648782
research-article2016
NSQXXX10.1177/0894318416648782Nursing Science QuarterlyFawcett / Essays on Nursing Science
Essays on Nursing Science
The Two Nursing Disciplinary Scientific
Revolutions: Florence Nightingale and
Martha E. Rogers
Kan Koffi, RN; MSc,1 and Jacqueline Fawcett, RN; PhD; FAAN2
Abstract
The purpose of this essay is to share Kan Koffi’s ideas about scientific revolutions in the discipline of nursing. Koffi has
proposed that the works of Florence Nightingale and Martha E. Rogers represent two scientific revolutions in nursing as
a learned discipline. The outcome of these two scientific revolutions is a catalyst for critical disciplinary and paradigmatic
debate about the universal conceptualization of nursing’s distinctive professional and scientific knowledge.
Keywords
Florence Nightingale, Martha E. Rogers, nursing discipline, scientific revolution
Jacqueline Fawcett (JF): I had the pleasure of meeting
Kan Koffi and hearing his presentation at the October
2015 annual conference of the Society of Rogerian
Scholars (SRS). I invited Kan to participate in a dia-
logue with me so that his ideas about scientific revolu-
tions in nursing could be shared with the readers of
Nursing Science Quarterly.
Kan, Your presentation at the SRS conference was fascinat-
ing. Please start by telling us the intent of your presentation.
Kan Koffi (KK): The intent of my presentation at the
SRS conference (Koffi, 2015) was to honor the work
done by Florence Nightingale (1820-1910) and Martha
Elizabeth Rogers (1914-1994). From the ever-present
and age-old concern for the nurturance of human
beings (SRS, 2010), the continuous effort of all nurses
is to understand human beings and environment. Both
Nightingale and Rogers made substantial and innova-
tive contributions to our understanding of human
beings and their environment. In doing so, their works
can be considered scientific revolutions in the develop-
ment of nursing as a learned discipline.
JF: What do you mean by a scientific revolution?
KK: Thomas Kuhn (1970) defined a scientific revolution
as “a special sort of change involving a certain sort of
reconstruction of group commitments” (p. 181).
Explaining the nature and the necessity of scientific
revolutions, Kuhn (1970) indicated that ‘‘scientific rev-
olutions are … episodes in which an older paradigm is
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Nursing Science Quarterly
2016, Vol. 29(3) 247­–250
© The Author(s) 2016
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DOI: 10.1177/0894318416648782
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replaced in whole or in part by [a new] one’’ (p. 92). He
regarded the rise of a scientific revolution in a disci-
pline as requiring a change of the scientists’ worldview,
explaining, “paradigm changes do cause scientists to
see the world of their research-engagement differently.
… [and] after a revolution, scientists are responding to
a different world” (Kuhn, 1970, p. 111).
JF: Kuhn (1970) maintained that scientific revolutions
disrupt what he called normal science. Please explain
what normal science is and why you regard nursing as
normal science.
KK: Kuhn (1970) explained that ‘‘normal science means
research firmly based upon one or more past scientific
achievements, achievements that some particular scien-
tific community acknowledges for a time as supplying
the foundation for its further practice” (p. 10). He
referred to these types of achievements as disciplinary
paradigms, and described a paradigm as ‘‘some accepted
examples of actual scientific practice–examples which
include law, theory, application, and instrumentation
together [that] provide [the basic framework] from
which spring particular coherent traditions of scientific
research’’ (Kuhn, 1970, p. 10) in a given discipline.
From Nightingale’s research work to Rogers’ concep-
tual and theoretical work, nursing as a profession, then a
discipline (Donaldson & Crowley, 1978/2004), pro-
ceeded that way.
1
PhD Student, University of Ottawa, Canada
2
Professor, University of Massachusetts Boston
248 Nursing Science Quarterly 29(3)
JF: Kuhn (1970) mentioned that anomalies are the cata-
lyst for scientific revolutions. Please explain what
Kuhn meant by anomalies.
KK: Within a disciplinary paradigm, anomalies are prob-
lems that cannot be solved by the prevailing paradigm.
Discovery, according to Kuhn (1970) begins when sci-
entists become aware of an anomaly. The discovery
can be accounted for only by an adjustment to the para-
digm, so that the anomaly is no longer anomalous. The
buildup of paradigmatic anomalies disrupts normal
science and, therefore, creates a scientific revolution.
