Garrett Science and Modern Thought in Nursing

Pragmatism & Praxis for Evidence-Based Practice
1. Auflage 2013
ISBN: 978-0-9919846-0-2
Verlag: Northern Lights Media
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 520 Seiten

This exciting new text presents a pragmatic approach to nursing science that underpins evidence-based practice (EBP), including an exploration of research methodologies, and examples of bad-science and pseudoscience in practice. The text explains the foundational principles underpinning scientific enquiry, written in a creative and accessible manner, challenging the dogma of postmodern approaches to nursing knowledge. A good science detection guide is included.

Autoren/Hrsg.

Garrett, Bernie

Leseproben

Chapter I: Science: Why Should I Care?

It ain’t ignorance that causes all the troubles in this world; it’s the things that people know that ain’t so.

Edwin Howard Armstrong (1890-1954)

For such a highly science-based health discipline it seems a paradox that most nurse’s knowledge of scientific philosophy (the fundamental nature of knowledge) remains fairly limited. Indeed, the same is true of most health professions, and many nurses will not have explored some of the basic principles of science since primary/elementary school, as they are often not covered in any depth in modern secondary school curricula, and rarely in modern university undergraduate nursing programs. Although the methods of scientific inquiry are examined in nursing curricula, the underlying philosophy behind modern science is often only explored in very basic terms (such as by contrasting positivist and humanist approaches). This can give rise to some confusion over what is, and what is not scientific inquiry. This book seeks to address this and give both practicing nurses and students a sound understanding of modern scientific thought and its origins. Readers will also find the tools to consider and make sound scientific arguments to support practice, and readily detect poorly constructed, pseudo-scientific or simply bad scientific practice. In this book we will consider key scientific concepts and principles that underpin contemporary evidence-based health care and explore the practical application of the philosophy of science for nursing.

You may ask, “why should I care about scientific philosophy, as I’ve got by fine without any in-depth knowledge of this so far?” In short, the answer is that in order to provide the best quality professional care, you need to be able to discriminate effectively between alternative therapeutic interventions, quickly identify illegitimate and inaccurate arguments, and make decisions that support the optimum health care outcomes for your patients and clients.  With the explosion of the information age we have a growing volume of unscientific, pseudo-scientific and simply bad science in nursing and other health care disciplines. There seems to have been an erosion of science in nursing education where the philosophy of science and the approaches that underpin evidence-based practice (EBP) often get limited time in the classroom today, or at least unequal time compared to alternative discourses. The long answer to “why should I care?” is more complex, and in the book I will argue a number of reasons why it is essential to get a firm grounding in this area to be an effective contemporary nurse, and in particular to counter the growing trend in questionable health practices that are presented as scientifically based health care, and the increasing popularity in seeking alternative frameworks of understanding to explain nursing phenomena under the guise of scientific inquiry. The disciplines of science and nursing are being assailed in both contemporary socio-political structures and within academia. A good knowledge of scientific philosophy will help you identify bogus arguments that may erode the quality of nursing care.  Let us explore why nurses should become better acquainted with the philosophy of science to inform and improve their practice.

Science Under Siege

Over the last twenty-five years an interesting irony has arisen in the way science is perceived versus how much it is relied upon in our increasingly technological world. The public view of science seem to be becoming more and more negative in western society (Sagen, 1997, Goldacre 2008) despite the fact that that same society has become increasingly more reliant upon it to function. Although we now live in a world where we rely on the products of science to fulfill our basic and more advanced needs, postmodern academics now question the fundamental principles of science, and its value to society, and people who put belief in expert opinion or other authorities frequently reject scientific findings in favour of testimonial or dogma (Frazier, 2009; Freese, 2001). 

This trend is also becoming apparent in health care and in nursing practice. Naturopaths and media figures such as Jenny McCarthy tell people to ignore the scientific evidence on vaccinations and trust in their vital energy or intuition in making vaccination choices for their children. Bizarre alternative therapies, health machines, traditional remedies and nutritional supplements based on magical explanations continue to proliferate with no real evidence of substantive benefits. Many of my colleagues would argue that as nurses this is as it should be, as we must consider a multiplicity of narratives and be culturally nonjudgmental in such considerations. There may be some merit in this as a philosophical stance, and this highlights the alignment of nursing with the methods of the humanities rather than the naturalistic sciences, which few would argue, is now well established. Nevertheless, as health professionals we also have a duty to balance personal perspectives with EBP, and the wider socio economic implications for health care. 

This polarization of perspectives has been a significant trend in latter 20th century academia, and particularly in nursing. C.P. Snow suggested in a famous 1959 Rede lecture, (and later in his book) that there were diverging trends between the cultures of science and the humanities which he called “the great divide” and that the split between the two cultures of science and the humanities was a great hindrance in solving the world’s problems (Snow, 1993). John Brockman also suggested there was a third culture, of scientists communicating directly with the public about their work in media without the intervening assistance of editors (Brockman, 1995). However, today, incompetent and sensationalist reporting not to mention stereotyping by the media make it difficult for scientists to get their work understood (see Chapter Seven for a number of examples). Advertisers make use of science and scientists to promote products (usually in iconic white lab coats), but science in the media is generally portrayed as nerdy, boring and difficult, whilst scientists are typically portrayed as either morally negligent, mad/evil villains, boffins, eccentric loonies, or (perhaps more worryingly) spending their lives developing the latest cosmetic products. These popular culture images of science and scientists have impacted public trust and confidence in science-based health care. In a 2006 Harris survey of trust in various professions only about 50% of those surveyed identified doctors and nurses as being completely trusted to give professional advice that was best for patients.

Much of the public remains scientifically illiterate due to continuing poor science education in our schools, and even worse, many physicians and nurses fail to truly understand scientific methodology, often failing to discriminate effectively between a sound hypothesis and hyperbole. We should consider whether or not we want to continue down this path for the future development of nursing, and if scientific literacy is actually necessary for a nursing qualification. Currently, scientific illiteracy is not a major impediment to success in business, politics or in the arts; nursing could soon join their ranks in this respect.

Nursing Epistemology

As professional practitioners focused on health care, nurses are concerned with the why and how questions of health care in their everyday practice. For example, “why is my patient experiencing pain?” or “how is this drug likely to affect my patient’s mental state?” etc.  In order to answer these in any meaningful way nurses need some common terms of reference, and a framework of understanding health care phenomena. In this, we are still struggling as a discipline to establish consensus as to the best way forward, although this is hardly surprising, as philosophers have been struggling with these big questions for centuries. Questions such as: “what are the necessary and sufficient conditions of knowledge?” “what are its sources?” and “what is the structure of knowledge, and what are its limits?”  The study of the nature of knowledge and justified belief is known as epistemology, and this and its relationship to nursing knowledge is one of the key areas that seem to interest nursing theorists. Indeed, we even have the academic journal Nursing Philosophy primarily dedicated to exploring this very area.

In our consideration of the epistemology of nursing knowledge we must also consider what we mean by the concept of justification itself. We can argue that the more recent trend towards evidence based health care, medicine and nursing has resolved some of this debate for nursing, but even that has been severely criticized by several nursing academics (Holmes, Murray, Perron, & Rail, 2006). In the following chapters we will see why a scientific approach makes good sense for developing our nursing epistemology and justifying our practice. Indeed, science itself represents a belief framework as much as any other, so before we go too much further perhaps we should consider what science actually is?

Science and Technology in Nursing

Simply put, science is a way of understanding the world. The term comes from the Latin, scientia meaning knowledge. Science was originally synonymous with philosophy in the ancient world and today is still used less formally to describe any systematic field...