11th November 2021
The University of Worcester has arranged an online seminar on concept analysis, to take place on 2nd December, starting at 17:30 GMT:
The four speakers will all talk for 10-15 minutes, and then there will be a discussion/comment/question/answer session. In my own contribution, I’ll be reviewing four different approaches to something that might be called ‘concept analysis’, each of them based on a different understanding of what philosophy is and what it tries to do. The canonical version of concept analysis in nursing, the one associated with Walker & Avant, was based on their interpretation of analytic philosophy as it was in the 1950s and 1960s. But things have moved on since then, and we’ve seen (among other developments) a resurgence of interest in ‘ordinary language’ philosophy, and the emergence of ‘conceptual engineering’ and ‘conceptual ethics’. I’ll discuss both of these, alongside the classic ‘method of cases’ and ‘concept analysis’ as it is understood in the nursing literature.
It should be a really interesting conversation, and I look forward to seeing you there!
20th February 2021
My thanks to everyone who attended the book launch on Tuesday. I think it was pretty successful, and the feedback has been very positive. Personally, I thought Sally Thorne was the star of the show – not just because she said nice things about the book, but because she comes over as so warm, bright and enthusiastic (having met her, I know that she is all of those things). I also have her permission to post something she said as a mini-book-review. It’s now included in the book’s page at the Routledge website, along with something by Martin Lipscomb:
A distinctive book, in a category all of its own. Lively, entertaining and delightfully disruptive. Professor Sally Thorne, University of British Columbia; Editor-in-Chief, Nursing Inquiry.
Beautifully written. Clear. Logical. Focused. Persuasive. Completely fascinating. Martin Lipscomb, Senior Lecturer, University of Worcester.
We’re currently discussing the follow-up seminar which will occur later in the year. Details still to be finalised, but I’ll post them when they’ve been agreed. In the meantime, if there is anyone who was unable to attend, but who would like to see the recording, you can now watch the video on a YouTube channel. Link below.
11th February 2021
We now have 250 people registered for the launch. I’m sure quite a few people won’t be able to make it, owing to work and other pressures, but we should still get a decent turn-out. Had a practice yesterday, just to make sure we all know how the software works; and I can confirm that we will be able to upload a recording of the event to a YouTube channel. I’ll post a link as soon as that becomes available.
Below is a link to the official Routledge flyer.
My colleagues at Worcester are currently planning an online seminar on book-related themes, which will take place in the early summer. There’s still a fair bit of organising to do, including deciding on a date, but we’ll say a little more about what we have in mind at the launch.
Given that there won’t be a massive amount of time at the launch, I will be undertaking to reply to anybody who writes to me in order to ask a question about the book, or a related topic. So if you don’t get a chance to ask your question(s) next Tuesday, please do contact me by email.
That’s it for now. Hope to see some of you at the launch!
28th January 2021
The first pages of the book can now be read via Google Scholar. Search with “Paley Concept Analysis in Nursing”, and you’ll find it. Aside from cover, blurb and contents, you’ll be able to see the preface, the glossary, and part of Chapter 1. At least, that’s what I could see when I tried it.
Close to 200 people have now registered for the launch, representing 21 different countries. I’m don’t know how many I was anticipating, but I’m pretty sure it wasn’t that many. My thanks again to everyone who has signed up. Less than three weeks to go now, and I’m really looking forward to it.
Another update soon.
21st January 2021
Thanks to everyone who has signed up for the launch. At the last count, we had 164 registrations, and we believe that there are several more to come. It looks like being a genuinely international event, with people attending from all over the world. I’ll post an update, with more details, in a couple of weeks…
11th January 2021
I’m delighted to announce an online book launch event on 16th February, coinciding with the publication by Routledge of Concept Analysis in Nursing: A New Approach.
The event has been organised by the University of Worcester. Attendance is free.
After an introduction by Professor Roger Watson, I’ll be giving a short presentation. Professor Sally Thorne will respond, and then we’ll have a question and answer session. The event will last no more than an hour.
Chapter summaries can be found below (10th September post). Details and registration are at: https://www.eventbrite.co.uk/e/book-launch-tickets-127739126165
If you have any queries, please email me (email@example.com) or Paul Snelling (firstname.lastname@example.org).
31st December 2020
Coming soon: details of an online book launch event, being organised by the University of Worcester.
In the meantime, let me wish anyone reading this as happy a new year as the circumstances allow… but, much more importantly, a safe one.
14th September 2020
A few snippets from people who have read the pre-publication version:
Beautifully written. Clear. Logical. Focused. Persuasive. Completely fascinating. Martin Lipscomb, Senior Lecturer, University of Worcester
A formidable display of meticulous, subtle and scholarly writing. Trevor Hussey, Professor Emeritus, Buckinghamshire New University
This is a very important book, not only for what it says about concept analysis, but also for its implications for qualitative research in nursing. Elisabeth Bergdahl, Senior Lecturer, Örebro University
10th September 2020
Below are 200 word chapter summaries.
Chapter 1 Aims, methods, conventions
An introduction to what the book aims to achieve, along with notes on the academic resources it makes use of. The overall aim of Part I is to make one particular claim more plausible than it might seem initially: The word ‘concept’ is a very useful one, to the point of being indispensable. Nevertheless, the word does not name anything. Or in soundbite terms: there are no such things as concepts. If this claim has any mileage, we will need an alternative to concept analysis as currently practised in nursing. Part II illustrates one possible alternative with a pair of case studies. It undertakes an exploration of the use of two expressions of interest to nursing: ‘hope’ and ‘moral distress’. ‘Hope’ is a common-or-garden word which has come to have clinical significance. In contrast, ‘moral distress’ is a phrase coined by a philosopher in the 1980s; unlike ‘hope’, it is not used in everyday conversation. Both are investigated using philosophical and linguistic approaches described in Part I. The chapter introduces a hypothetical Reader, discusses the style of argument, and concludes with a potted history of concept analysis in nursing since Walker & Avant launched the canonical version.