JF: Thank you for explaining how normal science is dis-
rupted when anomalies begin to appear and how a sci-
entific revolution occurs when a new paradigm that
will account for the anomalies is proposed. Please tell
us why you regard Nightingale’s work and Rogers’
work as scientific revolutions.
KK: The first scientific revolution in nursing was cata-
lyzed by the dissemination of Nightingale’s works.
Her publications heralded the advent of modern nurs-
ing as a profession with its own professional knowl-
edge about safe and sanitary environments (Burns &
Grove, 1997).
The Nightingale revolution began with her recognition
of the influence of environment on health. The major anom-
aly was the death of so many soldiers during the Crimean
war, which she proposed was due to the unsanitary settings
in which wounded soldiers were treated. Her introduction
of ‘‘sanitary science through female nursing in military
hospitals by reducing the death rate of British army soldiers
from 42.7 to 2.2 per cent (1854-1855) … within six months’
time’’ (Donahue, 1996, pp. 197, 204), and the publication
of her book, Notes on Nursing: What It Is and What It Is
Not (Nightingale, 1859), became a scientific revolution.
The revolution continued with Nightingale’s establish-
ment of the first three-year independent training program
for nurses at London’s St. Thomas Hospital in 1860
(Donahue, 1996). This training program became the model
for modern nursing educational programs worldwide.
Thus, Nightingale moved nursing from the vocational era
to the professional era and became the founder of modern
nursing.
Nightingale’s focus on safe and sanitary environments,
which she documented with statistical research, represents
the first paradigmatic normal science of nursing. Her work is
the foundation for nursing research-based practice.
JF: Now, please tell us what nursing paradigmatic anom-
aly gave rise to the revolution that Rogers’ work
catalyzed.
KK: Rogers’ works catalyzed the second scientific revo-
lution in nursing. Rogers (1970) recognized that the
early nurse theorists and practicing nurses viewed the
human being as a collection of parts, and that the main
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paradigmatic anomaly in nursing was that nurses were
‘‘unable to express themselves fully in a scientific
way’’ (Phillips, 1994, p. vii). Her works allow nurses
‘‘to articulate in a succinct way [the scientific language
that they] could not [previously] express’’ (Phillips,
1994, p. vii) about their own professional activities.
A thematic analysis of Rogers’ works revealed three para-
digmatic foundations, ontology, epistemology, and method-
ology (Guba, 1990) of nursing as a normal science. I refer to
the three foundations collectively as the ontosystem of the
homeodynamic (see Figure). The ontological foundation is
the philosophy of the unitary human being. The philosophy
is based on a new worldview of the human being and the
pandimensional environment as an integrated unitary whole
(Rogers, 1992/1994; Koffi, Menin, & Andoh, 2011). The
epistemological foundation is the homeodynamic science,
the three interrelated principles of which are helicy, reso-
nancy, and integrality (Rogers, 1992/1994).
Although Rogers always rejected the idea of caring as
nursing practice, claiming that caring is not unique to nursing
or to human kind. I have labeled the methodological founda-
tion as the homeodynamic art of caring. The goal of the
homeodynamic art of caring is ‘‘to participate in the process
of change so that people may benefit’’ (Rogers, 1988, p. 101).
As can be seen in the Figure, the homeodynamic art of caring
encompasses many theories and models that I have catego-
rized into several components that update the six main schools
of thought in nursing (Kérouac, Pepin, Ducharme, Duquette,
& Major, 1994): the school of human caring, the school of
human patterns, the school of health promotion, the school of
outcomes, the school of needs, and the school of interaction.
Different theorists from different epistemologies have
elaborated the theories and models comprising the nursing
schools of thought. They serve to describe, analyse, and pre-
dict about the practical development of nursing practice.
Collectively, they are the methodological tools for the pro-
fessional practice of the homeodynamic science.
JF: In what ways are these nursing schools of thought
consistent with the homeodynamic science? I am par-
ticularly interested in how you regard the school of
interaction as consistent with the homeodynamic sci-
ence, as Rogers always contended that human beings
and environment are a unitary, integrated, coextensive
entity.
KK: The consistency of the nursing schools of thought
with the homeodynamic science derives from two
logical ways of reasoning. It derives first, by the
wideness of the philosophical foundation of the
homeodynamic science, from deductive reasoning,
and second, by dialectic reasoning. The broad scope
of the homeodynamic science allows dialectic and
alternative use of the different schools of thought and
their associated theories and models. This dialectic
Fawcett / Essays on Nursing Science 249
Figure.  The Ontosystem of the Homeodynamic: The universal conceptualization of the discipline of nursing
©2015 Kan Koffi
link of the homeodynamic science with nursing
schools of thought provides a comprehensive view of
nursing as a philosophy, a science, and a profession,
that is, normal science.
