An emerging discourse: toward epistemic diversity in nursing

Grounded in a postmodern feminist methodology, this article undertakes an initial analysis of a newly emerging discourse in contemporary nursing academia in the United States. Two currently prominent discourses in nursing, a dominant discourse informed by the processes and values of "science" in the Enlightenment sense and a concurrent marginalized discourse informed by postmodernism, are described as a context for the emerging discourse. A genealogy informed by the work of Foucault is presented as a basis for an analysis of the power effects resulting from the conflict between these 2 discourses. Finally, 3 recent texts in nursing are analyzed and common themes identified as indicative of a new intertextual discourse, termed "epistemic diversity," emerging from this discursive conflict.     

Live supervision and family systems nursing: postmodern influences and dilemmas

Live supervision and family systems nursing: postmodern influences and dilemmas
Evolving nursing practices in a graduate nursing education programme that offers live clinical supervision in family systems nursing can be conceptualized within a postmodern perspective. Postmodernism is described as a debate about knowledge that questions traditional foundational theories or explanations in science, culture, religion and literature. Practices of a clinical supervision system, i.e. a graduate student, supervisor, and clinical team, illustrate postmodern influences on clinical work with families. Dilemmas posed by contemporaneity of modern and postmodern influences are also explored.     

A philosophical analysis of evidence‐based practice in mental health nursing

Mental health nurses need to be aware that their knowledge base does not exist in isolation from other cultural practices. They/I/we must become more willing to engage in theoretical problem solving that directly affects clinical practice issues such as the introduction of evidence‐based practice. Critical discussion of evidence‐based practice should be informed by the complex issues that permeate all our socio‐cultural and linguistic practices. This paper examines some of the major philosophical problems in the debate over the use of evidence‐based practice in mental health nursing using both Foucault’s formulation of discourse analysis and Derrida’s construal of deconstruction. The conclusion reached is that postmodern philosophy offers a way to rid nursing of incessant naiive attacks on either quantitative or qualitative research methods which underpin the debate over evidence‐based practice in mental health nursing.     

Judgements without rules: towards a postmodern ironist concept of research validity

The past decade has seen the gradual emergence of what might be called a postmodern perspective on nursing research. However, the development of a coherent postmodern critique of the modernist position has been hampered by some misunderstandings and misrepresentations of postmodern epistemology by a number of writers, leading to a fractured and distorted view of postmodern nursing research. This paper seeks to distinguish between judgemental relativist and epistemic relativist or ironist positions, and regards the latter as offering the most coherent critique of modernist/(post)positivist nursing research. The writings of poststructuralist philosophers, including Barthes, Lyotard, Derrida, Foucault and Rorty are examined, and a number of criteria for a postmodern ironist concept of research validity or trustworthiness are suggested. Whilst these writers reject the idea of Method as a guarantee of valid research, they nevertheless believe that value judgements can and must be made, and turn to notions of ironism, différance, and the different. Ultimately, the postmodern ironist reader of the research report must make a judgement without criteria, based on her own practical wisdom or 'prudence'.     

A review of the literature on the historical development of community mental health services in the United Kingdom

Community mental health encompasses a diverse range of statutory, voluntary and informal care services. However, little has been written about how changes in policy, legislation and philosophies throughout time impact on the service user experience of mental health care today. The purpose of this paper was to review the literature using systematic approaches and address the question: ‘How have historical factors influenced the development of community mental health care in the United Kingdom?’ Following a comprehensive literature search, we included 70 texts. Owing to the difficulties of classifying historical texts numerically, two themes were identified: (1) changing perspectives towards mental illness and the mentally ill; and (2) the complexities of mental health care provision. We structured the review around these themes. A narrative approach was used to illustrate the diversity within the identified texts. In response to the review question, an exploration of the historical literature demonstrates that some form of community care has always been evident. It also suggests that over time different philosophical ideas have influenced mental health policy and service structure. These have in turn shaped the care a service user receives when they come into contact with mental health professionals.     

The panopticon re-visited?: An exploration of the social and political dimensions of contemporary health care and nursing practice

Insights from critical and postmodern perspectives are used to explore some of the aspects of contemporary nursing practice and health care which are taken for granted. Such an exploration begins to deconstruct the power relations implicit within the socio-political context of the health care arena in which nursing operates. In particular, the work of the French philosopher Michel Foucault is used to explore the discourses of the various health care “experts”. Aspects of women's health and nursing practice are used as exemplars of the limiting effects of such discourses.     

Medical humanities in nurse education

The author describes the way in which nursing knowledge is developing through medical humanities. This is the study of medical themes and concerns in fictional representations of illness and health, to understand the effect of illness on individuals and society. Thus, the study of medical humanities shows how the humanities, such as literature and philosophy, can enhance nurse education.     