Chapter 2 Concepts, words and pictures
Outlines four themes which recur throughout the book. First, the importance of pictures in philosophy; in particular the picture of concepts as quasi-objects. Second, the relation between concepts and words, and two different accounts we might give of that relation. One account implies that all the uses of a word like ‘hope’ express one and the same concept, which is a singular something underlying those uses. The other implies that there are only uses of ‘hope’, and that ‘the concept of hope’ is just a way of referring, in the vaguest terms, to the pattern of use. The concept is not something additional which explains the pattern. Third, the assumption that individual words are the basic units of meaning, and that the grammar of a sentence has no effect on the meaning of its constituent words. Fourth, the claim that ‘there are no such things as concepts’, and what it means. If concepts are supposed to be abstract objects or mental images; if they have components, boundaries and structures; if they’re the building blocks of theory and the constituents of thought… if that’s what concepts are supposed to be, then there are indeed no such things.
Chapter 3 ‘A noun is a naming word’. Discuss
‘Concept’ is a noun, and nouns are naming words. So ‘concept’ must be the name of something, or a class of things, whether mental items or abstract objects. This is a common assumption, but the aim of this chapter is to plant a few seeds of doubt. First, while the ‘nouns are naming words’ principle looks plausible in the case of words for concrete things, we can ask how far it applies to some abstract nouns. Second, there are reasons to think that no word is intrinsically a noun; and, if this is correct, the principle is problematic from the outset. Third, there are many familiar nouns, or words acting as nouns, that are difficult to construe as names for things. Examples are nouns which only occur in complex prepositions, such as ‘on behalf of’. Does the noun ‘behalf’ name the class of behalves? Idiomatic English has many similar examples: nominalised adjectives (‘all of a sudden’), complex quantifiers (‘not a scrap of’), colloquialisms (‘take the mickey’), and so on. In all these expressions, the noun cannot be ‘detached’ from the parent phrase to be used as a ‘naming’ word. Concluding thought: imagine ‘concept’ as non-detachable from ‘the concept of X’.
Chapter 4 Referring without identifying or describing
Referring, identifying and describing are different activities that words are used for. For example, you can refer without describing or identifying (‘She wants her stuff’); you can describe without identifying (‘It is dark green’); and you can identify (or name) without describing (‘It is a peacock’). This chapter is primarily concerned with the possibility of ‘referring without identifying/naming or describing’. Some English nouns are specialists in this: ‘She wants her stuff’; ‘I’ll get my things now. ‘Thing’ can be used to form ad hoc categories or thematic groupings: ‘things associated with going to a movie’. This phrase refers to a diverse and ill-defined category of things – booking tickets, show times, film classification, popcorn, and so on – without identifying any of them. In some contexts, less specialised nouns can have a similar function: ‘Football must get its act together’. Here ‘football’ refers to another diverse and ill-defined category of things – players, fans, clubs, managers, boards, governing bodies, policy making, legal requirements, sanctions – without identification. Some types of metonymy achieve the same thing: ‘The pen is mightier than the sword’. These are all variations on the theme of non-identifying reference. A concluding thought: ‘the concept of X’ may have a similar function.
Chapter 5 ‘The concept of…’
There are several nouns which can be used to form thematic groupings without using expressions like ‘things associated with…’. ‘The world of…’ is an example. ‘The world of sport’ refers to a diverse and ill-defined domain of items: sports, players, competitions, clubs, fans, sponsors, journalists, and more. It refers (vaguely) to these items without identifying/naming any of them. Similar expressions include: ‘the role of…’ and ‘the culture of…’. This chapter suggests that ‘the concept of…’ is another. If that’s right, to talk about ‘the concept of X’ is to refer (vaguely) to a diverse, ill-defined domain of things without identifying them. This domain includes: how X is understood, discussed, thought about; how the word ‘X’ is used, and with what purpose; how Xs can be distinguished from non-Xs; and so on. Similarly, to suggest that someone ‘possesses the concept of X’ is to say that she can recognise examples of X, labels them appropriately, can distinguish between Xs and non-Xs, knows basic facts about Xs, knows how to use Xs; and so on. The chapter discusses other uses of ‘concept’; but they all involve the idea that, like ‘thing’, ‘concept’ is an example of (in linguistics terms) ‘vague language’.
Chapter 6 Must there be concepts?
Concepts must exist. Reference to them is essential. If we didn’t have them, we could not categorise or make judgments. And concepts are the constituents of thought. So their existence is indisputable. This chapter responds to such arguments. First, the fact that reference to concepts is essential does not mean that they exist. We refer essentially to many things that are known not to exist: averages, point masses, frictionless planes. Second, it is often true to say that someone has the concept of X. However, it doesn’t follow from this that there exists an object (the concept) which she has. Equally, it is often true to say that someone has time to do Y. But it doesn’t follow that there is an object (that is, time) which she has. If we did not have concepts, we could not categorise. This is correct, but it is what Wittgenstein calls a ‘grammatical rule’, not an empirical claim. Third, if concepts are constituents of thought, we must say what thoughts are. If thoughts are identified with inner speech or imagery, then they’ll have constituents; but many thoughts are accompanied by neither. Conversely, if some thoughts are ‘unsymbolized’, they cannot have constituents at all.
