Paranoid investments in nursing: a schizoanalysis of the evidence-based discourse

Abstract  There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence-based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari's concept of schizoanalysis . As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of thought and scientific integrity through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing.     

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.     

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.     

Freedom to roam: a Deleuzian overture for the concept of care in nursing

From a position informed by the philosophical legacy of Gilles Deleuze and Felix Guattari, this paper examines the idea of ‘care’ in nursing theory and philosophy. Deleuze and Guattari make a distinction between, on the one hand, ‘concepts’, which are the proper domain of philosophy and, on the other, ‘functives’ which are the domain of science and all other empirical matters. At first blush, this distinction and use of the word concept appears rather odd, but Deleuze and Guattari hold it to be important for reasons that go beyond the acknowledged and obvious differences between philosophy and science. In Deleuzian terms, a ‘functive’ is any proposition that makes a verifiable truth‐claim about actual states of affairs, whereas a ‘concept’ is a philosophical tool that, although it is used in statements that make claims and that seek to affect our thinking on states of affairs, is not a representation of them in any verifiable (functive) sense. In this respect, philosophical concepts, and the statements in which they are used, are neither true nor false. I argue that the way in which the word ‘care’ is used in much nursing theory and philosophy conflates concept (neither true nor false) with functive (either true or false) with less than productive results. I seek to persuade that if we can gain more clarity between the use of care as a would‐be functive and its use as a philosophical concept, this would strengthen the purpose of the use of the idea of care in nursing theory. This is to say that I take the view that the role of ‘care’ as a philosophical concept is to be used in statements that ‘think the event’ called nursing; that seek to be ‘worthy of the event’, but without being an actual part of the event. Finally, I show how the concept of care in nursing philosophy has been, and can continue to be, reworked to achieve the permanent task of surveying the ever‐shifting planes of the event and how it is described.     

Concept dimension for nursing and Deleuze

The study aimed at identifying and analyzing the meaning of concept according to Deleuze, in Philosophy, and Rodgers, in Nursing. Based on an extract of reality, Deleuze creates the concept and calls it "plan of immanence". For Rodgers, in nursing, the concept emerges at the actual moment one wishes to construct the conceptual bases for Nursing. The authors demonstrate that, although Deleuze and Rodgers come from different areas, the meaning they attribute to concept shares the happening of things and beings, which reflect the experienced reality. For Rodgers, the concept is characterized by its essential elements while, for Deleuze, by what he called components, that is, by essence.     

Autonomy and caring: Towards a Marxist understanding of nursing work

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of “caring” and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change.     

Towards a developmental ethology: exploring Deleuze's contribution to the study of health and human development

This article explores the work of French thinker Gilles Deleuze and argues for the application of his central ideas to the study of health and human development. Deleuze's work furnishes a host of ontological and epistemological resources for such analysis, ushering in new methods and establishing new objects of inquiry. Of principal interest are the inventive conceptualizations of affect, multiplicity and relationality that Deleuze proposes, and the novel reading of subjectivity that these concepts support. This article introduces a developmental ethology in exploring Deleuze's contributions to the study of human development and its varied courses and processes. Taken from a Deleuzean perspective, human development will be characterized as a discontinuous process of affective and relational encounters. It will be argued further that human development is advanced in the provision of new affective sensitivities and new relational capacities. This course is broadly consistent with existing approaches to human development--particularly those associated with Amartya Sen's capabilities model--with the considerable advantage of offering a more viable working theory of the ways in which developmental capacities are acquired, cultivated and maintained. A provisional research agenda consistent with this developmental ethology is offered by way of conclusion.     

Communicative action,education, and knowledge: an approximation to the Habermas thinking

This paper has the objective of presenting a synthesis of Habermas thought on communicative action, relating this with formal education, and more specifically with nursing education. Initially, different concepts of truth and knowledge, as well as the characteristics of modern age education, are pointed out. Secondly, the language concept, which serves as the base to Habermas communicative action theory, is presented. Finally, the study presents the contributions of this author to the materialization of a dialog-based form of teaching learning.     

Meaning and normativity in nurse–patient interaction

Abstract It is a fundamental assumption in nursing theory that it is important for nurses to understand how patients think about themselves and the contexts they are in. According to modern theories of hermeneutics, a nurse and a patient must share the same concepts in order to communicate beliefs with the same content. But nurses and patients seldom understand medical concepts in exactly the same way, so how can this communicative aim be achieved in interaction involving medical concepts? The article uses a theory of concepts from recent cognitive science and philosophy of mind to argue that nurses and patients can share medical concepts despite the diversity of understanding. According to this theory, two persons who understand medical language in different ways will nevertheless possess the same medical concepts if they agree about the normative standards for the applications of the concepts. This entails that nurses and patients normally share medical concepts even though patients’ conceptions of disease and illness are formed in idiosyncratic ways by their social and cultural contexts. Several practical implications of this argument are discussed and linked to case studies. One especially important point is that nurses should seek to make patients feel comfortable with deferring to a medical understanding. In many cases, an adequate understanding of patients presupposes that nurses manage to do this. Another implication is that deference‐willingness to normative meaning is not equivalent to the actual application of concepts. Deference‐willingness should rather be thought of as a pre‐communicative attitude that it is possible for patients who are not fully able to communicate to possess. What is important is that nurses and patients have the intention of conforming to the same meaning.     

