Pensar Enfermagem / v.29 n.01 / March 2025

DOI: 10.71861/pensarenf.v29i1.344 / e00344

Theoretical Article

How to cite this article: Guimarães GL, Mendonza IYQ, Goveia VR, Ribeiro EG, Barbosa JAG, Guimarães

MO. The Kuhnian incommensurability thesis and its use in nursing for critique of the scientific fact of “skin

wound in bedridden patients”. Pensar Enf [Internet]. 2025 Mar; 29(1): e00344. Available from:

https://doi.org/10.71861/pensarenf.v29i1.344

The Kuhnian incommensurability thesis and its use

in nursing for critique of the scientific fact of “skin

wound in bedridden patients”

Abstract

Introduction

This study presents an epistemological reflection on nursing based on the philosophy of

Thomas Kuhn. The incommensurability thesis is a central element of his framework,

allowing for a critique of epistemic shifts occurring as paradigms are replaced. Nursing

scholars have identified two successive paradigms: the Empirical and the Nightingale

paradigms, the latter of which laid the foundation for the professional and scientific

development of the field. Applying the Kuhnian thesis to nursing requires selecting a

common scientific fact across paradigms. This study’s scientific fact under analysis is the

“skin wound in bedridden patients.”

Objective

To apply the incommensurability thesis to understand the concept of the

scientific fact “skin wound in bedridden patients” across paradigm traditions in nursing

during the 19th century.

Method

The following research question guided this study: How does the incommensurability thesis

influence the concept of the scientific fact “skin wound in bedridden patients” across paradigm traditions in

nursing? To comprehensively address this question, we structured the text into three

sections: (1) an overview of the key elements underpinning the Kuhnian thesis, (2) the

development of the concept of the scientific fact within the Empirical paradigm, and (3) its

development within the Nightingale paradigm, based on the text Notes on Nursing: What It

Is and What It Is Not.

Results

The concept of the scientific fact remained stable across paradigm traditions.

Conclusion

Applying the incommensurability thesis made it possible to assess that the concept of “skin

wound in bedridden patients” remained unchanged within both the Empirical and

Nightingale paradigms. This finding supports the understanding that conceptual

modifications are rare and tend to be limited to a specific type, which Kuhn termed “point

by point.” The Nightingale paradigm introduced substantive changes in patient care,

organizational structures, education, and the promotion of research practice.

Keywords

Nursing; Knowledge; Health; Research; Wounds and Injuries.

Gilberto de Lima Guimarães1

1 orcid.org/0000-0001-6027-372X

Isabel Yovana Quispe Mendoza2

orcid.org/0000-0002-7063-8611

Vania Regina Goveia3

orcid.org/0000-0003-2967-1783

Edmar Geraldo Ribeiro4

orcid.org/0000-0002-7201-9566

Jaqueline Almeida Guimarães Barbosa5

orcid.org/0000-0002-9175-0055

Mariana Oliveira Guimarães6

orcid.org/0000-0002-4934-1055

1Department of Basic Nursing, Federal University of

Minas Gerais, Belo Horizonte, Brazil.

2Department of Basic Nursing, Federal University of

Minas Gerais, Belo Horizonte, Brazil.

3Department of Basic Nursing, Federal University of

Minas Gerais, Belo Horizonte, Brazil.

4Risoleta Tolentino Neves Hospital, Federal University

of Minas Gerais, Belo Horizonte, Brazil.

5Department of Basic Nursing, Federal University of

Minas Gerais, Belo Horizonte, Brazil.

6Department of Pediatric Dentistry, São Leopoldo

Mandic Colleges, Belo Horizonte, Brazil.

Corresponding author:

Edmar Geraldo Ribeiro

E-mail: edmargribeiro@gmail.com

Received: 14 Sep 2024

Accepted: 03 Apr 2025

Editor: Florinda Galinha de Sá

Guimarães, G.

Theoretical Article

Introduction

This study presents an epistemological reflection on

nursing based on the philosophy of Thomas Kuhn. The

incommensurability thesis is a central pillar of his

framework, providing a means to evaluate epistemic

changes that occur as paradigms replace one another.

Nursing scholars have identified two successive paradigms:

the Empirical paradigm and the Nightingale paradigm, the

latter of which laid the foundation for the professional and

scientific development of the field. Moreover, nursing

adopts the term paradigm in the sense of professional

transformation, indicating the occurrence of a revolution.1-

The Empirical paradigm emphasizes the art of the

profession and technical-scientific knowledge as

fundamental to nursing care. The Nightingale paradigm

introduced a broader perspective, valuing knowing how to

do (art and management), knowing how to think (scientific

knowledge and research), and knowing how to coexist

(ethics). This paradigm shift led to substantive changes in

care practices, organizational structures, education, and the

promotion of research activity, thereby breaking away from

the Empirical paradigm. Consequently, nursing, as a

scientific discipline, must undertake an intellectual effort to

conduct an epistemic critique of its paradigmatic tradition.

