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The hidden and forgotten evidence

2012; Wiley; Volume: 26; Issue: 4 Linguagem: Inglês

10.1111/scs.12012

1471-6712

Katie Eriksson, Kari Martinsen,

Nursing Diagnosis and Documentation

Evidence is concerned with reality and truth and pertains to general nursing science as well as practical caring. Surprisingly little attention has been paid to the question of evidence in our journals of nursing science, a fact which can be seen as paradoxical in view of the increased diversity of empirical studies. Is it really the case that the identity of nursing science is rather feeble and that we are hiding behind a seemingly obvious concept of evidence rooted in natural science? Multiplicity of knowledge can either be a rich resource or a "Maya's veil" covering up reality and reducing caring to techniques and procedures. Absolute evidence presupposes that the ontological questions have been elucidated and given verbal expression. The ontological questions which concern human life are eternal and difficult to capture. It is the ontological evidence and the fundamental questions of caring that we, Kari Martinsen and Katie Eriksson, have made the subject of our dialogues since the beginning of the 1980s. We are both grappling with these questions, from a shared background in humanist sciences but rooted in different traditions. We maintain that working with the ontological questions yields evident insights, an absolute form of evidence which needs to be constantly re-created, using rediscovered and creative words and concepts that others can receive, find resonance in, transform, and share again and again, in new forms of expression. This implies that what is evident, has to be dressed in words, in Eriksson's expression, or that dynamic word shaping is important, in Martinsen's expression. Not everything can be expressed in the same way, and when one aims to express the fundamental presuppositions of human existence, then a narrative style in the form of that-statements and a more essayist type of writing are required and unavoidable. These that-statements have to do with life's fundamental conditions not chosen or created by human beings. Included under such phenomena would be that life is vulnerable, that we are frail and fallible beings, that we are dependent on each other and at each other's mercy in matters of responsibility and power, that we are always sensing and always trying to make sense of what is touching us through sensing, that suffering is an integral part of life, that life is finite and death assured, but also that life is sustained by phenomena such as hope, mercy and charity. These fundamental aspects of existence are subsumed under the ontological questions where ethos and the ethical questions are integrated. All of this presupposes a concept of evidence rooted in the human sciences, as discussed in our book Å se og å innse ("To see and to realize") 1, where we present a more holistic/comprehensive concept of evidence. Evidence as a concept of nursing science unifies what is human and what is nature-given. Katie Eriksson approaches the question of evidence from an etymological, conceptual, and linguistic perspective anchored in Gadamer's philosophical hermeneutics and his views on evidence. Evidence as a concept pertains to truth, reality, and being in the world; it involves seeing, realizing, making visible, and clothing thoughts into words. The etymology of concept and Gadamer's hermeneutical philosophy provides a deeper understanding of the concept of evidence. Ontological or absolute evidence is based on being and the true reality that extends beyond the immediate reality. Evidence as a concept and phenomenon has been part of the scientific discussion for centuries and was originally developed in law. Schjøth (1933), a Norwegian philosopher, emphasized in the early 1900s that evidence does not mean creating a more or less good concept of experience, but it is a means to bring about knowledge of reality. The concept of evidence is derived from the Latin evidentis and eviden'tia and means quite generally a basic feature of the truth. Evidentis consists of ē (ex), out of, and vidēre, meaning "see" and "realize", which is related to know. Etymologically, the concept of know is derived from to see, experience and feel. The Sanskrit word veda means I know. The Sanskrit word vedayati means allow to know, announce, inform. These dimensions are the basis of a caring science ontological definition of the concept of evidence. Based on the linguistic importance of evidence-evident, it can be seen that these words, in their original meaning, have a completely different signification than today's empirically highlighted concepts of evidence. Ontological evidence implies that the true reality may emerge and become visible in all its beauty and goodness. That which is evident, according to Gadamer, is always something that has been said and which then needs to be made visible and valid. Nothing is evident until it is spoken and dressed in words. According to Gadamer, it is likewise clear that the evident is always something surprising that widens the field observed. It is like when you finally understand something. Kari Martinsen enters the discussion of evidence from the point of view of phenomenological philosophy. The task is to work with what is present in everyday experience but overlooked. Phenomenological philosophy will remind our everyday understanding about something in its own presuppositions which it has difficulty making explicit: the existence of life's fundamental conditions as expressed through that-statements. These represent phenomena, which are by their very nature universal and typical in appearing before us in singular situations. We cannot lock their meanings into tight definitions, nor do we have exhaustive knowledge about them. We cannot know more about them than we ourselves have experienced or others have shared with us of their experience. We can discover something about them on the basis of a singular situation which is always sensitively tuned, filled with impressions, and which a person is seeking to express. All life is tuned. We recognize tuned sensations which emerge from holding in our hands something of the life of a vulnerable person. We have in our own lives experienced what the compassion of others can mean. In our sensing we are always tuned by impressions carrying significant meanings, impressions which we are touched by and which move us. Phenomenology deals with releasing and expressing some of the meaning inherent in the impression which moves us (life's fundamental conditions expressed through that-statements). It is to uncover and be able to describe the tuned sensations within the phenomena that reveal their universality in the singular situation. "The articulation of impressions" is my designation of this phenomenological philosophy which takes as its pivot the thinking of K.E. Løgstrup, the Danish philosopher. In the articulation of impressions two aspects are essential: The first concerns what the individual person receives, the meanings carried by the impression itself. This is what is being received, e.g. from the patient. In the interpreting release of the impression one needs to be aware of the resistance which the impression in itself offers against our intervention. It is a critical resistance or challenge to the understanding subject exerted by the phenomenon which makes an impression on us. It evokes a cautious gentleness not to violate or infringe on the untouchable zone of the other. The second aspect essential to the articulation of impressions is what the individual person contributes. Here we find three inseparable considerations: That we are open and perceptive to what makes an impression on us, that we actively discipline ourselves to stay with the impression and let it sensitively tune us, allowing some meanings to emerge from what has made an impression on us, and that we make room for reminiscences in the interpretation of our impression. In reminiscing, we will in the here and now be reminded of something which brings us toward something else. Reminiscence refers us to a creative aspect of articulating our impressions in a sensitively tuned space for thought. The articulation of impressions involves the art of actively shaping words, which aims to find expressions allowing the tuned sensitivities of the impression to resonate through. Phenomenology is concerned with interpreting the sensitively tuned impressions. It invites a variety of expressions in narrative form. Phenomenology can thus not be said to be an expression of "sameness," for which it has been criticized. It is rather the opposite, setting distinctions and contrasts in order to describe the same phenomenon in the greatest possible range of nuances and variations. This enables us to recognize vulnerability as a phenomenon as described in a variety of situations. It is necessary to discuss and reflect upon evidence as a concept of human and caring science. We maintain the ethical obligation of constantly repeating the basic sustaining expressions of care to open up for alternative insight into true reality. In the sensitively tuned space for thought in phenomenological philosophy, and in Gadamer's philosophical hermeneutics, there must be room for reflection, wondering and imagination, and furthermore for expressions that assume and reflect a connection between the concrete aspects of the situation and the phenomena one strives to express (life's fundamental conditions in the form of that-statements). There is thus no avoiding the dynamic shaping of expressions which may uncover and display the ontological aspects of human existence as evident, as well as articulate them, translate them into words and deeds which can reach the suffering person. Absolute evidence exists only here and now in a concrete situation where the universal meets the particular and is unified in a receptivity of truth, where theory and its practical application are joined in a harmonious unity: the fundamental, sustaining idea of caring, and a great variety of knowledge forms is developed for the good of mankind.