Nursing history as philosophy—towards a critical history of nursing

Mainstream nursing history often positions itself in opposition to philosophy and many nursing historians are reticent of theorizing. In the quest to illuminate the lives of nurses and women current historical approaches are driven by reformist aspirations but are based on the conception that nursing or caring is basically good and the timelessness of universal values. This has the effect of essentialising political categories of identity such as class, race and gender. This kind of history is about affirmation rather than friction and about the conservation of memory and musealization. In contrast, we will focus on how we imagine nursing history could be used as a philosophical, critical perspective to challenge the ongoing transformations of our societies. Existing reality must be confronted with strangeness and the historically different can assume the function of this counterpart, meaning present and past must continuously be set in relation to each other. Thus, critical history is always the history of the present but not merely the pre‐history of the present – critique must rather present different realities and different certainties. In this paper, we use this approach to discuss the implementation of the nursing process (NP) in Germany. The nursing process appears to be a technology that helped to set up an infrastructure ‐ or assemblage ‐ to transform nursing interventions into a commodity exchangable between consumers and nurses in a free market. In our theoretical perspective, we argue that NP was a step in the realization of the German ordoliberal program, a specific variety of neoliberalism. In order to implement market‐orientation in the healthcare system it was necessary to transform hospitals into calculable spaces and to make all performances in the hospital calculable. This radically transformed not just the systems, but the ways in which nurses and patients conveived of themselves.     

Mixed method nursing studies: a critical realist critique

Abstract  Mixed method study designs are becoming increasingly popular among nurse researchers. Mixed studies can have advantages over single method or methodological investigative designs. However, these advantages may be squandered where researchers fail to think through and justify their theoretic decisions. This paper argues that nurse researchers do not always pay sufficient heed to the philosophic and theoretic elements of research design and, in consequence, some mixed study reports lack argumentative coherence and validity. It is here suggested that Hempel's concept of equivalence can be stretched to usefully illustrate one of the main threats to argumentative coherence in mixed study design. The critical realist theory of Roy Bhaskar is then introduced and this, it is proposed, offers one means by which Hempel's equivalence dilemma can be overcome. Critical realists recognize the existence of logical connections between the ontological, epistemological, and methodological premises that underpin their work. They are therefore more likely to produce coherent studies than uncritical pragmatists who ignore such linkages and, paradoxically, critical realists can be epistemological pluralists because, in re-conceptualizing the ontological basis of inquiry, problems associated with the mixing of alternative metaphysics are circumvented.     

Self-transcendence: Lonergan's key to integration of nursing theory, research, and practice

Abstract This paper proposes that the philosophy of Bernard Lonergan can provide insight into the challenge of integrating nursing theory, research and practice. The author discusses Lonergan's work in regard to reflective understanding, authenticity and the human person as a subject of consciously developing unity. This is followed by a discussion of two key elements in Lonergan's work that relate to nursing: the subject–object challenge of nursing inquiry and common sense vs. scientific knowledge. The author suggests that integration of nursing theory, science and practice may be achieved through self‐transcendence.     

The Ruptured Supervisory Alliance and Its Repair: On Supervisor Apology as a Reparative Intervention

This investigation was a qualitative evaluation of the Counseling Competencies Scale (CCS; Swank, Lambie, &; Witta, 2012 Swank, J. M., Lambie, G. W., &; Witta, E. L. (2012). The Counseling Competencies Scale: A measure of counseling skills, dispositions, and behaviors. Counselor Education &; Supervision, 51, 189–206.[Crossref] , [Google Scholar]) with clinical supervisors (N = 6) and their supervisees (N = 23) during their graduate-level practicum counseling experience. Five themes were identified (cognitive understanding, emotional understanding, feedback, trustworthiness, and gatekeeping), underscoring both the benefits and challenges within utilizing the CCS.     

