Reconciling nursing's art and science dualism: Toward a processual logic of nursing

There is an enduring debate in nursing regarding the art–science dualism, involving an articulation of two distinct ‘kinds’ of disciplinary knowledge: objective/scientific and subjective/artistic. Nursing identifies both as necessary, yet unbridgeable, which creates problems in constructing a coherent disciplinary knowledge base. We describe how this problem arises based on an ontological assumption of two different kinds of ‘stuff’ in the world: that with essential determinate properties and that without essential properties. We experiment with a solution by ontologically understanding the world as made from a single kind: That the most irreducible element of the world is process, in that reality is a continuous construction whereby subject and object are products, not independent constituents, of reality. Process philosophy overcomes nursing's ontological bifurcation and enables nursing's art–science dualism to be re‐conceptualized as a cohesive logic of skilled reality production. An unavoidable implication of a process turn in nursing philosophy is that the disciplinary goal no longer becomes a privileged ‘body of knowledge’ that authorizes, which has always been a defining challenge in nursing. Rather, and more productively perhaps, the aim is for greater sophistication and plurality in its ongoing commitment to attuning to reality in ways that shape disciplinary attainment.     

The potential contributions of critical social theory to nursing science.

As a theoretical and philosophical orientation to science, critical social theory (CST) is increasingly used in nursing inquiry, theory, and practice to address oppressive sociopolitical conditions influencing health and health care. Although the emancipatory focus of CST is well aligned with nursing's social mandate, the examination of ontological and epistemological assumptions underlying CST reveal important incongruities in relation to the unique epistemological requirements of nursing science for both generalizable and particular knowledge. This article examines the potential contributions of CST to nursing science and areas of philosophical compatibility and incongruity. The author argues that the most significant contribution of CST to nursing science may be achieved by critiquing the fundamental ideologies upon which nursing knowledge is developed. By interrogating these ideological assumptions, and by maintaining the integrity of our diverse epistemological requirements, CST can advance nursing science towards progressive, emancipatory objectives.     

Providing rehabilitation services for people with dementia through intermediate care

This article describes a Department of Health-funded study that mapped rehabilitation services--and examples of good practice--for older people with dementia in England. The findings suggest that there are potential benefits in locating rehabilitation services within intermediate care, including a higher service profile with clearer care pathways and access to a wider range of professionals across health and social care. The author concludes that a seamless range of services can be provided via intermediate care, but argues that nurses need to challenge the perception that rehabilitation cannot be achieved for people with dementia.     

Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.     

The development of community psychiatric nursing: a professional project?

In this paper the author argues that the development of community psychiatric nursing can be understood as a professional project However, the case of community psychiatric nursing cannot be adequately understood from mainstream literature on the subject of professionalization within the health care division of labour The inadequacy of such literature is that it either concentrates upon the pre-eminent case of medicine or regards nursing's professionalization as being unitary The author posits that the professional projects of general nursing and community psychiatric nursing have different and even opposing interests To contextualize community psychiatric nurses'(CPNs') professional project the author examines the history of mental nursing, from which community psychiatric nursing evolved, the development of community mental health care, which allowed for the inception of community psychiatric nursing, CPNs'relationships with both psychiatrists, whose patronage assisted CPNs'initial growth as para-professionals, and general practitioners, who later assisted a more functionally autonomous role for CPNs in primary care, and social policy towards community care that enhanced CPNs'growth In conclusion the author argues that recent government-led changes in the management of community mental health care now impel CPNs to change the direction of their strategy for occupational survival and advancement     

Nursing: an integration of art and science within the experience of the practitioner

In this paper it is proposed that whilst nursing knowledge is underpinned by the philosophies of art and science they are integrated in such a way that nursing is greater than their sum and is thus a unique discipline It begins with an exploration of the philosophies underpinning art and science, and their relationship to nursing The discussion then moves on to examine critically the nature and development of theory in nursing with reference to art and science, the nursing knowledge thus generated and how that knowledge is learned and expressed The paper concludes with an evaluation of how far the discipline of nursing lies within the paradigms of science and of art, and whether indeed art and science may be, to some extent, false distinctions The authors conclude that nursing may be viewed as an integration of art and science, expressed through the practitioner's unique, yet also shared experience     

The influence of liberal political ideology on nursing science

Previous notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy - individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy - are primarily manifested in relation to: (i) the individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health.     

The art of nursing: communication and self-expression

Nursing is considered both an art and a science, yet the nature of art and science has been historically depicted as two distinct fields of inquiry in the health professions. To meet the health challenges of the future, blending science and art through nursing theory, research, and practice is critical. This article describes how nurses in a master's of nursing program at Dalhousie University broke with tradition for the practicum course to articulate and apply the theoretical elements of knowing using aesthetic inquiry. The challenge was in articulating and guiding students through the theory of aesthetic knowing, the linkages with the fine arts, and the conceptualization of nursing art.     