Chapter 7 Wittgenstein, language and method
If ‘the concept of X’ is a way of referring vaguely to the pattern of usage of the word ‘X’, then concept analysis should be superseded by explorations of the use of words in various constructions and contexts. However, Wittgenstein’s idea of language as a labyrinth implies that these patterns of usage are far more complex than we give them credit for. For example, ‘hope’ is often assumed to be the name of an inner state of the person. But if its uses are carefully sifted, this assumption fails to fit a significant proportion of cases. Its functions are in fact extremely varied. Yet the conviction persists that there must be a ‘core’ meaning for any word, and that all uses must be related to that core. Wittgenstein suggests that, while this may be true for many words, it is not true of all. His notion of ‘family resemblances’, for example, implies that there are numerous ordinary words with uses so disparate that some of them have nothing in common with others. The chapter concludes with a review of Wittgenstein-esque methods used in the book, including analogies, thought experiments, and fine-grained description of the uses and functions of words.
Chapter 8 ‘Hope’: the basic schema
This is the first of three chapters which explore the ordinary, non-clinical uses of ‘hope’. It focuses on ‘hope’ as a verb, and as a count noun. Chapter 8 turns the attention to ‘hope’ as a mass noun. Chapter 9 examines ‘hope’ in other grammatical contexts, especially negation. This chapter introduces the ‘basic schema’ associated with the verb. The schema has four main elements, representing what can generally be inferred from statements of the form ‘P hopes that/for/to X’. The basic schema is not a definition, but it is used as (in Wittgenstein’s terms) a ‘centre of variation’. Both verb and count noun necessarily take a grammatical object: one hopes for something. However, ‘hope’ is unusual in being both an ‘attraction’ verb and an ‘epistemic’ verb. It is like both ‘want’ and ‘believe’. It can express either a preference, or a proposition, or both simultaneously, using different syntactic markers in each case. A standard function of the ‘belief’ component is to imply that the desired outcome is possible. In its continuous aspects (‘is hoping’), the verb implies contingency: a timetable, a goal, an agenda. Significantly, both the ‘attraction’ and the ‘epistemic’ aspects of the verb can be dominant or recessive.
Chapter 9 ‘Hope’: the mass noun
Some of the mass noun’s functions overlap with the count noun’s. For example, both can be used as shell nouns (‘There is some hope of an increase’ ‘The hope of finding survivors faded’). But most are distinct, in particular elliptical uses. These occur when the object of hope is not specified, but is left for the audience to infer. In ‘The man on death row had lost hope’, for example, the natural inference is that the object of hope was a reprieve or a commutation of sentence. However, there is a spectrum of ellipsis, ranging from cases like this one, to examples such as ‘The birth of a baby gave us hope for the future’, which has a much fuzzier cloud of possibilities, the details being left to the reader’s imagination. At the end of the spectrum are examples such as ‘The country must regain its capacity to symbolise hope’, where ‘hope’ refers not only to an indeterminate number of possible objects-of-hope, but also to the ideals, projects, psychological states, and social structures conducive to hoping. Finally, the mass noun can be the subject of a sentence (‘Hope dies last’), a role which it is arguably a disguised plural.
Chapter 10 ‘Hope’: negations, modals and modifiers
There are several types of ‘negative’ hope statements: ‘There is no hope of…’, ‘She has no hope of…’, ‘without hope’, ‘hopeless’, and more. What most have in common is that they make no reference to inner states of the person. Rather, they deny that a certain outcome is possible. In many cases, ‘hope’ is almost equivalent to ‘chance’ (‘She has no hope/chance of succeeding’), the main difference being that ‘hope’ is positively valenced where ‘chance’ is not. There is also an interesting switch of perspective. ‘Ann hopes to win’ implies that Ann wants to win and believes she can. ‘Ann has no hope of winning’ implies that it’s the speaker who believes she cannot. ‘Hopeless’ is rarely applied to people (when its usual sense is ‘incompetent’). It is more usually applied to tasks, causes and situations. ‘It’s a hopeless task’ does not refer to an inner state or its absence; it refers to the impossibility of completing the task. Interrogatives are comparable. ‘Is there any hope?’ asks whether a desired outcome is possible. Even ‘hopelessness’ is regularly applied to situations; but at the far end of the ellipsis spectrum, it sometimes does refer to a state of mind.
Chapter 11 ‘Hope’ in health care
There are three important aspects of what nursing (and health care generally) has done in its discussions of hope. First, it has overlooked most of the uses of the word reviewed in Chapters 7-9, and drawn from a narrowly selective range. Second, it has grafted on to this narrow range a set of different anticipatory concepts such as optimism, goal-directedness, and ambition. Third, it has appropriated the word ‘hope’ for new tasks. In health care, ‘hope’ has functions it doesn’t have in ordinary usage; in some instances, ordinary usage effectively disallows these new functions. This does not imply that its use in nursing is wrong. It is routine for technical disciplines to appropriate familiar words, ignore many of their everyday uses, and give them new functions. Still, there might be a problem if you create a technical term without realising that this is what you’ve done, thinking that you have ‘clarified’ the concept . That is often the situation in health care. Sometimes, this lack of awareness has no practical consequences; but sometimes it has unfortunate methodological or clinical implications. This chapter elaborates these points, assessing the work of writers such as Dufault & Martocchio, Herth, Morse, and Snyder.
Chapter 12 ‘Moral distress’
Jameton distinguished between types of ethically inflected situation, one being moral distress. He didn’t define ‘moral distress’, and he showed no particular interest in the states of mind induced by the type of situation concerned. So it is Wilkinson who invented the modern concept, by creating this definitional schema: < state of mind > caused by < precipitating circumstances >. Subsequent authors have made suggestions about what should go in the two definitional slots, the trend being to greatly expand the range of possibilities in both. As a result, recent ‘definitions’ are unusably general (example, Fourie’s ‘psychological response to a morally challenging situation’). This chapter suggests that ‘moral distress’ can be seen, not as the name of a psychological state, but as a normative classification used to bolster a narrative concerning nursing’s identity. It does so by transforming a number of different discourses into a single narrative: ‘Virtual moral agent, thwarted, suffers’. This switches attention from economic, legal, political, and institutional issues (among others) to the suffering nurse; and the emotional cadence shifts accordingly. In this respect, the literature on ‘moral distress’ can be seen as a symptom of a discrepancy between nursing’s mandate and nursing’s licence.
