Postmodern nursing

Public Interest, Summer, 2000 by Sarah Glazer

For these nurses, words like "reality," "objective," "evidence-based practice," "quantitative research," and even "measurement" have become code words for all that is evil, patriarchal, and insensitive about modern science and modern medicine. In their place, they have substituted the fashionable phrases of feminism, postmodernism, and hermeneutics: "constructed reality," "social construction," "lived experience," and--to a baffling extent--such terms as "phenomenology" and "epistemology."

Nursing is divided into two warring camps. Nowhere is that better demonstrated than in a fictional dialogue recently composed by two Ph.D. nurses from the antiscience faction. The dialogue was published in the October 1999 issue of Nursing Science Quarterly, which has become a repository for science-bashing together with some of the profession's nuttier quasi-scientific theories. In the dialogue, a fictitious researcher of the "natural science" school (read old-fashioned science) attempts to recruit a fictitious researcher who represents the "human science paradigm," the holistic antiscience view to which the authors subscribe.

At the outset, the "human science" nurse announces that she cannot possibly collaborate on research with the "natural science" researcher because their worldviews are so different. As readers, we can tell immediately that the natural science researcher is the bad guy (girl) because she believes in "an objective reality ... measurement, control ... theory testing and inference making." The human science researcher is the good guy, who believes in "constructed reality, mutual process and epistemological notions of description, pattern, interpretation ... and participation."

The human science researcher views patients' comments as taking primacy over all other types of research data. She asserts proudly, "I believe that quality of life is exactly what the person describes it as being, and I would accept the participants' accounts as truth." In contrast, she says accusingly of old-fashioned science: "When you reduce persons to numerical representations, you strip them of all meaning." She bewails the tendency for peer reviewers (presumably at stodgier journals than Nursing Science Quarterly) to penalize nurse researchers who fail to employ standard methods like a hypothesis, controls, or discussions of the reliability and validity of their methods and data. Just in case there's any doubt about who wins this ideological battle, Violet M. Malinski, R.N., Ph.D., associate professor at Hunter-Bellevue School of Nursing, Hunter College, New York, comments approvingly that the authors "show the flaw in the argument for evidence-based practice."

As part of these culture wars, nurse practitioners--initially regarded within the profession as the peak of skilled accomplishment--have come in for criticism from the antiscience camp. Nurse practitioners are in danger of giving in to "the temptation to mimic physicians" and of becoming too partial to "causal biomedical thinking," charges Hunter College R. N. Ph.D. Steven L. Baumann. By contrast, Baumann praises those nurse practitioners who are not biomedically oriented, who "rely less on diagnostic testing," and who buy into a worldview that "reveals the limits of reductionistic cause-effect thinking." Such nurse practitioners, he argues approvingly, are more likely to "respect alternative healing modalities and folkways." From there it's a short leap of faith for Baumann to defend nurse practitioners who integrate therapeutic touch into their practice.