In the July/September 2014 issue of the Journal of Forensic Nursing, Ms. Julie Valentine's article, "Why We Do What We Do: A Theoretical Evaluation of the integrated practice model for Forensic Nursing Science," provides an insightful and timely appraisal of an important theory. I commend Ms. Valentine for her thoughtful examination of the integrated practice model and agree with her conclusion that the integrated practice model has many strengths but must now evolve to keep pace with a rapidly changing healthcare environment. I was equally pleased to see Ms. Virginia Lynch concur with Ms. Valentine's call for a remodeling of the theory in the same journal issue in her commentary, "Enrichment of Theory Through Critique, Restructuring, and Application."

Given the likelihood of changes to the integrated practice model, it is important to examine the philosophical underpinnings of the theory and consider where further clarification and revision are needed to strengthen the theory. Ms. Valentine highlights several such areas in her article. In particular, she notes that, although truth is an assumption of the theory influenced by Plato's philosophy of truth, it is not defined or represented in the model. I contend that the lack of a clear definition of truth and its role within the model is not merely a limitation but a significant epistemological dilemma that must be resolved before further theory development. In her commentary, Ms. Lynch asserts, "The enduring purpose of this new science is to determine truth, where the scales of justice may be poised on the testimony of the forensic nurse" (Lynch, 2014, p. 121). Considering the integral role of truth in forensic nursing, clarifying the definitions of truth and the related concept of knowledge is critical to successful theory revision. These concepts are complex, and because the model uses an integrated approach, a uniform understanding of how we know what truth is across the many disciplines and entities that interact with forensic nursing patients can by no means be assumed. Nurses must have a sound philosophical basis for their theories and ultimately their practice, beginning with consensus on the theoretical and operational definitions of important constructs (Chinn & Kramer, 2010; Hardy, 1974). Thus, I pose the following philosophical questions to address this issue.

First, how should nurses define truth? This question can become quite complex when we consider that how a patient defines truth may not be the same as how laws and the legal system define truth. Social norms and cultural context further complicate how the patient may conceptualize truth and what public policies are in place. Moreover, policies in different countries and different levels of jurisdiction (e.g., federal, state, and local) do not offer a uniform definition of what constitutes truth or how truth is determined, both in general and in specific forensic situations. Patient-centered care is a tenant of nursing science, and we espouse our commitment to advocacy and respect for patient rights to autonomy and self-determination (American Nurses Association, 2010). However, if there is discrepancy between a patient's definition of truth and the legal system's definition of truth, what should be the role and response of the forensic nurse? To answer this question, we must first know what truth means to a forensic nurse and how it fits into a nursing paradigm, in light of both our duty to the law and duty to the patient.

This question leads to a second, related philosophical area to explore: what is the role of nursing knowledge in forensic science? How do we know what we know, and how does a forensic nurse's knowledge function in a legal context? Ms. Valentine notes that Carper's fundamental patterns of knowing is "a framework applicable to forensic nursing" and that, in Lynch's original model, "the fundamental patterns of knowing categories[horizontal ellipsis]are all apparent within forensic nursing" (Carper, 1978; Valentine, 2014, p. 115). However, knowledge, like truth, is a complex concept that cannot merely be deemed "applicable" and "apparent" to a theory without further explanation. It is particularly unclear what the role of nonempirical nursing knowledge is in forensic nursing theory. Of course, as Ms. Lynch points out, "ways of knowing are manifested throughout the forensic nurse's standards of professional performance" (Lynch, 2014, p. 120). Nevertheless, nursing knowledge in forensic science concerns the legal system as well as the patient. Consequently, we must ask how our esthetic, personal, ethical, and emancipatory knowledge, in addition to empirical knowledge, contribute to the nurse's determination of truth and what the roles of these nonempirical categories of knowledge are in a legal context (Carper, 1978; Chinn & Kramer, 2010).

A key function of nursing knowledge in the emancipatory domain is to "seek freedom from institutional and institutionalized social and political contexts that sustain advantage for some and disadvantage for other" (Chinn & Kramer, 2010, p. 6). Forensic nurses have a unique role in the praxis of this emancipatory knowledge as they seek justice for their patients. Developing forensic nursing theory is essential to the field's future research, education, and practice, and we would be remiss to ignore key philosophical questions about our own conceptions of truth and knowledge before revising the integrated practice model. I applaud Ms. Valentine and Ms. Lynch for their innovative work in forensic nursing theory development and commitment to continued scholarly advancement in the field.

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