8th August 2020
A new summary of the whole book, an improvement (I think) on the 9th June version below. At the moment, I’m assuming that Routledge will base the blurb on this summary. But there’s still time, just about, for changes of mind…
In this book, John Paley argues that there are no such things as concepts. If concepts are abstract objects or mental images; if they have components, boundaries and structures; if they’re the building blocks of theory and the constituents of thought… if that’s what concepts are, then there really are no such things. In which case, we can’t do concept analysis as nursing understands it. What we can do instead is explore the use of expressions that are important to nursing, and examine their functions in various grammatical constructions. Drawing on Wittgenstein and Construction Grammar, the book first makes a case for dispensing with the traditional concept of a ‘concept’, and then provides two examples of a linguistic investigation, examining the use of ‘hope’ and ‘moral distress’. Casting doubt on the assumption that ‘hope’ always stands for an ‘inner’ state of the person, the book shows that the word’s function varies with the grammatical construction it appears in. Similarly, it suggests that ‘moral distress’ is not the name of a mental state, but a normative classification used to bolster a narrative concerning nursing’s identity.
30th June 2020
Brevity is something I find quite difficult a lot of the time. So I set myself the challenge of summarising each chapter in 60 words or less. The idea was to represent the through-argument of the book as succinctly as possible. Obviously, details, detours, explanations and qualifications are omitted, as are ancillary topics additionally dealt with. So here we go…
Chapter 1 Aims, methods, conventions
Part I argues that the noun ‘concept’ is indispensable, but does not name anything. In soundbite terms: there are no such things as concepts. If this is correct, an alternative to concept analysis – as currently practised in nursing – is needed. Part II illustrates this alternative with two extended case studies, ‘hope’ and ‘moral distress’, drawing on Wittgenstein and Construction Grammar.
Chapter 2 Concepts, words and pictures
It is widely believed that all uses of the word ‘X’ express the concept of X, a singular something which underlies the uses, and which has an analysable structure. This book suggests that there are no concepts, only uses of ‘X’. The expression ‘the concept of X’ is merely a way of referring, vaguely, to the pattern of use.
Chapter 3 ‘A noun is a naming word’. Discuss
‘Concept’ is a noun. It is generally assumed that nouns are ‘naming’ words: they are ‘labels’ for things or classes of things (an assumption apparently confirmed by the dictionary). However, there are many familiar words which are nouns, but which do not name anything. Equally, there are many nouns which sometimes name things and sometimes don’t.
Chapter 4 Referring without identifying or describing
A particularly significant non-naming function that nouns (and noun phrases) can have is to refer, in the vaguest terms, to an ontologically diverse, ill-defined domain of items, without naming, identifying or describing any of them. Some nouns are specialists (‘things’: for example, ‘things associated with going to a movie’), while other nouns can do it in certain contexts and constructions.
Chapter 5 ‘The concept of…’
‘The concept of X’ is a noun phrase with the function of non-identifying reference. It refers vaguely to a domain of ontologically diverse items – how X is thought about, discussed, understood; the pattern of use associated with the word ‘X’ – but does not identify or describe any of them. In this respect at least, ‘concept’ is rather like ‘thing’.
Chapter 6 Must there be concepts?
‘We must have concepts in order to be able to categorise, make judgments, have thoughts.’ This is, in a sense, true; but it is a ‘grammatical rule’, not an empirical claim. It may be correct to say that somebody ‘has the concept of X’, but it does not follow that there is something – a ‘concept’ – which she has.
Chapter 7 Wittgenstein, language and method
‘The concept of X’ refers, vaguely, to the pattern of usage of the word ‘X’. So concept analysis should give way to investigations of the use ‘X’ in various linguistic contexts. According to Wittgenstein, these patterns can be very complex, labyrinthine; according to construction grammar, the functions of ‘X’ can differ with its morphology and the constructions it appears in.
Chapter 8 ‘Hope’: the basic schema
‘Hope’ can be a verb, count noun or mass noun. As verb and count noun, it takes a grammatical object: one hopes for something. Unusually, the verb is both an ‘attraction’ and an ‘epistemic’ verb. It is akin to both ‘want’ and ‘believe’, expressing either a preference, or a proposition, or both simultaneously, using different syntactic markers in each case.
Chapter 9 ‘Hope’: the mass noun
The mass noun is frequently used with ellipsis, where the object-of-hope must be inferred by the reader. At the far end of the ellipsis spectrum, ‘hope’ refers (vaguely) not only to an indeterminate number of possible but unspecified objects-of-hope, but also to the various plans, projects, psychological states and social structures conducive to hoping (another example of referring without identifying).
Chapter 10 ‘Hope’: negations, modals and modifiers
In these constructions, ‘hope’ very rarely refers to an ‘inner state’ of the individual. Rather, it alludes to the impossibility of a positively valenced outcome. Negations usually state that there is no chance of the outcome occurring. They typically report the speaker’s assessment of this probability, not that of the person referred to in the negating sentence.
Chapter 11 ‘Hope’ in health care
Nursing, like philosophy, overlooks most ordinary uses of ‘hope’, as reviewed in Chapters 8-10, and draws from a narrowly selective range. It grafts on to this narrow range a number of different concepts, such as goal-directedness and optimism, and appropriates ‘hope’ for new tasks. This is legitimate, provided it is not assumed that the everyday concept has been ‘clarified’.