Continuing education in psychiatric nursing: a reflection on concepts

The concern with continuing education programs that prepare nurses to work in psychiatric nursing led us to conduct this study, the first one on the "development of psychiatric and mental health nursing personnel" research line. Its objective is to make a reflection on the concepts of continuing education, in-service and permanent, found in recent nursing education literature. To carry out the literature review of the concepts we reviewed the MEDLINE and LILACS data bases, theses and dissertations and a number of classical titles on the theme. After the analysis of the concepts and discussions with experts, we concluded that the continuing in-service education denomination is the one that presents more consonance with the authors and experts that were consulted, as well as the one that better meets the demands of knowledge in the area of psychiatric nursing towards the quality of assistance.     

The science of meaning in chronic illness.

A generation of 'insider research' into the subjective experience of being ill and the social context in which illness experience is played out provides us with a developing theoretical knowledge of what has come to be understood as the 'meaning' of illness. In this paper, a critical analysis of the tradition of meaning research forms the basis for an interpretive synthesis of what we now know and where future research might most appropriately be directed. Problems arising from some of the traditional approaches to knowledge development are articulated and potential solutions arising from more recent methodological advances are proposed. The relevance of this analysis for nursing practice knowledge and for the strategies for nursing's scientific development are considered.     

Postmodernism and nursing knowledge development

Postmodernism is a philosophical and social movement which stresses that ideas are temporary, research data should be considered only in context, reality is transcendent, grand theories are invalid, problems are deconstructed, and findings should have practical value. Manifestations of the postmodern paradigm are reflected in the epistemological shifts of nursing science and knowledge development in the professional community of nurses in Western countries. This article explores the context within which this movement emerged, delineates how it has deconstructed "language" and "subject" to frame a new paradigm and outlines related implications on nursing knowledge development. Both challenges and opportunities face the nursing profession as it evolves into a postmodern paradigm.     

Human love – the inner essence of nursing ethics according to Estrid Rodhe. A study using the approach of history of ideas

The aim of this study is to describe the idea pattern of nursing ethics in the textbook written by the Swedish nurse Estrid Rodhe (1911). The purpose is to increase understanding of the ideas in early written history of nursing ethics by using the method of history of ideas. A theoretical premise, but also a fascinating factor in this study, is that the ethics of one profession is always contextual in relation to current period. The historical context of Rodhe’s time was a time of difficult societal circumstances in Europe. Nurses’ work was demanding, but a distinctive feature was enthusiasm to develop nursing. Discussion of the moral issues of nursing was intense, and the characteristics of a good nurse consisted of being as altruistic and unselfish woman. Based on our analysis, the inner essence of Rodhe’s idea pattern consists of human love. It is reflected in her ideas of calling‐based altruism, virtuous woman as a personal reason for being a nurse and nurses’ ethical duty to implementation and subservience. Rodhe’s thinking reflects the conventions of her time. The role of personal moral characteristics of nurses was highlighted and not viewed as separable from the professional. Her textbook represented nursing knowledge of ethics written by a nurse and making her a pioneer of the early written history of nursing in general. Understanding the past helps us comprehend current issues in nursing and makes visible cultural values that form the basis for today and tomorrow. It also provides a possibility to observe the same fundamental features in spite of temporal distance. Here, the history of ideas is a beneficial and fruitful method to increase our understanding of nursing ethics.     

The Myth of the Cave and the experience of illness

In this paper, I will consider, from a number of philosophical and real‐life perspectives, what happens to us when we fall ill and what the experience of falling ill tells us about the nature of our being. I will take up the oft used Myth of the Cave from Plato's Republic and use this as a means to interpret the experience of falling ill. Plato gave us the allegory to show that what we think we know might not be all there is to know and that what we take for truth may not, at least, be the whole truth. I will argue that The Myth of the Cave provides an allegorical basis for coming to understand ourselves as finite and mortal through the experience of illness. We emerge from the dark safety of our everyday lives into the world of illness; this brings us up short as we come face to face with our own mortality. To make the argument, I will use examples from my own experience of illness and some of those other which have been recounted to me. I will also refer to the work of Havi Carel on illness and mortality, the conception of illness as leading to a feeling of not‐being‐at‐home with our bodies (unheimlich) discussed by Frederick Svenaeus, and Gadamer's notion of illness as a loss of equilibrium. Underpinning the argument throughout will be Heidegger's existential analysis of dying in which he discusses the experience of anxiety and the way that separates us from the world of involvements.     