This process requires the establishment of a common

scientific fact between these traditions.1-7

The incommensurability thesis is the most significant

consequence of replacing one paradigm with another. For

Kuhn, scientific revolutions are episodes of non-

cumulative scientific development in which an older

paradigm is entirely or partially replaced by a new one that

is incompatible and incommensurable with the previous

one. Applying Kuhn’s theory to nursing requires

adjustments that respect the idiosyncratic characteristics of

the discipline.1-4

Two assumptions must be accepted to accommodate the

distinct nature of nursing and, consequently, apply the

Kuhnian thesis. The first is the recognition that nursing

constitutes a scientific community. For Kuhn, science is a

collective construction, where its members establish

commitments, define shared objectives, and, through

manuals, educate future generations, thereby forming a

community. All these elements are present in nursing,

notably in its professional and scientific education, the

definition of common goals, and the formal training

process through manuals.5-11

The second assumption is the adoption of the Nightingale

paradigm. It is important to clarify Kuhn’s understanding

of the term paradigm, particularly after he revised his original

formulation in response to critiques from his peers. He

identified four constitutive elements: symbolic

generalizations, metaphysical parts, epistemic values, and

exemplars. From this perspective, these elements will be

described within the context of nursing. For the nursing

community, the Nightingale paradigm guides both

professional and scientific activities, making it possible to

identify symbolic generalizations—in Kuhnian terms, these

are expressions, terms, or formulations that members of a

scientific community use without requiring prior

explanation or justification. The Nightingale paradigm

includes terms and expressions whose meanings are

undisputed, such as health, person, environment, and

nursing.1.3,5-11

Within the Nightingale paradigm, it is also possible to

identify the metaphysical parts of the paradigm, epistemic

values, and exemplars. In Kuhn’s theory, the metaphysical

parts of the paradigm refer to the commitments accepted

by researchers that are linked to a system of beliefs.

In nursing, this can be observed from a holistic perspective,

which serves as an integrative element in education,

professional practice, and research.1,3,5-11

The epistemic values of science, identified by Kuhn as

simplicity, fecundity, internal coherence, and plausibility,

are acknowledged in nursing’s scientific production. By

exemplars, he refers to problem-solving models that students

of a given science are trained to recognize through the

education they receive from manuals, shaping their

scientific worldview. This characterization is evident in

nursing, as students have access to manuals that guide their

professional and scientific training, allowing them to

engage with the problems and solutions that define

professional practice and its existing challenges.1,3,5-11

Based on these assumptions, it was necessary to identify a

scientific fact in the literature from both the Empirical and

Nightingale paradigms, enabling a philosophical analysis

between these paradigmatic traditions. The selection

process was complex due to the scarcity of scientific

literature on nursing in the 19th century. Thus, the criterion

for identifying the scientific fact was to choose a

phenomenon of interest to both paradigms in clinical

practice and education contexts. As a result, the scientific

fact “skin wound in bedridden patients” was

established”.1,2,12-17

The justification and relevance of this study lie in the

premise that nursing, as a science in the process of

becoming, must shed light on its paradigmatic tradition.

This effort enables the field to understand the process of

its construction and, consequently, to either rectify or

reaffirm the direction it currently follows.

This study aimed to apply the incommensurability thesis to

understand the concept of the scientific fact “skin wound

in bedridden patients” throughout the 19th century within

different paradigmatic traditions in nursing.

Method

The following research question guides this study: How does

the incommensurability thesis influence the concept of the scientific fact

“skin wound in bedridden patients” across paradigm traditions in

nursing? To comprehensively address this question, the text

is structured into three sections. The first section presents

the key elements that underpin the Kuhnian thesis. The

Pensar Enfermagem / v.29 n.01 / March 2025

DOI: 10.71861/pensarenf.v29i1.344 / e00344

Theoretical Article

second develops the concept of the scientific fact “skin

wound in bedridden patients” within the Empirical

paradigm. Finally, the third section examines the concept

of this fact within the Nightingale paradigm, based on the

text Notes on Nursing: What It Is and What It Is Not.1,3

Development

Key elements underpinning the incommensurability thesis

Kuhn draws on the political meaning of the term revolution

to illustrate the rupture between the old and the new,

thereby supporting the incommensurability thesis. To this

end, he examined various scientific works and, through

them, identified the radical transformations within the

scientific community, demonstrating how these shifts led

to changes in thought and in the practice of science.

