Concept Analysis in Nursing

A New Approach

John Paley

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367149680
• eBook ISBN: 9780429620423
• Topic: Medicine
• Subtopic: Health Care Delivery

Concept analysis is an established genre of inquiry in nursing, introduced in the 1970s. Currently, over 100 concept studies are published annually, yet the methods used within this field have rarely been questioned. In Concept Analysis in Nursing: A New Approach, Paley provides a critical analysis of the philosophical assumptions that underpin nursing's concept analysis methods. He argues, provocatively, that there are no such things as concepts, as traditionally conceived.

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 new approach, 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 argues that 'moral distress' is not the name of a mental state, but a normative classification used to bolster a narrative concerning nursing's identity.

Concept Analysis in Nursing is a fresh and challenging book written by a philosopher interested in nursing. It will appeal to researchers and postgraduate students in the areas of nursing, health, philosophy and linguistics. It will also interest those familiar with the author's previous book, Phenomenology as Qualitative Research.

1 Aims, methods, conventions

What sort of thing is a concept? What are people referring to when they use the word ‘concept’? What does it mean to say that Jones doesn’t understand the concept of risk, or that Andrew Jameton introduced the concept of moral distress, or that Ford’s Model T was a revolutionary concept in automobiles, or that children acquire the concept of false belief by the time they are four to five years old, or that in the 1940s early ambulation was a whole new concept in postpartum care? If we acquire, or have, or possess a concept, what sort of having is that, and what exactly is it that comes into our possession? Is a concept a mental item, an ability, or an abstract entity of some kind?

I think the first of these questions takes us down a cul-de-sac. Ask what sort of thing a concept is, and you are already committed (a) to the assumption that it is something, and (b) to the project of trying to determine its nature. The important question – ‘Is there, in fact, any such thing?’ – has been answered by default. I would rather ask: ‘How do we use the word “concept”? What does using the word permit us to do that is useful?’

1.1 Two aims

My first aim is to make the following claim more plausible than it will seem now:

The word ‘concept’ is extremely useful, to the point of being indispensable. Nevertheless, the word doesn’t name anything. In soundbite terms, ‘there are no such things as concepts’.

Humour me. Suppose, just for a minute, that this claim is true. In that case, there can be no such thing as concept analysis, since there is nothing to analyse. However, there might be an alternative that scratches the same itch. This alternative would not be an analysis of ‘concepts’. Instead, it would be an investigation of interesting words and expressions. In nursing, rather than ‘analysing the concept of hope’, we could explore different uses of the word ‘hope’ – as a noun, as a verb – and the different functions it can have in a range of grammatical constructions: positive statements, negative statements, first-person uses, third-person uses, with or without ellipsis and so on. (This is not at all the same thing as doing concept analysis, as will become clear.)

My second aim is to illustrate this alternative with two case studies.

1.2 Two expressions

The expressions chosen for the case studies are of interest for different reasons. ‘Hope’ is a common-or-garden term which has come to have clinical significance. There is now a sizeable literature on hope in health care. ‘Moral distress’, in contrast, is an invented phrase, coined in 1984. The ‘concept’ of moral distress has been the subject of intensive academic discussion in nursing and, more recently, other health care disciplines.

In summary: 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 explores the uses of ‘hope’ and ‘moral distress’, as an example of a different approach.

1.3 Summary of the argument in Part I

The claim that ‘there are no such things as concepts’ seems massively implausible, so throughout the first half of the book, I’ll have to beg the reader’s indulgence, particularly as the discussion draws on material which, for some people, will be unfamiliar. I don’t think this material is intrinsically difficult, but its unfamiliarity may require a bit of patience.

Here is a single-paragraph summary of the argument in Part I:

Concepts are usually treated as if they were objects of some kind, whether abstract entities or mental items. They are said to have structures, boundaries, components and attributes. They are, supposedly, the constituents of thoughts and the building blocks of theory. Part I argues that, although ‘concept’ is an indispensable word, there are no such things as concepts in this familiar sense. Concepts are neither abstract objects nor mental states. The word ‘concept’ is invaluable, for reasons I explain, but it doesn’t name anything.