Electronic health record as a panopticon: A disciplinary apparatus in nursing practice

The specific arrangements of power/knowledge that characterize nurse interactions with the electronic health record form a panopticon. As health care moves into the 21st century, sophisticated technologies like the electronic health record shape the terrain of professional possibilities. The longer it is in use, the more it is possible to excavate the inherent disciplinary function of electronic health record. A panopticon is a generalizable, replicable apparatus of power that cultivates discipline when similar behaviours are desired from a group of people. This paper traces the arrangements of power/knowledge that characterize nurse interactions with the electronic health record rooted in a trauma critical care setting. Examining the apparatuses of power/knowledge enforced through panopticism in nursing makes the invisible visible. This in turn enables nurses to address the intended and unintended consequences of the electronic health record. If nurses are to effectively shape the direction of their own futures and the future of health care, nurses will need to unpack the invisible techniques of power such as the electronic health record as a panopticon. In the process of building a visible identity, contextualizing nursing knowledge to better care for patients on the one hand and understand the relationships of power that limit us on the other, nurses are neither apolitical nor powerless. Considering the dialectic of power/knowledge in the healthcare setting helps to illuminate spaces to recharacterize nursing, reveal the contributions and knowledge of nurses, and consolidate the professional power of nurses to affect meaningful change and self‐governance in the healthcare setting.     

Midnight reckonings: on a question of knowledge and nursing

Abstract The paper contrasts understandings of knowledge grounded in Enlightenment norms with the departures from those norms taken by some strands of feminism and hermeneutics, as well as the contributions made by the writing of Michel Foucault. A reading of Foucault's writings on knowledge, power and the discursive constitution of self and world is offered as a potentially useful frame within which to raise questions about nursing, nurses and knowledge.     

Carspecken's five-stage critical qualitative research method: an application to nursing research

In this article, the authors provide an account of Carspecken's (1996) five-stage approach to "doing" critical ethnography, or what he has termed critical qualitative research (CQR). They provide the reader with an overview of the concepts presented in Carspecken's book Critical Ethnography in Educational Research and describe how they applied several of his ideas within a research project that explored renal nurses' decision making using a critical ethnographic approach. They briefly describe the five stages of CQR and incorporate within the article an example of how they applied the stages. They propose this approach as a useful method for nursing and other health-related research.     

Carspecken's critical approach as a way to explore nursing leadership issues

Nursing leaders are attempting to provide effective support for staff as well as optimal client care in the most challenging of times for the health care industry globally. Regardless of where leaders practice, their health care setting will have its own socially constructed way of getting the work done. In this article the authors suggest Carspecken's critical methodology, particularly his use of the pragmatic horizon, as a useful method to assist leaders in recognizing their own behaviors as a first step to providing leadership that is more emancipatory. The aim of this reflection and resulting action is increasing leadership effectiveness to improve health care outcomes.     

Photo methods for qualitative research in nursing: an ontological and epistemological perspective

Abstract  The use of photo research methods is influenced by underlying ontological and epistemological assumptions. Variant assumptions about reality and knowledge converge to conceive a relationship between the knower and what can be known. These assumptions provide the rationale for decided ways of engaging participants in the process of scientific inquiry. In this paper, we examine how perspectives of realism and relativism may shape epistemological understandings and influence type and use of photo methods in qualitative research. Based on deliberations about underlying ontological and epistemological assumptions and related strengths and challenges of photo methods, we assert that photo methods contribute to the development of knowledge that both matters to participants and informs nursing practice.     

Health as a resource for everyday life: advancing the conceptualization

This paper examines the conceptualization of health as a resource and the implications that such a definition has for public health programs and policies. First introduced in the Ottawa Charter for Health Promotion, health is commonly defined by practitioners, policy makers, and scholars as a resource for everyday life. However, despite frequent references to health as a resource, little attention has been paid to the meaning of this one-line phrase. Thus, we draw on a multidisciplinary body of literature to examine key features of health that characterize it as a resource, as well as its similarities, differences, and associations with other resources. We argue that, as a resource, health is appropriately conceptualized as a type of capital that can be invested in by individuals and societal institutions to achieve positive health returns. Similar to human capital, health is embodied in individuals, and, as such, it is not a tradable resource like money. Health cannot be exchanged or sold for goods and services and it cannot be obtained directly in exchange for goods and services. Instead, as a type of capital, health is a stock of biopsychosocial resources that people can draw on to participate in society. Although health shares some characteristics with human capital, we contend that health is not a component of human capital, as some scholars indicate. Lastly, we maintain that there are important program and policy implications, both positive and negative, of adopting an economic definition of health.     