Through the lens of Merleau-Ponty: advancing the phenomenological approach to nursing research

Abstract   Phenomenology has proved to be a popular methodology for nursing research. I argue, however, that phenomenological nursing research could be strengthened by greater attention to its philosophical underpinnings. Many research reports devote more page space to procedure than to the philosophy that purportedly guided it. The philosophy of Maurice Merleau-Ponty is an excellent fit for nursing, although his work has received less attention than that of Husserl and Heidegger. In this paper, I examine the life and thought of Merleau-Ponty, with emphasis on concepts, such as perception, intentionality and embodiment, which have particular relevance to the discipline of nursing.     

A 'quiet' crisis in health care: developing our capacity to hear

Abstract In this paper we suggest that it is a mistake to understand the current situation in nursing as primarily a problem of 'shortage', a problem which may be solved through supplying 'more nurses, faster'. This way of thinking is understood as reflecting an invalidation of nurses and nursing and, by fostering false beliefs about nursing, as functioning to exacerbate rather than resolve the current situation. Unlike many mainstream conceptualizations of the current situation in nursing, we begin by understanding the experiences and concerns of nurses as meaningful. Feminist and hermeneutic philosophies, as well as Foucauldian perspectives on discourse, encourage us to take seriously the gender relations of power through which nursing comes to be articulated and to cultivate ways of thinking which can generate more productive analyses of the current situation in nursing. Rather than accepting instrumental understandings of nursing as adequate, we question the everyday beliefs and assumptions, the dominant discourses at work both in the world and in ourselves, which allow the suffering of nurses to be thought irrelevant and their concerns to remain unheard. We theorize both why the suffering of nurses can be considered irrelevant in this way and the difference it would make were we to take the experiences of nurses seriously. This undertaking requires that we reflect on that which constrains – and enables – the ways we are able to write, speak and think about nursing.     

颈内静脉置管在血透中常见问题及护理措施

报道了对109例颈内静脉置管进行血液透析病人的观察,结果如下:颈内静脉置管进行血透最易发生的问题是:皮下血肿、感染、导管堵塞、空气栓塞、脱管,在护理实践中采取相应护理措施,使常见问题得到有效控制.     

Nursing care for undergraduate students

Although care is pointed as the essence of the nursing profession, there is a lack of discussion on its meaning in the nursing education. The objective of this study is to identify the meaning of care for graduate students aiming at contributing to a more contextualized teaching. In order to guide the study, we used the concepts of affiliation and membership notion from ethnomethodology. The subjects were students from a state nursing graduation course in Rio de Janeiro. The data were collected through semi-structured interviews taken after group dynamics which objective was to apprehend the way students described care until that moment in their nursing course. We concluded that as students become more involved with nursing they incorporate concepts that contribute to reinforce or to transform their previous experiences and experiences acquired during the graduation course. Therefore, concepts and behaviors are apprehended and reproduced by students as components of their professional identity.     

Capitalism, psychiatry, and schizophrenia: a critical introduction to Deleuze and Guattari's Anti-Oedipus

Abstract Published in 1972, Anti-Oedipus was the first of a number of collaborative works between the French philosopher, Gilles Deleuze, and the French psychoanalyst and political activist, Felix Guattari. As the first of a two-volume body of work that bears the subtitle, Capitalism and Schizophrenia , Anti-Oedipus is, to say the least, an unconventional work that should be understood, in part, as a product of its time – created as it was among the political and revolutionary fervour engendered by the events of 'May 1968'. However, this paper will suggest that Anti-Oedipus – as a critique of psychoanalysis and the Oedipus complex, as well as being a study of the relationship between capitalism and schizophrenia – should also be understood in a less 'time-bound' fashion. In particular, the paper will examine Deleuze and Guattari's formulation of a concept of 'desire' and its employment in relation to subjectivity, time, capitalism, representation, and the radical 'therapeutic' practice that they refer to as 'schizoanalysis'. Moreover, nearly 40 years after the events of May 1968 and against possible doubts concerning the contemporary relevance of psychoanalysis, it will be suggested that psychoanalysis and the Oedipus complex are to be understood as symptomatic of a wider 'malaise' that can be discerned within psychiatry, psychotherapy, and contemporary capitalist society itself, and that it is this that forms the broader target of the book's critique. Accordingly, by providing an accessible and critical introduction to Anti-Oedipus , the paper also hopes to stimulate further discussion and research regarding both the critique and the contribution that the work can make to contemporary psychiatry, psychotherapy, and mental health nursing generally.     

