What constitutes core disciplinary knowledge?

A hallmark of the PhD in nursing is that it signifies something that extends beyond professional practice and research competencies. That something has commonly been referred to as ‘core disciplinary knowledge’. However, agreement as to what this constitutes can be maddeningly elusive. With a continuing proliferation of doctoral preparation options for nurses, options that will shape the future of ideas with the discipline, there are compelling reasons to try to come to some shared understanding of what this notion of core disciplinary knowledge entails, how one engages with it and on what basis we might determine that it has been suitably acquired. Expressed simply, when we think of core disciplinary knowledge, we are most typically referring to the intellectual structures within which the discipline delineates its unique focus of vision and social mandate. In early reflections on this question with respect to the future of doctoral education in nursing, Meleis (1988) reminded us that it orients us as to the critical questions around which graduate training ought to be concerned as well as to the unique knowledge it collectively has to offer. Over the years, various academic nursing leadership entities have tried to articulate a meaningful vision of what core disciplinary knowledge might entail. The American Association of Colleges of Nursing (2002, 289) framed it as having three components: historic and philosophic foundations to the development of nursing knowledge; existing and evolving substantive nursing knowledge; and methods and processes of theory/knowledge development. The Canadian Association of Schools of Nursing (2011, 2) similarly referred to it as ‘disciplinary knowledge related to the history, practice context and theoretical underpinnings of nursing’. Common aspects pertain to the historic and current understandings of the philosophical and theoretical grounding of disciplinary knowledge – those approaches to reasoning, conceptualizing and interpretive application that differentiate ‘a nursing lens’ on the world from that of any other (Holt 2014; Royal College of Nursing 2003). Each reinforces the central claim that this core disciplinary knowledge has to do with the conceptual glue within which the myriad pieces and parts of this complex discipline of ours have attained the kind of coherence that is fundamental to distinguishing it as a unique discipline. Although debate and divisiveness have been legend within our collective philosophic and theoretical history, those who engage in deep study of that history typically find themselves reassured to discover much more cohesiveness than difference in the essential values and underpinnings (Risjord 2010). Indeed, much of what was contested in the era of the conceptual model battles can be reframed as something of a misinterpretation as to whether those entities ought properly to be understood as products of science or philosophy (Thorne and Sawatzky in press). This argument for a meaningful coherence within the complexity (much as chaos theory would have anticipated) is showcased in a recent collection of short philosophical reflections. Forss, Ceci and Drummond (2013) invited leading nurse philosophers, including a number of current and recent Nursing Inquiry Editorial Board members (David Allen, Patricia Benner, Sally Gadow, Dave Holmes, Mary Ellen Purkis, Trudy Rudge, Sally Thorne) to articulate their distinctive and highly personalized responses to such questions as what constitute the most important problems in contemporary nursing for which philosophizing is needed, what obligations follow from studying nursing from a philosophical perspective and where the field of philosophy in nursing is headed. As former Nursing Inquiry Editor-in-Chief Sioban Nelson observes on the book jacket, this collection is an ‘homage to eclecticism’. It showcases ‘multiple perspectives, approaches and philosophical influences’ in an ‘intimate and enlightening array of reflections on the profound questions of nursing practice, health-care and the human condition’. And what it clearly reveals is a profound valuing of this distinctive ‘nursing angle of vision’ on such questions – a perspective that is grounded in that which is unique and particular about our intellectual tradition even as it is applied and enacted within a shared or interdisciplinary universe. The risk, in this world in which doctoral education models are shifting and interdisciplinary education is all the rage, is that without clarity as to this ambiguous entity called ‘core disciplinary knowledge’, we may stand to lose it. And I believe we need this entity on multiple planes, including its role as a structure for practice education, its direction for knowledge generation and its function as our moral compass. At the basic educational level, with or without conceptual models, we must continue to insist on some form of systematic assessment processes informed by a nursing (not biomedical) logic, an embedded approach to practice that will ensure the ongoing strength of nursing's angle of vision. By recasting this as the philosophy of nursing science rather than nursing theory, we would inherently reflect a curiosity for multiple perspectives rather than a singular line of reasoning, moving beyond the trappings of the theoretical world in which it was assumed that the natural progression of science would lead to the dominance of one theory over others. Although they were limited by their vision about what an ideas framework for the discipline ought to look like, and the larger world of knowledge claims in which it ought to find a fit, the ideas those early theorists were grappling with continue to be important and relevant. With a couple of generations of solid philosophizing in the discipline under our belt, we can now work our way out of that dilemma and find ways of articulating ‘core disciplinary knowledge’ that are as powerful but less constraining than were those earlier traditions. In terms of knowledge generation, we need to ensure that our inquiry is not simply curiosity based but guided by a commitment to the fundamental problems that shape our world. Providing training in research methods absent the intellectual structures that tell us what to apply it toward reflects an outdated model of the kind of disinterested intellectual utopia of the academy that can only weaken and erode the profession (Rolfe 2011). Although nursing is classically interested in all forms of knowledge, it must also retain an interest in itself, ensuring a sustained intellectual core from which it contributes not only to its own distinctive practices but also to the wider worlds of both interdisciplinary healthcare delivery and population health policy. At all levels, but perhaps most particularly at the doctoral level, it is imperative that we continue to value and integrate nursing philosophy (Pesut and Johnson 2008). Finally, we need this kind of knowledge to retain that sense of ‘internal morality’ that has always been a hallmark of nursing (Newham 2013). And just as recent developments in applied ethical reasoning have steered us away from documenting certainties in favor of finding ways to engage coherently and relationally with complex and uncertain challenges, we are likely less interested in the facts of this internal morality than in the processes through which we discern, engage and enact it using a nursing perspective (Storch, Rodney and Starzomski 2013). At the most basic level, this requires the kind of understanding of context and impact that derives from the intellectual structure we ideally see manifest in the encounter of every nurse with every patient. The future of the discipline depends on new generations of academic nursing leaders prepared with this core disciplinary knowledge in sufficient measure to make informed choices about the education of the next generation – not only to the practice, or to the study of things, but to the alignment that represents the thinking structure of the discipline. Although we will never effectively codify, constrain, delineate or delimit it, we do need to keep wrestling with it and trust that it is, in fact, the essence of what keeps us on the course that is our collective disciplinary mandate. And while we may never be able to conclusively define it, I would argue that we certainly do know it when we see it in action!