Can professional nursing value claims be refused? Might nursing values be accepted provisionally and tentatively?

Value-act relationships are less secure than is commonly supposed and this insecurity is leveraged to address two questions. First, can nurses refuse professional value claims (e.g., claims regarding care and compassion)? Second, even when value claims are accepted, might values be held provisionally and tentatively? These questions may seem absurd. Nurses deliver care and nursing is, we are told, a profession the members of which hold and share values. However, focusing attention on the problematic nature of professional value claims qua claims permits a more conciliatory and realistic stance to be taken towards nurses holding alternative values and value interpretations. This could prove beneficial.

Can philosophy benefit nurses and/or nursing? Heidegger and Strauss, problems of knowledge and context.

When researchers and scholars claim their work is based on a philosophical idea or a philosopher's corpus of ideas (and theory/theorist can be substituted for philosophy/philosopher), and when 'basing' signifies something significant rather than subsidiary or inconsequential, what level of understanding and expertise can readers reasonably expect authors to possess? In this paper, some of the uses to which philosophical ideas and named philosophers (Martin Heidegger and Leo Strauss) are put in exegesis is critiqued. Considering problematic instances of idea-name use may enable the question: 'Can philosophy benefit nurses and/or nursing?' to be better understood if not answered.

Nursing's professional character: A chimera?

Does nursing possess a character? The idea that professions have characters is hard to sustain, and the possibility that nursing as a collectively or occupation lacks a character is worth considering. To this end it is argued that absent robust theoretical and/or evidential scaffolding it is implausible to suppose that nursing has an objectively real (reality describing) character, and if 'nursing's character' is chimeric or illusory, aspects of our conception of professionalism require reappraisal. Specifically, traits and values that attach to nursing and are implicated in the concept of character are, shorn of their moorings, untethered. This may be significant.

Teaching the ideas of others: Is there a problem?

University nurse educators do not always possess subject expertize in the non-nursing disciplines from which the ideas they use in teaching are derived. This is potentially problematic. Subject expertize can be variously defined. Nonetheless, expertize is associated with education, and education is often assessed by processes culminating in accreditation. Nurse educators, however, do not hold first degrees in every subject they take ideas from (e.g. biology, ethics, pharmacology, philosophy, psychology, sociology, etc.), and in consequence ideas are brought to the attention of students studying for first and higher degrees by educators who lack accreditation at the level at which the ideas they use in teaching are taken. Disjunctures between accredited learning and teaching generate epistemological and other conundrums. Nevertheless, bluntly, absent subject expertize, educators risk talking nonsense when poorly understood ideas are presented to students.

Complexity and ambition in nurse education.

Panel contribution by Martin Lipscomb to online event "Addressing current debates in nursing theory, education, and practice". Event hosted by the University of California Irvine, in association with the International Philosophy of Nursing Society.

Neoliberalism and neoliberals: What are we talking about?

The terms neoliberalism and neoliberal play a variety of roles ranging from major to trivial in the papers they appear in. Both phrases carry pejorative connotations in nurse writing. Yet irrespective of the role assumed in argument, readers are rarely provided with enough information to determine what the descriptors mean in a substantive or concrete sense. It is proposed that scholars who use these terms in their work should consider expressing themselves more carefully than often occurs at present. Virtue signalling in academic writing should, absent critical argument, be discouraged.

Politics in the classroom.

Nursing and midwifery is, in the UK, regulated by the Nursing and Midwifery Council (NMC). Regulatory duties include establishing standards for education, and from January 2019, new educational programmes will be approved against standards detailed in the document Future nurse: Standards of proficiency for registered nurses (NMC, 2019-hereafter "the standards"). This publication lists "the knowledge and skills that registered nurses must demonstrate when caring for people" (NMC, 2019, p.3), and from September 2020, registration (licence) will require the successful completion of programmes that have been ratified against these standards. The importance of this document in a UK context cannot be understated. However, less parochially, learning outcomes contained in section 7 of the standards raise questions that require educator attention whenever politically sensitive topics (broadly conceived) are discussed. This study explores these questions insofar as they relate to the stance (neutrality or partisanship) that educators adopt in politicized discussion, and the management of student speech/expression. Pratt, Boll and Collins' (2007) paper Towards a plurality of perspectives for nurse educators is recruited to structure argument.

Just how wide should 'wide reading' be?

Educationalists introduce students to literature search strategies that, with rare exceptions, focus chiefly on the location of primary research reports and systematic reviews of those reports. These sources are, however, unlikely to adequately address the normative and/or metaphysical questions that nurses frequently and legitimately interest themselves in. To meet these interests, non-research texts exploring normative and/or metaphysical topics might and perhaps should, in some situations, be deemed suitable search targets. This seems plausible and, moreover, students are encouraged to 'read widely'. Yet accepting this proposition creates significant difficulties. Specifically, if non-research scholarly sources and artistic or literary (humanities) products dealing with normative/metaphysical issues were included in what are, at present, scientifically orientated searches, it is difficult to draw boundaries around what--if anything--is to be excluded. Engaging with this issue highlights problems with qualitative scholarship's designation as 'evidence'. Thus, absurdly, if qualitative scholarship's findings are labelled evidence because they generate practice-relevant understanding/insight, then any literary or artistic artefact (e.g. a throwaway lifestyle magazine) that generates kindred understandings/insights is presumably also evidence? This conclusion is rejected and it is instead proposed that while artistic, literary, and qualitative inquiries can provide practitioners with powerful and stimulating non-evidential understanding, these sources are not evidence as commonly conceived.

Research report appraisal: how much understanding is enough?

