;e12228. https://doi.
org/10.1111/nup.12228