Chapter 12 ‘Moral distress’
The history of ‘moral distress’ is a history of definitions, the trend being to vastly expand the range of psychological states and circumstances to which it supposedly refers. However, the expression is not the name of a definable psychological state experienced by the individual nurse. It is rather a normative classification used in the ongoing project of defining nursing’s identity.
12th June 2020
The officially agreed title is now:
Concept Analysis in Nursing: A New Approach
That’s the third different version, but I think we’ll be sticking with it. The book does pretty much what it says on the tin. It is a new approach. Part I makes a case for saying that there are no such things as concepts (but there are such things as words, used in a variety of ways). Part II consists of two extended case studies, exploring the patterns of use associated with ‘hope’ and ‘moral distress’. One is a common-or-garden word that has come to have clinical significance; the other is an expression introduced to the nursing literature in the 1980s.
See below for the list of chapters. I’ll post a fuller summary in the next few days.
9th June 2020
So the ‘concepts’ book is now somewhere between its third and fourth drafts. The main task, initially, was to chop it down from about 150,000 words in the first draft to no more than 110,000 words (including notes, references, and so on). I’ve just about managed that… but, more importantly, in doing so I’ve made it leaner, crisper, tighter. I think. Still some way to go, but it’s getting there.
I’ve had to cut a chapter, the one on ‘objectivity’, although arguably that was never the best fit. So Part II now consists of four chapters on ‘hope’, and one on ‘moral distress’. And here was me thinking one chapter on ‘hope’ would cover it. A short, everyday word, but one whose pattern of use is unexpectedly complex.
The full line-up now looks like this:
 Aims, methods, conventions
Part I Nouns, names, concepts
 Concepts, words and pictures
 ‘A noun is a naming word’. Discuss
 Naming, denoting, identifying, referring, describing
 ‘The concept of…’
 Must there be concepts?
 Wittgenstein, language and method
Part II The Grammar of ‘hope’ and ‘moral distress’
 ‘Hope’: the basic schema
 ‘Hope’ as a mass noun
 ‘Hope’: negations, modals and modifiers
 ‘Hope’ in health care
 ‘Moral distress’
I’ve had a first go at a 200 word summary of the whole thing, which was (unsurprisingly) tricky. The publishers will use something like this as the basis for the blurb. But it’s only a first shot, and will get tweaked a lot over the next three months. Anyway, for what it’s worth:
Part I of this book argues that although the noun ‘concept’ is an indispensable one, it does not name anything, or any class of things. In soundbite terms: there are no such things as concepts. The expression ‘the concept of X’ refers, in the vaguest terms, to how X is thought about, and how the word ‘X’ is used in a variety of contexts. This implies that concept analysis, as currently practised in nursing, is not viable. Instead, we can explore the use of key terms in different contexts and grammatical constructions. In Part II, this alternative is illustrated through two case studies: ‘hope’, an everyday word which has come to have clinical significance; and ‘moral distress’, an expression coined in 1984. The case studies suggest that nursing neglects most uses of ‘hope’ – drawing instead from a narrowly selective range – and grafts on to this narrow range different concepts such as goal-directedness and optimism. This is not to ‘clarify’ the concept, but to introduce new technical terms. A second conclusion is that ‘moral distress’ is not the name of a psychological state of individual nurses, but a normative classification used in the ongoing project of defining nursing’s identity.
I hope there will also be a change of title, but I will need to discuss that with Routledge before confirming. The current title is: Concept Analysis in Nursing: A Critical Reappraisal. But there’s not a great deal in it that’s critical, and I’m not convinced ‘reappraisal’ is the right term for what the book tries to do.
More soon, hopefully. In the meantime, stay safe.
8th June 2020
Not quite as big a gap as it looks, although admittedly my last post was January this year.
On that occasion, I mentioned an upcoming workshop at the University of Worcester. That went ahead, and went reasonably well, although many of the questions and comments demonstrated that I hadn’t yet worked out a way to explain what I thought I was up to. I’ve improved on that a bit since, or at least I think I have, so it was an extremely useful, if sobering, experience. My thanks to everybody concerned: the people who attended, and Martin and Paul for the invitation.
Of course, that was pre-lockdown. To anyone reading this: I hope that you and the people you care about are safe and well.
27th November 2017
The reply to van Manen is now finished, and both papers – my responses to van Manen and Giorgi – are under review. These two paragraphs from the Introduction provide an outline of my response:
Both articles are studies in misreading. Interestingly, however, each author misreads in a different way, and for different reasons. Giorgi is confined by a hermetic epistemology, which prompts him to ignore vast tracts of the relevant academic literature, even when he is accusing me of being ill-informed, and to criticise what he imagines I must have said rather than what I did say (Paley 2018). Van Manen, on the other hand, has an idée fixe which prevents him from recognising that the book is not about a certain philosophical tradition (known as ‘phenomenology’), but about a particular type of qualitative research (also known, unfortunately and confusingly, as ‘phenomenology’). A second idée fixe disposes him to misread an earlier article of mine and (much more seriously) three works by Heidegger.
My aim in this paper is to describe these two idées fixes, and exhibit their consequences. In doing so, I will examine what van Manen has to say on four crucial topics: meaning, lived experience, empathy, and boredom (specifically, Heidegger’s analysis of boredom in The Fundamental Concepts of Metaphysics). I will also take a brief look at an ad hominem comment in van Manen’s article, which throws additional light on his approach.
I’m now getting back to the book on concepts, and am hoping to have completed a couple of chapters from that early in the new year. I will also post an outline – inevitably, this is going to be a work in progress – at some point in January.
6th October 2017
My response to Giorgi’s review article is now complete, and will be submitted in the near future. You’ll have to wait for publication to read the whole thing, but here are the first two paragraphs:
Amedeo Giorgi (2017) has published a review article devoted to Phenomenology as Qualitative Research: A Critical Analysis of Meaning Attribution (Paley 2017). Anyone reading the article, but unfamiliar with the book, will get a distorted view of what it’s about, whom it’s addressed to, what it seeks to achieve, and how it goes about presenting its arguments. Not mildly distorted, in need of the odd correction here and there, but systematically misrepresented.