When appraising research papers, how much understanding is enough? More specifically, in deciding whether research results can inform practice, do appraisers need to substantively understand how findings are derived or is it sufficient simply to grasp that suitable analytic techniques were chosen and used by researchers? The degree or depth of understanding that research appraisers need to attain before findings can legitimately/sensibly inform practice is underexplored. In this paper it is argued that, where knowledge/justified beliefs derived from research evidence prompt actions that materially affect patient care, appraisers have an epistemic duty to demand high (maximal) rather than low (minimal) levels of understanding regards finding derivation (i.e. appraisers have a duty to seek a superior epistemic situation). If this argument holds assumptions about appraiser competence/ability and the feasibility of current UK conceptions of evidence based practice are destabilized.

Some may beg to differ: individual beliefs and group political claims.

While nurses can and do behave as intentional political agents, claims that nurses collectively do (empiric), should (normative) or must (regulatory) act to advance political objectives lack credibility. This paper challenges the coherence and legitimacy of political demands placed upon nurses. It is not suggested that nurses ought not to contribute to political discourse and activity. That would be foolish. However, the idea that nursing can own or exhibit a general political will is discarded. It is suggested that to protect and advance political discussion, to aid explanatory adequacy and clarity, the form in which nursing associates itself with political claims merits critical appraisal. Thus significant numbers of nurses probably reject or disagree with many of the political claims that attach to them--claims often made on their behalf. More specifically, the individual beliefs and goals of nurses can be in conflict with the political pronouncements of nursing scholars and organizations (group agents). It is proposed that nurses need not share substantive normative beliefs/goals and, if this proposal holds, group descriptors such as 'nurses' and 'nursing' cannot meaningfully or easily attach to political claims. Shared value theory is linked to the fallacy of composition and the concept of collective ascription error is introduced to explore the implausibility of using group descriptors such as 'nurses' and 'nursing' to refer to the beliefs/goals of all nurses.

Abductive reasoning and qualitative research.

Abduction, deduction and induction describe forms of reasoning. Deduction and induction are discussed in the nursing literature. However, abduction has been largely neglected by nurse scholars. In this paper it is proposed that abduction may play a part in qualitative data analysis - specifically, in the identification of themes, codes, and categories. Abduction is not, in research, restricted to or associated with any particular methodology. Nevertheless, situating abduction in qualitative research facilitates the identification of three interlinked issues. First, it is suggested that abductively derived claims require support from deductive and inductively sourced evidence if they are to 'hold' and, yet, in qualitative research this is clearly problematic. Second, difficulties in choosing between alternative plausible hypotheses (i.e. concerning theme, code, and category description) are explored through an examination of the 'generality problem'. Third, the role of background and auxiliary theories in adjudicating between hypothesis options is discussed. It is argued that if qualitative researchers utilize abductive inference in the manner suggested, then the peculiarly fallible nature of abduction must be acknowledged and, in consequence, the action guiding potential of qualitative research findings is compromised.

Questioning the use value of qualitative research findings.

In this paper the use value of qualitative research findings to nurses in practice is questioned. More precisely it is argued that, insofar as action follows belief then, in all but the rarest of cases, the beliefs that nurses in practice can justifiably derive from or form on the basis of qualitative research findings do not sanction action in the world and the assumption, apparently widely held, that qualitative research can as evidence productively inform practice collapses. If qualitative research does not have a substantive action guiding potential then, in consequence, three conclusions are permitted. First, regarding the requirement that nurses ground actions on evidence, regulators should redraft methodologically neutral or permissive guidelines to specify the sorts of research evidence that can serve this function. Second, qualitative methodologies should receive less prominence in nurse education programmes. Third, qualitative researchers should make it clear that their work cannot inform practice. Alternatively, if this claim is advanced the process by which this is to be achieved should be explicitly stated.

Challenging the coherence of social justice as a shared nursing value.

Normative and prescriptive claims regarding social justice are often inadequately developed in the nursing literature and, in consequence, they must be rejected in their current form. Thus, claims regarding social justice are frequently presented as mere assertion (without clarification or supporting argument) or, alternatively, when assertions are supported that support may be weak (e.g. social justice is repeated juxtaposed against contentious assumptions regarding market disutility). This paper challenges the coherence of social justice as a shared nursing value and it is suggested that claims regarding the concept should be tempered.

Events and event identity: under-explored topics in nursing.

Theoretic interest in the nature of events and event identity is apparent across a wide range of fields. However, this interest has not yet made itself known in nursing. In this paper, it is asserted that nurse theoreticians and researchers should consider the problematic of events and event identity. It is suggested that engagement with these issues is important because the manner in which this component of explanation is integrated into argument has concrete implications for our understanding of healthcare practice. Indeed, refusal to engage with such issues may jeopardize explanatory coherence.

Participant overexposure and the role of researcher judgement.

Ethical conduct discussion often focuses on decisions made before and during the research process. In contrast, this paper offers a reflective and personal post-factum critique of two distinct elements of ethical practice that emerged from a recent study of aspects of activity at a hospice in England. First, it is suggested that researcher judgement in protecting participants from 'overexposure' may have been insufficiently developed. Second, it is proposed that an unnecessarily individualist (biomedical) model of ethical good practice was uncritically accepted and that assumptions inherent in this approach should have been more thoroughly questioned. In conducting this study 'usual' measures were taken to protect from harm the individuals and organisation taking part. Before collecting data, which took the form of interview transcripts and notes made by the researcher in his role as staff nurse (participant observation), ethical approval was secured. Interviewees were known to the interviewer prior to interview.