As the most well established of the 4 levels, the significance and role of meta-theoretical knowledge in nursing is revealed through a partial list of issues addressed through this mode of inquiry: (1) clarification of the relationship between nursing science and practice, (2) definition, development, and testing of nursing theory, (3) establishment of the academic discipline of nursing, and (4) examination and interpretation of fundamental philosophic perspectives and their connection to nursing science. The long list of exemplary scholarship that represents these 4 categories of philosophic inquiry in nursing is well represented in anthologies such as the one by Nicoll,6 but one example also illustrates the value of the discipline's meta-theoretical thinking. In 1978 when Carper7 published her influential article on the fundamental patterns of knowing in nursing, she initiated a spirited dialogue that continues to this day—in print, classrooms, and practice arenas throughout the world.