Giorgi’s article is a study in misreading. Giorgi misreads the book’s mise en scène; he misreads its narrative arc; he misreads individual arguments; he misreads the philosophy of science literature; he misreads short, straightforward sentences; he misreads his own data; he misreads the title; he misreads the blurb; he misreads the acknowledgements. In addition, there are serious failures of scholarship (ironically, he demonstrates how unacquainted he is with the relevant academic literature at the very moment he is accusing me of being ill-informed).
My reply to van Manen is about half written, and will be completed during the next few weeks. I’ll post an update, with a short extract, when it’s ready.
Meanwhile, here are a few comments on Brian Sohn’s review in Issues in Mental Health Nursing (all links below, 28th July).
Like both Giorgi and van Manen, Sohn can’t read what’s on the page in front of him. This inability is apparent from the first paragraph, where he suggests that my ‘main critique of PQR has two prongs: phenomena are devoid of essences and bracketing is impossible’. But I nowhere claim that phenomena are devoid of essences; and I mention bracketing just once, in a footnote, confessing that I don’t understand how it is done (see below). I do not claim it is impossible. Main critique?
Bracketing resurfaces later in the review, when Sohn claims: ‘Paley says that with the departures van Manen takes, he brings external theory to the interpretation – he is incapable of bracketing in the narrow, subtractive sense that Paley understands it’. The one footnote on bracketing says nothing about van Manen; and I don’t understand where Sohn gets ‘narrow, subtractive sense’ from.
Here is the footnote that refers to bracketing. It’s the first full paragraph on p. 36 of the book:
Some authors (usually those who talk of ‘bracketing’) say that, having identified their presuppositions, they can disable them, as if toggling them to ‘off ’. I have a problem with this: I do not understand how either of the two steps can be achieved. In the first place, how do I identify the relevant presuppositions? Is it not likely that the ones which exert most influence on my thinking will be unconscious, or at least very difficult to retrieve? Is it possible to identify these presuppositions by introspection? If so, how? How does it work? What do I have to do? If not, what other psychological process is involved? In the second place, how can the presuppositions, once identified, be turned off? Is this a kind of ignoring? If so, how convincing can it be to assure the reader that my preconceptions and prejudices have played no part in the analysis because I have ignored them? What evidence of that can I provide? If it is not a kind of ignoring, what else is it?
This is just a series of questions about what (some) other people mean by ‘bracketing’ and how they go about it. How does Sohn squeeze the ‘narrow, subtractive sense’ out of this paragraph? What, come to that, does he mean by the expression? Does he have a ‘broad, non-subtractive’ concept of bracketing? If so, how does it work? Are the questions I ask in the footnote illegitimate? If someone says that they have done some ‘bracketing’, is it ‘post-positivist’ to ask how they went about it? Why?
Perhaps, to use Sohn’s term, it’s too ‘logic-laden’. Perhaps we have to take these things on trust. If a researcher says she’s bracketed, then she’s bracketed. End of. It’s unacceptably logical to inquire how she did it. Is that how it works?
A few other snippets:
‘Unlike Paley, phenomenologists believe that phenomena have immutable qualities.’ I’m still trying to find the place where I say they don’t, or that they are devoid of essences. There’s a footnote on p. 35 where this topic comes up briefly: ‘The essence of water, for example, is presumably H2O. The meaning of water might refer to the pleasures of sailing or swimming, its significance in certain religions (baptism), and so on.’ Similarly, at the top of p. 22 I say: ‘We must be able to distinguish between the essence of X (smoking, for example) and the effects of X. The essence of smoking (inhaling tobacco smoke) is one thing, the effect of smoking (cancer) is another .’ Presumably, then, I think that at least some phenomena (water, smoking) have essences, and that H2O is an immutable quality of water. So where is Sohn getting his ‘devoid of essences’ claim from?
‘Paley’s mathematization of meaning…’ Sorry? Where?
‘Paley embarks on a mission to develop a theory of meaning because, he says, phenomenologists have not done so.’ This is ambiguous. I don’t claim that phenomenologists have not theorised meaning. This would obviously not be true of writers in the phenomenology-as-philosophy (PP) tradition. What I say is that PQR writers (qualitative researchers, especially in nursing, who refer to their approach as ‘phenomenology’) don’t provide a theory of meaning. Nor do the methodologists most frequently cited by these writers.
‘Paley seems to ignore that the quest of PQR is to find meaning.’ It is a principal thesis of Chapter 2 that PQR is different from other types of qualitative research precisely insofar as it aims at meaning attribution. ‘It attributes meaning to the phenomenon.’ (p. 17). That’s ignoring the ‘meaning’ quest of PQR? Seriously?
All three critical reviews so far – Giorgi, van Manen, Sohn – attack claims which the book does not make. The misreading is pervasive. This is interesting in itself; and, in the reply to Giorgi, I try to account for it by outlining the hermetic epistemology which I think is largely responsible.
28th July 2017
Another critical review, by Brian Sohn, has been published in Issues in Mental Health Nursing. Brian Sohn.