According to Kuhn, a scientific revolution begins when

there is a growing perception that the prevailing paradigm

no longer provides satisfactory answers to the questions

posed. At this point, researchers develop an internal

awareness of the paradigm’s shortcomings.3,5,6,10,18-21

Kuhn notes that observers external to the scientific

community often perceive no significant changes

occurring. However, among scientists dissatisfied with the

prevailing paradigm, a rupture becomes evident as the

emerging research problems differ from those of the

previous paradigm. Once deemed inadequate, scientific

works begin to demand and establish a new approach to

scientific inquiry.3,5,6,10,18-21

For Kuhn, this is not merely an assessment of the methods

or techniques accepted by a given scientific community but

rather an insurrection against the prevailing paradigm that

guides normal science. It is not uncommon for groups

engaged in scientific debate to simultaneously employ

arguments rooted in both the current and emerging

paradigms. However, this debate serves only to persuade

and gain support for the new paradigm.3,5,6,10,18-21

Kuhn aims to convince critics to acknowledge the

discontinuity between the current and the revolutionary

paradigm, thereby reinforcing the validity of his argument

in favor of the incommensurability thesis. He challenges

the notion that science progresses through sequential

growth and development as the sole means of expanding

scientific knowledge. If accepted, this premise would

substantiate the thesis of a rupture between paradigms. To

support his reasoning, Kuhn poses a key question: Is there

an intrinsic reason why assimilating a new type of phenomenon or a

new scientific theory requires the rejection of older paradigms?3

Some argue that the solution to a scientific problem could

emerge without destroying previous scientific practice, as it

might simply address previously unknown situations.

Alternatively, a new theory could provide an explanation

that, while novel, does not significantly alter the paradigm

but rather represents an update. If these possibilities were

accepted, the growth and development of scientific

knowledge would be strictly cumulative and linear. For

Kuhn, despite the apparent reasonableness of this model of

scientific progress, historical evidence suggests otherwise,

as the end of a paradigm period leads to a new theory that

compels researchers to generate new knowledge.3,5,6,10,18-21

It is important to clarify that Kuhn does not claim that

cumulative and linear growth does not exist. Instead, he

presents a philosophical critique of this model, highlighting

its limitations and weaknesses. He acknowledges that

during the period of normal science, knowledge production

is predominantly cumulative, which in turn makes it

difficult for scientists to recognize that this is not the only

mode of scientific development.3,5,6,10,18-21

Furthermore, Kuhn raises another question: How can new

scientific knowledge emerge if everything is so rigid? According to

him, a discovery can only arise when prior expectations

about the nature of a phenomenon and the scientist’s

instruments prove incorrect. Thus, new knowledge

emerges from anomalies found within a paradigm, as these

anomalies drive researchers to seek solutions that are not

accounted for in the traditional paradigm. As a result, the

researcher turns to developing new concepts, methods,

instruments, and techniques.3,5

According to Kuhn, three conditions lead to the emergence

of a new theory. The first is the exhaustion of the existing

paradigm’s ability to analyze phenomena. However, its

transformative power is limited, as exhaustion alone is

insufficient to justify researchers abandoning a paradigm.

The second condition involves a phenomenon whose

essence is identified by the paradigm but whose details can

only be refined through the broader articulation of the

theory. Although this is the researcher’s primary focus, this

type of investigation aims to further delineate the paradigm

rather than generate something new. When investigative

dissatisfaction persists and the possibilities for

accommodation are exhausted, the researcher encounters

the third condition that leads to paradigm disruption—the

anomaly. This anomaly cannot be explained within the

framework of the existing paradigm, and consequently,

only the anomaly itself has the intrinsic power to generate

something new. Kuhn asserts that new theories emerge to

address anomalies, meaning that a successful theory must

allow for predictions that differ from those derived from

its predecessor. If the theories were logically compatible,

such differences would not occur 3,5

In this way, Kuhn establishes a critique of the notion that

scientific development is exclusively linear and cumulative.

He highlights historical evidence supporting this

perspective and presents a position opposing the idea of

strict logical plausibility. For example, he refers to the

historical comparison between Newtonian and Einsteinian

theories. While they use identical terms, these terms do not

retain the same meaning, as they are embedded in distinct

theoretical frameworks that represent different realities.

