Response
Debate on articles in Contemporary Nurse
Susan Tregoning
School of Nursing and Midwifery, University of South Australia, SA
PP: 005 - 007
Article Text
The thesis of Stephen Kermode's article, The Organization: A problem for the professionalization of nursing, 3(3) is persuasive. The emergence of the organisation as the dominant employment setting has created increasingly bureaucratic forms of controlling work and these threaten the 'ideal typical' characteristics of professional work, a trend with significant implications for nursing. In other words, bureaucratised forms of social control typified by modern management practices (strategic planning, the quality movement and industrial relations reform) are inimical to high levels of autonomy and self regulation, the ability to set remuneration levels according to market forces, control over client throughput, and service delivery on a fee for service basis. Professional workers have strategies to resist management control, but the writing is on the wall for nurses. The predominantly organisational setting in which they work, set largely within large public bureaucracies, the constant domination by other professions (read medicine), and the female dominated workforce are all factors that subjugate the prospects for professionalisation.
Kermode's epistemology is flawed if he wishes to ground his arguments in postmodernism. At least if we read his discourse from the perspective of Lyotard there is a problem. If forms of knowledge, such as those of managers, nurses, and other knowledge workers are little more than language-games, there can be no privileged accounts, and a diversity of understandings is more likely to be typical of bureaucratisation and professionalisation than the dominance of any one discourse. What passes for social reality is likely to be characterised by organisational instability, in which forms of discourse grounded in social forms are likely to shift as they compete not for dominance, but for recognition of their knowledge claims. Another limitation is that Kermode deconstructs the discourse of managerialism up to a point, but the equivalent analysis of nursing knowledge is missing. Similarly, he takes his own discourse for granted.
At least he seems content to adopt a privileged standpoint, from which to conduct a postmodern analysis and read off the relationship between bureaucratisation and professionalisation. A little more deconstruction would show that the two discourses are mutually dependant. Therefore, Kermode does less than justice to the theories of postmodernism he uses to set up his analysis. Neither does he come to terms with the influence of culture on the professionalisation of nurses and the bureaucratisation of their work. As the concept of postmodernism implies notions of paradox, ambiguity and the open ended nature of reality, it would be strange, indeed, if these characteristics were not found to typify the professionalisation and bureacratisation of Australian nursing. I look forward to reading more articles by Kermode, but I am left with a question. If managerialism oppresses professionalism, how is it that critical articles are possible? Perhaps they are postmodern paradoxes. Perhaps they are only ambiguities. I suspect, however, that the answer to my question will remain uncertain until the complexity of the issues involved is recognised and taken into account.
Michael Clinton, Head, School of Nursing Queensland University of Technology
As discussed by Jeanne Madison in her article, Mentors and preceptors in the nursing profession, in Volume 3(3) the establishment of reliable mentee/mentor relationships is vital to the advancement of nursing practice and nursing scholarship. It is within these relationships that innovative strategies evolve and the meshing of the 'old' and the 'new' occur - this is intimately connected to our profession's successful progress.
The use of the term novice is concerning. The mentees chosen by mentors are frequently the very talented and motivated. The mentee is not usually at the level of novice as defined by Benner (1984). It may be more appropriate to refer to mentees as solely 'less-experienced' or just 'mentees' This respectfully acknowledges the life/professional experiences the 'novices' bring into the relationships; it also preserves/enhances confidence, integrity and the creative potential of mentees. These are all areas which desperately need intra-disciplinary enhancement. It is no longer acceptable to claim the position of feminine repression or dysfunctional, paternalistic organisations in relation to why mentorship programs do not exist. Mentorships often do not exist because we (nurses) still cannot work through the issues of horizontal violence, professional/personal insecurities, and the tall poppy syndrome. It's 1994; the global changes in which our profession is participating are numerous. The times demand high levels of expertise, integrity and ingenuity. Mentorship is a powerful tool to successfully impact and direct the inevitable changes.
Mentorship relationships are invaluable tools for our profession. We need to support each other in actively seeking and establishing relationships with people currently possessing the specific skills that are in deficit. Members of our profession that have reached an appropriate developmental level must be receptive to being in the mentor role. Because of our diversity and desire for expanded roles, we (nurses) must be vigilant for opportunities for ourselves and colleagues not only in our usual settings, but in areas not previously presenced by nursing. To do this we need strong, capable mentors.
In conclusion, in advancing our profession we haphazardly- frequently unconsciously-align our best 'new blood' with our most talented. When we decide to individually and collectively use our intelligence and creativity to take our best skills forward in a straightforward and strategised manner- making the pathway easier for ourselves and our colleagues, then we have truly arrived at 'being' a discipline and profession.