Buddhist thought and nursing: a hermeneutic exploration

In this paper I lay out the ground for a creative dialogue between Buddhist thought and contemporary nursing. I start from the observation that in tracing an arc from the existential human experience of suffering to finding compassionate responses to suffering in everyday practice Buddhist thought already appears to present significant affinities with nursing as a practice discipline. I discuss some of the complexities of entering into a cross-cultural dialogue, which is already well under way in the working out of Western forms of Buddhism, and which is beginning to be reflected in nursing literature. I introduce philosophical hermeneutics as a useful framework for elaborating an open and constructive exchange. I then discuss key Mahayana Buddhist concepts of emptiness and two truths that lead to a dynamic and open way of understanding reality and responding in the world. I turn to examples of original texts to give a flavour of the varied and distinctive forms of literature in the Buddhist tradition. This is intended partly to keep the reader alert to cultural difference (from a Western standpoint, that is) while exploring the creative potential of Buddhist thought. Hermeneutics again provides a framework for interpretation. This paper establishes a philosophical ground for a critical and creative dialogue between Buddhist thought and nursing.     

Governing through community allegiance: a qualitative examination of peer research in community-based participatory research

The disappointing results of many public health interventions have been attributed in part to the lack of meaningful community engagement in the planning, implementation, and evaluation of these initiatives. Community-based participatory research (CBPR) has emerged as an alternative research paradigm that directly involves community members in all aspects of the research process. Their involvement is often said to be an empowering experience that builds capacity. In this paper, we interrogate these assumptions, drawing on interview data from a qualitative study investigating the experiences of 18 peer researchers (PRs) recruited from nine CBPR studies in Toronto, Canada. These individuals brought to their respective projects experience of homelessness, living with HIV, being an immigrant or refugee, identifying as transgender, and of having a mental illness. The reflections of PRs are compared to those of other research team members collected in separate focus groups. Findings from these interviews are discussed with an attention to Foucault’s concept of ‘governmentality’, and compared against popular community-based research principles developed by Israel and colleagues. While PRs spoke about participating in CBPR initiatives to share their experience and improve conditions for their communities, these emancipatory goals were often subsumed within corporatist research environments that limited participation. Overall, this study offers a much-needed theoretical engagement with this popular research approach and raises critical questions about the limits of community engagement in collaborative public health research.     

Obesity,neoliberalism and epidemic psychology: critical commentary and alternative approaches to public health

Obesity and neoliberalism are two concepts that generate plenty of concern and debate, arguably leading to more heat than light when terms like ‘epidemic’ are thrown into the fray. Drawing from critical weight studies, this paper offers critical commentary on the recent designation of obesity as a ‘neoliberal epidemic’ that can be attributed to energy-dense foods and a toxic mode of political economic organization. After delineating neoliberalism and the use of this concept in health studies, discussion turns towards contrasting invocations in the ‘fat field’ before seeking to navigate a course through this terrain. In addition to contributing to critical weight studies and the obesity debate, this commentary engages discussions on the perils of invoking neoliberalism in public health critique. In conclusion, we move from critique to hope with reference to epistemologies derived from alternative health practices, notably frameworks incorporating Indigenous knowledge(s).     