Thus, the differences between successive paradigms over

time are both necessary and irreconcilable. A new theory

introduces new problems, which in turn require new

Guimarães, G.

Theoretical Article

strategies, solutions, and methodological tools, further

distinguishing it from its predecessor. Consequently, the

science that emerges from a scientific revolution is

incompatible and incommensurable with the science that

preceded it.3,5,10,18-21

After facing strong criticism from Karl Popper and Imre

Lakatos, Kuhn sought to clarify his argument regarding the

incommensurability thesis, particularly in his essay What

Are Scientific Revolutions?. In this text, Kuhn differentiates

between two types of scientific development: cumulative

and linear progress and revolutionary progress. He argues

that the majority of scientific research results from the

former, as normal science builds knowledge by adding to

the existing body of scientific understanding, making

cumulative progress the most common conception of

scientific advancement.5

However, Kuhn also points out that scientific development

can occur in a non-cumulative and non-linear manner,

allowing historians of science to identify distinctive clues

indicative of a revolutionary form of knowledge

development. This revolutionary process involves

discoveries that cannot be accommodated within the

conceptual boundaries of previously accepted theories. To

make or assimilate such discoveries, altering how

phenomena are conceptualized and described

becomes necessary.5

Kuhn highlights a scientific discovery of a revolutionary

nature—Newton’s Second Law of Motion. In this law, the

concepts of force and mass differ from those previously in

use before its introduction. He emphasizes that a change in

the way of thinking occurs, expressed through a new

meaning assigned to these terms. With this example, Kuhn

demonstrates that the development of scientific knowledge

cannot be exclusively cumulative, as it is impossible to

transition from the old to the new merely by adding to pre-

existing knowledge. Naturally, this does not mean that no

terms retain their original meaning, allowing for

communication among practitioners of a given paradigm.

Rather, Kuhn argues that the semantic understanding of

terms—when modified by a new theory—causes their

usage to differ between paradigms. He designates this

process as point-by-point translation, which he considers

the foundation of incommensurability.3,5,10

In alignment with the previously discussed elements of the

incommensurability thesis, certain approximations must be

made to understand the scientific fact “skin wound in

bedridden patients” across paradigm traditions, given that

Kuhn primarily focused on analyzing scientific theories

within the field of physics.3

Three key assertions can be made to address the research

question posed in this study: (1) every paradigm possesses

an epistemological identity, meaning it exhibits distinct

characteristics; (2) the scientific knowledge within a

paradigm is linked to the belief that its framework is

operational, though philosophical shifts may be underway;

and (3) the development of a paradigm dictates a specific

mode of action for researchers. In nursing, both the

Empirical paradigm and the Nightingale paradigm adhere

to the first two assumptions (1 and 2), defining professional

practice in care and education. However, only the

Nightingale paradigm actively promotes knowledge

production in the field (3). With this distinction established,

the next step is to examine the concept of “skin wound in

bedridden patients” within the Empirical paradigm.

The concept of the scientific fact “skin wound in bedridden patients”

in the Empirical paradigm

Before proceeding, it is important to recognize that, from

a historical perspective, the scientific fact “skin wound in

bedridden patients” has undergone various classifications

and terminological changes before reaching its

contemporary designation as pressure injury. However, in

the teaching of both the science and art of nursing in the

19th century, this condition was referred to as eschar or

decubitus ulcer. This section seeks to comprehensively

examine this fact.1,2,15-17,22

The term eschar or decubitus ulcer emerged within the

Empirical paradigm and was used to describe a type of

wound that develops on the skin of bedridden patients. In

this study, the term bedridden is assumed synonymous with

immobility in bed, as this nomenclature reflects the

prevailing scientific thought of the 19th century. The term

was introduced by the French physician Jean-Martin

Charcot, who worked at the Salpêtrière women’s asylum.

Charcot observed and described a type of wound found on

the skin of hospitalized, bedridden patients with spinal cord

injuries, designating it decubitus eschar. This nomenclature

appears in his book Lectures on Diseases of the Nervous System,

published in 1877.16

Charcot’s initial concerns regarding skin wounds in patients

with spinal cord injuries date back to 1868. In response to

this observed phenomenon, and based on a cause-and-

effect relationship, he formulated an explanation by

associating this type of wound with trophic alterations that

affected tissue nutrition. In his theorization, the wound

resulted from an interruption in the supply of nutrients to

the nerves, leading to what became known as Charcot’s

Neurotrophic Theory. In describing the wound that

developed on the skin of hospitalized and bedridden

patients, he noted that its progression followed a pattern of

ulceration, eventually leading to deep necrosis in the sacral

region. According to Charcot, localized pressure was not

the primary cause of its development.15-17,22

Charcot considered the development of decubitus eschar

to be slow, progressive, and asymptomatic. His theory

differentiated between skin wounds based on their

pathophysiological origins, categorizing them into passive

lesions (resulting from functional inactivity) and trophic

disturbances secondary to acute nervous system injuries. In

this classification, he identified three distinct types of

lesions based on their onset: decubitus ominosus (wounds

appearing on the buttocks before the patient’s death), acute

decubitus (wounds appearing after a neurological injury,

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correlating the location of skin damage with the affected