Max van Manen’s review article will be published in the Indo-Pacific Journal of Phenomenology. Max van Manen
Amedeo Giorgi’s will be published in the Journal of Phenomenological Psychology. Amedeo Giorgi
Martin Lipscomb’s review is on Early View at Nursing Philosophy. Martin Lipscomb
Roger Watson’s review is also on Early View at Nursing Philosophy. Roger Watson
For very brief remarks on the review articles by van Manen and Giorgi, see below. I’m writing a separate response to each one, as it’s impossible to squeeze everything I want to say into just one paper. I will comment on both of them (a bit less brief, but still pretty sketchy in view of the time constraints) when I give my paper at the IPONS conference in Worcester (Friday, 1st September). Draft programme here: IPONS conference
27th June 2017
Another change of plan. I’m finding it impossible to confine myself to a summary, or to present what I want to say in note form. I’m several thousand words in, and still talking about Giorgi. Barely mentioned van Manen yet. The problem is, you can’t untangle the arguments – and they are seriously tangled – without a fair amount of explanation. For example, consider Giorgi’s appeal to incommensurability, and his view that ‘to criticize the work of a scientific community from outside the perspective that the community adopts is, at best, risky, and most usually leads to fallacious conclusions.’ It’s impossible to say what’s wrong with that in a few quick soundbites. Apart from anything else, you have to present some fairly detailed stuff on developments after the publication of The Structure of Scientific Revolutions. I could, I suppose, cite authors like Howard Sankey: ‘Returning to the topic from a perspective of the contemporary scene in the philosophy of science is like visiting a battlefield from a forgotten war. The positions of the warring sides may still be made out. But the battlefield is overgrown with grass. One may find evidence of the fighting that once took place, perhaps bullet marks or shell holes. But the fighting ceased long ago. The battle is a thing of the past. The problem of incommensurability is no longer a live issue.’ Or I could quote Kuhn himself: ‘Most readers of my text have supposed that when I spoke of theories as incommensurable, I meant that they could not be compared. But “incommensurability” is a term borrowed from mathematics, and it has no such implication.’ (The Road Since Structure) But this would be too quick, too glib. The matter demands a much fuller examination. And incommensurability is just one of the things Giorgi talks about that I want to dissect. Then there’s van Manen, and his account of Heidegger’s discussion of boredom (among other things). Explaining how that goes badly awry is another non-soundbite task.
So what I initially thought of as a ‘summary’ is effectively on its way to becoming the ‘comprehensive response’. I also have to finish my paper for the IPONS conference in Worcester, realistically by the end of July when I’m off to Italy. So, this time, I won’t try to predict when I might post a longer response. However, I’ll probably provide occasional updates over the next few weeks, and/or comments on aspects of the two review articles that I find particularly interesting.
16th June 2017
The link to Giorgi’s review article has been added below.
I was tempted to post a progress report on my response to both review articles, Giorgi’s and van Manen’s. But I’ll wait till I’m properly ready, which will be some time in the next week or two. I’ve given myself a bit more time, because I have spent the last few days re-reading Heidegger’s The Fundamental Concepts of Metaphysics, a book I haven’t looked at for a number of years. It includes a lengthy discussion of boredom, which Professor van Manen cites in his article. Van Manen thinks Heidegger’s “phenomenological question is, ‘what is it like to be bored?'”, and he quotes several passages from Heidegger’s analysis in support of that view. I don’t think van Manen’s interpretation of these passages is correct, but I wanted to read the book again before commenting further. I’ve also been catching up with some of the secondary literature.
Anyway, a more detailed response will have to wait. The plan is to write a rejoinder to the two articles, in summary form, and post it here by the end of June at the latest. After that, I’ll have to concentrate on my paper for the IPONS conference in Worcester. Then, in the early Autumn, I’ll draft a comprehensive response to both van Manen and Giorgi.
Sorry for the delay… but watch this space!
26th May 2017
I’ve just received reviews of PQR by Max van Manen and Amedeo Giorgi. Needless to say, they are highly critical. No surprises there. Actually, they’re not reviews, they’re review articles (Giorgi’s runs to over 25,000 words). I have read both of them a couple of times so far, but am now starting on the slow-and-careful, taking-notes reads. I will be posting informal replies on this site during June, and at some point I will submit more formal responses to the relevant journals. There is a general sense in the academic world that one doesn’t reply to book reviews. But, as I say, these are review articles. They count as scholarly contributions, and are as susceptible to challenge and critical engagement as any other type of academic paper.
In the meantime, here is the link to van Manen’s article, which will be published in the Indo-Pacific Journal of Phenomenology. Max van Manen
And the link to Giorgi’s, which will be published in the Journal of Phenomenological Psychology. Amedeo Giorgi
Two other reviews are in the works. One, by Martin Lipscomb, is online early at Nursing Philosophy. Martin Lipscomb Another, by Roger Watson, will be appearing in the same journal.
I’ll post a link to the Watson review as soon as it appears. Links will also be available on the IPONS website. IPONS book reviews
I would suggest that anyone who reads the articles by van Manen and Giorgi (or those by Lipscomb and Watson, for that matter) should have a look at the book as well, and not take it for granted that their accounts of what it’s about, what’s in it, and what kinds of arguments it contains, are necessarily accurate. Reading the essays by MvM and AG, I was reminded of Paul Feyerabend’s comments in Part Three of Science in a Free Society (responding to reviews of Against Method).
“There are three things which never fail to amaze me when reading reviews of my book: the disregard for argument, the violence of the reaction, the general impression I seem to make on my readers… I am very grateful that you are so deeply concerned about my book, and that you have put so much time, energy, and especially imagination into the review.”
I should add that Feyerabend’s reply to Agassi, along with his other “Conversations with Illiterates” (the title of SIAFS Part 3) is a very caustic piece of writing, which I will not of course be trying to imitate.
20th August 2016
PHENOMENOLOGY… AND CONCEPT ANALYSIS
The book is finally out, and available on Amazon in hardback and e-book formats.
Have spent the last couple of weeks compiling a distribution list, and sending out an announcement to several hundred people, mainly in nursing and other health disciplines, who have (or possibly once had) some sort of interest in phenomenology as a qualitative research method.