Within the homeodynamic paradigm, interaction does not
signify a relation between dichotomous parts. Instead, the nurse
is concerned with manifestations of human patterns that express
the person, family, or community’s changing wholeness.
JF: Now, please tell us, what is the outcome of the two
scientific revolutions in nursing? How have these rev-
olutions contributed, and will continue to contribute, to
the advancement of the application of nursing scien-
tific and professional knowledge to practice?
KK: The outcomes of the two scientific revolutions in
nursing have been the professionalization of nursing
that evolved from Nightingale’s work, followed by the
disciplinary and paradigmatic revolution that is repre-
sented by Rogers’ works, from which derive the phi-
losophy of the unitary human being, the homeodynamic
science, and the homeodynamic art of caring. When
the homeodynamic art is applied in professional prac-
tice, the homeodynamician (the professional nurse or
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midwife) participates knowingly in the dynamic and
innovative change of human patterns that portend the
human being’s becoming.
JF: Kan, thank you very much for sharing your interpre-
tation of Nightingale’s and Rogers’ works as nursing
scientific revolutions and their outcomes for the
discipline
KK: Thank you for this opportunity to share these few
critical ideas about nursing’s 21st century challenges
with the readers of Nursing Science Quarterly.
JF: Kan and I welcome seeing readers’ thoughts about
and interpretations of the two scientific revolutions in
nursing in future issues of Nursing Science Quarterly.
References
Burns, N., & Grove, S. K. (1997). The practice of nursing research:
Conduct, critique, and utilization (3rd ed.). Philadelphia:
Saunders.
Donahue, M. P. (1996). Nursing, the finest art: An illustrated his-
tory (2nd ed.) St Louis: Mosby-Year Book.
Donaldson, S. K., & Crowley, D. M. (2004). The discipline of nursing,
In P. G. Reed, N. C. Shearer, & L. H. Nicoll (Eds.), Perspectives
on nursing theory (4th ed., pp. 293-304). Philadelphia: Lippincott
Williams and Wilkins. Originally published 1978.
250 Nursing Science Quarterly 29(3)

Guba, E. G. (1990). The alternative paradigm dialog. In E. G. Guba
(Ed.), The paradigm dialog (pp. 17-27). London: Sage.
Kérouac, S., Pepin, I., Ducharme, F., Duquette, A., & Major, F.
(1994). La pensée infirmière. [Nursing thought]. Laval,
Quebec, Canada: Editions études vivantes.
Koffi, K. (2015, October 9). “What about the Science of Unitary
Human Being, the Second Nursing Scientific Revolution?” Paper
presented at the 2015 Society of Rogerian Scholars Conference,
“Provocative Ideas and Innovations in Unitary Nursing Science.”
Lewis University, Oak Brook Campus, Oak Brook, IL.
Koffi, K., Menin, M., & Andoh, A. T. (2011). Efficacité d’un pro-
gramme d’intégration de la vaccination dans les soins (PIVS) sur
la réduction de la fréquence des occasions de vaccination man-
quées en Côte d’Ivoire. [The efficacy of integrating vaccination
in primary health care program to prevent missed opportunities
of vaccination in Côte d’Ivoire.] Recherche en Soins Infirmiers,
September (106), 86-91.
Kuhn, T. S. (1970). The structure of scientific revolutions (2nd ed.,
enlarged). Chicago: The University of Chicago Press.
Nightingale, F. (1859). Notes on nursing: What it is and what it is
not. London: Harrison.
Phillips, J. R. (1994). Foreword. In V. M. Malinski & E. A. M.
Barrett (Eds.) Martha E. Rogers: Her life and her work
(pp. v-ix). Philadelphia: F. A. Davis.
Rogers, M. E. (1970). An introduction to the theoretical basis of
nursing, Philadelphia: F. A. Davis.
Rogers, M. E. (1988). Nursing science and art: A prospective.
Nursing Science Quarterly, 1, 99-102.
Rogers, M. E. (1994). Nursing science and the space age. In V.
M. Malinski & E. A. M. Barret (Eds.) Martha E. Rogers: Her
life and her work (pp. 256-267). Philadelphia: F. A. Davis.
Originally published 1992.
Society of Rogerian Scholars (2010). Home page. http://www.soci-
etyofrogerianscholars.org/.

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