nerve), and chronic decubitus (wounds developing in the skin

of inactive patients).15-17,22

The widespread dissemination of Charcot’s Neurotrophic

Theory within the scientific community sparked intense

debate. It is well established that scientific progress occurs

through the confrontation of ideas among scholars,

facilitating the refinement of existing knowledge, the

formulation of theories, and the identification of evidence

to support or refute explanations. Such a dynamic was

evident in the historical debate in health sciences involving

Eduard Brown-Séquard, a neurophysiologist and

prominent critic of Charcot’s Neurotrophic Theory.3-5,10,15-

17,22

In his experimental studies involving animals,

Brown-Séquard asserted that when the spinal cord of a test

subject was severed, no ulceration occurred as long as

preventive measures were implemented, such as daily skin

hygiene, keeping the area dry, and ensuring it was free from

bodily waste. Furthermore, he observed that in cases where

ulceration did develop, the wound could be healed by

relieving compression and maintaining the aforementioned

preventive actions. Based on these experiments, Brown-

Séquard concluded that skin ulceration in paraplegic

patients was not a direct consequence of paralysis.15-17,22

Brown-Séquard’s work focused on identifying preventive

actions to avoid the emergence of skin wounds, whereas

Charcot’s theory rejected the possibility of prevention.

According to Charcot, decubitus eschar was an inevitable

outcome of a slow, gradual, and irreversible process of

nerve degeneration.15-17,22

In 1873, the English surgeon and pathologist James Paget,

in his article Clinical Lectures on Bedsore, contributed to the

debate by proposing that pressure on the skin could be a

causal factor in developing these wounds. He argued that if

the affected area was not kept clean and free from bodily

waste, the skin wound would progress rapidly, particularly

in bony prominences, most notably the calcaneus, hip, and

sacral region.15-17,22

Amid this scientific debate, nursing was developing its

practical care approach, blending traditional and modern

practices in caring for hospitalized, bedridden patients with

skin wounds. Because nursing was practiced within the

hospital setting, it played a fundamental role in

transforming hospitals into therapeutic environments.

Among the key aspects of nursing practice at the time were

patient nutrition, personal hygiene, and comfort.15-17,22

Within the Empirical paradigm, nurses were educated

through manuals written by physicians. In normal science,

scientific findings are disseminated through manuals,

fostering unity within the scientific community, essential

for building a body of scientific knowledge and transmitting

it to new members. In the context of nursing practice, these

manuals provided nurses with guidelines for action and

justification for their practical knowledge.15-17,22

Hospital medicine recognized that hospitals could not fully

evolve into therapeutic spaces without improving nurses’

intellectual training. This growing relationship between

medicine and nursing allowed nurses access to scientific

discoveries and theoretical developments, such as cell

theory, microbiology, and the conceptual debate between

Charcot and James Paget on decubitus eschar.15-17,22

In this context, nursing established a curriculum that

included subjects such as anatomy, hygiene, preparation

and administration of medications, and theoretical and

practical training in patient care. Within the Empirical

paradigm, nurses were responsible for treating decubitus

eschar, with their interventions including washing, covering

with gauze, cauterization, and removal of devitalized

tissue.15-17,22

The debates among Charcot, Paget, and Brown-Séquard

regarding this topic reflect what Kuhn identified as the

most common mode of scientific development and

progress—the cumulative and linear model, which enables

the construction of scientific knowledge. In this model, the

various contributions of researchers help assemble the

“puzzle” of knowledge, thereby structuring scientific

understanding and providing answers to the problems

posed. Within this development mode, participants analyze

the phenomenon—skin wound in bedridden patients—

from a specific perspective that defines its scope. This

allows for establishing cause-and-effect relationships,

identifying characteristics, and proposing solutions,

whether in the form of treatment or prevention.15-17,22,23

Given these considerations, within the Empirical paradigm,

the concept of decubitus eschar refers to a type of wound that

develops on the skin of bedridden patients, particularly in

the sacral region (buttocks), hip joint, and calcaneus (heel).