Interprofessional socialization as a way to introduce collaborative competencies to first-year health science students

Abstract

Interprofessional education (IPE) is the cornerstone of preparing future health care providers but remains to be a challenge for many health science programs. We aimed to develop and evaluate an interprofessional conference for first-year health science students with goals to provide students with interprofessional socialization opportunity and introduce IPE principles. A half-day conference was based upon core competencies for health professionals and involved 277 first-year health sciences, nursing, pharmacy, physical therapy, and speech language pathology and audiology students. Alcohol and substance misuse was chosen as a topic for its relevance to college students and health professionals. Results from program evaluation revealed that the conference was successful in exposing students to core interprofessional competencies and provided useful information about alcohol and substance misuse. This study advocates for early inclusion of IPE in the health professions curricula in the form of interprofessional socialization.     

An integrative science approach: value added in stress research

Integrative approaches to understanding complex health issues can transcend disciplinary and knowledge boundaries and provide opportunities to view phenomena from diverse perspectives. These broad approaches to understanding phenomena of interest to nursing might provide new directions for nursing research and be a requisite for delivering safe, responsible, and holistic nursing care. The relationship between stress and illness is a strong example of a field of study that can be understood more fully from an integrative perspective. The potential of an integrative approach to contribute to improvements in human health and well-being outweigh historical biases that have been associated with an integrative science approach.     

Nursing science: the challenge to develop knowledge

The development of knowledge for nursing poses an exciting, scholarly adventure for the profession's scientists. A series of challenges are involved: the challenge to develop the substantive content needed for practice within nursing's disciplinary perspective, the challenge to sustain excellence in the developing science base and in the preparation of nurse researchers, and the challenge of disseminating stable, appropriate research results to the profession's clinicians and to the public. Nursing is entering into a new era, moving from the stage of establishing structures to support nursing research and building the cadre of scientists needed to conduct investigations, to the stage of focusing on the identification and study of the phenomena which comprise the body of knowledge needed for practice. A number of directions or priorities for nursing research are evident for the future. The questions of concern are how to centralize nursing's scientific endeavors and resources as well as prepare researchers who are on the cutting edge or frontiers of science, and what strategies can be used to facilitate excellence in these efforts. The dilemma of transferring research findings into practice in a timely but scientifically appropriate manner requires a partnership between practitioners and researchers. Both are committed to making clinical decisions based on accurate, relevant information. Such research based practice requires a merger of the talents and expertise of those providing practice and those developing the knowledge base for the profession.     

Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development

BACKGROUND: Two dominant discourses in contemporary nursing theory and knowledge development have evolved over the past few decades, in part by unitary science views and caring theories. Rogers' science of unitary human beings (SUHB) represents the unitary directions in nursing. Caring theories and related caring science (CS) scholarship represent the other. These two contemporary initiatives have generated two parallel, often controversial, seemingly separate and unrelated, trees of knowledge for nursing science. AIM: This paper explores the evolution of CS and its intersection with SUHB that have emerged in contemporary nursing literature. We present a case for integration, convergence, and creative synthesis of CS with SUHB. A trans-theoretical, trans-disciplinary context emerges, allowing nursing to sustain its caring ethic and ontology, within a unitary science. METHODS: The authors critique and review the seminal, critical issues that have separated contemporary knowledge developments in CS and SUHB. Foundational issues of CS, and Watson's theory of transpersonal caring science (TCS), as a specific exemplar, are analysed, alongside parallel themes in SUHB. By examining hidden ethical-ontological and paradigmatic commonalities, trans-theoretical themes and connections are explored and revealed between TCS and SUHB. CONCLUSIONS: Through a creative synthesis of TCS and SUHB we explicate a distinct unitary view of human with a relational caring ontology and ethic that informs nursing as well as other sciences. The result: is a trans-theoretical, trans-disciplinary view for nursing knowledge development. Nursing's history has been to examine theoretical differences rather than commonalities. This trans-theoretical position moves nursing toward theoretical integration and creative synthesis, vs. separation, away from the 'Balkanization' of different theories. This initiative still maintains the integrity of different theories, while facilitating and inviting a new discourse for nursing science. The result: Unitary Caring Science that evokes both science and spirit.     

Nursing science: more promise than threat

This paper considers the issue of nursing science. Nursing, as an art, has long been accepted as integral to nursing. Nursing, as a science, however, is a more recent concept. Nursing science is viewed as a threat to the profession by its opponents, while the proponents of nursing science see it as a promise for advancement of the discipline. This paper examines the issue of nursing science by looking at its history and development, the definition of science, and five factors critical to the nursing science issue. The author concludes that nursing science is, in varying respects, both a threat and a promise. It is clear that the preponderance of evidence favours the promise nursing science holds for the profession of nursing. It is not a matter of choosing either art or science, but rather skillfully blending both for the betterment of nursing. Both art and science are necessary in nursing--neither, however, is sufficient.     