Am now relaxing in Italy, starting to think – intermittently – about my next project. Although I’m not going to make any kind of decision till I return to the UK, the current front-runner is something (possibly another book) on concept analysis. I’m reading stuff on cognitive linguistics, the philosophy of language, and the theory of argumentation and definition, as well as classic statements in the nursing literature of what concept analysis involves: Walker & Avant, Rodgers, Morse, Penrod & Hupcey, and so on. I’m starting to think about a radically different approach which abandons or reverses some of the key assumptions made by nurse authors; and the book, if I actually write one, would be largely devoted to examples of this alternative in action, rather than to a lot of philosophical carping and criticism.
This train of thought was kicked off by the event on moral distress which I took part in during May (see below). The title of this event was “What is moral distress in nursing?”, and that got me wondering about the nature of “What is X?” questions. I have no idea if anyone reads this, but I’ll report back on where I’ve got to, and perhaps indicate the direction the project is moving in, later in the year.
8th June 2016
IN PURSUIT OF PRACTICAL WISDOM FOR NURSING
Derek is modifying his neo-Aristotelian virtue ethics in response to situationist considerations. Doing “the right thing” is not just a matter of individual moral agents (nurses) acting virtuously. He is now interested in the idea that institutions can make it easier for practitioners to do the right thing, or make it more likely that they will do so. It’s not fully clear how they will achieve this, but one example he gave was adopting policies that encourage whistle-blowers, rather than deterring and penalising them.
There are two levels which an institution can aspire to: (a) the “enabling organisation”, adopting structures and policies which increase the likelihood of nurses doing the right thing; (b) the “virtuous organisation” whose aim is to go beyond the minimalist target of the enabling organisation – acting ethically, or at least acting not-unethically – and encourage nurses to become virtuous. Type (b) is desirable because under an (a) regime, people might act correctly in a minimalist, utilitarian sort of way, but won’t necessarily be virtuous. An organisation adopting (b) will encourage people to cultivate virtue, cultivate the habit of virtue, and make it possible for them to do so. Becoming virtuous will make acting ethically part of someone’s character: they won’t just be responding to conducive situational factors.
Again, however, the details of how an organisation achieves “virtuous” status are not fully clear. This is work in progress.
Personally, I have two related worries about this picture (putting aside my general scepticism about the idea of moral agency and virtue in nursing). First, it’s all a bit abstract and utopian (Derek admits to being an idealist). The idea of an organisation that makes “doing the right thing” more likely is not really something one can oppose… any more than one can oppose better education, a stronger economy, or world peace. But the problem is: how to get there. In the absence of further details about that, the proposal is not much more than utopian rhetoric.
Second, I think it over-generalises. “Doing the right thing” or “acting virtuously” covers a very wide range of different circumstances. This is where the discussion links up with what I said about moral distress (see below). Doing the right thing (DTRT) when faced with severe understaffing is one sort of situation; DTRT when expected to follow the instructions of a particular doctor who you think has got it wrong is another sort; DTRT when there is a clash of legitimate perspectives among patients, families and health care staff is another; DTRT when complying with restrictive hospital protocols is another; DTRT when trying to balance the needs of the individual patient and a wider population of patients is another; DTRT when certain services and/or interventions are being rationed is another; and so on. I’m not sure how you design organisational structures capable of promoting DTRT in all these different types of situation. Approaching the matter in a more piecemeal and problem-solving way – here’s a specific problem we need to sort out, what can we do about that? – looks more promising to me. Still very difficult, but more manageable.
In any case, I don’t think there’s much evidence for cross-situational virtue: that a tendency to act ethically or virtuously in one sort of situation is associated with a tendency to act in a similar way in other sorts of situation. In fact, there’s a certain amount of evidence to suggest that this sort of cross-situational consistency may be rather rare. To that extent, designing “generically” DTRT organisations (so to speak) does not look like a viable project – less so than addressing specific kinds of situation on a problem-solving basis.
But I suppose that brings us back to the more general issue of the situationist challenge to concepts of character and virtue… and that is a continuing, undecided debate in moral philosophy and moral psychology.
6th June 2016
IN PURSUIT OF PRACTICAL WISDOM FOR NURSING
Off to the University of Worcester on Wednesday to attend a seminar given by Derek Sellman, Professor at the University of Alberta and Editor of Nursing Philosophy. Synopsis: Derek’s abstract.
A report on this event later in the week.
20th May 2016
THE “MORAL DISTRESS” DEBATE
Enjoyed the debate at the Wellcome Collection last night. The four speakers each had ten minutes to summarise their thoughts, and then the audience joined in for the second hour. It was an engaged and lively discussion.
My own ten minutes’ worth was based on this Outline. At the invitation of Ann Gallagher, I’ll be working the outline up into a full paper, for submission to Nursing Ethics.
My thanks to Georgina Morley for inviting me, and to the sixty or so people who turned up and made the evening so interesting.
Thanks, too, to Michael Traynor for sending the photo! Next to me, in order, left to right: Deborah Bowman, Jill Maben, and Lesley Baillie. Ann Gallagher is on her feet, out of shot, giving her talk.
23rd April 2016
“WHAT IS MORAL DISTRESS IN NURSING?”
This is a debate to be held in the Burroughs Room at the WellcomeCollection (183 Euston Road, London, NW1 2BE) on Thursday 19th May from 7:00 to 9:00 p.m. It has been organised by Georgina Morley of the University of Birmingham.
I’ll be taking part, along with:
Jill Maben OBE, Professor of Nursing Research, King’s College London
Ann Gallagher, Professor of Ethics and Care, University of Surrey, and Editor of international journal ‘Nursing Ethics’.
Lesley Baillie, Professor of Nursing, London South Bank University and Florence Nightingale Foundation Chair.
The debate will be chaired by:
Deborah Bowman, Professor of Bioethics, Clinical Ethics, and Medical Law at St George’s University