And now a brief chapter-by-chapter summary:

1. [2] We generally think of ‘the concept of hope’ (for example) as a singular something which underlies the various uses of the word ‘hope’. ‘Hope’ expresses the same concept whenever it is used, irrespective of the grammatical construction it appears in. This is a familiar picture of the relation between words and concepts. In this chapter, I outline an alternative picture. The function of the word ‘hope’ varies with the constructions it occurs in; and the expression ‘the concept of hope’ is just a way of referring (vaguely) to the overall pattern of usage.
2. [3] We assume that nouns are naming words, and the assumption is more deeply entrenched than we realise. ‘Concept’ is a noun, so it must name something. However, this chapter shows that many nouns don’t name anything at all, even if they are extremely useful; and some nouns don’t always name things, even if they sometimes do. The non-naming functions of nouns – or any other type of word – vary with the linguistic context in which they appear.
3. [4] One important non-naming function of nouns is this: to refer to something without naming it, or (more often) to refer to a domain of things without naming, identifying or describing any of the items in that domain. This function is most visible in words such as ‘things’ and ‘stuff’; but other nouns also perform this function in certain linguistic contexts. These contexts include anaphoric reference and some types of metonymy. (Terms such as these are explained in the Glossary, and more fully when we get to the relevant chapters.)
4. [5] The expression ‘the concept of X’ has this referring-without-naming function. It enables us to refer to a large, ill-defined, diverse domain of things – how X is understood, thought about, discussed; how the word ‘X’ is used, and with what purpose; how Xs are identified; and so on – without identifying, or needing to identify, any of those things. Concept possession is explained in a similar way, with a further observation: if someone ‘has the concept of X’, it does not follow that there is ‘something that she has’. Many idiomatic uses of the verb ‘to have’ are such that, if someone ‘has an X’, there is no ‘X’ that she possesses.
5. [6] We generally assume that there must be concepts. In this chapter, I consider two ‘indispensability arguments’: there must be concepts because, if there were not: (a) we could not categorise things, could not have beliefs and could not make judgments; (b) there would be nothing to serve as the constituents of thoughts or propositions. I show why, given the preceding discussion, these arguments do not have any traction.
6. [7] ‘The concept of X’ is not a singular something which explains the various uses of ‘X’. It is rather an expression which permits us to refer, in vague terms, to the pattern of usage associated with ‘X’. So ‘concept analysis’ – if it is supposed to lead to a ‘definition’, or a list of the concept’s structure and attributes – is a non-starter. The alternative is to explore the uses of ‘X’, bearing in mind that the same word can have many different uses, and that its function varies with the grammatical constructions in which it occurs. This approach combines Wittgenstein’s methods with something called Construction Grammar. (I introduce the latter in Section 2.4; see also the Glossary.)

There will be several things here that seem, in varying degrees, unclear, too vague or obviously wrong. That’s the price of an ultra-short summary. However, I hope this overview gives a general indication of the direction of travel.

1.4 The hypothetical reader

One way in which I try to make the reading, especially in Part I, more user-friendly is to have occasional conversations with someone called Reader. This figure is obviously hypothetical, though what she says is based on conversations I’ve had with friends and colleagues. They occur where I have a suspicion about what the (real) reader might be thinking. The conversations are also an opportunity for a change of style. They are as informal as I can make them, and sometimes report what was in fact said by someone eager to explain to me why I was wrong.

For example, I’ve suggested that: ‘there are no such things as concepts’. A familiar reaction to this claim is something like:

Reader: No, that’s ridiculous. We talk about concepts all the time. How can there not be any?

Me: If we want to prove the existence of something, is it enough to point out that we use the corresponding word all the time? For example, we use the word ‘if’ all the time. Does that prove that ‘ifs’ exist?

Reader: ‘If’ isn’t a noun. Obviously ‘ifs’ don’t exist. ‘If’ isn’t that kind of word. Stick to nouns. ‘Concept’ is a noun.

Me: ‘Unicorn’, then. That’s a noun. But the fact that we use it, and understand it, doesn’t prove unicorns exist.

Reader: Oh, come on! Everyone knows that unicorns are mythical. But you can’t say everyone knows concepts are mythical.

Me: No, I can’t. But we’re discussing a particular argument: ‘We use the word “X”, therefore Xs must exist’. All I’m saying is: this argument, on its own, doesn’t work.

1.5 Style of argument

There’s a remark of Wittgenstein’s that I really like: ‘Philosophy is like trying to open a safe with a combination lock: each little adjustment of the dials seems to achieve nothing, only when everything is in place does the door open’ (Wittgenstein 1981: Ch. 6). I originally found this cited in Millikan (2017: 10), and it struck me as a neat summary of my experience in writing the book. I suspect that it will also reflect the experience of reading it (Part I, anyway). One-paragraph summaries may be useful, but there is a fair amount of detail in every chapter because I try to cover ...

Table of contents

• Cover
• Half-Title
• Series
• Title
• Copyright
• Contents
• List of figures
• Preface and acknowledgements
• Glossary
• 1 Aims, methods, conventions
• PART I Concepts
• PART II Words
• Index