Foundations for a human science of nursing: Gadamer, Laing, and the hermeneutics of caring


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The professions of nursing and nurse education are currently experiencing a crisis of confidence, particularly in the UK, where the Francis Report and other recent reviews have highlighted a number of cases of nurses who no longer appear willing or able to care'. The popular press, along with some elements of the nursing profession, has placed the blame for these failures firmly on the academy and particularly on the relatively recent move to all-graduate status in England for pre-registration student nurses. This has come to be known in the UK as the too-posh-to-wash' argument, that there is an incommensurability between being educated to degree level and performing basic nursing tasks. I will argue in this paper that the diagnosis of the problem is substantively correct, but the formulation and the prescription are misguided and dangerous. I will suggest that the growing emphasis on research-based and evidence-based practice is the logical conclusion of an inappropriate scientific paradigm for nursing which is underpinned by the social sciences, by technical rationality, and by a focus on people. In contrast, I will suggest that a more fruitful way of thinking about and practising nursing and nurse education is to consider it as a human science with a focus on persons in which evidence for practice derives largely from practice itself. The history of the idea of a human science is traced from its roots in nineteenth century hermeneutics to the work of Gadamer and R.D. Laing in the 1960s, and I attempt to imagine a paradigm for nursing practice, scholarship, and education based on Laing's existential-phenomenological' approach with a focus on the endeavour to understand and relate to individual persons rather than to make broad prescriptions for practice based on statistical and other generalizations.
机译:护理和护士教育行业目前正面临信任危机,尤其是在英国,《弗朗西斯报告》和其他近期评论都在英国强调了一些不再表现出愿意或能够护理的护士案例。大众媒体以及护理界的某些人士将这些失败的责任牢牢地归咎于学院,尤其是相对较早的英格兰预注册学生护士升格为全研究生的情况。这在英国已被称为“太容易洗”的论点,即受过学位教育和执行基本护理任务之间存在不可估量的关系。在本文中,我将论证该问题的诊断在本质上是正确的,但其配方和处方是错误的且危险的。我将建议,越来越重视基于研究和基于证据的实践,这是不适当的护理科学范式的逻辑结论,该范式由社会科学,技术合理性以及对人的关注作为基础。相反,我将建议,一种更有意义的思考和实践护理和护士教育的方式是将其视为一门人类科学,重点关注那些实践证据主要来自实践本身的人。人文科学概念的历史可以追溯到19世纪诠释学的起源,其历史可以追溯到1960年代Gadamer和RD Laing的工作,我试图基于Laing的存在主义思想来设想护理实践,学术和教育的范式,现象学的方法侧重于努力理解和联系个人,而不是根据统计和其他概括为实践制定广泛的处方。



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