Kathleen Hudson, Department of Nursing Science James Cook University of North Queensland
Allan Walters, in his article, Phenomonology as a way of understanding in nursing, in Volume 3(3) makes distinctions between the inquiry traditions of Husserlian phenomenology and Heideggerian hermeneutics. In 1989, when I first read the two philosophers, there were few signposts to assist the novice researcher through interpretive traditions. In addition, the nursing literature was sparse. It is remarkable that recently nurses debating the issues are making clear distinctions between phenomenologies, and journal articles have appeared around the globe. This paper is both timely and relevant as an Australian contribution to the discussion and to nursing inquiry as our methodologies evolve. The purpose of this rejoinder is to sharpen the distinctions and expand the methodological implications of phenomenological traditions for a nursing research agenda.
The first distinction is between Husserl's epistemological focus and Heidegger's ontological orientation. Husserl emphasises epistemological questions of knowing and the research focus is on lived experience. This approach privileges experience. Heidegger emphasises ontological-existential questions of being and the focus is on the way we understand. This understanding is situated in the context of our daily lives. Walters attempts to make these distinctions but in the section 'phenomenology as a way of knowing', he treats phenomenology as a single nursing epistemological project. However, while stating that he does not want to discriminate between the two approaches, the author draws on the work located in Heideggerian phenomenology by Taylor (1992) and Allen et al (1986), and Husserlian phenomenology from Davis (1973), Oiler (1986), Ornery (1983) and Riemen (1983). The merging of the work and ideas from Husserlian and Heideggerian nurse scholars tends to confuse rather than assist the reader in understanding this difficult terrain.
The second distinction, as Walters rightly argues, is that Husserl's phenomenology was the culmination of the Cartesian tradition, and came to mean the study of phenomena as they appear through the consciousness. Central to Husserl's approach was the fundamental recognition of experience as the ultimate ground and meaning of knowledge. The hallmark of a genuinely phenomenological inquiry is that its task is 'a matter of describing'. This emphasis on description of experience appears as an empiricist conception of knowledge.
It is based on an extraction of consciousness from existence. It is the act that turns the experiencing into a subject, confronting an objective world from which it has separated itself. The tradition relies on the dual virtues of detachment and objectivity. Husserl did actually proclaim himself to be a positivist. Husserl's student, Heidegger, reacted against the Cartesian tradition and extended Husserl's philosophy to examine its ontological status. His idea of the hermeneutical is not only a central notion but it assumes ontological significance: the hermeneutic circle describes both the structure of understanding and the structure of our understanding of Being. As Heidegger presents the hermeneutic circle, we always have a prior grasp of the whole, through which our understanding is enabled to grasp the parts of that whole and in so doing, articulate the whole.
A third distinction is now evident. The application of bracketing and the hermeneutic circle are mutually exclusive. The notion of bracketing is central to Husserlian phenomenology, and Walters makes clear his understanding of this contentious aspect of phenomenology. As Walters writes, 'the transcendental phenomenology of Husserl has its focus on the description of the lived world from the viewpoint of a detached observer'. Walters writes that the phenomenology of Heidegger 'was based on an existential perspective which considered that the observer cannot separate themselves from the world'. Heidegger criticises the notion that the meaning is totally neutral and unsullied by the interpreter's own normative goals or view of the world. The interpreter inevitably brings certain background expectations and frames of meaning to bear in the act of understanding. These cannot be ignored, forgotten or bracketed. Experiences are already within our common background understanding and are brought into focus in order to be understood. Hermeneutics means rejecting the notion that there is such a thing as 'objectivity'. It is therefore, not so much a case of acquiring new knowledge, but that 'the world', which has already been understood comes to be interpreted. Implicit in Hiedegger's notion is that the researcher participates in making data.
The methodological implications for the nursing research agenda are particularly interesting when applied in the analysis of data, however they should be viewed as contingent applications arising from these perspectives.
Thus analysis (using the frameworks of Van Kaam, Colaizzi, Giorgi, Parse, Coyne and Smith) tend to follow the Husserlian tradition and are based on decontextualising and recontextualising. Transcripts are disaggregated into a series of fragments, which are then regrouped into overarching analytic themes or structures of experiences. Difficulties lie in escaping the initial categories (they furnish a conceptual grid) and lend themselves to recapitulating positivist assumptions. Researchers remain aloof, the panorama of their views and interests are bracketed. This is the way knowledge is generated using not only a Husserlian phenomenological approach, but many other 'qualitative' methodologies.
Amidst other equally legitimate hermeneutic approaches and perspectives, the analysis following the ideas of Heidegger or Gadamer view data as text. Researchers bring their interests to the data whereby meaning and significance may be read into them. This is part of the ongoing process of observation, interviewing, reading and writing. This approach pays more attention to the structure of the texts. This means a suspension of the above analytical mode through reading and rereading all sources of data. It is recognised that data are themselves textual products, and that they report and incorporate rhetorical accomplishments on the part of the participants (including the researcher). This approach concerns itself with a narrative which can reflect a story, an event and the effect of the narrative on the reader. Participants and researchers are self-interpreting, their stories couched in a narrative format and biographical in their point of view. Interpreters are part of the tradition they interpret. Textual fields are prominently 'post-modern' where the whole world is a text.
Dr Tina Koch, School of Nursing Flinders University of South Australia
eContent Home