Against meaning

Abstract The idea of meaning plays, together with the notion of caring, a pivotal role in recent nursing theory, informing its approach to philosophy, research and practice. Unlike caring, however, it has received relatively little analytical attention – a fact that is surprising in view of the scepticism about meaning that is characteristic of much contemporary philosophy and social theory. This paper reviews the philosophical literature on meaning, highlighting sceptical currents in the Wittgensteinian corpus, neo-behaviourism and poststructuralism. It also considers a similar line of thought that has emerged in social theory, questioning the explanatory value of concepts such as 'practice', 'culture', 'norms', 'tacit knowledge', and 'tradition'. All these perspectives suggest that there is something wrong with the common-sense picture of a set of shared, implicit rules that account for our ability to understand and communicate; and they all point to an alternative picture which is naturalistic, materialist and causal, and which depicts 'shared meaning' as a rather mysterious quality, unable to explain the familiar regularities of verbal and nonverbal behaviour. In this picture, while the idea of meaning can be retained, it ceases to be something shared, and becomes something individual and idiosyncratic, a unique cluster of associations, concomitants, and other habits of thought. The paper closes with a brief interpretation of what the alternative implies for a research methodology in nursing. In particular, it proposes that certain well established approaches will have to be abandoned, and that qualitative strategies will have to be grounded in a rigorous scientific framework, rather than in techniques (such as phenomenology), which presuppose a misleading and inaccurate conception of what meaning is.     

CONDUCTING FEMINIST RESEARCH IN NURSING: PERSONAL AND POLITICAL CHALLENGES

The challenges of doing feminist nursing research include both personal and political elements. Some of these arise from the threefold influences of being nurses, women, and academics within a larger social context that may be antithetical to feminist values. This paper explores such challenges, using examples from the research of each of the three authors. It includes discussion of such concepts as the tendency to reify certain methodologies and the political forces that may drive research decisions. The authors summarize the challenges of doing feminist nursing research as learning to integrate diverse approaches rather than adhering to a politically correct way of conducting research. They draw on their own research experiences to illustrate the internal conflicts and personal struggles inherent in overcoming the perception that there is one proper way to conduct feminist inquiry.     

Evidence for practice, epistemology, and critical reflection

Abstract  Evidence-based practice (EBP) has become a critical concept for ethical, accountable professional nursing practice. However, critical analysis of the concept suggests that EBP overemphasizes the value of scientific evidence while underplaying the role of clinical judgement and individual nursing expertise. This paper explores the empiricist position that valid evidence is the basis for all knowledge claims. We argue against the positivist idea that science should be regarded as the only credible means for generating evidence on which to base knowledge claims. We propose that the process of critically reflecting on evidence is a fundamental feature of empirical epistemology. We suggest that critical reflection on evidence derived from science, arts and humanities and, in particular, nursing practice experience can provide a sound basis for knowledge claims. While we do not attempt to define what counts as evidence, it is argued that there is much to be gained by making the processes of critical reflection explicit, and that it can make a valid contribution to expert nursing practice, without recourse to irreducible concepts such as intuition.     

REFLECTIONS ON PRACTICE: DEFINING RURAL NURSING CARE

ABSTRACT: This paper is the result of reflection on and content analysis of five studies in rural nursing by two independent research teams: one in south-west Victoria (three studies), the other in southern Queensland (two studies). The studies explored the nature of rural nursing work, the experiences of rural nurses and patients, and one attempt to promote an alternative mode of rural nursing service delivery. The major focus of this paper is the world view of nursing contained in the participants' experiences of rural health care and nursing in particular. The findings of the studies are examined to identify the concepts of care expressed by the participants and the role these concepts have in building a much needed conceptual framework for rural nursing education and practice.     

A Time to Live and a Time to Die: Heterotopian Spatialities and Temporalities in a Pediatric Palliative Care Team

The death of a child creates especially poignant feelings and extreme stress, distress, and devastation for family members and healthcare providers. In addition, serious or long-term illness forces a reconstruction of our experiences with time and space. In this paper, we report on a long-term ethnographic study of a Pediatric Palliative Care Team (PPCT). Using the concepts of spatiality and temporality; Deleuze’s concepts of smooth and striated spaces; Innis’s concepts of space and time biases; Foucault’s concept of heterotopian space—places with multiple layers of meaning; and a related concept of heterokairoi—moments in time with multiple possibilities—we consider how the PPCT constructs and reconstructs meaning in the midst of chaos, ethical dilemmas, and heartbreaking choices.