Constructing a 'plausible narrative of progress' for nursing: a neopragmatist suggestion

Identity, difference, and the associated subject of cultural diversity pose challenges for nursing. As the demographics of the world change, demands are rising for nurses to provide sensitive, individualized care to people living in our ever-changing global community. Issues concerning gender, sexuality, disability, age, language, economic and occupational status, multiculturalism, and ethnicity are made more complex because many of these topics strike a personal chord for individual nurses. In order for nursing to provide appropriate care to the world's people and to meet future challenges, nursing must define itself in new ways. Kikuchi and Simmons have stated that the best way for nursing to approach this task is through the development of a 'sound' philosophy of nursing that will 'accommodate diversity in nursing thought'. They contend that before we can establish a philosophy of nursing, nurses will have to agree upon the nature of reality, human beings, truth, and knowledge. This paper will suggest that neopragmatism, as described by Richard Rorty, is a way to assure diversity of thought in nursing. However, I will argue against the requirement for this philosophy to be 'sound' in the sense that Kikuchi and Simmons use this term. In place of their call for 'truth and unity in nursing thought'. I will attempt to demonstrate how neopragmatic ideas relate to the construction of what Rorty called a unifying 'plausible narrative of progress'. This change will allow nursing to abandon the dead end debate over epistemologies and instead focus on more important issues related to improving nursing practice.     

Medical and nursing clinical decision making: a comparative epistemological analysis

Abstract The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skilful conduct of clinical decision making.     

The world as the new local clinic: A critical analysis of three discourses of global medical competency

The effects of globalization on health are the focus of administrators, educators, policy makers and researchers as they work to consider how best to train and regulate health professionals to practice in a globalized world. This study explores what happens to constructs such as medical competence when the context of medical practice is discursively expanded to include the whole world. An archive of texts was assembled (1970–2011) totaling 1100 items and analyzed using a governmentality approach. Texts were included that articulated rationales for pursuing global education activities, and/or that implicitly or explicitly took a position on medical competencies in relation to practicing medicine in international or culturally diverse contexts, or in dealing with health issues as global concerns. The analysis revealed three distinct visions, representative of a primarily western mentality, for preparing physicians to practice in a globalized world: the universal global physician, the culturally versed global physician and the global physician advocate. Each has its own epistemological relationship to globalization and is supported by an evidence base. All three discourses are active and productive, sometimes within the same context. However, the discourse of the universal global physician is currently the most established. The challenge to policy makers and educators in evolving regulatory frameworks and curricula that are current and relevant necessitates a better understanding of the socio-political effects of globalization on medical education, and the ethical, political, cultural and scientific issues underlying efforts to prepare students to practice competently in a globalized world.     

Bioinformatics: The philosophical and ethical issues at stake in a new modality of research practices

This article deals with the integration of ethical reflection into the research practices of the project at the Lille Nord-Pas-de-Calais genopole: “Multifactorial genetic pathologies and therapeutic innovations”. The general hypothesis of this text is that changes in research practices in biology (mainly through the use of bioinformatics) imply changes in medical practices, which require critical reflection. This hypothesis could be broken down into three sub-hypotheses: (1) Research in biology is undergoing a complete transformation; (2) Research in biology is a cultural practice, which cannot be reduced to a simple cognitive action; (3) Research in biology is a techno-scientific practice. As for the method, the aim of our research at the Medical Ethics Centre is to elucidate the philosophical and ethical range of biomedical practices. This work entails a double task for reflection. On the one hand, from the revelation of ethical tensions present in these practices, we have to think about what is at stake in these practices, and more broadly in society. On the other hand, we have to analyse the conditions enabling the actors to assume the significance of ethical reflection in their practices. The method set up to undertake this double task could be qualified as “narrative hermeneutics”, as its aim is to attempt to interpret the stakes in practices from proximity with these practices and from what their actors have to say about them. The text then goes on to analyse more specifically the emergence and place of bioinformatics in present-day biomedical research.     

The lost path to emancipatory practice: towards a history of reflective practice in nursing

This paper historicizes the taken‐for‐granted acceptance of reflection as a fundamental professional practice in nursing. It draws attention to the broad application of reflective practice, from pedagogy to practice to regulation, and explores the epistemological basis upon which the authority of reflective discourse rests. Previous work has provided a series of critiques of the logic and suitability of reflective practice across all domains of nursing. The goal of this paper is to commence a history of nursing's reflective identity. The paper begins with a discussion of Dewey and Schön then focuses on Habermas's Theory of Communicative Action as the epistemological basis of reflective practice's standing as a authoritative discourse in nursing.