It is characterized by significant tissue damage below the

epidermis, which is aggravated by external factors, such as

the presence of bodily waste in the wound.

The concept of the scientific fact “skin wound in bedridden patients”

in the Nightingale paradigm

It is acknowledged that the “world” envisioned by Florence

Nightingale differs from the “world” of the Empirical

paradigm. Her worldview enabled her to recognize a

phenomenon that had previously gone unnoticed,

particularly regarding nursing practice and its three

dimensions: knowing how to act (practical knowledge),

knowing how to think (scientific reasoning), and knowing

how to interact (ethical conduct).1,4

According to Hoyningen-Huene, when a member of a

scientific community adopts a new paradigm, their

worldview is altered, leading them to perceive the

environment in which they work in a completely different

way. In this sense, Florence Nightingale was immersed in a

new worldview, undergoing a philosophical transformation

that enabled her to approach scientific knowledge of

nursing practice (the phenomenal world) from a new

perspective. This shift had a profound impact on her

Guimarães, G.

Theoretical Article

professional practice. Her revisited world allowed her to

identify the professional and scientific transformation she

introduced into nursing through epidemiological methods.

This enabled her to conduct quantitative assessments of the

health-disease relationship and the causal connection

between nursing care and decubitus eschar.4,10

Florence Nightingale introduced into nursing practice an

element that had never before been applied to patient care:

observation guided by the scientific method. Through this

approach, she sought to identify cause-and-effect

relationships in the health-disease process by recognizing

signs and symptoms.1,3,4,10

In scientific rationality, systematic observation corresponds

to the data collection stage of an investigation. It is well

known that this is the starting point of the research process.

In professional nursing practice, the nurse initiates the

nursing process through this type of observation.

According to Florence Nightingale, a scientifically trained

nurse can recognize and distinguish between different

illnesses, such as the various types of eruptions caused by

fevers or measles, along with their prodromal signs and

symptoms. This observational ability results from

systematic training, which stems from scientific rationality

and enables nurses to differentiate physiological

manifestations from pathological conditions in the human

body. Consequently, nurses become skilled in assessing the

skin’s condition, whether it appears dry or perspiring. By

conducting a rigorous study of the patient’s reactions—a

process essential for identifying cause-and-effect

relationships—the nurse can assess the patient’s health

condition with scientific critical thinking. This allows the

nurse to develop the necessary knowledge about the

patient and perform lucid, well-reasoned professional

actions.1,3,4,10,16.23

Florence Nightingale identified the relationship between

biological and physical factors and the occurrence of

decubitus eschar, as well as the nurse’s role in its

prevention. In her view, the development of decubitus

eschar was directly linked to insufficient nursing care

provided to the patient. The occurrence of such wounds

carried a negative connotation, as it was regarded as a

failure in nursing care. According to Nightingale, if a

patient feels cold, develops a fever, experiences fainting

spells, feels unwell after meals, or presents with decubitus

eschar, these conditions are generally not due to the illness

itself but rather to inadequate nursing care.1,3,4,10,16,23

Although the etiology of skin injuries is now better

understood, nurses remain responsible for preventing these

wounds, requiring specialized knowledge for early

identification and implementation of preventive measures.

It is widely recognized that skin care is a central aspect of

nursing practice within the Nightingale paradigm.1,3,4,10,16,23

Florence Nightingale was convinced that preventing

decubitus eschar depended on the nurse’s ability to

thoroughly assess the patient’s skin condition, particularly

in individuals who were bedridden and unconscious. By the

time of her work, the studies of Charcot and Paget were

already circulating, and the term decubitus eschar was being

used to describe this type of skin injury. During her

experience in the Crimean War, Nightingale had access to

soldiers with various types of wounds, including those with

gunshot-related traumatic brain injuries who were

unconscious. It is well established that unconscious and

immobilized patients, especially when affected by

additional risk factors, have an increased likelihood of

developing decubitus eschar. Given this, it can be inferred

that Nightingale recognized two fundamental elements of

the concept of decubitus eschar within the Empirical

paradigm: skin integrity loss and prolonged immobility in

bed.1-4,16-23

Additionally, Florence Nightingale understood that

improperly maintained or poorly adjusted bed linens could

cause skin wounds in bedridden patients, particularly in

areas of bony prominence. In this regard, maintaining an

appropriate standard of hygiene was a primary objective of

nursing care, as skin contact with fecal or urinary residue

exposed the patient to both physical and microbiological

harm. According to Nightingale, maintaining patient

hygiene was essential for recovery and the prevention of

decubitus eschar. Based on this reasoning, a third defining

element of decubitus eschar, common to both the

Empirical paradigm and Nightingale’s thought, can be

identified: the formation of a wound in an area of bony

prominence in bedridden patients.1-4

Thus, within the Nightingale paradigm in the 19th century,

the concept of decubitus eschar referred to a type of wound

affecting bedridden patients who had partially or

completely lost their ability to move independently, with its

appearance localized in areas of bony prominence. It is

evident that the conceptual elements identified by Florence

Nightingale were the same as those found in the Empirical

paradigm.