Nursing, art and science: revisiting the two cultures

I begin this paper by setting out the importance of the Two Cultures debate, given that many nurse authors would agree with Closs's position that the art versus science debate should be closed finally. I suggest that issues are every bit as present and urgent in our current era as they were in the past. A brief tracing of the history of the Two Cultures debate highlights the relevance of the central features of the debate for nursing. I then focus on nursing's current understanding of science and art and attempt to defend science from some of the accusations levelled at it, while also questioning some of the claims made on behalf of the arts. In the latter sections of the paper, I make a case for the development of 'nursing humanities' and argue the vital importance of overcoming the Two Cultures divide for the everyday practices of nurses and midwives.     

Envisioning the future in symptom science

Symptom assessment and management continues to be a priority issue for nursing science and practice. However, as the complexity of symptom etiology and expression becomes clear, new approaches and technologies are needed to better address biology and context, common data sources need to be built and shared, and addressing the impact of empirical findings on health policy becomes essential. In this article, we provide a forum to reflect on the future direction of symptom science, with the goal of stimulating further dialogue and improving outcomes for patients and families around the world and for years to come.     

Occupational health and school health: a natural alliance?

BACKGROUND: The United Kingdom National Health Service aims to provide a holistic 'cradle to grave' service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly-stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime. AIM: This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services. DISCUSSION: The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined. CONCLUSION: We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers.     

Miracles take a little longer: Project 2000 and the health-promoting nurse

This paper suggests that the new paradigm for nurse education is being prevented from fulfilling itself because of factors operating within the taught, hidden and wider curriculum. Firstly it is argued that the theoretical components relating to social science, health education/promotion and nursing need to be clearly integrated for nursing students. This integration is demonstrated through the analysis of two nursing models. Secondly it is argued that the taught curriculum needs to be supported by a suitable hidden curriculum both within the educational and clinical setting. Role models which demonstrate integrated theory occurring in practice are a vital component of this. Thirdly it is argued that without the wider social and political context supporting the aims of the ‘new’ nurse education, meaningful success will be very difficult to achieve.     

The practitioner as policy analyst: a study of student reflections of an interprofessional course in higher education

Health and welfare practitioners in the United Kingdom have experienced and continue to experience considerable turbulence as services and occupational boundaries undergo restructuring. To a significant extent such turbulence is driven by policies that promote interprofessional agendas. This paper reports on an evaluation of a higher education programme that adopted a social policy approach to the analysis of interprofessional working. The retrospective views were sought of nursing, midwifery, social work and community and youth work post-qualifying students with use of semi-structured questionnaires and focus groups. Although difficulties were encountered with the political science focus to the programme, overall the participants very positively evaluated the opportunity to engage in policy analysis in a shared learning environment. Given the highly politicised, complex and shifting environment of interprofessional working, it is suggested that the study lends support to the argument that 'policy acumen' is a central skill for contemporary health and welfare practitioners. The paper, therefore, starts to explore issues of particular relevance for educationalists involved in developing frameworks for interprofessional programmes particularly in higher education.     

Nursing science: basic, applied, or practical? Implications for the art of nursing

Nursing has long been described as both a science and an art. If the science of nursing is to be relevant to the art of nursing, then it must be conceptualized and pursued such that these two central components of nursing remain connected. Current conceptualizations of nursing science are examined in terms of the consequences that each conceptualization might have for the art of nursing. Pursuing nursing science as a basic science or an applied science disarticulates the science of nursing and the art of nursing. The author concludes that only if nursing science is conceptualized and pursued as a practical science will the science of nursing be consistently relevant to the art of nursing.     

Living in a glasshouse: exploring occupational alienation

BACKGROUND: Community mental health care has shifted focus from resettlement to empowerment, reflecting a wider agenda for social inclusion. PURPOSE: This study evaluated mental health day services from the perspectives of thirty-nine clients. METHOD: Data analysis of the four focus groups explored the implications for occupational therapy. The data collected were subjected to constant comparative analysis and theoretical sampling. RESULTS: Participants described how mental health day services structured their day and enabled access to support networks. However, many perceived aspects of the services as fostering their dependence and threatening sessions they valued. This dependency led to them feeling alienated and wishing to seek greater influence over decisions about their current and future life. The concept of occupational alienation was used to further interpret their situation. PRACTICE IMPLICATIONS: Occupational therapy could overcome occupational alienation experienced by mental health day service clients, through the development of services within and beyond day services which promote a sense of belonging and offers meaningful occupation.