Developing an understanding of gender sensitive care: exploring concepts and knowledge

BACKGROUND: In the United Kingdom (UK), concern about inequalities in health and health care has led to interest in gender sensitivity in health policy and practice. AIM: To develop an understanding of possibilities for gender sensitive care through exploring the concepts of gender and gender sensitivity and through reviewing relevant knowledge about gender and health. METHODS: The dimensions of the concept of gender and theories explaining gender relations are explored through a review of key social science texts. A discussion of gender sensitivity draws on Bowden's analysis of gender sensitive ethics. A literature review of evidence about gender and health identifies relevant knowledge for gender sensitive care. FINDINGS: Seven features of the concept of gender are identified. Gender sensitivity involves an understanding of the socio-political context of experience and relationships. The social context also affects health. Differences in male and female mortality and morbidity rates are likely to be related to differences in economic resources, differences in men and women's position in public and private worlds, to power in social relations and to sexuality and body image. Possibilities for gender sensitive care may be supported through feminist approaches and through a postmodernist understanding of the manner in which discourses shape our understanding of gender and gender relations. Valuing care is a feature of gender sensitivity. CONCLUSION: Gender sensitive care involves recognizing the significance of research related to social influences on health and understanding nursing in its socio-political context, and care in the context of gender relations. Experiential learning can synthesize learning across varied learning modes, bridging learning through experience and formal analysis. Exploring concepts, evidence about gender and health and personal experience will all be important in the development of gender sensitive care.     

The process of Danish nurses’ professionalization and patterns of thought in the 20th century

In this article,we address how the professionalization process is reflected in the way Danish nursing textbooks present ‘nursing’ to new members of the profession during the 20th century. The discussion is based on a discourse analysis of seven Danish textbooks on basic nursing published between 1904 and 1996. The analysis was inspired by the work of Michel Foucault, in particular the concepts of rupture and rules of formation. First, we explain how the dominating role of the human body in nursing textbooks disappears in the mid‐20th century. This transformation can of course be attributed to changes in tasks and responsibilities for nurses or to the implementation of increasing amounts of knowledge and theories from other disciplines than medicine into the nurses’ knowledge base. However, inspired by Foucault, we consider these historical changes to be the conditions of possibilities and not causes. The second part of the analysis shows that along with ‘the disappearance of the body’, a second discursive change appears: the role of doctors and medicine changes fundamentally from about mid‐20th century. Finally, we argue that this discursive reorganization enabling new patterns of thought to emerge was driven by a professional interest in describing nursing as an independent profession.     

A process-environment model for mentoring undergraduate research students

Undergraduate nursing student engagement in research remains much contested. The debate centers on whether undergraduate education is preparation for application of research findings to practice versus early exposure and engagement to discovery of new knowledge focused research as is done in graduate education. We take the position that involvement in research is beneficial but mentorship is required if the endeavor is to be meaningful. In the absence of a model to guide effective mentorship for undergraduate co-researchers we synthesized the available undergraduate mentorship literature and relevant pedagogy to develop a mentorship model for use by nurse educators who undertake research with nursing students. This was applied and refined through active engagement in, and reflection on, the execution of a research project exploring peoples' experiences of mental illness. Synthesis of the evidence and reflections led to the development of a process-environment mentorship model. This model provides an evidence- and experientially-based framework for mentoring undergraduate student co-researchers.     

Foucault could have been an operating room nurse

BACKGROUND: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. AIM: Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. CONTENT: The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. CONCLUSIONS: This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.     

Toward a North-South dialogue: revisiting nursing theory (from the South)

In nursing, the current world situation calls us to revisit our knowledge schemes and revise the extent to which they assist us in improving the health of the world peoples. In this discussion, I offer a Latin American nursing perspective to knowledge development in our discipline. I suggest that a persistent concern to develop elaborate conceptualizations has distracted our attention from the realities practicing nurses face throughout the world. In their abstractness, (North) American nursing theories have conveyed a view that presumingly universal imposes itself as hegemonic in the international nursing community. Yet the exportation of these theories to other countries introduces a view that is foreign to practicing nurses. The world situation as well as the disparate and concurrent human paths that we witness and experience calls for approaches that are more in tune with the local realities of nursing practices.     

Transcending marginalization in knowledge development

Quality care requires a body of knowledge that reflects the experiences and the responses of the marginalized populations to health and illness, and requires demarginalization of nursing knowledge. We argue the significance of developing an understanding of people who are marginalized, and organize our arguments and discussions into four sections: (i) developing knowledge that is not marginalizing; (ii) developing knowledge about marginalized populations; (iii) integrating nursing knowledge and making it visible; and (iv) the future of research enterprise. We propose that nurses critically consider strategies and processes to deal with and transcend marginalization of populations and of nursing knowledge.     

From angels to handmaidens: changing constructions of nursing's public image in post-war Britain

The public image of nursing is an important barometer of how the profession is valued in society. Recent research into images of nurses tends to use content analysis to substantiate claims that the mass media misrepresent the profession, perpetuating outmoded conceptions of nursing work. Such a strategy treats the nature of nursing itself as unproblematic, an object to be more or less accurately 'represented'. But these are assumptions that need to be questioned. The systems of belief and value that produce representations of nursing both reveal and constitute the institutional practices that regulate nursing as a profession, which in turn shape the material form and substance of representational constructs. Drawing on fictional and factual popular and official representations of nursing and nursing work on film, television and in recruitment literature, it is argued that although nursing was consistently constructed as 'women's work' for much of the 20th century, a noticeable shift is perceivable in the status of nursing's public image between the late 1930s and early 1970s.