Conclusion

Kuhn’s incommensurability thesis revealed that the

concept of the scientific fact “skin wound in bedridden

patients” remained unchanged, reinforcing the proposition

that conceptual modifications are a rare phenomenon,

typically limited to a process that Kuhn termed point by point.

The paradigm shift in nursing led to a transformation in

both the science and the art of the profession. The

Nightingale paradigm introduced a new way of thinking,

acting, and engaging, thereby establishing a decisive break

from the Empirical paradigm, fundamentally altering

clinical care, professional organization, education, and

research practices. It is assessed that the dimension of

scientific reasoning (knowing how to think) allowed

nursing to engage with the scientific advances and debates

of the late 19th century. Kuhn’s thesis proves to be a

valuable tool for the epistemological critique of nursing,

particularly in analyzing the transition between the

Empirical and Nightingale paradigms. It is believed that, in

the event of a future rupture of the currently dominant

Pensar Enfermagem / v.29 n.01 / March 2025

DOI: 10.71861/pensarenf.v29i1.344 / e00344

Theoretical Article

Nightingale paradigm, identifying a new scientific fact

could indicate the occurrence of point-by-point

conceptual modifications.

Authorship

Guimarães GL: Conception and design of the study; Writing

the manuscript; Critical revision of the manuscript;

Approval of the final version of the manuscript and taking

responsibility for it;

Mendonza IYQ: Conception and design of the study;

Writing the manuscript; Critical revision of the manuscript;

Approval of the final version of the manuscript and taking

responsibility for it;

Goveia VR: Conception and design of the study; Writing the

manuscript; Critical revision of the manuscript; Approval of

the final version of the manuscript and taking responsibility

for it;

Ribeiro EG: Conception and design of the study; Writing

the manuscript; Critical revision of the manuscript;

Approval of the final version of the manuscript and taking

responsibility for it;

Barbosa JAG: Conception and design of the study; Writing

the manuscript; Critical revision of the manuscript;

Approval of the final version of the manuscript and taking

responsibility for it;

Guimarães MO: Conception and design of the study;

Writing the manuscript; Critical revision of the manuscript;

Approval of the final version of the manuscript and taking

responsibility for it.

Conflicts of interest and Funding

No conflicts of interest have been declared by the authors

Sources of support / Financing

The study was not funded.

Bibliography

1.Nightingale F. Notas da Enfermagem – o que é e o que

não é. São Paulo: Cortez; 1989.

2. Aperibense PGGS, Silva ATMF. Nightingale

Nightingale como tema no ensino de história da

enfermagem. Hist enferm Rev eletrônica [Internet]. 2020;

[cited July 18, 2024] 11(Esp.):15-27. Available from:

http://dx.doi.org/10.1590/0034-7167-2017-0691.

3. Kuhn TS. A Estrutura das Revoluções Científicas. 12a.

São Paulo: Perspectiva; 2013.

4. Sandvik AH, Hilli Y. Understanding and formation: A

process of becoming a nurse. Nursing Philosophy

[Internet]. 2023; [cited July 18, 2024] 24:12387. Available

from: https://doi.org/10.1111/nup.12387

5. Kuhn TS. Capítulo 10: Comensurabilidade,

comparatibilidade, comunicabilidade. In Kuhn TS. O

caminho desde a Estrutura. 2ª ed. São Paulo: Editora

Unesp; 2017. p.47-76

6. Kuhn TS. Reflexões sobre os meus críticos. In: Kuhn TS.

Acrítica e o desenvolvimento do conhecimento. Quarto

volume das atas do Colóquio Internacional sobre Filosofia

da Ciência, realizado em Londres em 1965. Tradução

doctávio Mendes Cajado. São Paulo: Cultrix; 1979. p.109-

243

7. Lakatos I. História de la Ciencia y sus reconstrociones

racionales. Madrid: Editora Tecnos; 1987.

8. Laudan L. Sciense and Values: The aims of Sciense and

their role in the scientific debate. Berkeley: University of

California Press; 1994.

