Clinical epistemology: a dialectic of nursing assessment.

Clinical assessment in nursing combines general knowledge from theory and research with particular knowledge about a client. A philosophical account of this synthesis is required to elucidate the paradox of knowledge that is both general and particular. The approach developed here is a dialectical model of clinical knowledge that culminates in existential safety rather than epistemic certainty. In the model, nursing assessment is the progression from subjective vulnerability through levels of objectivity (disengagement, reduction, holism) to an intersubjectivity in which nurse and client express their combined understanding in a relational narrative. The discussion concludes with reflection on the role of theory in a dialectically complete clinical narrative.