In this book it explores science and technology, makes connections between these epistemic, cultural, and political trends, and develops profound insights into the nature of our postmodernity.

This paper evaluates attempts to defend established concepts of expertise and clinical judgement against the incursions of evidence‐based practice. Two related arguments are considered. The first suggests that standard accounts of evidence‐based practice imply an overly narrow view of ‘evidence’, and that a more inclusive concept, incorporating ‘patterns of knowing’ not recognised by the familiar evidence hierarchies, should be adopted. The second suggests that statistical generalisations cannot be applied non‐problematically to individual patients in specific contexts, and points out that this (...) is why we need clinical judgement. In evaluating the first argument, I propose a criterion for what counts as evidence. It is a minimalist criterion but the ‘patterns of knowing’, referred to in the literature, still fail to meet it. In evaluating the second argument, I will outline the powerful empirical reasons we have for thinking that decisions based on research evidence are usually better than decisions based on clinical judgement; and show that current efforts to rehabilitate clinical judgement seriously underestimate the strength of these reasons. By way of conclusion, I will sketch the ways in which the concept of expertise will have to be modified if we accept evidence‐based practice as a template for health‐care. (shrink)

The language of ‘experience’ in nursing research This paper is an analysis of how the signifier ‘experience’ is used in nursing research. We identify a set of issues we believe accompany the use of experience but are rarely addressed. These issues are embedded in a spectrum that includes ontological commitments, visions of the person/self and its relation to ‘society’, understandings of research methodology and the politics of nursing. We argue that a poststructuralist understanding of the language of experience in research (...) opens up additional ways to analyze the relationship between the conduct of nursing research and cultural/political commitments. (shrink)

The influence of liberal political ideology on nursing sciencePrevious 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. (shrink)

Recognising relationships: reflections on evidence‐based practice This paper argues for a broadening of the way evidence is developed and used in health‐care. It contends that the current political and policy imperatives and the evidence‐based practice movement are in direct tension with the other major ideological movements that promote patient‐centred healthcare services. Nursing is affected by this tension because it is more naturally focused on relationships with clients to achieve health outcomes. The unresolved and mounting tension could be alleviated by embracing (...) a broader definition of what counts as evidence and by focusing more on patient‐centred healthcare methodologies and acknowledging the interdependency of distinct ways of generating new knowledge. A number of case studies are used to illustrate how research focusing on patient perspectives and nurses’ response to patient experiences can improve the evidence base for nursing. (shrink)

Postmodernism has been one of the most influential social and philosophical movements of the past decade, but it has also been one of the most misunderstood and misrepresented. In the first part of this book, Gary Rolfe offers a clear and concise introduction to modernist and postmodernist thought, drawing on the work of key thinkers such as Lyotard, Derrida, Foucault and Barthes. In part two, he applies this understanding of postmodernism to a number of published works on postmodernist nursing and (...) midwifery research, exploring themes of power, truth and authority in the discourse of nursing. (shrink)

Poststructuralism changes the way we understand the relations between human beings, their culture, and the world. Following a brief account of the historical relationship between structuralism and poststructuralism, this Very Short Introduction traces the key arguments that have led poststructuralists to challenge traditional theories of language and culture. Whilst the author discusses such well-known figures as Barthes, Foucault, Derrida, and Lacan, she also draws pertinent examples from literature, art, film, and popular culture, unfolding the poststructuralist account of what it means (...) to be a human being. (shrink)

Ideology is one of the most controversial terms in the political vocabulary, exciting both revulsion and inspiration. This book examines the reasons for those views, and explains why ideologies deserve respect as a major form of political thinking. It investigates the centrality of ideology both as a political phenomenon and as an organizing framework of political thought and action. It explores the changing understandings of ideology as a concept, and the arguments of the main ideologies. By employing the latest insights (...) from a range of disciplines, the reader is introduced to the vitality and force of a crucial resource at the disposal of societies, through which sense and purpose is assigned to the political world. (shrink)

Evidence‐based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent ‘regimes of truth’, four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the (...) controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare. (shrink)

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. (shrink)

The essays in this volume represent an approach to human knowledge that has had a profound influence on many recent thinkers. Popper breaks with a traditional commonsense theory of knowledge that can be traced back to Aristotle. A realist and fallibilist, he argues closely and in simple language that scientific knowledge, once stated in human language, is no longer part of ourselves but a separate entity that grows through critical selection.

This edition includes new essays by philosopher Michael Williams and literary scholar David Bromwich, as well as Rorty's previously unpublished essay "The ...

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. (shrink)

Ideology and ideological state apparatuses -- Reply to John Lewis -- Freud and Lacan -- A letter on art in reply to André Daspre.

'a pre-eminently sane, lucid, and concise statement about the central issues, the key examples, and the notorious derilections of postmodernism. I feel a fresh wind blowing away the miasma coiling around the topic. ' -Ihab Hassan, University of Wisconsin, Milwaukee'the most intellectually incisive, coherent and comprehensive meditation upon the history and significance of postmodernism that I have yet encountered.' -Patricia Waugh, University of Durham'easily the best introduction to postmodernism currently available' -Hans Bertens, Utrecht University.