9. Gattei S. Thomas Kuhn’s linguistic turn, and the legacy

of logical empirismo: incommensurability, rationality and

the search for truth. USA: Ashgate Publishing Limited;

2008.

10. Hoyningen-Huene P. Reconstructing Scientific

Revolutions: Thomas S. Kuhn’s Philosophy of Science.

Chicago: University of Chicago Press; 1993.

11. Kitcher P. The advacement of Sciense: sciense whithout

legend, objetivity without ilusions. New York: Oxford

University Press; 1993.

12. Lee HK, Jeong HS. Effectiveness of Flaps Controlling

Inflammation for Severe Pressure Sores in Older Patients

with Multiple Comorbidities. J Wound Manag Res

[Internet]. 2020 [cited July 18, 2024] Jun;16(2):88-93.

Available from:

https://doi.org/10.22467/jwmr.2020.01025

13. European Pressure Ulcer Advisory Panel, National

Pressure Injury Advisory Panel and Pan Pacific Pressure

Injury Alliance. Prevention and Treatment of Pressure

Ulcers/Injuries: Clinical Practice Guideline. The

International Guideline. Emily Haesler (Ed.).

EPUAP/NPIAP/PPPIA: 2019 [cited July 19, 2024].

Available from:

https://doi.org/10.1016/j.jtv.2019.01.001

14. García-Fernández FP, Rodríguez-Palma M, Soldevilla-

Agreda, J, Verdú-Soriano J, Pancorbo-Hidalgo PL. Modelo

teórico y marcos conceptuales de las lesiones por presión y

otras heridas crónicas. Historia y desarrollo. Gerokomos

[Internet]. 2022; [cited July 18, 2024] 33(2):105-110.

Available from:

https://scielo.isciii.es/pdf/geroko/v33n2/1134-928X-

geroko-33-02-105.pdf

15. Jin S, Burm CE, Park J. Consistent Reconstruction of

Sacrococcygeal Pressure Ulcers using Modification of En

Bloc Sliding Gluteus Maximus Myocutaneous Flap

Technique. J Wound Manag Res [Internet]. 2024 Fev; [cited

July 18, 2024] 20(1):46-54. Available from:

https://doi.org/10.22467/jwmr.2023.02838

16. Torra-Bou JE, Verdú-Soriano J, Sarabia-Lavin R, Paras-

Bravo P, Soldevilla-Ágreda JJ, López-Casanova P, García-

Fernández F. Una contribución al conocimiento del

Guimarães, G.

Theoretical Article

contexto histórico de las úlceras por presión. Gerokomos

[Internet]. 2017; [cited July 18, 2024] 28(3):151-157.

Available from:

https://scielo.isciii.es/pdf/geroko/v28n3/1134-928X-

geroko-28-03-00151.pdf

17. Park KH, Baek K, Kim M. Prospective, Randomized,

Non-inferiority Trial to Compare the Efficacy of 3%

Povidone-Iodine Foam Dressing and Silver Foam Dressing

in the Treatment of Pressure Injuries. J Wound Manag Res

[Internet]. 2023 Fev; [cited July 18, 2024] ;19(1):13-20.

Available from:

https://doi.org/10.22467/jwmr.2023.02376

18. Wiggers E, Donoso MTV. Discorrendo sobre os

períodos pré e pós Nightingale Nightingale: a enfermagem

e sua historicidade. Enferm Foco [Internet]. 2020; [cited

July 18, 2024]; 11(1): 58-61. Available from:

https://doi.org/10.21675/2357-

707X.2020.v11.n1.ESP.3567

19. Lipscomb M. Nursing’s professional character: A

chimera? Nursing Philosophy [Internet]. 2024; [cited July

18, 2024]; 25:12477. Available from:

https://doi.org/10.1111/nup.12477

20. Pearson MR, Egglestone S, Winship G. The biological

paradigm of psychosis in crisis: A Kuhnian analysis.

Nursing Philosophy [Internet]. 2023; [cited July 18, 2024];

24:12418. Available from:

https://doi.org/10.1111/nup.12418

21. Sankey H. The incommensurability thesis. 1st edition.

USA: Routledge; 1994.

22. Kwon R, Rendon J, Janis JE. Pressure sores. Plastic

Surgery. 4 ed. New York: Elsevier; 2018.

23. Karlsson M, Pennbrant S. Ideas of caring in nursing

practice. Nurs Philosophy [Internet]. 2020; [cited July 18,

2024]; 21:12325. Available from:

https://doi.org/10.1111/nup.12325Study limitations